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Szabó, Zoltán
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Publications (10 of 54) Show all publications
Ahn, H. C., Holm, J., Najar, A., Hellers, G. & Szabó, Z. (2018). A New Total Artificial Heart Concept Allowing Replacement or Support of the Native Heart. Journal of Clinical & Experimental Cardiology, 9(2), Article ID 1000569.
Open this publication in new window or tab >>A New Total Artificial Heart Concept Allowing Replacement or Support of the Native Heart
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2018 (English)In: Journal of Clinical & Experimental Cardiology, E-ISSN 2155-9880, Vol. 9, no 2, article id 1000569Article in journal (Refereed) Published
Abstract [en]

A total artificial heart (TAH) is typically used to bridge the time to heart transplantation. A device designed by Robert Jarvik has been improved through the years and under the name of Syncardia™ this has been the most successful commercially available TAH so far. Since 2008 the Carmat™ heart has been under development in Europe. The Scandinavian Real Heart™ is based on a unique physiological concept where the atrio-ventricular valve plane is of utmost importance in the pumping function of the heart. It consists of two identical parts driven separately by independent motors and in this first animal study we have used one part as a left ventricular assist device. This new concept makes the device flexible as it may be used not only as a TAH but also as a separate pump for left or right ventricular assist.

Place, publisher, year, edition, pages
Los Angeles, United States: Omics Publishing Group, 2018
Keywords
Heart assist; Total artificial heart; Ventricular assist device; Left ventricular assist device
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-146044 (URN)10.4172/2155-9880.1000569 (DOI)
Available from: 2018-03-23 Created: 2018-03-23 Last updated: 2018-04-04Bibliographically approved
Grams, M. E., Sang, Y., Coresh, J., Ballew, S., Matsushita, K., Molnar, M. Z., . . . Kovesdy, C. P. (2016). Acute Kidney Injury After Major Surgery: A Retrospective Analysis of Veterans Health Administration Data.. American Journal of Kidney Diseases, 67(6), 872-880
Open this publication in new window or tab >>Acute Kidney Injury After Major Surgery: A Retrospective Analysis of Veterans Health Administration Data.
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2016 (English)In: American Journal of Kidney Diseases, ISSN 0272-6386, E-ISSN 1523-6838, Vol. 67, no 6, p. 872-880Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Few trials of acute kidney injury (AKI) prevention after surgery have been conducted, and most observational studies focus on AKI following cardiac surgery. The frequency of, risk factors for, and outcomes after AKI following other types of major surgery have not been well characterized and may present additional opportunities for trials in AKI.

STUDY DESIGN: Observational cohort study.

SETTING & PARTICIPANTS: 3.6 million US veterans followed up from 2004 to 2011 for the receipt of major surgery (cardiac; general; ear, nose, and throat; thoracic; vascular; urologic; and orthopedic) and postoperative outcomes.

FACTORS: Demographics, health characteristics, and type of surgery.

OUTCOMES: Postoperative AKI defined by the KDIGO creatinine criteria, postoperative length of stay, end-stage renal disease, and mortality.

RESULTS: Postoperative AKI occurred in 11.8% of the 161,185 major surgery hospitalizations (stage 1, 76%; stage 2, 15%, stage 3 [without dialysis], 7%; and AKI requiring dialysis, 2%). Cardiac surgery had the highest postoperative AKI risk (relative risk [RR], 1.22; 95% CI, 1.17-1.27), followed by general (reference), thoracic (RR, 0.92; 95% CI, 0.87-0.98), orthopedic (RR, 0.70; 95% CI, 0.67-0.73), vascular (RR, 0.68; 95% CI, 0.64-0.71), urologic (RR, 0.65; 95% CI, 0.61-0.69), and ear, nose, and throat (RR, 0.32; 95% CI, 0.28-0.37) surgery. Risk factors for postoperative AKI included older age, African American race, hypertension, diabetes mellitus, and, for estimated glomerular filtration rate < 90mL/min/1.73m(2), lower estimated glomerular filtration rate. Participants with postoperative AKI had longer lengths of stay (15.8 vs 8.6 days) and higher rates of 30-day hospital readmission (21% vs 13%), 1-year end-stage renal disease (0.94% vs 0.05%), and mortality (19% vs 8%), with similar associations by type of surgery and more severe stage of AKI relating to poorer outcomes.

LIMITATIONS: Urine output was not available to classify AKI; cohort included mostly men.

CONCLUSIONS: AKI was common after major surgery, with similar risk factor and outcome associations across surgery type. These results can inform the design of clinical trials in postoperative AKI to the noncardiac surgery setting.

Place, publisher, year, edition, pages
Saunders Elsevier, 2016
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-122028 (URN)10.1053/j.ajkd.2015.07.022 (DOI)000376508000013 ()26337133 (PubMedID)
Available from: 2015-10-16 Created: 2015-10-16 Last updated: 2017-12-01
Grams, M. E., Sang, Y., Coresh, J., Ballew, S. H., Matsushita, K., Levey, A. S., . . . Kovesdy, C. P. (2016). Candidate Surrogate End Points for ESRD after AKI. Journal of the American Society of Nephrology, 27(9), 2851-2859
Open this publication in new window or tab >>Candidate Surrogate End Points for ESRD after AKI
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2016 (English)In: Journal of the American Society of Nephrology, ISSN 1046-6673, E-ISSN 1533-3450, Vol. 27, no 9, p. 2851-2859Article in journal (Refereed) Published
Abstract [en]

AKI, a frequently transient condition, is not accepted by the US Food and Drug Association as an end point for drug registration trials. We assessed whether an intermediate-term change in eGFR after AKI has a sufficiently strong relationship with subsequent ESRD to serve as an alternative end point in trials of AKI prevention and/or treatment. Among 161,185 United States veterans undergoing major surgery between 2004 and 2011, we characterized in-hospital AKI by Kidney Disease Improving Global Outcomes creatinine criteria and decline in eGFR from prehospitalization to postdischarge time points and quantified associations of these values with ESRD and mortality over a median of 3.8 years. An eGFR decline of ≥30% at 30, 60, and 90 days after discharge occurred in 3.1%, 2.5%, and 2.6%, of survivors without AKI and 15.9%, 12.2%, and 11.7%, of survivors with AKI. For patients with in-hospital AKI compared with those with no AKI and stable eGFR, a 30% decline in eGFR at 30, 60, and 90 days after discharge demonstrated adjusted hazard ratios (95% confidence intervals) of ESRD of 5.60 (4.06 to 7.71), 6.42 (4.76 to 8.65), and 7.27 (5.14 to 10.27), with corresponding estimates for 40% decline in eGFR of 6.98 (5.21 to 9.35), 8.03 (6.11 to 10.56), and 10.95 (8.10 to 14.82). Risks for mortality were smaller but consistent in direction. A 30%-40% decline in eGFR after AKI could be a surrogate end point for ESRD in trials of AKI prevention and/or treatment, but additional trial evidence is needed.

Place, publisher, year, edition, pages
American Society of Nephrology, 2016
Keywords
acute renal failure, end stage kidney disease, glomerular filtration rate
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-129985 (URN)10.1681/ASN.2015070829 (DOI)000382270500029 ()26857682 (PubMedID)
Note

Funding agencies: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) [K08DK092287]; National Kidney Foundation; National Institutes of Health/NIDDK [R01DK100446, R01DK096920]; Department of VA, Veterans Health Administration, Office of Research and De

Available from: 2016-07-04 Created: 2016-07-04 Last updated: 2017-11-28Bibliographically approved
Svensson, A. S., Escobar Kvitting, J.-P., Kovesdy, C. P., Cederholm, I. & Szabó, Z. (2016). Changes in serum cystatin C, creatinine, and C-reactive protein after cardiopulmonary bypass in patients with normal preoperative kidney function.. Nephrology (Carlton. Print), 21(6), 519-525
Open this publication in new window or tab >>Changes in serum cystatin C, creatinine, and C-reactive protein after cardiopulmonary bypass in patients with normal preoperative kidney function.
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2016 (English)In: Nephrology (Carlton. Print), ISSN 1320-5358, E-ISSN 1440-1797, Vol. 21, no 6, p. 519-525Article in journal (Refereed) Published
Abstract [en]

AIM: The use of cardiopulmonary bypass (CPB) can cause changes in serum creatinine and cystatin C independent of glomerular filtration rate. We aimed to quantify the temporal changes of these biomarkers and C-reactive protein (CRP) after CPB.

METHODS: This was a prospective study at an academic medical center between April and October 2013. We compared postoperative changes in serum creatinine and cystatin C in 38 patients with normal preoperative kidney function who underwent cardiac surgery using CPB and did not develop perioperative acute kidney injury (AKI). The effect of inflammation on intra-individual changes was examined in mixed effects regressions, using measurements of pre- and postoperative CRP.

RESULTS: Both serum creatinine (79.9 ± 22.7 vs. 92.6 ± 21.4 µmol/L, p = 0.001) and cystatin C (1.16 ± 0.39 vs. 1.33 ± 0.37 mg/L, p = 0.012) decreased significantly in the first 8 hours postoperatively compared to preoperatively, as a result of hemodilution. Thereafter serum creatinine returned to preoperative levels, whereas serum cystatin C continued to rise and was significantly elevated at 72 hours post-CPB compared to preoperative levels (1.53 ± 0.48 vs. 1.33 ± 0.37 mg/L, p = 0.003). CRP levels increased significantly post-CPB and were significantly associated with increases in both serum creatinine and cystatin C.

CONCLUSIONS: Serum creatinine and cystatin C appear not to be interchangeable biomarkers during and immediately after CPB. Processes unrelated to kidney function such as acute inflammation have a significant effect on post-CPB changes in these biomarkers, and may result in significant increases in serum cystatin C that could erroneously be interpreted as AKI. This article is protected by copyright. All rights reserved.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2016
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-122030 (URN)10.1111/nep.12630 (DOI)000379594600010 ()26396066 (PubMedID)
Note

Funding agencies: county council of Ostergotland [LIO-205491, LIO-277491]

Available from: 2015-10-16 Created: 2015-10-16 Last updated: 2017-12-01
Grams, M., Sang, Y., Coresh, J., Ballew, S., Matsushita, K., Greene, T., . . . Szabó, Z. (2015). Decline in Estimated Glomerular Filtration Rate After Acute Kidney Injury: A Surrogate Endpoint?. In: ASN (American Society of Nephrology): . Paper presented at ASN (American Society of Nephrology) American society of nephrology kidney week 2015. , 26
Open this publication in new window or tab >>Decline in Estimated Glomerular Filtration Rate After Acute Kidney Injury: A Surrogate Endpoint?
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2015 (English)In: ASN (American Society of Nephrology), 2015, Vol. 26Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Background: Often a transient condition, acute kidney injury (AKI) is not currently accepted as an endpoint for drug registration trials by the US FDA. We sought to determine whether an intermediate-term change in eGFR after AKI has a sufficiently strong relationship with subsequent ESRD to serve as an alternative endpoint in clinical trials of AKI preventionand/or treatment.

Methods: We evaluated 161,185 US veterans who underwent major surgery between2004-2011. Post-surgical AKI was defined by the KDIGO creatinine criteria;decline in eGFR was calculated from pre-hospitalization value to two time-points post-discharge (60-days, 90-days) and related to ESRD and mortality using Cox proportional hazards regression.

Results: In-hospital mortality varied by AKI status, ranging from 1% for patients without AKI to 35% for those with dialysis-requiring AKI. An eGFR decline of ³30% at 60-days was relatively frequent: 2.5%, 9.7%, 17.2%, and 28.6% in those with no AKI, Stage 1 AKI, Stage 2 AKI, and Stage 3 AKI, respectively. There was a graded relationship between eGFR decline at 60-days and risk of ESRD in persons both with and without AKI (Figure). Compared to stable eGFR/no in-hospital AKI, the adjusted hazard ratio (HR) of ESRD associated with a 30% decline at 60-days after AKI was 6.42 (95% CI: 4.8-8.7). Risks for mortality associated with eGFR decline were smaller: the HR for 30% decline 60-days after in-hospital AKI was 1.59 (95% CI: 1.46-1.73). Risk relationships were similar at 90-days.

Conclusions: A 30% decline in eGFR from pre-hospitalization baseline to 60-days or 90-days after an episode of AKI may be an acceptable surrogate endpoint in trials of AKI prevention and/or treatment.

National Category
Clinical Medicine Physiology
Identifiers
urn:nbn:se:liu:diva-122513 (URN)
Conference
ASN (American Society of Nephrology) American society of nephrology kidney week 2015
Available from: 2015-11-06 Created: 2015-11-06 Last updated: 2018-01-10
Szabó, Z., Harangi, M., Nylander, E., Ljungman, A., Theodorsson, A., Ahn, H. & Davidsson, B. (2015). How students perceive problem-based learning (PBL) group tutorials at a Swedish Medical College. Med Ed Publish, 6(17)
Open this publication in new window or tab >>How students perceive problem-based learning (PBL) group tutorials at a Swedish Medical College
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2015 (English)In: Med Ed Publish, ISSN 2312-7996, Vol. 6, no 17Article in journal (Refereed) Published
Abstract [en]

Introduction: student perception of problem-based learning (PBL) group tutorials was investigated at a Swedish University Medical College 27 years after the introduction of PBL into the curriculum.

Methods: a survey questionnaire comprising 43 questions answered on a Likert-type scale, together with one open question was used. The questionnaire was distributed to all 821 students taking part in the Linköping University medical program at the beginning of the Spring Term 2013. The results were subjected to explorative factor analysis, descriptive statistics and ANOVA. Responses to the open question where analyzed qualitatively by categorization.

Results: 84 per cent of the 821 students completed the survey. Four factors describing student perception were identified: 1) PBL as a method of learning; 2) the tutor’s role; 3) PBL, stress and feelings of insecurity; and 4) traditional teaching methods within the PBL curriculum. The Cronbach´s alpha value was 0,788 overall. Two hundred and seventy-six students answered the open question declaring that they would appreciate more precise aims and objectives, smaller tutorial groups, and more formal lectures.

Conclusions: the results of this study on PBL group tutorials, as seen from the student’s perspective, stress the importance of tutorial quality, tutor competence, tutorial group size and the quality and aims of the curriculum. Too much emphasis on the teacher’s research merits against the educational ones, and the inability to adapt to the needs and wishes of new generations of students seems a probable cause for the erosion of PBL.

Keywords
Problem-based learning, group work, tutors, self-directed learning
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-122164 (URN)10.15694/mep.2015.006.0017 (DOI)
Available from: 2015-10-22 Created: 2015-10-22 Last updated: 2018-02-21
Szabó, Z. (2015). Letter: New forceps for videolaryngoscopic intubation [Letter to the editor]. Anaesthesia, 70(8), 1004-1005
Open this publication in new window or tab >>Letter: New forceps for videolaryngoscopic intubation
2015 (English)In: Anaesthesia, ISSN 0003-2409, E-ISSN 1365-2044, Vol. 70, no 8, p. 1004-1005Article in journal, Letter (Other academic) Published
Abstract [en]

n/a

Place, publisher, year, edition, pages
Wiley: 12 months, 2015
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-120440 (URN)10.1111/anae.13160 (DOI)000357731200025 ()26152262 (PubMedID)
Available from: 2015-08-12 Created: 2015-08-11 Last updated: 2017-12-04
Grams, M., Sang, Y., Ballew, S., Szabó, Z., Matsushita, K., Kalantar-Zadeh, K., . . . Kovesdy, C. (2014). Incidence of and risk factors for acute kidney injury after major surgery. In: : . Paper presented at Journal of the American Society of Nephrology 2014. , 25
Open this publication in new window or tab >>Incidence of and risk factors for acute kidney injury after major surgery
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2014 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Other Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-114946 (URN)
Conference
Journal of the American Society of Nephrology 2014
Available from: 2015-03-06 Created: 2015-03-06 Last updated: 2015-03-18
Szabó, Z., Harangi, M., Nylander, E., Theodorsson, A. & Davidson, B. (2014). Problem-based learning (PBL): tutor perception of group work and learning. MedEdPublish, 3(46), 1-11
Open this publication in new window or tab >>Problem-based learning (PBL): tutor perception of group work and learning
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2014 (English)In: MedEdPublish, ISSN 2312-7996, Vol. 3, no 46, p. 1-11Article in journal (Refereed) Published
Abstract [en]

Introduction: This paper reports a survey on how PBL is perceived by tutors. A questionnaire including 45 questions answered on a Likert-type scale, and an open question was constructed. The aim was to identify factors that tutors believe promote or impede student learning. All faculty tutors (116) teaching five different student semester cohorts at our medical college during the Spring Term of 2013 were included. Seventy-four tutors responded (64%). Methods:Descriptive statistics, explorative factor analysis.Results:Factor analysis identified five factors which explained 52 % of the variation. These factors were: PBL as a pedagogic method; tutoring problem analysis in the group; barriers to student learning; the tutor ́s role in the group; and the relationship betweentheory and practice. The model as a whole showed high reliability (Chrombach ́s alpha = 0,81). When responding to the open question, the tutors suggested organizational changes, improvement in tutor competence, clear goals in the curriculum, and smaller tutorial groups/miscellaneous. Conclusions:The tutors’ approach adhered to classical PBL methodology, and they considered it to be a good instrument for student learning. The tutorial group was seen as promoting learning. Problems related to group dynamics and tutor competence were considered a hindrance to learning.

Place, publisher, year, edition, pages
MedEdWorld, 2014
Keywords
Problem - based learning, group work, tutor, competence, self - directed learning
National Category
Didactics
Identifiers
urn:nbn:se:liu:diva-121186 (URN)10.15694/mep.2014.003.0046 (DOI)
Available from: 2015-09-08 Created: 2015-09-08 Last updated: 2015-10-22Bibliographically approved
Svensson, A., Kovesdy, C. P., Escobar Kvitting, J.-P., Cederholm, I. & Szabó, Z. (2014). Serum cystatin C as disgnostic marker of acute kidney injury after cardiopulmonary bypass: a word of caution. In: : . Paper presented at Journal of the American Society of Nephrology 2014.
Open this publication in new window or tab >>Serum cystatin C as disgnostic marker of acute kidney injury after cardiopulmonary bypass: a word of caution
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2014 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-114950 (URN)
Conference
Journal of the American Society of Nephrology 2014
Available from: 2015-03-06 Created: 2015-03-06 Last updated: 2015-06-11
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