Upsala journal of medical sciences最新文献

{"title":"Ventilation with the esophageal-tracheal Combitube during general anaesthesia: assessing complications in 540 patients.","authors":"Nicole Harrison,&nbsp;Sahra Pajenda,&nbsp;Lukasz Szarpak,&nbsp;Anna-Maria Buschsieweke,&nbsp;Mostafa Somri,&nbsp;Michael Frass,&nbsp;Bernhard Panning,&nbsp;Oliver Robak","doi":"10.48101/ujms.v128.9212","DOIUrl":"https://doi.org/10.48101/ujms.v128.9212","url":null,"abstract":"<p><strong>Background: </strong>The esophageal-tracheal Combitube (ETC) was developed for the management of difficult airways but can also be used for general anaesthesia.</p><p><strong>Methods: </strong>This clinical study collected data from patients undergoing anaesthesia with the ETC in order to assess the rate of complications.</p><p><strong>Results: </strong>Five hundred forty patients were ventilated with the ETC. In 94.8% (512/540), insertion was performed for the first time by the respective physician. The following minor complications were observed: 38.7% sore throat, 30.9% blood on tube as sign of mucosal lesions and 17.0% cyanotic tongue. Experience decreased the risk of mucosal lesions (odds ratio [OR]: 2.3, 95% confidence interval [CI]: 1.5-3.5). A higher than recommended volume of the oropharyngeal cuff was associated with blood on the ETC (OR: 1.5, 95% CI: 1.0-2.3) and tongue cyanosis (OR: 2.3, 95% CI: 1.4-3.7). Ventilation for more than 2 h was associated with tongue cyanosis (OR: 2.2, 95% CI: 1.6-3.1) and tongue protrusion (OR: 1.4, 95% CI: 1.1-1.9).</p><p><strong>Conclusion: </strong>We conclude that the Combitube may be used for short procedures requiring general anaesthesia, but the high rate of minor complications limits its value when other alternatives such as a laryngeal mask airway are available. The tested method appears safe regarding major complications, but minor complications are common. Adherence to recommended cuff volumes, experience with the ETC and limiting its use to surgeries lasting less than 2 h might reduce the rate of complications.</p>","PeriodicalId":23458,"journal":{"name":"Upsala journal of medical sciences","volume":"128 ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10265346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9646581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No effects on heart rate variability in depression after treatment with dorsomedial prefrontal intermittent theta burst stimulation.","authors":"Johan Bengtsson,&nbsp;Erik Olsson,&nbsp;Jonas Persson,&nbsp;Robert Bodén","doi":"10.48101/ujms.v128.8949","DOIUrl":"https://doi.org/10.48101/ujms.v128.8949","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to investigate whether treatment of a depressive episode with intermittent theta burst stimulation (iTBS) over the dorsomedial prefrontal cortex (DMPFC) had any effects on heart rate variability (HRV). We also investigated if changes in HRV covaried with symptom change after iTBS and if HRV could predict symptom change.</p><p><strong>Methods: </strong>We included 49 patients with a current depressive episode. All were randomized to receive a double-blind treatment course with active or sham iTBS over the DMPFC. HRV data were obtained from 1 h of night data before and after the iTBS. The standard deviation of the RR interval (SDNN) was chosen as primary outcome measure. Depressive, negative, and anxiety symptoms as well as self-rated health were assessed by clinicians or by self-report.</p><p><strong>Results: </strong>The group×time linear mixed model revealed no effect of iTBS on SDNN (estimate = -1.8, 95% confidence interval [CI]: -19.9 to 16.2). There were neither correlations between HRV and depressive, negative, or anxiety symptom change after iTBS nor with self-assessed health. No predictive value of HRV was found.</p><p><strong>Conclusions: </strong>Treatment for depression with dorsomedial iTBS had neither negative nor positive effects on the cardiac autonomic nervous system.</p>","PeriodicalId":23458,"journal":{"name":"Upsala journal of medical sciences","volume":"128 ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10084494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9303878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of physiological stress markers at the emergency department to readmission and death within 90 days: a prospective observational study.","authors":"Lee Ti Davidson,&nbsp;Ulf Martin Schilling,&nbsp;Hans J Arnqvist,&nbsp;Fredrik H Nystrom,&nbsp;Simona I Chisalita","doi":"10.48101/ujms.v128.9300","DOIUrl":"https://doi.org/10.48101/ujms.v128.9300","url":null,"abstract":"<p><strong>Background: </strong>Predicting the risk of readmission or death in patients at the emergency department (ED) is essential in identifying patients who would benefit the most from interventions. We aimed to explore the prognostic value of mid-regional proadrenomedullin (MR-proADM), mid-regional pro-atrial natriuretic peptide (MR-proANP), copeptin, and high-sensitivity troponin T (hs-TnT) to identify patients with a higher risk of readmission and death among patients presenting with chest pain (CP) and/or shortness of breath (SOB) in the ED.</p><p><strong>Methods: </strong>This single-center prospective observational study included non-critically ill adult patients with a chief complaint of CP and/or SOB who visited the ED at Linköping University Hospital. Baseline data and blood samples were collected, and patients were followed up for 90 days after inclusion. The primary outcome was a composite of readmission and/or death from non-traumatic causes within 90 days of inclusion. Binary logistic regression was used and receiver operating characteristics (ROC) curves were constructed to determine the prognostic performance for predicting readmission and/or death within 90 days.</p><p><strong>Results: </strong>A total of 313 patients were included and 64 (20.4%) met the primary endpoint. MR-proADM > 0.75 pmol/L (odds ratio [OR]: 2.361 [95% confidence interval [CI]: 1.031 - 5.407], <i>P</i> = 0.042) and multimorbidity (OR: 2.647 [95% CI: 1.282 - 5.469], <i>P</i> = 0.009) were significantly associated with readmission and/or death within 90 days. MR-proADM increased predictive value in the ROC analysis to age, sex, and multimorbidity (<i>P</i> = 0.006).</p><p><strong>Conclusions: </strong>In non-critically ill patients with CP and/or SOB in the ED, MR-proADM and multimorbidity may be helpful for the prediction of the risk of readmission and/or death within 90 days.</p>","PeriodicalId":23458,"journal":{"name":"Upsala journal of medical sciences","volume":"128 ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10202081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9892794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A long-term follow-up study of labor market marginalization in psychiatric patients with and without personality disorder.","authors":"Hanna Spangenberg,&nbsp;Mia Ramklint,&nbsp;Adriana Ramirez","doi":"10.48101/ujms.v128.9014","DOIUrl":"https://doi.org/10.48101/ujms.v128.9014","url":null,"abstract":"<p><strong>Background: </strong>Personality disorders (PDs) in adulthood are considered stable over time and are likely to have lasting psychosocial impact on the affected individual, including in areas like vocational functioning. The aim of this study was to study labor market marginalization (LMM) and receipt of social welfare benefits during 13 years from age 18 to 25 years in a sample of former psychiatric patients with and without PD.</p><p><strong>Methods: </strong>This study followed-up 186 former psychiatric patients who were thoroughly assessed in 2002-2004, including for PD, and compared them with controls. Participants were divided into three groups: former patients with PD, without PD, and a matched control group from the general population. Register data on employment, sick leave absence, disability pensioning, education, days of psychiatric care, income, and receipt of social welfare benefits in 2003-2016 were collected.</p><p><strong>Results: </strong>Former patients had more days of unemployment, sick leave absence, and disability pensioning and received more social welfare benefits than controls during the study period. Differences between patients with and without PD were smaller than expected, but significant as regards receipt of social welfare benefits. PD also had an effect on income at age 30 years.</p><p><strong>Conclusions: </strong>Early onset of psychiatric disorders impairs vocational functioning up to 13 years after diagnosis, and most in those with PD.</p>","PeriodicalId":23458,"journal":{"name":"Upsala journal of medical sciences","volume":"128 ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10392854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9923898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased plasma endostatin and GDF15 in indolent non-Hodgkin lymphoma.","authors":"Josefin Hidman,&nbsp;Anders Larsson,&nbsp;Måns Thulin,&nbsp;Torbjörn Karlsson","doi":"10.48101/ujms.v128.9392","DOIUrl":"https://doi.org/10.48101/ujms.v128.9392","url":null,"abstract":"<p><strong>Background: </strong>Increased microvascular density correlates with more advanced disease and unfavorable overall survival in non-Hodgkin lymphoma (NHL), suggesting that angiogenesis is important for disease progression. However, studies of anti-angiogenic agents in NHL patients, have generally not shown favorable outcomes. The aim of this study was to investigate whether plasma levels of a subset of angiogenesis-associated proteins are increased in indolent B-cell derived NHL (B-NHL) and to investigate whether the levels differ between patients with asymptomatic versus symptomatic disease.</p><p><strong>Methods: </strong>Plasma levels of growth differentiation factor 15 (GDF15), endostatin, matrix metalloproteinase 9 (MMP9), neutrophil gelatinase-associated lipocalin (NGAL), long pentraxin 3 (PTX3), and galectin 3 (GAL-3) were measured by ELISA in 35 patients with symptomatic indolent B-NHL, 41 patients with asymptomatic disease, and 62 healthy controls. Bootstrap t-tests were used to assess the relative differences in biomarker levels between groups. Group differences were visualized using a principal component plot.</p><p><strong>Results: </strong>Mean plasma endostatin and GDF15 levels were significantly higher in symptomatic and asymptomatic lymphoma patients than in controls. Symptomatic patients had higher mean MMP9 and NGAL than controls.</p><p><strong>Conclusions: </strong>The finding of increased plasma endostatin and GDF15 in patients with asymptomatic indolent B-NHL suggests that increased angiogenic activity is an early event in indolent B-NHL disease progression.</p>","PeriodicalId":23458,"journal":{"name":"Upsala journal of medical sciences","volume":"128 ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10202080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9892789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Admission of patients with chest pain and/or breathlessness from the emergency department in relation to risk assessment and copeptin levels – an observational study","authors":"Lee Ti Davidson, Emilia Gauffin, Preben Henanger, M. Wajda, Daniel B. Wilhelms, B. Ekman, H. Arnqvist, Martin Schilling, S. Chisalita","doi":"10.48101/ujms.v127.8941","DOIUrl":"https://doi.org/10.48101/ujms.v127.8941","url":null,"abstract":"Background One of the most critical decisions that emergency department (ED) physicians make is the discharge versus admission of patients. We aimed to study the association of the decision in the ED to admit patients with chest pain and/or breathlessness to a ward with risk assessment using the Rapid Emergency Triage and Treatment System (RETTS), the National Early Warning Score (NEWS), and plasma levels of the biomarkers copeptin, midregional proadrenomedulin (MR-proADM), and midregional proatrial natriuretic peptide (MR-proANP). Methods Patients presenting at the ED with chest pain and/or breathlessness with less than one week onset were enrolled. Patients were triaged according to RETTS. NEWS was calculated from the vital signs retrospectively. Results Three hundred and thirty-four patients (167 males), mean age 63.8 ± 16.8 years, were included. Of which, 210 (62.8%) patients complained of chest pain, 65 (19.5%) of breathlessness, and 59 (17.7%) of both. Of these, 176 (52.7%) patients were admitted to a ward, and 158 (47.3%) patients were discharged from the ED. In binary logistic models, age, gender, vital signs (O2 saturation and heart rate), NEWS class, and copeptin were associated with admission to a ward from the ED. In receiver-operating-characteristics (ROC) analysis, copeptin had an incremental predictive value compared to NEWS alone (P = 0.002). Conclusions Emergency physicians’ decisions to admit patients with chest pain and/or breathlessness from the ED to a ward are related to age, O2 saturation, heart rate, NEWS category, and copeptin. As an independent predictive marker for admission, early analysis of copeptin might be beneficial when improving patient pathways at the ED.","PeriodicalId":23458,"journal":{"name":"Upsala journal of medical sciences","volume":"127 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2022-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43170379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward a granular molecular-anatomic map of the blood vasculature - single-cell RNA sequencing makes the leap.","authors":"Christer Betsholtz","doi":"10.48101/ujms.v127.9051","DOIUrl":"https://doi.org/10.48101/ujms.v127.9051","url":null,"abstract":"<p><p>Single-cell RNA sequencing (scRNAseq) marks the birth of a new era in physiology and medicine. Within foreseeable future, we will know exactly what genes are expressed - and at what levels - in all the different cell types and subtypes that make up our bodies. We will also learn how a particular cell state, whether it occurs during development, tissue repair, or disease, reflects precise changes in gene expression. While profoundly impacting all areas of life science, scRNAseq may lead to a particular leap in vascular biology research. Blood vessels pervade and fulfill essential functions in all organs, but the functions differ. Innumerable organ-specific vascular adaptations and specializations are required. These, in turn, are dictated by differential gene expression by the two principal cellular building blocks of blood vessels: endothelial cells and mural cells. An <i>organotypic</i> vasculature is essential for functions as diverse as thinking, gas exchange, urine excretion, and xenobiotic detoxification in the brain, lung, kidney, and liver, respectively. In addition to the organotypicity, vascular cells also differ along the vascular arterio-venous axis, referred to as <i>zonation</i>, differences that are essential for the regulation of blood pressure and flow. Moreover, gene expression-based molecular changes dictate states of <i>cellular activity</i>, necessary for angiogenesis, vascular permeability, and immune cell trafficking, i.e. functions necessary for development, inflammation, and repair. These different levels of cellular heterogeneity create a nearly infinite phenotypic diversity among vascular cells. In this review, I summarize and exemplify what scRNAseq has brought to the picture in just a few years and point out where it will take us.</p>","PeriodicalId":23458,"journal":{"name":"Upsala journal of medical sciences","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2022-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9602202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40446746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ulcerative colitis progression: a retrospective analysis of disease burden using electronic medical records.","authors":"David Dahlgren,&nbsp;Lars Agréus,&nbsp;Jan Stålhammar,&nbsp;Per M Hellström","doi":"10.48101/ujms.v127.8833","DOIUrl":"https://doi.org/10.48101/ujms.v127.8833","url":null,"abstract":"Background Ulcerative colitis (UC) is a debilitating inflammatory bowel disease. Present knowledge regarding UC disease progression over time is limited. Objective To assess UC progression to severe disease along with disease burden and associated factors. Methods Electronic medical records linked with Swedish national health registries (2005–2015) were used to identify disease progression of UC. Odds of all-cause and disease-related hospitalization within 1 year were compared between patients with disease progression and those without. Annual indirect costs were calculated based on sick leave, and factors related to UC progression were examined. Results Of the 1,361 patients with moderate UC, 24% progressed to severe disease during a median of 5.2 years. Severe UC had significantly higher odds for all-cause (OR [odds ratio] 1.47, 95% CI [confidence interval]: 1.12–1.94, P < 0.01) and UC-related hospitalization (OR 2.47, 95% CI: 1.76–3.47, P < 0.0001) compared to moderate disease. Average sick leave was higher in patients who progressed compared to those who did not (64.4 vs 38.6 days, P < 0.001), with higher indirect costs of 151,800 SEK (16,415 €) compared with 92,839 SEK (10,039 €) (P < 0.001), respectively. UC progression was related to young age (OR 1.62, 95% CI: 1.17–2.25, P < 0.01), long disease duration (OR 1.09, 95% CI: 1.03–1.15, P < 0.001), and use of corticosteroids (OR 2.49, 95% CI: 1.67–3.72, P < 0.001). Conclusion Disease progression from moderate to severe UC is associated with more frequent and longer hospitalizations and sick leave. Patients at young age with long disease duration and more frequent glucocorticosteroid medication are associated with progression to severe UC.","PeriodicalId":23458,"journal":{"name":"Upsala journal of medical sciences","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2022-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9602193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40446747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Molecular tools to monitor health and disease - and lucky coincidences.","authors":"Ulf Landegren","doi":"10.48101/ujms.v127.8987","DOIUrl":"https://doi.org/10.48101/ujms.v127.8987","url":null,"abstract":"<p><p>Improved methods for molecular analyses are obviously central for medical research. I will describe herein our work developing tools to reveal molecular states in health and disease. I will recount how I got started in this endeavor, and how our early work characterizing genetic variation led onto high-throughput protein measurements and to techniques for imaging the distribution of proteins and their activity states in tissues. I will also describe a more recent technique to measure even exceedingly rare genetic variants in order to monitor recurrence of disease for tumor patients.</p>","PeriodicalId":23458,"journal":{"name":"Upsala journal of medical sciences","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2022-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9602189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40456245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tissue-based diagnosis of systemic amyloidosis: Experience of the informal diagnostic center at Uppsala University Hospital.","authors":"Justina Damjanovic Vesterlund,&nbsp;Elisabet Ihse,&nbsp;Ulrika Thelander,&nbsp;Alice Zancanaro,&nbsp;Gunilla T Westermark,&nbsp;Per Westermark","doi":"10.48101/ujms.v127.8913","DOIUrl":"https://doi.org/10.48101/ujms.v127.8913","url":null,"abstract":"Diagnosis of systemic amyloidosis is a clinical challenge and usually relies on a tissue biopsy. We have developed diagnostic methods based on the presence of amyloid deposits in abdominal subcutaneous fat tissue. This tissue is also used to determine the biochemical type of amyloidosis, performed by western blot and immunohistochemical analyses with the aid of in-house developed rabbit antisera and mouse monoclonal antibodies. Mass spectrometric methods are under development for selected cases. The diagnostic outcome for 2018-2020 was studied. During this period, we obtained 1,562 biopsies, of which 1,397 were unfixed subcutaneous fat tissue with varying degrees of suspicion of systemic amyloidosis. Of these, 440 contained amyloid deposits. The biochemical nature of the amyloid was determined by western blot analysis in 319 specimens and by immunohistochemistry in further 51 cases.","PeriodicalId":23458,"journal":{"name":"Upsala journal of medical sciences","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2022-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9602200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40456246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}