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Georgiopoulos C, Tisell A, Holmgren RT, Eleftheriou A, Rydja J, Lundin F, Tobieson L. Noninvasive assessment of glymphatic dysfunction in idiopathic normal pressure hydrocephalus with diffusion tensor imaging. J Neurosurg 2024; 140:612-620. [PMID: 37724800 DOI: 10.3171/2023.6.jns23260] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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] [Received: 02/07/2023] [Accepted: 06/04/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE Diffusion tensor imaging (DTI) along the perivascular space (ALPS) (DTI-ALPS)-by calculating the ALPS index, a ratio accentuating water diffusion in the perivascular space-has been proposed as a noninvasive, indirect MRI method for assessing glymphatic function. The main aim of this study was to investigate whether DTI-ALPS would reveal glymphatic dysfunction in idiopathic normal pressure hydrocephalus (iNPH) and whether the ALPS index was associated with disease severity. METHODS Thirty iNPH patients (13 men; median age 77 years) and 27 healthy controls (10 men; median age 73 years) underwent MRI and clinical assessment with the Timed Up and Go test (TUG) and Mini-Mental State Examination (MMSE); only the patients were evaluated with the Hellström iNPH scale. MRI data were analyzed with the DTI-ALPS method and Radscale screening tool. RESULTS iNPH patients showed significantly lower mean ALPS index scores compared with healthy controls (median [interquartile range] 1.09 [1.00-1.15] vs 1.49 [1.36-1.59], p < 0.001). Female healthy controls showed significantly higher ALPS index scores than males in both hemispheres (e.g., right hemisphere 1.62 [1.47-1.67] vs 1.33 [1.14-1.41], p = 0.001). This sex difference was not seen in iNPH patients. The authors found a moderate exponential correlation between mean ALPS index score and motor function as measured with time required to complete TUG (r = -0.644, p < 0.001), number of steps to complete TUG (r = -0.571, p < 0.001), 10-m walk time (r = -0.637, p < 0.001), and 10-m walk steps (r = -0.588, p < 0.001). The authors also found a positive linear correlation between mean ALPS index score and MMSE score (r = 0.416, p = 0.001). Simple linear regression showed a significant effect of diagnosis (B = -0.39, p < 0.001, R2 = 0.459), female sex (B = 0.232, p = 0.002, R2 = 0.157), and Evans index (B = -4.151, p < 0.001, R2 = 0.559) on ALPS index. Multiple linear regression, including diagnosis, sex, and Evans index score, showed a higher predictive value (R2 = 0.626) than analysis of each of these factors alone. CONCLUSIONS The ALPS index, which was significantly decreased in iNPH patients, could serve as a marker of disease severity, both clinically and in terms of neuroimaging. However, it is important to consider the significant influence of biological sex and ventriculomegaly on the ALPS index, which raises the question of whether the ALPS index solely reflects glymphatic function or if it also encompasses other types of injury. Future studies are needed to address potential confounding factors and further validate the ALPS method.
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Affiliation(s)
- Charalampos Georgiopoulos
- 1Department of Radiology, Clinical Sciences, Lund University, Lund, Sweden
- 2Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- 3Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Anders Tisell
- 3Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- 4Department of Medical Radiation Physics and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Rafael T Holmgren
- 5Department of Neurosurgery and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Andreas Eleftheriou
- 6Department of Neurology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- 7Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece; and
| | - Johanna Rydja
- 8Department of Activity and Health and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Fredrik Lundin
- 6Department of Neurology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Lovisa Tobieson
- 5Department of Neurosurgery and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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2
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Broström A, Alimoradi Z, Lind J, Ulander M, Lundin F, Pakpour A. Worldwide estimation of restless legs syndrome: a systematic review and meta-analysis of prevalence in the general adult population. J Sleep Res 2023; 32:e13783. [PMID: 36600470 DOI: 10.1111/jsr.13783] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 01/06/2023]
Abstract
This systematic review, meta-analysis and meta-regression assessed the prevalence of restless legs syndrome (RLS) in the general adult population. Studies identified in Scopus, PubMed, Web of Science, and PsycInfo between January 2000 and February 2022 were included if they used a case-control or cross-sectional design and reported data regarding the prevalence of RLS. The protocol was pre-registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42022300709). A total of 97 studies including 483,079 participants from 33 different countries met the eligibility criteria. The Newcastle Ottawa Scale was used to evaluate the methodological quality, and the fill-and-trim method was used to correct probable publication bias, while the jack-knife method was performed to assess small study effect. The corrected overall pooled prevalence of RLS was 3% (95% confidence interval [CI] 1.4%-3.8%). The pooled prevalence of RLS syndrome was affected by methodological quality (no data from non-respondents in the included studies), gender (higher among women), study design (lower prevalence in case-control versus cohort and cross-sectional studies). The figures for corrected pooled prevalence among men, women, alcohol consumers and smokers were 2.8% (95% CI 2%-3.7%); 4.7% (95% CI 3.2%-6.3%); 1.4% (95% CI 0%-4.2%); and 2.7% (95% CI 0%-5.3%), respectively. The prevalence among male and female participants was lower in community-based versus non-community-based studies. Moreover, the prevalence was higher in developed versus developing countries and among elders versus adults. In conclusion, RLS is a common disorder in the general adult population, with a higher prevalence in women; however, prevalence data are affected by study design and quality.
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Affiliation(s)
- Anders Broström
- School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden
| | - Zainab Alimoradi
- Social Determinants of Health Research Centre, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Jonas Lind
- Department of Biomedical and Clinical Sciences, Division of Neurobiology, Linköping University, Linköping, Sweden.,Section of Neurology, Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden
| | - Martin Ulander
- Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Division of Neurobiology, Linköping University, Linköping, Sweden
| | - Fredrik Lundin
- Department of Neurology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Amir Pakpour
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
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3
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Eek T, Lundin F, Larsson M, Hamilton P, Georgiopoulos C. Neural suppression in odor recognition memory. Chem Senses 2023; 48:7008795. [PMID: 36715106 PMCID: PMC9940621 DOI: 10.1093/chemse/bjad001] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Indexed: 01/31/2023] Open
Abstract
Little is known about the neural basis of lower- and higher-order olfactory functions such as odor memory, compared with other sensory systems. The aim of this study was to explore neural networks and correlates associated with 3 functions: passive smelling (PS), odor encoding (OE), and in particular odor recognition memory (ORM). Twenty-six healthy participants were examined using functional magnetic resonance imaging conducted across 3 sessions, one for each function. Independent component analysis revealed a difference between sessions where a distinct ORM component incorporating hippocampus and posterior cingulate showed delayed triggering dissociated from odor stimulation and recognition. By contrasting Hit for ORM (target odors correctly recognized as old) and a combination of PS and detected odors from OE, we found significantly lower activations in amygdala, piriform cortex, insula, thalamus, and the inferior parietal lobule. Region of interest analysis including anterior insula, posterior cingulate gyrus, dentate gyrus, left middle frontal gyrus, amygdala, and piriform cortex demonstrated that Hit were associated with lower activations compared with other memory responses. In summary, our findings suggest that successful recognition of familiar odors (odor familiarity) is associated with neural suppression in the abovementioned regions of interest. Additionally, network including the hippocampus and posterior cingulate is engaged in a postrecognition process. This process may be related to incidental encoding of less familiar and more novel odors (odor novelty) and should be subject for future research.
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Affiliation(s)
- Tom Eek
- Corresponding author: Department of Neurology, Linköping University Hospital, 581 85 Linköping, Sweden.
| | - Fredrik Lundin
- Department of Neurology, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Maria Larsson
- Gösta Ekman Laboratories, Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Paul Hamilton
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Charalampos Georgiopoulos
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
- Department of Radiology, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Diagnostic Radiology, Department of Clinical Sciences, Medical Faculty, Lund University, Lund, Sweden
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4
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Molarius A, Lundin F. Living conditions, lifestyle habits and health in the general population in spring 2020 and one year into the COVID-19 pandemic in Sweden - Results from two cross-sectional studies carried out in 2020 and 2021. Prev Med Rep 2022; 31:102093. [PMID: 36568471 PMCID: PMC9762037 DOI: 10.1016/j.pmedr.2022.102093] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 12/16/2022] [Accepted: 12/17/2022] [Indexed: 12/23/2022] Open
Abstract
The aim of the study was to investigate mental and physical health as well as living conditions and lifestyle habits in the adult general population in spring 2020 and one year into the COVID-19 pandemic in Sweden comparing results from two cross-sectional studies carried out in February-May 2020 and 2021. The study population comprises 2,273 persons in 2020 and 2,216 persons in 2021 who responded to the national public health survey sent to random population samples in one county in Sweden. The age group was 16-84 years, and the response rates were 45% and 44%, respectively. Differences in living conditions (economic difficulties, social support and worrying about losing one's job), lifestyle habits (physical activity, daily smoking, sitting duration and alcohol use), and health (self-rated health, pain in shoulders or neck, sleeping difficulties, anxiety or worry, and obesity) between years 2020 and 2021 were analysed using multiple binary logistic regression in men and women, adjusting for age group and educational level. Very few statistically significant differences were observed between 2020 and 2021 regarding living conditions, lifestyle factors and health. The main finding was that the prevalence of anxiety and worry increased among women. Surveillance of the long-term public health consequences of the pandemic in the general population using robust data and methods, is important for planning and targeting preventive activities.
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Affiliation(s)
- Anu Molarius
- Centre for Clinical Research, Region Värmland, Karlstad, Sweden,Department of Public Health Sciences, Karlstad University, Karlstad, Sweden,Corresponding author at: Centre for Clinical Research, Region Värmland, 651 85 Karlstad, Sweden.
| | - Fredrik Lundin
- Department for Sustainable Development, Region Värmland, Karlstad, Sweden
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5
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Piehl F, Eriksson-Dufva A, Budzianowska A, Feresiadou A, Hansson W, Hietala MA, Håkansson I, Johansson R, Jons D, Kmezic I, Lindberg C, Lindh J, Lundin F, Nygren I, Punga AR, Press R, Samuelsson K, Sundström P, Wickberg O, Brauner S, Frisell T. Efficacy and Safety of Rituximab for New-Onset Generalized Myasthenia Gravis: The RINOMAX Randomized Clinical Trial. JAMA Neurol 2022; 79:1105-1112. [PMID: 36121672 DOI: 10.1001/jamaneurol.2022.2887] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Importance Rituximab is a third-line option for refractory generalized myasthenia gravis (MG) based on empirical evidence, but its effect in new-onset disease is unknown. Objective To investigate the efficacy and safety of rituximab compared with placebo as an add-on to standard of care for MG. Design, Setting, and Participants This randomized, double-blind, placebo-controlled study took place throughout 48 weeks at 7 regional clinics in Sweden. Key inclusion criteria were age older than 18 years, onset of generalized symptoms within 12 months or less, and a Quantitative Myasthenia Gravis (QMG) score of 6 or more. Patients were screened from October 20, 2016, to March 2, 2020. Key exclusion criteria included pure ocular MG, suspected thymoma, previous thymectomy, and prior noncorticosteroid immunosuppressants or high doses of corticosteroids. Interventions Participants were randomized 1:1 without stratification to a single intravenous infusion of 500 mg of rituximab or matching placebo. Main Outcomes and Measures Minimal disease manifestations at 16 weeks defined as a QMG score of 4 or less with prednisolone, 10 mg or less daily, and no rescue treatment. Results Of 87 potentially eligible patients, 25 were randomized to rituximab (mean [SD] age, 67.4 [13.4] years; 7 [28%] female) and 22 to placebo (mean [SD] age, 58 [18.6] years; 7 [32%] female). Compared with placebo, a greater proportion with rituximab met the primary end point; 71% (17 of 24) in the rituximab group vs 29% (6 of 21) in the placebo group (Fisher exact test P = .007; probability ratio, 2.48 [95% CI, 1.20-5.11]). Secondary end points, comparing changes in Myasthenia Gravis Activities of Daily Living and Myasthenia Gravis Quality of Life at 16 weeks with QMG at 24 weeks did not differ between groups with censoring for rescue treatment (per-protocol analysis) but were in favor of active treatment when rescue treatment was taken into account by worst rank imputation (post hoc analysis). Rescue treatments were also more frequent in the placebo arm (rituximab: 1 [4%]; placebo, 8 [36%]). One patient in the placebo arm had a myocardial infarction with cardiac arrest and 1 patient in the active arm experienced a fatal cardiac event. Conclusions and Relevance A single dose of 500 mg of rituximab was associated with greater probability of minimal MG manifestations and reduced need of rescue medications compared with placebo. Further studies are needed to address long-term benefit-risk balance with this treatment. Trial Registration ClinicalTrials.gov Identifier: NCT02950155.
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Affiliation(s)
- Fredrik Piehl
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Neuroimmunology Unit, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ann Eriksson-Dufva
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Neuroimmunology Unit, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anna Budzianowska
- Department of Neurology and Rehabilitation, Ryhov Regional Hospital, Jönköping, Sweden
| | - Amalia Feresiadou
- Department of Neurology, Uppsala University Hospital, Uppsala, Sweden.,Department of Medical Sciences, Section of Neurology, Uppsala University, Uppsala, Sweden
| | - William Hansson
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Max Albert Hietala
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Irene Håkansson
- Department of Neurology, Linköping University Hospital, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Rune Johansson
- Department of Neurology and Rehabilitation, Central Hospital Karlstad, Karlstad, Sweden
| | - Daniel Jons
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Sahlgrenska Academy, Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Gothenburg University, Gothenburg, Sweden
| | - Ivan Kmezic
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Christopher Lindberg
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Sahlgrenska Academy, Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Gothenburg University, Gothenburg, Sweden
| | - Jonas Lindh
- Department of Neurology and Rehabilitation, Ryhov Regional Hospital, Jönköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Fredrik Lundin
- Department of Neurology, Linköping University Hospital, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ingela Nygren
- Department of Neurology, Uppsala University Hospital, Uppsala, Sweden.,Department of Medical Sciences, Section of Neurology, Uppsala University, Uppsala, Sweden
| | - Anna Rostedt Punga
- Clinical Neurophysiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Department of Neurophysiology, Uppsala University Hospital, Uppsala, Sweden
| | - Rayomand Press
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Kristin Samuelsson
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Peter Sundström
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Oskar Wickberg
- Department of Neurology and Rehabilitation, Central Hospital Karlstad, Karlstad, Sweden
| | - Susanna Brauner
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Neuroimmunology Unit, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Frisell
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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6
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Bergquist F, Ehrnebo M, Nyholm D, Johansson A, Lundin F, Odin P, Svenningsson P, Hansson F, Bring L, Eriksson E, Dizdar N. Pharmacokinetics of Intravenously (DIZ101), Subcutaneously (DIZ102), and Intestinally (LCIG) Infused Levodopa in Advanced Parkinson Disease. Neurology 2022; 99:e965-e976. [PMID: 35705502 PMCID: PMC9519246 DOI: 10.1212/wnl.0000000000200804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 04/14/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Intestinal levodopa/carbidopa gel infusion (LCIG) is superior to oral treatment in advanced Parkinson disease. The primary objective of this trial was to investigate whether continuous subcutaneous or intravenous infusion with a continuously buffered acidic levodopa/carbidopa solution yields steady-state plasma concentrations of levodopa that are equivalent in magnitude, and noninferior in variability, to those obtained with LCIG in patients with advanced Parkinson disease. METHODS A concentrated acidic levodopa/carbidopa (8:1) solution buffered continuously and administered intravenously (DIZ101) or subcutaneously (DIZ102) was compared with an approved LCIG in a randomized, 3-period crossover, open-label, multicenter trial. Formulations were infused for 16 hours to patients with Parkinson disease who were using LCIG as their regular treatment. Patients were recruited from several university neurology clinics but came to the same phase I unit for treatment. Pharmacokinetic variables and safety including dermal tolerance are reported. The primary outcomes were bioequivalence and noninferior variability of DIZ101 and DIZ102 vs LCIG with respect to levodopa plasma concentrations. RESULTS With dosing adjusted to estimated bioavailability, DIZ101 and DIZ102 produced levodopa plasma levels within standard bioequivalence limits compared with LCIG in the 18 participants who received all treatments. Although the levodopa bioavailability for DIZ102 was complete, it was 80% for LCIG. Therapeutic concentrations of levodopa were reached as quickly with subcutaneous administration of DIZ102 as with LCIG and remained stable throughout the infusions. Owing to poor uptake of LCIG, carbidopa levels in plasma were higher with DIZ101 and DIZ102 than with the former. All individuals receiving any of the treatments (n = 20) were included in the evaluation of safety and tolerability. Reactions at the infusion sites were mild and transient. DISCUSSION It is feasible to rapidly achieve high and stable levodopa concentrations by means of continuous buffering of a subcutaneously administered acidic levodopa/carbidopa-containing solution. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov identifier: NCT03419806. Registration first posted on February 5, 2018, first patient enrolled on February 16, 2018.
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Affiliation(s)
- Filip Bergquist
- From the Department of Pharmacology (F.B., E.E.), University of Gothenburg; Neurology (F.B.), Sahlgrenska University Hospital, Göteborg; Department of Pharmaceutical Biosciences (M.E.), Uppsala University; Pharm Assist Sweden AB (M.E.), Uppsala; Department of Neuroscience (D.N.), Uppsala University; Department of Clinical Neurosciences (A.J., P.S.), Karolinska Institutet (A.J., P.S.), Solna; Department of Biomedical and Clinical Sciences (F.L., N.D.), Linköping University (F.L., N.D.); Neurology (P.O.), Department of Clinical Sciences, Lund University; CTC Clinical Trial Consultants AB (F.H.), Uppsala; and Dizlin Pharmaceuticals (L.B.) Gothenburg, Sweden.
| | - Mats Ehrnebo
- From the Department of Pharmacology (F.B., E.E.), University of Gothenburg; Neurology (F.B.), Sahlgrenska University Hospital, Göteborg; Department of Pharmaceutical Biosciences (M.E.), Uppsala University; Pharm Assist Sweden AB (M.E.), Uppsala; Department of Neuroscience (D.N.), Uppsala University; Department of Clinical Neurosciences (A.J., P.S.), Karolinska Institutet (A.J., P.S.), Solna; Department of Biomedical and Clinical Sciences (F.L., N.D.), Linköping University (F.L., N.D.); Neurology (P.O.), Department of Clinical Sciences, Lund University; CTC Clinical Trial Consultants AB (F.H.), Uppsala; and Dizlin Pharmaceuticals (L.B.) Gothenburg, Sweden
| | - Dag Nyholm
- From the Department of Pharmacology (F.B., E.E.), University of Gothenburg; Neurology (F.B.), Sahlgrenska University Hospital, Göteborg; Department of Pharmaceutical Biosciences (M.E.), Uppsala University; Pharm Assist Sweden AB (M.E.), Uppsala; Department of Neuroscience (D.N.), Uppsala University; Department of Clinical Neurosciences (A.J., P.S.), Karolinska Institutet (A.J., P.S.), Solna; Department of Biomedical and Clinical Sciences (F.L., N.D.), Linköping University (F.L., N.D.); Neurology (P.O.), Department of Clinical Sciences, Lund University; CTC Clinical Trial Consultants AB (F.H.), Uppsala; and Dizlin Pharmaceuticals (L.B.) Gothenburg, Sweden
| | - Anders Johansson
- From the Department of Pharmacology (F.B., E.E.), University of Gothenburg; Neurology (F.B.), Sahlgrenska University Hospital, Göteborg; Department of Pharmaceutical Biosciences (M.E.), Uppsala University; Pharm Assist Sweden AB (M.E.), Uppsala; Department of Neuroscience (D.N.), Uppsala University; Department of Clinical Neurosciences (A.J., P.S.), Karolinska Institutet (A.J., P.S.), Solna; Department of Biomedical and Clinical Sciences (F.L., N.D.), Linköping University (F.L., N.D.); Neurology (P.O.), Department of Clinical Sciences, Lund University; CTC Clinical Trial Consultants AB (F.H.), Uppsala; and Dizlin Pharmaceuticals (L.B.) Gothenburg, Sweden
| | - Fredrik Lundin
- From the Department of Pharmacology (F.B., E.E.), University of Gothenburg; Neurology (F.B.), Sahlgrenska University Hospital, Göteborg; Department of Pharmaceutical Biosciences (M.E.), Uppsala University; Pharm Assist Sweden AB (M.E.), Uppsala; Department of Neuroscience (D.N.), Uppsala University; Department of Clinical Neurosciences (A.J., P.S.), Karolinska Institutet (A.J., P.S.), Solna; Department of Biomedical and Clinical Sciences (F.L., N.D.), Linköping University (F.L., N.D.); Neurology (P.O.), Department of Clinical Sciences, Lund University; CTC Clinical Trial Consultants AB (F.H.), Uppsala; and Dizlin Pharmaceuticals (L.B.) Gothenburg, Sweden
| | - Per Odin
- From the Department of Pharmacology (F.B., E.E.), University of Gothenburg; Neurology (F.B.), Sahlgrenska University Hospital, Göteborg; Department of Pharmaceutical Biosciences (M.E.), Uppsala University; Pharm Assist Sweden AB (M.E.), Uppsala; Department of Neuroscience (D.N.), Uppsala University; Department of Clinical Neurosciences (A.J., P.S.), Karolinska Institutet (A.J., P.S.), Solna; Department of Biomedical and Clinical Sciences (F.L., N.D.), Linköping University (F.L., N.D.); Neurology (P.O.), Department of Clinical Sciences, Lund University; CTC Clinical Trial Consultants AB (F.H.), Uppsala; and Dizlin Pharmaceuticals (L.B.) Gothenburg, Sweden
| | - Per Svenningsson
- From the Department of Pharmacology (F.B., E.E.), University of Gothenburg; Neurology (F.B.), Sahlgrenska University Hospital, Göteborg; Department of Pharmaceutical Biosciences (M.E.), Uppsala University; Pharm Assist Sweden AB (M.E.), Uppsala; Department of Neuroscience (D.N.), Uppsala University; Department of Clinical Neurosciences (A.J., P.S.), Karolinska Institutet (A.J., P.S.), Solna; Department of Biomedical and Clinical Sciences (F.L., N.D.), Linköping University (F.L., N.D.); Neurology (P.O.), Department of Clinical Sciences, Lund University; CTC Clinical Trial Consultants AB (F.H.), Uppsala; and Dizlin Pharmaceuticals (L.B.) Gothenburg, Sweden
| | - Fredrik Hansson
- From the Department of Pharmacology (F.B., E.E.), University of Gothenburg; Neurology (F.B.), Sahlgrenska University Hospital, Göteborg; Department of Pharmaceutical Biosciences (M.E.), Uppsala University; Pharm Assist Sweden AB (M.E.), Uppsala; Department of Neuroscience (D.N.), Uppsala University; Department of Clinical Neurosciences (A.J., P.S.), Karolinska Institutet (A.J., P.S.), Solna; Department of Biomedical and Clinical Sciences (F.L., N.D.), Linköping University (F.L., N.D.); Neurology (P.O.), Department of Clinical Sciences, Lund University; CTC Clinical Trial Consultants AB (F.H.), Uppsala; and Dizlin Pharmaceuticals (L.B.) Gothenburg, Sweden
| | - Leif Bring
- From the Department of Pharmacology (F.B., E.E.), University of Gothenburg; Neurology (F.B.), Sahlgrenska University Hospital, Göteborg; Department of Pharmaceutical Biosciences (M.E.), Uppsala University; Pharm Assist Sweden AB (M.E.), Uppsala; Department of Neuroscience (D.N.), Uppsala University; Department of Clinical Neurosciences (A.J., P.S.), Karolinska Institutet (A.J., P.S.), Solna; Department of Biomedical and Clinical Sciences (F.L., N.D.), Linköping University (F.L., N.D.); Neurology (P.O.), Department of Clinical Sciences, Lund University; CTC Clinical Trial Consultants AB (F.H.), Uppsala; and Dizlin Pharmaceuticals (L.B.) Gothenburg, Sweden
| | - Elias Eriksson
- From the Department of Pharmacology (F.B., E.E.), University of Gothenburg; Neurology (F.B.), Sahlgrenska University Hospital, Göteborg; Department of Pharmaceutical Biosciences (M.E.), Uppsala University; Pharm Assist Sweden AB (M.E.), Uppsala; Department of Neuroscience (D.N.), Uppsala University; Department of Clinical Neurosciences (A.J., P.S.), Karolinska Institutet (A.J., P.S.), Solna; Department of Biomedical and Clinical Sciences (F.L., N.D.), Linköping University (F.L., N.D.); Neurology (P.O.), Department of Clinical Sciences, Lund University; CTC Clinical Trial Consultants AB (F.H.), Uppsala; and Dizlin Pharmaceuticals (L.B.) Gothenburg, Sweden
| | - Nil Dizdar
- From the Department of Pharmacology (F.B., E.E.), University of Gothenburg; Neurology (F.B.), Sahlgrenska University Hospital, Göteborg; Department of Pharmaceutical Biosciences (M.E.), Uppsala University; Pharm Assist Sweden AB (M.E.), Uppsala; Department of Neuroscience (D.N.), Uppsala University; Department of Clinical Neurosciences (A.J., P.S.), Karolinska Institutet (A.J., P.S.), Solna; Department of Biomedical and Clinical Sciences (F.L., N.D.), Linköping University (F.L., N.D.); Neurology (P.O.), Department of Clinical Sciences, Lund University; CTC Clinical Trial Consultants AB (F.H.), Uppsala; and Dizlin Pharmaceuticals (L.B.) Gothenburg, Sweden
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7
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Sartipy F, Garcia Pereira Filho AJ, Lundin F, Wahlberg E, Sigvant B. Presence of asymptomatic Peripheral Arterial Disease in combination with common risk factors elevates the cardiovascular risk Substantially. Int J Cardiol Cardiovasc Risk Prev 2022; 13:200130. [PMID: 35493293 PMCID: PMC9043415 DOI: 10.1016/j.ijcrp.2022.200130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/10/2022] [Accepted: 03/21/2022] [Indexed: 12/24/2022]
Abstract
Background and aims This study evaluates the risks for adverse cardiovascular (CV) events in Asymptomatic Peripheral Arterial Disease (APAD) combined with different traditional CV risk factors. Methods A population-based observational study of 8000 subjects, identified 559 subjects as having APAD through ankle-brachial index (ABI) measurements and questionnaires regarding limb symptoms. This cohort and subgroups classified by presence of different traditional CV risk factors at baseline were assessed for 10 years on CV outcome. The recorded endpoints were all-cause mortality, CV mortality and non-fatal CV events. Results Before subdividing the APAD subjects, the CV mortality incidence was 28.5 deaths per 1000 person-years as compared to 8.7 deaths for references without APAD. For subjects with hypertension at baseline the CV mortality incidence was 35.4 when combined with APAD and 11.7 without. In women with hypertension but without other risk factors, presence of APAD increased the age-adjusted Hazard Ratio (HR) for fatal and non-fatal CV events by 1.86 [CI 1.54,2.24, p < 0.001]. Conclusions ABI measurements should be considered an important indication for aggressive multifactorial risk factor reduction in populations with any other prevalent CV risk factor. In hypertension, diabetes mellitus and a smoking history, coexisting APAD contributes significantly to the increased age-adjusted CV risk.
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Affiliation(s)
- Fredrik Sartipy
- Section of Vascular Surgery, Department of Clinical Science and Education, Karolinska Institutet at Södersjukhuset, Kirurgkliniken, Sjukhusbacken 10, 118 83, Stockholm, Sweden
| | | | - Fredrik Lundin
- Centre of Clinical Research, County Council of Värmland, Älvgatan 49, 652 30, Karlstad, Sweden
| | - Eric Wahlberg
- Department of Medicine and Health, Linköping University, Linkoping University Hospital, SE 581-53, Linköping, Sweden
| | - Birgitta Sigvant
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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8
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Pereira Filho AJG, Sartipy F, Lundin F, Wahlberg E, Sigvant B. Impact of Ankle-Brachial Index Calculations for Peripheral Arterial Disease Prevalence and as a Predictor for Cardiovascular Risk. Eur J Vasc Endovasc Surg 2022; 64:217-224. [DOI: 10.1016/j.ejvs.2022.05.001] [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] [Received: 05/11/2021] [Revised: 04/25/2022] [Accepted: 05/03/2022] [Indexed: 12/24/2022]
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Rydja J, Kollén L, Ulander M, Tullberg M, Lundin F. Physical Capacity and Activity in Patients With Idiopathic Normal Pressure Hydrocephalus. Front Neurol 2022; 13:845976. [PMID: 35418936 PMCID: PMC8996117 DOI: 10.3389/fneur.2022.845976] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/28/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Most patients with idiopathic normal pressure hydrocephalus (iNPH) improve gait after surgery. However, knowledge on physical capacity and activity after shunt surgery is limited. One of the aims of this study was to evaluate the effect of shunt surgery in patients with iNPH on short-distance walking, functional exercise capacity, functional strength, and variables of activity and sleep, 3 and 6 months postoperatively. Another aim was to evaluate the effect of a physical exercise program. Additionally, we studied how changes in short-distance walking were correlated with functional exercise capacity and voluntary walking. Methods In total, 127 patients were consecutively included and randomized to the exercise group (n = 62) or the control group (n = 65). Participants in the exercise group underwent the supervision of a 12-week exercise program. All patients were assessed before surgery, at 3 and 6 months postoperatively with the 10-m walk test (10MWT), the 6-min walk test (6MWT), 30-s chair stand test (30sCST), and with the actigraphic recordings of activity variables measured for a total of 24 h/day for at least 3 days. Results All patients improved at 3 months postoperatively in the 10MWT (p < 0.001), 6MWT (p < 0.001), and 30sCST (p < 0.001). These results were maintained after 6 months. Actigraphic recordings for voluntary walking (steps per minute) were improved and nighttime sleep (%) increased after 6 months (p = 0.01, p = 0.04). There were no significant differences between the exercise group and the control group, except for the postoperative change in the proportion of daytime sleep after 3 months, which was slightly more reduced compared to baseline in the exercise group (p = 0.04). Changes after 3 months in the 10MWT and 6MWT were moderately correlated (ρ= −0.49, p = 0.01) whereas the correlation between the 10MWT and voluntary walking was weak (ρ = −0.34, p = 0.01). Conclusion Shunt surgery improved short-distance walking, functional exercise capacity, functional strength, and voluntary walking. An exercise program did not affect these outcomes. Short-distance walking was weakly correlated with voluntary walking, indicating improved physical capacity does not directly translate to increased physical activity. Further research should address how interventions should be tailored to promote physical activity after shunt surgery. Trial Registration clinicaltrials.gov, Id: NCT02659111.
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Affiliation(s)
- Johanna Rydja
- Department of Activity and Health and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Lena Kollén
- Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Martin Ulander
- Department of Clinical Neurophysiology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Mats Tullberg
- Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Fredrik Lundin
- Department of Neurology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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10
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Sundström N, Lundin F, Arvidsson L, Tullberg M, Wikkelsø C. The demography of idiopathic normal pressure hydrocephalus: data on 3000 consecutive, surgically treated patients and a systematic review of the literature. J Neurosurg 2022; 137:1-11. [PMID: 35395629 DOI: 10.3171/2022.2.jns212063] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 02/07/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to describe the demographic characteristics of patients with idiopathic normal pressure hydrocephalus (iNPH) through an analysis of 3000 consecutive, surgically treated Swedish patients and a systematic review of the literature. METHODS Data on age, sex, comorbidities, diagnostic delay, initial symptoms, and severity of symptoms at diagnosis were extracted from the Swedish Hydrocephalus Quality Registry. In addition, a systematic PRISMA-based review of the literature published from database inception until August 2019 was performed using the PubMed, Cochrane, and Scopus databases on the basis of two concepts: normal pressure hydrocephalus and demography and their association with related terms. Of 1020 unique articles, 16 were eligible for study inclusion and were assessed for quality using the Newcastle-Ottawa Scale. Mean and weighted mean values were calculated. RESULTS The mean patient age at the time of surgery was 74.4 years, 79% of patients were in their 70s, and 60% of the patients were men. Almost 50% of the patients had symptoms from four main domains (i.e., balance, gait, cognition, and urinary dysfunction) at disease onset. Patients aged < 60 years (2%) reported more headaches and fewer balance problems than those aged ≥ 60. Women were more impaired in function than men at the time of diagnosis. Dementia (Mini-Mental State Examination score < 25) was found in 47% of the patients. Men had more diabetes, heart disease, hypertension, and stroke than women, and comorbidity correlated with increased impairment. The incidence of surgery for iNPH was 20%-40% of the disease incidence according to survey and operation-based studies. CONCLUSIONS Most iNPH patients undergo surgery in their 70s. Those aged < 60 years show slightly different symptomatology and probably present with a specific disease entity, indicating that the lower age limit for iNPH should be 60 years. iNPH patients have severe impairment preceded by a long diagnostic delay. Even though the included study designs differed, the systematic review showed that the disorder has a very low treatment incidence. The importance of diagnosing and treating iNPH is further emphasized by the fact that iNPH may account for a considerable part of all cases of dementia.
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Affiliation(s)
- Nina Sundström
- 1Department of Radiation Sciences, Radiation Physics, Biomedical Engineering, Umeå University, Umeå
| | - Fredrik Lundin
- Departments of2Neurology and
- 3Biomedical and Clinical Sciences, Linköping University, Linköping
| | - Lisa Arvidsson
- 4Department of Neurosurgery, Karolinska University Hospital, Stockholm
- 5Department of Clinical Neuroscience, Karolinska Institutet, Stockholm; and
| | - Mats Tullberg
- 6Hydrocephalus Research Unit, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carsten Wikkelsø
- 6Hydrocephalus Research Unit, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Johansson B, Fengsrud E, Lundin F, Bojö L, Poci D. The a' velocity by tissue-Doppler echocardiography correlates to invasive mean left atrial pressure in patients with normal ejection fraction. SCAND CARDIOVASC J 2022; 56:6-12. [PMID: 35137668 DOI: 10.1080/14017431.2022.2032317] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To evaluate the correlation of a' velocity by tissue-Doppler measurements with invasively measured mean left atrial pressure in patients with normal ejection fraction. DESIGN In this retrospective study, we evaluated the septal a', lateral a' and average a' velocity by tissue-Doppler echocardiography, in 125 in-hospital patients, 1-12 h before an elective pulmonary vein isolation due to intermittent atrial fibrillation, and compared to invasively measured mean left atrial pressure (LAP) during the invasive procedure. The patients, aged 35-81 years, had to be in sinus rhythm at both examinations, no atrial fibrillation during two procedures, no or mild valve disease and normal ejection fraction (>50%). RESULTS Invasively measured mean LAP correlated well to septal a' (r = -0.435), lateral a' (r = -0.473) and average a' velocity (r = -0.491). Normal mean LAP (≤12 mmHg) was found in 95 patients and elevated mean LAP (>12 mmHg) in 30 patients. The patients with elevated mean LAP had a lower septal a' velocity (6.5 ± 2.7 vs 8.6 ± 2.3 cm/s; p < .01), lateral a' velocity (5.9 ± 2.3 vs 8.6 ± 2.1 cm/s; p < .01) and average a' velocity (6.2 ± 2.4 vs 8.8 ± 2.1 cm/s; p < .01) compared to patients with normal mean LAP. Septal a', lateral a' and average a' velocity were good predictors of elevated mean LAP with AUC of 0.78, 0.83 and 0.82. Average a' velocity with cut-off < 7.25 cm/s had a sensitivity of 83% and a specificity of 77% to predict elevated mean LAP. CONCLUSION The a' velocity is a good indicator of mean LAP and might be considered in the evaluation of left ventricle filling pressure in patients with normal ejection fraction.
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Affiliation(s)
- Benny Johansson
- Department of Heart-Lung and Clinical Physiology, School of Medical Sciences, Örebro University Hospital, Örebro, Sweden
| | - Espen Fengsrud
- Department of Heart-Lung and Clinical Physiology, School of Medical Sciences, Örebro University Hospital, Örebro, Sweden
| | - Fredrik Lundin
- Centre for statistical Clinical Research, County Council of Värmland, Värmland, Sweden
| | - Leif Bojö
- Department of Clinical Physiology, Central Hospital, Karlstad, Sweden
| | - Dritan Poci
- Department of Heart-Lung and Clinical Physiology, School of Medical Sciences, Örebro University Hospital, Örebro, Sweden
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12
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Sundström N, Rydja J, Virhammar J, Kollén L, Lundin F, Tullberg M. The timed up and go test in idiopathic normal pressure hydrocephalus: a Nationwide Study of 1300 patients. Fluids Barriers CNS 2022; 19:4. [PMID: 35012586 PMCID: PMC8750754 DOI: 10.1186/s12987-021-00298-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 10/01/2021] [Accepted: 12/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to describe the outcome measure timed up and go (TUG) in a large, nationwide cohort of patients with idiopathic normal pressure hydrocephalus (iNPH) pre- and post-operatively. Furthermore, to compare the TUG test to the 10-m walk test (10MWT), the iNPH scale, the modified Rankin scale (mRS) and the Mini Mental State Examination (MMSE), which are commonly applied in clinical assessment of iNPH. METHODS Patients with iNPH (n = 1300), registered in the Swedish Hydrocephalus Quality Registry (SHQR), were included. All data were retrieved from the SHQR except the 10MWT, which was collected from patient medical records. Clinical scales were examined pre- and 3 months post-operatively. Data were dichotomised by sex, age, and preoperative TUG time. RESULTS Preoperative TUG values were 19.0 [14.0-26.0] s (median [IQR]) and 23 [18-30] steps. Post-operatively, significant improvements to 14.0 [11.0-20.0] s and 19 [15-25] steps were seen. TUG time and steps were higher in women compared to men (p < 0.001) but there was no sex difference in improvement rate. Worse preoperative TUG and younger age favoured improvement. TUG was highly correlated to the 10MWT, but correlations of post-operative changes were only low to moderate between all scales (r = 0.22-0.61). CONCLUSIONS This study establishes the distribution of TUG in iNPH patients and shows that the test captures important clinical features that improve after surgery independent of sex and in all age groups, confirming the clinical value of the TUG test. TUG performance is associated with performance on the 10MWT pre- and post-operatively. However, the weak correlations in post-operative change to the 10MWT and other established outcome measures indicate an additional value of TUG when assessing the effects of shunt surgery.
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Affiliation(s)
- Nina Sundström
- Department of Radiation Sciences, Radiation Physics, Biomedical Engineering, Umeå University, Umeå, Sweden.
| | - Johanna Rydja
- Department of Activity and Health, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Johan Virhammar
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| | - Lena Kollén
- Department of Neurology, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Fredrik Lundin
- Department of Neurology, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Mats Tullberg
- Hydrocephalus Research Unit, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Rydja J, Kollén L, Hellström P, Owen K, Lundgren Nilsson Å, Wikkelsø C, Tullberg M, Lundin F. Physical exercise and goal attainment after shunt surgery in idiopathic normal pressure hydrocephalus: a randomised clinical trial. Fluids Barriers CNS 2021; 18:51. [PMID: 34809666 PMCID: PMC8607575 DOI: 10.1186/s12987-021-00287-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 09/23/2021] [Accepted: 11/11/2021] [Indexed: 02/06/2023] Open
Abstract
Background Rehabilitation in iNPH is suggested to be an important factor to improve patients’ functions but there are lack of clinical trials evaluating the effect of rehabilitation interventions after shunt surgery in iNPH. The objective of this study was to evaluate the effect of a physical exercise programme and goal attainment for patients with idiopathic normal pressure hydrocephalus (iNPH) after surgery compared to a control group. Methods This was a dual centre randomised controlled trial with assessor blinding, intention-to-treat (ITT) and per protocol (PP) analysis. Individuals diagnosed with iNPH scheduled to undergo shunt surgery at the Linköping University Hospital in Linköping and Sahlgrenska University Hospital in Gothenburg, Sweden were consecutively eligible for inclusion. Inclusion was conducted between January 2016 and June 2018. The patients were randomised 1:1 using sequentially numbered sealed envelopes to receive either written exercise information (control group) or written information and an additional supervised high-intensity, functional exercise programme (HIFE) executed twice weekly over 12 weeks (exercise group). Preoperatively, the patients set individual goals. The primary outcome was change from baseline in the total iNPH scale score at the post-intervention follow-up. Secondary outcomes were goal attainment, and change in the separate scores of gait, balance, neuropsychology and continence and in the total score after 6 months. Results In total, 127 participants were randomised to the exercise group (n = 62) and to the control group (n = 65). In the ITT population (exercise group, n = 50; control group, n = 59), there were no between-group differences in the primary outcome, but the attrition rate in the exercise group was high. The exercise group improved more than the control group in the balance domain scores after 6 months. Post-intervention, the PP exercise population achieved their set goals to a greater extent than the controls. Conclusions An additional effect of the 12-week HIFE-programme on the overall improvement according to the iNPH-scale after shunt surgery in iNPH was not shown. This could be due to high attrition rate. However, the long-term effect on balance and higher goal achievement indicate beneficial influences of supervised physical exercise. Trial registration clinicaltrials.gov, NCT02659111. Registered 20 January 2016, https://clinicaltrials.gov/ct2/show/NCT02659111 Supplementary Information The online version contains supplementary material available at 10.1186/s12987-021-00287-8.
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Affiliation(s)
- Johanna Rydja
- Department of Activity and Health, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping University Hospital, 581 85, Linköping, Sweden.
| | - Lena Kollén
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Per Hellström
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katarina Owen
- Department of Activity and Health, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Åsa Lundgren Nilsson
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carsten Wikkelsø
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mats Tullberg
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Fredrik Lundin
- Department of Neurology, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Petersson M, Feresiadou A, Jons D, Ilinca A, Lundin F, Johansson R, Budzianowska A, Roos AK, Kågström V, Gunnarsson M, Sundström P, Piehl F, Brauner S. Patient-Reported Symptom Severity in a Nationwide Myasthenia Gravis Cohort: Cross-sectional Analysis of the Swedish GEMG Study. Neurology 2021; 97:e1382-e1391. [PMID: 34376512 PMCID: PMC8520390 DOI: 10.1212/wnl.0000000000012604] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/09/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To describe myasthenia gravis activities of daily living (MG-ADL) in relation to clinical characteristics in a large Swedish nationwide cohort. METHODS In a cross-sectional prevalence cohort study, the Genes and Environment in Myasthenia Gravis study, performed from November 2018 through August 2019, patients with myasthenia gravis (MG) were invited to submit an extensive 106-item life environment questionnaire, including the MG-ADL score. Patients were classified into early-onset MG (EOMG, <50 years), late-onset MG (LOMG, ≥50 years), or thymoma-associated MG (TAMG). Comparisons of disease-specific characteristics were made between subgroups, sexes, and different MG-ADL scores. RESULTS A total of 1,077 patients were included, yielding a 74% response rate: 505 (47%) were classified as EOMG, 520 (48%) LOMG, and 45 (4%) TAMG. Mean age at inclusion was 64.3 years (SD 15.7) and mean disease duration was 14.6 years (SD 14.0). Complete MG-ADL scores (n = 1,035) ranged from 0p to 18p, where 26% reported a score of 0p. Higher MG-ADL scores were associated with female sex, obesity, and diagnostic delay (odds ratio [OR] 1.62, 1.72, and 1.69; p adj = 0.017, 0.013, and 0.008) and inversely correlated with high educational attainment (OR 0.59; p adj = 0.02), but not with age at inclusion, disease subtype, or disease duration. Almost half of the population (47%) reported MG-ADL ≥3p, corresponding to an unsatisfactory symptom state. DISCUSSION In this nationwide study, comprising more than 40% of the prevalent MG population in Sweden, almost half of the patients reported current disease symptoms associated with an unsatisfactory symptom state, indicating the need for improved treatment options.
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Affiliation(s)
- Malin Petersson
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Amalia Feresiadou
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Daniel Jons
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Andreea Ilinca
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Lundin
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Rune Johansson
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Anna Budzianowska
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Anna-Karin Roos
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Viktor Kågström
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Martin Gunnarsson
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Peter Sundström
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Piehl
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Susanna Brauner
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden.
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15
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Ocias LF, Skogstam A, Kjerstadius T, Lundin F, Tevell S. Higher rate of SARS-CoV-2 IgG seropositivity in hospital-based healthcare workers compared to elderly care staff in a Swedish low-prevalence region: a cross-sectional study. Infect Dis (Lond) 2021; 53:920-929. [PMID: 34350813 DOI: 10.1080/23744235.2021.1959949] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Previous seroprevalence studies have demonstrated higher anti-SARS-CoV-2 IgG seroprevalence in healthcare workers (HCWs) than in the background population during the first phase of the 2020 COVID-19 pandemic. These studies, however, focussed mainly on hospital employees. AIM To perform a cross-sectional study comparing the seroprevalence of hospital-based HCWs with those employed in elderly care (home care and nursing homes). METHODS Employees (n = 4955) in the county of Värmland, Sweden, were recruited between weeks 27 and 42 and tested for IgG antibodies against SARS-CoV-2. Serological results were combined with self-reported questionnaire data. FINDINGS IgG seroprevalence was 5.7% in the total group of HCWs, and was higher among those employed in hospital-based healthcare than among those working in elderly care (8.4% vs. 3.7%, p < .001). Being employed as an assistant nurse, working in a COVID-19 unit, and being exposed via co-workers or private acquaintances were all associated with IgG seropositivity. CONCLUSION The difference in seroprevalence between HCWs in the two settings suggests that not only the profession but also factors in the workplace environment may be of importance. As all studied exposures were associated with IgG seropositivity, and asymptomatic infection was detected in 7.5% of participants, preventing outbreaks among HCWs is challenging. Adequate use of personal protective equipment when working with patients regardless of COVID-19 status, source control in situations with co-workers in which distancing is not possible, and routines enabling symptomatic staff to isolate pending PCR results are required to prevent healthcare-associated outbreaks of COVID-19.
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Affiliation(s)
- Lukas Frans Ocias
- Department of Clinical Microbiology, Karlstad Hospital, Karlstad, Sweden.,Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden
| | - Anna Skogstam
- Department of Infection Prevention and Control, Karlstad Hospital, Karlstad, Sweden
| | | | - Fredrik Lundin
- Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden
| | - Staffan Tevell
- Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden.,Department of Infectious Diseases, Karlstad Hospital, Karlstad, Sweden.,Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
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16
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Rydja J, Eleftheriou A, Lundin F. Evaluating the cerebrospinal fluid tap test with the Hellström iNPH scale for patients with idiopathic normal pressure hydrocephalus. Fluids Barriers CNS 2021; 18:18. [PMID: 33827613 PMCID: PMC8025497 DOI: 10.1186/s12987-021-00252-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/01/2020] [Accepted: 03/23/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The cerebrospinal fluid tap test (CSF TT) is used for selecting shunt surgery candidates among patients with idiopathic normal pressure hydrocephalus (iNPH). We aimed to evaluate the predictive value of the CSF TT, by using the Hellström iNPH scale for shunted iNPH patients with a standardized method. METHODS One hundred and sixteen shunt-operated iNPH patients were retrospectively included in this study. The gait and balance domains in the iNPH scale were used as outcome measures for the CSF TT and the total iNPH scale score as the postoperative outcome. A positive response to CSF TT was defined as a change of ≥ 5 points in the gait domain and ≥ 16 points in the balance domain. Differences between CSF TT responders and non-responders, sensitivity, specificity, positive and negative predictive values, accuracy, and correlations between changes from baseline to post CSF TT and from baseline to the postoperative follow-up, were calculated. RESULTS In the CSF TT there were 63.8% responders in the gait domain and correspondingly 44.3% in the balance domain. CSF TT responders had a significantly better postoperative outcome in the total scale score (gait P ≤ 0.001, balance P ≤ 0.012) and gait CSF TT responders improved more in gait (P ≤ 0.001) and balance CSF TT responders in balance (P ≤ 0.001). No differences between CSF TT gait or balance responders could be found in neuropsychological or urinary continence assessments postoperatively. The sensitivity and specificity of the CSF TT and the outcome of the total iNPH scale score postoperatively were 68.1% and 52.0% for gait and 47.8% and 68.0% for balance, respectively. CONCLUSIONS The CSF TT, with the Hellström iNPH scale as the outcome measure, has clear limitations in predicting postoperative results. The gait domain may be used to predict outcomes for gait, but the balance domain is too insensitive.
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Affiliation(s)
- Johanna Rydja
- Department of Activity and Health, and Department of Biomedical and Clinical Sciences, Linköping University, 581 85 Linköping, Sweden
| | - Andreas Eleftheriou
- Department of Neurology, and Department of Biomedical and Clinical Sciences, Linköping University, 581 85 Linköping, Sweden
| | - Fredrik Lundin
- Department of Neurology, and Department of Biomedical and Clinical Sciences, Linköping University, 581 85 Linköping, Sweden
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17
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Eleftheriou A, Huang-Link Y, Lundin F. Optical Coherence Tomography Revealing Ganglion Cell Loss in Idiopathic Normal Pressure Hydrocephalus. World Neurosurg 2021; 149:e1061-e1066. [PMID: 33444824 DOI: 10.1016/j.wneu.2021.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/01/2021] [Accepted: 01/02/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although there may theoretically be a disturbance in the eye or the visual pathways due to abnormal cerebrospinal fluid (CSF) dynamics in idiopathic normal pressure hydrocephalus (iNPH), it has not been studied systemically. Optical coherence tomography (OCT) is a noninvasive, reproducible procedure for quantitative and qualitative analysis of retinal morphology. METHODS OCT was used to study the eye fundus before and after a CSF tap test in patients with iNPH compared with healthy individuals (HIs). Twelve patients with iNPH (6 females and 6 males) with a median age of 76 years (64-84 years) and 21 HIs (11 females and 10 males) with a median age of 73 years (64-79 years) were included. The patients underwent neurological, cognitive, and physiotherapeutic evaluation. Brain magnetic resonance imaging, CSF tap test via lumbar puncture, and subsequently CSF analysis were performed. OCT was performed before and after CSF removal. HIs underwent OCT once. RESULTS The patients had significantly reduced retinal ganglion cell layer thickness 71 μm (56-81 μm) compared with the HIs, 79.5 μm (72-90 μm) (P = 0.001), but no significant changes were observed before or after the CSF tap test. All patients improved in motor function in a 10-m walk test after the CSF tap test. The median CSF pressure was 15 and 1 cm H2O, respectively, before and after lumbar puncture with removal of median 43.5 mL CSF. CONCLUSIONS This pilot study shows OCT findings that differ from HIs and implies a rational for becoming a valuable tool in the diagnosis of iNPH. Further studies are warranted to elucidate the pathology of the retina in iNPH.
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Affiliation(s)
- Andreas Eleftheriou
- Department of Neurology, Division of Neurobiology, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Division of Neurobiology, Linköping University, Linköping, Sweden.
| | - Yumin Huang-Link
- Department of Neurology, Division of Neurobiology, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Division of Neurobiology, Linköping University, Linköping, Sweden
| | - Fredrik Lundin
- Department of Neurology, Division of Neurobiology, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Division of Neurobiology, Linköping University, Linköping, Sweden
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18
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Sartipy F, Lundin F, Wahlberg E, Sigvant B. Cardiovascular long-term outcome and prophylactic treatment patterns in peripheral arterial disease in a population-based cohort. Eur Heart J Qual Care Clin Outcomes 2020; 5:310-320. [PMID: 31304962 DOI: 10.1093/ehjqcco/qcz037] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 07/08/2019] [Accepted: 07/12/2019] [Indexed: 12/31/2022]
Abstract
AIMS This study evaluates 10-year follow-up data on associated comorbidity, mortality, and pharmacological treatment patterns for men and women with different stages of peripheral arterial disease (PAD) in a population-based setting. METHODS AND RESULTS This was a prospective observational population-based cohort study, based on physical examinations and questionnaires at baseline supplemented with national register data between 2005 and 2015. Subjects were placed in subgroups defined by ankle-brachial index levels and reported symptoms; asymptomatic PAD (APAD), intermittent claudication (IC), severe limb ischaemia (SLI), or references (Ref). Cox proportional hazards regression models were used for analysis with adjustments for sex and baseline age and comorbidity. The cohort consisted of 5080 subjects (45% males). At baseline, APAD, IC, and SLI were prevalent in 559 (11%), 320 (6.3%), and 78 (1.5%) subjects, respectively. A significant increased risk for cardiovascular (CV) death, even when adjusted for age and baseline morbidity, were noted in all PAD stages as compared with reference group with a small difference between APAD and IC, an adjusted hazard ratio 1.80 (confidence interval 1.45-2.22) and 1.95 (1.50-2.53), respectively. Only about 60% of PAD subjects received medical prophylactic treatment as recommended in guidelines. CONCLUSION Peripheral arterial disease subjects had significantly increased CV morbidity and mortality risks, especially males. Asymptomatic PAD subjects confer similar risk for CV events as symptomatic patients. Our findings motivate enhanced preventive efforts of all PAD stages, including in asymptomatic disease.
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Affiliation(s)
- Fredrik Sartipy
- Department of Clinical Science and Education, Section of Vascular Surgery, Karolinska Institutet at Södersjukhuset, Kirurgkliniken, Sjukhusbacken 10, Stockholm, Sweden
| | - Fredrik Lundin
- Centre of Clinical Research, County Council of Värmland, Älvgatan 49, Karlstad, Sweden
| | - Eric Wahlberg
- Department of Medicine and Health, Linköping University, Linkoping University Hospital, SE Linköping, Sweden
| | - Birgitta Sigvant
- Department of Surgical Sciences, Uppsala University, Uppsala, Dag Hammarskjölds väg 38, Sweden
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Welander G, Lundin F, Sigvant B. P1331OPTIMAL PLANNING OF VASCULAR ACCESS IS CALLED FOR IN WOMEN. AVF ARE MORE INTERVENED AND ABANDONED DESPITE LESS CO-MORBIDITY. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1331] [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: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Central venous catheter (CVC) increase the risk of infection, central stenosis, hospitalizations, morbidity, mortality and later arterio-venous (AV) access failure. Vascular access planning begins in the predialysis stage of Chronic Kidney Disease (CKD). An optimal timely referral to vascular surgeon is possible since 80 % of patients are known to kidney units before initiating hemodialysis (HD). Despite this, some 71 % (75% women and 68 % men respectively) of incident patients had a CVC as vascular access when starting HD in Sweden during 2017. Some reports have shown increased risk of AVF failure in women which has been contradicted by others. The aim of this study was to determine factors of importance for achieving a functioning fistula for women and men.
Method
Data from the national Swedish Renal Registry (SRR), that covers the disease progression from CKD phase to renal replacement therapy, was used as well as mandatory national registries. Data was extracted from 2011 to 2017 for, sex, age, primary renal diagnosis, number of CVC, patient phase, co-morbidity, socio-economic factors as well as interventions and complications. A Royston-Palmer model was used for hazard ratio (HR). Cumulative incidence plots were used for fistula patency.
P value < .005 was considered significant
Results
The study included 5040 patients at baseline (33% women). The mean age, the time in dialysis before fistula placement and numbers of CVC did not differ between the sexes. Prevalence of polycystic kidney disease was the only primary diagnosis that differed between the sexes (10.7% among women versus 6.5% among men respectively p<.01). Cancer, hypertension and ischemic heart disease, was more prevalent among men (24.0 vs 19.1 p<.001, 80,9% vs 75.7, p<.001 and 25.3 vs 18.0 p<001). Education level were similar between the sexes whereas more men were married and born in Sweden as compared women (49.3 vs 41.6 p<.001 and 78.9 vs 73.0 p<.001). Age, diabetes and peripheral arterial disease increased the risk for reinterventions by 6% and 28% and 36% (HR 1.06 [1.03,1.15], 1.28[1.18,1.40], and 1.36[1.19,1.56] respectively. The risk for reintervention and abandonment was higher for women (HR 1.19 [95% CI: 1,09,1,56, and 1.42[1,26,1.60)]. Figure 1. shows cumulative incidence for primary patency in lower arm fistula for men and women. Incidence of secondary patency abandonment is higher for women with lower and upper arm AVF while no differences between men and women were observed for AV grafts.
Conclusion
When receiving the first fistulas, men present a higher co-morbidity as compared to women while age and time of dialysis with a CVC is similar between the sexes. Only 42% will receive an AVF in CKD phase with detriment for men. The consequence of placement in CKD phase could matter and needs to be further analysed. AVF confers a higher risk for reintervention and abandonment, particularly among women which may explain the higher use of CVC. This higher risk must be taken into account when planning for vascular access and follow up.
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Affiliation(s)
- Gunilla Welander
- Uppsala Universitetet, Department of medical sciences, Uppsala, Sweden
- Region Värmland, Centrum för klinisk forskning, Karlstad, Sweden
| | - Fredrik Lundin
- Region Värmland, Centrum för klinisk forskning, Karlstad, Sweden
| | - Birgitta Sigvant
- Region Värmland, Centrum för klinisk forskning, Karlstad, Sweden
- Department of surgical sciences, Uppsala Universitetet, Sweden
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20
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Abstract
Objective: To evaluate a group-based music intervention in patients with Parkinson’s
disease. Design: Parallel group randomized controlled trial with qualitative
triangulation. Setting: Neurorehabilitation in primary care. Subjects: Forty-six patients with Parkinson’s disease were randomized into intervention
group (n = 26), which received training with the
music-based intervention, and control group (n = 20)
without training. Interventions: The intervention was delivered twice weekly for 12 weeks. Main measures: Primary outcome was Timed-Up-and-Go subtracting serial 7’s (dual-task
ability). Secondary outcomes were cognition, balance, concerns about
falling, freezing of gait, and quality of life. All outcomes were evaluated
at baseline, post-intervention, and three months post-intervention. Focus
groups and individual interviews were conducted with the intervention group
and with the delivering physiotherapists. Results: No between-group differences were observed for dual-task ability.
Between-group differences were observed for Falls Efficacy Scale (mean
difference (MD) = 6.5 points; 95% confidence interval (CI) = 3.0 to 10.0,
P = 0.001) and for Parkinson Disease Questionnaire-39
items (MD = 8.3; 95% CI = 2.7 to 13.8, P = 0.005) when
compared to the control group post-intervention, but these were not
maintained at three months post-intervention. Three themes were derived from
the interviews: Expectations versus Results, Perspectives on
Treatment Contents, and Key Factors for
Success. Conclusion: Patient-reported outcomes and interviews suggest that the group-based music
intervention adds value to mood, alertness, and quality of life in patients
with Parkinson’s disease. The study does not support the efficacy in
producing immediate or lasting gains in dual-tasking, cognition, balance, or
freezing of gait.
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Affiliation(s)
- Petra Pohl
- Department of Activity and Health, and Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ewa Wressle
- Department of Acute Internal Medicine and Geriatrics, Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
| | - Fredrik Lundin
- Department of Neurology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Paul Enthoven
- Pain and Rehabilitation Centre, and Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden
| | - Nil Dizdar
- Department of Neurology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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21
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Sigvant B, Sartipy F, Lundin F, Wahlberg E. Cardiovascular Disease Remains the Main Cause of Death in All Peripheral Arterial Disease Stages. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.06.664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Objectives. To compare the ability of the E/a' ratio and the recommended diastolic parameters in the American Society of Echocardiography (ASE) and the European Association of Cardiovascular Imaging (EACVI), in predicting a dominant diastolic pulmonary vein flow in patients with normal ejection fraction. Design. We retrospectively evaluated the diastolic function according to the ASE/EACVI guidelines, the S/D ratio and the septal, lateral and average E/a' ratio in 293 unselected in-hospital patients, aged 39-86 years, in sinus rhythm and with no or mild valve disease, having a normal systolic function (EF > 50%). Results. The S/D ratio had a positive association to septal, lateral and average E/a ratio (R2 = 0.25, 0.35 and 0.32). The association to average E/e' ratio, LA vol index and TR velocity was weak (R2 = 0.037, 0.033 and 0.087) and for e' velocity negatively. In patients with S/D ratio <1, septal, lateral, average E/a' ratio, average E/e ratio, LA vol index (p<.001) and TR velocity (p<.05) were significantly higher compared to patients with S/D ratio ≥1. No significant difference was seen in e' velocity. The septal, lateral and average E/a' ratio were significantly higher in patients with S/D ratio <1 regardless a normal or impaired diastolic function according to the ASE/EACVI guidelines (p<.001). The ASE/EACVI algorithm detected 21 patients with S/D ratio <1 compared to 28 patients using average E/a' ratio with cut-off >14. Conclusion: E/a' ratio might be a useful new diastolic parameter in patients with a normal ejection fraction as it is more closely related to the S/D ratio than the established ASE/EACVI diastolic parameters.
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Affiliation(s)
- Benny Johansson
- Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden
| | - Fredrik Lundin
- Centre for statistical Clinical Research, County Council of Värmland, Karlstad, Sweden
| | - Rolf Tegeback
- Department of Clinical Physiology, Länssjukhuset Sundsvall-Harnosand, Sundsvall, Sweden
| | - Leif Bojö
- Department of Clinical Physiology, Central Hospital, Karlstad, Sweden
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23
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Eleftheriou A, Rashid AS, Lundin F. Late Transient Contrast-Induced Encephalopathy after Percutaneous Coronary Intervention. J Stroke Cerebrovasc Dis 2018; 27:e104-e106. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.12.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 12/18/2017] [Accepted: 12/31/2017] [Indexed: 10/18/2022] Open
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24
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Abstract
OBJECTIVES To compare the ability of the a´ velocity and the e´ velocity in predicting a dominant diastolic pulmonary vein flow (S/D ratio <1) in patients with normal ejection fraction. DESIGN We retrospectively evaluated the diastolic function according to the ASE/EACVI guidelines, the S/D ratio and the septal, lateral and average a´ velocity in 293 unselected in-hospital patients, aged 39-86 years, in sinus rhythm and with no or mild valve disease, having a normal systolic function (EF >50%). RESULTS There was a good linear correlation between the S/D ratio and the a´ velocity, but a tendency towards a negative correlation between the S/D ratio and the e´ velocity. S/D ratio <1 was seen in 43 patients. These patients had a significantly lower a´ velocity compared to those with S/D-ratio ≥1, septal (6,1 ± 2,4 v 8,8 ± 2,1 cm/s; p < .001) and lateral (6,0 ± 2,6 v 9,3 ± 2,5 cm/s; p < .001) No significant difference was seen in the septal e´ velocity (6,8 ± 2,4 v 6,8 ± 2,1 cm/s), lateral e´ velocity (9,4 ± 2,6 v 9,1 ± 2,8 cm/s) or in the ejection fraction (58,6 ± 4,4% v 58,7 ± 4,0%). A diastolic dysfunction was present in 62 patients, normal diastolic function in 231 patients. The a´ velocity was significantly lower in patients with S/D ratio <1 in both groups (p < .01). CONCLUSION The a´ velocity is superior to the e´ velocity in predicting S/D ratio <1 in patients with normal ejection fraction regardless the ASE/EACVI diastolic classification. A failing left atrium seems to be the explanation.
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Affiliation(s)
- Benny Johansson
- a Department of Clinical Physiology , Örebro University Hospital , Örebro , Sweden
| | - Fredrik Lundin
- b Centre for Statistical Clinical Research , Karlstad , Sweden
| | - Rolf Tegeback
- c Department of Clinical Physiology , Central Hospital , Sundsvall , Sweden
| | - Leif Bojö
- d Department of Clinical Physiology , Central Hospital , Karlstad , Sweden
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25
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Abstract
OBJECTIVES Could a diastolic dysfunction and an increased LV-filling pressure according to ASE/EACVI guidelines be detected or ruled out by the E/a´ratio in patients with decreased ejection fraction. DESIGN We retrospectively evaluated the diastolic function of 113 unselected in-hospital patients, aged 40-84 years, in sinus rhythm and with no or mild valve disease, having a decreased systolic function (EF ≤50%) using the new ASE/EACVI guidelines and compared these results with the E/a´ratio derived from the E wave in the mitral flow and the a´velocity in the tissue Doppler. RESULTS The average E/a´ ratio is a strong predictor of a grade II-III diastolic dysfunction and an elevated left atrial pressure according to ASE/EACVI guidelines with an AUC of 0.92. An average E/a´ ratio with a cut-off >10 had a sensitivity of 97.6% and a negative predictive value of 98.2% in detecting or ruling out a grade II-III diastolic dysfunction and an elevated left atrial pressure according to the current guidelines. CONCLUSION The average E/a´ ratio might be useful as a fast screening tool of a left ventricular dysfunction and an increased left ventricular filling pressure in patients with a decreased ejection fraction.
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Affiliation(s)
- Benny Johansson
- a Department of Clinical Physiology , Örebro University Hospital , Örebro , Sweden
| | - Fredrik Lundin
- b Centre for statistical Clinical Research , County Council of Värmland , Karlstad , Sweden
| | - Rolf Tegerback
- c Department of Clinical Physiology , Central Hospital , Sundsvall , Sweden
| | - Leif Bojö
- d Department of Clinical Physiology , Central Hospital , Karlstad , Sweden
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26
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Eleftheriou A, Ulander M, Lundin F. Circadian rhythm in idiopathic normal pressure hydrocephalus. Clin Neurol Neurosurg 2017; 164:72-74. [PMID: 29202376 DOI: 10.1016/j.clineuro.2017.11.018] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/20/2017] [Accepted: 11/28/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The pathogenesis of idiopathic normal pressure hydrocephalus (iNPH) takes place in structures close to the cerebral ventricular system. Suprachiasmatic nucleus (SCN), situated close to the third ventricle, is involved in circadian rhythm. Diurnal disturbances are well-known in demented patients. The cognitive decline in iNPH is potentially reversible after a shunt operation. Diurnal rhythm has never been studied in iNPH. We hypothesize that there is a disturbance of circadian rhythm in iNPH-patients and the aim was to study any changes of the diurnal rhythm (mesor and circadian period) as well as any changes of the diurnal amplitude and acrophase of the activity in iNPH-patients before and after a shunt operation. PATIENTS AND METHODS Twenty consecutive iNPH-patients fulfilling the criteria of the American iNPH-guidelines, 9 males and 11 females, mean age 73 (49-81) years were included. The patients underwent a pre-operative clinical work-up including 10m walk time (w10mt) steps (w10ms), TUG-time (TUGt) and steps (TUGs) and for cognitive function an MMSE score was measured. In order to receive circadian rhythm data actigraphic recordings were performed using the SenseWear 2 (BodyMedia Inc Pittsburgh, PA, USA) actigraph. Cosinor analyses of accelerometry data were performed in "R" using non-linear regression with Levenburg- Marquardt estimation. Pre- and post-operative data regarding mesor, amplitude and circadian period were compared using Wilcoxon-Mann-Whitney test for paired data. RESULTS Twenty patients were evaluated before and three month post-operatively. Motor function (w10mt, w10ms, TUGt, TUGs) was significantly improved while MMSE was not significantly changed. Actigraphic measurements (mesor, amplitude and circadian period) showed no significant changes after shunt operation. CONCLUSION This is the first systematic study of circadian rhythm in iNPH-patients. We found no significant changes in circadian rhythm after shunt surgery. The conceptual idea of diurnal rhythm changes in hydrocephalus is still interesting from a theoretical standpoint and warrants further studies that could include a combination of better designed actigraphic studies in combination with neuroendocrine markers and imaging methods.
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Affiliation(s)
- Andreas Eleftheriou
- Department of Neurology, University Hospital, Linköping, Sweden; Department of Clinical and Experimental Medicine (IKE), Division of Neuroscience, Linköping University, Sweden.
| | - Martin Ulander
- Department of Clinical Neurophysiology, University Hospital, Linköping, Sweden; Department of Clinical and Experimental Medicine (IKE), Linköping University, Sweden
| | - Fredrik Lundin
- Department of Neurology, University Hospital, Linköping, Sweden; Department of Clinical and Experimental Medicine (IKE), Division of Neuroscience, Linköping University, Sweden
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27
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Al-Amiri B, Lundin F, Waldén M. Extended pelvic lymph-node dissection and radiotherapy with curative intent in high-risk lymph-node-positive prostate cancer: a possible curative strategy? Scand J Urol 2017; 52:101-107. [PMID: 29020868 DOI: 10.1080/21681805.2017.1382568] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study evaluated the outcome with a treatment strategy for high-risk prostate cancer (PCa) using extended pelvic lymph-node dissection (eLND) followed by external beam radiation therapy (EBRT) in lymph-node-positive (LNpos) and lymph-node-negative (LNneg) cases compared with the strategy with limited pelvic lymph-node dissection (lLND) and only giving EBRT to LNneg cases. MATERIALS AND METHODS From 2000 to 2006, 124 men with high-risk PCa underwent lLND and initiated androgen deprivation therapy (ADT) before planned EBRT. LNpos patients were excluded from EBRT following the SPCG-7 study strategy (group I). From 2007 to 2013, 111 patients underwent eLND and started ADT before EBRT, and LNneg and most LNpos patients received EBRT (group II). Using Kaplan-Meier plots and multivariable Cox regression, biochemical recurrence-free, metastasis-free, cancer-specific survival and overall survival were compared during a 10 year follow-up. RESULTS PSA progression-free survival rates after 2, 4, 6, 8 and 10 years were 78%, 66%, 52%, 45% and 41% in group I, and 88%, 83%, 78%, 69% and 69% in group II (p < 0.001), respectively. Group II had a lower risk of PSA progression [hazard ratio (HR) = 0.43, 95% confidence interval (CI) 0.27,0.69, p = 0.001], metastasis development (HR = 0.51, 95% CI 0.27,0.97, p = 0.040) and overall mortality (HR = 0.49, 95% CI 0.26,0.92, p = 0.027), but not of PCa-specific death (HR = 0.45, 95% CI 0.19,1.08, p = 0.074). CONCLUSION A treatment strategy for high-risk PCa with eLND combined with EBRT in LNneg and LNpos cases may improve outcome compared to a strategy with lLND and offering EBRT only to LNneg cases but ADT to LNpos cases.
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Affiliation(s)
- Bashar Al-Amiri
- a Department of Surgery and Urology , Central Hospital , Karlstad , Sweden
| | - Fredrik Lundin
- b Center for Clinical Research , County Council of Värmland , Karlstad , Sweden
| | - Mauritz Waldén
- a Department of Surgery and Urology , Central Hospital , Karlstad , Sweden
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28
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Adam A, Robison J, Lu J, Jose R, Badran N, Vivas-Buitrago T, Rigamonti D, Sattar A, Omoush O, Hammad M, Dawood M, Maghaslah M, Belcher T, Carson K, Hoffberger J, Jusué Torres I, Foley S, Yasar S, Thai QA, Wemmer J, Klinge P, Al-Mutawa L, Al-Ghamdi H, Carson KA, Asgari M, de Zélicourt D, Kurtcuoglu V, Garnotel S, Salmon S, Balédent O, Lokossou A, Page G, Balardy L, Czosnyka Z, Payoux P, Schmidt EA, Zitoun M, Sevestre MA, Alperin N, Baudracco I, Craven C, Matloob S, Thompson S, Haylock Vize P, Thorne L, Watkins LD, Toma AK, Bechter K, Pong AC, Jugé L, Bilston LE, Cheng S, Bradley W, Hakim F, Ramón JF, Cárdenas MF, Davidson JS, García C, González D, Bermúdez S, Useche N, Mejía JA, Mayorga P, Cruz F, Martinez C, Matiz MC, Vallejo M, Ghotme K, Soto HA, Riveros D, Buitrago A, Mora M, Murcia L, Bermudez S, Cohen D, Dasgupta D, Curtis C, Domínguez L, Remolina AJ, Grijalba MA, Whitehouse KJ, Edwards RJ, Eleftheriou A, Lundin F, Fountas KN, Kapsalaki EZ, Smisson HF, Robinson JS, Fritsch MJ, Arouk W, Garzon M, Kang M, Sandhu K, Baghawatti D, Aquilina K, James G, Thompson D, Gehlen M, Schmid Daners M, Eklund A, Malm J, Gomez D, Guerra M, Jara M, Flores M, Vío K, Moreno I, Rodríguez S, Ortega E, Rodríguez EM, McAllister JP, Guerra MM, Morales DM, Sival D, Jimenez A, Limbrick DD, Ishikawa M, Yamada S, Yamamoto K, Junkkari A, Häyrinen A, Rauramaa T, Sintonen H, Nerg O, Koivisto AM, Roine RP, Viinamäki H, Soininen H, Luikku A, Jääskeläinen JE, Leinonen V, Kehler U, Lilja-Lund O, Kockum K, Larsson EM, Riklund K, Söderström L, Hellström P, Laurell K, Kojoukhova M, Sutela A, Vanninen R, Vanha KI, Timonen M, Rummukainen J, Korhonen V, Helisalmi S, Solje E, Remes AM, Huovinen J, Paananen J, Hiltunen M, Kurki M, Martin B, Loth F, Luciano M, Luikku AJ, Hall A, Herukka SK, Mattila J, Lötjönen J, Alafuzoff I, Jurjević I, Miyajima M, Nakajima M, Murai H, Shin T, Kawaguchi D, Akiba C, Ogino I, Karagiozov K, Arai H, Reis RC, Teixeira MJ, Valêncio CG, da Vigua D, Almeida-Lopes L, Mancini MW, Pinto FCG, Maykot RH, Calia G, Tornai J, Silvestre SSS, Mendes G, Sousa V, Bezerra B, Dutra P, Modesto P, Oliveira MF, Petitto CE, Pulhorn H, Chandran A, McMahon C, Rao AS, Jumaly M, Solomon D, Moghekar A, Relkin N, Hamilton M, Katzen H, Williams M, Bach T, Zuspan S, Holubkov R, Rigamonti A, Clemens G, Sharkey P, Sanyal A, Sankey E, Rigamonti K, Naqvi S, Hung A, Schmidt E, Ory-Magne F, Gantet P, Guenego A, Januel AC, Tall P, Fabre N, Mahieu L, Cognard C, Gray L, Buttner-Ennever JA, Takagi K, Onouchi K, Thompson SD, Thorne LD, Tully HM, Wenger TL, Kukull WA, Doherty D, Dobyns WB, Moran D, Vakili S, Patel MA, Elder B, Goodwin CR, Crawford JA, Pletnikov MV, Xu J, Blitz A, Herzka DA, Guerrero-Cazares H, Quiñones-Hinojosa A, Mori S, Saavedra P, Treviño H, Maitani K, Ziai WC, Eslami V, Nekoovaght-Tak S, Dlugash R, Yenokyan G, McBee N, Hanley DF. Abstracts from Hydrocephalus 2016. Fluids Barriers CNS 2017; 14:15. [PMID: 28929972 PMCID: PMC5471936 DOI: 10.1186/s12987-017-0054-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- A Adam
- Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - J Robison
- Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - J Lu
- Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - R Jose
- Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - N Badran
- Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - T Vivas-Buitrago
- Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - D Rigamonti
- Johns Hopkins University, Baltimore, MD, USA.,Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.,Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.,Johns Hopkins Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - A Sattar
- Johns Hopkins Aramco Healthcare, Ras Tanura, Saudi Arabia.,Primary Care, Johns Hopkins Aramco Healthcare, Ras Tanura, Saudi Arabia
| | - O Omoush
- Johns Hopkins Aramco Healthcare, Ras Tanura, Saudi Arabia.,Primary Care, Johns Hopkins Aramco Healthcare, Ras Tanura, Saudi Arabia
| | - M Hammad
- Johns Hopkins Aramco Healthcare, Ras Tanura, Saudi Arabia
| | - M Dawood
- Johns Hopkins Aramco Healthcare, Ras Tanura, Saudi Arabia
| | - M Maghaslah
- Johns Hopkins Aramco Healthcare, Ras Tanura, Saudi Arabia
| | - T Belcher
- Johns Hopkins Aramco Healthcare, Ras Tanura, Saudi Arabia
| | - K Carson
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - J Hoffberger
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - I Jusué Torres
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - S Foley
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - S Yasar
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - Q A Thai
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - J Wemmer
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - P Klinge
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - L Al-Mutawa
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - H Al-Ghamdi
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - K A Carson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - M Asgari
- The Interface Group, Institute of PhysiologyUniversity of Zurich, Zurich, Switzerland
| | - D de Zélicourt
- The Interface Group, Institute of PhysiologyUniversity of Zurich, Zurich, Switzerland
| | - V Kurtcuoglu
- The Interface Group, Institute of PhysiologyUniversity of Zurich, Zurich, Switzerland.,Institute of Physiology, University of Zurich, Zurich, Switzerland.,Neuroscience Center Zurich and the Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - S Garnotel
- BioFlowImage Laboratory, University of Picardie Jules Verne, Amiens, France.,Reims Mathematics Laboratory, University of Reims Champagne-Ardenne, Reims, France.,Image Processing Laboratory, University Hospital of Amiens-Picardie, Amiens, France.,BioFlowImage Laboratory, Department of Medical Image Processing, University Hospital of Picardie Jules Verne, Amiens, France
| | - S Salmon
- Reims Mathematics Laboratory, University of Reims Champagne-Ardenne, Reims, France
| | - O Balédent
- BioFlowImage Laboratory, University of Picardie Jules Verne, Amiens, France.,Image Processing Laboratory, University Hospital of Amiens-Picardie, Amiens, France.,BioFlowImage Laboratory, Department of Medical Image Processing, University Hospital of Picardie Jules Verne, Amiens, France
| | - A Lokossou
- BioFlowImage Laboratory, Department of Medical Image Processing, University Hospital of Picardie Jules Verne, Amiens, France
| | - G Page
- BioFlowImage Laboratory, Department of Medical Image Processing, University Hospital of Picardie Jules Verne, Amiens, France
| | - L Balardy
- Department of Geriatric, University Hospital of Toulouse, Toulouse, France.,Departments of Geriatric, University Hospital of Toulouse, Toulouse, France.,Department of Geriatry, University Hospital Toulouse, Toulouse, France
| | - Z Czosnyka
- Neurosciences department, University of Cambridge, Cambridge, UK.,Brain Physics Lab, Academic Neurosurgery, University of Cambridge, Cambridge, UK
| | - P Payoux
- Department of Nuclear Medicine, University Hospital of Toulouse, Toulouse, France.,Department of Nuclear Medicine, University Hospital Toulouse, Toulouse, France.,INSER TONIC 1014, Toulouse Neuroimaging Center, Toulouse, France
| | - E A Schmidt
- UMR 1214-INSERM/UPS-TONIC Toulouse Neuro-Imaging Center, Toulouse, France.,Department of Neurosurgery, University Hospital of Toulouse, Toulouse, France.,Department of Neurosurgery, University Hospital Toulouse, Toulouse, France
| | - M Zitoun
- BioFlowImage, University Hospital of Picardie Jules Verne, Amiens, France
| | - M A Sevestre
- BioFlowImage, University Hospital of Picardie Jules Verne, Amiens, France
| | - N Alperin
- University of Miami Health System, Miami, FL, USA
| | - I Baudracco
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - C Craven
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - S Matloob
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - S Thompson
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - P Haylock Vize
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - L Thorne
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - L D Watkins
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK.,The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - A K Toma
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK.,The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Karl Bechter
- Department Psychiatry II/Bezirkskliniken, Ulm University, Günzburg, Germany
| | - A C Pong
- Neuroscience Research Australia, Randwick, Australia.,School of Medical Sciences, University of New South Wales, Kensington, Australia
| | - L Jugé
- Neuroscience Research Australia, Randwick, Australia.,School of Medical Sciences, University of New South Wales, Kensington, Australia
| | - L E Bilston
- Neuroscience Research Australia, Randwick, Australia.,Prince of Wales Clinical School, University of New South Wales, Kensington, Australia
| | - S Cheng
- Neuroscience Research Australia, Randwick, Australia.,Department of Engineering, Faculty of Science and Engineering, Macquarie University, Sydney, Australia
| | - W Bradley
- Department of Radiology, University of California San Diego Health System, San Diego, CA, USA
| | - F Hakim
- Department of Surgery, Section of Neurosurgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia.,Neurosurgery Department, Hospital Universitario, Fundación Santafe de Bogota, Bogota, Colombia
| | - J F Ramón
- Department of Surgery, Section of Neurosurgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia.,Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia.,Neurosurgery Department, Hospital Universitario, Fundación Santafe de Bogota, Bogota, Colombia
| | - M F Cárdenas
- Department of Surgery, Section of Neurosurgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - J S Davidson
- Department of Surgery, Section of Neurosurgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - C García
- Department of Surgery, Section of Neurosurgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - D González
- Department of Surgery, Section of Neurosurgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - S Bermúdez
- Department of Diagnostic Imaging, Section of Neuroradiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - N Useche
- Department of Diagnostic Imaging, Section of Neuroradiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - J A Mejía
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - P Mayorga
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - F Cruz
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - C Martinez
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - M C Matiz
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - M Vallejo
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - K Ghotme
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - H A Soto
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - D Riveros
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - A Buitrago
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - M Mora
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - L Murcia
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - S Bermudez
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - D Cohen
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - D Dasgupta
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - C Curtis
- Department of Microbiology, University College London Hospital NHS Foundation Trust, London, UK
| | - L Domínguez
- Neurosurgery Department, Cartagena University, Cartagena de Indias, Colombia
| | - A J Remolina
- Neurosurgery Department, Cartagena University, Cartagena de Indias, Colombia
| | - M A Grijalba
- Neurosurgery Department, Cartagena University, Cartagena de Indias, Colombia
| | - K J Whitehouse
- Department of Paediatric Neurosurgery, Bristol Royal Hospital for Children, Bristol, UK
| | - R J Edwards
- Department of Paediatric Neurosurgery, Bristol Royal Hospital for Children, Bristol, UK
| | - A Eleftheriou
- Department of Neurology, University Hospital, Linköping, Sweden
| | - F Lundin
- Division of Neuroscience, Department of Clinical and Experimental Medicine (IKE), Linköping University, Linköping, Sweden
| | - K N Fountas
- Department of Neurosurgery, School of Medicine, University of Thessaly, Larisa, Greece
| | - E Z Kapsalaki
- Department of Diagnostic Radiology, School of Medicine, University of Thessaly, Larisa, Greece
| | - H F Smisson
- Department of Neurosurgery, Georgia Neurosurgical Institute, Macon, GA, USA
| | - J S Robinson
- Department of Neurosurgery, Georgia Neurosurgical Institute, Macon, GA, USA
| | - M J Fritsch
- Klinik für Neurochirurgie, Dietrich-Bonhoeffer-Klinikum, Neubrandenburg, Germany
| | - W Arouk
- Klinik für Neurochirurgie, Dietrich-Bonhoeffer-Klinikum, Neubrandenburg, Germany
| | - M Garzon
- Great Ormond Street Hospital, London, UK
| | - M Kang
- Great Ormond Street Hospital, London, UK
| | - K Sandhu
- Great Ormond Street Hospital, London, UK
| | | | - K Aquilina
- Great Ormond Street Hospital, London, UK
| | - G James
- Great Ormond Street Hospital, London, UK
| | - D Thompson
- Great Ormond Street Hospital, London, UK
| | - M Gehlen
- Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland.,Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - M Schmid Daners
- Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - A Eklund
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - J Malm
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - D Gomez
- Neurosurgery Department, Hospital Universitario, Fundación Santafe de Bogota, Bogota, Colombia
| | - M Guerra
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, UACh, Valdivia, Chile
| | - M Jara
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, UACh, Valdivia, Chile
| | - M Flores
- Laboratorio de Polímeros, Facultad de Ciencias, UACh, Valdivia, Chile
| | - K Vío
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, UACh, Valdivia, Chile
| | - I Moreno
- Laboratorio de Polímeros, Facultad de Ciencias, UACh, Valdivia, Chile
| | - S Rodríguez
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, UACh, Valdivia, Chile
| | - E Ortega
- Instituto de Neurociencias Clínicas, Facultad de Medicina, UACh, Valdivia, Chile
| | - E M Rodríguez
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, UACh, Valdivia, Chile.,Instituto de Histologia y Patologia, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - J P McAllister
- Department of Neurosurgery, St. Louis Children's Hospital, St. Louis, MO, USA
| | - M M Guerra
- Instituto de Histologia y Patologia, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - D M Morales
- Department of Neurosurgery, St. Louis Children's Hospital, St. Louis, MO, USA
| | - D Sival
- Department of Pediatrics Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A Jimenez
- Departamento de Biología Celular, Genética y Fisiología Facultad de Ciencias, Universidad de Malaga, Malaga, Spain
| | - D D Limbrick
- Department of Neurosurgery, St. Louis Children's Hospital, St. Louis, MO, USA.,Department of Pediatrics, St. Louis Children's Hospital, St. Louis, MO, USA
| | - M Ishikawa
- Rakuwa Villa Ilios, Kyoto, Japan.,Normal Pressure Hydrocephalus Center, Otowa Hospital, Kyoto, Japan
| | - S Yamada
- Normal Pressure Hydrocephalus Center, Otowa Hospital, Kyoto, Japan.,Department of Neurosurgery, Otowa Hospital, Kyoto, Japan
| | - K Yamamoto
- Department of Neurosurgery, Otowa Hospital, Kyoto, Japan
| | - A Junkkari
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.,Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - A Häyrinen
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - T Rauramaa
- Department of Pathology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.,Department of Pathology, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine-Pathology, University of Eastern Finland, Kuopio, Finland
| | - H Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - O Nerg
- Neurology of NeuroCenter, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.,Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland
| | - A M Koivisto
- Neurology of NeuroCenter, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.,Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - R P Roine
- University of Eastern Finland, Kuopio Finland and Helsinki and Uusimaa Hospital DistrictGroup Administration, Helsinki, Finland
| | - H Viinamäki
- Department of Psychiatry, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - H Soininen
- Department of Neurology, University of Eastern Finland, Kuopio, Finland.,Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - A Luikku
- Neurology of NeuroCenter, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - J E Jääskeläinen
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.,Department of Neurosurgery, Kuopio University Hospital, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - V Leinonen
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.,Department of Neurosurgery, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.,Department of Neurosurgery, Kuopio University Hospital, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - U Kehler
- Neurosurgical Department, Asklepios Klinik Hamburg Altona, Hamburg, Germany
| | - O Lilja-Lund
- Department of Pharmacology and Clinical Neuroscience, Unit of Neurology, Östersund, Umeå University, Umeå, Sweden
| | - K Kockum
- Department of Pharmacology and Clinical Neuroscience, Unit of Neurology, Östersund, Umeå University, Umeå, Sweden
| | - E M Larsson
- Department of Radiology, Uppsala University, Uppsala, Sweden
| | - K Riklund
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - L Söderström
- Department of Pharmacology and Clinical Neuroscience, Unit of Neurology, Östersund, Umeå University, Umeå, Sweden
| | - P Hellström
- Hydrocephalus Research Unit, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - K Laurell
- Department of Pharmacology and Clinical Neuroscience, Unit of Neurology, Östersund, Umeå University, Umeå, Sweden
| | - M Kojoukhova
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.,Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - A Sutela
- Department of Radiology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.,Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - R Vanninen
- Department of Radiology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - K I Vanha
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - M Timonen
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - J Rummukainen
- Department of Pathology, Kuopio University Hospital, Kuopio, Finland
| | - V Korhonen
- Department of Neurosurgery, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - S Helisalmi
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - E Solje
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - A M Remes
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - J Huovinen
- Department of Neurosurgery, Kuopio University Hospital, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - J Paananen
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Neurology, Kuopio University Hospital, Kuopio, Finland.,Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - M Hiltunen
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Department of Neurology, Kuopio University Hospital, Kuopio, Finland.,Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - M Kurki
- Department of Neurosurgery, Kuopio University Hospital, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Analytical and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Stanley Center for Psychiatric Research, Broad Institute for Harvard and MIT, Cambridge, MA, USA
| | - B Martin
- Biological Engineering, University of Idaho, Moscow, ID, USA
| | - F Loth
- Mechanical Engineering, University of Akron, Akron, Ohio, USA
| | - M Luciano
- Neurosurgery, Johns Hopkins University, Baltimore, MA, USA.,Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - A J Luikku
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - A Hall
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland
| | - S K Herukka
- Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland
| | - J Mattila
- VTT Technical Research Centre of Finland, Tampere, Finland.,Combinostics Ltd, Tampere, Finland
| | - J Lötjönen
- VTT Technical Research Centre of Finland, Tampere, Finland.,Combinostics Ltd, Tampere, Finland
| | - I Alafuzoff
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Rudbeck Laboratory, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.,Department of Pathology and Cytology, Uppsala University Hospital, Uppsala, Sweden
| | - I Jurjević
- Department of Neurosurgery, Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Pharmacology and Department of Neurology, University of Zagreb School of Medicine, Zagreb, Croatia
| | - M Miyajima
- Department of Neurosurgery, Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - M Nakajima
- Department of Neurosurgery, Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - H Murai
- Department of Neurosurgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - T Shin
- Department of Neurosurgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - D Kawaguchi
- Department of Neurosurgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - C Akiba
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - I Ogino
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - K Karagiozov
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - H Arai
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - R C Reis
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - M J Teixeira
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - C G Valêncio
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - D da Vigua
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - L Almeida-Lopes
- Núcleo de Pesquisa e Ensino de Fototerapia nas Ciências da Saúde (NUPEN), São Carlos, Brazil
| | - M W Mancini
- Núcleo de Pesquisa e Ensino de Fototerapia nas Ciências da Saúde (NUPEN), São Carlos, Brazil
| | - F C G Pinto
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - R H Maykot
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - G Calia
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - J Tornai
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - S S S Silvestre
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - G Mendes
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - V Sousa
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - B Bezerra
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - P Dutra
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - P Modesto
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - M F Oliveira
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - C E Petitto
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - H Pulhorn
- Department of Neurosurgery, The Walton Centre, Liverpool, UK
| | - A Chandran
- Department of Neuroradiology, The Walton Centre, Liverpool, UK
| | - C McMahon
- Department of Neurosurgery, The Walton Centre, Liverpool, UK
| | - A S Rao
- The Johns Hopkins Hospital, Baltimore, MD, USA
| | - M Jumaly
- The Johns Hopkins Hospital, Baltimore, MD, USA
| | - D Solomon
- The Johns Hopkins Hospital, Baltimore, MD, USA.,Neurology, Johns Hopkins Hospital, Baltimore, MD, USA.,Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - A Moghekar
- The Johns Hopkins Hospital, Baltimore, MD, USA
| | - N Relkin
- Department of Neurology, Weill Cornell Medical College, New York, NY, USA
| | - M Hamilton
- Department of Neurosurgery, University of Calgary, Alberta, Canada
| | - H Katzen
- Department of Neurology, University of Miami, Miami, FL, USA
| | - M Williams
- Department of Neurosurgery, Washington University, Seattle, WA, USA
| | - T Bach
- Utah Data Collection Center (DCC), University of Utah, Salt Lake City, UT, USA
| | - S Zuspan
- Utah Data Collection Center (DCC), University of Utah, Salt Lake City, UT, USA
| | - R Holubkov
- Utah Data Collection Center (DCC), University of Utah, Salt Lake City, UT, USA
| | | | - G Clemens
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - P Sharkey
- School of Business, Loyola University Maryland, Baltimore, MD, USA
| | - A Sanyal
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - E Sankey
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - K Rigamonti
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - S Naqvi
- Primary Care, Johns Hopkins Aramco Healthcare, Abqaiq, Saudi Arabia
| | - A Hung
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - E Schmidt
- Department of Neurosurgery, University Hospital Toulouse, Toulouse, France
| | - F Ory-Magne
- Department of Neurology, University Hospital Toulouse, Toulouse, France.,INSER TONIC 1014, Toulouse Neuroimaging Center, Toulouse, France
| | - P Gantet
- Department of Nuclear Medicine, University Hospital Toulouse, Toulouse, France
| | - A Guenego
- Department of Neurosurgery, University Hospital Toulouse, Toulouse, France.,Department of Neuroradiology, University Hospital Toulouse, Toulouse, France
| | - A C Januel
- Department of Neuroradiology, University Hospital Toulouse, Toulouse, France
| | - P Tall
- Department of Neuroradiology, University Hospital Toulouse, Toulouse, France
| | - N Fabre
- Department of Neurology, University Hospital Toulouse, Toulouse, France
| | - L Mahieu
- Department of Ophtalmology, University Hospital Toulouse, Toulouse, France
| | - C Cognard
- Department of Neuroradiology, University Hospital Toulouse, Toulouse, France
| | - L Gray
- Department of Physiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | | | - K Takagi
- Normal Pressure Hydrocephalus Center, Kashiwa-Tanaka Hospital, Kashiwa, Japan
| | - K Onouchi
- Department of Neurology, Kashiwa-Tanaka Hospital, Kashiwa, Japan
| | - S D Thompson
- The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - L D Thorne
- The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - H M Tully
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - T L Wenger
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - W A Kukull
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - D Doherty
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - W B Dobyns
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - D Moran
- Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - S Vakili
- Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - M A Patel
- Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - B Elder
- Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - C R Goodwin
- Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - J A Crawford
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - M V Pletnikov
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - J Xu
- F. M. Kirby Research Center for Functional Brain Imaging at the Kennedy Krieger Institute, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - A Blitz
- Department of Radiology and Radiological Science, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - D A Herzka
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - H Guerrero-Cazares
- Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - A Quiñones-Hinojosa
- Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.,Department of Oncology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - S Mori
- Department of Radiology-Magnetic Resonance Research, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - P Saavedra
- Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - H Treviño
- Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - K Maitani
- Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.,Tohoku University School of Medicine, Sendai, Japan
| | - W C Ziai
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - V Eslami
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S Nekoovaght-Tak
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - R Dlugash
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - G Yenokyan
- Department of Biostatistics, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - N McBee
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - D F Hanley
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Håkansson I, Sandstedt A, Lundin F, Askmark H, Pirskanen R, Carlson K, Piehl F, Hägglund H. Successful autologous haematopoietic stem cell transplantation for refractory myasthenia gravis – a case report. Neuromuscul Disord 2017; 27:90-93. [DOI: 10.1016/j.nmd.2016.09.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 09/16/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
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30
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Sundström N, Malm J, Laurell K, Lundin F, Kahlon B, Cesarini KG, Leijon G, Wikkelsö C. Incidence and outcome of surgery for adult hydrocephalus patients in Sweden. Br J Neurosurg 2016; 31:21-27. [DOI: 10.1080/02688697.2016.1229749] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Nina Sundström
- Department of Radiation Sciences, Biomedical Engineering, Umeå University, Umeå, Sweden
| | - Jan Malm
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Katarina Laurell
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Fredrik Lundin
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Babar Kahlon
- Department of Neurosurgery, University Hospital, Lund, Sweden
| | - Kristina G Cesarini
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Göran Leijon
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Carsten Wikkelsö
- Institution of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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31
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Sigvant B, Lundin F, Wahlberg E. The Risk of Disease Progression in Peripheral Arterial Disease is Higher than Expected: A Meta-Analysis of Mortality and Disease Progression in Peripheral Arterial Disease. Eur J Vasc Endovasc Surg 2016; 51:395-403. [DOI: 10.1016/j.ejvs.2015.10.022] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 10/26/2015] [Indexed: 10/22/2022]
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32
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Sundström N, Malm J, Laurell K, Lundin F, Kahlon B, Cesarini K, Wikkelsö C. Population based incidence and outcome of surgery for adult patients with hydrocephalus in Sweden. Fluids Barriers CNS 2015. [PMCID: PMC4582841 DOI: 10.1186/2045-8118-12-s1-o32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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33
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Eleftheriou A, Ulander M, Lundin F. Circadian rhythm in idiopathic normal pressure hydrocephalus. Fluids Barriers CNS 2015. [PMCID: PMC4582328 DOI: 10.1186/2045-8118-12-s1-p13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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34
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Khalili P, Sundström J, Jendle J, Lundin F, Jungner I, Nilsson PM. Sialic acid and incidence of hospitalization for diabetes and its complications during 40-years of follow-up in a large cohort: the Värmland survey. Prim Care Diabetes 2014; 8:352-357. [PMID: 24996911 DOI: 10.1016/j.pcd.2014.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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: 07/03/2013] [Revised: 05/09/2014] [Accepted: 06/03/2014] [Indexed: 10/25/2022]
Abstract
AIM To examine the association of sialic acid (SA) with first recorded diabetes mellitus-related hospitalization. METHODS From a population-based study in Värmland, Sweden, between 1962 and 1965, 87,035 men and women were selected and followed for first recorded diabetes-related hospitalization until 2005. The association of SA was calculated and stratified for gender by Cox's proportional hazards models. Adjustments were made for conventional risk factors and socioeconomic status. Association analyses were made for comparisons between SA-levels above and below median. RESULTS The mean age was 47.2 (SD 13.0) years and the total numbers of incident diabetes-related hospitalizations in men and women were 3445 and 3273, respectively. Hazard ratios per one standard deviation of SA were 1.12 (95% CI: 1.08-1.17, p<0.0001) in men and 1.17 (95% CI: 1.13-1.22, p<0.0001) in women. Interaction analyses indicated a relatively higher SA-associated risk in women than in men with above median SA levels. CONCLUSIONS In this large population-based cohort followed for more than 40 years, elevated SA, as a marker of systemic inflammation, was independently associated with risk of diabetes and diabetes-related hospitalizations.
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Affiliation(s)
- Payam Khalili
- Department of Cardiology and Acute Internal Medicine, Central Hospital, Karlstad, Sweden; Faculty of Health Sciences and Medicine, Örebro University, Örebro, Sweden.
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Johan Jendle
- Faculty of Health Sciences and Medicine, Örebro University, Örebro, Sweden; Endocrine and Diabetes Center, Central Hospital, Karlstad, Sweden
| | - Fredrik Lundin
- Statistical Unit, Värmland County Council, Karlstad, Sweden
| | - Ingmar Jungner
- Department of Medicine, Clinical Epidemiological Unit, Karolinska Institute, Stockholm, Sweden
| | - Peter M Nilsson
- Faculty of Health Sciences and Medicine, Örebro University, Örebro, Sweden; Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
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Abstract
BACKGROUND The diagnosis of Sever's injury (apophysitis calcanei) has previously been partly based on radiographic findings in the calcaneal apophysis. Sclerosis and fragmentation have been supposed to represent signs of inflammation due to tractions from the Achilles tendon. The clinical findings, diagnostic criteria, and studied population are often poorly defined. We sought to define diagnostic criteria by analyzing clinical and radiographic characteristics in a population with Sever's injury and to compare the findings with those of a control group of matched, symptom-free children. METHODS We assessed 30 consecutive children with Sever's injury with high levels of pain but high physical activity levels in sports activities and 15 pain-free matched controls. RESULTS One-leg heel standing showed 100% sensitivity; the squeeze test, 97%; and the palpation test, 80%. All three tests showed 100% specificity. All of the patients and controls showed increased density of the apophysis. Half of the pain-free controls showed fragmentation versus almost 90% of children with heel pain. CONCLUSIONS The diagnosis of Sever's injury is clinical, not radiologic. Radiologic findings of increased density and fragmentation are found also in pain-free controls with high levels of physical activity and may, therefore, represent normal growth and development. We suggest that the diagnosis of Sever's injury should be based on patient history and the results of two specific clinical tests.
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Affiliation(s)
- Stefan Perhamre
- Centre of Sports Medicine, Värmland County Council, Karlstad, Sweden
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36
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Lundin F, Personne M, Hanberger H. [Botulism is a treatable, very rare type of poisoning. Smoked vacuum packed whitefish provided guidance to the diagnosis]. Lakartidningen 2014; 111:551-552. [PMID: 24734378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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37
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Lundin F, Tisell A, Leijon G, Leinhard OD, Davidsson L, Grönqvist A, Wikkelsø C, Lundberg P. Preoperative and postoperative 1H-MR spectroscopy changes in frontal deep white matter and the thalamus in idiopathic normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry 2013; 84:188-93. [PMID: 23134662 DOI: 10.1136/jnnp-2012-302190] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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] [Indexed: 11/04/2022]
Abstract
BACKGROUND In a previous study we found significantly decreased N-acetyl aspartate (NAA) and total N-acetyl (tNA) groups in the thalamus of patients with idiopathic normal pressure hydrocephalus (iNPH) compared with healthy individuals (HI). No significant difference between the groups could be found in the frontal deep white matter (FDWM). OBJECTIVE The primary aim of this study was to investigate if these metabolites in the thalamus were normalised after shunt surgery. The secondary aim was to investigate postoperative metabolic changes in FDWM. SUBJECTS AND METHODS Fourteen patients with iNPH, mean age 74 years, and 15 HI, also mean age 74 years, were examined. Assessment of a motor score (MOSs) was performed before and after shunt surgery. Absolute quantitative (1)H-MR spectroscopy (1.5 T, volumes of interest 2.5-3 ml) was performed on the patients in the FDWM and in the thalamus, before and 3 months after shunt surgery, and also once on the HI. The following metabolites were analysed: tNA, NAA, total creatine, total choline (tCho), myo-inositol (mIns), glutamate and lactate concentrations. MRI volumetric calculations of the lateral ventricles were also performed. RESULTS At 3 months postoperatively, we found no significant changes of tNA or NAA in the thalamus. In contrast, in the FDWM, there was a significant increase of tCho (p=0.01) and a borderline significant decrease of mIns (p=0.06). 12/14 patients were shunt responders (motor function). Median reduction of the lateral ventricle was 16%. A weak correlation between MOS and ventricular reduction was seen. CONCLUSIONS Normalisation of thalamic tNA and NAA could not be detected postoperatively. The increased tCho and decreased mIns in the FDWM postoperatively might relate to clinical improvement.
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Affiliation(s)
- Fredrik Lundin
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping,
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38
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Bornehag CG, Moniruzzaman S, Larsson M, Lindström CB, Hasselgren M, Bodin A, von Kobyletzkic LB, Carlstedt F, Lundin F, Nånberg E, Jönsson BAG, Sigsgaard T, Janson S. The SELMA study: a birth cohort study in Sweden following more than 2000 mother-child pairs. Paediatr Perinat Epidemiol 2012; 26:456-67. [PMID: 22882790 DOI: 10.1111/j.1365-3016.2012.01314.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [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] [Indexed: 12/14/2022]
Abstract
BACKGROUND This paper describes the background, aim and study design for the Swedish SELMA study that aimed to investigate the importance of early life exposure during pregnancy and infancy to environmental factors with a major focus on endocrine disrupting chemicals for multiple chronic diseases/disorders in offspring. METHODS The cohort was established by recruiting women in the 10th week of pregnancy. Blood and urine from the pregnant women and the child and air and dust from home environment from pregnancy and infancy period have been collected. Questionnaires were used to collect information on life styles, socio-economic status, living conditions, diet and medical history. RESULTS Of the 8394 reported pregnant women, 6658 were invited to participate in the study. Among the invited women, 2582 (39%) agreed to participate. Of the 4076 (61%) non-participants, 2091 women were invited to a non-respondent questionnaire in order to examine possible selection bias. We found a self-selection bias in the established cohort when compared with the non-participant group, e.g. participating families did smoke less (14% vs. 19%), had more frequent asthma and allergy symptoms in the family (58% vs. 38%), as well as higher education among the mothers (51% vs. 36%) and more often lived in single-family houses (67% vs. 60%). CONCLUSIONS These findings indicate that the participating families do not fully represent the study population and thus, the exposure in this population. However, there is no obvious reason that this selection bias will have an impact on identification of environmental risk factors.
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Arne M, Lundin F, Boman G, Janson C, Janson S, Emtner M. Factors associated with good self-rated health and quality of life in subjects with self-reported COPD. Int J Chron Obstruct Pulmon Dis 2011; 6:511-9. [PMID: 22069362 PMCID: PMC3206767 DOI: 10.2147/copd.s24230] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [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] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Recent guidelines for chronic obstructive pulmonary disease (COPD) state that COPD is both preventable and treatable. To gain a more positive outlook on the disease it is interesting to investigate factors associated with good, self-rated health and quality of life in subjects with self-reported COPD in the population. METHODS In a cross-sectional study design, postal survey questionnaires were sent to a stratified, random population in Sweden in 2004 and 2008. The prevalence of subjects (40-84 years) who reported having COPD was 2.1% in 2004 and 2.7% in 2008. Data were analyzed for 1475 subjects. Regression models were used to analyze the associations between health measures (general health status, the General Health Questionnaire, the EuroQol five-dimension questionnaire) and influencing factors. RESULTS The most important factor associated with good, self-rated health and quality of life was level of physical activity. Odds ratios for general health varied from 2.4 to 7.7 depending on degree of physical activity, where subjects with the highest physical activity level reported the best health and also highest quality of life. Social support and absence of economic problems almost doubled the odds ratios for better health and quality of life. CONCLUSIONS In this population-based public health survey, better self-rated health status and quality of life in subjects with self-reported COPD was associated with higher levels of physical activity, social support, and absence of economic problems. The findings indicated that of possible factors that could be influenced, promoting physical activity and strengthening social support are important in maintaining or improving the health and quality of life in subjects with COPD. Severity of the disease as a possible confounding effect should be investigated in future population studies.
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Affiliation(s)
- Mats Arne
- Primary Care Research Unit, County Council of Värmland, Universitetsgatan 3, Karlstad, Sweden.
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40
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Lundin F, Tisell A, Dahlqvist Leinhard O, Tullberg M, Wikkelsö C, Lundberg P, Leijon G. Reduced thalamic N-acetylaspartate in idiopathic normal pressure hydrocephalus: a controlled 1H-magnetic resonance spectroscopy study of frontal deep white matter and the thalamus using absolute quantification. J Neurol Neurosurg Psychiatry 2011; 82:772-8. [PMID: 21217158 DOI: 10.1136/jnnp.2010.223529] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [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: 11/04/2022]
Abstract
INTRODUCTION Patients with idiopathic normal pressure hydrocephalus (INPH) frequently have a reduction in cerebral blood flow in the subcortical frontal lobe/basal ganglia/thalamic areas. With magnetic resonance spectroscopy, the metabolism in the brain can be examined. The aim of this study was to investigate if there was a compromised metabolism in the thalamus and in the subcortical frontal areas in INPH patients. This was done by measuring total creatine, myo-inositol, total choline, N-acetylaspartate (NAA), total N-acetylaspartate (tNA), glutamate and lactate levels. A comparison was made with healthy individuals (HI). SUBJECTS AND METHODS 16 patients (nine males, seven females, mean age 74 years, range 49-83) diagnosed as INPH and 15 HI (nine males, six females, mean age 74 years, range 62-89) were examined. (1)H magnetic resonance spectroscopy (1.5 T, point-resolved spectroscopy, echo time/relaxation time 30/3000 ms, volume of interest 2.5-3 ml) was performed in frontal deep white matter and in the thalamus. Absolute quantification with internal water as a reference was used. RESULTS INPH patients had lower NAA (p=0.02) and lower tNA (p=0.05) concentrations in the thalamus compared with HI. NAA and tNA in the frontal deep white matter did not differ between patients and HI. The absolute metabolic concentrations of total creatine, myo-inositol total choline, tNA, lactate and Cr ratios in frontal deep white matter and in the thalamus were similar in INPH patients and HI. CONCLUSION Reduced thalamic NAA and tNA in INPH patients suggest a compromised metabolic neuronal function in these regions. Thus, the thalamus might have an important role in the pathogenesis of INPH.
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Affiliation(s)
- F Lundin
- Department of Clinical and Experimental Medicine, Division of Neuroscience, Linköping University, Linköping, Sweden.
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41
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Sigvant B, Lundin F, Nilsson B, Bergqvist D, Wahlberg E. Differences in presentation of symptoms between women and men with intermittent claudication. BMC Cardiovasc Disord 2011; 11:39. [PMID: 21718516 PMCID: PMC3141760 DOI: 10.1186/1471-2261-11-39] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 06/30/2011] [Indexed: 11/28/2022] Open
Abstract
Background More women than men have PAD with exception for the stage intermittent claudication (IC). The purpose of this study was to evaluate differences in disease characteristics between men and women when using current diagnostic criteria for making the diagnosis IC, defined as ABI < 0.9 and walking problems. Study Design Cohort study Methods 5040 elderly (median age 71) subjects participated in a point-prevalence study 2004. They had their ABI measured and filled out questionnaires covering medical history, current medication, PAD symptoms and walking ability. The prevalence of IC was 6.5% for women and 7.2% for men (P = 0.09). A subset of subjects with IC (N = 56) was followed up four years later with the same procedures. They also performed additional tests aiming to determine all factors influencing walking ability. Results Men with IC had more concomitant cardiovascular disease and a more profound smoking history than women. Women, on the other hand, reported a lower walking speed (P < 0.01) and more joint problems (P = 0.018). In the follow up cohort ABI, walking ability and amount of atherosclerosis were similar among the sexes, but women more often reported atypical IC symptoms. Conclusion Sex differences in the description of IC symptoms may influence diagnosis even if objective features of PAD are similar. This may influence accuracy of prevalence estimates and selection to treatment.
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Wikström S, Lundin F, Ley D, Pupp IH, Fellman V, Rosén I, Hellström-Westas L. Carbon dioxide and glucose affect electrocortical background in extremely preterm infants. Pediatrics 2011; 127:e1028-34. [PMID: 21444592 DOI: 10.1542/peds.2010-2755] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [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] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To investigate if Paco(2) and plasma glucose levels affect electrocortical activity. METHODS Ours was an observational study of 32 infants with a gestational age of 22 to 27 weeks. We performed simultaneous single-channel electroencephalogram (EEG) and repeated blood gas/plasma glucose analyses during the first 3 days (n = 247 blood samples with corresponding EEG). Interburst intervals (IBIs) and EEG power were averaged at the time of each blood sample. RESULTS There was a linear relationship between Paco(2) and IBI; increasing Paco(2) was associated with longer IBIs. One day after birth, a 1-kPa increase in Paco(2) was associated with a 16% increase in IBI in infants who survived the first week without severe brain injury. EEG power was highest at a Paco(2) value of 5.1 kPa and was attenuated both at higher and lower Paco(2) values. Corrected for carbon dioxide effects, plasma glucose was also associated with IBI. Lowest IBI appeared at a plasma glucose level of 4.0 mmol/L, and there was a U-shaped relationship between plasma glucose level and EEG with increasing discontinuity at glucose concentrations above and below 4.0 mmol/L. CONCLUSIONS Both carbon dioxide and plasma glucose level influenced EEG activity in extremely preterm infants, and values considered to be within normal physiologic ranges were associated with the best EEG background. Increasing EEG discontinuity occurred at carbon dioxide levels frequently applied in lung-protection strategies; in addition, moderate hyperglycemia was associated with measurable EEG changes. The long-term effects of changes in carbon dioxide and glucose on brain function are not known.
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Affiliation(s)
- Sverre Wikström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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43
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Perhamre S, Lundin F, Klässbo M, Norlin R. A heel cup improves the function of the heel pad in Sever's injury: effects on heel pad thickness, peak pressure and pain. Scand J Med Sci Sports 2011; 22:516-22. [PMID: 21410537 DOI: 10.1111/j.1600-0838.2010.01266.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Sever's injury (apophysitis calcanei) is considered to be the dominant cause of heel pain among children between 8 and 15 years. Treating Sever's injury with insoles is often proposed as a part of a traditional mix of recommendations. Using a custom-molded rigid heel cup with a brim enclosing the heel pad resulted in effective pain relief without reducing the physical activity level in our previous two studies. The purpose of this study was to assess the effect of the heel cup on heel pad thickness and heel peak pressure (n=50). The difference in heel pad thickness and in heel peak pressure using a sports shoe without and with a heel cup was compared. With the heel cup the heel pad thickness improved significantly and the heel peak pressure was significantly reduced. These effects correlated with a significant reduction in pain when using the heel cup in a sports shoe, compared with using a sports shoe without the heel cup. A heel cup, providing an effective heel pad support in the sports shoe, improved the heel pad thickness and reduced heel peak pressure in Sever's injury with corresponding pain relief.
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Affiliation(s)
- S Perhamre
- Centre of Sports Medicine in Värmland, Värmland County Council, Karlstad, Sweden
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44
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Sigvant B, Henriksson M, Lundin F, Wahlberg E. Asymptomatic peripheral arterial disease: is pharmacological prevention of cardiovascular risk cost-effective? ACTA ACUST UNITED AC 2011; 18:254-61. [DOI: 10.1177/1741826710389368] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- B Sigvant
- Inst of Molecular Med and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Karstad Hospital, Sweden
| | - M Henriksson
- Center for Technology Assessment, Department of Medicine and Health Sciences, Linköping University, Sweden
| | - F Lundin
- Medical Research Center, Karlstad Hospital, Sweden
| | - E Wahlberg
- Inst of Molecular Med and Surgery, Karolinska Institutet, Stockholm, Sweden
- The Heart Centre, Linköping University Hospital, Sweden
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Larsson M, Hägerhed-Engman L, Kolarik B, James P, Lundin F, Janson S, Sundell J, Bornehag CG. PVC--as flooring material--and its association with incident asthma in a Swedish child cohort study. Indoor Air 2010; 20:494-501. [PMID: 21070375 DOI: 10.1111/j.1600-0668.2010.00671.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
UNLABELLED The Dampness in Buildings and Health study (DBH) started in the year 2000 in Värmland, Sweden, with a baseline questionnaire sent to all children (n = 14,077) aged 1-6. Five years later, a follow-up questionnaire was sent to the children who were 1-3 years at baseline. A total of 4779 children participated in both the baseline and the follow-up studies and constitute the study population in this cohort study. The aim of this study was to examine the association between exposure to PVC-flooring in the child's and parent's bedroom in homes of children aged 1-3 and the incidence of asthma, rhinitis, and eczema during the following 5-year period. Adjusted analyses showed that the incidence of asthma among children was associated with PVC-flooring in the child's bedroom (AOR 1.52; 95% CI 0.99-2.35) and in the parent's bedroom (1.46; 0.96-2.23). The found risks were on borderline of significance and should therefore be interpreted with caution. There was further a positive relationship between the number of rooms with PVC-flooring and the cumulative incidence of asthma. PVC-flooring was found to be a stronger risk factor for incident asthma in multifamily homes when compared with single-family houses and in smoking families compared with non-smoking families and in women. PRACTICAL IMPLICATIONS These longitudinal data from the DBH study found an association between the presence of PVC-flooring in the home and incident asthma in children. However, earlier results from the DBH study have shown that PVC-flooring is one important source for phthalates in indoor dust, and exposure to such phthalates was found to be associated with asthma and allergy among children. This emphasizes the need for prospective studies that focus on the importance of prenatal and neonatal exposure to phthalates in the development of asthma and allergy in children.
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Affiliation(s)
- M Larsson
- Karlstad University, Health and Environmental Sciences, Karlstad, Sweden.
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46
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Perhamre S, Lundin F, Norlin R, Klässbo M. Sever's injury; treat it with a heel cup: a randomized, crossover study with two insole alternatives. Scand J Med Sci Sports 2010; 21:e42-7. [PMID: 20673253 DOI: 10.1111/j.1600-0838.2010.01140.x] [Citation(s) in RCA: 25] [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] [Indexed: 11/29/2022]
Abstract
Sever's injury (apophysitis calcanei) is considered to be the dominant cause of heel pain among children. Common advice is to reduce physical activity. However, our previous study showed that application of insoles reduced pain in Sever's injury without having to reduce physical activity. The purpose of this study was to test which of the two insoles, the heel wedge or the heel cup, provided best pain relief during sport activity in boys with Sever's injury (n=51). There was a crossover design in the first randomized part of the study. In the second part, the boys, 9-14 years, chose which insole they preferred. There was a reduction in odds score for pain to a fifth (a reduction of 80%) for the cup compared with the wedge (P<0.001). When an active choice was made, the heel cup was preferred by >75% of the boys. All boys maintained their high level of physical activity throughout. At 1-year follow-up, 22 boys still used an insole and 19 of them reported its effect on pain as excellent or good (n=41).
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Affiliation(s)
- S Perhamre
- Centre of Sports Medicine in Värmland, Karlstad, Sweden
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Khalili P, Lundin F, Jendle J, Jungner I, Nilsson P. INCREASED PULSE-PRESSURE AND SYSTEMIC INFLAMMATION FOR RISK PREDICTION OF CARDIO-VASCULAR DISEASE DURING 40 YEARS OF FOLLOW-UP IN 96,000 SUBJECTS; THE VÄRMLAND HEALTH STUDY, SWEDEN: 3C.02. J Hypertens 2010. [DOI: 10.1097/01.hjh.0000378307.63489.b4] [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]
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48
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Lundin F, Tisell A, Leinhard O, Lundberg A, Tullberg M, Wikkelsö C, Leijon G. O.051 Magnetic Resonance Spectroscopy of INPH-metabolism in the frontal deep white matter and in thalamus. Clin Neurol Neurosurg 2008. [DOI: 10.1016/s0303-8467(08)70056-8] [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: 10/21/2022]
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49
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Lundin F, Rousseau A, Kadowaki A. [A case report. Risperidone induced fecal incontinence as a result of reduced anal sphincter tonus]. Lakartidningen 2004; 101:4006, 4008. [PMID: 15633339] [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] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- Fredrik Lundin
- Neurologiska kliniken Universitetssjukhuset i Linköping.
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50
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Abstract
A retrospective cohort study was conducted in individuals 65 years of age and older using Medicaid-reimbursed claims to assess the risk of hip fracture in users of two sedative-hypnotic drugs, triazolam and temazepam. Using the triazolam cohort as the referent group, the rate ratio was 0.92 (95% confidence interval, 0.72 to 1.17) for hip fracture with temazepam. Stratifying by age, sex, race, residence, time enrolled in Medicaid, prescription number, combinations of these, and several other potential confounding variables did not materially change the results. Compared with the short-acting benzodiazepine hypnotic temazepam, use of triazolam, an ultra-short-acting benzodiazepine hypnotic, did not decrease the risk of hip fracture. This study did not determine that either drug, compared with no use in an insomniac control group, increases the risk of hip fracture. However, because sedative-hypnotic drugs have been found in other studies to increase the risk of falling and hip fracture, they should be used with caution, especially in the elderly.
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Affiliation(s)
- D K Wysowski
- Office of Epidemiology and Biostatistics, Food and Drug Administration, Rockville, Maryland, USA
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