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  • 51.
    Arnlind, Anna
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Neurosurgery.
    Danielsson, Marita
    Linköping University, Department of Biomedical and Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Övr Regionledningskontoret. Swedish Natl Patient Insurance Co LOF, Sweden.
    Engerström, Lars
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Tobieson, Lovisa
    Linköping University, Department of Biomedical and Clinical Sciences, The Division of Cell and Neurobiology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Neurosurgery.
    Orwelius, Lotti
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US.
    Patients with aneurysmal subarachnoid haemorrhage treated in Swedish intensive care: A registry study2024In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576Article in journal (Refereed)
    Abstract [en]

    Background: Aneurysmal subarachnoid haemorrhage (aSAH) is a life-threatening disease with high mortality and morbidity. Patients with aSAH in Sweden are cared for at one of six neuro intensive care units (NICU) or at a general intensive care unit (ICU).This study aimed to describe the incidence, length of stay, time in ventilator and mortality for these patients. Methods: This is a retrospective, descriptive study of patients with aSAH, registered in the Swedish Intensive care Registry between 2017 and 2019. The cohort was divided in sub-cohorts (NICU and general ICU) and regions. Mortality was analysed with logistic regression. Results: A total of 1520 patients with aSAH from five regions were included in the study. Mean age of the patients were 60.6 years and 58% were female. Mortality within 180 days of admission was 30% (n = 456) of which 17% (n = 258) died during intensive care. A majority of the patients were treated at one hospital and in one ICU (70%, n = 1062). More than half of the patients (59%, n = 897) had their first intensive care admission at a hospital with a NICU. Patients in the North region had the lowest median GCS (10) and the highest SAPS3 score (60) when admitted to NICU. Treatment with invasive mechanical ventilation differed significantly between regions; 91% (n = 80) in the region with highest proportion versus 56% (n = 94) in the region with the lowest proportion, as did mortality; 16% (n = 44) versus 8% (n = 23). No differences between regions were found regarding age, sex and length of stay. Conclusions: Patients with aSAH treated in a NICU or in an ICU in Sweden differs in characteristics. The study further showed some differences between regions which might be reduced if there were national consensus and treatment guidelines implemented.

  • 52.
    Asbun, H.J.
    et al.
    Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, United States.
    Moekotte, A.L.
    Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
    Vissers, F.L.
    Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
    Kunzler, F.
    Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, United States.
    Cipriani, F.
    Department of Surgery, San Raffaele Hospital, Milan, Italy.
    Alseidi, A.
    Division of Hepatopancreatobiliary and Endocrine Surgery, Virginia Mason Medical Center, Seattle, VA, United States.
    DAngelica, M.I.
    Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY, United States.
    Balduzzi, A.
    Division of Pancreatic Surgery, University Hospital of Verona, Verona, Italy.
    Bassi, C.
    Division of Pancreatic Surgery, University Hospital of Verona, Verona, Italy.
    Björnsson, Bergthor
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Boggi, U.
    Division of General and Transplant Surgery, University of Pisa, Pisa, Italy.
    Callery, M.P.
    Department of General and Gastrointestinal Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States.
    Del, Chiaro M.
    Department of Surgery, Division of Surgical Oncology, University of Colorado, Denver, CO, United States.
    Coimbra, F.J.
    Department of Abdominal Surgery, AC Camargo Cancer Center, São Paulo, Brazil.
    Conrad, C.
    Department of Surgery, St. Elizabeths Medical Center, Boston, MA, United States.
    Cook, A.
    Wessex Institute, University of Southampton, United Kingdom.
    Coppola, A.
    General Surgery and Liver Transplant, Unit Department of General Surgery, Fondazione Policlinico, Universitario Agostino Gemelli, IRCCS, Rome, Italy.
    Dervenis, C.
    Department of Surgery, Medical School, University of Cyprus, Cyprus.
    Dokmak, S.
    Department of Surgery, Beaujon Hospital, Paris, France.
    Edil, B.H.
    Department of Surgery, University of Oklahoma, Oklahoma City, OK, United States.
    Edwin, B.
    Intervention Centre, Department of HPB Surgery, Oslo University Hospital, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
    Giulianotti, P.C.
    Division of Minimally Invasive, General Surgery and Robotic Surgery, University of Illinois, Chicago, IL, United States.
    Han, H.-S.
    Department of Surgery, Seoul National University Hospital, Seoul, South Korea.
    Hansen, P.D.
    Department of Surgery, Portland Providence Medical Center, Portland, OR, United States.
    Van, Der Heijde N.
    Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
    Van, Hilst J.
    Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
    Hester, C.A.
    Department of Surgery, University of Texas, Southwestern Medical Center, Dallas, TX, United States.
    Hogg, M.E.
    Department of Surgery, NorthShore University Health System, Evanston, IL, United States.
    Jarufe, N.
    Department of Digestive Surgery, Pontifical Catholic University of Chile, Santiago, Chile.
    Jeyarajah, D.R.
    Department of HPB Surgery, Methodist Richardson Medical Center, Richardson, TX, United States.
    Keck, T.
    Clinic for Surgery, University of Schleswig-Holstein Campus Lübeck, Lübeck, Germany.
    Kim, S.C.
    Department of Surgery, Ulsan University, College of Medicine, Asan Medical Center, Seoul, South Korea.
    Khatkov, I.E.
    Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russian Federation.
    Kokudo, N.
    Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan.
    Kooby, D.A.
    Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, United States.
    Korrel, M.
    Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
    De, Leon F.J.
    HPB and Transplant Unit, Regional Hospital, Málaga, Spain.
    Lluis, N.
    Department of Surgery, Bellvitge University Hospital, Barcelona, Spain.
    Lof, S.
    Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
    Machado, M.A.
    Department of Surgery, University of São Paulo, São Paulo, Brazil.
    Demartines, N.
    Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland.
    Martinie, J.B.
    Division of HPB Surgery, Department of Surgery, Carolinas Health Care Hospital, Charlotte, NC, United States.
    Merchant, N.B.
    Division of Surgical Oncology, Department of Surgery, University of Miami, Miller School of Medicine, Miami, FL, United States.
    Molenaar, I.Q.
    Department of Surgery, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, Netherlands.
    Moravek, C.
    Pancreatic Cancer Action Network, Manhattan Beach, CA, United States.
    Mou, Y.-P.
    Department of Gastroenterology and Pancreatic Surgery, Zhengjiang Provincial Peoples Hospital, Peoples Hospital of Hangzhou Medical College, Zhejiang, China.
    Nakamura, M.
    Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
    Nealon, W.H.
    Department of Surgery, Northwell Health, Manhasset, NY, United States.
    Palanivelu, C.
    Department of Surgical Gastroenterology and HPB Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India.
    Pessaux, P.
    Division of Hepato-Biliary and Pancreatic Surgery, Nouvel Hôpital Civil, Institut Hospitalo-Universitaire de Strasbourg, Strasbourg, France.
    Pitt, H.A.
    Department of Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States.
    Polanco, P.M.
    Department of Surgery, University of Texas, Southwestern Medical Center, Dallas, TX, United States.
    Primrose, J.N.
    Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
    Rawashdeh, A.
    Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
    Sanford, D.E.
    Division of Hepatobiliary, Pancreatic, and Gastrointestinal Surgery, Barnes-Jewish Hospital, Alvin J. Siteman Cancer Center, Washington University, School of Medicine, St. Louis, MO, United States.
    Senthilnathan, P.
    Department of Surgical Gastroenterology and HPB Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India.
    Shrikhande, S.V.
    Department of Surgery, Tata Memorial Center, Mumbai, India.
    Stauffer, J.A.
    Department of General Surgery, Mayo Clinic Florida, Jacksonville, FL, United States.
    Takaori, K.
    Department of Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan.
    Talamonti, M.S.
    Department of Surgery, NorthShore University Health System, Evanston, IL, United States.
    Tang, C.N.
    Department of Surgery, Pamela Youde Nethersle Eastern Hospital, Chai Wan, Hong Kong, Hong Kong.
    Vollmer, C.M.
    Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States.
    Wakabayashi, G.
    Center for Advanced Treatment of HPB Diseases, Ageo Central General Hospital, Saitama, Japan.
    Walsh, R.M.
    Department of General Surgery, Cleveland Clinic, Cleveland, OH, United States.
    Wang, S.-E.
    Department of Surgery, Taipei Veterans General Hospital, National Yang Ming University, Taipei, Taiwan.
    Zinner, M.J.
    Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, United States.
    Wolfgang, C.L.
    Division of Surgical Oncology, Department of Surgery, John Hopkins University, School of Medicine, Baltimore, MD, United States.
    Zureikat, A.H.
    Division of Surgical Oncology, Department of Surgery, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States.
    Zwart, M.J.
    Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
    Conlon, K.C.
    Department of Surgery, Trinity College Dublin, Tallaght University Hospital, Dublin, Ireland.
    Kendrick, M.L.
    Department of Surgery, Mayo Clinic, Rochester, MN, United States; Department of Surgery, Istituto Fondazione Poliambulanza, Brescia, Italy.
    Zeh, H.J.
    Division of Surgical Oncology, Department of Surgery, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States.
    Hilal, M.A.
    Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
    Besselink, M.G.
    Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
    The Miami International Evidence-based Guidelines on Minimally Invasive Pancreas Resection2020In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 271, no 1Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to develop and externally validate the first evidence-based guidelines on minimally invasive pancreas resection (MIPR) before and during the International Evidence-based Guidelines on Minimally Invasive Pancreas Resection (IG-MIPR) meeting in Miami (March 2019).Summary Background Data: MIPR has seen rapid development in the past decade. Promising outcomes have been reported by early adopters from high-volume centers. Subsequently, multicenter series as well as randomized controlled trials were reported; however, guidelines for clinical practice were lacking. Methods: The Scottisch Intercollegiate Guidelines Network (SIGN) methodology was used, incorporating these 4 items: systematic reviews using PubMed, Embase, and Cochrane databases to answer clinical questions, whenever possible in PICO style, the GRADE approach for assessment of the quality of evidence, the Delphi method for establishing consensus on the developed recommendations, and the AGREE-II instrument for the assessment of guideline quality and external validation. The current guidelines are cosponsored by the International Hepato-Pancreato-Biliary Association, the Americas Hepato-Pancreato-Biliary Association, the Asian-Pacific Hepato-Pancreato-Biliary Association, the European-African Hepato-Pancreato-Biliary Association, the European Association for Endoscopic Surgery, Pancreas Club, the Society of American Gastrointestinal and Endoscopic Surgery, the Society for Surgery of the Alimentary Tract, and the Society of Surgical Oncology. Results: After screening 16,069 titles, 694 studies were reviewed, and 291 were included. The final 28 recommendations covered 6 topics; laparoscopic and robotic distal pancreatectomy, central pancreatectomy, pancreatoduodenectomy, as well as patient selection, training, learning curve, and minimal annual center volume required to obtain optimal outcomes and patient safety.Conclusion: The IG-MIPR using SIGN methodology give guidance to surgeons, hospital administrators, patients, and medical societies on the use and outcome of MIPR as well as the approach to be taken regarding this challenging type of surgery. © 2019 Wolters Kluwer Health, Inc. All rights reserved.

  • 53.
    Ashley, Thomas
    et al.
    Connaught Hosp, Sierra Leone.
    Ashley, Hannah F.
    Connaught Hosp, Sierra Leone; Upper Eden Med Practice, England.
    Wladis, Andreas
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Center for Disaster Medicine and Traumatology.
    Nordin, Par
    Umea Univ, Sweden.
    Ohene-Yeboah, Michael
    Univ Ghana, Ghana.
    Rukas, Rimantas
    Trondheim Reg & Univ Hosp, Norway.
    Lipnickas, Vytautas
    Vilnius Univ Hosp Santaros Klin, Lithuania.
    Smalle, Isaac O.
    Connaught Hosp, Sierra Leone.
    Holm, Kristina
    Malarsjukhuset, Sweden.
    Kalsi, Herta
    Capio St Gorans Hosp, Sweden.
    Palmu, Juuli
    Orebro Univ Hosp, Sweden.
    Sahr, Foday
    Coll Med & Allied Hlth Sci COMAHS, Sierra Leone; Republ Sierra Leone Armed Forces RSLAF, Sierra Leone.
    Beard, Jessica H.
    Temple Univ, PA USA.
    Loefgren, Jenny
    Karolinska Inst, Sweden.
    Bolkan, Hakon A.
    Trondheim Reg & Univ Hosp, Norway; Norwegian Univ Sci & Technol NTNU, Norway.
    van Duinen, Alex J.
    Trondheim Reg & Univ Hosp, Norway; Norwegian Univ Sci & Technol NTNU, Norway.
    Standardised Competency-Based Training of Medical Doctors and Associate Clinicians in Inguinal Repair with Mesh in Sierra Leone2023In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 47, no 10, p. 2330-2337Article in journal (Refereed)
    Abstract [en]

    IntroductionIn low-income settings, there is a high unmet need for hernia surgery, and most procedures are performed with tissue repair techniques. In preparation for a randomized clinical trial, medical doctors and associate clinicians received a short-course competency-based training on inguinal hernia repair with mesh under local anaesthesia. The aim of this study was to evaluate feasibility, safety and effectiveness of the training.MethodsAll trainees received a one-day theoretical module on mesh hernia repair under local anaesthesia followed by hands-on training. Performance was assessed using the American College of Surgeons Groin Hernia Operative Performance Rating System. Patients were followed up two weeks and one year after surgery. Outcomes of the patients operated on during the training trial were compared to the 229 trial patients operated on after the training.ResultsDuring three surgical camps, seven medical doctors and six associate clinicians were trained. In total, 129 patients were operated on as part of the training. Of the 13 trainees, 11 reached proficiency. Patients in the training group had more wound infections after two weeks (8.5% versus 3.1%; p = 0.041). There was no difference in recurrence and mortality after one year, and none of the deaths were attributed to the surgery.Discussion and conclusionMesh repair is the international standard for inguinal hernia repair worldwide. Nevertheless, this is not widely accessible in low-income settings. This study has demonstrated that short-course intensive hands-on training of MDs and ACs in mesh hernia repair is effective and safe.Trial Registration: International Clinical Trial Registry ISRCTN63478884.

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  • 54.
    Ashley, Thomas
    et al.
    Kamakwie Wesleyan Hosp, Sierra Leone; North Cumbria Univ Hosp, England.
    Ashley, Hannah
    Lakes Med Practice, England.
    Wladis, Andreas
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Center for Disaster Medicine and Traumatology.
    Bolkan, Hakon A.
    Norwegian Univ Sci & Technol, Norway; Univ Trondheim Hosp, Norway.
    van Duinen, Alex J.
    Norwegian Univ Sci & Technol, Norway; Univ Trondheim Hosp, Norway.
    Beard, Jessica H.
    Temple Univ, PA 19122 USA.
    Kalsi, Hertta
    Skane Univ Hosp, Sweden.
    Palmu, Juuli
    Kiruna Hosp, Sweden.
    Nordin, Par
    Umea Univ, Sweden.
    Holm, Kristina
    Malarsjukhuset, Sweden.
    Ohene-Yeboah, Michael
    Univ Ghana, Ghana.
    Lofgren, Jenny
    Karolinska Univ Hosp, Sweden.
    Outcomes After Elective Inguinal Hernia Repair Performed by Associate Clinicians vs Medical Doctors in Sierra Leone A Randomized Clinical Trial2021In: JAMA Network Open, E-ISSN 2574-3805, Vol. 4, no 1, article id e2032681Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE Task sharing of surgical duties with medical doctors (MDs) without formal surgical training and associate clinicians (ACs; health care workers corresponding to an educational level between that of a nurse and an MD) is practiced to provide surgical services to people in low-resource settings. The safety and effectiveness of this has not been fully evaluated through a randomized clinical trial. OBJECTIVE To determine whether task sharing with MDs and ACs is safe and effective in mesh hernia repair in Sierra Leone. DESIGN, SETTING, AND PARTICIPANTS This single-blind, noninferiority randomized clinical trial included adult, healthy men with primary inguinal hernia randomized to receiving surgical treatment from an MD or an AC. In Sierra Leone, ACs practicing surgery have received 2 years of surgical training and completed a 1-year internship. The study was conducted between October 2017 and February 2019. Patients were followed up at 2 weeks and 1 year after operations. Observers were blinded to the study arm of the patients. The study was carried out in a first-level hospital in rural Sierra Leone. Data were analyzed from March to June 2019. INTERVENTIONS All patients received an open mesh inguinal hernia repair under local anesthesia. The control group underwent operations performed by MDs, and the intervention group underwent operations performed by ACs. MAIN OUTCOMES AND MEASURES The primary end point was hernia recurrence at 1 year. Outcomes were assessed by blinded observers at 2 weeks and 1 year after operations. RESULTS A total of 230 patients were recruited (mean [SD] age, 43.0 [13.5] years), and all but 1 patient underwent inguinal hernia repair between October 23, 2017, and February 2, 2018, performed by 5 MDs and 6 ACs. A total of 114 patients were operated on by MDs, and 115 patients were operated on by ACs. There were no crossovers between the study arms. The follow-up rate was 100% at 2 weeks and 94.1% at 1 year. At 1 year, hernia recurrence occurred in 7 patients (6.9%) operated on by MDs and 1 patient (0.9%) operated on by ACs (absolute difference, -6.0 [95% CI, -11.2 to 0.7] percentage points; P < .001). CONCLUSIONS AND RELEVANCE These findings demonstrate that task sharing of elective mesh inguinal hernia repair with ACs was safe and effective. The task sharing debate should progress to focus on optimizing surgical training programs for nonsurgeons and building capacity for elective surgical care in low- and middle-income countries.

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  • 55.
    Atzor, Marie-Christin
    et al.
    Philipps Univ Marburg, Germany.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology.
    von Lersner, Ulrike
    Humboldt Univ, Germany.
    Weise, Cornelia
    Philipps Univ Marburg, Germany.
    Effectiveness of Internet-Based Training on Psychotherapists' Transcultural Competence: A Randomized Controlled Trial2024In: Journal of Cross-Cultural Psychology, ISSN 0022-0221, E-ISSN 1552-5422Article in journal (Refereed)
    Abstract [en]

    Treating culturally diverse patients (CDPs) presents considerable challenges for psychotherapists, including language barriers, differing beliefs, and insecurities. Improving their transcultural competence requires training, but empirical evidence is lacking. This 6-week randomized controlled trial evaluated the impact of standardized internet-based training on psychotherapists' transcultural competence (i.e., awareness, engagement, and handling challenges). Demographic data were collected before training. Transcultural competence was measured at pre-training, post-training, and 3-month follow-up. Training satisfaction was assessed at post-training and follow-up visits. In the guided training group (GTG; n = 83), psychotherapists received hands-on training with practical exercises, weekly knowledge assessments, and online feedback. The second condition comprised a non-guided control group (CG; n = 90) that received only text-based training. Primary analyses on both intent-to-treat (n = 173) and completer analyses (n = 95) indicated significant improvements in transcultural awareness and engagement after 6 weeks of training for both groups. Significant within-group improvements were noted, as evidenced by large Cohen's d effect sizes for both groups. No between-group differences were observed. Qualitative assessments revealed that GTG participants evaluated the training's concept and content significantly more positively than CG participants and felt significantly less insecure about treating CDPs. Such training could pave the way for the long-term development of innovative, culturally sensitive mental health care services that more effectively meet the needs of CDPs.

  • 56.
    Axelsson, Daniel
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Ryhov County Hospital, Sweden.
    Blomberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping. Ryhov County Hospital, Sweden.
    Maternal obesity, obstetric interventions and post-partum anaemia increase the risk of post-partum sepsis: a population-based cohort study based on Swedish medical health registers2017In: Infectious Diseases, ISSN 2374-4235, E-ISSN 2374-4243, Vol. 49, no 10, p. 765-771Article in journal (Refereed)
    Abstract [en]

    Background: The objective was to estimate whether maternal obesity and/or obstetric interventions are associated with diagnosed maternal post-partum sepsis. Methods: A retrospective observational cohort study including all deliveries in Sweden between 1997 and 2012 (N=1,558,752). Cases of sepsis (n=376) were identified by International Classification of Diseases, (ICD-10) codes A40, A41 and O 85 in the Medical Birth Register and the National Patient Register. The reference population was non-infected, and therefore, women with any other infection diagnosis and/or with dispensed antibiotics within eight weeks post-partum were excluded. Information on dispensed drugs was available in the prescribed drug Register. Women with sepsis were compared with non-infected women concerning maternal characteristics and obstetric interventions. Adjusted odds ratios (aOR) were determined using the Mantel-Haenszel technique. Adjustments were made for maternal age, parity and smoking. Results: Obese women (body mass index 30) had a doubled risk of sepsis (3.6/10,000) compared with normal weight women (2.0/10,000) (aOR 1.85 (95%CI: 1.37-2.48)). Induction of labour (aOR 1.44 (95%CI: 1.09-1.91)), caesarean section overall (aOR 3.06 (95%CI: 2.49-3.77)) and elective caesarean section (aOR 2.41 (95%CI: 1.68-3.45)) increased the risk of sepsis compared with normal vaginal delivery. Post-partum anaemia due to acute blood loss was associated with maternal sepsis (aOR 3.40 (95%CI: 2.59-4.47)). Conclusions: Maternal obesity, obstetric interventions and post-partum anaemia due to acute blood loss increased the risk of diagnosed post-partum sepsis indicating that interventions in obstetric care should be considered carefully and anaemia should be treated if resources are available.

  • 57.
    Axelsson, Lars
    et al.
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Holmberg, Erik
    Reg Canc Ctr Western Sweden, Sweden; Univ Gothenburg, Sweden.
    Nyman, Jan
    Univ Gothenburg, Sweden.
    Hogmo, Anders
    Karolinska Univ Hosp, Sweden.
    Sjodin, Helena
    Karolinska Univ Hosp, Sweden.
    Gebre-Medhin, Maria
    Lund Univ Hosp, Sweden.
    von Beckerath, Mathias
    Orebro Univ Hosp, Sweden.
    Ekberg, Tomas
    Uppsala Univ Hosp, Sweden.
    Farnebo, Lovisa
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Sensory Organs and Communication. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology.
    Talani, Charbél
    Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Spak, Lena Norberg
    Norrlands Univ Hosp, Sweden.
    Notstam, Isak
    Cty Hosp Sundsvall Harnosand, Sweden.
    Hammerlid, Eva
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Swedish National Multicenter Study on Head and Neck Cancer of Unknown Primary: Prognostic Factors and Impact of Treatment on Survival2021In: International Archives of Otorhinolaryngology, ISSN 1809-9777, E-ISSN 1809-4864, Vol. 25, no 03, p. e433-e442Article in journal (Refereed)
    Abstract [en]

    Introduction Head and neck cancer of unknown primary (HNCUP) is a rare condition whose prognostic factors that are significant for survival vary between studies. No randomized treatment study has been performed thus far, and the optimal treatment is not established. Objective The present study aimed to explore various prognostic factors and compare the two main treatments for HNCUP: neck dissection and (chemo) radiation vs primary (chemo) radiation. Methods A national multicenter study was performed with data from the Swedish Head and Neck Cancer Register (SweHNCR) and from the patients medical records from 2008 to 2012. Results Two-hundred and sixty HNCUP patients were included. The tumors were HPVpositive in 80%. The overall 5-year survival rate of patients treated with curative intent was 71%. Age (p < 0.001), performance status (p = 0.036), and N stage (p = 0.046) were significant factors for overall survival according to the multivariable analysis. Treatment with neck dissection and (chemo) radiation (122 patients) gave an overall 5-year survival of 73%, and treatment with primary (chemo) radiation (87 patients) gave an overall 5-year survival of 71%, with no significant difference in overall or disease-free survival between the 2 groups. Conclusions Age, performance status, and N stage were significant prognostic factors. Treatment with neck dissection and ( chemo) radiation and primary (chemo)

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  • 58.
    Axelsson, Peter
    et al.
    Univ Gothenburg, Sweden.
    Farnebo, Simon
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Bjorkman, Anders
    Univ Gothenburg, Sweden.
    Hand surgery training in Sweden - bridging the gap between specialities2022In: Journal of Hand Surgery, European Volume, ISSN 1753-1934, E-ISSN 2043-6289, Vol. 47, no 6, p. 669-671Article in journal (Refereed)
    Abstract [en]

    n/a

  • 59.
    Azhar, Najia
    et al.
    Department of Surgery, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.
    Johanssen, Anette
    Department of Digestive Surgery, Akershus University Hospital, Lørenskog, Norway.
    Sundström, Tove
    Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.
    Folkesson, Joakim
    Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Wallon, Conny
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Kørner, Hartvig
    Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
    Blecic, Ljiljana
    Department of Gastrointestinal Surgery, Østfold Hospital, Fredrikstad, Norway.
    Forsmo, Håvard Mjørud
    Department of Gastrointestinal and Emergency Surgery, Haukeland University Hospital, Bergen, Norway.
    Øresland, Tom
    Faculty of Medicine, University of Oslo, Oslo, Norway.
    Yaqub, Sheraz
    Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway.
    Buchwald, Pamela
    Department of Surgery, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.
    Schultz, Johannes Kurt
    Department of Digestive Surgery, Akershus University Hospital, Lørenskog, Norway.
    Laparoscopic Lavage vs Primary Resection for Acute Perforated Diverticulitis: Long-term Outcomes From the Scandinavian Diverticulitis (SCANDIV) Randomized Clinical Trial2021In: JAMA Surgery, ISSN 2168-6254, E-ISSN 2168-6262, Vol. 156, no 2, p. 121-127Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE Perforated colonic diverticulitis usually requires surgical resection, with significant morbidity. Short-term results from randomized clinical trials have indicated that laparoscopic lavage is a feasible alternative to resection. However, it appears that no long-term results are available.

    OBJECTIVE To compare long-term (5-year) outcomes of laparoscopic peritoneal lavage and primary resection as treatments of perforated purulent diverticulitis.

    DESIGN, SETTING, AND PARTICIPANTS This international multicenter randomized clinical trial was conducted in 21 hospitals in Sweden and Norway, which enrolled patients between February 2010 and June 2014. Long-term follow-upwas conducted between March 2018 and November 2019. Patients with symptoms of left-sided acute perforated diverticulitis, indicating urgent surgical need and computed tomography-verified free air, were eligible. Those available for trial intervention (Hinchey stages<iv) were="" included="" in="" the="" long-term="" follow-up.<="" p="" style="box-sizing: border-box; margin: 0px; list-style: none; padding: 0px; font-family: inherit;"></iv)>

    INTERVENTIONS Patients were assigned to undergo laparoscopic peritoneal lavage or colon resection based on computer-generated, center-stratified block randomization.

    MAIN OUTCOMES AND MEASURES The primary outcome was severe complications within 5 years. Secondary outcomes included mortality, secondary operations, recurrences, stomas, functional outcomes, and quality of life.

    RESULTS Of 199 randomized patients, 101were assigned to undergo laparoscopic peritoneal lavage and 98were assigned to colon resection. At the time of surgery, perforated purulent diverticulitiswas confirmed in 145 patients randomized to lavage (n = 74) and resection (n = 71). The median follow-upwas 59 (interquartile range, 51-78; full range, 0-110) months, and 3 patientswere lost to follow-up, leaving a final analysis of 73 patients who had had laparoscopic lavage (mean [SD] age, 66.4 [13] years; 39 men [53%]) and 69 who had received a resection (mean [SD] age, 63.5 [14] years; 36 men [52%]). Severe complications occurred in 36%(n = 26) in the laparoscopic lavage group and 35%(n = 24) in the resection group (P = .92). Overall mortalitywas 32%(n = 23) in the laparoscopic lavage group and 25%(n = 17) in the resection group (P = .36). The stoma prevalencewas 8%(n = 4) in the laparoscopic lavage group vs 33% (n = 17; P =.002) in the resection group among patients who remained alive, and secondary operations, including stoma reversal, were performed in 36%(n = 26) vs 35%(n = 24; P = .92), respectively. Recurrence of diverticulitiswas higher following laparoscopic lavage (21% [n = 15] vs 4%[n = 3]; P = .004). In the laparoscopic lavage group, 30%(n = 21) underwent a sigmoid resection. Therewere no significant differences in the EuroQoL-5Dquestionnaire or Cleveland Global Quality of Life scores between the groups.

    CONCLUSIONS AND RELEVANCE Long-term follow-up showed no differences in severe complications. Recurrence of diverticulitis after laparoscopic lavage was more common, often leading to sigmoid resection. This must be weighed against the lower stoma prevalence in this group. Shared decision-making considering both short-term and long-term consequences is encouraged.

  • 60.
    Backström, Fredrik
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Disaster Medicine and Traumatology.
    Bäckström, Denise
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Sadi, Lin
    Capio St Gorans Hosp, Sweden.
    Andersson, Peter
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Norrköping. Vrinnevi Hosp, Sweden.
    Wladis, Andreas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Capio St Gorans Hosp, Sweden.
    Surgical Needs at the End of the Battle of Mosul: Results from Mosul General HospitalIn: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323Article in journal (Refereed)
    Abstract [en]

    Purpose The aim of the study was to analyze the surgical needs of patients seeking emergency care at the Mosul General Hospital in the final phase of the battle of Mosul in northern Iraq between an international military coalition and rebel forces. During the conflict, the International Red Committee of the Red Cross (ICRC) supported the hospital with staff and resources. Ceasefire in the conflict was declared at the end of July 2017. Methods Routinely collected hospital data from the ICRC-supported Mosul General Hospital from June 6, 2017, to October 1, 2017 were collected and analyzed retrospectively. All patients with weapon-related injuries as well as all patients with other types of injuries or acute surgical illness were included. Results Some 265 patients were admitted during the study period. Non-weapon-related conditions were more common than weapon-related (55.1%). The most common non-weapon-related condition was appendicitis followed by hernia and soft tissue wounds. Blast/fragment was the most frequent weapon-related injury mechanism followed by gunshot. The most commonly injured body regions were chest and abdomen. Children accounted for 35.3% of all weapon-related injuries. Patients presented at the hospital with weapon-related injuries more than 2 months after the official declaration of ceasefire. A majority of the non-weapon-related, as well as the weapon-related conditions, needed surgery (88.1% and 87.6%, respectively). Few postoperative complications were reported. Conclusions The number of children affected by the fighting seems to be higher in this cohort compared to previous reports. Even several months after the fighting officially ceased, patients with weapon-related injuries were presenting. Everyday illnesses or non-weapon-related injuries dominated. This finding underlines the importance of providing victims of conflicts with surgery for life-threatening conditions, whether weapon related or not.

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  • 61.
    Bagge, Roger Olofsson
    et al.
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Mikiver, Rasmus
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Regional Cancer Center.
    Marchetti, Michael A.
    Skagit Reg Hlth, WA USA.
    Lo, Serigne N.
    Univ Sydney, Australia; Univ Sydney, Australia.
    van Akkooi, Alexander C. J.
    Univ Sydney, Australia; Univ Sydney, Australia.
    Coit, Daniel G.
    Mem Sloan Kettering Canc Ctr, NY USA.
    Ingvar, Christian
    Lund Univ, Sweden.
    Isaksson, Karolin
    Lund Univ, Sweden; Kristianstad Hosp, Sweden.
    Scolyer, Richard A.
    Univ Sydney, Australia; Univ Sydney, Australia; Royal Prince Alfred Hosp, Australia; NSW Hlth Pathol, Australia; Univ Sydney, Australia.
    Thompson, John F.
    Univ Sydney, Australia; Univ Sydney, Australia.
    Varey, Alexander H. R.
    Univ Sydney, Australia; Univ Sydney, Australia; Westmead Hosp, Australia.
    Wong, Sandra L.
    Dartmouth Hitchcock Med Ctr, NH USA.
    Lyth, Johan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Forskningsstrategiska enheten.
    Bartlett, Edmund K.
    Mem Sloan Kettering Canc Ctr, NY USA.
    Population-Based Validation of the MIA and MSKCC Tools for Predicting Sentinel Lymph Node Status2024In: JAMA Surgery, ISSN 2168-6254, E-ISSN 2168-6262Article in journal (Refereed)
    Abstract [en]

    Importance Patients with melanoma are selected for sentinel lymph node biopsy (SLNB) based on their risk of a positive SLN. To improve selection, the Memorial Sloan Kettering Cancer Center (MSKCC) and Melanoma Institute Australia (MIA) developed predictive models, but the utility of these models remains to be tested.Objective To determine the clinical utility of the MIA and MSKCC models.Design, Setting, and Participants This was a population-based comparative effectiveness research study including 10 089 consecutive patients with cutaneous melanoma undergoing SLNB from the Swedish Melanoma Registry from January 2007 to December 2021. Data were analyzed from May to August 2023.Main Outcomes and Measures, The predicted probability of SLN positivity was calculated using the MSKCC model and a limited MIA model (using mitotic rate as absent/present instead of count/mm(2) and excluding the optional variable lymphovascular invasion) for each patient. The operating characteristics of the models were assessed and compared. The clinical utility of each model was assessed using decision curve analysis and compared with a strategy of performing SLNB on all patients.Results Among 10 089 included patients, the median (IQR) age was 64.0 (52.0-73.0) years, and 5340 (52.9%) were male. The median Breslow thickness was 1.8 mm, and 1802 patients (17.9%) had a positive SLN. Both models were well calibrated across the full range of predicted probabilities and had similar external area under the receiver operating characteristic curves (AUC; MSKCC: 70.8%; 95% CI, 69.5-72.1 and limited MIA: 69.7%; 95% CI, 68.4-71.1). At a risk threshold of 5%, decision curve analysis indicated no added net benefit for either model compared to performing SLNB for all patients. At risk thresholds of 10% or higher, both models added net benefit compared to SLNB for all patients. The greatest benefit was observed in patients with T2 melanomas using a threshold of 10%; in that setting, the use of the nomograms led to a net reduction of 8 avoidable SLNBs per 100 patients for the MSKCC nomogram and 7 per 100 patients for the limited MIA nomogram compared to a strategy of SLNB for all.Conclusions and Relevance This study confirmed the statistical performance of both the MSKCC and limited MIA models in a large, nationally representative data set. However, decision curve analysis demonstrated that using the models only improved selection for SLNB compared to biopsy in all patients when a risk threshold of at least 7% was used, with the greatest benefit seen for T2 melanomas at a threshold of 10%. Care should be taken when using these nomograms to guide selection for SLNB at the lowest thresholds.

  • 62.
    Balci, Deniz
    et al.
    Bahcesehir Univ, Turkey.
    Nadalin, Silvio
    Univ Hosp Tubingen, Germany.
    Mehrabi, Arianeb
    Heidelberg Univ, Germany.
    Alikhanov, Ruslan
    Moscow Clin Res Ctr Named Loginov AS, Russia.
    Fernandes, Eduardo S. M.
    Univ Federaldo Rio de Janeiro, Brazil.
    Di Benedetto, Fabrizio
    Univ Modena & Reggio Emilia, Italy.
    Hernandez-Alejandro, Roberto
    Univ Rochester, NY USA.
    Björnsson, Bergthor
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Efanov, Mikhail
    Moscow Clin Res Ctr Named Loginov AS, Russia.
    Capobianco, Ivan
    Univ Hosp Tubingen, Germany.
    Clavien, Pierre-Alain
    Univ Hosp Zurich, Switzerland.
    Kirimker, Elvan Onur
    Univ Sch Med Ankara, Turkey.
    Petrowsky, Henrik
    Univ Hosp Zurich, Switzerland.
    Revival of associating liver partition and portal vein ligation for staged hepatectomy for perihilar cholangiocarcinoma: An international multicenter study with promising outcomes2023In: Surgery, ISSN 0039-6060, E-ISSN 1532-7361, Vol. 173, no 6, p. 1398-1404Article in journal (Refereed)
    Abstract [en]

    Background: Associating liver partition and portal vein ligation for staged hepatectomy for per-ihilar cholangiocarcinoma has been considered to be contraindicated due to the initial poor results. Given the recent reports of improved outcomes, we aimed to collect the recent expe-riences of different centers performing associating liver partition and portal vein ligation for staged hepatectomy for perihilar cholangiocarcinoma to analyze factors related to improved outcomes. Methods: This proof-of-concept study collected contemporary cases of associating liver partition and portal vein ligation for staged hepatectomy for perihilar cholangiocarcinoma and analyzed for morbidity, short and long-term survival, and factors associated with outcomes. Results: In total, 39 patients from 8 centers underwent associating liver partition and portal vein ligation for staged hepatectomy for perihilar cholangiocarcinoma from 2010 to 2020. The median preoperative future liver remnant volume was 323 mL (155-460 mL). The median future liver remnant increase was 58.7% (8.9%-264. 5%) with a median interstage interval of 13 days (6-60 days). Post-stage 1 and post-stage 2 biliary leaks occurred in 2 (7.7%) and 4 (15%) patients. Six patients (23%) after stage 1 and 6 (23%) after stage 2 experienced grade 3 or higher complica-tions. Two patients (7.7%) died within 90 days after stage 2. The 1-, 3-, and 5-year survival was 92%, 69%, and 55%, respectively. A subgroup analysis revealed poor survival for patients under-going additional vascular resection and lymph node positivity. Lymph node-negative patients showed excellent survival demonstrated by 1-, 3-, and 5-year survival of 86%, 86%, and 86%. Conclusion: This study highlights that the critical attitude toward associating liver partition and portal vein ligation for staged hepatectomy for perihilar cholangiocarcinoma needs to be revised. In selected patients with perihilar cholangiocarcinoma, associating liver partition and portal vein ligation for staged hepatectomy can achieve favorable survival that compares to the outcome of established surgical treatment strategies reported in benchmark studies for perihilar cholangiocarcinoma including 1-stage hepatectomy and liver transplantation. (c) 2023 Elsevier Inc. All rights reserved.

  • 63.
    Balduzzi, A.
    et al.
    Univ Amsterdam, Netherlands; Univ Verona Hosp Trust, Italy.
    van Hilst, J.
    Univ Amsterdam, Netherlands.
    Korrel, M.
    Univ Amsterdam, Netherlands.
    Lof, S.
    Univ Amsterdam, Netherlands; Univ Hosp Southampton NHS Fdn Trust, England.
    Al-Sarireh, B.
    Morriston Hosp, Wales.
    Alseidi, A.
    Virginia Mason Med Ctr, WA 98101 USA.
    Berrevoet, F.
    Ghent Univ Hosp, Belgium.
    Björnsson, Bergthor
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    van den Boezem, P.
    Radboud Univ Nijmegen, Netherlands.
    Boggi, U.
    Univ Pisa, Italy.
    Busch, O. R.
    Univ Amsterdam, Netherlands.
    Butturini, G.
    Pederzoli Hosp, Italy.
    Casadei, R.
    St Orsola Marcello Malpighi Hosp, Italy.
    van Dam, R.
    Maastricht Univ, Netherlands; Univ Hosp RWTH Aachen, Germany.
    Dokmak, S.
    Hosp Beaujon, France.
    Edwin, B.
    Oslo Univ Hosp, Norway; Inst Clin Med, Norway.
    Sahakyan, M. A.
    Oslo Univ Hosp, Norway; Inst Clin Med, Norway; Yerevan State Med Univ M Heratsi, Armenia.
    Ercolani, G.
    AUSL Romagna Forli, Italy; Univ Bologna, Italy.
    Fabre, J. M.
    Hop St Eloi, France.
    Falconi, M.
    Univ Vita Salute, Italy.
    Forgione, A.
    Osped Niguarda Ca Granda, Italy.
    Gayet, B.
    Inst Mutualiste Montsouris, France.
    Gomez, D.
    Nottingham Univ Hosp NHS Fdn Trust, England.
    Koerkamp, B. Groot
    Erasmus MC, Netherlands.
    Hackert, T.
    Heidelberg Univ Hosp, Germany.
    Keck, T.
    Univ Hosp Schleswig Holstein UKSH, Germany.
    Khatkov, I
    Moscow Clin Sci Ctr, Russia.
    Krautz, C.
    Univ Hosp Erlangen, Germany.
    Marudanayagam, R.
    Univ Hosp Birmingham, England.
    Menon, K.
    Kings Coll Hosp NHS Fdn Trust, England.
    Pietrabissa, A.
    Univ Hosp Pavia, Italy.
    Poves, I
    Hosp del Mar, Spain.
    Cunha, A. Sa
    Hop Paul Brousse, France.
    Salvia, R.
    Univ Verona Hosp Trust, Italy.
    Sanchez-Cabus, S.
    Hosp Clin Barcelona, Spain.
    Soonawalla, Z.
    Oxford Univ Hosp NHS Fdn Trust, England.
    Abu Hilal, M.
    Univ Hosp Southampton NHS Fdn Trust, England; Ist Osped Fdn Poliambulanza, Italy; Southampton Univ, England.
    Besselink, M. G.
    Univ Amsterdam, Netherlands.
    Laparoscopic versus open extended radical left pancreatectomy for pancreatic ductal adenocarcinoma: an international propensity-score matched study2021In: Surgical Endoscopy, ISSN 0930-2794, E-ISSN 1432-2218, Vol. 35, no 12, p. 6949-6959Article in journal (Refereed)
    Abstract [en]

    Background A radical left pancreatectomy in patients with pancreatic ductal adenocarcinoma (PDAC) may require extended, multivisceral resections. The role of a laparoscopic approach in extended radical left pancreatectomy (ERLP) is unclear since comparative studies are lacking. The aim of this study was to compare outcomes after laparoscopic vs open ERLP in patients with PDAC. Methods An international multicenter propensity-score matched study including patients who underwent either laparoscopic or open ERLP (L-ERLP; O-ERLP) for PDAC was performed (2007-2015). The ISGPS definition for extended resection was used. Primary outcomes were overall survival, margin negative rate (R0), and lymph node retrieval. Results Between 2007 and 2015, 320 patients underwent ERLP in 34 centers from 12 countries (65 L-ERLP vs. 255 O-ERLP). After propensity-score matching, 44 L-ERLP could be matched to 44 O-ERLP. In the matched cohort, the conversion rate in L-ERLP group was 35%. The L-ERLP R0 resection rate (matched cohort) was comparable to O-ERLP (67% vs 48%; P = 0.063) but the lymph node yield was lower for L-ERLP than O-ERLP (median 11 vs 19, P = 0.023). L-ERLP was associated with less delayed gastric emptying (0% vs 16%, P = 0.006) and shorter hospital stay (median 9 vs 13 days, P = 0.005), as compared to O-ERLP. Outcomes were comparable for additional organ resections, vascular resections (besides splenic vessels), Clavien-Dindo grade &gt;= III complications, or 90-day mortality (2% vs 2%, P = 0.973). The median overall survival was comparable between both groups (19 vs 20 months, P = 0.571). Conversion did not worsen outcomes in L-ERLP. Conclusion The laparoscopic approach may be used safely in selected patients requiring ERLP for PDAC, since morbidity, mortality, and overall survival seem comparable, as compared to O-ERLP. L-ERLP is associated with a high conversion rate and reduced lymph node yield but also with less delayed gastric emptying and a shorter hospital stay, as compared to O-ERLP.

  • 64.
    Baldvinsdottir, Bryndis
    et al.
    Lund Univ, Sweden.
    Kronvall, Erik
    Lund Univ, Sweden.
    Ronne-Engstrom, Elisabeth
    Uppsala Univ, Sweden.
    Enblad, Per
    Uppsala Univ, Sweden.
    Lindvall, Peter
    Umea Univ, Sweden.
    Aineskog, Helena
    Umea Univ, Sweden.
    Fridriksson, Steen
    Univ Gothenburg, Sweden.
    Klurfan, Paula
    Univ Gothenburg, Sweden.
    Svensson, Mikael
    Karolinska Inst, Sweden.
    Alpkvist, Peter
    Karolinska Inst, Sweden.
    Hillman, Jan
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Neurosurgery.
    Eneling, Johanna
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology.
    Nilsson, Ola G.
    Lund Univ, Sweden.
    Adverse events associated with microsurgial treatment for ruptured intracerebral aneurysms: a prospective nationwide study on subarachnoid haemorrhage in Sweden2023In: Journal of Neurology, Neurosurgery and Psychiatry, ISSN 0022-3050, E-ISSN 1468-330X, Vol. 94, no 7, p. 575-580Article in journal (Refereed)
    Abstract [en]

    BackgroundAdverse events (AEs) or complications may arise secondary to the treatment of aneurysmal subarachnoid haemorrhage (SAH). The aim of this study was to identify AEs associated with microsurgical occlusion of ruptured aneurysms, as well as to analyse their risk factors and impact on functional outcome. MethodsPatients with aneurysmal SAH admitted to the neurosurgical centres in Sweden were prospectively registered during a 3.5-year period (2014-2018). AEs were categorised as intraoperative or postoperative. A range of variables from patient history and SAH characteristics were explored as potential risk factors for an AE. Functional outcome was assessed approximately 1 year after the bleeding using the extended Glasgow Outcome Scale. ResultsIn total, 1037 patients were treated for ruptured aneurysms, of which, 322 patients were treated with microsurgery. There were 105 surgical AEs in 97 patients (30%); 94 were intraoperative AEs in 79 patients (25%). Aneurysm rerupture occurred in 43 patients (13%), temporary occlusion of the parent artery &gt;5 min in 26 patients (8%) and adjacent vessel injury in 25 patients (8%). High Fisher grade and brain oedema on CT were related to increased risk of AEs. At follow-up, 38% of patients had unfavourable outcome. Patients suffering AEs were more likely to have unfavourable outcome (OR 2.3, 95% CI 1.10 to 4.69). ConclusionIntraoperative AEs occurred in 25% of patients treated with microsurgery for ruptured intracerebral aneurysm in this nationwide survey. Although most operated patients had favourable outcome, AEs were associated with increased risk of unfavourable outcome.

  • 65.
    Bang, Peter
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Children's and Women's Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, H.K.H. Kronprinsessan Victorias barn- och ungdomssjukhus.
    Woelfle, Joachim
    Univ Erlangen Nurnberg, Germany.
    Perrot, Valerie
    Ipsen Pharma, France.
    Sert, Caroline
    Ipsen Pharma, France.
    Polak, Michel
    Univ Paris, France.
    Effectiveness and safety of rhIGF1 therapy n patients with or without Laron syndrome2021In: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 184, no 2, p. 267-276Article in journal (Refereed)
    Abstract [en]

    Objective: The European Increlex (R) Growth Forum Database Registry monitors the effectiveness and safety of recombinant human insulin-like growth factor-1 (rhIGF1; mecasermin, Increlex (R)) therapy in patients with severe primary IGF1 deficiency (SPIGFD). We present data from patients with and without a reported genetic diagnosis of Laron syndrome (LS). Design: Ongoing, open-label, observational registry (NCT00903110). Methods: Children and adolescents receiving rhIGF1 therapy from 10 European countries were enrolled in 2008-2017 (n = 242). The treatment-naive/prepubertal (NPP) cohort (n = 138) was divided into subgroups based on reported genetic diagnosis of LS (n = 21) or non-LS (n = 117). Multivariate analysis of the NPP-non-LS subgroup was conducted to identify factors predictive of growth response (first-year-height standard deviation score (SDS) gain &gt;= 0.3). Assessments included change in height and weight over 5 years and adverse events (AEs). Results: Height SDS gain from baseline was greater in the NPP-LS than the NPP-non-LS subgroup after 1 years treatment (P &lt; 0.05). In the NPP-non-LS subgroup, 56% were responders; young age at baseline was a positive independent predictive factor (P &lt; 0.001). NPP-non-LS-responders and the NPP-LS subgroup had a similar mean age (6.07 years vs 7.00 years) at baseline and height SDS gain in year 1 (0.64 vs 0.70), although NPP-non-LS-responders were taller (P &lt; 0.001) at baseline. BMI SDS changes did not differ across subgroups. Treatment-emergent AEs were experienced by 65.3% of patients; hypoglycaemia was most common. Conclusions: In most NPP children with SPIGFD, with or without LS, rhIGF1 therapy promotes linear growth. The safety profile was consistent with previous studies.

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  • 66.
    Bannister, Patricia
    et al.
    Dental School, University of Manchester, Manchester, UK.
    Lindberg, Nina
    Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
    Jeppesen, Karin
    Copenhagen Cleft Palate Center, University Hospital of Copenhagen, Copenhagen, Denmark.
    Elfving-Little, Ulla
    Cleft Palate and Craniofacial Center, Helsinki University Central Hospital, Helsinki, Finland.
    Semmingsen, Ann-Margritt
    Division of Surgery and Clinical Neuroscience, Oslo University Hospital, Oslo, Norway.
    Paganini, Anna
    Department of Plastic Surgery, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Gustavsson, Annica
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Slevin, Emma
    Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland, UK.
    Jacobsen, Gry
    Center for Cleft Lip and Palate, Haukeland University Hospital, Bergen, Norway.
    Eyres, Phil
    Dental School, University of Manchester, Manchester, UK.
    Semb, Gunvor
    Dental School, University of Manchester, Manchester, UK;Department of Plastic and Reconstructive Surgery, Oslo University of Hospital Rikshospitalet and Statped, Sørøst, Hospital Oslo, Norway.
    Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 3. Descriptive study of postoperative nursing care following first stage cleft closure.2017In: Journal of Plastic Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 51, no 1, p. 6p. 21-26Article in journal (Refereed)
    Abstract [en]

    Background:Cleft lip and palate is one of the most common congenital anomalies requiring surgical treatment in children, normally commenced in the first year of life. Following the initiation of a group of multicentre surgical trials of primary surgery, variations in postoperative recovery and management became apparent. An agreement was made for a nurse-led survey in eight surgical centres to document postoperative care and recovery. Materials and methods:A postoperative recovery clinical report form was developed to capture relevant data for the children participating in the four arms of the trials. This included the age and weight at admission, the postoperative recovery setting, pain management, postoperative feeding, post-operative complications, and length of hospital stay. Results:Four hundred and three nursing forms from the first surgical procedure were returned for analysis. Differences in important aspects of care such as postoperative analgesia and postoperative feeding were evident. Postoperative care was influenced by local custom and practice, as little firm clinical evidence exists to guide optimal management. Conclusion:Postoperative recovery may play a significant role in the future selection of surgical protocols, and future trials need to consider cross-study site training to familiarise nurses, prior to any changes in surgical methods. Trial registration:ISRCTN29932826. [ABSTRACT FROM AUTHOR]

  • 67.
    Barmano, Neshro
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Structured management, Symptoms, Health-related Quality of Life and Alcohol in Patients with Atrial Fibrillation2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting at least 2.9 % of the Swedish population. Although AF is associated with increased risk of ischaemic stroke, there have been many reports on the underuse of oral anticoagulants (OAC) and non-adherence to guidelines in other areas as well. AF is also associated with disabling symptoms and decreased health-related quality of life (HRQoL), but some patients are asymptomatic. The reasons for the great variation of symptoms remain unclear. Furthermore, although research on AF has increased, studies have mainly focused on treatment, while studies on risk factors, such as alcohol consumption, have only recently gained attention.

    The aim of this thesis was to investigate whether structured care of patients with AF could improve guideline adherence and HRQoL compared to standard care, and to determine which factors affect symptoms and HRQoL prior to treatment with radiofrequency catheter ablation (RFA), as well as improvement after RFA. Furthermore, we aimed to examine the associations of alcohol consumption with cardiac biomarkers, the size of the left atrium (LA), and re-ablation.

    This thesis is based on two studies. In the ‘Structured Management and Coaching – Patients with Atrial Fibrillation’ (SMaC-PAF) study, 176 patients were recruited to the intervention group, receiving a structured follow-up programme, and 146 patients were recruited to the control group, receiving standard care. The two groups were compared in regard to adherence to guidelines and patient-reported outcome measures (PROMs) assessing symptoms and HRQoL.

    In the ‘Symptom burden, Metabolic profile, Ultrasound findings, Rhythm, neurohormonal activation, haemodynamics and health-related quality of life in patients with atrial Fibrillation’ (SMURF) study, 192 patients referred for their first RFA of AF were included. PROMs questionnaires were filled out, echocardiography was performed, and cardiac biomarkers were analysed. Alcohol consumption was assessed through interview and through analysis of ethyl glucuronide in hair (hEtG). AF recurrence and re-ablation within 12 months were examined.

    In the first study, after one year, 94% (n=112) and 74% (n=87) of patients with indication for OAC in the intervention and the control groups, respectively, actually received treatment with OAC (p <0.01). Both groups improved in anxiety and HRQoL scores over the year, but in the intervention group, arrhythmia-specific symptoms were less frequently experienced and the SF-36 scores were more similar to the norm population.

    In the second study, the most important predictors of arrhythmia-related symptoms and HRQoL prior to RFA were anxiety, depression and low-grade inflammation, while frequent AF attacks prior to RFA, freedom from AF recurrence after RFA, female gender, no enlarged LA, absence of diabetes, and the presence of heart failure were significant predictors of improvement in symptoms and HRQoL after RFA. Men with hEtG ≥7 pg/mg had higher levels of cardiac biomarkers, larger LA volumes and a higher re-ablation rate than men with hEtG <7 pg/mg, while no such findings were present in women.

    In conclusion, structured management was superior to standard care in patients with AF, emphasising the importance of structured care, adjusted to local requirements, in order to improve the care and well-being of patients with AF. Although the reasons for the great variety of symptoms in patients with AF still are not yet fully understood, it seems that psychological factors and inflammation play a role, and that improvement in symptoms and HRQoL after RFA is influenced by gender, diabetes, heart failure, LA size and the frequency of attacks before, as well as freedom from AF after, RFA. Finally, alcohol consumption corresponding to hEtG ≥7 pg/mg was associated with higher levels of cardiac biomarkers, larger LA size and a higher rate of re-ablation in men, implying that men with an hEtG-value ≥7 pg/mg have a higher risk for LA remodelling that could potentially lead to a deterioration of the AF situation.

    List of papers
    1. Structured care of patients with atrial fibrillation improves guideline adherence
    Open this publication in new window or tab >>Structured care of patients with atrial fibrillation improves guideline adherence
    2016 (English)In: Journal of Atrial Fibrillation, ISSN 1941-6911, Vol. 9, no 4Article in journal (Refereed) Published
    Abstract [en]

    There are many reports of lack of guideline adherence in the treatment of patients with atrial fibrillation (AF), and AF affects health-related quality of life (HRQoL) negatively. The aim of this study was to investigate whether structured care compared to standard care of a general AF population could improve guideline adherence and HRQoL, and reduce symptoms,anxiety and depression.

    Methods

    In total, 176 patients were recruited to the intervention and 146 patients to the control group.The intervention consisted of a structured follow-up program, while patients serving as controls received standard care. The primary outcome was guideline adherence evaluated through: appropriate use of oral anticoagulants (OAC) and antiarrhythmics, whether echocardiogram and thyroid lab tests were performed, and patient-reported outcome measures (PROMs), assessed with the questionnaires SF-36, EQ-5D, HADS and ASTA at baseline and after one year.

    Results

    Guideline adherence was significantly better in the intervention group, 91% vs. 63% (p < 0.01), mainly due to appropriate OAC treatment 94% vs. 74% (p < 0.01). Symptoms assessed with ASTA were less frequent and the negative impact of AF was reduced in the intervention group after one year/ at follow-up. Five scales in SF-36, and the visual analogue scale for current health status in EQ-5D (EQ-VAS), improved significantly in both groups.

    Conclusion

    Structured care of patients with AF significantly improved guideline adherence and patients reported fewer symptoms and a reduced negative impact on disease-specific HRQoL compared to standard care at one year follow-up.

    Place, publisher, year, edition, pages
    Overland Park, KS, United States: CardioFront LLC, 2016
    Keywords
    Atrial fibrillation, Guideline Adherence, Anticoagulants, Health-related Quality of life, Symptoms, Anxiety.
    National Category
    Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-157019 (URN)10.4022/jafib.1498 (DOI)
    Available from: 2019-05-23 Created: 2019-05-23 Last updated: 2019-06-12Bibliographically approved
    2. Factors Predicting Arrhythmia-Related Symptoms and Health-Related Quality of Life in Patients Referred for Radiofrequency Ablation of Atrial Fibrillation: An Observational Study (the SMURF Study)
    Open this publication in new window or tab >>Factors Predicting Arrhythmia-Related Symptoms and Health-Related Quality of Life in Patients Referred for Radiofrequency Ablation of Atrial Fibrillation: An Observational Study (the SMURF Study)
    2017 (English)In: JACC: Clinical Electrophysiology, ISSN 2405-500X, E-ISSN 2405-5018, Vol. 3, no 5, p. 9p. 497-502Article in journal (Refereed) Published
    Abstract [en]

    Conclusions Anxiety, depression, and low-grade inflammation were the factors that predicted both arrhythmia-related symptoms and HRQoL in patients with AF. Obesity was the most significant predictor of patient general physical status. These factors need to be addressed in patients with AF to improve management of their disease. Intensive risk factor modification can be of great importance. (Reasons for Variations in Health Related Quality of Life and Symptom Burden in Patients With Atrial Fibrillation [SMURF]; NCT01553045)

    Place, publisher, year, edition, pages
    Elsevier, 2017. p. 9
    Keywords
    anxiety; arrhythmia-related symptoms; atrial fibrillation; health-related quality of life; obesity
    National Category
    Cardiac and Cardiovascular Systems
    Identifiers
    urn:nbn:se:liu:diva-145630 (URN)10.1016/j.jacep.2016.12.004 (DOI)
    Available from: 2018-03-09 Created: 2018-03-09 Last updated: 2024-02-23
    3. The association between alcohol consumption, cardiac biomarkers, left atrial size and re-ablation in patients with atrial fibrillation referred for catheter ablation
    Open this publication in new window or tab >>The association between alcohol consumption, cardiac biomarkers, left atrial size and re-ablation in patients with atrial fibrillation referred for catheter ablation
    Show others...
    2019 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 14, no 4, article id e0215121Article in journal (Refereed) Published
    Abstract [en]

    Background

    Information on alcohol consumption in patients undergoing radiofrequency ablation (RFA) of atrial fibrillation (AF) is often limited by the reliance on self-reports. The aim of this study was to describe the long-term alcohol consumption, measured as ethyl glucuronide in hair (hEtG), in patients undergoing RFA due to AF, and to examine potential associations with cardiac biomarkers, left atrial size and re-ablation within one year after the initial RFA.

    Methods

    The amount of hEtG was measured in patients referred for RFA, and a cut-off of 7 pg/mg was used. N-terminal pro B-type natriuretic peptide (NT-proBNP) and the mid-regional fragment of pro atrial natriuretic peptide (MR-proANP) were examined and maximum left atrium volume index (LAVI) was measured. The number of re-ablations was examined up to one year after the initial RFA. Analyses were stratified by gender, and adjusted for age, systolic blood pressure, body mass index, presence of heart failure and heart rhythm for analyses regarding NT-proBNP, MR-proANP and LAVI and heart rhythm being replaced by type of AF for analyses regarding re-ablation.

    Results

    In total, 192 patients were included in the study. Median (25th– 75th percentile) NT-proBNP in men with hEtG ≥ 7 vs. < 7 pg/mg was 250 (96–695) vs. 130 (49–346) pg/ml (p = 0.010), and in women it was 230 (125–480) vs. 230 (125–910) pg/ml (p = 0.810). Median MR-proANP in men with hEtG ≥ 7 vs. < 7 pg/mg was 142 (100–224) vs. 117 (83–179) pmol/l (p = 0.120) and in women it was 139 (112–206) vs. 153 (93–249) pmol/l (p = 0.965). The median of maximum LAVI was 30.1 (26.7–33.9) vs. 25.8 (21.4–32.0) ml/m2 (p = 0.017) in men, and 25.0 (18.9–29.6) vs. 25.7 (21.7–34.6) ml/m2 (p = 0.438) in women, with hEtG ≥ 7 vs. < 7 pg/ml, respectively. Adjusted analyses showed similar results, except for MR-proANP turning out significant in men with hEtG ≥ 7 vs. < 7 pg/mg (p = 0.047). The odds ratio of having a re-ablation was 3.5 (95% CI 1.3–9.6, p = 0.017) in men with hEtG ≥ 7 vs. < 7 pg/mg, while there was no significant difference in women.

    Conclusions

    In male patients with AF and hEtG ≥ 7 pg/mg, NT-proBNP and MR-proANP were higher, LA volumes larger, and there was a higher rate of re-ablations, as compared to men with hEtG < 7 pg/mg. This implies that men with an alcohol consumption corresponding to an hEtG-value ≥ 7, have a higher risk for LA remodelling that could potentially lead to a deterioration of the AF situation.

    Place, publisher, year, edition, pages
    San Francisco, CA, United States: Public Library of Science, 2019
    National Category
    Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-157020 (URN)10.1371/journal.pone.0215121 (DOI)000463992600055 ()30970005 (PubMedID)2-s2.0-85064164504 (Scopus ID)
    Note

    Funding agencies: County Council of Ostergotland [LIO-280731, LIO-445511]; Carldavid Jonsson Research Foundation; Linkoping University; Biosense Webster; Johnson Johnson; Heart Foundation

    Available from: 2019-05-23 Created: 2019-05-23 Last updated: 2021-06-14Bibliographically approved
    4. Predictors of improvement in arrhythmia-specific symptoms and health-related quality of life after catheter ablation of atrial fibrillation
    Open this publication in new window or tab >>Predictors of improvement in arrhythmia-specific symptoms and health-related quality of life after catheter ablation of atrial fibrillation
    Show others...
    2019 (English)In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 42, no 2, p. 247-255Article in journal (Refereed) Published
    Abstract [en]

    Background The primary goal of radiofrequency ablation (RFA) of atrial fibrillation (AF) is to improve symptoms and health-related quality of life (HRQoL). However, most studies have focused on predictors of AF recurrence rather than on predictors of improvement in symptoms and HRQoL. Hypothesis We sought to explore predictors of improvement in arrhythmia-specific symptoms and HRQoL after RFA of AF, and to evaluate the effects on symptoms, HRQoL, anxiety, and depression. Methods We studied 192 patients undergoing their first RFA of AF. The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), arrhythmia-specific questionnaire in tachycardia and arrhythmia (ASTA), and hospital anxiety and depression scale (HADS) questionnaires were filled out at baseline, at 4 months, and at a 1-year follow-up. Results All questionnaire scale scores improved significantly over time. In the ASTA symptom scale score, female gender and amp;gt; 10 AF episodes the month before RFA were significant positive predictors of improvement, while diabetes and AF recurrence within 12 months after RFA were significant negative predictors (R-2 = 0.18; P amp;lt; 0.001). In the ASTA HRQoL scale score, the presence of heart failure and amp;gt; 10 AF episodes the month before RFA were significant positive predictors of improvement, while diabetes, maximum left atrial volume and AF recurrence were significant negative predictors (R-2 = 0.20; P amp;lt; 0.001). Conclusion Left atrial volume, gender, diabetes, heart failure, the frequency of AF attacks prior to RFA, and recurrence of AF after RFA were significant factors affecting improvement in symptoms and HRQoL after RFA of AF. Future studies are warranted to confirm these findings.

    Place, publisher, year, edition, pages
    WILEY, 2019
    Keywords
    atrial fibrillation; catheter ablation; health-related quality of life; symptom burden
    National Category
    Cardiac and Cardiovascular Systems
    Identifiers
    urn:nbn:se:liu:diva-154666 (URN)10.1002/clc.23134 (DOI)000458424300006 ()30548275 (PubMedID)
    Note

    Funding Agencies|Biosense Webster; Carldavid Jonsson Research Foundation; County Council of Ostergotland [LIO-280731LIO-445511]; Heart Foundation, Linkoping University

    Available from: 2019-03-04 Created: 2019-03-04 Last updated: 2022-11-17
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    Structured management, Symptoms, Health-related Quality of Life and Alcohol in Patients with Atrial Fibrillation
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  • 68.
    Bartek, Jiri Jr.
    et al.
    Copenhagen Univ Hosp, Denmark; Karolinska Univ Hosp, Sweden.
    Laugesen, Christian
    Copenhagen Univ Hosp, Denmark.
    Mirza, Sadia
    Karolinska Univ Hosp, Sweden.
    Forsse, Axel
    Odense Univ Hosp, Denmark.
    Petersen, Michael Anders
    Odense Univ Hosp, Denmark.
    Corell, Alba
    Sahlgrens Univ Hosp, Sweden.
    Dyhrfort, Philip Wilhelm
    Uppsala Univ Hosp, Sweden.
    Redebrandt, Henrietta Nittby
    Lund Univ Hosp, Sweden.
    Reen, Linus
    Lund Univ Hosp, Sweden.
    Zolfaghari, Shaian
    Lund Univ Hosp, Sweden.
    Tobieson, Lovisa
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Neurosurgery.
    Carlsvärd, Björn
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Neurosurgery.
    Bergholt, Bo
    Arhus Univ Hosp, Denmark.
    Bashir, Asma
    Arhus Univ Hosp, Denmark.
    Soerensen, Preben
    Alborg Univ Hosp, Denmark.
    Bilgin, Arzu
    Alborg Univ Hosp, Denmark.
    Johansson, Conny
    Umea Univ Hosp, Sweden.
    Lindvall, Peter
    Umea Univ Hosp, Sweden.
    Forander, Petter
    Uppsala Univ Hosp, Sweden.
    Bellander, Bo-Michael
    Karolinska Univ Hosp, Sweden.
    Springborg, Jacob B.
    Copenhagen Univ Hosp, Denmark.
    Jakola, Asgeir S.
    Sahlgrens Univ Hosp, Sweden; Sahlgrens Acad, Sweden.
    Scandinavian Multicenter Acute Subdural Hematoma (SMASH) Study: Study Protocol for a Multinational Population-Based Consecutive Cohort2019In: Neurosurgery, ISSN 0148-396X, E-ISSN 1524-4040, Vol. 84, no 3, p. 799-803Article in journal (Refereed)
    Abstract [en]

    BACKGROUND Traumatic acute subdural hematomas (ASDHs) are associated with high rate of morbidity and mortality, especially in elderly individuals. However, recent reports indicate that the morbidity and mortality rates might have improved. OBJECTIVE To evaluate postoperative (30-d) mortality in younger vs elderly (70 yr) patients with ASDH. Comparing younger and elderly patients, the secondary objectives are morbidity patterns of care and 6 mo outcome according to Glasgow outcome scale (GOS). Finally, in patients with traumatic ASDH, we aim to provide prognostic variables. METHODS This is a large-scale population-based Scandinavian study including all neurosurgical departments in Denmark and Sweden. All adult (18 yr) patients surgically treated between 2010 and 2014 for a traumatic ASDH in Denmark and Sweden will be included. Identification at clinicaltrials.gov is NCT03284190. EXPECTED OUTCOMES We expect to provide data on potential differences between younger vs elderly patients in terms of mortality and morbidity. We hypothesize that elderly patients selected for surgery have a similar pattern of care as compared with younger patients. We will provide functional outcome in terms of GOS at 6 mo in younger vs elderly patients undergoing ASDH evacuation. Finally, clinical useful prognostic factors for favorable (GOS 4-5) vs unfavorable (GOS 1-3) will be identified. DISCUSSION An improved understanding of the clinical outcome, treatment and resource allocation, clinical course, and the prognostic factors of traumatic ASDH will allow neurosurgeons to make better treatment decisions.

  • 69.
    Barth, Cornelia Anne
    et al.
    Cochrane Switzerland, Unisanté, Route de la Corniche 10, CH-1010, Lausanne, Switzerland.
    Wladis, Andreas
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Region Östergötland, Regionledningskontoret, Center for Disaster Medicine and Traumatology.
    Roy, Nobhojit
    The George Institute of Global Health, New Delhi, India.
    Blake, Catherine
    School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
    Muhammad Kolo, Sanda
    International Committee of the Red Cross, Maiduguri, Nigeria.
    O'Sullivan, Cliona
    School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
    Ways to improve surgical outcomes in low- and middle-income countries2022In: Bulletin of the World Health Organization, ISSN 0042-9686, E-ISSN 1564-0604, Vol. 100, no 11, p. 726-732Article in journal (Refereed)
    Abstract [en]

    Global surgery initiatives such as the Lancet Commission on Global Surgery have highlighted the need for increased investment to enhance surgical capacity in low- and middle-income countries. A neglected issue, however, is surgery-related rehabilitation, which is known to optimize functional outcomes after surgery. Increased investment to enhance surgical capacity therefore needs to be complemented by promotion of rehabilitation interventions. We make the case for strengthening surgery-related rehabilitation in lower-resource countries, outlining the challenges but also potential solutions and policy directions. Proposed solutions include greater leadership and awareness, augmented by recent global efforts around the World Health Organization's Rehabilitation 2030 initiative, and professionalization of the rehabilitation workforce. More research on rehabilitation is needed in low- and middle-income countries, along with support for system approaches, notably on strengthening and integrating rehabilitation within the health systems. Finally, we outline a set of policy implications and recommendations, aligned to the components of the national surgical plan proposed by the Lancet Commission: infrastructure, workforce, service delivery, financing, and information management. Collaboration and sustained efforts to embed rehabilitation within national surgical plans is key to optimize health outcomes for patients with surgical conditions and ensure progress towards sustainable development goal 3: health and well-being for all.

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  • 70.
    Bartha, Erzsebet
    et al.
    Karolinska Univ Hosp, Sweden.
    Ahlstrand, Rebecca
    Orebro Univ, Sweden.
    Bell, Max
    Karolinska Univ Hosp, Sweden.
    Björne, Håkan
    Karolinska Univ Hosp, Sweden.
    Brattström, Olof
    Karolinska Univ Hosp, Sweden.
    Helleberg, Johan
    Karolinska Univ Hosp, Sweden.
    Nilsson, Lena
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US.
    Semenas, Egidijus
    Uppsala Univ Hosp, Sweden.
    Kalman, Sigridur
    Karolinska Univ Hosp, Sweden.
    ASA classification and surgical severity grading used to identify a high-risk population, a multicenter prospective cohort study in Swedish tertiary hospitals2021In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 65, no 9, p. 1168-1177Article in journal (Refereed)
    Abstract [en]

    Background Identification of surgical populations at high risk for negative outcomes is needed for clinical and research purposes. We hypothesized that combining two classification systems, ASA (American Society of Anesthesiology physical status) and surgical severity, we could identify a high-risk population before surgery. We aimed to describe postoperative outcomes in a population selected by these two classifications system. Methods Data were collected in a Swedish multicentre, time-interrupted prospective, consecutive cohort study. Eligibility criteria were age &gt;= 18 years, ASA &gt;= 3, elective or emergent, major to Xmajor/complex (Specialist Procedure Codes used in United Kingdom), gastrointestinal, urogenital or orthopaedic procedures. Postoperative morbidity was identified by the Postoperative Morbidity Survey on postoperative days 3 +/- 1, 7 +/- 1, 10 + 5 and graded for severity by the Clavien-Dindo system. Mortality was assessed at 30, 180 and 360 days. Results Postoperative morbidity was 78/48/47 per cent on postoperative days 3/7/10. Majority of morbidities (67.5 per cent) were graded as &gt;1 by Clavien-Dindo. Any type of postoperative morbidity graded &gt;1 was associated with increased risk for death up to one year. The mortality was 5.7 per cent (61/1063) at 30 days, 13.3 per cent (142/1063) at 6 months and 19.1 per cent (160/1063) at 12 months. Conclusion Severity classification as major to Xmajor/complex and ASA &gt;= 3 could be used to identify a high-risk surgical population concerning postoperative morbidity and mortality before surgery. Combining the two systems future electronic data extraction is possible of a high-risk population in tertiary hospitals.

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  • 71.
    Baubeta Fridh, Erik
    et al.
    Ryhov Cty Hosp, Sweden; Gothenburg Univ, Sweden.
    Andersson, Manne
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Ryhov Cty Hosp, Sweden.
    Thuresson, Marcus
    Statisticon AB, Sweden.
    Nordanstig, Joakim
    Gothenburg Univ, Sweden.
    Falkenberg, Marten
    Gothenburg Univ, Sweden.
    Impact of Preoperative Symptoms and Revascularized Arterial Segment in Patients With Chronic Limb-Threatening Ischemia2019In: Vascular and Endovascular Surgery, ISSN 1538-5744, E-ISSN 1938-9116, Vol. 53, no 5, p. 365-372Article in journal (Refereed)
    Abstract [en]

    Background: Little is known about the relative impact of the preoperative symptoms rest pain and tissue loss, and of the arterial segment revascularized, on amputation rate and mortality in patients with chronic limb-threatening ischemia (CLTI). We wanted to investigate this topic further. Method: This population-based observational cohort study involved 10 419 patients revascularized for CLTI in Sweden, 2008 to 2013. Data were collected from health-care registries and medical records. The effect of preoperative symptoms and revascularized arteries was determined using Cox regression models. A competing risk analysis was used to determine the effect of symptoms on the combined endpoint "amputation or death". Results: The amputation rate during a mean follow-up of 2 years was 7.5% in patients with rest pain, 15.6% in patients with tissue loss only, and 20.1% when both symptoms were present. Mortality was 39% lower in patients with rest pain only than in those with both symptoms. Revascularizations targeted the aortoiliac, femoropopliteal, and infrapopliteal segments in 19.4%, 76.8%, and 30.6%, respectively. Distal revascularizations were associated with a higher amputation rate, but this difference disappeared after adjustment for comorbidities. Aortoiliac revascularizations were associated with high mortality. Competing risk analysis showed that mortality became the major determinant of amputation-free survival outcomes from 1 year after revascularization. Conclusions: Tissue loss implies a clearly worse prognosis compared to rest pain for patients with CLTI. Most revascularizations for CLTI are done in the femoropopliteal segment. Infrapopliteal procedures are associated with a higher amputation rate, whereas aortoiliac revascularizations are associated with higher mortality.

  • 72.
    Baumgartner, Ruth
    et al.
    Karolinska Inst, Sweden.
    Gilg, Stefan
    Karolinska Inst, Sweden.
    Björnsson, Bergthor
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Hasselgren, Kristina
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Ghorbani, Poya
    Karolinska Inst, Sweden.
    Sauter, Christina
    Karolinska Inst, Sweden.
    Stål, Per
    Karolinska Inst, Sweden.
    Sandström, Per
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Sparrelid, Ernesto
    Karolinska Inst, Sweden.
    Engstrand, Jennie
    Karolinska Inst, Sweden.
    Impact of post-hepatectomy liver failure on morbidity and short- and long-term survival after major hepatectomy2022In: BJS Open, E-ISSN 2474-9842, Vol. 6, no 4, article id zrac097Article in journal (Refereed)
    Abstract [en]

    Background Post-hepatectomy liver failure (PHLF) is one of the most serious postoperative complications after hepatectomy. The aim of this study was to assess the impact of the International Study Group of Liver Surgery (ISGLS) definition of PHLF on morbidity and short- and long-term survival after major hepatectomy. Methods This was a retrospective review of all patients who underwent major hepatectomy (three or more liver segments) for various liver tumours between 2010 and 2018 at two Swedish tertiary centres for hepatopancreatobiliary surgery. Descriptive statistics, regression models, and survival analyses were used. Results A total of 799 patients underwent major hepatectomy, of which 218 patients (27 per cent) developed ISGLS-defined PHLF, including 115 patients (14 per cent) with ISGLS grade A, 76 patients (10 per cent) with grade B, and 27 patients (3 per cent) with grade C. The presence of cirrhosis, perihilar cholangiocarcinoma, and gallbladder cancer, right-sided hemihepatectomy and trisectionectomy all significantly increased the risk of clinically relevant PHLF (grades B and C). Clinically relevant PHLF increased the risk of 90-day mortality and was associated with impaired long-term survival. ISGLS grade A had more major postoperative complications compared with no PHLF but failed to be an independent predictor of both 90-day mortality and long-term survival. The impact of PHLF grade B/C on long-term survival was no longer present in patients surviving the first 90 days after surgery. Conclusions The presently used ISGLS definition for PHLF should be reconsidered regarding mortality as only PHLF grade B/C was associated with a negative impact on short-term survival; however, even ISGLS grade A had clinical implications. The aim was to assess the ISGLS criteria for post-hepatectomy liver failure (PHLF) in a cohort of patients with major hepatectomy. The presently used ISGLS definition for PHLF should be reconsidered regarding mortality as only PHLF grade B/C was associated with a negative impact on short-term survival.

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  • 73.
    Beard, Jessica H.
    et al.
    Temple Univ, PA 19140 USA.
    Ohene-Yeboah, Michael
    Univ Ghana, Ghana.
    Tabiri, Stephen
    Univ Dev Studies, Ghana.
    Amoako, Joachim K. A.
    Univ Ghana, Ghana.
    Abantanga, Francis A.
    Univ Dev Studies, Ghana.
    Sims, Carrie A.
    Univ Penn, PA 19104 USA.
    Nordin, Paer
    Umea Univ, Sweden.
    Wladis, Andreas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Disaster Medicine and Traumatology.
    Harris, Hobart W.
    Univ Calif San Francisco, CA 94143 USA.
    Lofgren, Jenny
    Karolinska Inst, Sweden.
    Outcomes After Inguinal Hernia Repair With Mesh Performed by Medical Doctors and Surgeons in Ghana2019In: JAMA Surgery, ISSN 2168-6254, E-ISSN 2168-6262, Vol. 154, no 9, p. 853-859Article in journal (Refereed)
    Abstract [en]

    Key PointsQuestionWhat are the outcomes after mesh inguinal hernia repair performed by medical doctors compared with surgeons in Ghana? FindingsIn this cohort study of 242 men with primary reducible inguinal hernia, there was no significant difference in hernia recurrence at 1 year after inguinal hernia repair with mesh performed by medical doctors compared with surgeons (0.9% vs 2.8%). MeaningThis study shows that medical doctors can be trained to perform inguinal hernia repair with mesh in men with good results in a low-resource setting and appears to support surgical task sharing to combat the global burden of hernia disease. ImportanceInguinal hernia is the most common general surgical condition in the world. Although task sharing of surgical care with nonsurgeons represents one method to increase access to essential surgery, the safety and outcomes of this strategy are not well described for hernia repair. ObjectiveTo compare outcomes after inguinal hernia repair with mesh performed by medical doctors and surgeons in Ghana. Design, Setting, and ParticipantsThis prospective cohort study was conducted from February 15, 2017, to September 17, 2018, at the Volta Regional Hospital in Ho, Ghana. Following successful completion of a training course, 3 medical doctors and 2 surgeons performed inguinal hernia repair with mesh according to the Lichtenstein technique on 242 men with primary, reducible inguinal hernia. Main Outcomes and MeasuresThe primary end point was hernia recurrence at 1 year. The noninferiority limit was set at 5 percentage points. Secondary end points included postoperative complications at 2 weeks and patient satisfaction, pain, and self-assessed health status at 1 year. ResultsTwo-hundred forty-two patients were included; 119 men underwent operations performed by medical doctors and 123 men underwent operations performed by surgeons. Preoperative patient characteristics were similar in both groups. Two-hundred thirty-seven patients (97.9%) were seen at follow-up at 2 weeks, and 223 patients (92.1%) were seen at follow-up at 1 year. The absolute difference in recurrence rate between the medical doctor group (1 [0.9%]) and the surgeon group (3 [2.8%]) was -1.9 (1-tailed 95% CI, -4.8; Pamp;lt;.001), demonstrating noninferiority of the medical doctors. There were no statistically significant differences in postoperative complications (34 [29.1%] vs 29 [24.2%]), patient satisfaction (112 [98.2%] vs 108 [99.1%]), severe chronic pain (1 [0.9%] vs 4 [3.7%]), or self-assessed health (85.9 vs 83.7 of 100) for medical doctors and surgeons. Conclusions and RelevanceThis study shows that medical doctors can be trained to perform elective inguinal hernia repair with mesh in men with good results and high patient satisfaction in a low-resource setting. This finding supports surgical task sharing to combat the global burden of hernia disease. This cohort study compares the outcomes associated with inguinal hernia repair performed by medical doctors vs surgeons in Ghana.

  • 74.
    Bebbington, Emily
    et al.
    Bangor Univ, Wales.
    Miles, Joanna
    Norfolk & Norwich Univ Hosp, England.
    Young, Amber
    Bristol Ctr Surg Res, England.
    van Baar, Margriet E.
    Maasstad Hosp, Netherlands.
    Bernal, Nicole
    Ohio State Univ, OH 43210 USA; Amer Burn Assoc, IL USA.
    Brekke, Ragnvald Ljones
    Haukeland Hosp, Norway.
    van Dammen, Lotte
    Dutch Burns Fdn, Netherlands.
    Elmasry, Moustafa
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Inoue, Yoshiaki
    Lambdax Bldg, Japan.
    McMullen, Kara A.
    Univ Washington, WA USA.
    Paton, Lia
    NHS Natl Serv Scotland, Scotland.
    Thamm, Oliver C.
    German Soc Burn Treatment DGV, Germany; Univ Witten Herdecke, Germany.
    Tracy, Lincoln M.
    Monash Univ, Australia.
    Zia, Nukhba
    Johns Hopkins Bloomberg Sch Publ Hlth, MD 21205 USA.
    Singer, Yvonne
    Griffith Univ, Australia.
    Dunn, Ken
    Burn Care Informat Grp NHS, England.
    Exploring the similarities and differences of burn registers globally: Results from a data dictionary comparison study2024In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 50, no 4, p. 850-865Article in journal (Refereed)
    Abstract [en]

    Introduction: Pooling and comparing data from the existing global network of burn registers represents a powerful, yet untapped, opportunity to improve burn prevention and care. There have been no studies investigating whether registers are sufficiently similar to allow data comparisons. It is also not known what differences exist that could bias analyses. Understanding this information is essential prior to any future data sharing. The aim of this project was to compare the variables collected in countrywide and intercountry burn registers to understand their similarities and differences. Methods: Register custodians were invited to participate and share their data dictionaries. Inclusion and exclusion criteria were compared to understand each register population. Descriptive statistics were calculated for the number of unique variables. Variables were classified into themes. Definition, method, timing of measurement, and response options were compared for a sample of register concepts. Results: 13 burn registries participated in the study. Inclusion criteria varied between registers. Median number of variables per register was 94 (range 28 - 890), of which 24% (range 4.8 - 100%) were required to be collected. Six themes (patient information, admission details, injury, inpatient, outpatient, other) and 41 subthemes were identified. Register concepts of age and timing of injury show similarities in data collection. Intent, mechanism, inhalational injury, infection, and patient death show greater variation in measurement. Conclusions: We found some commonalities between registers and some differences. Commonalities would assist in any future efforts to pool and compare data between registers. Differences between registers could introduce selection and measurement bias, which needs to be addressed in any strategy aiming to facilitate burn register data sharing. We recommend the development of common data elements used in an international minimum data set for burn injuries, including standard definitions and methods of measurement, as the next step in achieving burn register data sharing. (c) 2024 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

  • 75.
    Bednarska, Olga
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Gastroentorology.
    Peripheral and Central Mechanisms in Irritable Bowel Syndrome: in search of links2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Irritable bowel syndrome (IBS) is a chronic visceral pain disorder with female predominance, characterized by recurrent abdominal pain and disturbed bowel habits in the absence of an identifiable organic cause. This prevalent and debilitating disease, which accounts for a substantial economic and individual burden, lacks exact diagnostic tools and effective treatment, since its pathophysiology remains uncertain. The bidirectional and multilayered brain-gut axis is a well-established disease model, however, the interactions between central and peripheral mechanisms along the brain-gut axis remain incompletely understood. One of the welldescribed triggering factors, yet accounting for only a fraction of IBS prevalence, is bacterial gastroenteritis that affects mucosal barrier function. Altered gut microbiota composition as well as disturbed intestinal mucosal barrier function and its neuroimmune regulation have been reported in IBS, however, the impact of live bacteria, neither commensal nor pathogenic, on intestinal barrier has not been studied yet. Furthermore, abnormal central processing of visceral sensations and psychological factors such as maladaptive coping have previously been suggested as centrally-mediated pathophysiological mechanisms of importance in IBS. Brain imaging studies have demonstrated an imbalance in descending pain modulatory networks and alterations in brain regions associated with interoceptive awareness and pain processing and modulation, particularly in anterior insula (aINS), although biochemical changes putatively underlying these central alterations remain poorly understood. Most importantly, however, possible associations between these documented changes on central and peripheral levels, which may as complex interactions contribute to disease onset and chronification of symptoms, are widely unknown.

    This thesis aimed to investigate the peripheral and central mechanisms in women with IBS compared to female healthy controls (HC) and to explore possible mutual associations between these mechanisms.

    In Paper I, we studied paracellular permeability and passage of live bacteria, both commensal and pathogenic through colonic biopsies mounted in Ussing chambers. We explored the regulation of the mucosal barrier function by mast cells and the neuropeptide vasoactive intestinal polypeptide (VIP) as well as a correlation between mucosal permeability and gastrointestinal and psychological symptoms. We observed increased paracellular permeability and the passage of commensal and pathogenic live bacteria in patients with IBS compared with HC, which was diminished by blocking the VIP receptors as well as after stabilizing mast cells in both groups. Moreover, higher paracellular permeability was associated with less somatic and psychological symptoms in patients.

    In Paper II, we aimed to determine the association between colonic mucosa paracellular permeability and structural and resting state functional brain connectivity. We demonstrated different patterns of associations between mucosa permeability and functional and structural brain connectivity in IBS patients compared to HC. Specifically, lower paracellular permeability in IBS, similar to the levels detected in HC, was associated with more severe IBS symptoms and increased functional and structural connectivity between intrinsic brain resting state network and descending pain modulation brain regions. Our findings further suggested that this association between mucosa permeability and functional brain connectivity was mainly mediated by coping strategies.

    In Paper III, we investigated putative alterations in excitatory and inhibitory neurotransmission of aINS, as the brain’s key node of the salience network crucially involved in cognitive control, in IBS patients relative to HC and addressed possible connections with both symptoms and psychological factors. We found decreased concentrations of the excitatory neurotransmitter Glx in bilateral aINS in IBS patients compared to HC, while inhibitory neurotransmitter GABA+ levels were comparable. Further, we demonstrated hemisphere-specific associations between abdominal pain, coping and aINS excitatory neurotransmitter concentration.

    In conclusion, this thesis broadens the knowledge on peripheral and central mechanisms in IBS and presents novel findings that bring together the ends of brain-gut axis. Our results depict association between mucosal permeability, IBS symptoms and functional and structural connectivity engaging brain regions involved in emotion and pain modulation as well as underlying neurotransmitter alterations.

    List of papers
    1. Vasoactive Intestinal Polypeptide and Mast Cells Regulate Increased Passage of Colonic Bacteria in Patients With Irritable Bowel Syndrome
    Open this publication in new window or tab >>Vasoactive Intestinal Polypeptide and Mast Cells Regulate Increased Passage of Colonic Bacteria in Patients With Irritable Bowel Syndrome
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    2017 (English)In: Gastroenterology, ISSN 0016-5085, E-ISSN 1528-0012, Vol. 153, no 4, p. 948-+Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND amp; AIMS: Irritable bowel syndrome (IBS) is associated with intestinal dysbiosis and symptoms of IBS develop following gastroenteritis. We aimed to study the passage of live bacteria through the colonic epithelium, and determine the role of mast cells (MCs) and vasoactive intestinal polypeptide (VIP) in barrier regulation in IBS and healthy individuals. METHODS: Colon biopsies from 32 women with IBS and 15 age-matched healthy women (controls) were mounted in Ussing chambers; we measured numbers of fluorescently labeled Escherichia coli HS and Salmonella typhimurium that passed through from the mucosal side to the serosal side of the tissue. Some biopsies were exposed to agents that block the VIP receptors (VPAC1 and VPAC2) or MCs. Levels of VIP and tryptase were measured in plasma and biopsy lysates. Number of MCs and MCs that express VIP or VIP receptors were quantified by immunofluorescence. Biopsies from an additional 5 patients with IBS and 4 controls were mounted in chambers and Salmonella were added; we studied passage routes through the epithelium by transmission electron microscopy and expression of tight junctions by confocal microscopy. RESULTS: In colon biopsies from patients with IBS, larger numbers of E coli HS and S typhimurium passed through the epithelium than in biopsies from controls (P amp;lt;.0005). In transmission electron microscopy analyses, bacteria were found to cross the epithelium via only the transcellular route. Bacterial passage was reduced in biopsies from patients with IBS and controls after addition of antibodies against VPACs or ketotifen, which inhibits MCs. Plasma samples from patients with IBS had higher levels of VIP than plasma samples from controls. Biopsies from patients with IBS had higher levels of tryptase, larger numbers of MCs, and a higher percentage of MCs that express VPAC1 than biopsies from controls. In biopsies from patients with IBS, addition of Salmonella significantly reduced levels of occludin; subsequent addition of ketotifen significantly reversed this effect. CONCLUSIONS: We found that colonic epithelium tissues from patients with IBS have increased translocation of commensal and pathogenic live bacteria compared with controls. The mechanisms of increased translocation include MCs and VIP.

    Place, publisher, year, edition, pages
    W B SAUNDERS CO-ELSEVIER INC, 2017
    Keywords
    Intestinal Permeability; Bacteria; Ketotifen; Inflammation
    National Category
    Gastroenterology and Hepatology
    Identifiers
    urn:nbn:se:liu:diva-142158 (URN)10.1053/j.gastro.2017.06.051 (DOI)000411835200024 ()28711627 (PubMedID)
    Note

    Funding Agencies|Stiftelsen Halsofonden, County Council of Ostergotland; Diarrheal Disease Research Centre, Linkoping University; AFA research foundation; Bengt-Ihre fonden, County Council of Ostergotland; Fondo de Investigacion Sanitaria, Instituto de Salud Carlos III, Subdireccion General de Investigacion Sanitaria, Ministerio de Economia y Competitividad [FI12/00254]; NIH [R01 DK048351]; [CP10/00502]; [PI13/00935]; [MV16/00028]; [CIBEREHD CB06/04/0021]

    Available from: 2017-10-24 Created: 2017-10-24 Last updated: 2024-01-10
    2. Interactions between gut permeability and brain structure and function in health and irritable bowel syndrome
    Open this publication in new window or tab >>Interactions between gut permeability and brain structure and function in health and irritable bowel syndrome
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    2019 (English)In: NeuroImage: Clinical, E-ISSN 2213-1582, Vol. 21, article id 101602Article in journal (Refereed) Published
    Abstract [en]

    Changes in brain-gut interactions have been implicated in the pathophysiology of chronic visceral pain in irritable bowel syndrome (IBS). Different mechanisms of sensitization of visceral afferent pathways may contribute to the chronic visceral pain reports and associated brain changes that characterize IBS. They include increased gut permeability and gut associated immune system activation, and an imbalance in descending pain inhibitory and facilitatory mechanisms. In order to study the involvement of these mechanisms, correlations between gut epithelial permeability and live bacterial passage, and structural and functional brain connectivity were measured in women with moderate-to-severe IBS and healthy women. The relationships between gut permeability and functional and anatomical connectivity were significantly altered in IBS compared with the healthy women. IBS participants with lower epithelial permeability reported increased IBS symptoms, which was associated with increased functional and structural connectivity in endogenous pain facilitation regions. The findings suggest that relationships between gut permeability and the brain are significantly altered in IBS and suggest the existence of IBS subtypes based on these interactions.

    Place, publisher, year, edition, pages
    Elsevier, 2019
    Keywords
    Irritable bowel syndrome; Gut epithelial permeability; Resting state fMRI; Brain-gut interactions; Default mode network; Coping skills
    National Category
    Neurosciences
    Identifiers
    urn:nbn:se:liu:diva-155612 (URN)10.1016/j.nicl.2018.11.012 (DOI)000460337700015 ()30472166 (PubMedID)2-s2.0-85056893948 (Scopus ID)
    Note

    Funding Agencies|AFA FOrskning [AFA140417]; County Council of Ostergotland [SLS-693541, SLS-503411]; Region Ostergotland [LIO-700871, LIO-606201, LIO-536281, LIO-514271]; Deutsche Forschungsgemeinschaft [DFG IC 81/1-1]; Bengt-Ihre Fonden

    Available from: 2019-03-20 Created: 2019-03-20 Last updated: 2024-01-17Bibliographically approved
    3. Reduced excitatory neurotransmitter levels in anterior insulae are associated with abdominal pain in irritable bowel syndrome
    Open this publication in new window or tab >>Reduced excitatory neurotransmitter levels in anterior insulae are associated with abdominal pain in irritable bowel syndrome
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    2019 (English)In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 160, no 9, p. 2004-2012Article in journal (Refereed) Published
    Abstract [en]

    Irritable bowel syndrome (IBS) is a visceral pain condition with psychological comorbidity. Brain imaging studies in IBS demonstratealtered function in anterior insula (aINS), a key hub for integration of interoceptive, affective, and cognitive processes. However,alterations in aINS excitatory and inhibitory neurotransmission as putative biochemical underpinnings of these functional changesremain elusive. Using quantitative magnetic resonance spectroscopy, we compared women with IBS and healthy women (healthycontrols [HC]) with respect to aINS glutamate 1 glutamine (Glx) and g-aminobutyric acid (GABA1) concentrations and addressedpossible associations with symptoms. Thirty-nine women with IBS and 21 HC underwent quantitative magnetic resonancespectroscopy of bilateral aINS to assess Glx and GABA1 concentrations. Questionnaire data from all participants and prospectivesymptom-diary data from patients were obtained for regression analyses of neurotransmitter concentrations with IBS-related andpsychological parameters. Concentrations of Glx were lower in IBS compared with HC (left aINS P , 0.05, right aINS P , 0.001),whereas no group differences were detected for GABA1concentrations. Lower right-lateralized Glx concentrations in patients weresubstantially predicted by longer pain duration, while less frequent use of adaptive pain‐coping predicted lower Glx in left aINS. Ourfindings provide first evidence for reduced excitatory but unaltered inhibitory neurotransmitter levels in aINS in IBS. The results alsoindicate a functional lateralization of aINS with a stronger involvement of the right hemisphere in perception of abdominal pain and ofthe left aINS in cognitive pain regulation. Our findings suggest that glutaminergic deficiency may play a role in pain processing in IBS.

    Place, publisher, year, edition, pages
    Lippincott Williams & Wilkins, 2019
    Keywords
    Irritable bowel syndrome, Functional magnetic resonance imaging, Quantitative magnetic resonance spectroscopy, Insula, Visceral pain, Coping
    National Category
    Radiology, Nuclear Medicine and Medical Imaging
    Identifiers
    urn:nbn:se:liu:diva-160012 (URN)10.1097/j.pain.0000000000001589 (DOI)000512903900011 ()31045748 (PubMedID)
    Note

    Funding agencies: NIHUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA [P41-RR14075, R01 RR16594-01A1, R01 NS052585-01, K08 MH01573, K01 MH01798]; County Council of Ostergotland; AFA research foundation [DNR. 140407]; Bengt-Ihre f

    Available from: 2019-09-02 Created: 2019-09-02 Last updated: 2024-01-10Bibliographically approved
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  • 76.
    Beka, Ervin
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Hanna, Hanan
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Olofsson, Pia
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Gimm, Oliver
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Hemithyroidectomy, does the indication influence the outcome?2024In: Langenbeck's archives of surgery (Print), ISSN 1435-2443, E-ISSN 1435-2451, Vol. 409, no 1, article id 1Article in journal (Refereed)
    Abstract [en]

    PurposeHemithyroidectomies are mainly performed for two indications, either therapeutically to relieve compression symptoms or diagnostically for suspicious nodule(s). In case of the latter, one could consider the approach to be rather extensive since the majority of patients have no symptoms and will have benign disease. The aim of this study is to investigate the complication rates of diagnostic hemithyroidectomy and to compare it with the complication rates of compressive symptoms hemithyroidectomy.MethodsData from patients who had undergone hemithyroidectomy either for compression symptoms or for excluding malignancy were extracted from a well-established Scandinavian quality register (SQRTPA). The following complications were analyzed: bleedings, wound infections, and paresis of the recurrent laryngeal nerve (RLN). Risk factors for these complications were examined by univariable and multivariable logistic regression.ResultsA total of 9677 patients were included, 3871 (40%) underwent surgery to exclude malignancy and 5806 (60%) due to compression symptoms. In the multivariable analysis, the totally excised thyroid weight was an independent risk factor for bleeding. Permanent (6-12 months after the operation) RLN paresis were less common in the excluding malignancy group (p = 0.03).ConclusionA range of factors interfere and contribute to bleeding, wound infections, and RLN paresis after hemithyroidectomy. In this observational study based on a Scandinavian quality register, the indication "excluding malignancy" for hemithyroidectomy is associated with less permanent RLN paresis than the indication "compression symptoms." Thus, patients undergoing diagnostic hemithyroidectomy can be reassured that this procedure is a safe surgical procedure and does not entail an unjustified risk.

  • 77.
    Berg, Malin
    et al.
    Department of Otorhinolaryngology-Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Adnan, Ali
    Department of Otorhinolaryngology-Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Högmo, Anders
    Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Sjödin, Helena
    Theme Cancer, HHLH, Karolinska University Hospital, Stockholm, Sweden.
    Gebre-Medhin, Maria
    Department of Oncology and Radiation Physics, Skåne University Hospital, Lund University, Lund, Sweden.
    Laurell, Göran
    Department of Surgical Sciences, Section of Otorhinolaryngology and Head and Neck Surgery, Uppsala University, Uppsala, Sweden.
    Reizenstein, Johan
    Department of Oncology, Örebro University Hospital and Örebro University, Örebro, Sweden.
    Farnebo, Lovisa
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Sensory Organs and Communication. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology.
    Norberg, Lena Spaak
    Department of Clinical Sciences/ENT, Umeå University, Umeå, Sweden.
    Notstam, Isak
    Department of Clinical Sciences/ENT, Umeå University, Umeå, Sweden.
    Holmberg, Erik
    Regional Cancer Center Western Sweden, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Cange, Hedda Haugen
    Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Hammerlid, Eva
    Department of Otorhinolaryngology-Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
    A national study of health-related quality of life in patients with cancer of the base of the tongue compared to the general population and to patients with tonsillar carcinoma2021In: Head and Neck, ISSN 1043-3074, E-ISSN 1097-0347, Vol. 43, no 12, p. 3843-3856Article in journal (Refereed)
    Abstract [en]

    Background: This exploratory, registry-based, cross-sectional study aimed to evaluate patients' health-related quality of life (HRQOL) in a subsite of oropharyngeal cancer: cancer of the base of the tongue (CBT). Methods: CBT patients, treated with curative intent, completed the EORTC QLQ-C30 and QLQ-H&N35 questionnaires 15 months after diagnosis. The HRQOL of CBT patients was compared to reference scores from the general population and to that of tonsillar carcinoma patients. Results: The 190 CBT patients scored significantly worse than members of the general population on most scales. CBT patients with human papilloma virus (HPV)-positive tumors had significantly better HRQOL on 8 of 28 scales than HPV-negative patients. Compared to 405 tonsillar carcinoma patients, CBT patients had significantly worse HRQOL on 8 of the 28 scales, the majority local head and neck related problems. Conclusion: One year after treatment, CBT patients' HRQOL was significantly worse in many areas compared to that of the general population and slightly worse than that of tonsillar carcinoma patients. © 2021 Wiley Periodicals LLC.

  • 78.
    Bergengren, Oskar
    et al.
    Uppsala Univ, Sweden.
    Belozerov, Alexej
    Uppsala Univ, Sweden.
    Bill-Axelson, Anna
    Uppsala Univ, Sweden.
    Garmo, Hans
    Uppsala Univ Hosp, Sweden.
    Hagberg, Oskar
    Lund Univ, Sweden.
    Aljabery, Firas
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Urology in Östergötland.
    Gardmark, Truls
    Karolinska Inst, Sweden.
    Jahnson, Staffan
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Urology in Östergötland.
    Jerlstrom, Tomas
    Orebro Univ, Sweden.
    Malmstrom, Per-Uno
    Uppsala Univ, Sweden.
    Sherif, Amir
    Umea Univ, Sweden.
    Strock, Viveka
    Sahlgrens Univ Hosp, Sweden; Univ Gothenburg, Sweden.
    Souroderkvist, Karin
    Umea Univ, Sweden.
    Ullen, Anders
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Holmberg, Lars
    Uppsala Univ, Sweden; Kings Coll London, England.
    Haggstrom, Christel
    Uppsala Univ, Sweden; Umea Univ, Sweden.
    Liedberg, Fredrik
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Short term outcomes after robot assisted and open cystectomy- A nation-wide population-based study2023In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 49, no 4, p. 868-874Article in journal (Refereed)
    Abstract [en]

    Introduction: We aimed to compare short term outcomes after robot assisted radical cystectomy (RARC) and open radical cystectomy (ORC) for urinary bladder cancer in a large population.Materials and methods: We included all patients without distant metastases who underwent either RARC or ORC with ileal conduit between 2011 and 2019 registered in the Bladder cancer data Base Sweden (BladderBaSe) 2.0. Primary outcome was unplanned readmissions within 90 days, and secondary out-comes within 90 days of surgery were reoperations, Clavien 3-5 complications, total days alive and out of hospital, and mortality. The analysis was carried out using multivariate regression models.Results: Out of 2905 patients, 832 were operated with RARC and 2073 with ORC. Robotic procedures were to a larger extent performed during later years, at high volume centers (47% vs 17%), more often for organ-confined disease (82% vs. 72%) and more frequently in patients with high socioeconomic status (26% vs. 21%). Patients operated with RARC were more commonly readmitted (29% vs. 25%). In multi -variable analysis RARC was associated with decreased risk of Clavien 3-5 complications (OR 0.58, 95% CI 0.47-0.72), reoperations (OR 0.53, 95% CI 0.39-0.71) and had more days alive and out of hospital (mean difference 3.7 days, 95% CI 2.4-5.0).Conclusion: This study illustrates the "real-world" effects of a gradual and nation-wide introduction of RARC. Patients operated with RARC had fewer major complications and reoperations but were more frequently readmitted compared to ORC. The observed differences were largely due to more wound related complications among patients treated with ORC.(c) 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

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  • 79.
    Bergkvist, Max
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Zötterman, Johan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Henricson, Joakim
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Dermatology and Venerology.
    Iredahl, Fredrik
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Tesselaar, Erik
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics.
    Farnebo, Simon
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Vascular Occlusion in a Porcine Flap Model: Effects on Blood Cell Concentration and Oxygenation.2017In: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 5, no 11, article id e1531Article in journal (Refereed)
    Abstract [en]

    Background: Venous congestion in skin flaps is difficult to detect. This study evaluated the ability of tissue viability imaging (TiVi) to measure changes in the concentration of red blood cells (CRBC), oxygenation, and heterogeneity during vascular provocations in a porcine fasciocutaneous flap model.

    Methods: In 5 pigs, cranial gluteal artery perforator flaps were raised (8 flaps in 5 pigs). The arterial and venous blood flow was monitored with ultrasonic flow probes. CRBC, tissue oxygenation, and heterogeneity in the skin were monitored with TiVi during baseline, 50% and 100% venous occlusion, recovery, 100% arterial occlusion and final recovery, thereby simulating venous and arterial occlusion of a free fasciocutaneous flap. A laser Doppler probe was used as a reference for microvascular perfusion in the flap.

    Results: During partial and complete venous occlusion, increases in CRBC were seen in different regions of the flap. They were more pronounced in the distal part. During complete arterial occlusion, CRBC decreased in all but the most distal parts of the flap. There were also increases in tissue oxygenation and heterogeneity during venous occlusion.

    Conclusions: TiVi measures regional changes in CRBC in the skin of the flap during arterial and venous occlusion, as well as an increase in oxygenated hemoglobin during venous occlusion that may be the result of reduced metabolism and impaired delivery of oxygen to the tissue. TiVi may provide a promising method for measuring flap viability because it is hand-held, easy to-use, and provides spatial information on venous congestion.

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  • 80.
    Bergman, Emma Ahlen
    et al.
    Karolinska Univ Hosp, Sweden.
    Hartana, Ciputra Adijaya
    Karolinska Univ Hosp, Sweden.
    Johansson, Markus
    Sundsvall Hosp, Sweden; Umea Univ, Sweden.
    Linton, Ludvig B.
    Karolinska Univ Hosp, Sweden.
    Berglund, Sofia
    Karolinska Univ Hosp, Sweden.
    Hyllienmark, Martin
    TLA Targeted Immunotherapies AB, Sweden.
    Lundgren, Christian
    Karolinska Univ Hosp, Sweden.
    Holmstrom, Benny
    Akad Univ Hosp, Sweden.
    Palmqvist, Karin
    Umea Univ, Sweden; Ostersund Cty Hosp, Sweden.
    Hansson, Johan
    Uppsala Univ, Sweden.
    Alamdari, Farhood
    Vastmanland Hosp, Sweden.
    Huge, Ylva
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Urology in Östergötland.
    Aljabery, Firas
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Urology in Östergötland.
    Riklund, Katrine
    Umea Univ, Sweden.
    Winerdal, Malin E.
    Karolinska Univ Hosp, Sweden.
    Krantz, David
    Karolinska Univ Hosp, Sweden.
    Zirakzadeh, A. Ali
    Karolinska Univ Hosp, Sweden; Umea Univ, Sweden.
    Marits, Per
    Karolinska Univ Hosp, Sweden.
    Sjoholm, Louise K.
    Karolinska Inst, Sweden.
    Sherif, Amir
    Umea Univ, Sweden; Umea Univ, Sweden.
    Winqvist, Ola
    Karolinska Univ Hosp, Sweden.
    Increased CD4(+) T cell lineage commitment determined by CpG methylation correlates with better prognosis in urinary bladder cancer patients2018In: Clinical epigenetics, ISSN 1868-7075, Vol. 10, article id 102Article in journal (Refereed)
    Abstract [en]

    Background: Urinary bladder cancer is a common malignancy worldwide. Environmental factors and chronic inflammation are correlated with the disease risk. Diagnosis is performed by transurethral resection of the bladder, and patients with muscle invasive disease preferably proceed to radical cystectomy, with or without neoadjuvant chemotherapy. The anti-tumour immune responses, known to be initiated in the tumour and draining lymph nodes, may play a major role in future treatment strategies. Thus, increasing the knowledge of tumour-associated immunological processes is important. Activated CD4(+) T cells differentiate into four main separate lineages: Th1, Th2, Th17 and Treg, and they are recognized by their effector molecules IFN-gamma, IL-13, IL-17A, and the transcription factor Foxp3, respectively. We have previously demonstrated signature CpG sites predictive for lineage commitment of these four major CD4(+ )T cell lineages. Here, we investigate the lineage commitment specifically in tumour, lymph nodes and blood and relate them to the disease stage and response to neoadjuvant chemotherapy. Results: Blood, tumour and regional lymph nodes were obtained from patients at time of transurethral resection of the bladder and at radical cystectomy. Tumour-infiltrating CD4(+ )lymphocytes were significantly hypomethylated in all four investigated lineage loci compared to CD4(+) lymphocytes in lymph nodes and blood (lymph nodes vs rumour-infiltrating lymphocytes: IFNG -4229 bp p amp;lt; 0.0001, IL13 -11 bp p amp;lt; 0.05, IL17A -122 bp p amp;lt; 0.01 and FOXP3 -77 bp pamp;gt; 0.05). Examination of individual lymph nodes displayed different methylation signatures, suggesting possible correlation with future survival. More advanced post-cystectomy tumour stages correlated significantly with increased methylation at the IFNG -4229 bp locus. Patients with complete response to neoadjuvant chemotherapy displayed significant hypomethylation in CD4(+ )T cells for all four investigated loci, most prominently in IFNG p amp;lt; 0.0001. Neoadjuvant chemotherapy seemed to result in a relocation of Th1-committed CD4(+) T cells from blood, presumably to the tumour, indicated by shifts in the methylation patterns, whereas no such shifts were seen for lineages corresponding to IL13, IL17A and FOXP3. Conclusion: Increased lineage commitment in CD4(+) T cells, as determined by demethylation in predictive CpG sites, is associated with lower post-cystectomy tumour stage, complete response to neoadjuvant chemotherapy and overall better outcome, suggesting epigenetic profiling of CD4(+) T cell lineages as a useful readout for clinical staging.

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  • 81.
    Bergmark, K
    et al.
    Gynecological Oncology, Department of Oncology-Pathology, Radiumhemmet, Karolinska Institutet, Stockholm, Sweden. Clinical Cancerepidemiology, Department of Oncology–Pathology, Karolinska Institutet, Stockholm, Sweden .
    Åvall-Lundqvist, Elisabeth
    Gynecological Oncology, Department of Oncology-Pathology, Radiumhemmet, Karolinska Institutet, Stockholm, Sweden.
    Dickman, P W
    Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden .
    Henningsohn, L
    Clinical Cancerepidemiology, Department of Oncology–Pathology, Karolinska Institutet, Stockholm, Sweden . Department of Urology, Huddinge Hospital, Huddinge, Sweden .
    Steineck, G
    Clinical Cancerepidemiology, Department of Oncology–Pathology, Karolinska Institutet, Stockholm, Sweden. Clinical Cancerepidemiology, Stockholm City Council, Stockholm, Sweden .
    Lymphedema and bladder-emptying difficulties after radical hysterectomy for early cervical cancer and among population controls.2006In: International Journal of Gynecological Cancer, ISSN 1048-891X, E-ISSN 1525-1438, Vol. 16, no 3, p. 1130-1139Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to acquire knowledge that can be used to refine radical hysterectomy to improve quality-of-life outcome. Data were collected in 1996-1997 by means of an anonymous postal questionnaire in a follow-up study of two cohorts (patients and population controls). We attempted to enroll all 332 patients with stage IB-IIA cervical cancer registered in 1991-1992 at the seven departments of gynecological oncology in Sweden and 489 population controls. Ninety three (37%) of the 256 women with a history of cervical cancer who answered the questionnaire (77%) were treated with surgery alone. Three-hundred fifty population controls answered the questionnaire (72%). Women treated with radical hysterectomy, as compared with controls, had an 8-fold increase in symptoms indicating lymphedema (25% reported distress due to lymphedema), a nearly 9-fold increase in difficult emptying of the bladder, and a 22-fold increase in the need to strain to initiate bladder evacuation. Ninety percent of the patients were not willing to trade off survival for freedom from symptoms. Avoiding to induce long-term lymphedema or bladder-emptying difficulties would probably improve quality of life after radical hysterectomy (to cure cervical cancer). Few women want to compromise survival to avoid long-term symptoms.

  • 82.
    Bergmark, Karin
    et al.
    Department of Oncology, Gynecological Oncology, Clinical Cancer Epidemiology, Karolinska Institutet PO Box 4402 S-102 68 Stockholm Sweden.
    Åvall-Lundqvist, Elisabeth
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Department of Oncology, Gynecological Oncology, Karolinska Institutet, Stockholm Sweden.
    Dickman, Paul W
    Department of Oncology, Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden.
    Henningsohn, Lars
    Department of Oncology, Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden / Department of Urology, Huddinge Hospital, Stockholm, Sweden.
    Steineck, Gunnar
    Department of Oncology, Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden.
    Patient-rating of distressful symptoms after treatment for early cervical cancer.2002In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 81, no 5, p. 443-450Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: More refined information on sources of symptom-induced distress in a patient population can improve the quality of pretreatment information, make follow-up visits more efficient and guide research priorities in the efforts to modify treatments.

    METHODS: In a population-based epidemiological study covering all of Sweden, data were collected 1996-97 by means of an anonymous postal questionnaire. We attempted to enroll all 332 patients with stage IB-IIA cervical cancer registered in 1991-92 at the seven departments of gynecological oncology in Sweden.

    RESULTS: A total of 256 cases (77%) completed the questionnaire. After surgery, alone or in combination with intracavitary radiotherapy, several symptoms related to sexual dysfunction are the primary sources of symptom-induced distress (reduced orgasm frequency: much distress 23% (surgery alone) and 23% (intracavitary radiotherapy and surgery), respectively, overall intercourse dysfunction: much distress 17% and 20%, respectively, followed by lymphedema (much distress 14% and 14%, respectively). Dyspareunia (much distress 24%) and defecation urgency (much distress 22%) are two leading causes of distress after surgery and external radiotherapy. After treatment with radiotherapy alone, loose stool and dyspareunia were the two most distressful symptoms (much distress 19% each). When a symptom occurs, fecal leakage and reduced orgasm frequency are the two most distressful ones (measured as much distress, 38% each).

    CONCLUSIONS: The observed symptoms are distressful and should, if one focuses on patient satisfaction, be given priority.

  • 83.
    Bergthorsdottir, R
    et al.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Nilsson, A G
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Gillberg, P
    Shire, Danderyd, Sweden.
    Ekman, Bertil
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Endocrinology. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Wahlberg, Jeanette
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Endocrinology. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Health-Related Quality of Life In Patients With Adrenal Insufficiency Receiving Plenadren Compared With Immediate-Release Hydrocortisone.2015In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 18, no 7, p. A616-Article in journal (Refereed)
    Abstract [en]

    Background

    Previous studies in patients with primary adrenal insufficiency (PAI) on conventional replacement therapy suggest decreased health-related quality of life (HRQoL), and that patients report more frequently fatigue, increased anxiety and inability to work compared to background population.

    Objectives

    To study self-reported health status with EQ-5D in patients with PAI. Patients treated with Plenadren (modified-release hydrocortisone) were compared with patients treated with immediate release hydrocortisone (IRHC) replacement therapy.

    Methods

    This was a cross-sectional, multi-centre, non-interventional survey of patients with PAI receiving Plenadren or immediate release hydrocortisone (IRHC) replacement.

    Subjects

    One hundred thirty-four adult patients with PAI of whom 36 (19 females [53%]) were treated with Plenadren and 98 (77 females [79%]) were treated with IRHC, were included.

    MAIN OUTCOME MEASURE

    HRQoL described by the EQ-5D, a generic preference-based measure of health.

    RESULTS

    Patients on Plenadren and on IRHC had a mean ± SD age of 53.1 ± 12.7 years and 48.0 ± 13.1 years, respectively (P=0.043). The majority of the patients were diagnosed more than 5 years ago (69%). The mean ± SD daily Plenadren and IRHC doses were 27.0 ± 6.8 mg and 26.6 ± 10.9 mg, respectively (P=0.807). 47% of the Plenadren patients had been receiving Plenadren and 82% of the IRHC patients had been receiving IRHC for more than 3 years. Patients receiving Plenadren had better HRQoL measured by the EQ-5D questionnaire compared to patients replaced with IRHC (0.76 ± 0.18 vs 0.68 ± 0.18, respectively [P=0.040]).

    CONCLUSIONS

    Replacement therapy with Plenadren in patients with PAI confers measurable benefit on HRQoL relative to IRHC as estimated by the EQ-5D questionnaire, and may therefore be advantageous when compared to IRHC substitution.

  • 84.
    Bernfort, Lars
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Granfeldt, Daniel
    PharmaLex Sweden, Sweden.
    Ryd, Leif
    Episurf Med, Sweden.
    Individualized metal implants for focal cartilage lesions in the knee can be cost-effective: A simulation on 47-year-old in a Swedish setting2023In: JOURNAL OF ISAKOS JOINT DISORDERS & ORTHOPAEDIC SPORTS MEDICINE, ISSN 2059-7754, Vol. 8, no 3, p. 197-203Article in journal (Refereed)
    Abstract [en]

    Objectives: In the aging population, the knee is the joint most commonly causing impaired function and incapacity. While definite treatment by prosthetic replacement is often performed late, symptomatic knee cartilage lesions cause much suffering also in younger ages. Early intervention could, therefore, be instituted at an early stage to the benefit of both patients and society. Small, metal surface, resurfacing implants have been tested with promising results. A system that features patient-specific implants and surgical instruments shows good clinical results and favorable survival rates. This study aims to assess the cost utility of this metal device compared with microfracture (MFX), being the standard procedure in Sweden. Methods: We constructed a simulation model in Excel. In the model, a cohort of 47-year-old patients (which is the mean age of patients treated with the metal implant) with symptomatic knee cartilage lesions received either MFX or metal implantation. Outcomes for the cohort were simulated over 40 years, such as in a previously published model based on MFX, and sensitivity analyses (deterministic and probabilistic) of the results were undertaken. Data on transition probabilities, costs, and quality of life were taken from clinical data, published literature, and official price lists. Only direct medical costs were included. Results: Results from the analysis showed that the metal device is a cost-effective treatment strategy compared with MFX. The incremental cost-effectiveness ratio (ICER) reached acceptable levels at similar to 5 years postoperatively. Over the full-time horizon of 40 years, the metal device was cost saving with concomitant gains in quality-adjusted life years (QALYs), translating to a dominant treatment strategy. Results were robust according to sensitivity analysis with the initial success rate of up to three years for both metal and MFX having the largest impact. Conclusions: A metal implant may be a cost-effective treatment alternative for patients in their 40s when compared to MFX in a Swedish setting.

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  • 85.
    Berrevoet, Frederik
    et al.
    Department of General and Hepatopancreaticobiliary Surgery, Ghent University Hospital, Ghent, Belgium.
    Doerhoff, Carl
    General Surgery, Surgicare of Missouri, Jefferson City, MO, USA.
    Muysoms, Filip
    Department of Surgery, AZ Maria Middelares Ghent, Ghent, Belgium.
    Hopson, Steven
    Bon Secours Hernia Center, Mary Immaculate Hospital, Newport News, VA, USA.
    Muzi, Marco Gallinella
    University Hospital Tor Vergata, Rome, Italy.
    Nienhuijs, Simon
    Catharina Hospital, Eindhoven, the Netherlands.
    Kullman, Eric
    Medicinskt Centrum Linköping, Linköping, Sweden.
    Tollens, Tim
    Imelda Hospital-General Surgery Imelda Hospital, Bonheiden, Belgium.
    Schwartz, Mark R
    Monmouth Medical Center, Long Branch, NJ.
    LeBlanc, Karl
    Our Lady of Lakes Regional Medical Center, Baton Rouge, LA.
    Velanovich, Vic
    Tampa General Hospital, University of South Florida, Tampa, FL, USA.
    Jørgensen, Lars Nannestad
    Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
    A multicenter prospective study of patients undergoing open ventral hernia repair with intraperitoneal positioning using the monofilament polyester composite ventral patch: interim results of the PANACEA study2017In: Medical Devices: Evidence and Research, ISSN 1179-1470, Vol. 10, p. 81-88Article in journal (Refereed)
    Abstract [en]

    This study assessed the recurrence rate and other safety and efficacy parameters following ventral hernia repair with a polyester composite prosthesis (Parietex™ Composite Ventral Patch [PCO-VP]).

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  • 86.
    Billaud Feragen, Kristin
    et al.
    Oslo University Hospital, Norway; Statped Sorost, Norway.
    Semb, Gunvor
    University of Manchester, England; National Hospital Norway, Norway.
    Heliovaara, Arja
    University of Helsinki, Finland.
    Lohmander, Anette
    Karolinska Institute, Sweden.
    Johannessen, Emma Christine
    Statped Sorost, Norway.
    Boysen, Betty Marie
    University of Copenhagen Hospital, Denmark.
    Havstam, Christina
    Sahlgrens University Hospital, Sweden.
    Lundeborg, Inger
    Linköping University, Department of Clinical and Experimental Medicine, Division of Speech language pathology, Audiology and Otorhinolaryngology. Linköping University, Faculty of Medicine and Health Sciences.
    Nyberg, Jill
    Karolinska University Hospital, Sweden.
    Pedersen, Nina-Helen
    Statped Vest, Norway.
    Bogh-Nielsen, Joan
    Cleft Palate Centre, Denmark.
    Eyres, Philip
    University of Manchester, England.
    Bradbury, Eileen
    Private Practice, Manchester, UK.
    Rumsey, Nichola
    University of West England, England.
    Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 10. Parental perceptions of appearance and treatment outcomes in their 5-year-old child2017In: Journal of Plastic Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 51, no 1, p. 81-87Article in journal (Refereed)
    Abstract [en]

    Background and aim: Few studies have explored childrens emotional and behavioural reactions to cleft surgery and treatment-related stress. The objective was to investigate parents evaluations of appearance and treatment outcomes in their 5-year-old child with unilateral cleft lip and palate (UCLP), and their perceptions of how their child was coping with treatment, comparing this information with recorded postsurgical complications.Design: Three parallel group randomised clinical trials were undertaken as an international multicentre study by 10 cleft teams in five countries: Denmark, Finland, Sweden, Norway, and the UK.Methods: Three different surgical procedures for primary palatal repair were tested against a common procedure in the total cohort of 448 children born with a non-syndromic UCLP. A total of 356 parents completed the Scandcleft Parent Questionnaire, and 346 parents completed the Cleft Evaluation Profile.Results: The results indicated that the majority of parents were satisfied with cleft-related features of their childs appearance. Further, most children coped well with treatment according to their parents. Nevertheless, 17.5% of the children showed minor or short-term reactions after treatment experiences, and 2% had major or lasting difficulties. There were no significant relationships between parent perceptions of treatment-related problems and the occurrence of post-surgical medical complications.Conclusions: Most parents reported satisfaction with their childs appearance. However, treatment-related problems were described in some children, urging cleft centres to be aware of potential negative emotional and behavioural reactions to treatment in some young children, with a view to preventing the development of more severe treatment-related anxiety.

  • 87.
    Bjerså, Kristofer
    et al.
    Department of Surgery, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg; Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Forsberg, Anna
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg; Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Fagevik Olsén, Monika
    Institute of Neuroscience and Physiology, Sahlgrenska academy, University of Gothenburg; Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Perceptions of complementary therapies among Swedish registered professions in surgical care2011In: Complementary Therapies in Clinical Practice, ISSN 1744-3881, E-ISSN 1873-6947, Vol. 17, no 1, p. 44-49Article in journal (Refereed)
    Abstract [en]

    There is increasing interest in complementary and alternative medicine (CAM) among healthcare professions. However, no studies have been conducted in Sweden or in a surgical context. The aim of this study is to describe different perceptions of complementary therapies among registered healthcare professions in Swedish surgical care. Sixteen interviews were conducted with registered physicians, nurses, physiotherapists and clinical dieticians at a Swedish university hospital. Analysis was made with a phenomenographic research approach. The findings showed variations in perceptions of the definition of complementary therapies. A constructive approach toward use was observed, but there was a conflict in matters of indications and contraindications, and also criticism over a lack of knowledge. There was seen to be a need for education to be able to act professionally. Scepticism over high costs of treatment was highlighted. In conclusion, a need for policies on management, education and research in the field of CAM should be addressed.

  • 88.
    Bjurberg, Maria
    et al.
    Lund Univ, Sweden.
    Holmberg, Erik
    Reg Canc Ctr West, Sweden; Sahlgrens Acad, Sweden.
    Borgfeldt, Christer
    Skane Univ Hosp, Sweden; Lund Univ, Sweden.
    Floter-Radestad, Angelique
    Karolinska Inst, Sweden.
    Dahm-Kahler, Pernilla
    Sahlgrens Univ Hosp, Sweden.
    Hjerpe, Elisabet
    Visby Hosp, Sweden.
    Hogberg, Thomas
    Lund Univ, Sweden.
    Kjölhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Marcickiewicz, Janusz
    Reg Canc Ctr West, Sweden; Halland Hosp, Sweden.
    Rosenberg, Per
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology. Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology.
    Stalberg, Karin
    Uppsala Univ, Sweden.
    Tholander, Bengt
    Uppsala Univ Hosp, Sweden.
    Hellman, Kristina
    Karolinska Univ Hosp, Sweden.
    Åvall Lundqvist, Elisabeth
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Primary treatment patterns and survival of cervical cancer in Sweden: A population-based Swedish Gynecologic Cancer Group Study2019In: Gynecologic Oncology, ISSN 0090-8258, E-ISSN 1095-6859, Vol. 155, no 2, p. 229-236Article in journal (Refereed)
    Abstract [en]

    Objective: Survival in cervical cancer has improved little over the last decades. We aimed to elucidate primary treatment patterns and survival. Methods: Population-based study of patients included in the Swedish Quality Registry for Gynecologic Cancer diagnosed 2011-2015. Main outcome was 5-year relative survival (RS). Age-standardised RS (AS-RS) was estimated for the total cohort and for the pooled study population of squamous, adenosquamous-, adenocarcinoma. Results: Median follow-up time was 4.6 years. The study population consisted of 2141 patients; 97% of the 2212 patients in the total cohort and the 5-year AS-RS was 71% and 70%, respectively. RS stage IB1: surgery alone 95% vs. 72% for definitive chemoradiotherapy (CT-RT) (p amp;lt; 0.001). In stage IIA1 74% had CTRL, and 47% of operated patients received adjuvant (CT)-RT. RS stage IB2: surgically treated 81% (69% received adjuvant (CT)-RT) vs. 76% for (CT)-RT (p = 0.73). RS stage IIB: 77% for CT-RT + brachytherapy BT), 37% for RT + BT (p = 0.045) and 27% for RT-BT (p amp;lt; 0.001). Stages III-IVA; amp;lt;40% received CT-RT + BT, RS 45% vs. 18% for RT-BT (RR 4.1, p amp;lt; 0.001). RS stage IVB 7%. Conclusion: Primary treatment of cervical cancer in Sweden adhered to evidence-based standard of care. Areas of improvement include optimising treatment for stages III-IVA, and avoiding combining surgery and radiotherapy. (C) 2019 Elsevier Inc. All rights reserved.

  • 89.
    Bjursten, Henrik
    et al.
    Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden.
    Koul, Sasha
    Department of Cardiology, Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
    Pétursson, Pétur
    Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Odenstedt, Jacob
    Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Hagström, Henrik
    Department of Public Health and Clinical Medicine, Heart Centre, Umeå University, Umeå University Hospital, Umeå, Sweden.
    Backes, Jenny
    Department of Cardiothoracic and Vascular Surgery, Orebro University Hospital, Örebro, Sweden.
    Nielsen, Niels Erik
    Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Rück, Andreas
    Department of Cardiology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden.
    Johansson, Jan
    Department of Cardiology, Blekinge Hospital, Karlskrona, Sweden.
    James, Stefan
    Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Settergren, Magnus
    Department of Cardiology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden.
    Götberg, Matthias
    Department of Cardiology, Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
    Yndigen, Troels
    Department of Cardiology, Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
    Characteristics and Outcomes of Patients Receiving a Second Rescue Valve During Transcatheter Aortic Valve Implantation2024In: Structural heart : the journal of the Heart Team, ISSN 2474-8706, Vol. 8, no 2Article in journal (Refereed)
    Abstract [en]

    Transcatheter aortic valve implantation (TAVI) has become a safe procedure. However, complications occur, including uncommon complications such as valve malposition, which requires the implantation of an additional rescue valve (rescue-AV). The aim was to study the occurrence and outcomes of rescue-AV in a nationwide registry.

  • 90.
    Björnsson, Bergthor
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Hasselgren, Kristina
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Rosok, Bard
    Oslo Univ Hosp, Norway.
    Larsen, Peter Noergaard
    Univ Copenhagen, Denmark.
    Urdzik, Jozef
    Uppsala Univ, Sweden.
    Schultz, Nicolai A.
    Univ Copenhagen, Denmark.
    Carling, Ulrik
    Oslo Univ Hosp, Norway.
    Fallentin, Eva
    Univ Copenhagen, Denmark.
    Gilg, Stefan
    Karolinska Univ Hosp, Sweden.
    Sandström, Per
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Lindell, Gert
    Lund Univ, Sweden.
    Sparrelid, Ernesto
    Karolinska Univ Hosp, Sweden.
    Segment 4 occlusion in portal vein embolization increase future liver remnant hypertrophy - A Scandinavian cohort study2020In: International Journal of Surgery, ISSN 1743-9191, E-ISSN 1743-9159, Vol. 75, p. 60-65Article in journal (Refereed)
    Abstract [en]

    Background: The additional value of including segment 4 (S4) portal branches in right portal vein embolization (rPVE) is debated. The aim of the study was to explore this in a large multicenter cohort. Material and methods: A retrospective cohort study consisting of all patients subjected to rPVE from August 2012 to May 2017 at six Scandinavian university hospitals. PVE technique was essentially the same in all centers, except for the selection of main embolizing agent (particles or glue). All centers used coils or particles to embolize S4 branches. A subgroup analysis was performed after excluding patients with parts of or whole S4 included in the future liver remnant (FLR). Results: 232 patients were included in the study, of which 36 received embolization of the portal branches to S4 in addition to rPVE. The two groups (rPVE vs rPVE + S4) were similar (gender, age, co-morbidity, diagnosis, neoadjuvant chemotherapy, bilirubin levels prior to PVE and embolizing material), except for diabetes mellitus which was more frequent in the rPVE + S4 group (p = 0.02). Pre-PVE FLR was smaller in the S4 group (333 vs 380 ml, p = 0.01). rPVE + S4 resulted in a greater percentage increase of the FLR size compared to rPVE alone (47 vs 38%, p = 0.02). A subgroup analysis, excluding all patients with S4 included in the FLR, was done. There was no longer a difference in pre-PVE FLR between groups (333 vs 325 ml, p = 0.9), but still a greater percentage increase and also absolute increase of the FLR in the rPVE + S4 group (48 vs 38% and 155 vs 112 ml, p = 0.01 and 0.02). Conclusion: In this large multicenter cohort study, additional embolization of S4 did demonstrate superior growth of the FLR compared to standard right PVE.

  • 91.
    Björnsson, Bergthor
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Lindhoff Larsson, Anna
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Hjalmarsson, C.
    Blekinge Hosp, Sweden; Lund Univ, Sweden.
    Gasslander, Thomas
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Sandström, Per
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Author response to: Comment on: Comparison of the duration of hospital stay after laparoscopic or open distal pancreatectomy: randomized controlled trial2020In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 107, no 8, p. e279-e279Article in journal (Other academic)
    Abstract [en]

    n/a

  • 92.
    Björnsson, Bergthor
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Lindhoff Larsson, Anna
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Hjalmarsson, C.
    Blekinge Hosp, Sweden; Lund Univ, Sweden.
    Gasslander, Thomas
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Sandström, Per
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Author response to: Comment on: TheLAPOPtrial of laparoscopic or open distal pancreatectomy2020In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 107, no 9, p. e356-e356Article in journal (Other academic)
    Abstract [en]

    n/a

  • 93.
    Björnsson, Bergthor
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Lindhoff Larsson, Anna
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Hjalmarsson, C.
    Blekinge Hosp, Sweden; Lund Univ, Sweden.
    Gasslander, Thomas
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Sandström, Per
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Comparison of the duration of hospital stay after laparoscopic or open distal pancreatectomy: randomized controlled trial2020In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 107, no 10, p. 1281-1288Article in journal (Refereed)
    Abstract [en]

    Background Studies have suggested that laparoscopic distal pancreatectomy (LDP) is advantageous compared with open distal pancreatectomy (ODP) regarding hospital stay, blood loss and recovery. Only one randomized study is available, which showed enhanced functional recovery after LDP compared with ODP. Methods Consecutive patients evaluated at a multidisciplinary tumour board and planned for standard distal pancreatectomy were randomized prospectively to LDP or ODP in an unblinded, parallel-group, single-centre superiority trial. The primary outcome was postoperative hospital stay. Results Of 105 screened patients, 60 were randomized and 58 (24 women, 41 per cent) were included in the intention-to-treat analysis; there were 29 patients of mean age 68 years in the LDP group and 29 of mean age 63 years in the ODP group. The main indication was cystic pancreatic lesions, followed by neuroendocrine tumours. The median postoperative hospital stay was 5 (i.q.r. 4-5) days in the laparoscopic group versus 6 (5-7) days in the open group (P = 0 center dot 002). Functional recovery was attained after a median of 4 (i.q.r. 2-6) versus 6 (4-7) days respectively (P = 0 center dot 007), and duration of surgery was 120 min in both groups (P = 0 center dot 482). Blood loss was less with laparoscopic surgery: median 50 (i.q.r. 25-150) ml versus 100 (100-300) ml in the open group (P = 0 center dot 018). No difference was found in the complication rates (Clavien-Dindo grade III or above: 4 versus 8 patients respectively). The rate of delayed gastric emptying and clinically relevant postoperative pancreatic fistula did not differ between the groups. Conclusion LDP is associated with shorter hospital stay than ODP, with shorter time to functional recovery and less bleeding. Registration number: ISRCTN26912858 ( ).

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  • 94.
    Björnsson, Bergthor
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Lundgren, L
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    A Personal Computer Freeware as a Tool for Surgeons to Plan Liver Resections.2016In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 105, no 3, p. 153-157Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: The increase in liver surgery and the proportion of resections done on the margin to postoperative liver failure make preoperative calculations regarding liver volume important. Earlier studies have shown good correlation between calculations done with ImageJ and specimen weight as well as volume calculations done with more robust systems. The correlation to actual volumes of resected liver tissue has not been investigated, and this was the aim of this study.

    MATERIAL AND METHODS: A total of 30 patients undergoing well-defined liver resections were included in this study. Volumes calculated with ImageJ were compared to volume measurements done after the retrieval of resected liver tissue.

    RESULTS AND CONCLUSIONS: A strong correlation between calculated and measured liver volume was found with sample concordance correlation coefficient (ρc) = 0.9950. The knowledge on the nature of liver resections sets liver surgeons in a unique position to be able to accurately predict the volumes to be resected and, therefore, also the volume that will remain after surgery. This becomes increasingly important with the evolvement of methods to extend the boundaries of liver surgery. ImageJ is a reliable tool to preoperatively assess liver volume.

  • 95.
    Björnsson, Bergthor
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Sandström, Per
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Detailed reporting is of utmost importance when a controversial treatment is being evaluated2019In: HPB, ISSN 1365-182X, E-ISSN 1477-2574, Vol. 21, no 9, p. 1250-1250Article in journal (Other academic)
    Abstract [en]

    n/a

  • 96.
    Björnsson, Bergthor
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Sandström, Per
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Increasing evidence for minimally invasive approach to distal pancreatectomy2019In: Laparoscopic Surgery, E-ISSN 2616-4221, Vol. 3Article in journal (Refereed)
  • 97.
    Björnsson, Bergthor
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Sandström, Per
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Lindhoff Larsson, Anna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Hjalmarsson, Claes
    Blekinge Hosp, Sweden; Lund Univ, Sweden.
    Gasslander, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Laparoscopic versus open distal pancreatectomy (LAPOP): study protocol for a single center, nonblinded, randomized controlled trial2019In: Trials, E-ISSN 1745-6215, Vol. 20, article id 356Article in journal (Refereed)
    Abstract [en]

    BackgroundEarlier nonrandomized studies have suggested that laparoscopic distal pancreatectomy (LDP) is advantageous compared with open distal pancreatectomy (ODP) regarding hospital stay, blood loss, and recovery. Only one randomized study has been conducted showing reduced time to functional recovery after LDP compared with ODP.MethodsLAPOP is a prospective randomized, nonblinded, parallel-group, single-center superiority trial. Sixty patients with lesions in the pancreatic body or tail that are found by a multidisciplinary tumor board to need surgical resection will be randomized to receive LDP or ODP. The primary outcome variable is postoperative hospital stay, and secondary outcomes include functional recovery (defined as no need for intravenous medications or fluids and as the ability of an ambulatory patient to perform activities of daily life), perioperative bleeding, complications, need for pain medication, and quality of life comparison.DiscussionThe LAPOP trial will test the hypothesis that LDP reduces postoperative hospital stay compared with ODP.Trial registrationISRCTN, 26912858. Registered on 28 September 2015.

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  • 98.
    Björnsson, Bergthor
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Sparrelid, E.
    Karolinska Institute, Sweden.
    Hasselgren, Kristina
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
    Gasslander, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Isaksson, B.
    Karolinska Institute, Sweden.
    Sandström, Per
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Associating Liver Partition and Portal Vein Ligation for Primary Hepatobiliary Malignancies and Non-Colorectal Liver Metastases2016In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 105, no 3, p. 158-162Article in journal (Refereed)
    Abstract [en]

    Background and Aims: Associating liver partition and portal vein ligation for staged hepatectomy may increase the possibility of radical resection in the case of liver malignancy. Concerns have been raised about the high morbidity and mortality associated with the procedure, particularly when applied for diagnoses other than colorectal liver metastases. The aim of this study was to analyze the initial experience with associating liver partition and portal vein ligation for staged hepatectomy in cases of non-colorectal liver metastases and primary hepatobiliary malignancies in Scandinavia. Materials and Methods: A retrospective analysis of all associating liver partition and portal vein ligation for staged hepatectomy procedures performed at two Swedish university hospitals for non-colorectal liver metastases and primary hepatobiliary malignancies was performed. The primary focus was on the safety of the procedure. Results and Conclusion: Ten patients were included: four had hepatocellular cancer, three had intrahepatic cholangiocarcinoma, one had a Klatskin tumor, one had ocular melanoma metastasis, and one had a metastasis from a Wilms tumor. All patients completed both operations, and the highest grade of complication (according to the Clavien-Dindo classification) was 3A, which was observed in one patient. No 90-day mortality was observed. Radical resection (R0) was achieved in nine patients, while the resection was R2 in one patient. The low morbidity and mortality observed in this cohort compared with those of earlier reports on associating liver partition and portal vein ligation for staged hepatectomy for diagnoses other than colorectal liver metastases may be related to the selection of patients with limited comorbidity. In addition, procedures other than associating liver partition and portal vein ligation for staged hepatectomy had been avoided in most of the patients. In conclusion, associating liver partition and portal vein ligation for staged hepatectomy can be applied to primary hepatobiliary malignancies and non-colorectal liver metastases with acceptable rates of morbidity and mortality.

  • 99.
    Björnsson Hallgren, Hanna
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Holmgren, Theresa
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping. Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology.
    Good outcome after repair of trauma-related anterosuperior rotator cuff tearsda prospective cohort study2021In: Journal of shoulder and elbow surgery, ISSN 1058-2746, E-ISSN 1532-6500, Vol. 30, no 7, p. 1636-1646Article in journal (Refereed)
    Abstract [en]

    Background: Anterosuperior rotator cuff tears with a displaced long head of the biceps tendon are most often trauma-related, and patients with these conditions often present with severe pain and shoulder dysfunction. Repair of the subscapularis and supraspinatus and a biceps tenodesis or a tenotomy are the recommended treatments based on retrospective studies. The aim of this study was to prospectively evaluate clinical and structural treatment outcome in a cohort of trauma-related anterosuperior injuries in patients with previously healthy shoulders. Materials and methods: Patients seeking care for a suspected rotator cuff injury after shoulder trauma were screened according to a protocol including clinical examination, baseline scoring with Western Ontario Rotator Cuff Index (WORC) and numeric rating scale of pain, ultrasound, and magnetic resonance imaging (MRI). Those with anterosuperior injuries were offered surgical treatment, structured postoperative physiotherapy, and inclusion in the present study with 1-year follow-up, including MRI, baseline scores, Constant-Murley score, and Patient Global Impression of Change. Thirty-three patients (78% men) with a mean age of 59 (40-76) years were included. Results: All patients had a biceps pulley lesion, a displaced biceps tendon, and incomplete full-thickness subscapularis and supraspinatus tears. Six patients declined surgery. At follow-up, the operated patients reached a median WORC score of 86% and a median change from baseline to follow-up of 50% (P = .0001). Pain decreased (P = .0001) at rest, at night, and during activity. The median Constant-Murley score was 86% of the contralateral nonoperated shoulder, 58% of the contralateral abduction strength recovered after surgery, and 86% reported that they were recovered or much improved. All repairs and tenodeses healed except for 2 supraspinatus tendons. The 6 nonoperated patients reached a median WORC score of 90, a change in the median value from baseline to follow-up of 31, but reported more pain, and a smaller proportion considered themselves as recovered or much improved. In all patients, the 1-year MRIs had signal changes in the upper muscular portion of subscapularis, consistent with fatty infiltration, regardless of operative or nonoperative treatment. Conclusion: Anterosuperior rotator cuff injury with an associated pulley lesion and displaced long head of the biceps tendon may be treated successfully with surgery as the majority of patients in our cohort clinically recovered or were much improved without pain after a year. With a 1-year perspective, nonoperatively treated patients may also reach a reasonable clinical outcome. Independently of treatment or tendon healing, residual subscapularis muscle injury was seen, which may have long-term implications. (C) 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

  • 100.
    Blaha, M.
    et al.
    Univ Hosp Hradec Kralove, Czech Republic.
    Berlin, Gösta
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Audzijoniene, J.
    Univ Hosp, Lithuania.
    Griskevicius, A.
    Univ Hosp, Lithuania.
    Dykes, J.
    Lund Univ, Sweden.
    Bhuiyanova, Z.
    UHKT, Czech Republic.
    Lanska, M.
    Univ Hosp Hradec Kralove, Czech Republic.
    Eich, T.
    Uppsala Akad Univ Hosp, Sweden.
    Vrielink, H.
    Sanquin Blood Supply, Netherlands.
    Witt, V.
    St Anna Kinderspital MUW, Austria.
    Seval, G. C.
    Ankara Univ, Turkey.
    Ilhan, O.
    Ankara Univ, Turkey.
    Stegmayr, B.
    Umea Univ, Sweden.
    Analysis of extracorporeal photopheresis within the frame of the WAA register2021In: Transfusion and apheresis science, ISSN 1473-0502, E-ISSN 1878-1683, Vol. 60, no 5, article id 103172Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to investigate safety and if extracorporeal photopheresis (ECP) may change health criteria (HC) and quality of life (QoL). Material and method: 560 patients (33 % women) were treated with ECP for a total of 13,871 procedures during a 17-years period. Mean age was 48 years (+/- 18, range 3-81 years). Self-estimation of QoL was graded: 0 (suicidal) up to 10 (best ever) and HC: 0 (Bed ridden, ICU condition) up to 10 (athletic). Adverse events were analyzed. ANOVA and paired comparisons were performed. Results: Patients were treated due to graft versus host disease (GVHD, n = 317), skin lymphoma (n = 70), solid organ transplants (n = 47), skin diseases (n = 20) and other diseases (n = 106). Adverse events (AEs) were registered in 5.4 % of the first treatments and in 1.2 % of the subsequent procedures. Severe AEs were present in 0.04 % of all procedures. No patient died due to the procedure. Tingling and stitching were the most common AE. For those with GVHD an improvement was noticed within approximately 10 procedures of ECP in the severity stage, QoL (from a mean of 6.1 to 6.8, p 0.002) and the HC (6.1 - 6.4, p &lt; 0.014) and improved further with added procedures. Conclusion: Photopheresis is an established therapy with few side effects. The present study of soft variables indicate that GVHD shows benefits upon ECP within approximately 10 procedures in regard to the severity of mainly skin GVHD, and lower baseline levels of HC and QoL.

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