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  • 801.
    Styrke, Johan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Sojka, Peter
    Institutionen för Hälsovetenskap, Mittuniversitetet.
    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. Akut- och Katastrofmedicinskt Centrum, Norrlands Universitetssjukhus.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Sex-differences in symptoms, disability, and life satisfaction three years after mild traumatic brain injury: a population-based cohort study2013Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 45, nr 8, s. 749-757Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To investigate sex differences in symptoms, structure of symptoms, disability and life satisfaction 3 years after mild traumatic brain injury. Secondary aims were to find risk factors for adverse outcome.

    DESIGN: Population-based cohort study.Patients: The cohort comprised 137,000 inhabitants at risk in a defined population served by a single hospital in northern Sweden. Patients attending the emergency department following a mild traumatic brain injury in 2001 were included.

    METHODS: Of 214 patients aged 18–64 years, 163 answered a questionnaire on symptoms, disability, and life-satisfaction 3 years post-injury. The instruments were analysed with descriptive statistics. A principal component analysis of the Rivermead Post-Concussion Symptoms Questionnaire was conducted. Risk factors were identified using logistic regression.

    RESULTS: Post-concussion syndrome was found in 50% of the women and 30% of the men. Disability was found in 52% of the women and 37% of the men, and 57% of the women and 56% of the men were satisfied with their lives. For both genders, high frequency of symptoms was a risk factor for disability and low life satisfaction. Back pain was a risk factor for disability. Living alone was a risk factor for low levels of life satisfaction. The principal component analysis revealed differences between the sexes.

    CONCLUSION: There are sex differences in outcome 3 years after mild traumatic brain injury. Women and men should be analysed separately.

  • 802.
    Styrke, Johan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Sojka, Peter
    Institutionen för Hälsovetenskap, Mittuniversitetet.
    Björnstig, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Symptoms, disability, and life satisfaction five years after whiplash injuries: a population-based cohort studyArtikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective

    To study symptoms and disabilities five years after participants sustained whiplash injuries using questionnaires designed for mild traumatic brain injury. A second aim was to study life satisfaction and a third aim was to investigate differences between women and men regarding these variables.

    Design

    Population-based cohort study

    Methods

    In total 186 persons (100 women and 86 men) aged 18-64 answered questionnaires on pain intensity (Visual Analogue Scale) symptoms (Rivermead Post Concussion Symptoms Questionnaire, RPQ), disabilities (Rivermead Head Injury Follow Up Questionnaire RHFUQ) and life satisfaction (LiSat-11) five years post injury.

    Results

    The most common symptoms reported on the RPQ were fatigue (41%), poor memory (39%), and headache (37%). The presence of three symptoms or more was reported by 54% of the women and 50% of the men. Inability to sustain previous workload (44%) and fatigue at work (43%) were the most frequently reported disabilities on the RHFUQ. Only 39% were satisfied with their somatic health and 60% with their mental health. Women reported significantly higher pain intensity than men. No significant differences between women and men regarding symptoms, disabilities, and life satisfaction were found.

    Conclusion

    These findings highlight the importance of assessing and quantifying symptoms in addition to neck pain in persons with long-term problems after whiplash injury and may provide a possibility to identify subgroups to tailor rehabilitation interventions. The high proportions of disability and low life satisfaction have to be taken into account when managing persons with chronic whiplash associated disorder. 

  • 803.
    Styrke, Johan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Bylund, Per-Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Akut- och Katastrofmedicinskt Centrum, Norrlands Universitetssjukhus.
    Sojka, Peter
    Institutionen för Hälsovetenskap, Mittuniversitetet.
    Björnstig, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    A 10-year incidence of acute whiplash injuries after road traffic crashes in a defined population in Northern Sweden2012Inngår i: PM&R, ISSN 1934-1482, E-ISSN 1934-1563, Vol. 4, nr 10, s. 739-747Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective

    To examine the annual incidence of acute whiplash injuries after road traffic crashes in a geographic catchment area in Northern Sweden during the period 2000-2009.

    Design

    Descriptive epidemiology determined by prospectively collected data from a defined population.

    Setting

    The study was conducted at a public hospital in Sweden.

    Participants

    The population of the hospital's catchment area (136,600 inhabitants in 1999 and 144,500 in 2009).

    Methods

    At the emergency department, all injured persons (approximately 11,000 per year) were asked to answer a questionnaire about the injury incident. Data from the medical records also were analyzed. From 2000-2009, 15,506 persons were injured in vehicle crashes. Persons who were subject to an acute neck injury within whiplash-associated disorder grades 1-3 were included. The overall and annual incidences were calculated as incidence. Age, gender, type of injury event, and direction of impact were described. The incidences were compared with national statistics on insurance claims from 2003, 2007, and 2008 to detect changes in the proportions of claims.

    Main Outcome Measures

    The annual incidence of acute whiplash injuries. Secondary outcome measures were types of injury events, age and gender distribution, changes in the proportion of rear-end crashes during 2000-2009, and changes in the proportion of insurance claims during 2003-2008.

    Results

    During 2000-2009, 3297 cases of acute whiplash injury were encountered. The overall incidence was 235/100,000/year. The average yearly increase in incidence was 1.0%. Women comprised 51.9% and men 48.1% of the injured. Car occupants (86.4%) and bicycle riders (6.1%) were most frequently injured. The proportion of rear-end crashes decreased from 55% to 45% from 2000-2009. The proportion of insurance claims significantly decreased between 2003 and 2008 (P < .0001, χ2 test).

    Conclusion

    The incidence of emergency department visits attributable to acute whiplash injuries after road traffic crashes have been relatively stable during the past decade in our area, except in 2007 and 2008, when a peak occurred.

  • 804.
    Styrke, Johan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Bylund, Per-Olof
    Sojka, Peter
    Björnstig, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Neck injury after whiplash trauma in a defined population in Northern Sweden: long term sick leave and costs of low productivity2014Inngår i: Epidemiology: Open Access, ISSN 2161-1165, Vol. 4, nr 4, artikkel-id 1000170Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Neck injuries following whiplash trauma can lead to long-term sequelae. Population-based studies covering traffic and non-traffic whiplash trauma are rare. The aim was to describe the incidence of neck injuries following whiplash trauma during one year, from a well-defined area served by a single hospital, and the resulting long-term sick leave during a five-year follow-up. Possible risk factors for sick leave and the cost of lost productivity were also studied.

    Methods: From the injury register of Umeå University Hospital, the year 2001’s data set of soft tissue neck injuries and fractures was extracted. Those injured by whiplash trauma were included. The Swedish Social Insurance Agency provided five-year post-injury data on sick leave in 2006. Epidemiological aspects were described, a logistic regression was conducted to find risk factors for long-term sick leave, and the cost of lost productivity was calculated.

    Results: Four hundred and seventeen cases were included. The incidence was 383 per 100,000 person-year. In 14% of 18-64 year olds, sick leave was granted for more than two weeks and the median number of sick days in this group was 298. Old age, having a Whiplash Associated Disorders (WAD) grade of 1, being injured in traffic and being injured at velocity exceeding 50 km/h were significant risk factors for sick leave. A few (6%) had fractures, however, their average sick-leave time was not significantly longer than the sick leave of those with only soft tissue injuries. The cost to society for lost productivity was estimated at 4.4 million Euros during the five-year follow-up.

    Conclusion: Neck injuries following whiplash trauma arise from both traffic and non-traffic injury events and affect people of all ages. Consequently long-term sick leave occur in a minority of the patients, commonly among older persons and persons injured in traffic. The costs to society from lost productivity is high.

  • 805.
    Styrke, Johan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Bylund, Per-Olof
    Akut- och Katastrofmedicinskt Centrum, Norrlands Universitetssjukhus.
    Sojka, Peter
    Institutionen för Hälsovetenskap, Mittuniversitetet.
    Björnstig, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Whiplash trauma: epidemiology, long-term sick leave and its' costsArtikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Introduction

    Neck injuries following whiplash trauma are common and primarily caused by traffic incidents but are also caused by fall incidents and sporting mishaps. The economic consequences to society for the consequent sick leave are significant. Original studies covering all types of cervical spine injuries (WAD-grade 1-4) following whiplash trauma and the following sick leave are rare. The aim of this study was to describe the epidemiology of neck injuries caused by whiplash trauma and the resulting long-term sick leave of patients in a well-defined area who sought medical attention within a one-year period and with a five-year follow-up. Possible risk factors for sick leave and the cost of loss of productivity were also studied.

    Materials and Methods

    From the ongoing injury registration of Umeå University Hospital, the only hospital in the area, we extracted the year 2001’s data set of neck injuries (acute WAD 1-4). Those injured by whiplash trauma were included. The Swedish Social Insurance Agency provided five-year post-injury data on sick leave because of the injury in question. This is a compulsory register of all Swedes. Epidemiological aspects were described and follow-up data were analysed to find risk factors for long-term sick leave.

    Results

    The incidence was 383/100,000/year for all ages. In 14% of 18-64 year olds, sick leave was granted for more than two weeks and the median number of sick days in this group was 298. Older age, having a WAD-grade of 1, being injured in traffic crashes and being injured at velocity exceeding 50 km/h were significant risk factors for being granted sick leave. A few (6%) had more serious cervical spine injuries (WAD 4). However, their average time on sick leave was not significantly longer than the sick leave of those with WAD 1-3. The cost to society for loss of productivity was estimated at 5.6 million USD during the 5-year follow-up.

    Conclusion

    Whiplash injuries affect many people including the young. The long-term periods of sick leave described in this paper indicate individual suffering as well as a societal economic burden. Finding preventive measures is of most importance.

  • 806.
    Styrke, Johan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Sojka, Peter
    Institutionen för Hälsovetenskap, Mittuniversitetet.
    Björnstig, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Traumatic brain injuries in a well-defined population: epidemiological aspects and severity2007Inngår i: Journal of Neurotrauma, ISSN 0897-7151, E-ISSN 1557-9042, Vol. 24, nr 9, s. 1425-1436Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim was to describe epidemiological and medical aspects of 449 cases of traumatic brain injury (TBI) from a well-defined geographical area with a population of 137,000 inhabitants. An episode of disturbed consciousness was a prerequisite for inclusion in the study. The incidence of TBI was 354/100,000 inhabitants. Median age was 23 years, range 0–91 years; 55% were men and 45% were women; 33% children 0–14 years, 50% adults 15–64 years, and 17% elderly persons 65–91 years old. Severity classification was based on Glasgow Coma Scale (GCS) on arrival; mild TBI 97% (GCS 13–15), moderate 1% (GCS 9–12), and severe 2% (GCS 3–8). The most common injury events were falls (55%) and vehicle-related events (30%). The percentage of falls was high among children and elderly persons but among adults vehicle-related injury events were also prominent. At least 17% of all patients were under the influence of alcohol, especially adult male bicyclists. CT was performed on 163 cases (36%) revealing 34 cases with intracranial hemorrhage (ICH) which is 21% of the examined or 8% of all the injured. The rate of ICH increased with increasing age (from 3% among children to 17% among the elderly persons) and also increased with decreasing GCS from 6% in the group of mild TBI to 60% among those with severe TBI. Attention should be directed to acute management of mild TBI in order to detect potentially dangerous ICH as well as to preventive actions against falls and vehicle related accidents.

  • 807.
    Stålnacke, Britt-Marie
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Björnstig, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Karlsson, Kurt
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Klinisk kemi.
    Sojka, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Klinisk fysiologi. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    One-year follow-up of patients with mild traumatic brain injury: post-concussion symptoms, disabilities and life satisfaction at follow-up in relation to serum levels of S-100B and neuron-specific enolase in acute phase2005Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 37, nr 5, s. 300-305Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To investigate, in patients with mild traumatic brain injury, serum concentrations of S-100B and neurone-specific enolase in acute phase and post-concussion symptoms, disabilities and life satisfaction 1 year after the trauma.

    DESIGN: Prospective study.

    PATIENTS: Eighty-eight patients (age range 18-87 years).

    METHODS: Blood samples were taken on admission and about 7 hours later. At follow-up 15 +/- 4 months later, the patients filled in questionnaires about symptoms (Rivermead Post Concussion Symptoms), disability (Rivermead Head Injury Follow-up) and life satisfaction (LiSat-11).

    RESULTS: Concentrations of S-100B and neurone-specific enolase were regularly increased in the first blood sample. Of the 69 patients participating in the follow-up, 45% reported post-concussion symptom, 48% exhibited disability and 55% were satisfied with "life as a whole". In comparison with the "sick-leave" situation on admission to hospital, 3 patients were on sick-leave at the time of follow-up because of the head trauma. Stepwise forward logistic regression analysis revealed a statistically significant association (p<0.05) between disability and S-100B and dizziness.

    CONCLUSION: In spite of frequent persistent symptoms, disabilities and low levels of life satisfaction, the sick-leave frequency was low at follow-up. The association between S-100B and disability supports the notion that long-term consequences of a mild brain injury may partly be a result of brain tissue injury.

  • 808. Sugimoto, Hikaru
    et al.
    Mundel, Thomas M
    Sund, Malin
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Kirurgi.
    Xie, Liang
    Cosgrove, Dominic
    Kalluri, Raghu
    Bone-marrow-derived stem cells repair basement membrane collagen defects and reverse genetic kidney disease.2006Inngår i: Proc Natl Acad Sci U S A, ISSN 0027-8424, Vol. 103, nr 19, s. 7321-6Artikkel i tidsskrift (Fagfellevurdert)
  • 809. Sullivan, Richard
    et al.
    Peppercorn, Jeffrey
    Sikora, Karol
    Zalcberg, John
    Meropol, Neal J.
    Amir, Eitan
    Khayat, David
    Boyle, Peter
    Autier, Philippe
    Tannock, Ian F.
    Fojo, Tito
    Siderov, Jim
    Williamson, Steve
    Camporesi, Silvia
    McVie, J. Gordon
    Purushotham, Arnie D.
    Naredi, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Eggermont, Alexander
    Brennan, Murray F.
    Steinberg, Michael L.
    De Ridder, Mark
    McCloskey, Susan A.
    Verellen, Dirk
    Roberts, Terence
    Storme, Guy
    Hicks, Rodney J.
    Ell, Peter J.
    Hirsch, Bradford R.
    Carbone, David P.
    Schulman, Kevin A.
    Catchpole, Paul
    Taylor, David
    Geissler, Jan
    Brinker, Nancy G.
    Meltzer, David
    Kerr, David
    Aapro, Matti
    Delivering affordable cancer care in high-income countries2011Inngår i: The Lancet Oncology, ISSN 1470-2045, E-ISSN 1474-5488, Vol. 12, nr 10, s. 933-980Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The burden of cancer is growing, and the disease is becoming a major economic expenditure for all developed countries. In 2008, the worldwide cost of cancer due to premature death and disability (not including direct medical costs) was estimated to be US$895 billion. This is not simply due to an increase in absolute numbers, but also the rate of increase of expenditure on cancer. What are the drivers and solutions to the so-called cancer-cost curve in developed countries? How are we going to afford to deliver high quality and equitable care? Here, expert opinion from health-care professionals, policy makers, and cancer survivors has been gathered to address the barriers and solutions to delivering affordable cancer care. Although many of the drivers and themes are specific to a particular field-eg, the huge development costs for cancer medicines-there is strong concordance running through each contribution. Several drivers of cost, such as over-use, rapid expansion, and shortening life cycles of cancer technologies (such as medicines and imaging modalities), and the lack of suitable clinical research and integrated health economic studies, have converged with more defensive medical practice, a less informed regulatory system, a lack of evidence-based sociopolitical debate, and a declining degree of fairness for all patients with cancer. Urgent solutions range from re-engineering of the macroeconomic basis of cancer costs (eg, value-based approaches to bend the cost curve and allow cost-saving technologies), greater education of policy makers, and an informed and transparent regulatory system. A radical shift in cancer policy is also required. Political toleration of unfairness in access to affordable cancer treatment is unacceptable. The cancer profession and industry should take responsibility and not accept a substandard evidence base and an ethos of very small benefit at whatever cost; rather, we need delivery of fair prices and real value from new technologies.

  • 810.
    Sund, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Effects of tirapazamine on experimental colorectal liver metastases after radiofrequency ablation (Br J Surg 2012; 99567-575)2012Inngår i: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 99, nr 4, s. 576-576Artikkel i tidsskrift (Annet vitenskapelig)
  • 811.
    Sund, Malin
    et al.
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Kirurgi.
    Hamano, Yuki
    Sugimoto, Hikaru
    Sudhakar, Akulapalli
    Soubasakos, Mary
    Yerramalla, Udaya
    Benjamin, Laura E
    Lawler, Jack
    Kieran, Mark
    Shah, Amish
    Kalluri, Raghu
    Function of endogenous inhibitors of angiogenesis as endothelium-specific tumor suppressors.2005Inngår i: Proc Natl Acad Sci U S A, ISSN 0027-8424, Vol. 102, nr 8, s. 2934-9Artikkel i tidsskrift (Fagfellevurdert)
  • 812.
    Sund, Malin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Kalluri, Raghu
    Tumor stroma derived biomarkers in cancer2009Inngår i: Cancer Metastasis Review, ISSN 0167-7659, E-ISSN 1573-7233, Vol. 28, nr 1-2, s. 177-183Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In recent years the importance of the tumor stroma for the development, promotion and invasion of cancer is becoming increasingly clear. Besides a malignantly transformed cancer cell, tumors also contains many other cell types, including endothelial cells, fibroblasts and cells of the immune system. These cells together with the cancer cells produce the sum extracellular matrix (ECM) of the tumor. The ECM and the non-malignant cells of the tumor are defined as the "tumor stroma". Just as the malignant cell itself can be the source of substances that can be used as biomarkers of cancer, the tumor stroma contains factors that potentially can be used as biomarkers when treating patients with cancer. In this review we will discuss the role of the tumor stroma as a source of new cancer biomarkers. This concept highlights a novel view of cancer and treats them as organized organs. Additionally, this further stresses the importance of including factors related to the tumor stroma into the diagnostic and therapeutic equation of cancer.

  • 813.
    Sund, Malin
    et al.
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Kirurgi.
    Maeshima, Yohei
    Kalluri, Raghu
    Bifunctional promoter of type IV collagen COL4A5 and COL4A6 genes regulates the expression of alpha5 and alpha6 chains in a distinct cell-specific fashion.2005Inngår i: Biochem J, ISSN 1470-8728, Vol. 387, nr Pt 3, s. 755-61Artikkel i tidsskrift (Fagfellevurdert)
  • 814.
    Sund, Malin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Nyberg, Pia
    Eikesdal, Hans Petter
    Endogenous matrix-derived inhibitors of angiogenesis2010Inngår i: Pharmaceuticals, Vol. 3, s. 3021-3039Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Endogenous inhibitors of angiogenesis are proteins or fragments of proteins that are formed in the body, which can inhibit the angiogenic process. These molecules can be found both in the circulation and sequestered in the extracellular matrix (ECM) surrounding cells. Many matrix-derived inhibitors of angiogenesis, such as endostatin, tumstatin, canstatin and arresten, are bioactive fragments of larger ECM molecules. These substances become released upon proteolysis of the ECM and the vascular basement membrane (VBM) by enzymes of the tumor microenvironment. Although the role of matrix-derived angiogenesis inhibitors is well studied in animal models of cancer, their role in human cancers is less established. In this review we discuss the current knowledge about these molecules and their potential use as cancer therapeutics and biomarkers.

  • 815.
    Sund, Malin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Xu, Li Li
    Rahman, Arman
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Qian, Bi-Feng
    Hammarström, Marie-Louise
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Immunologi/immunkemi.
    Danielsson, Åke
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Reduced susceptibility to dextran sulphate sodium-induced colitis in the interleukin-2 heterozygous (IL-2) mouse.2005Inngår i: Immunology, ISSN 0019-2805, E-ISSN 1365-2567, Vol. 114, nr 4, s. 554-564Artikkel i tidsskrift (Fagfellevurdert)
  • 816.
    Sund, Malin
    et al.
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Kirurgi.
    Zeisberg, Michael
    Kalluri, Raghu
    Endogenous stimulators and inhibitors of angiogenesis in gastrointestinal cancers: basic science to clinical application.2005Inngår i: Gastroenterology, ISSN 0016-5085, Vol. 129, nr 6, s. 2076-91Artikkel i tidsskrift (Fagfellevurdert)
  • 817. Sundberg, Rosita
    et al.
    Torén, Kjell
    Franklin, Karl A
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Gislason, Thorarinn
    Omenaas, Ernst
    Svanes, Cecilie
    Janson, Christer
    Asthma in men and women: Treatment adherence, anxiety, and quality of sleep2010Inngår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 104, nr 3, s. 337-344Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to compare female and male asthmatics with special emphasis on reported adherence, anxiety, and quality of sleep. The study included 470 subjects with current asthma from the Nordic countries, who took part in the European Community Respiratory Health Survey (ECRHS) II. Subjects were investigated with a structured clinical interview, including questions on the presence of respiratory symptoms and therapy. They were also asked to fill in the self-reported Hospital Anxiety Depression scale and the Basic Nordic Sleep Questionnaire. Inhaled corticosteroids (OR=0.55) and a doctor's appointment in the last 12 months (OR=0.54) implied a significantly reduced risk for non-adherence in normal situations. At exacerbation in asthma, women had a significantly decreased risk for non-adherence (OR=0.46). Female gender and anxiety were independent risk factors for both insomnia (OR=3.67 and 2.53, respectively) and daytime sleepiness (OR=2.53 and 2.04, respectively). Women with asthma have a more positive attitude towards their medication, have a higher reported adherence, and use inhaled corticosteroids more often than men. At the same time women report more often anxiety and insomnia than men. Awareness of sex differences in the manifestations and attitudes towards treatment of asthma is important in order to improve asthma management.

  • 818. Sundbom, F
    et al.
    Lindberg, E
    Bjerg, A
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Franklin, Karl
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Gunnbjörnsdottir, M
    Middelveld, R
    Torén, K
    Janson, C
    Asthma symptoms and nasal congestion as independent risk factors for insomnia in a general population: results from the GA (2) LEN survey2013Inngår i: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 68, nr 2, s. 213-219Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Asthma and rhinitis have been related to insomnia. The aim of this study was to further analyse the association between asthma, nasal symptoms and insomnia and to identify risk factors for sleep disturbance among patients with asthma, in a large population-based set of material.

    METHOD: In 2008, a postal questionnaire was sent to a random sample of 45 000 adults in four Swedish cities. The questionnaire included questions on insomnia, asthma, rhinitis, weight, height, tobacco use and physical activity.

    RESULTS: Twenty-five thousand six hundred and ten subjects participated. Asthma was defined as either current medication for asthma or at least one attack of asthma during the last 12 months, and 1830 subjects (7.15%) were defined as asthmatics. The prevalence of insomnia symptoms was significantly higher among asthmatics than non-asthmatics (47.3% vs 37.2%, <0.0001). In the subgroup reporting both asthma and nasal congestion, 55.8% had insomnia symptoms compared with 35.3% in subjects without both asthma and nasal congestion. The risk of insomnia increased with the severity of asthma, and the adjusted OR for insomnia was 2.65 in asthmatics with three symptoms compared with asthmatics without symptoms. Nasal congestion (OR 1.50), obesity (OR 1.54) and smoking (OR 1.71) also increased the risk of insomnia.

    CONCLUSION: Insomnia remains a common problem among asthmatics. Uncontrolled asthma and nasal congestion are important, treatable risk factors for insomnia. Lifestyle factors, such as smoking and obesity, are also risk factors for insomnia among asthmatics.

  • 819.
    Sundqvist, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Tumor-infiltrating lymphocytes and the risk of perioperative infections and cancer-specific survival after colorectal cancer surgery2017Independent thesis Basic level (professional degree), 20 poäng / 30 hpOppgave
  • 820.
    Sundström, Anna
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för tillämpad utbildningsvetenskap, Beteendevetenskapliga mätningar (BVM).
    Albertsson, Pontus
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Self- and peer-assessments of ambulance drivers' driving performance2012Inngår i: IATSS Research, ISSN 0386-1112, Vol. 36, nr 1, s. 40-47Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of the present study was to develop and examine the quality of the Ambulance Driver Self-assessment Questionnaire (ADSQ) and the Ambulance Driver Peer-assessment Questionnaire (ADPQ) measuring aspects of, driving performance, driving style and driving competence. In addition the ADSQ measures self-reflection and safety-attitudes. The aim of the study was also to examine ambulance drivers' self- and peer-assessments as well as to examine the accuracy of self-assessments by comparing self-assessed and peer-assessed driving performance, driving style and competence. 76 ambulance drivers employed at two ambulance stations in northern Sweden completed ADSQ and ADPQ. Item analyses were conducted to examine the psychometric properties of the items, and based on the results some revisions were made to improve the questionnaires. The revised questionnaires were functioning rather well, although some subscale demonstrated low internal consistency. Subscale inter-correlations provided support for construct validity. Self- and peer-assessments indicated safe driving performance and good driver competence, which is positive from a traffic safety perspective. A comparison of mean self- and peer-assessment ratings, controlling for age, gender and driving experience showed no significant differences, except for the subscale overtaking. This indicates that ambulance drivers' self-assessments are realistic in most areas.

  • 821.
    Sunnevang, Cecilia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Lecuyer, Erwan
    Hynd, David
    Carroll, Jolyon
    Kruse, Dion
    Bostrom, Ola
    Evaluation of Near-Side Oblique Frontal Impacts Using THOR With SD3 Shoulder2014Inngår i: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957X, Vol. 15, nr Supplement 1, s. S96-S102Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Within the EC Seventh Framework project THORAX, the Mod-Kit THOR was upgraded with a new thorax and shoulder. The aim of this study was to investigate whether the THOR ATD met a set of prerequisites to a greater extent than Hybrid III and by that measure whether the dummy could serve as a potential tool for future evaluation of serious head and chest injuries in near-side oblique frontal impacts.

    Method: A small-overlap/oblique sled system was used to reflect occupant forces observed in oblique frontal crashes. The head and thoracic response from THOR was evaluated for 3 combinations: belt only with no deformation of the driver's side door (configuration A), belt only in combination with a predeformed door (configuration B), and prepretensioning belt and driver airbag (PPT+DAB) in combination with a predeformed door (configuration C). To evaluate head injury risk, the head injury criterion (HIC) and brain injury criteria (BrIC) were used. For evaluation of the thoracic injury risk, 3 injury criteria proposed by the THORAX project were evaluated: Dmax, DcTHOR, and strain (dummy rib fractures).

    Results: Unlike Hybrid III, the THOR with SD3 shoulder interacted with the side structure in a near-side oblique frontal impact. HIC values for the 3 test configurations corresponded to a 90% (A) and 100% (B and C) risk of Abbreviated Injury Scale (AIS) 2+ head injury, and BrIC values resulted in a 100% risk of AIS 2+ head injury in configurations A and B. In C the risk was reduced to 75%. The AIS 2+ thoracic injury risks based on Dmax were similar (14-18%) for all tests. Based on DcTHOR, AIS 2+ injury risk increased from 29 to 53% as the predeformed door side was introduced (A to B), and the risk increased, to 64%, as a PPT+DAB was added (C). Considering the AIS 2+ injury risk based on strain, tests in A resulted in an average of 3 dummy rib fractures (17%). Introducing the predeformed door (B) increased the average of dummy fractures to 5 (39%), but in C the average number of dummy rib fractures decreased to 4 (28%).

    Conclusions: THOR with an SD3 shoulder should be the preferred ATD rather than the Hybrid III for evaluating head and thorax injuries in oblique frontal impacts. Thoracic interaction with the predeformed door was not well captured by the 3D IR-Traccs; hence, use of deflection as an injury predictor in oblique loading is insufficient for evaluating injury risk in this load case. However, injury risk evaluation may be performed using the strain measurements, which characterize loading from seat belt and airbag as well as the lateral contribution of the structural impact in the loading condition used in this study.

  • 822.
    Sunnevang, Cecilia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Autoliv Res, Vargarda, Sweden.
    Rosén, Erik
    Bostrom, Ola
    Real-life fatal outcome in car-to-car near-side impacts--implications for improved protection considering age and crash severity.2009Inngår i: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957X, Vol. 10, nr 2Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Recent studies have shown that current side airbags, protecting head and chest, are saving lives in near-side impacts (Kahane 2007; McCartt and Kyrychenko 2007). The aim of this study was to analyze NASS/CDS real-life data on fatal trauma in near-side car-to-car crashes, stratified by age into non-senior and senior occupants. Furthermore, a hypothetical model explaining side airbag effectiveness as a function of lateral delta-v was presented. The model together with the field data was then used to demonstrate further enhancement of side airbag restraint performance.

    METHOD: Weighted NASS/CDS data from 1994 to 2006 for front seat occupants in near-side car-to-car impacts was used to calculate the exposure, incidence, and risk of fatal trauma with respect to lateral delta-v. The dataset was also divided into non-senior (10-59 years) and senior (age > or = 60 years) occupants. The hypothetical model was created to adjust the NASS/CDS data to represent a car fleet fully equipped with current side airbag protection. The model was then used to evaluate the increase in effectiveness of improved side airbag protection achieved by increasing the lateral delta-v in the range where the airbag have most mitigating effect, increasing the airbag protection level within the delta-v range currently tested, and a combination of the two approaches.

    RESULTS: From the NASS/CDS data, the median delta-v for fatal injury was 37 km/h for the total sample. When stratified with respect to age, the median delta-v for fatal injury was 41 km/h for non-seniors and 28 km/h for senior occupants. The exposures for both age groups were similar. However, the fatal incidence showed a difference in delta-v range between non-senior and senior occupants. Applying the airbag model increased the median delta-v to 40 km/h for the total sample and 47 and 30 km/h for non-seniors and seniors, respectively.

    CONCLUSIONS: Current side airbag systems offer very good protection for non-senior occupants up to delta-v 40 km/h. Though still high, the protection for senior occupants is lower. To enhance side airbag protection, the side airbag performance should be maximized where the fatal incidence is high. Therefore, to further reduce non-senior fatalities, the test speed should be increased. To further reduce senior fatalities, the protection level within severities currently tested should be increased. A combination of the two approaches would result in about a 40 percent increase of the side airbag effectiveness.

  • 823.
    Sunnevang, Cecilia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Sui, Bo
    Lindkvist, Mats
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Krafft, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Census Study of Real-Life Near-Side Crashes with Modern Side Airbag-Equipped Vehicles in the United States2015Inngår i: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957X, Vol. 16, nr Supplement 1, s. S117-S124Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: This study aimed to investigate the crash characteristics, injury distribution, and injury mechanisms for Maximum Abbreviated Injury Score (MAIS) 2+ injured belted, near-side occupants in airbag-equipped modern vehicles. Furthermore, differences in injury distribution for senior occupants compared to non-senior occupants was investigated, as well as whether the near-side occupant injury risk to the head and thorax increases or decreases with a neighboring occupant. Method: National Automotive Sampling System's Crashworthiness Data System (NASS-CDS) data from 2000 to 2012 were searched for all side impacts (GAD L&R, all principal direction of force) for belted occupants in modern vehicles (model year > 1999). Rollovers were excluded, and only front seat occupants over the age of 10 were included. Twelve thousand three hundred fifty-four MAIS 2+ injured occupants seated adjacent to the intruding structure (near-side) and protected by at least one deployed side airbag were studied. To evaluate the injury risk influenced by the neighboring occupant, odds ratio with an induced exposure approach was used. Result: The most typical crash occurred either at an intersection or in a left turn where the striking vehicle impacted the target vehicle at a 60 to 70 degrees angle, resulting in a moderate change of velocity (delta-V) and intrusion at the B-pillar. The head, thorax, and pelvis were the most frequent body regions with rib fracture the most frequent specific injury. A majority of the head injuries included brain injuries without skull fracture, and non-senior rather than senior occupants had a higher frequency of head injuries on the whole. In approximately 50% of the cases there was a neighboring occupant influencing injury outcome. Conclusion: Compared to non-senior occupants, the senior occupants sustained a considerably higher rate of thoracic and pelvis injuries, which should be addressed by improved thorax side airbag protection. The influence on near-side occupant injury risk by the neighboring occupant should also be further evaluated. Furthermore, side airbag performance and injury assessments in intersection crashes, especially those involving senior occupants in lower severities, should be further investigated and side impact dummy biofidelity and injury criteria must be determined for these crash scenarios.

  • 824.
    Sunnevång, Cecilia
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Characteristics of nearside car crashes: an integrated approach to side impact safety2016Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Introduction: Approximately 1.25 million people globally are killed in traffic accidents yearly. To achieve the UN Global Goal of a 50% reduction of fatal and serious injuries in 2020 a safer infrastructure, as well as new safety technologies, will be needed. Side crashes represent 20% of all serious and 25 % of fatal injuries. The overall aim of this thesis is to provide guidelines for improved side impact protection. First, by characterizing nearside crashes and injury outcome, including injuries from the farside occupant, for non-senior and senior front seat occupants. Second, to determine whether the WorldSID dummy provides opportunities for improved in-crash occupant protection. And third, by relating in-crash occupant protection to pre-crash countermeasures, to explore a holistic approach for side crashes using the integrated safety chain from safe driving to crash.

    Methods: NASS/CDS data for both older and modern vehicles was used to provide exposure, incidence, and risk for fatal injury as well as detailed injury distribution and crash characteristics. The WorldSID dummy was compared to Post Mortem Human Subjects (PMHS) in impactor tests at high and low severities to demonstrate the possibilities of this tool. Crash tests were performed to evaluate WorldSID crash test dummy assessments of injuries found in the NASS/CDS data. The integrated safety chain was used to demonstrate how to evaluate occupant protection in side crashes from a larger perspective, involving infrastructure and Automated Emergency Braking.

    Result: Most side crashes occur at intersections. The head, thorax, and pelvis are the most frequently injured body regions, and seniors have a higher risk for rib fractures compared to non-seniors. The WorldSID dummy response was similar to the PMHS response at the higher impact speed, but not at the lower. In conjunction with improved airbags infrastructural change, and the use of Automated Emergency Braking, can effectively reduce the number of fatalities and injured occupants in side impacts.

    Conclusion: Future focus for side impact protection should be on intersection crashes, improved occupant protection for senior occupants, and protection for and from the farside occupant, reducing injury risk to the head, thorax, and pelvis. The WorldSID dummy has the ability to reproduce humanlike responses in lateral and oblique impacts. However, at a low crash severity, chest deflection could be underestimated, which must be taken into consideration when evaluating, for example, pre-crash inflated side airbags. Analyzing nearside crashes using the integrated safety chain shows that speed management by means of roundabouts is an efficient countermeasure reducing the number of injurious crashes, as well as reducing variations in crash severity. In combination with an Automated Emergency Braking a large part of side crashes could be avoided or crash severity mitigated. Rather than developing structures and airbags for high-speed crashes, it is important to consider alternative countermeasures. Hence the need for an integrated approach to side impacts.

  • 825.
    Sunnevång, Cecilia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Hynd, David
    Carroll, Jolyon
    Dahlgren, Mikael
    Comparison of the THORAX Demonstrator and HIII sensitivity to crash severity and occupant restraint variation2014Konferansepaper (Fagfellevurdert)
    Abstract [en]

    The thorax is the most frequently injured body region in frontal impacts. This study aimed to compare the THORAX Demonstrator THOR and HIII injury risk predictions in relation to expected injury risk reductions based on trends observed in real life data.   Sled tests were performed in a body‐in‐white representing a mid‐sized family car. To relate the test results to real life, the AIS3+ thoracic injury risks measured by the THOR and HIII were compared for different test configurations. For the driver position a 6 kN belt was compared to a 4 kN belt plus airbag and a 3 kN belt plus airbag (same pulse). On the passenger side the same restraint in EuroNCAP ODB (64 km/h) and FMVSS 208 ODB (40 km/h) tests were evaluated. Injury criteria compared were Cd and DEQ(Lin) for the HIII and Dmax, Dc‐THOR and strain for the THOR.   The level of thoracic injury risk needs further investigation, but the expected injury risk reduction from a predicted high to a low risk was demonstrated by THOR, contrary to the HIII. The large variations in injury risk as well as the sensitivity to crash severity indicate that the THOR dummy should be the preferred tool for evaluation of frontal impact occupant protection.

  • 826.
    Sunnevång, Cecilia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Autoliv Research, Vårgårda, Sweden.
    Pipkorn, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Boström, Ola
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Assessment of Bilateral Thoracic Loading on the Near-Side Occupant Due to Occupant-to-Occupant Interaction in Vehicle Crash Tests2015Inngår i: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957X, Vol. 16, nr Supplement 2, s. S217-S223Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: This study aims, by means of the WorldSID 50th percentile male, to evaluate thoracic loading and injury risk to the near-side occupant due to occupant-to-occupant interaction in combination with loading from an intruding structure.Method: Nine vehicle crash tests were performed with a 50th percentile WorldSID male dummy in the near-side (adjacent to the intruding structure) seat and a THOR or ES2 dummy in the far-side (opposite the intruding structure) seat. The near-side seated WorldSID was equipped with 6 + 6 IR-Traccs (LH and RH) in the thorax/abdomen enabling measurement of bilateral deflection. To differentiate deflection caused by the intrusion, and the deflection caused by the neighboring occupant, time history curves were analyzed. The crash tests were performed with different modern vehicles, equipped with thorax side airbags and inflatable curtains, ranging from a compact car to a large sedan, and in different loading conditions such as car-to-car, barrier, and pole tests. Lateral delta V based on vehicle tunnel acceleration and maximum residual intrusion at occupant position were used as a measurement of crash severity to compare injury measurements.Result: In the 9 vehicle crash tests, thoracic loading, induced by the intruding structure as well as from the far-side occupant, varied due to the size and structural performance of the car as well as the severity of the crash. Peak deflection on the thoracic outboard side occurred during the first 50ms of the event. Between 70 to 150ms loading induced by the neighboring occupant occurred and resulted in an inboard-side peak deflection and viscous criterion. In the tests where the target vehicle lateral delta V was below 30km/h and intrusion less than 200mm, deflections were low on both the outboard (20-40mm) and inboard side (10-15mm). At higher crash severities, delta V 35km/h and above as well as intrusions larger than 350mm, the inboard deflections (caused by interaction to the far-side occupant) were of the same magnitude or even higher (30-70mm) than the outboard deflections (30-50mm).Conclusion: A WorldSID 50th percentile male equipped with bilateral IR-Traccs can detect loading to the thorax from a neighboring occupant making injury risk assessment feasible for this type of loading. At crash severities resulting in a delta V above 35km/h and intrusions larger than 350mm, both the inboard deflection and VC resulted in high risks of Abbreviated Injury Scale (AIS) 3+ injury, especially for a senior occupant.

  • 827.
    Sunnevång, Cecilia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Subit, D
    Pipkorn, B
    Kent, R
    Rate dependent spine motion and chest deflection differences between WorldSID and PMHS under localized constant-speed impactsArtikkel i tidsskrift (Fagfellevurdert)
  • 828.
    Sunnevång, Cecilia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Autoliv Research, Vårgårda, Sweden .
    Subit, Damien
    Kindig, Matthew
    Lessley, David
    Lamp, John
    Boström, Ola
    Kent, Richard
    Response of the Worldwide Side Impact Dummy (WorldSID) to Localized Constant-Speed Impacts.2011Inngår i: Annals of advances in automotive medicine. Association for the Advancement of Automotive Medicine. Scientific Conference, ISSN 1943-2461, Vol. 55, s. 231-241Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The objective of this study was to evaluate WorldSID constant-speed shoulder and thorax impact responses in terms of impact force, external and internal deflection (1D and 2D IR-Tracc response) for two velocities (1 m/s and 3 m/s), at three impact levels (shoulder, upper thorax and mid thorax) in three impact directions (lateral, +15° posterolateral, -15° anteraolateral). In addition, the impact force and external deflection were compared to previously published cadaver data. Each impact condition was repeated twice. A total of 42 tests were performed. The WorldSID's lowest peak impact force and external deflection were found for impact at shoulder level regardless of impact direction. Maximum force and deflection were found for impact at mid thorax. Comparison between WorldSID and PMHS showed similar external chest deflections for impacts at 3 m/s. The peak impact force response with respect to impact level was found to be reversed for the WorldSID compared to the PMHS, for which shoulder impact resulted in the highest peak force. External time history responses for the WorldSID compared to the one PMHS impacted at 1 m/s in lateral impact direction showed a significant difference in both timing and magnitude. External deflections at upper and mid thorax were approximately twice as high as the internal 1D deflection measured by the IR-Tracc. However, taking into account the rotation of the rib, the calculated 2D deflection response at the posterior impact direction was closer to the external deflection, and thus also to the PMHS deflection response at 3 m/s. These findings emphasize the need of 2D deflection measurement.

  • 829.
    Svenmarker, S.
    et al.
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Kirurgi.
    Häggmark, S.
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Jansson, E.
    Lindholm, R.
    Appelblad, M.
    Sandström, E.
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Åberg, T.
    Use of heparin-bonded circuits in cardiopulmonary bypass improves clinical outcome2002Inngår i: Scand Cardiovasc J, Vol. 36, nr 4, s. 241-6Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: The use of heparin-coated surfaces in cardiopulmonary bypass has been shown to decrease the inflammatory response imposed by the contact between blood and artificial surfaces. One would expect this reaction to improve clinical outcome. However, this has been difficult to verify. This investigation is based on an aggregation of two randomized studies from our institution and highlights possible effects of heparin coating on a number of clinically oriented parameters. DESIGN: Departmental analysis of patients subjected to coronary artery bypass surgery using heparin-coated circuits. Cardiopulmonary bypass was employed using either the Carmeda or Duraflo heparin coatings compared with a control. The systemic heparin dose was reduced in the heparin-coated groups (ACT > 250 s) vs control group patients (ACT > 480 s). The effects of heparin coating related to clinical outcome were studied. RESULTS: The use of heparin-coated circuits reduced the mean length of stay in hospital from 7.8 +/- 2.5 to 7.3 +/- 1.8 days (p = 0.040) and postoperative ventilation time from 9.7 +/- 9.2 to 8.2 +/- 8.5 h (p = 0.018), blood loss 8 h post surgery from 676 +/- 385 to 540 +/- 245 ml (p = 0.001), individual perioperative change of haemoglobin loss (p = 0.001), leukocyte count (p = 0.000) and creatinine elevation (p = 0.000), proportion of patients exposed to allogenous blood transfusions 39.2 vs 23.9% (p = 0.001), postoperative coagulation disturbances 4.4 vs 0.4% (p = 0.006), postoperative deviations from the normal postoperative course 47.2 vs 36.7% (p = 0.035), neurological deviations 9.4 vs 3.9% (p = 0.021) and atrial fibrillation 26.4 vs 18.0% (p = 0.041). No effects were found with respect to perioperative platelet count, postoperative fever reaction and 5-year survival. CONCLUSION: Based on several indicators, the use of heparin coating in cardiopulmonary bypass is associated with improved clinical results.

  • 830.
    Svenmarker, S.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Sandström, E.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Karlsson, T.
    Häggmark, S.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Jansson, E.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Appelblad, M.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Lindholm, R.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Åberg, T.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Neurological and general outcome in low-risk coronary artery bypass patients using heparin coated circuits2001Inngår i: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 19, nr 1, s. 47-53Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The clinical significance of heparin coating in cardiopulmonary bypass has previously been investigated. However, few studies have addressed the possible influence on brain function and memory disturbances.

    Methods: Three hundred low-risk patients exposed to coronary bypass surgery were randomised into three groups according to type of heparin coating: Carmeda Bioactive Surface, Baxter Duraflo II and a control group. Outcome was determined from a number of clinically oriented parameters, including a detailed registry of postoperative deviations from the normal postoperative course. Brain damage was assessed through S100 release and memory tests, including a questionnaire follow-up.

    Results: Clinical outcome was similar for all groups. Blood loss (Duraflo only), transfusion requirements and postoperative creatinine elevation were reduced in the heparin-coated groups. A lower incidence of atrial fibrillation was noted in the Duraflo group. Heparin coating did not uniformly attenuate the release of S100 or the degree of memory impairment.

    Conclusions: Cardiopulmonary bypass (CPB) with heparin coating and a reduced dose of heparin seems to be safe. Clinical outcome and neurological injury seem not to be associated with type of heparin coating used for CPB. However, blood loss and transfusion requirements may be reduced.

  • 831.
    Svenmarker, Staffan
    et al.
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Kirurgi.
    Appelblad, Micael
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Kirurgi.
    Reporting of perfusion-related incidents: pitfalls and limitations.2005Inngår i: Perfusion, ISSN 0267-6591, Vol. 20, nr 5, s. 243-8Artikkel i tidsskrift (Fagfellevurdert)
  • 832.
    Svenmarker, Staffan
    et al.
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Kirurgi.
    Appelblad, Micael
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Kirurgi.
    Jansson, Erica
    Häggmark, Sören
    Measurement of the activated clotting time during cardiopulmonary bypass: differences between Hemotec ACT and Hemochron Jr apparatus.2004Inngår i: Perfusion, ISSN 0267-6591, Vol. 19, nr 5, s. 289-94Artikkel i tidsskrift (Fagfellevurdert)
  • 833.
    Svenmarker, Staffan
    et al.
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Kirurgi.
    Engström, Karl Gunnar
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Kirurgi.
    Karlsson, T
    Jansson, E
    Lindholm, R
    Aberg, Torkel
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Kirurgi.
    Influence of pericardial suction blood retransfusion on memory function and release of protein S100B.2004Inngår i: Perfusion, ISSN 0267-6591, Vol. 19, nr 6, s. 337-43Artikkel i tidsskrift (Fagfellevurdert)
  • 834.
    Svenmarker, Staffan
    et al.
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Kirurgi.
    Engström, Karl Gunnar
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Kirurgi.
    Karlsson, Thomas
    Jansson, Erica
    Lindholm, Ronny
    Åberg, Torkel
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Kirurgi.
    Influence of pericardial suction blood retransfusion on memory function and release of protein S100BArtikkel i tidsskrift (Fagfellevurdert)
  • 835.
    Svenmarker, Staffan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Häggmark, Sören
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Holmgren, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Näslund, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Serum markers are not reliable measures of renal function in conjunction with cardiopulmonary bypass2011Inngår i: Interactive Cardiovascular and Thoracic Surgery, ISSN 1569-9293, E-ISSN 1569-9285, Vol. 12, nr 5, s. 713-717Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The present study explored the influence of haemodilution on estimates of the glomerular filtration rate (GFR) in conjunction with cardiopulmonary bypass (CPB) and cardiac surgery. Ninety-eight patients (n = 98) undergoing coronary artery bypass grafting with the aid of CPB were examined. The serum concentration of cystatin C and creatinine was analysed prior to surgery, after completion of CPB and in the intensive care the day after surgery. The estimated GFR was calculated using standard equations based on the serum concentration of cystatin C and creatinine. It was found that haemodilution induced by CPB had significant effects on the estimated GFR. For cystatin C, the GFR increased by 50.5 ± 2.5 ml/min (P = 0.000) and for creatinine based GFR with 22.5 ± 0.9 ml/min (P = 0.000) using the 4-variable modification of diet renal disease formula and with 22.1 ± 0.93 ml/min (P = 0.000) for the Cockcroft-Gault formula, respectively. Similar effects of haemodilution on GFR were also detected postoperatively. Haemodilution induced by CPB may therefore significantly overestimate the renal function as indicated by GFR based on serum markers.

  • 836.
    Svenmarker, Staffan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Häggmark, Sören
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Hultin, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Holmgren, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Static blood-flow control during cardiopulmonary bypass is a compromise of oxygen delivery2009Inngår i: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 37, nr 1, s. 218-222Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Blood-flow control during cardiopulmonary bypass (CPB) is by tradition based on the patient's body surface area. Emergence of new techniques enables dynamic blood-flow control based on online measurement of venous oxygen saturation and oxygen consumption. Present investigation aimed to compare static versus dynamic blood-flow control with respect to use of oxygen and effects upon organ function. Methods: In this study, 100 coronary-artery-bypass surgical patients were prospectively randomised to static or dynamic hypothermic blood-flow control during CPB. In the static group, pump flow was set to 2.4 (litres per minute) times the patient's body surface area (m(2)) throughout the procedure. Pump flow in the dynamic group was varied according to the reading of the venous oxygen saturation and maintained at >75%. CPB-specific information was collected online. Blood samples were collected for analysis of haemoglobin, lactate, amylase, creatinine and C-reactive protein: pre-CPB, at weaning from CPB and on day 1 postoperatively. Results: Randomisation formed two uniform groups. Choice of static or dynamic blood-flow control during CPB had no significant effects on organ function as judged by lactate, amylase or creatinine levels. On increasing oxygen demand, oxygen balance was maintained by increasing venous oxygen extraction rates in the static flow mode and by increasing the pump flow rate in the dynamic group. Conclusions: Independent of the blood-flow control mode, oxygen balance remained preserved. However, the dynamic mode provided higher oxygen delivery, which may increase margins of safety and protection of organ function.

  • 837. Svensson, Sofie
    et al.
    Jirström, Karin
    Rydén, Lisa
    Roos, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Emdin, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Ostrowski, Michael C
    Landberg, Göran
    ERK phosphorylation is linked to VEGFR2 expression and Ets-2 phosphorylation in breast cancer and is associated with tamoxifen treatment resistance and small tumours with good prognosis2005Inngår i: Oncogene, ISSN 0950-9232, E-ISSN 1476-5594, Vol. 24, nr 27, s. 4370-4379Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Extracellular signal-regulated kinase (ERK)1/2 signalling mediates communication between growth factor receptors and the cell nucleus and has been linked to several key events in the transformation process such as proliferation and invasion. We therefore sought to delineate the degree of phosphorylated ERK1/2 in breast cancer and potential links to upstream receptors such as VEGFR2, ErbB2, downstream targets, such as Ets-2, as well as clinico-pathological parameters, clinical outcome and response to tamoxifen. ERK1/2 phosphorylation was assessed by immunohistochemistry using a phospho-specific ERK1/2 antibody in three breast cancer cohorts including a total of 886 tumours arranged in tissue arrays. Cohort I consisted of 114 patients, cohort II of 248 postmenopausal patients randomized to either 2 years of tamoxifen or no adjuvant treatment and cohort III of 524 patients. Surprisingly, ERK1/2 phosphorylation correlated inversely with tumour size. Phosphorylated ERK1/2 was further associated with the presence of VEGFR2 (cohorts II and III) and the degree of phosphorylated Ets-2, indicating in vivo, a signalling cascade from VEGFR2 via ERK1/2 to Ets-2 phosphorylation. Interestingly, ERK1/2 phosphorylation correlated with better survival in untreated patients independently of lymph-node status and tumour size indicating that ERK1/2 signalling might be associated with a less aggressive phenotype. Finally, patients with oestrogen receptor positive and ERK1/2 phosphorylated tumours also had an impaired tamoxifen response.

  • 838.
    Sylvan, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Jejunoileal bypass for morbid obesity: studies of the long-term effects1995Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    This study was aimed at investigating adverse and beneficial long-term effects of jejunoileal bypass (JIB) sugery in obese patients. The JIB was the first widly used surgical procedure for treatment of morbid obesity. The weight loss was remarkable, but the procedure was declared not appropiate for obesity surgery in the late 1970's. Serious late adverse effects such as liver cirrhosis and malignancies, have been postulated. Unexpectedly few studies have adressed these problems.

    In the long-term follow-up of 87 uniformly operated patients, several persisting beneficial effects were found. The mean Body Mass Index was 41.5 kg/m2 at the time of operation and 29.7 kg/m2 sixteen years after the operation. Diabetes type II and hyperlipidemia, common in an obese population, was not found in this group. Reversals were performed in 3% of the patients in contrast to 20-30% in many earlier studies. Revisions performed in 8% of the patients due to excessive weight loss could have contributed to the good long-term outcome.

    Percutaneous liver biopsies from 44 patients taken 14-20 (mean 17) years after JIB revealed normal or fatty liver, a lower degree of histological abnormalities than in 11 biopsies taken at the time of operations 1-14 (mean 6) years postoperatively. Liver cirrhosis seen early in one patient could not be found in the late biopsies.

    Reduced activity of the fibrinolytic system has been shown to be a new cardiovacular risk factor. In 45 patients studied 14-20 years after JIB, the levels of both plasminogen activator inhibitor type 1 (PAI-1) and tissue plasminogen activator (tPA) were significantly lower than in a control group of 10 morbidly obese patients ( PAI-1: 8.4 vs 32 U/mL, tPA: 7.2 vs 12 pg/L).

    Bile acids are regarded as cofactors in the carcinogenesis in the colon and experimentally an increased frequency of malignant tumors has been demonstated after JIB in carcinogen-induced rats. In 30 of the operated patients, colonoscopy with biopsy was performed 11-17 yeras after the operation. No evidence for malignant transformation was found as reflected by an abscense of polyp formation, histologic dysplasia or aneuploidia in flow cytometric DNA analysis.

    Eight hundred and thirty patients from 10 hospitals subjected to JIB were compared to 1660 controls with respect to malignant diagnosis over a 20 years period. No significantly increased risk for colorectal carcinoma could be demonstrated. However the overall risk for malignant disease was increased in the operated patients. The frequency of endometrial carcinoma was significantly elevated up to five years after the operation but was normal after that time.

    In conclusion the postulated progress of serious adverse effects of JIB such as liver cirrhosis and malignant disease has not been possible to demonstrate. Several beneficial effects such as weight loss and reduction of cardiovascular risk factors have been found a long time after the operation.

  • 839. Söderbäck, Harald
    et al.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Hellman, Per
    Sandblom, Gabriel
    Incisional hernia after surgery for colorectal cancer: a population-based register study.2018Inngår i: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 33, nr 10, s. 1411-1417Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Our knowledge on the incidence of incisional hernia and risk factors for developing incisional hernia following surgery for colorectal cancer is far from complete.

    METHODS: All procedures registered in the Swedish Colorectal Cancer Register (SCRCR) 2007-2013 were identified. Patients with comorbid disease diagnoses, registered at admissions and visits prior to the procedure and relevant to this study, were obtained from the National Patient Register (NPR). These diagnoses included cardiovascular disease, connective tissue disorders, liver cirrhosis, renal failure, diabetes, chronic obstructive lung disease and chronic inflammatory conditions. Data on occurrence of incisional hernias were obtained by combining data from the SCRCR and the NPR (International Classification of Diseases code).

    RESULTS: During 2007-2013, 39,984 procedures were registered in the SCRCR. After excluding laparoscopic procedures, procedures repeated on the same patient, procedures with concomitant liver resection and procedures without laparotomy, 28,913 cases remained for analysis. Five years after surgery, the cumulative incidence of incisional hernia was 5.3%. In multivariate proportional hazard analysis, significantly increased risk for incisional hernia was found for the male gender (hazard ratio [HR] 1.40, 95% confidence interval [CI] 1.21-1.62), operation time exceeding 180 min (HR 1.25, CI 1.08-1.45), body mass index (BMI) > 30 (HR 1.78, CI 1.51-2.09), age < 70 years (HR 1.34, CI 1.16-1.56) and postoperative wound complication (HR 2.09, CI 1.70-2.58).

    DISCUSSION: Men, patients younger than 70 years and patients with BMI > 30 face a higher risk for incisional hernia. The risk is also increased in cases where the procedure takes longer than 3 h or where postoperative wound complications occur. These patients will benefit from measures aimed at preventing the development of incisional hernia.

  • 840. Sörelius, K.
    et al.
    Svensson, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik.
    Matthiessen, P.
    Rutegård, Jörgen
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Rutegård, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    A nationwide study on the incidence of mesenteric ischaemia after surgery for rectal cancer demonstrates an association with high arterial ligation2019Inngår i: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 21, nr 8, s. 925-931Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: The incidence of mesenteric ischaemia after resection for rectal cancer has not been investigated in a population-based setting. The use of high ligation of the inferior mesenteric artery might cause such ischaemia, as the bowel left in situ depends on collateral blood supply after a high tie.

    Method: The Swedish Colorectal Cancer Registry was used to identify all patients subjected to an abdominal resection for rectal cancer during the years 2007-2017 inclusive. Mesenteric ischaemia within the first 30 postoperative days was recorded, classified as either stoma necrosis or colonic necrosis. Multivariable logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CIs) for mesenteric ischaemia in relation to high tie, with adjustment for confounding.

    Results: Some 14 657 patients were included, of whom 59 (0.40%) had a reoperation for any type of mesenteric ischaemia, divided into 34 and 25 cases of stoma necrosis and colonic necrosis, respectively. Compared with patients who did not require reoperation for mesenteric ischaemia following rectal cancer surgery, the proportion having high tie was greater (54.2% vs 38.5%; P = 0.032). The adjusted OR for reoperation due to any mesenteric ischaemia with high tie was 2.26 (95% CI 1.34-3.79), while the corresponding estimates for stoma and colonic necrosis, respectively, were 1.60 (95% CI 0.81-3.17) and 3.69 (95% CI 1.57-8.66).

    Conclusion: The incidence of reoperation for mesenteric ischaemia after abdominal resection for rectal cancer is low, but the use of a high tie might increase the risk of colonic necrosis demanding surgery.

  • 841. Sörelius, Karl
    et al.
    Wanhainen, Anders
    Wahlgren, Carl-Magnus
    Langenskiöld, Marcus
    Roos, Håkan
    Resch, Timothy
    Vaccarino, Roberta
    Arvidsson, Bengt
    Gillgren, Peter
    Bilos, Linda
    Pirouzram, Artai
    Holsti, Mari
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Mani, Kevin
    Nationwide Study on Treatment of Mycotic Thoracic Aortic Aneurysms2019Inngår i: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 57, nr 2, s. 239-246Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Mycotic aortic aneurysms are rare, life threatening, and complex. This nationwide study aimed to assess outcome after repair of mycotic thoracic aortic aneurysms (MTAAs).

    Methods: Patients treated in Sweden for MTAAs between 2000 and 2016 were identified in the Swedish vascular registry (2010–16) and local patient registries (2000–09). Primary outcome was survival, and secondary outcomes included surgical strategy, rate of infection related complications (IRC), and re-operations.

    Results: Fifty-two patients (median age 71 ± 8.1 years; 28 [54%] men, 13 [25%] ruptured) were identified (3.6% of all thoracic aortic aneurysm repairs in Sweden). Aneurysm location was aortic arch (n = 6; 11%), descending aorta (n = 42; 81%), and multiple locations (n = 4; 8%). Twenty-nine (56%) patients had positive cultures; the most prevalent agent was Staphylococcus aureus (n = 16; 31%). Operative techniques included thoracic endovascular aortic repair (TEVAR; n = 35 [67%]), fenestrated/branched TEVAR (n = 8; 15%), hybrid repair (n = 7; 14%), and open patch repair (n = 2; 4%). Survival was 92% (95% confidence interval [CI] 88–96) at 30 days, 88% (95% CI 84–93) at three months, 78% (73–84) at one year, and 71% (64–77) at five years. The mean follow up among survivors (> 90 days) was 45 months (range 4–216 months). Antibiotics were administered for a median of 15 weeks (range 0–220 weeks). IRCs occurred in nine patients (17%): sepsis (n = 3), graft infection (n = 3), recurrent mycotic aneurysm (n = 1), aorto-oesophageal/bronchial fistula (n = 2). Six (67%) IRCs were fatal; 80% occurred within the first year. Re-operations were performed in nine patients (17%).

    Conclusions: TEVAR was often used as treatment for MTAAs, with acceptable short- and long-term survival when compared with open cohorts in the literature. IRCs are of concern and warrant follow up and long-term antibiotic treatment.

  • 842. Søreide, Kjetil
    et al.
    Sund, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Epidemiological-molecular evidence of metabolic reprogramming on proliferation, autophagy and cell signaling in pancreas cancer2015Inngår i: Cancer Letters, ISSN 0304-3835, E-ISSN 1872-7980, Vol. 356, nr 2, s. 281-288Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Pancreatic cancer remains one of the deadliest human cancers with little progress made in survival over the past decades, and 5-year survival usually below 5%. Despite this dismal scenario, progresses have been made in understanding of the underlying tumor biology through among other definition of precursor lesions, delineation of molecular pathways, and advances in genome-wide technology. Further, exploring the relationship between epidemiological risk factors involving metabolic features to that of an altered cancer metabolism may provide the foundation for new therapies. Here we explore how nutrients and caloric intake may influence the KRAS-driven ductal carcinogenesis through mediators of metabolic stress, including autophagy in presence of TP53, advanced glycation end products (AGE) and the receptors (RAGE) and ligands (HMGB1), as well as glutamine pathways, among others. Effective understanding the cancer metabolism mechanisms in pancreatic cancer may propose new ways of prevention and treatment.

  • 843. Tang, Hongwei
    et al.
    Wei, Peng
    Duell, Eric J
    Risch, Harvey A
    Olson, Sara H
    Bueno-de-Mesquita, H Bas
    Gallinger, Steven
    Holly, Elizabeth A
    Petersen, Gloria
    Bracci, Paige M
    McWilliams, Robert R
    Jenab, Mazda
    Riboli, Elio
    Tjønneland, Anne
    Boutron-Ruault, Marie Christine
    Kaaks, Rudolph
    Trichopoulos, Dimitrios
    Panico, Salvatore
    Sund, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Peeters, Petra H M
    Khaw, Kay-Tee
    Amos, Christopher I
    Li, Donghui
    Axonal guidance signaling pathway interacting with smoking in modifying the risk of pancreatic cancer: a gene- and pathway-based interaction analysis of GWAS data2014Inngår i: Carcinogenesis, ISSN 0143-3334, E-ISSN 1460-2180, Vol. 35, nr 5, s. 1039-1045Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Cigarette smoking is the best established modifiable risk factor for pancreatic cancer. Genetic factors that underlie smoking-related pancreatic cancer have previously not been examined at the genome-wide level. Taking advantage of the existing Genome-wide association study (GWAS) genotype and risk factor data from the Pancreatic Cancer Case Control Consortium, we conducted a discovery study in 2028 cases and 2109 controls to examine gene-smoking interactions at pathway/gene/single nucleotide polymorphism (SNP) level. Using the likelihood ratio test nested in logistic regression models and ingenuity pathway analysis (IPA), we examined 172 KEGG (Kyoto Encyclopedia of Genes and Genomes) pathways, 3 manually curated gene sets, 3 nicotine dependency gene ontology pathways, 17 912 genes and 468 114 SNPs. None of the individual pathway/gene/SNP showed significant interaction with smoking after adjusting for multiple comparisons. Six KEGG pathways showed nominal interactions (P < 0.05) with smoking, and the top two are the pancreatic secretion and salivary secretion pathways (major contributing genes: RAB8A, PLCB and CTRB1). Nine genes, i.e. ZBED2, EXO1, PSG2, SLC36A1, CLSTN1, MTHFSD, FAT2, IL10RB and ATXN2 had P interaction < 0.0005. Five intergenic region SNPs and two SNPs of the EVC and KCNIP4 genes had P interaction < 0.00003. In IPA analysis of genes with nominal interactions with smoking, axonal guidance signaling $$\left(P=2.12\times 1{0}^{-7}\right)$$ and α-adrenergic signaling $$\left(P=2.52\times 1{0}^{-5}\right)$$ genes were significantly overrepresented canonical pathways. Genes contributing to the axon guidance signaling pathway included the SLIT/ROBO signaling genes that were frequently altered in pancreatic cancer. These observations need to be confirmed in additional data set. Once confirmed, it will open a new avenue to unveiling the etiology of smoking-associated pancreatic cancer.

  • 844. Tang, Hongwei
    et al.
    Wei, Peng
    Duell, Eric J
    Risch, Harvey A
    Olson, Sara H
    Bueno-de-Mesquita, H Bas
    Gallinger, Steven
    Holly, Elizabeth A
    Petersen, Gloria M
    Bracci, Paige M
    McWilliams, Robert R
    Jenab, Mazda
    Riboli, Elio
    Tjønneland, Anne
    Boutron-Ruault, Marie Christine
    Kaaks, Rudolf
    Trichopoulos, Dimitrios
    Panico, Salvatore
    Sund, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Peeters, Petra H M
    Khaw, Kay-Tee
    Amos, Christopher I
    Li, Donghui
    Genes-environment interactions in obesity- and diabetes-associated pancreatic cancer: a GWAS data analysis2014Inngår i: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 23, nr 1, s. 98-106Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Obesity and diabetes are potentially alterable risk factors for pancreatic cancer. Genetic factors that modify the associations of obesity and diabetes with pancreatic cancer have previously not been examined at the genome-wide level. METHODS: Using genome-wide association studies (GWAS) genotype and risk factor data from the Pancreatic Cancer Case Control Consortium, we conducted a discovery study of 2,028 cases and 2,109 controls to examine gene-obesity and gene-diabetes interactions in relation to pancreatic cancer risk by using the likelihood-ratio test nested in logistic regression models and Ingenuity Pathway Analysis (IPA). RESULTS: After adjusting for multiple comparisons, a significant interaction of the chemokine signaling pathway with obesity (P = 3.29 × 10(-6)) and a near significant interaction of calcium signaling pathway with diabetes (P = 1.57 × 10(-4)) in modifying the risk of pancreatic cancer were observed. These findings were supported by results from IPA analysis of the top genes with nominal interactions. The major contributing genes to the two top pathways include GNGT2, RELA, TIAM1, and GNAS. None of the individual genes or single-nucleotide polymorphism (SNP) except one SNP remained significant after adjusting for multiple testing. Notably, SNP rs10818684 of the PTGS1 gene showed an interaction with diabetes (P = 7.91 × 10(-7)) at a false discovery rate of 6%. CONCLUSIONS: Genetic variations in inflammatory response and insulin resistance may affect the risk of obesity- and diabetes-related pancreatic cancer. These observations should be replicated in additional large datasets. IMPACT: A gene-environment interaction analysis may provide new insights into the genetic susceptibility and molecular mechanisms of obesity- and diabetes-related pancreatic cancer.

  • 845. Tempe, Fredrik
    et al.
    Janes, Arthur
    Cengiz, Yucel
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Cost analysis comparing ultrasonic fundus-first and conventional laparoscopic cholecystectomy using electrocautery2013Inngår i: Surgical Endoscopy, ISSN 0930-2794, E-ISSN 1432-2218, Vol. 27, nr 8, s. 2856-2859Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Costs associated with laparoscopic fundus-first cholecystectomy using ultrasonic dissection versus a conventional laparoscopic cholecystectomy has not been compared. Adult patients subjected to elective laparoscopic cholecystectomy between June 2002 and March 2004 were randomized to either an ultrasonic fundus-first dissection or dissection from the triangle of Calot with electrocautery. Differences in direct and indirect costs related to either technique were studied. The duration of the operation and hospitalization was longer when dissection was with the conventional technique. With the ultrasonic fundus-first technique, the direct cost was 1,190 SEK lower, and the total cost, taking also the cost for sick leave into account, was 5,370 SEK lower. Both direct and indirect costs are lower with a laparoscopic fundus-first cholecystectomy using ultrasonic dissection than conventional laparoscopic cholecystectomy using electrocautery.

  • 846.
    Thodelius, Charlotta
    et al.
    Chalmers University of Technology, Gothenburg, Sweden.
    Ekman, Robert
    Chalmers University of Technology, Gothenburg, Sweden.
    Lundälv, Jörgen
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Department of Social Work, University of Gothenburg, Gothenburg, Sweden.
    Ekbrand, Hans
    Department of Sociology and Work Science, University of Gothenburg, Gothenburg, Sweden.
    Injury events sustained in residential environments: age and physical disability as explanatory factors for differences in injury patterns in Sweden2017Inngår i: Housing and Society, ISSN 2376-0923, Vol. 44, nr 1-2, s. 127-140Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim is to analyze how age and physical (dis)ability jointly condition the probability of different types of injuries in residential settings, in order to identify injury countermeasures. There is a need to identify risk factors associated with injuries involving disabled people in their homes. The data include 62,674 records of unintentional injuries in the residential settings from Injury Database 2001–2015. Injuries were twice as likely to occur in residential settings, compared to other environments. Individuals with dis-abilities were more likely to be injured in their residences through falls, compared to non disabled individuals. Contusion was a more common injury type in the disabled group, while open wounds were more common in the non disabled group. Age was the most important factor for predicting fractures and the risk for fractures increased by age, while risk factors related to physical disability did not appear to play a role. The evidence is clear that people with disabilities, and older people without disabilities, would benefit from safety interventions in their home to reduce harm from falls after they have occurred. In keeping with principles to support autonomy, it is recommended that a range of passive measures be implemented to reduce injury risks.

  • 847. Tikk, Kaja
    et al.
    Sookthai, Disorn
    Fortner, Renee T.
    Johnson, Theron
    Rinaldi, Sabina
    Romieu, Isabelle
    Tjonneland, Anne
    Olsen, Anja
    Overvad, Kim
    Clavel-Chapelon, Francoise
    Baglietto, Laura
    Boeing, Heiner
    Trichopoulou, Antonia
    Lagiou, Pagona
    Trichopoulos, Dimitrios
    Masala, Giovanna
    Krogh, Vittorio
    Tumino, Rosario
    Ricceri, Fulvio
    Mattiello, Amalia
    Agudo, Antonio
    Menendez, Virginia
    Sanchez, Maria-Jose
    Amiano, Pilar
    Chirlaque, Maria-Dolores
    Barricarte, Aurelio
    Bueno-de-Mesquita, HBas
    Monninkhof, Evelyn M.
    Onland-Moret, N. Charlotte
    Andresson, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Sund, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Weiderpass, Elisabete
    Khaw, Kay-Tee
    Key, Timothy J.
    Travis, Ruth C.
    Merritt, Melissa A.
    Riboli, Elio
    Dossus, Laure
    Kaaks, Rudolf
    Circulating prolactin and in situ breast cancer risk in the European EPIC cohort: a case-control study2015Inngår i: Breast Cancer Research, ISSN 1465-5411, E-ISSN 1465-542X, Vol. 17, artikkel-id 49Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction The relationship between circulating prolactin and invasive breast cancer has been investigated previously, but the association between prolactin levels and in situ breast cancer risk has received less attention.

    Methods We analysed the relationship between pre-diagnostic prolactin levels and the risk of in situ breast cancer overall, and by menopausal status and use of postmenopausal hormone therapy (HT) at blood donation. Conditional logistic regression was used to assess this association in a case-control study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, including 307 in situ breast cancer cases and their matched control subjects.

    Results We found a significant positive association between higher circulating prolactin levels and risk of in situ breast cancer among all women [pre-and postmenopausal combined, ORlog2 = 1.35 (95% CI 1.04-1.76), P-trend = 0.03]. No statistically significant heterogeneity was found between prolactin levels and in situ cancer risk by menopausal status (P-het = 0.98) or baseline HT use (P-het = 0.20), although the observed association was more pronounced among postmenopausal women using HT compared to non-users (P-trend = 0.06 vs P-trend = 0.35). In subgroup analyses, the observed positive association was strongest in women diagnosed with in situ breast tumors <4 years compared to >= 4 years after blood donation (P-trend = 0.01 vs P-trend = 0.63; P-het = 0.04) and among nulliparous women compared to parous women (P-trend = 0.03 vs P-trend = 0.15; P-het = 0.07).

    Conclusions Our data extends prior research linking prolactin and invasive breast cancer to the outcome of in situ breast tumours and shows that higher circulating prolactin is associated with increased risk of in situ breast cancer.The relationship between circulating prolactin and invasive breast cancer has been investigated previously, but the association between prolactin levels and in situ breast cancer risk has received less attention.

  • 848. Tikk, Kaja
    et al.
    Sookthai, Disorn
    Johnson, Theron
    Rinaldi, Sabina
    Romieu, Isabelle
    Tjønneland, Anne
    Olsen, Anja
    Overvad, Kim
    Clavel-Chapelon, Francoise
    Baglietto, Laura
    Boeing, Heiner
    Trichopoulou, Antonia
    Lagiou, Pagona
    Trichopoulos, Dimitrios
    Palli, Domenico
    Pala, V
    Tumino, Rosario
    Rosso, S
    Panico, Salvatore
    Agudo, A
    Menéndez, Virginia
    Sánchez, Maria-Jose
    Amiano, Pilar
    Castaño, J M Huerta
    Ardanaz, Eva
    Bas Bueno-de-Mesquita, H
    Monninkhof, Evelyn
    Onland-Moret, C
    Andersson, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Sund, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Weiderpass, Elisabete
    Khaw, Kay-Tee
    Key, Timothy J
    Travis, Ruth C
    Gunter, Marc J
    Riboli, Elio
    Dossus, Laure
    Kaaks, Rudolf
    Circulating prolactin and breast cancer risk among pre- and postmenopausal women in the EPIC cohort2014Inngår i: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 25, nr 7, s. 1422-1428Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Experimental and epidemiological evidence suggests that prolactin might play a role in the etiology of breast cancer. We analyzed the relationship of pre-diagnostic circulating prolactin levels with the risk of breast cancer by menopausal status, use of postmenopausal hormone replacement therapy (HRT) at blood donation, and by estrogen and progesterone receptor-status of the breast tumors. METHODS: Conditional logistic regression was used to analyze the data from a case-control study nested within the prospective European EPIC cohort, including 2250 invasive breast cancer and their matched control subjects. RESULTS: Statistically significant heterogeneity in the association of prolactin levels with breast cancer risk between women who were either pre- or postmenopausal at the time of blood donation was observed (Phet=0.04). Higher serum levels of prolactin were associated with significant increase in risk of breast cancer among postmenopausal women (ORQ4-Q1=1.29 [95%CI 1.05-1.58], Ptrend=0.09); however this increase in risk seemed to be confined to women who used postmenopausal HRT at blood donation (ORQ4-Q1=1.45 [95%CI 1.08-1.95], Ptrend=0.01), whereas no statistically significant association was found for the non-users of HRT (ORQ4-Q1 =1.11 [95%CI 0.83-1.49], Ptrend=0.80) (Phet=0.08). Among premenopausal women, a statistically non-significant inverse association was observed (ORQ4-Q1 =0.70 [95%CI 0.48-1.03], Ptrend=0.16). There was no heterogeneity in the prolactin-breast cancer association by hormone receptor status of the tumor. CONCLUSION: Our study indicates that higher circulating levels of prolactin among the postmenopausal HRT users at baseline may be associated with increased breast cancer risk.

  • 849.
    Tran, Mai Quynh Thanh
    et al.
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Kemiska institutionen.
    Nygren, Yvonne
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Kemiska institutionen.
    Lundin, Christina
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Naredi, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Björn, Erik
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Kemiska institutionen.
    Evaluation of cell lysis methods for platinum metallomic studies of human malignant cells2010Inngår i: Analytical Biochemistry, ISSN 0003-2697, E-ISSN 1096-0309, Vol. 396, nr 1, s. 76-82Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Three cell lysis methods-freeze-thaw, osmosis, and a chemical detergent-based method-were evaluated as sample treatment procedures for platinum metallomic studies of in vitro grown human malignant cells exposed to cisplatin. The lysis methods are relatively mild, resemble those commonly used in proteomic studies, and were selected because of the proven reactivity of platinum drug metabolites and indications that platinum in exposed cells and plasma is mainly associated with proteins. The chemical method gave an absolute lysis efficiency of greater than 80%, whereas the freeze-thaw and osmosis methods gave approximately 30% lower efficiency. The within- and between-batch lysis reproducibilities were, for all methods, better than 20 and 24% relative standard deviations, respectively. Total platinum concentration normalized to lysate protein content was statistically the same for all lysis methods. Reagents in the chemical lysis buffer did, however, react with platinum analyte compounds, making this method unsuitable for analysis of reactive compounds or for metallome profiling encompassing analytes with unknown reactivity. Of the lysis methods evaluated here, osmosis gave the highest cisplatin recovery, likely because this protocol is chemically inert and can be carried out at a constant low temperature. Therefore, it is the recommended cell lysis method for the determination of reactive and unknown intracellular platinum compounds.

  • 850. Triebner, Kai
    et al.
    Accordini, Simone
    Calciano, Lucia
    Johannessen, Ane
    Benediktsdóttir, Bryndís
    Bifulco, Ersilia
    Demoly, Pascal
    Dharmage, Shyamali C.
    Franklin, Karl A.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Garcia-Aymerich, Judith
    Gullón Blanco, José Antonio
    Heinrich, Joachim
    Holm, Mathias
    Jarvis, Debbie
    Jõgi, Rain
    Lindberg, Eva
    Martínez-Moratalla, Jesús
    Muniozguren Agirre, Nerea
    Pin, Isabelle
    Probst-Hensch, Nicole
    Raherison, Chantal
    Sánchez-Ramos, José Luis
    Schlünssen, Vivi
    Svanes, Cecilie
    Hustad, Steinar
    Leynaert, Bénédicte
    Gómez Real, Francisco
    Exogenous female sex steroids may reduce lung ageing after menopause: A 20-year follow-up study of a general population sample (ECRHS)2019Inngår i: Maturitas, ISSN 0378-5122, E-ISSN 1873-4111, Vol. 120, s. 29-34, artikkel-id S0378-5122(18)30602-9Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: Menopause involves hypoestrogenism, which is associated with numerous detrimental effects, including on respiratory health. Hormone replacement therapy (HRT) is often used to improve symptoms of menopause. The effects of HRT on lung function decline, hence lung ageing, have not yet been investigated despite the recognized effects of HRT on other health outcomes.

    STUDY DESIGN: The population-based multi-centre European Community Respiratory Health Survey provided complete data for 275 oral HRT users at two time points, who were matched with 383 nonusers and analysed with a two-level linear mixed effects regression model.

    MAIN OUTCOME MEASURES: We studied whether HRT use was associated with the annual decline in forced vital capacity (FVC) and forced expiratory volume in one second (FEV1).

    RESULTS: Lung function of women using oral HRT for more than five years declined less rapidly than that of nonusers. The adjusted difference in FVC decline was 5.6 mL/y (95%CI: 1.8 to 9.3, p = 0.01) for women who had taken HRT for six to ten years and 8.9 mL/y (3.5 to 14.2, p = 0.003) for those who had taken it for more than ten years. The adjusted difference in FEV1 decline was 4.4 mL/y (0.9 to 8.0, p = 0.02) with treatment from six to ten years and 5.3 mL/y (0.4 to 10.2, p = 0.048) with treatment for over ten years.

    CONCLUSIONS: In this longitudinal population-based study, the decline in lung function was less rapid in women who used HRT, following a dose-response pattern, and consistent when adjusting for potential confounding factors. This may signify that female sex hormones are of importance for lung ageing.

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