1
|
Magnuson A, Dean MN, Weaver J, Fontenelle JP, Lovejoy NR, Kolmann MA. Independent transitions to freshwater environments promote phenotypic divergence, not convergence, in stingrays. Integr Comp Biol 2024:icae023. [PMID: 38653716 DOI: 10.1093/icb/icae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Instances of convergent or parallel evolution provide a potent model system for exploring contingency and determinism in evolutionary biology. Likewise, the multiple, independent habitat transitions from saltwater to freshwater biomes offer opportunity for studying convergent evolution within and among different vertebrate lineages. For example, stingrays have invaded freshwater habitats multiple times across different continents, sometimes even several times within the same clade (e.g., Dasyatidae). We evaluated the frequency of saltwater-freshwater invasions in stingrays, compared ecological and phenotypic diversification among freshwater and saltwater lineages, and assessed the degree of convergence among freshwater species. Despite not being morphologically distinct from saltwater stingrays, freshwater stingrays do expand the margins of stingray morphological diversity. According to our data, trophic specialists occupied non-overlapping regions of morphospace, with piscivores and molluscivores being distinct from other diet guilds. Freshwater stingrays as a group did not strongly converge morphologically, neither did freshwater rays from different lineages which shared similar niches. These findings could be explained by there not being enough time for convergence to occur among more ancient and more recent freshwater lineages. Alternatively, the different ancestral bauplans of various freshwater ray lineages and weak selection on optimal phenotypes could promote contingency in the form of evolution along paths of least resistance.
Collapse
Affiliation(s)
- A Magnuson
- Department of Biology, University of Louisville, Louisville, KY 40292
| | - M N Dean
- Department of Infectious Diseases and Public Health, City University of Hong Kong, Kowloon, Hong Kong
| | - J Weaver
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
| | - J P Fontenelle
- Institute of Forestry and Conservation, University of Toronto, Toronto, ON M5S 2J5, Canada
| | - N R Lovejoy
- Department of Ecology & Evolutionary Biology, University of Toronto, Toronto, ON M5S 2J5, Canada
| | - M A Kolmann
- Department of Biology, University of Louisville, Louisville, KY 40292
| |
Collapse
|
2
|
Hildén K, Magnuson A, Montgomery S, Schwarcz E, Hanson U, Simmons D, Backman H. Previous pre-eclampsia, gestational diabetes mellitus and the risk of cardiovascular disease: A nested case-control study in Sweden. BJOG 2023. [PMID: 36974033 DOI: 10.1111/1471-0528.17454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/12/2023] [Accepted: 01/30/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE Pre-eclampsia and gestational diabetes mellitus (GDM) are two common pregnancy complications that affect birth outcomes and are associated with a long-term risk of cardiovascular disease (CVD). The aims of this study were to investigate if the pre-eclampsia association with CVD is independent of GDM and modified by body mass index (BMI) or GDM. DESIGN Case-control study. SETTING Sweden. POPULATION Cases were women with a first CVD event between 1991 and 2008 and a previous pregnancy who were matched with controls without CVD (1:5) by year of birth, age and region of birth. METHODS Conditional logistic regression was used to evaluate the associations of GDM, pre-eclampsia and maternal BMI with CVD adjusted for potential confounders and effect modifications with interaction tests. MAIN OUTCOME MEASURES CVD. RESULTS There were 2639 cases and 13 310 controls with complete data. Pre-eclampsia and GDM were independent risk factors for CVD (adjusted odds ratio [aOR] 2.59, 95% CI 2.12-3.17 and aOR 1.47, 95% CI 1.04-2.09, respectively). After stratifying by maternal BMI, the adjusted association of pre-eclampsia with CVD did not differ notably between BMI groups: normal weight (aOR 2.65, 95% CI 1.90-3.69), overweight (aOR 2.67, 95% CI 1.52-4.68) and obesity (aOR 3.03, 95% CI 0.74-12.4). Similar findings were seen when stratifying on GDM/non-GDM. CONCLUSIONS Pre-eclampsia and GDM are independent risk factors for later CVD and having both during pregnancy is a major risk factor for later CVD. The association between pre-eclampsia and CVD is not modified by BMI. Effective CVD preventive programs for high-risk women are urgently needed in order to improve women's long-term health.
Collapse
Affiliation(s)
- K Hildén
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - A Magnuson
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - S Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - E Schwarcz
- Department of Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - U Hanson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Faculty of Medicine, Health Örebro University, Örebro, Sweden
| | - D Simmons
- Faculty of Medicine, Health Örebro University, Örebro, Sweden
- School of Medicine, Western Sydney University, Campbelltown, Australia
| | - H Backman
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| |
Collapse
|
3
|
Arana E, Mohamed M, Culakova E, Tylock R, Wells M, Flannery M, Mustian K, Cupertino A, Magnuson A, Mohile S. Patient-reported pain augments Common Terminology Criteria for Adverse Events (CTCAEs) to detect pain in older adults with advanced cancer receiving treatment. J Geriatr Oncol 2022. [DOI: 10.1016/s1879-4068(22)00312-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
4
|
Gilmore N, Kehoe L, Morthi K, Hall B, Shabangu T, Jean J, Melnyk N, Liu J, Burnette B, Targia V, Mohile S, Magnuson A. Patient-centered Communication among Older Patients with Advanced Cancer and Oncologists – The Influence of Patient’s Race. J Geriatr Oncol 2022. [DOI: 10.1016/s1879-4068(22)00307-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
5
|
Yilmaz S, Janelsins MC, Flannery M, Culakova E, Wells M, Lin PJ, Loh KP, Epstein R, Kamen C, Kleckner AS, Norton SA, Plumb S, Alberti S, Doyle K, Porto M, Weber M, Dukelow N, Magnuson A, Kehoe LA, Nightingale G, Jensen-Battaglia M, Mustian KM, Mohile SG. Protocol paper: Multi-site, cluster-randomized clinical trial for optimizing functional outcomes of older cancer survivors after chemotherapy. J Geriatr Oncol 2022; 13:892-903. [PMID: 35292232 PMCID: PMC9283231 DOI: 10.1016/j.jgo.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/01/2022] [Accepted: 03/04/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Cancer survivors over the age of 65 have unique needs due to the higher prevalence of functional and cognitive impairment, comorbidities, geriatric syndromes, and greater need for social support after chemotherapy. In this study, we will evaluate whether a Geriatric Evaluation and Management-Survivorship (GEMS) intervention improves functional outcomes important to older cancer survivors following chemotherapy. METHODS A cluster-randomized trial will be conducted in approximately 30 community oncology practices affiliated with the University of Rochester Cancer Center (URCC) National Cancer Institute Community Oncology Research Program (NCORP) Research Base. Participating sites will be randomized to the GEMS intervention, which includes Advanced Practice Practitioner (APP)-directed geriatric evaluation and management (GEM), and Survivorship Health Education (SHE) that is combined with Exercise for Cancer Patients (EXCAP©®), or usual care. Cancer survivors will be recruited from community oncology practices (of participating oncology physicians and APPs) after the enrolled clinicians have consented and completed a baseline survey. We will enroll 780 cancer survivors aged 65 years and older who have completed curative-intent chemotherapy for a solid tumor malignancy within four weeks of study enrollment. Cancer survivors will be asked to choose one caregiver to also participate for a total up to 780 caregivers. The primary aim is to compare the effectiveness of GEMS for improving patient-reported physical function at six months. The secondary aim is to compare effectiveness of GEMS for improving patient-reported cognitive function at six months. Tertiary aims include comparing the effectiveness of GEMS for improving: 1) Patient-reported physical function at twelve months; 2) objectively assessed physical function at six and twelve months; and 3) patient-reported cognitive function at twelve months and objectively assessed cognitive function at six and twelve months. Exploratory health care aims include: 1) Survivor satisfaction with care, 2) APP communication with primary care physicians (PCPs), 3) completion of referral appointments, and 4) hospitalizations at six and twelve months. Exploratory caregiver aims include: 1) Caregiver distress; 2) caregiver quality of life; 3) caregiver burden; and 4) satisfaction with patient care at six and twelve months. DISCUSSION If successful, GEMS would be an option for a standardized APP-led survivorship care intervention. TRIAL REGISTRATION ClinicalTrials.govNCT05006482, registered on August 9, 2021.
Collapse
Affiliation(s)
- S Yilmaz
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA; Geriatric Oncology Research, James P Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA.
| | - M C Janelsins
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - M Flannery
- School of Nursing, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - E Culakova
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - M Wells
- Geriatric Oncology Research, James P Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - P-J Lin
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - K P Loh
- Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - R Epstein
- Department of Family Medicine Research, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - C Kamen
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - A S Kleckner
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
| | - S A Norton
- School of Nursing, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - S Plumb
- Geriatric Oncology Research, James P Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - S Alberti
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - K Doyle
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - M Porto
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - M Weber
- Department of Neurology, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - N Dukelow
- Department of Medicine, Physical Medicine and Rehabilitation, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - A Magnuson
- Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - L A Kehoe
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - G Nightingale
- Department of Pharmacy Practice, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA, USA
| | - M Jensen-Battaglia
- Geriatric Oncology Research, James P Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - K M Mustian
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - S G Mohile
- Geriatric Oncology Research, James P Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA; Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| |
Collapse
|
6
|
Noordhoek I, Sohn M, Wang L, Mohamed M, Mohile S, Loh K, Wildes T, Kyi K, Burnette B, Faller B, Bradley T, Magnuson A. Validation of the Cancer and Aging Research Group (CARG) Toxicity Score in the Community Oncology Setting. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00399-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
7
|
Kadambi S, Pan Z, Xu H, Kehoe L, Magnuson A, Mohile S, Burnette B, Bradley T, Bearden J, Loh K. Functional status in older adults with cancer, caregiver mastery, and caregiver depression. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00370-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
8
|
Sanapala C, Watson E, Jensen-Battaglia M, Culakova E, Sohn M, Flannery M, Magnuson A, Wildes T, Hazelwood D, Mohile S, Loh K. Correlation between the Short Physical Performance Battery (SPPB) and virtual SPPB (vSPPB) among older adults with myeloid malignancies. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00357-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
9
|
Watson E, Sanapala C, Klepin H, Mohile S, Wittink M, Norton S, Richardson D, Dale W, Magnuson A, Mendler J, Liesveld J, Huselton E, Leblanc T, El-Jawahri A, Wong M, Yang S, Loh K. Developing and adapting a patient-centered communication tool (UR-GOAL) for older patients with acute myeloid leukemia (AML) and their oncologist. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00358-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
10
|
Sztaniszlav A, Magnuson A, Bryngelsson IL, Edvardsson N, Sztaniszlav K, Poci D. Trends in all-cause mortality of atrial fibrillation in hospitalized patients in Sweden between 1995–2008. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Atrial fibrillation (AF) is the most common arrythmia. Both its incidence and prevalence increased significantly during the last decades. AF is associated with high morbidity and mortality.
Purpose
The aim of this study was to describe and evaluate the trends of all-cause mortality in patients first-ever hospitalized for AF, and the effect of age, sex, stroke risk, and education level on mortality over time.
Methods
In this observational retrospective cohort study, we enrolled the patients who were hospitalized primarily and for the first time because of AF between 1st January 1995 and 31st December 2004. In regard to the date of the index admission patients were divided into four cohorts and they were followed up to five years. Patients were compared with an age and sex matched control population. All data were collected from Swedish national registries. Kaplan-Meier plots and Cox regression with trend analysis were used for statistical evaluation.
Results
In total 64 489 AF patients (mean age 72±10.1 year) were included in this study. The control group comprised 116 893 individuals. 81.9% of the women and 58.5% of the men were older than 65 years of age. 65.5% of women and 58.5% of the men had a stroke risk of CHADS2-VA2Sc ≥2.
We found a significantly decreasing trend of the relative risk for all-cause mortality in AF patients over time: trend HR: 0.94 (95% CI: 0.92–0.96, p<0.001) in women and trend HR: 0.91 (95% CI: 0.89–0.93 p<0.001) in men. The mortality trends between AF patients and their controls did not show significant difference: trend HR: 0.99 (95% CI: 0.96–1.02, p=0.59) in women and trend HR: 1.00 (95% CI: 0.97–1.03, p=0.98) in men. The subpopulation analysis showed that the mortality risk remained unchanged over the time in women aged 18–69 years (trend HR: 0.91 – 95% CI: 0.82–1.02, p=0.099), in patients with low stroke risk (trend HR: 1.08 – 95% CI: 0.92–1.26, p=0.36 in women and trend HR: 0.95 – 95% CI: 0.87–1.05, p=0.30 in men) and in patients with post-secondary level of education (trend HR: 0.93 – 95% CI 0.83–1.04, p=0.23 in women and trend HR: 1.04 – 95% CI: 0.96–1.12, p=0.32 in men).
Conclusion
The all-cause mortality risk of the AF hospitalized patients was higher compared to control population and had a decreasing tendency during the time of the study. However, this trend is not significantly different from the control population. We found unchanged mortality trend in younger patients, in those with lower stroke risk, and in patients with higher education level.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
| | | | | | | | | | - D Poci
- Orebro University Hospital, Orebro, Sweden
| |
Collapse
|
11
|
Abstract
AIM The primary objective was to describe the incidence, symptoms, clinical signs, and time of onset of neonatal pneumothorax in Örebro County during 2011-2017. Secondary objectives were to describe risk factors, diagnostic procedures, treatments, and mortality and to compare preterm with term/post-term neonates. MATERIALS AND METHODS This retrospective population-based descriptive study included all neonates born in Örebro County during 2011-2017 and admitted to the neonatal intensive care unit at Örebro University Hospital at age <28 days with an x-ray verified diagnosis of "Pneumothorax originating in the perinatal period" in their medical record. RESULTS Seventy-five neonates matched the inclusion criteria. The incidence of neonatal pneumothorax in Örebro County during the study period was 3.1 (95% CI: 2.5-3.8) per 1000 live births. All neonates were <48 h at debut of respiratory symptoms and the most common symptom was tachypnea. Twelve (16%) received invasive treatment. The mortality rate was 2 (3%), none due to pneumothorax. CONCLUSION The incidence of 3.1 per 1000 live births was relatively high, but the frequency of invasive treatment and mortality was low, indicating a high proportion of mild pneumothoraces. The lack of patients aged >48 h indicates that most neonatal pneumothoraces now occur very early in life.
Collapse
Affiliation(s)
| | - A Magnuson
- Clinical Epidemiology and Biostatistics Department, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - A Ohlin
- Department of Pediatrics, Örebro University Hospital, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| |
Collapse
|
12
|
Hildén K, Magnuson A, Hanson U, Simmons D, Fadl H. Trends in pregnancy outcomes for women with gestational diabetes mellitus in Sweden 1998-2012: a nationwide cohort study. Diabet Med 2020; 37:2050-2057. [PMID: 32027045 DOI: 10.1111/dme.14266] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2020] [Indexed: 12/31/2022]
Abstract
AIM To assess whether incidence of maternal and neonatal outcomes for women with or without gestational diabetes mellitus (GDM) have changed over time. METHODS Population-based cohort study in Sweden including all singleton pregnancies over the period 1998-2012. GDM was diagnosed following Diabetic Pregnancy Study Group 1991 criteria. Poisson regression or negative binomial regression was used to model yearly relative change in numbers of cases and incidence of the outcomes with 95% confidence intervals (CI), and yearly absolute change in birthweight z-score. RESULTS The study included 1 455 667 pregnancies. The number of pregnancies increased over time and the overall prevalence of GDM was 1%. For women with GDM there was a significantly decreasing trend in incidence per year for large for gestational age (LGA) (0.986, 95% CI 0.975 to 0.996), birthweight z-score (-0.012, 95% CI -0.017 to -0.007) and birth trauma (0.937, 95% CI 0.907 to 0.968). The trend for small for gestational age (SGA) among women with GDM increased by an odds ratio per year (1.016, 95% CI 1.002 to 1.029). No significant interaction tests for maternal characteristics were found. Trends in outcomes for women without diabetes were similar to those for women with GDM. CONCLUSIONS This study shows that there were improvements in pregnancy outcomes for women with GDM between 1998 and 2012, although the incidence of SGA increased. Improvements followed similar trends in the background population. Inequalities in obstetric outcomes between women with GDM and those without have continued unchanged over 15 years, suggesting that new management strategies are required to reduce this gap.
Collapse
Affiliation(s)
- K Hildén
- Department of Obstetrics and Gynaecology, Örebro University, Örebro, Sweden
| | - A Magnuson
- Clinical Epidemiology and Biostatistics, Örebro University, Örebro, Sweden
| | - U Hanson
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - D Simmons
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - H Fadl
- Department of Obstetrics and Gynaecology, Örebro University, Örebro, Sweden
| |
Collapse
|
13
|
Jansson K, Strand I, Redler B, Magnuson A, Ungerstedt U, Norgren L. Results of intraperitoneal microdialysis depend on the location of the catheter. Scandinavian Journal of Clinical and Laboratory Investigation 2020; 64:63-70. [PMID: 15025430 DOI: 10.1080/00365510410004100] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Intraperitoneal microdialysis was recently described as a method for early detection of visceral ischemia. The method seems safe and accurate. The intra-abdominal catheter used may imply variations in results depending on the location of the catheter. The aim of the study was to investigate possible differences in metabolic parameters obtained depending on various locations of the intra-abdominal catheter, compared with using the subcutaneous reference catheter. METHOD After right-sided hemicolectomy in 12 patients, three catheters were placed and fixed intraperitoneally: one at the anastomosis, one in the omentum and one embedded between the small intestinal loops. A subcutaneous catheter placed in the pectoral region was used as reference. Analyses of lactate/pyruvate ratio and glucose and glycerol levels were done during a period of 45 hours postoperatively. RESULTS Lactate/pyruvate ratio decreased numerically at all three intraperitoneal locations during the study while the subcutaneous lactate/pyruvate ratio increased slightly. Significant differences between intraperitoneal and subcutaneous locations were found as well as differences between the three intraperitoneal locations. Highest values of the lactate/pyruvate ratio were found at the anastomosis, while the widest range was found at the small intestine. Subcutaneous glucose levels were lower while glycerol levels were higher compared with intraperitoneal values. CONCLUSIONS In evaluating postoperative metabolism, intraperitoneal microdialysis is influenced by the location of the microdialysis catheter. The same pattern is, however, recorded over time. The juxta-anastomotic region and the small intestinal loop area seem to be the most reasonable locations for measurements.
Collapse
Affiliation(s)
- K Jansson
- Department of Surgery, Orebro University Hospital, Orebro, Sweden.
| | | | | | | | | | | |
Collapse
|
14
|
Hildén K, Hanson U, Persson M, Magnuson A, Simmons D, Fadl H. Gestational diabetes and adiposity are independent risk factors for perinatal outcomes: a population based cohort study in Sweden. Diabet Med 2019; 36:151-157. [PMID: 30698864 PMCID: PMC6590111 DOI: 10.1111/dme.13843] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2018] [Indexed: 12/20/2022]
Abstract
AIMS To evaluate the interaction effects of gestational diabetes (GDM) with obesity on perinatal outcomes. METHODS A population-based cohort study in Sweden excluding women without pre-gestational diabetes with a singleton birth between 1998 and 2012. Logistic regression was performed to evaluate the potential independent associations of GDM and BMI with adverse perinatal outcomes as well as their interactions. Main outcome measures were malformations, stillbirths, perinatal mortality, low Apgar score, fetal distress, prematurity and Erb's palsy. RESULTS Some 1,294,006 women were included, with a GDM prevalence of 1% (n = 14,833). The rate of overweight/obesity was 67.7% in the GDM-group and 36.1% in the non-GDM-group. No significant interaction existed. Offspring of women with GDM had significantly increased risk of malformations, adjusted odds ratio (aOR) 1.16 (95% confidence intervals 1.06-1.26), prematurity, aOR 1.86 (1.76-1. 98), low Apgar score, aOR 1.36 (1.10-1.70), fetal distress, aOR 1.09 (1.02-1.16) and Erb's palsy aOR 2.26 (1.79-2.86). No risk for stillbirth or perinatal mortality was seen. Offspring of overweight (BMI 25-29.9 kg/m2 ), obese (BMI 30-34.9 kg/m2 ) and severely obese women (BMI ≥ 35.0 kg/m2 ) had significantly increased risks of all outcomes including stillbirth 1.51 (1.40-1.62) to 2.85 (2.52-3.22) and perinatal mortality 1.49 (1.40-1.59) to 2.83 (2.54-3.15). CONCLUSIONS There is no interaction effect between GDM and BMI for the studied outcomes. Higher BMI and GDM are major independent risk factors for most serious adverse perinatal outcomes. More effective pre-pregnancy and antenatal interventions are required to prevent serious adverse pregnancy outcomes among women with either GDM or high BMI.
Collapse
Affiliation(s)
- K. Hildén
- Department of Obstetrics & GynaecologySchool of Medical SciencesÖrebro UniversityÖrebroSweden
| | - U. Hanson
- School of Medical SciencesÖrebro UniversityÖrebroSweden
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
| | - M. Persson
- Department of MedicineClinical Epidemiology UnitKarolinska UniversitetssjukhusetSolnaSweden
| | - A. Magnuson
- Clinical Epidemiology and BiostatisticsSchool of Medical SciencesÖrebro UniversityÖrebroSweden
| | - D. Simmons
- School of Medical SciencesÖrebro UniversityÖrebroSweden
- School of MedicineWestern Sydney UniversityCampbelltownNSWAustralia
| | - H. Fadl
- Department of Obstetrics & GynaecologySchool of Medical SciencesÖrebro UniversityÖrebroSweden
| |
Collapse
|
15
|
Magnuson A, Sun T, Liu G, Tolba S, Lei X. 176 Supplemental dietary microalgal docosahexaenoic acid enriched this fatty acid and improved n-6. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Magnuson
- Cornell University,Ithaca, NY, United States
| | - T Sun
- Cornell University,Ithaca, NY, United States
| | - G Liu
- Cornell University,Ithaca, NY, United States
| | - S Tolba
- Cornell University,Ithaca, NY, United States
| | - X Lei
- Cornell University,Ithaca, NY, United States
| |
Collapse
|
16
|
Bjorkenheim A, Brandes A, Magnuson A, Chemnitz A, Edvardsson N, Poci D. P6602Patient-reported outcomes in relation to continuously monitored rhythm before and during two years after atrial fibrillation ablation using a disease-specific and a generic instrument. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Bjorkenheim
- Department of Cardiology, Örebro University Hospital, Örebro, Sweden
| | - A Brandes
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - A Magnuson
- Orebro University Hospital, Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, SE 70182, Orebro, Sweden
| | - A Chemnitz
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - N Edvardsson
- Sahlgrenska Academy at Sahlgrenska University Hospital, Göteborg, Sweden
| | - D Poci
- Department of Cardiology, Örebro University Hospital, Örebro, Sweden
| |
Collapse
|
17
|
Andersson T, Brygnelsson I, Magnuson A, Frober O, Henriksson K, Edvardsson N, Poci D. P4586What do patients with incident atrial fibrillation and no comorbidities at the time of diagnosis die of? Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
18
|
Siekmann W, Eintrei C, Magnuson A, Sjölander A, Matthiessen P, Myrelid P, Gupta A. Surgical and not analgesic technique affects postoperative inflammation following colorectal cancer surgery: a prospective, randomized study. Colorectal Dis 2017; 19:O186-O195. [PMID: 28258664 DOI: 10.1111/codi.13643] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/04/2017] [Indexed: 12/12/2022]
Abstract
AIM Epidural analgesia reduces the surgical stress response. However, its effect on pro- and anti-inflammatory cytokines in the genesis of inflammation following major abdominal surgery remains unclear. Our main objective was to elucidate whether perioperative epidural analgesia prevents the inflammatory response following colorectal cancer surgery. METHODS Ninety-six patients scheduled for open or laparoscopic surgery were randomized to epidural analgesia (group E) or patient-controlled intravenous analgesia (group P). Surgery and anaesthesia were standardized in both groups. Plasma cortisol, insulin and serum cytokines [interleukin 1β (IL-1β), IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p70, IL-13, tumour necrosis factor α, interferon γ, granulocyte-macrophage colony-stimulating factor, prostaglandin E2 and vascular endothelial growth factor] were measured preoperatively (T0), 1-6 h postoperatively (T1) and 3-5 days postoperatively (T2). Mixed model analysis was used, after logarithmic transformation when appropriate, for analyses of cytokines and stress markers. RESULTS >There were no significant differences in any serum cytokine concentration between groups P and E at any time point except for IL-10 which was 87% higher in group P [median and range 4.1 (2.3-9.2) pg/ml] compared to group E [2.6 (1.3-4.7) pg/ml] (P = 0.002) at T1. There was no difference in plasma cortisol and insulin between the groups at any time point after surgery. A significant difference in median serum cytokine concentration was found between open and laparoscopic surgery with higher levels of IL-6, IL-8 and IL-10 at T1 in patients undergoing open surgery compared to laparoscopic surgery. No difference in serum cytokine concentration was detected between the groups or between the surgical technique at T2. CONCLUSIONS Open surgery, compared to laparoscopic surgery, has greater impact on these inflammatory mediators than epidural analgesia vs intravenous analgesia.
Collapse
Affiliation(s)
- W Siekmann
- Department of Anaesthesiology and Intensive Care, Örebro University Hospital and School of Medical Sciences, Örebro University, Örebro, Sweden
| | - C Eintrei
- Department of Anesthesiology and Intensive Care, County Council of Östergötland, Linköping, Sweden
| | - A Magnuson
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - A Sjölander
- Cell and Experimental Pathology, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - P Matthiessen
- Department of Surgery, Örebro University Hospital and School of Medical Sciences, Örebro University, Örebro, Sweden
| | - P Myrelid
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Surgery, Linköping University Hospital, Linköping, Sweden
| | - A Gupta
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
19
|
Bjorkenheim A, Brandes A, Magnuson A, Chemnitz A, Svedberg L, Edvardsson N, Poci D. 1361Does zero atrial fibrillation burden after atrial fibrillation ablation mean that patients are free of symptoms? Europace 2017. [DOI: 10.1093/ehjci/eux157.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
20
|
Kuchálik J, Magnuson A, Tina E, Gupta A. Does local infiltration analgesia reduce peri-operative inflammation following total hip arthroplasty? A randomized, double-blind study. BMC Anesthesiol 2017; 17:63. [PMID: 28468607 PMCID: PMC5415732 DOI: 10.1186/s12871-017-0354-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 04/26/2017] [Indexed: 02/01/2023] Open
Abstract
Background Postoperative inflammation following total hip arthroplasty (THA) can lead to delayed mobilization and return of hip function. Our primary aim was to assess whether local infiltration analgesia (LIA) during surgery can prevent postoperative inflammation. Methods This is a sub-analysis of data from a broader double-blind study where 56 patients received spinal anaesthesia for THA. Additionally, Group FNB (Femoral Nerve Block) received an ultrasound-guided femoral nerve block using 30 mL of ropivacaine 7.5 mg/mL (225 mg), and 151.5 mL of saline peri-articularly intra-operatively. Group LIA received 30 mL saline in the femoral nerve block and ropivacaine 2 mg/mL, 300 mg (150 mL) + ketorolac 30 mg (1 mL) + adrenaline 0.5 mg (0.5 mL) peri-articularly. After 23 h, the LIA mixture (22 mL) was injected via a catheter placed peri-articularly in Group LIA and 22 mL saline in Group FNB. A battery of pro- and anti-inflammatory cytokines was assessed using a commercially available kit preoperatively and after 4 h and 3 days postoperatively. Additionally, CRP, platelet count and white blood count was determined pre- and postoperatively. Results There was a general trend towards an increase in pro-inflammatory cytokines postoperatively, which returned to normal levels after 3 days. IL-6 concentration was significantly lower 4 h postoperatively in Group LIA compared to Group FNB (p = 0.015). No other significant differences were found between the groups in other cytokines. CRP levels were significantly higher in Group FNB compared to Group LIA 3 days postoperatively (p < 0.001). No other significant differences were seen between the groups. Conclusion Local infiltration analgesia has a modest but short-lasting effect on postoperative inflammation in patients undergoing total hip arthroplasty. This is likely to be due to local infiltration of ketorolac and/or local anaesthetics in the LIA mixture. Future studies should be directed towards assessing whether the use of LIA translates into better patient outcomes. Trial registration EudraCT Number 2012-003875-20. Registered 3 December 2012
Collapse
Affiliation(s)
- J Kuchálik
- Department of Anesthesiology and Intensive Care, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - A Magnuson
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - E Tina
- Clinical Research Laboratory, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - A Gupta
- Perioperative Medicine and Intensive Care, Institution for Physiology and Pharmacology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden. .,Department of Anesthesiology and Intensive Care, Karolinska University Hospital, Solna, Stockholm, Sweden.
| |
Collapse
|
21
|
Booth A, Magnuson A, Fouts J, Foster MT. Adipose tissue: an endocrine organ playing a role in metabolic regulation. Horm Mol Biol Clin Investig 2017; 26:25-42. [PMID: 26910750 DOI: 10.1515/hmbci-2015-0073] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 01/01/2016] [Indexed: 12/14/2022]
Abstract
Adipose tissue is a complex endocrine organ with an intricate role in whole body homeostasis. Beyond storing energy, adipose tissue is fundamental in numerous processes including, but not limited to, metabolism, food intake and immune cell function. Adipokines and cytokines are the signaling factors from adipose tissue. These factors play a role in maintaining health, but are also candidates for pathologies associated with obesity. Indeed excessive adiposity causes dysregulation of these factors which negatively affect health and contribute to numerous obesity-induced co-morbidities. In particular, adipokines are fundamental in regulation of glucose homeostasis and insulin signaling, thus aberrant production of these adipose derived hormones correlates with the development and progression of type 2 diabetes. Therefore, elucidation of adipose regulation is crucial for understanding the pathophysiological basis of obesity and metabolic diseases such as type 2 diabetes. In the present review, we summarize current data on the relation between adipokines and adipose depot derived cytokines in the maintenance of glucose homeostasis. Specifically, physiological and molecular functions of several adipokines are defined with particular focus on interactions within the insulin-signaling pathway and subsequent regulation of glucose uptake in both standard and obesity-induced dysregulated conditions. This same relation will be discussed for cytokines and inflammation as well.
Collapse
|
22
|
Wickberg Å, Magnuson A, Holmberg L, Liljegren G. Luminal B/HER2-negative-like subtype is a predictor for local recurrence after breast-conserving surgery and shows no interaction with randomization to postoperative radiotherapy or not after 20 years of follow-up. Breast 2017. [DOI: 10.1016/s0960-9776(17)30340-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
23
|
Särnblad S, Magnuson A, Ekelund U, Åman J. Body fat measurement in adolescent girls with type 1 diabetes: a comparison of skinfold equations against dual-energy X-ray absorptiometry. Acta Paediatr 2016; 105:1211-5. [PMID: 26873351 PMCID: PMC5031196 DOI: 10.1111/apa.13366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 02/10/2016] [Indexed: 01/20/2023]
Abstract
Aim Skinfold measurement is an inexpensive and widely used technique for assessing the percentage of body fat (%BF). This study assessed the accuracy of prediction equations for %BF based on skinfold measurements compared to dual‐energy X‐ray absorptiometry (DXA) in girls with type 1 diabetes and healthy age‐matched controls. Methods We included 49 healthy girls and 44 girls with diabetes aged 12–19 years old, comparing the predicted %BF based on skinfold measurements and the %BF values obtained by a Lunar DPX‐L scanner. The agreement between the methods was assessed using an Bland–Altman plot. Results The skinfold measurements were significantly higher in girls with diabetes (p = 0.003) despite a nonsignificant difference in total %BF (p = 0.1). A significant association between bias and %BF was found for all tested equations in the Bland–Altman plots. Regression analysis showed that the association between skinfold measurements and %BF measured by DXA differed significantly (p = 0.039) between the girls with diabetes and the healthy controls. Conclusion The accuracy of skinfold thickness equations for assessment of %BF in adolescent girls with diabetes is poor in comparison with DXA measurements as criterion. Our findings highlight the need for the development of new prediction equations for girls with type 1 diabetes.
Collapse
Affiliation(s)
- S Särnblad
- Faculty of Medical Sciences School of Medicine Örebro University Örebro Sweden
| | - A Magnuson
- Faculty of Medical Sciences Clinical Epidemiology and Biostatistics Örebro University Örebro Sweden
| | - U Ekelund
- Department of Sport Medicine Norwegian School of Sport Sciences Oslo Norway
- Medical Research Council Epidemiology Unit Cambridge UK
| | - J Åman
- Faculty of Medical Sciences School of Medicine Örebro University Örebro Sweden
| |
Collapse
|
24
|
Jansson SPO, Fall K, Brus O, Magnuson A, Wändell P, Östgren CJ, Rolandsson O. Response to Carlsson et al.: Prevalence and incidence of diabetes mellitus: a nationwide population-based pharmaco-epidemiological study in Sweden. Diabet Med 2016; 33:1150-2. [PMID: 26444576 DOI: 10.1111/dme.12983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 08/14/2015] [Accepted: 09/30/2015] [Indexed: 10/23/2022]
Affiliation(s)
- S P O Jansson
- University Health Care Research Center, Region Örebro County, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - K Fall
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
- Clinical Epidemiology and Biostatistics, Örebro University, Örebro, Sweden
| | - O Brus
- Clinical Epidemiology and Biostatistics, Örebro University, Örebro, Sweden
| | - A Magnuson
- Clinical Epidemiology and Biostatistics, Örebro University, Örebro, Sweden
| | - P Wändell
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - C J Östgren
- Division of Community Medicine, Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- Department of Local Care West, County Council of Östergötland, Linköping, Sweden
| | - O Rolandsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| |
Collapse
|
25
|
Booth A, Magnuson A, Fouts J, Foster M. Adipose tissue, obesity and adipokines: role in cancer promotion. Horm Mol Biol Clin Investig 2015; 21:57-74. [PMID: 25781552 DOI: 10.1515/hmbci-2014-0037] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 01/07/2015] [Indexed: 01/03/2023]
Abstract
Adipose tissue is a complex organ with endocrine, metabolic and immune regulatory roles. Adipose depots have been characterized to release several adipocytokines that work locally in an autocrine and paracrine fashion or peripherally in an endocrine fashion. Adipocyte hypertrophy and excessive adipose tissue accumulation, as occurs during obesity, dysregulates the microenvironment within adipose depots and systemically alters peripheral tissue metabolism. The term "adiposopathy" is used to describe this promotion of pathogenic adipocytes and associated adipose - elated disorders. Numerous epidemiological studies confirm an association between obesity and various cancer forms. Proposed mechanisms that link obesity/adiposity to high cancer risk and mortality include, but are not limited to, obesity-related insulin resistance, hyperinsulinemia, sustained hyperglycemia, glucose intolerance, oxidative stress, inflammation and/or adipocktokine production. Several epidemiological studies have demonstrated a relationship between specific circulating adipocytokines and cancer risk. The aim of this review is to define the function, in normal weight and obesity states, of well-characterized and novel adipokines including leptin, adiponectin, apelin, visfatin, resistin, chemerin, omentin, nesfatin and vaspin and summarize the data that relates their dysfunction, whether associated or direct effects, to specific cancer outcomes. Overall research suggests most adipokines promote cancer cell progression via enhancement of cell proliferation and migration, inflammation and anti-apoptosis pathways, which subsequently can prompt cancer metastasis. Further research and longitudinal studies are needed to define the specific independent and additive roles of adipokines in cancer progression and reoccurrence.
Collapse
|
26
|
Darvish B, Dahlgren G, Irestedt L, Magnuson A, Möller C, Gupta A. Auditory function following post-dural puncture headache treated with epidural blood patch. A long-term follow-up. Acta Anaesthesiol Scand 2015; 59:1340-54. [PMID: 26105531 DOI: 10.1111/aas.12566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 04/21/2015] [Accepted: 05/10/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Epidural analgesia is commonly used for pain management during labor. Sometimes, accidental dural puncture (ADP) occurs causing severely debilitating headache, which may be associated with transient hearing loss. We investigated if auditory function may be impaired several years after ADP treated with epidural blood patch (EBP). METHODS Sixty women (ADP group) without documented hearing disability, who received EBP following ADP during labor between the years 2005-2011 were investigated in 2013 for auditory function using the following tests: otoscopic examination, tympanometry, pure tone audiometry, and transient-evoked otoacoustic emissions. Additionally, they responded to a questionnaire, the Speech, Spatial and Qualities (SSQ) of hearing, concerning perceived hearing impairment. The results were compared to a control group of 20 healthy, non-pregnant women in the same age group. RESULTS The audiometric test battery was performed 5.2 (1.9) years after delivery. No significant differences were found between the ADP and the control groups in tympanometry or otoacoustic emissions. Pure tone audiometry revealed a significant but small (< 5 dB) difference between the ADP and control groups (P < 0.05). The ability to hear speech in noise as measured by SSQ was significantly reduced in the ADP group compared to the control group (P < 0.05). CONCLUSIONS A minor hearing loss was detected in the ADP group compared to the control group in pure tone audiometry in some women and during speech-in-noise component several years after accidental dural puncture treated with an epidural blood patch. This small residual hearing loss has minor clinical significance.
Collapse
Affiliation(s)
- B. Darvish
- Department of Anesthesiology, Surgical Services and Intensive Care Medicine; Karolinska University Hospital; Solna Stockholm
- School of Medicine and Health Science; Örebro University; Örebro Sweden
| | - G. Dahlgren
- Department of Anesthesia and Intensive Care; Capio St Görans Hospital; Stockholm Sweden
| | - L. Irestedt
- Department of Anesthesiology, Surgical Services and Intensive Care Medicine; Karolinska University Hospital; Solna Stockholm
| | - A. Magnuson
- Clinical Epidemiology and Biostatistics; Faculty of Medicine and Health; Örebro University; Örebro Sweden
| | - C. Möller
- Audiological Research Centre; School of Medicine and Health Science; Örebro University/Swedish; Institute of Disability Research; Örebro Sweden
| | - A. Gupta
- Department of Anesthesiology, Surgical Services and Intensive Care Medicine; Karolinska University Hospital; Solna Stockholm
- Department of Anesthesia and Intensive care; School of Health and Medical Sciences; Örebro University; Örebro Sweden
| |
Collapse
|
27
|
Jansson SPO, Fall K, Brus O, Magnuson A, Wändell P, Östgren CJ, Rolandsson O. Prevalence and incidence of diabetes mellitus: a nationwide population-based pharmaco-epidemiological study in Sweden. Diabet Med 2015; 32:1319-28. [PMID: 25662570 DOI: 10.1111/dme.12716] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2015] [Indexed: 01/19/2023]
Abstract
AIM To investigate the changes in prevalence and incidence of pharmacologically and non-pharmacologically treated diabetes in Sweden during 2005 to 2013. METHODS We obtained data on gender, date of birth and pharmacologically and non-pharmacologically treated diabetes from national registers for all Swedish residents. RESULTS During the study period a total of 240 871 new cases of pharmacologically treated diabetes was found. The age-standardized incidence during the follow-up was 4.34 and 3.16 per 1000 individuals in men and women, respectively. A decreasing time trend in incidence for men of 0.6% per year (0.994, 95% CI 0.989-0.999) and for women of 0.7% per year (0.993, 95% CI 0.986-0.999) was observed. The age-standardized prevalence increased from 41.9 and 29.9 per 1000 in 2005/2006 to 50.8 and 34.6 in 2012/2013 in men and women, respectively. This corresponds to an annually increasing time trend for both men (1.024, 95% CI 1.022-1.027) and women (1.019, 95% CI 1.016-1.021). The total age-standardized prevalence of pharmacologically and non-pharmacologically treated diabetes (2012) was 46.9 per 1000 (55.6 for men and 38.8 for women). This corresponds to an annually increasing time trend (2010-2012) for both men (1.017, 95% CI 1.013-1.021) and women (1.012, 95% CI 1.008-1.016). CONCLUSIONS The prevalence of pharmacologically treated diabetes increased moderately during 8 years of follow-up, while the incidence decreased modestly. This is in contrast to the results reported by most other studies. The total prevalence of diabetes (both pharmacologically and non-pharmacologically treated) in Sweden is relatively low, from a global viewpoint.
Collapse
Affiliation(s)
- S P O Jansson
- Family Medicine Research Centre, Örebro County Council, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - K Fall
- Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - O Brus
- Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - A Magnuson
- Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - P Wändell
- Department of Neurobiology, Care Sciences and Society, Unit of Family Medicine, Karolinska Institutet, Huddinge, Sweden
| | - C J Östgren
- Division of Community Medicine, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Department of Local Care West, County Council of Östergötland, Linköping, Sweden
| | - O Rolandsson
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| |
Collapse
|
28
|
Savilampi J, Magnuson A, Ahlstrand R. Effects of remifentanil on esophageal motility: a double-blind, randomized, cross-over study in healthy volunteers. Acta Anaesthesiol Scand 2015; 59:1126-36. [PMID: 25923045 DOI: 10.1111/aas.12534] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 03/09/2015] [Accepted: 03/11/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent studies have shown that remifentanil increases the risk of aspiration and induces subjective swallowing difficulties. The mechanisms are not completely understood. Here, we investigated whether remifentanil impairs esophageal motility and hypothesized that this is one possible underlying mechanism. Naloxone was used to evaluate whether the effects of remifentanil are mediated through opioid receptors. We also examined subjective swallowing difficulties and the influence of metoclopramide on remifentanil-induced effects. METHODS Fourteen healthy volunteers participated in a double-blind, randomized, cross-over trial at the University Hospital in Örebro, Sweden. They were studied on two different occasions, during which they were randomly assigned to receive either naloxone given as a bolus of 6 μg/kg followed by an infusion of 0.1 μg/kg/min, or saline 5 min before target-controlled infusions of remifentanil at three target-site concentrations: 1, 2, and 3 ng/ml. On both occasions, 0.2 mg/kg metoclopramide was given before the final measurement. Five swallows were performed during each measuring condition, and the metrics defining esophageal motility were measured by high-resolution manometry. Outcomes were differences in the metrics at baseline vs. during remifentanil infusion, with naloxone vs. placebo, and with remifentanil before and after metoclopramide administration. Differences in swallowing difficulties were also recorded. RESULTS Remifentanil decreased swallow-evoked esophagogastric junction relaxation and the latency time of esophageal peristalsis. There were no significant effects of naloxone or metoclopramide on remifentanil-induced effects, and we detected no differences in swallowing difficulties. CONCLUSIONS Remifentanil induces dysfunction of esophageal motility; this may contribute to the elevated risk of regurgitation and aspiration.
Collapse
Affiliation(s)
- J. Savilampi
- Department of Anesthesiology and Intensive Care; Örebro University Hospital; Örebro Sweden
| | - A. Magnuson
- Department of Anesthesiology and Intensive Care; Örebro University Hospital; Örebro Sweden
| | - R. Ahlstrand
- Department of Anesthesiology and Intensive Care; Örebro University Hospital; Örebro Sweden
| |
Collapse
|
29
|
Booth A, Magnuson A, Foster M. Detrimental and protective fat: body fat distribution and its relation to metabolic disease. Horm Mol Biol Clin Investig 2015; 17:13-27. [PMID: 25372727 DOI: 10.1515/hmbci-2014-0009] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 02/12/2014] [Indexed: 02/06/2023]
Abstract
Obesity is linked to numerous comorbidities that include, but are not limited to, glucose intolerance, insulin resistance, dyslipidemia, and cardiovascular disease. Current evidence suggests, however, obesity itself is not an exclusive predictor of metabolic dysregulation but rather adipose tissue distribution. Obesity-related adverse health consequences occur predominately in individuals with upper body fat accumulation, the detrimental distribution, commonly associated with visceral obesity. Increased lower body subcutaneous adipose tissue, however, is associated with a reduced risk of obesity-induced metabolic dysregulation and even enhanced insulin sensitivity, thus, storage in this region is considered protective. The proposed mechanisms that causally relate the differential outcomes of adipose tissue distribution are often attributed to location and/or adipocyte regulation. Visceral adipose tissue effluent to the portal vein drains into the liver where hepatocytes are directly exposed to its metabolites and secretory products, whereas the subcutaneous adipose tissue drains systemically. Adipose depots are also inherently different in numerous ways such as adipokine release, immunity response and regulation, lipid turnover, rate of cell growth and death, and response to stress and sex hormones. Proximal extrinsic factors also play a role in the differential drive between adipose tissue depots. This review focuses on the deleterious mechanisms postulated to drive the differential metabolic response between central and lower body adipose tissue distribution.
Collapse
|
30
|
Kelly CJ, Zheng L, Campbell EL, Saeedi B, Scholz CC, Bayless AJ, Wilson KE, Glover LE, Kominsky DJ, Magnuson A, Weir TL, Ehrentraut SF, Pickel C, Kuhn KA, Lanis JM, Nguyen V, Taylor CT, Colgan SP. Crosstalk between Microbiota-Derived Short-Chain Fatty Acids and Intestinal Epithelial HIF Augments Tissue Barrier Function. Cell Host Microbe 2015; 17:662-71. [PMID: 25865369 DOI: 10.1016/j.chom.2015.03.005] [Citation(s) in RCA: 986] [Impact Index Per Article: 109.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 11/21/2014] [Accepted: 01/22/2015] [Indexed: 02/07/2023]
Abstract
Interactions between the microbiota and distal gut are fundamental determinants of human health. Such interactions are concentrated at the colonic mucosa and provide energy for the host epithelium through the production of the short-chain fatty acid butyrate. We sought to determine the role of epithelial butyrate metabolism in establishing the austere oxygenation profile of the distal gut. Bacteria-derived butyrate affects epithelial O2 consumption and results in stabilization of hypoxia-inducible factor (HIF), a transcription factor coordinating barrier protection. Antibiotic-mediated depletion of the microbiota reduces colonic butyrate and HIF expression, both of which are restored by butyrate supplementation. Additionally, germ-free mice exhibit diminished retention of O2-sensitive dyes and decreased stabilized HIF. Furthermore, the influences of butyrate are lost in cells lacking HIF, thus linking butyrate metabolism to stabilized HIF and barrier function. This work highlights a mechanism where host-microbe interactions augment barrier function in the distal gut.
Collapse
Affiliation(s)
- Caleb J Kelly
- Mucosal Inflammation Program, University of Colorado, Aurora, CO 80045, USA; Department of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Leon Zheng
- Mucosal Inflammation Program, University of Colorado, Aurora, CO 80045, USA; Department of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Eric L Campbell
- Mucosal Inflammation Program, University of Colorado, Aurora, CO 80045, USA; Department of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Bejan Saeedi
- Mucosal Inflammation Program, University of Colorado, Aurora, CO 80045, USA; Department of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Carsten C Scholz
- School of Medicine and Medical Science, Conway Institute, University College Dublin, Ireland
| | - Amanda J Bayless
- Mucosal Inflammation Program, University of Colorado, Aurora, CO 80045, USA; Department of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Kelly E Wilson
- Mucosal Inflammation Program, University of Colorado, Aurora, CO 80045, USA; Department of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Louise E Glover
- Mucosal Inflammation Program, University of Colorado, Aurora, CO 80045, USA; Department of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Douglas J Kominsky
- Mucosal Inflammation Program, University of Colorado, Aurora, CO 80045, USA; Department of Anesthesiology, University of Colorado, Aurora, CO 80045, USA
| | - Aaron Magnuson
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO 80523, USA
| | - Tiffany L Weir
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO 80523, USA
| | - Stefan F Ehrentraut
- Mucosal Inflammation Program, University of Colorado, Aurora, CO 80045, USA; Department of Medicine, University of Colorado, Aurora, CO 80045, USA; Department of Anesthesiology, University of Bonn, Bonn 53113, Germany
| | - Christina Pickel
- School of Medicine and Medical Science, Conway Institute, University College Dublin, Ireland
| | - Kristine A Kuhn
- Mucosal Inflammation Program, University of Colorado, Aurora, CO 80045, USA; Department of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Jordi M Lanis
- Mucosal Inflammation Program, University of Colorado, Aurora, CO 80045, USA; Department of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Vu Nguyen
- Department of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Cormac T Taylor
- School of Medicine and Medical Science, Conway Institute, University College Dublin, Ireland
| | - Sean P Colgan
- Mucosal Inflammation Program, University of Colorado, Aurora, CO 80045, USA; Department of Medicine, University of Colorado, Aurora, CO 80045, USA.
| |
Collapse
|
31
|
Zheng L, Kelly C, Campbell E, Saeedi B, Scholz C, Bayless A, Wilson K, Glover L, Kominsky D, Magnuson A, Weir T, Ehrentraut S, Nguyen V, Taylor C, Colgan S. Microbe‐Host Crosstalk between Short‐Chain Fatty Acids and Intestinal Epithelial HIF Provides a New Mechanism to Augment Tissue Barrier Function. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.282.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Leon Zheng
- Department of MedicineUniversity of ColoradoAuroraCOUnited States
| | - Caleb Kelly
- Department of MedicineUniversity of ColoradoAuroraCOUnited States
| | - Eric Campbell
- Department of MedicineUniversity of ColoradoAuroraCOUnited States
| | - Bejan Saeedi
- Department of MedicineUniversity of ColoradoAuroraCOUnited States
| | - Carsten Scholz
- School of MedicineUniversity College DublinBelfieldDublinIreland
| | - Amanda Bayless
- Department of MedicineUniversity of ColoradoAuroraCOUnited States
| | - Kelly Wilson
- Department of MedicineUniversity of ColoradoAuroraCOUnited States
| | - Louise Glover
- Department of MedicineUniversity of ColoradoAuroraCOUnited States
| | - Douglas Kominsky
- Department of MedicineUniversity of ColoradoAuroraCOUnited States
| | - Aaron Magnuson
- Department of Human Nutrition Colorado State UniversityFort CollinsCOUnited States
| | - Tiffany Weir
- Department of Human Nutrition Colorado State UniversityFort CollinsCOUnited States
| | | | - Vu Nguyen
- Department of MedicineUniversity of ColoradoAuroraCOUnited States
| | - Cormac Taylor
- School of MedicineUniversity College DublinBelfieldDublinIreland
| | - Sean Colgan
- Department of MedicineUniversity of ColoradoAuroraCOUnited States
| |
Collapse
|
32
|
Larzon T, Roos H, Gruber G, Henrikson O, Magnuson A, Falkenberg M, Lönn L, Norgren L. A Randomized Controlled Trial of the Fascia Suture Technique Compared with a Suture-mediated Closure Device for Femoral Arterial Closure after Endovascular Aortic Repair. J Vasc Surg 2015. [DOI: 10.1016/j.jvs.2014.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
33
|
Larzon T, Roos H, Gruber G, Henrikson O, Magnuson A, Falkenberg M, Lönn L, Norgren L. Editor's Choice - A Randomized Controlled Trial of the Fascia Suture Technique Compared with a Suture-mediated Closure Device for Femoral Arterial Closure after Endovascular Aortic Repair. Eur J Vasc Endovasc Surg 2015; 49:166-73. [DOI: 10.1016/j.ejvs.2014.10.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 10/03/2014] [Indexed: 12/17/2022]
|
34
|
Magnuson A, Fouts J, Booth A, Foster M. Obesity-induced chronic low grade inflammation: Gastrointestinal and adipose tissue crosstalk. ACTA ACUST UNITED AC 2015. [DOI: 10.15761/iod.1000124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
35
|
Ekmay RD, Chou K, Magnuson A, Lei XG. Continual feeding of two types of microalgal biomass affected protein digestion and metabolism in laying hens1. J Anim Sci 2015; 93:287-97. [DOI: 10.2527/jas.2014-7506] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
36
|
Magnuson A, Pandya C, Dale W, Wallace J, Flannery M, Mohile S. Higher symptom burden is associated with functional impairment and falls in older adults with cancer. J Geriatr Oncol 2014. [DOI: 10.1016/j.jgo.2014.09.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
37
|
Abstract
Cancer is common in older adults and the approach to cancer treatment and supportive measures in this age group is continuously evolving. Incorporating geriatric assessment (GA) into the care of the older patient with cancer has been shown to be feasible and predictive of outcomes, and there are unique aspects of the traditional geriatric domains that can be considered in this population. Geriatric assessment-guided interventions can also be developed to support patients during their treatment course. There are several existing models of incorporating geriatrics into oncology care, including a consultative geriatric assessment, geriatrician "embedded" within an oncology clinic and primary management by a dual-trained geriatric oncologist. Although a geriatrician or geriatric oncologist leads the geriatric assessment, is it truly a multidisciplinary assessment, and often includes evaluation by a physical therapist, occupational therapist, pharmacist, social worker and nutritionist.
Collapse
Affiliation(s)
- A Magnuson
- University of Rochester Medical Center, Rochester, NY
| | - W Dale
- University of Rochester Medical Center, Rochester, NY
| | - S Mohile
- University of Rochester Medical Center, Rochester, NY
| |
Collapse
|
38
|
Beraki Å, Magnuson A, Särnblad S, Åman J, Samuelsson U. Increase in physical activity is associated with lower HbA1c levels in children and adolescents with type 1 diabetes: results from a cross-sectional study based on the Swedish pediatric diabetes quality registry (SWEDIABKIDS). Diabetes Res Clin Pract 2014; 105:119-25. [PMID: 24846445 DOI: 10.1016/j.diabres.2014.01.029] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 01/14/2014] [Accepted: 01/28/2014] [Indexed: 01/15/2023]
Abstract
AIMS To evaluate the associations between physical activity (PA) and metabolic control, measured by glycated hemoglobin (HbA1c), in a large group of children and adolescents with type 1 diabetes. METHODS Cross-sectional analysis of data from 4655 patients, comparing HbA1c values with levels of physical activity. The data for the children and adolescents were obtained from the Swedish pediatric diabetes quality registry, SWEDIABKIDS. The patients were 7-18 years of age, had type 1 diabetes and were not in remission. Patients were grouped into five groups by frequency of PA. RESULTS Mean HbA1c level was higher in the least physically active groups (PA0: 8.8% ± 1.5 (72 ± 16 mmol/mol)) than in the most physically active groups (PA4: 7.7% ± 1.0 (60 ± 11 mmol/mol)) (p<0.001). An inverse dose-response association was found between PA and HbA1c (β: -0.30, 95% CI: -0.34 to -0.26, p<0.001). This association was found in both sexes and all age groups, apart from girls aged 7-10 years. Multiple regression analysis revealed that the relationship remained significant (β: -0.21, 95% CI: -0.25 to -0.18, p<0.001) when adjusted for possible confounding factors. CONCLUSIONS Physical activity seems to influence HbA1c levels in children and adolescents with type 1 diabetes. In clinical practice these patients should be recommended daily physical activity as a part of their treatment.
Collapse
Affiliation(s)
- Å Beraki
- Linköping University, Linköping, Sweden
| | - A Magnuson
- Clinical Epidemiology and Biostatistic Unit, Örebro University Hospital, Örebro, Sweden
| | - S Särnblad
- Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Department of Health and Clinical Science, Örebro University, Örebro, Sweden
| | - J Åman
- Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Department of Health and Clinical Science, Örebro University, Örebro, Sweden
| | - U Samuelsson
- Department of Clinical and Experimental Medicine, Division of Pediatrics and Diabetes Research Centre, Linköping University, Linköping S-581 85, Sweden.
| |
Collapse
|
39
|
Fadl H, Magnuson A, Östlund I, Montgomery S, Hanson U, Schwarcz E. Gestational diabetes mellitus and later cardiovascular disease: a Swedish population based case-control study. BJOG 2014; 121:1530-6. [PMID: 24762194 PMCID: PMC4232923 DOI: 10.1111/1471-0528.12754] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2013] [Indexed: 11/29/2022]
Abstract
Objective To identify if gestational diabetes mellitus (GDM) is a clinically useful marker of future cardiovascular disease (CVD) risk and if GDM combined with other risks (smoking, hypertension or body mass) identifies high-risk groups. Design Population-based matched case–control study. Setting National Swedish register data from 1991 to 2008. Population A total of 2639 women with a cardiovascular event and matched controls. Methods Conditional logistic regression examined associations with CVD before and after adjustment for conventional risk factors and confounders. Effect modification for the association of GDM with CVD by body mass index (BMI), smoking and chronic hypertension was assessed by stratification and interaction testing. Adjustment for diabetes post-pregnancy evaluated its mediating role. Main outcome measures Inpatient diagnoses or causes of death identifying ischemic heart disease, ischemic stroke, atherosclerosis or peripheral vascular disease. Results The adjusted odds ratios (and 95% confidence intervals) for the association of CVD with GDM are 1.51 (1.07–2.14), 2.23 (2.01–2.48) for smoking, 1.98 (1.71–2.29) for obesity and 5.10 (3.18–8.18) for chronic hypertension. In stratified analysis the association of CVD with GDM was only seen among women with BMI ≥25, with an odds ratio of 2.39 (1.39–4.10), but only women with a BMI <30 accounted for this increased risk. Adjustment for post-pregnancy diabetes attenuated it somewhat to 1.99 (1.13–3.52). Conclusions In the absence of other recognised cardiovascular risk factors, such as smoking, obesity or chronic hypertension, GDM is a useful marker of raised CVD risk among women with BMI between 25 and 29.
Collapse
Affiliation(s)
- H Fadl
- Department of Obstetrics and Gynaecology, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | | | | | | | | | | |
Collapse
|
40
|
Sackey H, Magnuson A, Sandelin K, Liljegren G, Bergkvist L, Fülep Z, Celebioglu F, Frisell J. Arm lymphoedema after axillary surgery in women with invasive breast cancer. Br J Surg 2014; 101:390-7. [PMID: 24536010 DOI: 10.1002/bjs.9401] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND The primary aim was to compare arm lymphoedema after sentinel lymph node biopsy (SLNB) alone versus axillary lymph node dissection (ALND) in women with node-negative and node-positive breast cancer. The secondary aim was to examine the potential association between self-reported and objectively measured arm lymphoedema. METHODS Women who had surgery during 1999-2004 for invasive breast cancer in four centres in Sweden were included. The study groups were defined by the axillary procedure performed and the presence of axillary metastases: SLNB alone, ALND without axillary metastases, and ALND with axillary metastases. Before surgery, and 1, 2 and 3 years after operation, arm volume was measured and a questionnaire regarding symptoms of arm lymphoedema was completed. A mixed model was used to determine the adjusted mean difference in arm volume between the study groups, and generalized estimating equations were employed to determine differences in self-reported arm lymphoedema. RESULTS One hundred and forty women had SLNB alone, 125 had node-negative ALND and 155 node-positive ALND. Women who underwent SLNB had no increase in postoperative arm volume over time, whereas both ALND groups showed a significant increase. The risk of self-reported arm lymphoedema 1, 2 and 3 years after surgery was significantly lower in the SLNB group compared with that in both ALND groups. Three years after surgery there was a significant association between increased arm volume and self-reported symptoms of arm lymphoedema. CONCLUSION SLNB is associated with a minimal risk of increased arm volume and few symptoms of arm lymphoedema, significantly less than after ALND, regardless of lymph node status.
Collapse
Affiliation(s)
- H Sackey
- Department of Molecular Medicine and Surgery, Karolinska Institute and Karolinska University Hospital, Stockholm
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Perniola A, Fant F, Magnuson A, Axelsson K, Gupta A. Postoperative pain after abdominal hysterectomy: a randomized, double-blind, controlled trial comparing continuous infusion vs patient-controlled intraperitoneal injection of local anaesthetic. Br J Anaesth 2014; 112:328-36. [DOI: 10.1093/bja/aet345] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
42
|
Sjöberg M, Magnuson A, Björk J, Benoni C, Almer S, Friis-Liby I, Hertervig E, Olsson M, Karlén P, Eriksson A, Midhagen G, Carlson M, Lapidus A, Halfvarson J, Tysk C. Infliximab as rescue therapy in hospitalised patients with steroid-refractory acute ulcerative colitis: a long-term follow-up of 211 Swedish patients. Aliment Pharmacol Ther 2013; 38:377-87. [PMID: 23799948 DOI: 10.1111/apt.12387] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 05/15/2013] [Accepted: 06/05/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Rescue therapy with infliximab (IFX) has been proven effective in a steroid-refractory attack of ulcerative colitis (UC). The long-term efficacy is not well described. AIM To present a retrospective study of IFX as rescue therapy in UC. Primary end points were colectomy-free survival at 3 and 12 months. METHODS In this multicentre study, 211 adult patients hospitalised between 1999 and 2010 received IFX 5 mg/kg as rescue therapy due to a steroid-refractory, moderate-to-severe attack of UC. Exclusion criteria were duration of current flare for >12 weeks, corticosteroid treatment for >8 weeks before hospitalisation, previous IFX therapy or Crohn's disease. RESULTS Probability of colectomy-free survival at 3 months was 0.71 (95% CI, 0.64-0.77), at 12 months 0.64 (95% CI, 0.57-0.70), at 3 years 0.59 (95% CI, 0.52-0.66) and at 5 years 0.53 (95% CI, 0.44-0.61). Steroid-free, clinical remission was achieved in 105/211 (50%) and 112/209 (54%) patients at 3 and 12 months respectively. Of 75 colectomies during the first year, 48 (64%) were carried out during the first 14 days, 13 (17%) on days 15-90 and 14 (19%) between 3 and 12 months. There were three (1.4%) deaths during the first 3 months. CONCLUSIONS Infliximab is an effective rescue treatment, both short- and long-term, in a steroid-refractory attack of UC. Most IFX failures underwent surgery during the first 14 days, which calls for studies on how to optimise induction treatment with IFX. Serious complications, including mortality, were rare.
Collapse
Affiliation(s)
- M Sjöberg
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Kuchálik J, Granath B, Ljunggren A, Magnuson A, Lundin A, Gupta A. Postoperative pain relief after total hip arthroplasty: a randomized, double-blind comparison between intrathecal morphine and local infiltration analgesia. Br J Anaesth 2013; 111:793-9. [PMID: 23872462 DOI: 10.1093/bja/aet248] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Postoperative pain after total hip arthroplasty (THA) can delay mobilization. This was assessed after intrathecal morphine (ITM) compared with local infiltration analgesia (LIA) using a non-inferiority design. METHODS Eighty patients were recruited in this randomized, double-blind study. ITM 0.1 mg (Group ITM) or periarticular local anaesthetic (ropivacaine 300 mg)+ketorolac 30 mg+ epinephrine 0.5 mg (total volume 151.5 ml) (Group LIA) were compared. After 24 h, 22 ml of saline (Group ITM) or ropivacaine (150 mg)+ketorolac (30 mg)+epinephrine (0.1 mg) (Group LIA) were injected via a catheter. After operation, rescue analgesic consumption, pain intensity, and home-readiness were measured. RESULTS Morphine consumption was equivalent, median difference 0 mg (95% confidence interval -4 to 4.5) between the groups at 0-24 h. During 24-48 h, it was lower in Group LIA (3 mg, 0-60 mg, median, range) compared with Group ITM (10 mg, 0-81 mg) (P=0.01). Lower pain scores were recorded at rest at 8 h in Group ITM (P<0.01), but in Group LIA on standing and mobilization, at 24-48 h (P<0.01). Paracetamol and tramadol consumption was lower in Group LIA (P=0.05 and 0.05, respectively) as was pruritus, nausea, and vomiting (P<0.05). CONCLUSION Lower pain intensity was recorded early after surgery in ITM group but later, analgesic consumption, pain intensity on mobilization, and side-effects were lower in patients receiving LIA. LIA is a good alternative to ITM in patients undergoing THA.
Collapse
MESH Headings
- Aged
- Aged, 80 and over
- Amides/administration & dosage
- Amides/adverse effects
- Amides/therapeutic use
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/adverse effects
- Analgesics, Opioid/therapeutic use
- Anesthesia, Local
- Anesthetics, Local/administration & dosage
- Anesthetics, Local/adverse effects
- Anesthetics, Local/therapeutic use
- Anti-Inflammatory Agents, Non-Steroidal/administration & dosage
- Anti-Inflammatory Agents, Non-Steroidal/adverse effects
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Arthroplasty, Replacement, Hip
- Double-Blind Method
- Early Ambulation
- Epinephrine/administration & dosage
- Epinephrine/adverse effects
- Epinephrine/therapeutic use
- Female
- Humans
- Injections, Spinal
- Ketorolac/administration & dosage
- Ketorolac/adverse effects
- Ketorolac/therapeutic use
- Length of Stay
- Male
- Middle Aged
- Morphine/administration & dosage
- Morphine/adverse effects
- Morphine/therapeutic use
- Pain Management/methods
- Pain Measurement
- Pain, Postoperative/drug therapy
- Ropivacaine
- Vasoconstrictor Agents/administration & dosage
- Vasoconstrictor Agents/adverse effects
- Vasoconstrictor Agents/therapeutic use
Collapse
Affiliation(s)
- J Kuchálik
- Department of Anaesthesiology and Intensive Care
| | | | | | | | | | | |
Collapse
|
44
|
Tracey A, Wei Y, Wang D, Magnuson A, Gentile C, Foster M, Pagliassotti M, Weir T. Protective effects of Fuzhuan Tea against high saturated fat diet‐induced inflammation and liver injury in Wistar rats. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.lb282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Yuren Wei
- Colorado State UniversityFort CollinsCO
| | - Dong Wang
- Colorado State UniversityFort CollinsCO
| | | | | | | | | | | |
Collapse
|
45
|
Hörer TM, Skoog P, Norgren L, Magnuson A, Berggren L, Jansson K, Larzon T. Intra-peritoneal microdialysis and intra-abdominal pressure after endovascular repair of ruptured aortic aneurysms. Eur J Vasc Endovasc Surg 2013; 45:596-606. [PMID: 23540804 DOI: 10.1016/j.ejvs.2013.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 03/02/2013] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study aims to evaluate intra-peritoneal (ip) microdialysis after endovascular aortic repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA) in patients developing intra-abdominal hypertension (IAH), requiring abdominal decompression. DESIGN Prospective study. MATERIAL AND METHODS A total of 16 patients with rAAA treated with an emergency EVAR were followed up hourly for intra-abdominal pressure (IAP), urine production and ip lactate, pyruvate, glycerol and glucose by microdialysis, analysed only at the end of the study. Abdominal decompression was performed on clinical criteria, and decompressed (D) and non-decompressed (ND) patients were compared. RESULTS The ip lactate/pyruvate (l/p) ratio was higher in the D group than in the ND group during the first five postoperative hours (mean 20 vs. 12), p = 0.005 and at 1 h prior to decompression compared to the fifth hour in the ND group (24 vs. 13), p = 0.016. Glycerol levels were higher in the D group during the first postoperative hours (mean 274.6 vs. 121.7 μM), p = 0.022. The IAP was higher only at 1 h prior to decompression in the D group compared to the ND group at the fifth hour (mean 19 vs. 14 mmHg). CONCLUSIONS Ip l/p ratio and glycerol levels are elevated immediately postoperatively in patients developing IAH leading to organ failure and subsequent abdominal decompression.
Collapse
Affiliation(s)
- T M Hörer
- Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital and Örebro University, Örebro, Sweden.
| | | | | | | | | | | | | |
Collapse
|
46
|
Sundström D, Waldenborg M, Magnuson A, Emilsson K. Chronic nicotine effects on left ventricular function in healthy middle-aged people: an echocardiographic study. Clin Physiol Funct Imaging 2013; 33:317-24. [PMID: 23692623 DOI: 10.1111/cpf.12031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 01/16/2013] [Indexed: 11/28/2022]
Abstract
AIMS Cigarettes and Swedish snuff influence the cardiovascular system in many ways. Cigarette and snuff usage have been linked with an acute impairment in several diastolic cardiac parameters during intake. The aim of this study is to investigate whether long-term usage of Swedish snuff or cigarettes also causes a more permanent impairment of systolic and/or diastolic cardiac parameters in the left ventricle in otherwise healthy middle-aged snuffers and smokers. METHODS AND RESULTS Eighty-seven age-matched volunteers were included and examined with echocardiography. The volunteers were divided into three subgroups; one group with non-tobacco users, one group with long-term smokers and finally one group with long-term snuffers. The smokers and snuffers were instructed not to use these products for at least 5 h before the examination. The systolic and diastolic cardiac parameters were collected at one time. Most of the systolic parameters measured were unaltered between the tobacco subgroups and non-tobacco users, and therefore, no alteration of significance was found in systolic parameters. Also, almost all of the diastolic parameters measured were not significantly impaired in the tobacco subgroups compared with non-tobacco users. However, the deceleration time (DT) was slightly prolonged (P<0·05) and thus statistically significant in the tobacco subgroups. This finding is somewhat difficult to interpret but may be seen as random. CONCLUSIONS This study reveals that most systolic- and diastolic cardiac parameters are not chronically significantly altered in middle-aged long-term tobacco users compared with age-matched non-tobacco users.
Collapse
Affiliation(s)
- D Sundström
- Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden.
| | | | | | | |
Collapse
|
47
|
Gustavsson A, Magnuson A, Blomberg B, Andersson M, Halfvarson J, Tysk C. Letter: the impact of smoking on clinical outcomes after endoscopic dilatation in Crohn's disease - authors' reply. Aliment Pharmacol Ther 2013; 37:500-1. [PMID: 23336689 DOI: 10.1111/apt.12213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 12/22/2012] [Indexed: 12/08/2022]
|
48
|
Gustavsson A, Magnuson A, Blomberg B, Andersson M, Halfvarson J, Tysk C. Smoking is a risk factor for recurrence of intestinal stricture after endoscopic dilation in Crohn's disease. Aliment Pharmacol Ther 2013. [PMID: 23205619 DOI: 10.1111/apt.12176] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Endoscopic balloon dilation is an efficacious and safe alternative to surgery as treatment of short intestinal strictures in Crohn's disease (CD). Factors predicting outcome of the procedure are not well described. AIM To evaluate whether smoking at diagnosis, treatment with azathioprine, or other clinical variables may affect clinical outcome after endoscopic dilation. The endpoint was requirement of a new intervention such as dilation or surgery with intestinal resection or strictureplasty. METHODS Retrospective study of 83 patients with CD who underwent endoscopic balloon dilation of an intestinal stricture between 1987 and 2009. RESULTS After index dilation 55/83 patients underwent a new intervention. Among current smokers, 31/32 (97%) underwent another intervention compared to 18/33 (55%) among never smokers (adjusted HR: 2.50, 95% CI: 1.14-5.50, P = 0.022). After 5 years, cumulative probability of new intervention was 0.81 in smokers compared to 0.52 in never smokers; difference 0.29 (95% CI: 0.07-0.52, P = 0.01). In 16 patients, therapy with azathioprine was initiated before or shortly after the index dilation; 7/16 underwent a new intervention compared to 48/67 of those without azathioprine (HR: 0.46, 95% CI: 0.21-1.03, P = 0.06). After adjustment for other variables, the association was even weaker (HR: 0.80, 95% CI: 0.29-2.18, P = 0.668). Sex, age at diagnosis, age at first dilation, balloon size, location of stricture, and treatment period did not influence outcome. CONCLUSIONS Smoking doubles the risk of recurrent stricture formation requiring a new intervention after index dilation. Maintenance therapy with azathioprine did not influence the subsequent course and need for a new intervention.
Collapse
Affiliation(s)
- A Gustavsson
- Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden
| | | | | | | | | | | |
Collapse
|
49
|
Fant F, Tina E, Sandblom D, Andersson SO, Magnuson A, Hultgren-Hörnkvist E, Axelsson K, Gupta A. Thoracic epidural analgesia inhibits the neuro-hormonal but not the acute inflammatory stress response after radical retropubic prostatectomy. Br J Anaesth 2013; 110:747-57. [PMID: 23295713 DOI: 10.1093/bja/aes491] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Epidural anaesthesia and analgesia has been shown to suppress the neuro-hormonal stress response, but its role in the inflammatory response is unclear. The primary aim was to assess whether the choice of analgesic technique influences these processes in patients undergoing radical retropubic prostatectomy. METHODS Twenty-six patients were randomized to Group P (systemic opioid-based analgesia) or Group E (thoracic epidural-based analgesia) perioperatively. Induction and maintenance of anaesthesia followed a standardized protocol. The following measurements were made perioperatively: plasma cortisol, glucose, insulin, C-reactive proteins, leucocyte count, plasma cytokines [interleukin (IL)-6, tumour necrosis factor (TNF)-α], and pokeweed mitogen-stimulated cytokines [interferon (IFN)-γ, IL-2, IL-12p70, IL-10, IL-4, and IL-17]. Other parameters recorded were pain, morphine consumption, and perioperative complications. RESULTS Plasma concentration of cortisol and glucose were significantly higher in Group P compared with Group E at the end of surgery, the mean difference was 232 nmol litre(-1) [95% confidence interval (CI) 84-381] (P=0.004) and 1.6 mmol litre(-1) (95% CI 0.6-2.5) (P=0.003), respectively. No significant differences were seen in IL-6 and TNF-α at 24 h (P=0.953 and 0.368, respectively) and at 72 h (P=0.931 and 0.691, respectively). IL-17 was higher in Group P compared with Group E, both at 24 h (P=0.001) and 72 h (P=0.018) after operation. Pain intensity was significantly greater in Group P compared with Group E (P<0.05) up to 24 h. CONCLUSIONS In this small prospective randomized study, thoracic epidural analgesia reduced the early postoperative stress response but not the acute inflammatory response after radical retrobupic prostatectomy, suggesting that other pathways are involved during the acute phase reaction.
Collapse
Affiliation(s)
- F Fant
- Department of Anesthesiology and Intensive Care, University Hospital, Örebro SE-701 85, Sweden.
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Gustavsson A, Magnuson A, Blomberg B, Andersson M, Halfvarson J, Tysk C. Endoscopic dilation is an efficacious and safe treatment of intestinal strictures in Crohn's disease. Aliment Pharmacol Ther 2012; 36:151-8. [PMID: 22612326 DOI: 10.1111/j.1365-2036.2012.05146.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 03/21/2012] [Accepted: 05/02/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bowel strictures are a major cause of morbidity, hospitalisation and surgery in Crohn's disease. AIM We report short- and long-term efficacy and safety of endoscopic balloon dilation of strictures due to Crohn's disease. METHODS Retrospective study of patients who underwent endoscopic balloon dilation between 1987 and 2009. RESULTS We performed 776 dilations, of which 621 (80%) were on anastomotic strictures, in 178 patients (94 women) with Crohn's disease. At first dilation, median (IQR) age of patients was 45 (37-56) years and disease duration 16 (8-22) years. Technical success rate was 689/776 (89%). A subset of 75 patients from the primary catchment area, with >5-year follow-up, underwent a total of 246 dilations. At 1-year follow-up, 60/75 (80%) patients had undergone no further intervention or one additional dilation only. At 3 and 5 years, corresponding figures were 43/75 (57%) and 39/75 (52%). Cumulative proportions of patients undergoing surgery at 1, 3 and 5 years were 13%, 28% and 36%. Complication rate per procedure for all 178 patients was 41/776 (5.3%), bowel perforation (n = 11, 1.4%), major bleeding requiring blood transfusion (n = 8, 1.0%), minor bleeding (n = 10, 1.3%) and abdominal pain or fever (n = 12, 1.5%). Ten patients underwent surgery due to complications (perforation n = 8, bleeding n = 2). There was no procedure-related mortality. CONCLUSIONS Endoscopic balloon dilation is an efficacious and safe alternative to surgical resection of intestinal strictures in Crohn's disease. At 5-year follow-up, 52% of patients required no further or one additional dilation only, whereas 36% had undergone surgical resection. Complication frequency was low.
Collapse
Affiliation(s)
- A Gustavsson
- Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Sweden
| | | | | | | | | | | |
Collapse
|