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Elawa, S., Mirdell, R., Stefanis, A., Droog Tesselaar, E. & Farnebo, S. (2024). Microcirculatory changes in the skin after postmastectomy radiotherapy in women with breast cancer. Scientific Reports, 14(1), Article ID 4149.
Open this publication in new window or tab >>Microcirculatory changes in the skin after postmastectomy radiotherapy in women with breast cancer
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2024 (English)In: Scientific Reports, E-ISSN 2045-2322, Vol. 14, no 1, article id 4149Article in journal (Refereed) Published
Abstract [en]

Postmastectomy radiotherapy (PMRT) increases the risk for complications after breast reconstruction. The pathophysiological mechanism underlying this increased risk is not completely understood. The aim of this study was to examine if there is a relationship between PMRT and microvascular perfusion in the skin directly after, and at 2 and 6 months after PMRT and to assess if there is impaired responsiveness to a topically applied vasodilator (Methyl nicotinate-MN) after PMRT. Skin microvascular responses after PMRT were measured on two sites in the irradiated chest wall of 22 women before, immediately after, and at 2 and 6 months after unilateral PMRT with the contralateral breast as a control. A significant increase in basal skin perfusion was observed in the irradiated chest wall immediately after RT (p < 0.0001). At 2 and 6 months after RT, there was no longer a difference in basal skin perfusion compared to the contralateral breast and compared to baseline. Similarly, the blood flow response in the skin after application of MN was stronger immediately after RT compared to before RT (p < 0.0001), but there was no difference at later time points. These results indicate that the increased risk for complications after surgical procedures are not directly related to changes in skin perfusion and microvascular responsiveness observed after postmastectomy RT.

Place, publisher, year, edition, pages
Nature Publishing Group, 2024
National Category
Cancer and Oncology Surgery
Identifiers
urn:nbn:se:liu:diva-201656 (URN)10.1038/s41598-024-54650-4 (DOI)001173675500030 ()38378732 (PubMedID)2-s2.0-85185473058 (Scopus ID)
Note

Funding: Linköping University

Available from: 2024-03-17 Created: 2024-03-17 Last updated: 2024-04-29Bibliographically approved
Elawa, S., Fredriksson, I., Steinvall, I., Zötterman, J., Farnebo, S. & Droog Tesselaar, E. (2024). Skin perfusion and oxygen saturation after mastectomy and radiation therapy in breast cancer patients. Breast, 75, Article ID 103704.
Open this publication in new window or tab >>Skin perfusion and oxygen saturation after mastectomy and radiation therapy in breast cancer patients
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2024 (English)In: Breast, ISSN 0960-9776, E-ISSN 1532-3080, Vol. 75, article id 103704Article in journal (Refereed) Epub ahead of print
Abstract [en]

The pathophysiological mechanism behind complications associated with postmastectomy radiotherapy (PMRT) and subsequent implant-based breast reconstruction are not completely understood. The aim of this study was to examine if there is a relationship between PMRT and microvascular perfusion and saturation in the skin after mastectomy and assess if there is impaired responsiveness to a topically applied vasodilator (Methyl nicotinate - MN). Skin microvascular perfusion and oxygenation >2 years after PMRT were measured using white light diffuse reflectance spectroscopy (DRS) and laser Doppler flowmetry (LDF) in the irradiated chest wall of 31 women with the contralateral breast as a control. In the non-irradiated breast, the perfusion after application of MN (median 0.84, 25th-75th centile 0.59-1.02 % RBC × mm/s) was higher compared to the irradiated chest wall (median 0.51, 25th-75th centile 0.21-0.68 % RBC × mm/s, p < 0.001). The same phenomenon was noted for saturation (median 91 %, 25th-75th centile 89-94 % compared to 89 % 25th-75th centile 77-93 %, p = 0.001). Eight of the women (26%) had a ≥10 % difference in skin oxygenation between the non-irradiated breast and the irradiated chest wall. These results indicate that late microvascular changes caused by radiotherapy of the chest wall significantly affect skin perfusion and oxygenation.

Place, publisher, year, edition, pages
Elsevier, 2024
National Category
Cancer and Oncology Surgery
Identifiers
urn:nbn:se:liu:diva-201655 (URN)10.1016/j.breast.2024.103704 (DOI)001216488000001 ()38460441 (PubMedID)2-s2.0-85186992326 (Scopus ID)
Available from: 2024-03-17 Created: 2024-03-17 Last updated: 2024-05-22Bibliographically approved
Verstraeten, S., Ansems, J., Van Ommen, W., Van Der Linden, D., Looijmans, F. & Tesselaar, E. (2023). Comparison of true non-contrast and virtual noncontrast images in the characterization of renal lesions using detector-based spectral CT. British Journal of Radiology, 96(1149), Article ID 20220157.
Open this publication in new window or tab >>Comparison of true non-contrast and virtual noncontrast images in the characterization of renal lesions using detector-based spectral CT
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2023 (English)In: British Journal of Radiology, ISSN 0007-1285, E-ISSN 1748-880X, Vol. 96, no 1149, article id 20220157Article in journal (Refereed) Published
Abstract [en]

Objectives: Renal lesions are sometimes incidentally detected during computed tomography (CT) examinations in which an unenhanced series is not included, preventing the lesions from being fully characterized. The aim of this study was to investigate the feasibility to use virtual non-contrast (VNC) images, acquired using a detector-based dual-energy CT, for the characterization of renal lesions. Methods: Twenty-seven patients (12 women) underwent a renal CT scan, including a non-contrast, an arterial, and a venous phase contrast-enhanced series, using a detector-based dual-energy CT scanner. VNC images were reconstructed from the venous contrast-enhanced series. The mean attenuation values of 65 renal lesions in both the VNC and true non-contrast (TNC) images were measured and compared quantitatively. Three radiologists blindly assessed all lesions using either VNC or TNC images in combination with contrast-enhanced images. Results: Sixteen patients had cystic lesions, five had angiomyolipoma (AML), and six had suspected renal cell carcinomas (RCC). Attenuation values in VNC and TNC images were strongly correlated (ρ = 0.7, mean difference −6.0 ± 13 HU). The largest differences were found for unenhanced high-attenuation lesions. Radiologists classified 86% of the lesions correctly using VNC images. Conclusions: In 70% of the patients, incidentally detected renal lesions could be accurately characterized using VNC images, resulting in less patient burden and a reduction in radiation exposure. Advances in knowledge: This study shows that renal lesions can be accurately characterized using VNC images acquired by detector-based dual-energy CT, which is in agreement with previous studies using dual-source and rapid X-ray tube potential switching technique. © 2023 The Authors.

Place, publisher, year, edition, pages
British Institute of Radiology, 2023
Keywords
Carcinoma, Renal Cell; Contrast Media; Female; Humans; Kidney; Kidney Neoplasms; Radiography, Dual-Energy Scanned Projection; Retrospective Studies; Tomography, X-Ray Computed; Veins; contrast medium; adult; angiomyolipoma; Article; cancer patient; clinical article; computer assisted tomography; contrast enhancement; controlled study; data analysis; dual energy computed tomography; feasibility study; female; human; image analysis; information processing; iterative reconstruction; kidney injury; quantitative analysis; radiation exposure; renal cell carcinoma; sensitivity and specificity; x-ray computed tomography; diagnostic imaging; kidney; kidney tumor; procedures; radiography; renal cell carcinoma; retrospective study; vein
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:liu:diva-200774 (URN)10.1259/bjr.20220157 (DOI)001171489400007 ()37334964 (PubMedID)2-s2.0-85168316035 (Scopus ID)
Available from: 2024-02-07 Created: 2024-02-07 Last updated: 2024-03-28Bibliographically approved
Vroman, H., Mosch, D., Eijkenaar, F., Naujokat, E., Mohr, B., Medic, G., . . . Franken, M. (2023). Continuous vital sign monitoring in patients after elective abdominal surgery: a retrospective study on clinical outcomes and costs. Journal of Comparative Effectiveness Research, 12(2), Article ID e220176.
Open this publication in new window or tab >>Continuous vital sign monitoring in patients after elective abdominal surgery: a retrospective study on clinical outcomes and costs
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2023 (English)In: Journal of Comparative Effectiveness Research, ISSN 2042-6305, E-ISSN 2042-6313, Vol. 12, no 2, article id e220176Article in journal (Refereed) Published
Abstract [en]

Plain language summary What is this article about?Continuous vital sign monitoring assists in identifying deteriorating patients outside intensive care. This study analyses changes in clinical outcomes and costs before and after implementation of a clinical vital sign monitoring device in postsurgical patients on a general ward in a Dutch hospital. What were the results?Results show that after implementation, patients were less likely to be admitted to the intensive care unit, had shorter length of stay and had lower hospital stay costs. Aim: To assess changes in outcomes and costs upon implementation of continuous vital sign monitoring in postsurgical patients. Materials & methods: Retrospective analysis of clinical outcomes and in-hospital costs compared with a control period. Results: During the intervention period patients were less frequently admitted to the intensive care unit (ICU) (p = 0.004), had shorter length of stay (p &lt; 0.001) and lower costs (p &lt; 0.001). The intervention was associated with a lower odds of ICU admission (odds ratio: 0.422; p = 0.007) and ICU related costs (odds ratio: -662.4; p = 0.083). Conclusion: Continuous vital sign monitoring may have contributed to fewer ICU admissions and lower ICU costs in postsurgical patients. Tweetable abstractA retrospective study of clinical outcomes and costs compared with a control period indicated that implementation of continuous vital sign monitoring in postsurgical patients in a general hospital in The Netherlands may have contributed to fewer intensive care unit admissions and lower intensive care unit costs.

Place, publisher, year, edition, pages
Becaris Publishing, 2023
Keywords
early warning score; outcomes research; real-world evidence; vital sign monitoring; wearable sensors
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-193522 (URN)10.2217/cer-2022-0176 (DOI)000913097500001 ()36645412 (PubMedID)10.2217/cer-2022-0176 (Scopus ID)
Available from: 2023-05-03 Created: 2023-05-03 Last updated: 2023-09-15Bibliographically approved
Booij, R., Sandstedt, M., Droog Tesselaar, E. & Farnebo, S. (2023). Photon-counting detector computed tomography (PCD-CT) – an emerging technology in hand and wrist imaging. Journal of Hand Surgery, European Volume, 48(5), 489-494
Open this publication in new window or tab >>Photon-counting detector computed tomography (PCD-CT) – an emerging technology in hand and wrist imaging
2023 (English)In: Journal of Hand Surgery, European Volume, ISSN 1753-1934, E-ISSN 2043-6289, Vol. 48, no 5, p. 489-494Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD, 2023
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:liu:diva-190072 (URN)10.1177/17531934221132692 (DOI)000878342500001 ()36324209 (PubMedID)
Available from: 2022-11-21 Created: 2022-11-21 Last updated: 2024-02-09Bibliographically approved
Högstedt, A., Farnebo, S., Tesselaar, E. & Ghafouri, B. (2021). Investigation of proteins important for microcirculation using in vivo microdialysis after glucose provocation: a proteomic study. Scientific Reports, 11(1), Article ID 19093.
Open this publication in new window or tab >>Investigation of proteins important for microcirculation using in vivo microdialysis after glucose provocation: a proteomic study
2021 (English)In: Scientific Reports, E-ISSN 2045-2322, Vol. 11, no 1, article id 19093Article in journal (Refereed) Published
Abstract [en]

Insulin has metabolic and vascular effects in the human body. What mechanisms that orchestrate the effects in the microcirculation, and how the responds differ in different tissues, is however not fully understood. It is therefore of interest to search for markers in microdialysate that may be related to the microcirculation. This study aims to identify proteins related to microvascular changes in different tissue compartments after glucose provocation using in vivo microdialysis. Microdialysis was conducted in three different tissue compartments (intracutaneous, subcutaneous and intravenous) from healthy subjects. Microdialysate was collected during three time periods; recovery after catheter insertion, baseline and glucose provocation, and analyzed using proteomics. Altogether, 126 proteins were detected. Multivariate data analysis showed that the differences in protein expression levels during the three time periods, including comparison before and after glucose provocation, were most pronounced in the intracutaneous and subcutaneous compartments. Four proteins with vascular effects were identified (angiotensinogen, kininogen-1, alpha-2-HS-glycoprotein and hemoglobin subunit beta), all upregulated after glucose provocation compared to baseline in all three compartments. Glucose provocation is known to cause insulin-induced vasodilation through the nitric oxide pathway, and this study indicates that this is facilitated through the interactions of the RAS (angiotensinogen) and kallikrein-kinin (kininogen-1) systems.

Place, publisher, year, edition, pages
NATURE PORTFOLIO, 2021
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-180545 (URN)10.1038/s41598-021-98672-8 (DOI)000700619200012 ()34580391 (PubMedID)
Note

Funding agencies: Linkoping University; ALF grants, Region Ostergotland, Linkoping

Available from: 2021-10-25 Created: 2021-10-25 Last updated: 2024-01-10Bibliographically approved
Tesselaar, E., Macková, P., Pagonis, C., Saers, S., Ahle, M. & Sandborg, M. (2021). MEASUREMENT OF SKIN DOSE AND RADIATION-INDUCED CHANGES IN SKIN MICROCIRCULATION IN CHRONIC TOTAL OCCLUSION PERCUTANEOUS CARDIAC INTERVENTIONS (CTO-PCI). Radiation Protection Dosimetry, 195(3-4), 257-263
Open this publication in new window or tab >>MEASUREMENT OF SKIN DOSE AND RADIATION-INDUCED CHANGES IN SKIN MICROCIRCULATION IN CHRONIC TOTAL OCCLUSION PERCUTANEOUS CARDIAC INTERVENTIONS (CTO-PCI)
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2021 (English)In: Radiation Protection Dosimetry, ISSN 0144-8420, E-ISSN 1742-3406, Vol. 195, no 3-4, p. 257-263Article in journal (Refereed) Published
Abstract [en]

Skin injuries may occur when radiation doses to the skin exceed 2 Gy. This study aimed to measure changes in skin microcirculation in patients undergoing chronic total occlusion percutaneous coronary interventions (CTO-PCI). In 14 patients, peak skin dose (PSD) was estimated with radiographic films and skin microcirculation was assessed with laser speckle contrast imaging (LSCI), before, 1 day after the intervention, and 4–6 weeks later. The mean PSD was 1.8 ± 0.9 Gy. Peak skin microcirculation increased by 12% from 45 ± 6 PU before to 50 ± 9 PU 1 day after the intervention (p = 0.01), and returned to 46 ± 8 PU after 4–6 weeks (p = 0.15). There was no significant correlation between PSD and the change in perfusion, neither 1 day (r = −0.13, p = 0.69) nor 4–6 weeks after the intervention (r = 0.33, p = 0.35). These results suggest that there are no radiation-induced microvascular changes in the skin after CTO-PCI at skin doses below 2 Gy.

Place, publisher, year, edition, pages
Oxford University Press, 2021
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-180433 (URN)10.1093/rpd/ncab024 (DOI)000711245400018 ()33709133 (PubMedID)
Note

Funding: ALF Grants, Region Ostergotland

Available from: 2021-10-20 Created: 2021-10-20 Last updated: 2024-03-25Bibliographically approved
Elgström, H., Tesselaar, E. & Sandborg, M. (2021). Signal-To-Noise Ratio Rate Measurement in Fluoroscopy For Quality Control and Teaching Good Radiological Imaging Technique. Radiation Protection Dosimetry, 195(3-4), 407-415
Open this publication in new window or tab >>Signal-To-Noise Ratio Rate Measurement in Fluoroscopy For Quality Control and Teaching Good Radiological Imaging Technique
2021 (English)In: Radiation Protection Dosimetry, ISSN 0144-8420, E-ISSN 1742-3406, Vol. 195, no 3-4, p. 407-415Article in journal (Refereed) Published
Abstract [en]

Visibility of low-contrast details in fluoroscopy and interventional radiology is important. Assessing detail visibility with human observers typically suffers from large observer variances. Objective, quantitative measurement of low-contrast detail visibility using a model observer, such as the square of the signal-to-noise ratio rate (SNR2rate), was implemented in MATLAB™ and evaluated. The expected linear response of SNR2rate based on predictions by the so-called Rose model and frame statistics was verified. The uncertainty in the measurement of SNR2rate for a fixed imaging geometry was 6% based on 16 repeated measurements. The results show that, as expected, reduced object thickness and x-ray field size substantially improved SNR2rate/PKA,rate with PKA,rate being the air kerma area product rate. The measurement precision in SNR2rate/PKA,rate (8–9%) is sufficient to detect small but important improvements, may guide the selection of better imaging settings and provides a tool for teaching good radiological imaging techniques to clinical staff.

Place, publisher, year, edition, pages
Oxford University Press, 2021
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:liu:diva-173104 (URN)10.1093/rpd/ncaa222 (DOI)000711245400037 ()33517437 (PubMedID)
Note

Funding: Avtal Lakarutbildning och Forskning (ALF) [LIO-357651]; Regionfinansierad Forskning och Utbildning (RFoU) from Region Ostergotland, Sweden [03008103]

Available from: 2021-02-01 Created: 2021-02-01 Last updated: 2022-05-26Bibliographically approved
Bergkvist, M., Henricson, J., Bergstrand, S., Strömberg, T., Droog Tesselaar, E. & Farnebo, S. (2020). Assessment of oxygenation with polarized light spectroscopy enables new means for detecting vascular events in the skin. Microvascular Research, 130, Article ID 104000.
Open this publication in new window or tab >>Assessment of oxygenation with polarized light spectroscopy enables new means for detecting vascular events in the skin
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2020 (English)In: Microvascular Research, ISSN 0026-2862, E-ISSN 1095-9319, Vol. 130, article id 104000Article in journal (Refereed) Published
Abstract [en]

Introduction: Impaired oxygenation in the skin may occur in disease states and after reconstructive surgery. We used tissue viability imaging (TiVi) to measure changes in oxygenation and deoxygenation of haemoglobin in an in vitro model and in the dermal microcirculation of healthy individuals. Materials and methods: Oxygenation was measured in human whole blood with different levels of oxygenation. In healthy subjects, changes in red blood cell concentration (C-RBC,(TiVi)), oxygenation (Delta C-OH,(TiVi)) and deoxygenation (Delta C-DOH,(TiVi)) of haemoglobin were measured during and after arterial and venous occlusion using TiVi and were compared with measurements from the enhanced perfusion and oxygen saturation system (EPOS). Results: During arterial occlusion, C-RBC,(TiVi) remained unchanged while Delta C-OH,(TiVi) decreased to -44.2 (10.4) AU (p = 0.04), as compared to baseline. After release, C-RBC,C-TiVi increased to 39.2 (18.8) AU (p &lt; 0.001), Delta C-OH,C-TiVi increased to 38.5. During venous occlusion, C-RBC,C-TiVi increased to 28.9 (11.2) AU (p &lt; 0.001), Delta C-OH,C-TiVi decreased to -52.2 (46.1) AU (p &lt; 0.001) compared to baseline after 5 min of venous occlusion. There was a significant correlation between the TiVi Oxygen Mapper and EPOS, for arterial (r = 0.92, p &lt; 0.001) and venous occlusion (r = 0.87, p &lt; 0.001), respectively. Conclusion: This study shows that TiVi can measure trends in oxygenation and deoxygenation of haemoglobin during arterial and venous stasis in healthy individuals.

Place, publisher, year, edition, pages
ACADEMIC PRESS INC ELSEVIER SCIENCE, 2020
Keywords
Tissue viability imaging; Red blood cell concentration; Oxygenation; Saturation; Enhanced perfusion and oxygen saturation (EPOS); Post-occlusive hyperaemia
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-166462 (URN)10.1016/j.mvr.2020.104000 (DOI)000536777500002 ()32194082 (PubMedID)
Note

Funding Agencies|Council of Ostergotland County, Sweden; Swedish Governmental Agency for Innovation Systems (VINNOVA)Vinnova [2015-0153]

Available from: 2020-06-20 Created: 2020-06-20 Last updated: 2024-01-10
Högstedt, A., Iredahl, F., Droog Tesselaar, E. & Farnebo, S. (2020). Effect of N-G-monomethyl l-arginine on microvascular blood flow and glucose metabolism after an oral glucose load. Microcirculation, 27(3), Article ID e12597.
Open this publication in new window or tab >>Effect of N-G-monomethyl l-arginine on microvascular blood flow and glucose metabolism after an oral glucose load
2020 (English)In: Microcirculation, ISSN 1073-9688, E-ISSN 1549-8719, Vol. 27, no 3, article id e12597Article in journal (Refereed) Published
Abstract [en]

Objective The aim of this study was to investigate whether the effects on local blood flow and metabolic changes observed in the skin after an endogenous systemic increase in insulin are mediated by the endothelial nitric oxide pathway, by administering the nitric oxide synthase inhibitor N-G-monomethyl l-arginine using microdialysis. Methods Microdialysis catheters, perfused with N-G-monomethyl l-arginine and with a control solution, were inserted intracutaneously in 12 human subjects, who received an oral glucose load to induce a systemic hyperinsulinemia. During microdialysis, the local blood flow was measured by urea clearance and by laser speckle contrast imaging, and glucose metabolites were measured. Results After oral glucose intake, microvascular blood flow and glucose metabolism were both significantly suppressed in the N-G-monomethyl l-arginine catheter compared to the control catheter (urea clearance: P amp;lt; .006, glucose dialysate concentration: P amp;lt; .035). No significant effect of N-G-monomethyl l-arginine on microvascular blood flow was observed with laser speckle contrast imaging (P = .81). Conclusion Local delivery of N-G-monomethyl l-arginine to the skin by microdialysis reduces microvascular blood flow and glucose delivery in the skin after oral glucose intake, presumably by decreasing local insulin-mediated vasodilation.

Place, publisher, year, edition, pages
WILEY, 2020
Keywords
insulin; l-NMMA; metabolism; microcirculation; microdialysis
National Category
Physiology
Identifiers
urn:nbn:se:liu:diva-162323 (URN)10.1111/micc.12597 (DOI)000494847400001 ()31628700 (PubMedID)
Note

Funding Agencies|ALF grants, Region Ostergotland, Linkoping, Sweden

Available from: 2019-11-28 Created: 2019-11-28 Last updated: 2024-01-10
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-8387-0583

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