Upsala journal of medical sciences最新文献

{"title":"Automated data extraction of electronic medical records: Validity of data mining to construct research databases for eligibility in gastroenterological clinical trials.","authors":"Nora Joseph,&nbsp;Ida Lindblad,&nbsp;Sara Zaker,&nbsp;Sharareh Elfversson,&nbsp;Maria Albinzon,&nbsp;Øyvind Ødegård,&nbsp;Li Hantler,&nbsp;Per M Hellström","doi":"10.48101/ujms.v127.8260","DOIUrl":"https://doi.org/10.48101/ujms.v127.8260","url":null,"abstract":"<p><strong>Background: </strong>Electronic medical records (EMRs) are adopted for storing patient-related healthcare information. Using data mining techniques, it is possible to make use of and derive benefit from this massive amount of data effectively. We aimed to evaluate validity of data extracted by the Customized eXtraction Program (CXP).</p><p><strong>Methods: </strong>The CXP extracts and structures data in rapid standardised processes. The CXP was programmed to extract TNFα-native active ulcerative colitis (UC) patients from EMRs using defined International Classification of Disease-10 (ICD-10) codes. Extracted data were read in parallel with manual assessment of the EMR to compare with CXP-extracted data.</p><p><strong>Results: </strong>From the complete EMR set, 2,802 patients with code K51 (UC) were extracted. Then, CXP extracted 332 patients according to inclusion and exclusion criteria. Of these, 97.5% were correctly identified, resulting in a final set of 320 cases eligible for the study. When comparing CXP-extracted data against manually assessed EMRs, the recovery rate was 95.6-101.1% over the years with 96.1% weighted average sensitivity.</p><p><strong>Conclusion: </strong>Utilisation of the CXP software can be considered as an effective way to extract relevant EMR data without significant errors. Hence, by extracting from EMRs, CXP accurately identifies patients and has the capacity to facilitate research studies and clinical trials by finding patients with the requested code as well as funnel down itemised individuals according to specified inclusion and exclusion criteria. Beyond this, medical procedures and laboratory data can rapidly be retrieved from the EMRs to create tailored databases of extracted material for immediate use in clinical trials.</p>","PeriodicalId":23458,"journal":{"name":"Upsala journal of medical sciences","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2022-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8809051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39930750","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":"Desmosomes in squamous cell carcinomas.","authors":"Vitorino Modesto Dos Santos,&nbsp;Lister Arruda Modesto Dos Santos,&nbsp;Taciana Arruda Modesto Sugai","doi":"10.48101/ujms.v127.8250","DOIUrl":"https://doi.org/10.48101/ujms.v127.8250","url":null,"abstract":"Dear Editor The differential diagnosis of adenocarcinomas and squamous cell cancer may present a challenging task in diagnostic pathology. We appreciated the informative study by Galindo et al. recently published in the Upsala Journal of Medical Science evaluating the expression of three desmosomal proteins in nonsmall cell lung cancer (1). Desmosomes are structures of the plasma membrane participating in intercellular adhesion; and proteins of the plakophilin (PKP) family, like desmoplakin and plakoglobin, play a functional role in the desmosome plaques, with PKP1 as a major component (1). Another desmosomal protein, desmoglein 3 (DSG3), can act as tumor suppressor and is downregulated in stages of invasion and metastasis. In addition, the study included several established markers for NSCLC differentiation (CK5/6, p40, p63, CK7, TTF1, and Napsin A) as well as the novel marker keratin 15 (KRT15) (1). Protein staining related to the desmosome plaque has been utilized to establish the diagnosis of squamous cell carcinoma (SCC), as the example of pulmonary and head and neck regions. Gene sequences corresponding to the desmosome plaque-related proteins PKP1, DSG3, and KRT15 are differentially expressed in primary pulmonary adenocarcinoma and SCC (1). The established and novel markers were evaluated to distinguish pulmonary SCCs (n = 41) from adenocarcinomas (n = 44) in small lung biopsies. Their respective specificities for correctly diagnosed SCC were 97.4%, 94.6%, and 100% (g). Using CK5/6, p63, and PKP1 correctly determined SCC in 97.6% of cases. Moreover, PKP1 and DSG3 expression showed association with the patient outcome (1). In addition to desmosome proteins, other tools have been used for diagnosis, clinical management, and prognostication of either suspicious or confirmed cases of SCC (1–5). PERP (apoptosis effector of p53 related to PMP22) can stabilize desmosomes and suppress the SCC development, and the local control of SCC becomes inefficient if it is absent (2). Holmes et al. analyzed the 2-year cumulative incidence of local recurrence in 44 patients with SCC and described 44.4% recurrence for the PERP-negative and 16.4% for the PERP-positive group. The authors highlighted that PERP loss at SCC surgical margins is a predictor of relapses (2). Overexpression of kallikrein 7 (KLK7) in oral SCC can promote degradation of desmosomes, favoring local tumor invasion and metastases to the lymph nodes (3). Kumar et al. studied KLK7 expression in 30 patients with oral SCCs compared to normal controls. KLK7 was differentially expressed in all tumors varying with the histopathological grades and clinical stages. KLK7 expression increased from SCC low to high grade and from clinical stages 1–4, and this enhanced activity promoted over-desquamation and was related to poor prognosis (3). The authors emphasized the potential role of KLK7 as a useful diagnostic marker for oral SCC to monitor response to therapy, or as a candidate target for the treatme","PeriodicalId":23458,"journal":{"name":"Upsala journal of medical sciences","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2022-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8788649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39904733","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":"Endocan as a potential marker in diagnosis and predicting disease severity in COVID-19 patients: a promising biomarker for patients with false-negative RT-PCR.","authors":"Esra Laloglu,&nbsp;Handan Alay","doi":"10.48101/ujms.v127.8211","DOIUrl":"https://doi.org/10.48101/ujms.v127.8211","url":null,"abstract":"<p><strong>Background: </strong>Endothelial-specific molecule 1 (endocan) has emerged as an inflammatory biomarker in recent years. The purpose of this study was to investigate the diagnostic value of serum endocan levels in the prediction of COVID-19 disease among patients with a false-negative reverse transcription polymerase change reaction (RT-PCR) test, and also to determine its correlation with the clinical severity of the disease.</p><p><strong>Methods: </strong>Thirty patients with positive RT-PCR results and 30 with false-negative RT-PCR results, both with suspected COVID-19 in terms of clinical, radiological, and laboratory findings, were included in the study. Thirty healthy controls were also enrolled.</p><p><strong>Results: </strong>Serum endocan levels were estimated to be 821.8 ± 99.3 pg/mL in COVID-19 RT-PCR (+) patients, 803.9 ± 97.0 pg/mL in RT-PCR false (-) patients with suspected COVID-19, and 382.9 ± 37.5 pg/mL in the control group. No significant difference was observed between RT-PCR (+) and RT-PCR false (-) patients (<i>P</i> = 0.68). However, serum endocan levels differed significantly between patient groups and control group (<i>P</i> < 0.05). With a cut-off value of 444.2 pg/mL serum endocan levels differentiated COVID-19 cases from healthy individuals with 92% sensitivity and 80% specificity. Moreover, a significant positive correlation was observed between serum endocan levels and clinical severity (<i>P</i> < 0.01, <i>r</i> = 0.94).</p><p><strong>Conclusions: </strong>There is a need for different laboratory markers capable of assisting diagnosis and showing COVID-19 infection in suspected COVID-19 RT-PCR false-negative patients. Endocan levels can be used as an assistant blood test for identifying COVID-19 patients with false-negative RT-PCR tests and in determining the clinical severity of the disease.</p>","PeriodicalId":23458,"journal":{"name":"Upsala journal of medical sciences","volume":"12 ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2022-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8788653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39904729","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":"Violence and sexual risk taking reported by young people at Swedish youth clinics.","authors":"Sofia Hammarström,&nbsp;Siw Alehagen,&nbsp;Helena Kilander","doi":"10.48101/ujms.v127.7823","DOIUrl":"https://doi.org/10.48101/ujms.v127.7823","url":null,"abstract":"<p><strong>Background: </strong>Early identification of sexual risk taking and exposure to violence is fundamental when seeking to strengthen young people's health. The purpose of this study was to study factors associated with sexual risk taking and ill health, as well as to study gender differences, and the associations amongst exposure to multiple forms of violence, sexual risk taking and ill health.</p><p><strong>Methods: </strong>This was a cross-sectional study based on data from 3,205 young people answering a questionnaire belonging to the Sexual health Identification Tool (SEXIT 2.0), during consultations at 12 youth clinics in Sweden. The analyses are based on descriptive statistics and nominal multiple regression analysis.</p><p><strong>Results: </strong>Male, transgender and non-binary youths reported significantly more events of sexual risk taking and ill health compared to women. Those who reported sexual initiation before the age of 15 (OR 2.87, CI 1.81-4.56), three or more sexual partners in the past 12 months (OR 2.68, CI 1.70-4.22) and to have ever experienced an unintended pregnancy (OR 2.29, CI 1.32-3.97) were more than twice as likely to report exposure to physical, emotional and sexual violence. Transgender, non-binary youths and women were more exposed to multiple violence (OR 3.68, 13.50) compared to men.</p><p><strong>Conclusions: </strong>Transgender and non-binary youths are exposed to significantly more violence compared to women and men. Experiences of sexual risk taking and ill health demonstrated strong associations with exposure to multiple violence.</p>","PeriodicalId":23458,"journal":{"name":"Upsala journal of medical sciences","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2022-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8788656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39601330","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":"Impact of treatment with immunomodulators and tumour necrosis factor antagonists on the incidence of infectious events in patients with inflammatory bowel disease.","authors":"Per Andersson,&nbsp;Pontus Karling","doi":"10.48101/ujms.v127.8167","DOIUrl":"https://doi.org/10.48101/ujms.v127.8167","url":null,"abstract":"<p><strong>Background: </strong>Corticosteroids, immunomodulators (IM) and tumour necrosis factor antagonists (anti-TNF) are commonly used in the treatment of inflammatory bowel disease (IBD) but they also supress the defence against infectious disease. The aim of this study was to analyse the incidence of infectious events in patients with IBD and the association to concomitant medical therapy.</p><p><strong>Methods: </strong>We performed a retrospective medical chart review of patients with IBD aged 18-65 years included in the Swedish Registry of Inflammatory Bowel Disease in the catchment area of Umeå University Hospital, Sweden. Data were collected from the period 01 January 2006, to 31 January 2019. An infectious event was defined as an outpatient prescription of antimicrobials or a positive diagnostic test for infection.</p><p><strong>Results: </strong>During a period of 5,120 observation-years, we observed 1,394 events in 593 patients. The mean number of infectious events per 100 person-years was 27.2 (standard deviation [SD]: 0.46). There were no differences in mean incidence rates between patients treated with no immunosuppression (23.0 events per 100 person-years, SD: 50.4), patients treated with IM monotherapy (27.6 events per 100 person-years, SD: 49.9), patients treated with anti-TNF monotherapy (34.3 events per 100 person-years, SD: 50.1) and patients on combination therapy (22.5 events per 100-person-years, SD: 44.2). In a multivariate logistic regression, female gender (adjusted odds ratio [AOR]: 2.24; 95% confidence interval [CI]: 1.49-3.37) and combination therapy (AOR: 3.46; 95% CI: 1.52-7.85) were associated with higher risks of infection (>32 events per 100 person years). Also, patients treated with any immunosuppression treatment for 25-75% (AOR: 2.29; 95% CI: 1.21-4.34) and for >75% (AOR: 1.93; 95% CI: 1.19-3.12) of the observation period were at higher risks compared to patients treated with immunosuppression <25% of the observation period.</p><p><strong>Conclusion: </strong>We observed no significant difference in risk for infections between patients on monotherapy with IM or anti-TNF and patients with low use of immunosuppression, but there was a significant risk for combination therapy.</p>","PeriodicalId":23458,"journal":{"name":"Upsala journal of medical sciences","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2022-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8788654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39601329","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 accuracy in diagnosing diverticulitis using predictive clinical factors.","authors":"Johanna Sigurdardottir,&nbsp;Abbas Chabok,&nbsp;Philippe Wagner,&nbsp;Maziar Nikberg","doi":"10.48101/ujms.v127.8803","DOIUrl":"https://doi.org/10.48101/ujms.v127.8803","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to identify clinical factors leading to increased diagnostic accuracy for acute colonic diverticulitis.</p><p><strong>Methods: </strong>Patients with clinical suspicion of acute colonic diverticulitis verified with computed tomography (CT) from two hospitals in Sweden between 9 January 2017 and 31 October 2017 were prospectively included. Symptoms, comorbidities, and laboratory results were documented. Candidate variables were analyzed using logistic regression, and the final variable set that yielded the most accurate predictions was identified using least absolute shrinkage and selection operator regression and evaluated using the area under the receiver operating characteristic (ROC) curve.</p><p><strong>Results: </strong>In total, 146 patients were included (73% women; median age 68 years; age range, 50-94 years). The clinical diagnostic accuracy was 70.5%. In the multiple logistic regression analysis, gender (female vs male odds ratio [OR]: 4.82; confidence interval [CI], 1.56-14.91), age (OR, 0.92; 95% CI, 0.87-0.98), pain on the lower left side of the abdomen (OR, 15.14; 95% CI, 2.65-86.58), and absence of vomiting (OR, 14.02; 95% CI, 2.90-67.88) were statistically significant and associated with the diagnosis of CT-verified diverticulitis. With seven predictors (age, gender, urinary symptoms, nausea, temperature, C-reactive protein, and pain left lower side), the area under the ROC curve was 0.82, and a formula was developed for calculating a risk score.</p><p><strong>Conclusion: </strong>We present a scoring system using common clinical variables that can be applied to patients with clinical suspicion of colonic diverticulitis to increase the diagnostic accuracy. The developed scoring system is available for free of charge at https://phille-wagner.shinyapps.io/Diverticulitis_risk_model/.</p>","PeriodicalId":23458,"journal":{"name":"Upsala journal of medical sciences","volume":"127 ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9793761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10524471","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":"Levels of bioactive endogenous lipids and health-related quality of life in Chronic Idiopathic Axonal Polyneuropathy.","authors":"Jonas Lind,&nbsp;Niclas Stensson,&nbsp;Björn Gerdle,&nbsp;Nazdar Ghafouri","doi":"10.48101/ujms.v127.8577","DOIUrl":"https://doi.org/10.48101/ujms.v127.8577","url":null,"abstract":"<p><strong>Background: </strong>Although neuropathic pain is a significant problem in polyneuropathy, the underlying molecular mechanisms are poorly understood. The endogenous bioactive lipids 2-arachidonoyl-glycerol (2-AG), oleoylethanolamide (OEA), palmitoylethanolamide (PEA), and stearoylethanolamide (SEA) are known to influence pain and inflammation in the peripheral nervous system. The aim of this study was to explore the plasma levels of endocannabinoids and related lipids and health-related quality of life in patients with polyneuropathy with and without pain.</p><p><strong>Methods: </strong>Patients (<i>n</i> = 48) with Chronic Idiopathic Axonal Neuropathy were included. Clinical data were retrieved from medical files. All patients filled out the SF-36 and EQ-5D questionnaires. In addition, blood samples were analyzed for 2-AG, OEA, PEA, and SEA.</p><p><strong>Results: </strong>Neuropathic pain was reported in 21 of the patients. There were significantly lower levels of 2-AG in patients with neuropathic pain (<i>P</i> = 0.03), but there were no significant differences in OEA (<i>P</i> = 0.61), PEA (<i>P</i> = 0.95), or SEA (<i>P</i> = 0.97) levels. The patients reporting pain in the hands had significantly lower SEA levels, 10.0 versus 15.0 (<i>P</i> = 0.03). The levels of 2-AG were significantly higher among patients reporting paresthesia in their feet (80.1 vs. 56.3; <i>P</i> = 0.02). Levels of PEA, SEA, and 2-AG were decreased in patients with loss of vibration. PEA and SEA were decreased in patients with loss of pain and temperature, and SEA decreased in patients with loss of sense of touch. However, the differences in the levels of bioactive endogenous lipids were not statistically significant when corrected for multiple comparisons.</p><p><strong>Conclusion: </strong>Alterations of 2-AG levels between polyneuropathy patients with and without neurogenic pain indicate that it could play an essential role. Further studies are warranted.</p>","PeriodicalId":23458,"journal":{"name":"Upsala journal of medical sciences","volume":"127 ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10445423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10077930","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":"Health-related quality of life as associated with asthma control, psychological status and insomnia.","authors":"Anna Rask-Andersen,&nbsp;Mai Leander,&nbsp;Fredrik Sundbom,&nbsp;Erik Lampa,&nbsp;Anna Oudin,&nbsp;Bénédicte Leynaert,&nbsp;Cecilie Svanes,&nbsp;Thorarinn Gislason,&nbsp;Kjell Torén,&nbsp;Christer Janson","doi":"10.48101/ujms.v127.8967","DOIUrl":"https://doi.org/10.48101/ujms.v127.8967","url":null,"abstract":"<p><strong>Background: </strong>Asthma is associated not only with lower health-related quality of life (HRQL) but also with psychological health and insomnia. The aim of this study was to investigate associations between HRQL, asthma symptoms, psychological status and insomnia in adults from three Nordic countries.</p><p><strong>Methods: </strong>This study comprised 2,270 subjects aged 29-55 from Sweden, Iceland and Norway. HRQL was measured with the 36-Item Short Form Health Survey (SF-36). The physical (PCS) and mental health (MCS) component scores were calculated with higher values, indicating better health status. Symptoms of depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS). Insomnia was assessed with the Basic Nordic Sleep Questionnaire. An asthma score consisting of a sum of the positive answers to five respiratory symptoms was used in the analysis. Spirometry and allergy tests were also performed.</p><p><strong>Results: </strong>High HADS and sleep disturbance scores were both related to a low PCS and MCS, respectively, after adjusting for confounders. High age and high body mass index (BMI) were associated with low scores on the PCS, whilst the opposite was found for the MCS. A higher asthma score was related to a low PCS. An interaction between the HADS and the asthma symptom score was observed for the PCS (<i>P</i> = 0.0002), where associations between psychological status and the PCS were more pronounced for individuals with more symptoms than for individuals without symptoms.</p><p><strong>Conclusions: </strong>In this study, we found that HRQL of life was independently related to the HADS, insomnia and asthma symptoms. Further prospective studies to identify the most efficient target for intervention in order to improve asthma control are needed.</p>","PeriodicalId":23458,"journal":{"name":"Upsala journal of medical sciences","volume":"127 ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9793762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10524469","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":"Effect of spironolactone on vascular stiffness in hemodialysis patients: a randomized crossover trial.","authors":"Michael Eklund,&nbsp;Olof Hellberg,&nbsp;Hans Furuland,&nbsp;Yang Cao,&nbsp;Kent Wall,&nbsp;Erik Nilsson","doi":"10.48101/ujms.v127.8594","DOIUrl":"https://doi.org/10.48101/ujms.v127.8594","url":null,"abstract":"<p><strong>Background: </strong>The role of spironolactone treatment in hemodialysis patients is debated, but a survival benefit is suggested. Mineralocorticoids and chronic kidney disease have been linked to cardiovascular fibrosis. Therefore, we hypothesized that spironolactone would affect vascular stiffness, cardiac systolic, and diastolic function in hemodialysis patients.</p><p><strong>Methods: </strong>This was a randomized crossover study in hemodialysis patients supplemented with an echocardiographic case series. All outcomes reported here were secondary in the trial and were assessed without blinding. Block randomization and allocation determined treatment order. Participants received 50 mg spironolactone daily for 12 weeks and untreated observation for another 12 weeks. Pulse wave velocity (PWV) was measured before and after treatment and observation. Doppler-echocardiography was conducted before and after treatment. Systemic arterial compliance indexed to body surface area (SACi), left ventricular ejection fraction (LVEF), the peak early diastolic mitral inflow velocity (E), the peak late diastolic mitral inflow velocity (A), and the peak early diastolic myocardial lengthening velocity (E') were measured. E/A and E/E' were then calculated. Statistical analyses were conducted per protocol. A generalized linear mixed model with random participant effects was used for PWV. The Wilcoxon signed-rank test was used for echocardiographic variables.</p><p><strong>Results: </strong>Thirty participants were recruited, 18 completed follow-up, and 17 were included in PWV-analyses. Spironolactone treatment showed a tendency toward an increase in PWV of 1.34 (95% confidence interval: -0.11 to 2.78) m/s, which was not statistically significant (<i>P</i> = 0.07). There were no significant changes in any of the other variables (LVEF, E/A, E/E', or SACi).</p><p><strong>Conclusions: </strong>We found no evidence supporting an effect of 12-week administration of spironolactone 50 mg daily on vascular stiffness, cardiac systolic, or diastolic function in hemodialysis patients.</p>","PeriodicalId":23458,"journal":{"name":"Upsala journal of medical sciences","volume":"127 ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9169545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10246495","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,&nbsp;Emilia Gauffin,&nbsp;Preben Henanger,&nbsp;Maciej Wajda,&nbsp;Daniel Wilhelms,&nbsp;Bertil Ekman,&nbsp;Hans J Arnqvist,&nbsp;Martin Schilling,&nbsp;Simona I Chisalita","doi":"10.48101/ujms.127.8941","DOIUrl":"https://doi.org/10.48101/ujms.127.8941","url":null,"abstract":"<p><strong>Background: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 (<i>P</i> = 0.002).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":23458,"journal":{"name":"Upsala journal of medical sciences","volume":"127 ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9793763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10524470","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}