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  • 1. Antonijev, Ewelina
    et al.
    Åstrand, Frida
    Interobserver variability of peak systolic velocity measurements in the common carotid artery2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Stroke is ranked as the number one cause of death in Vietnam and the second leading cause of death in the world. Stenosis in the carotid arteries is one of the major risk factors for stroke, making it extremely important to confirm the diagnosis. Duplex ultrasound including measurements of the peak systolic velocity is considered the most accurate method when it comes to screening of carotid stenosis. However, the survey method is user dependent and differences in the results related to the scanning technique of the examiner may occur. The aim of this study was to determine the diagnostic variability for measuring peak systolic velocity in the common carotid artery in order to investigate whether the obtained results differ depending on the examiner. 30 healthy volunteers underwent carotid duplex ultrasound performed by two different examiners. Peak systolic velocity was measured with pulsed waved Doppler caudally of the carotid bifurcation. A T-test and a Bland-Altman plot were later applied in order to determine interobserver variability between the examiners. Results showed no significant difference in the measurements, with a mean difference of -0.01 m/s. Despite low interobserver variability, reliable conclusions cannot be drawn from the results since both examiners lacked adequate experience.

  • 2.
    De Basso, Rachel
    Linköpings universitet, Fysiologi.
    Influence of genetics and mechanical properties on large arteries in man2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Arterial pathology is the major contributor to cardiovascular diseases and mortality. The mechanical properties of arteries are independent factors for cardiovascular disease and mortality, where genetics influence the structure of the arterial wall, which may result in change in arterial stiffness. The aims of this thesis were to study the mechanical properties of the popliteal artery (PA) in healthy subjects and the influence of angiotensin-converting enzyme (ACE) polymorphism and Fibrillin-1 (FBN1) polymorphism on large arteries. Further, the impact of FBN1 polymorphism on cardiovascular morbidity and mortality was investigated.

    The PA is, after the abdominal aorta, the most common site of aneurysmal development. The PA was studied in healthy subject with ultrasound and the diameter increased and the distensibility decreased with age, with men having lower distensibility than women. This seems not to be the behavior of a true muscular artery but rather of a central elastic artery such as the aorta, and might have implications for the susceptibility to aneurysm formation, as well as the association of dilating disease between the PA and the aorta. The wall stress in the PA was low and unaffected by age, probably caused by a compensatory remodeling response with an increase in wall thickness. This indicates that other mechanisms than wall stress contribute to the process of pathological dilatation in the PA.

    The ACE D allele may be associated with abdominal aortic aneurysm. Elderly men with the ACE D allele were associated with increased abdominal aortic stiffness compared to men carrying the I/I genotype. This suggests that the ACE D allele impairs arterial wall integrity, and in combination with local hemodynamic and other genetic factors it may have a roll in aneurysm formation.

    The FBN1 2/3 genotype has been associated with increased systolic blood pressure. The FBN1 2/3 genotype in middle-aged men was associated with increased abdominal aortic stiffness and blood pressure which indicates an increased risk for developing cardiovascular disease. The increased presence of plaque in the carotid artery of middle-aged men with the FBN1 2/3 genotype indicates a pathological arterial wall remodeling with a more pronounced atherosclerotic burden, but did however not affect the risk of cardiovascular events and/or death in this population. This relationship needs to be studied further.

  • 3.
    De Basso, Rachel
    et al.
    Jönköping Hospital.
    Hedblad, Bo
    Lund University.
    Carlson, Joyce
    Lund University.
    Persson, Margaretha
    Lund University.
    Östling, Gerd
    Lund University.
    Länne, Toste
    Linköping University.
    Increased carotid plaque burden in men with the fibrillin-1 2/3 genotype2014In: Clinical and experimental pharmacology & physiology, ISSN 0305-1870, E-ISSN 1440-1681, Vol. 41, no 9, p. 637-642Article in journal (Refereed)
    Abstract [en]

    Fibrillin-1 (FBN1) is an important constituent of the vascular wall and earlier studies have indicated an effect of the FBN1 2/3 genotype on blood pressure as well as aortic stiffness in men. The aim of the present study was to determine whether the FBN1 2/3 genotype was associated with the presence of carotid plaque and incident cardiovascular morbidity and mortality in middle-aged subjects. The FBN1 genotype was characterized in 5765 subjects (2424 men, 3341 women; age 45-69years) recruited from the Malmo Diet and Cancer Study Cardiovascular Cohort, Sweden. Plaque occurrence and intima-media thickness (IMT) of the carotid artery were assessed by ultrasound. The incidence of first cardiovascular events (myocardial infarction and stroke) and cause-specific mortality were monitored over a mean follow-up period of 13.2years. The most common FBN1 genotypes were 2/2, 2/3 and 2/4, which accounted for 92.2% (n=5317) of subjects. There were no differences between the three genotypes regarding age, blood pressure, glucose, lipids, smoking habits, common carotid artery diameter and intima-media thickness in men and women. The presence of plaque in the carotid artery was higher in men with the 2/3 genotype compared with the 2/2 and 2/4 genotypes (55% vs 46% and 50%, respectively; P=0.007). No similar differences were observed in women. No significant relationship was observed between FBN1 genotypes and the incidence of cardiovascular disease or all-cause mortality. The increased prevalence of plaque in the carotid artery of middle-aged men with the FBN1 2/3 genotype indicates pathological arterial wall remodelling with a more pronounced atherosclerotic burden.

  • 4.
    De Basso, Rachel
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Sandgren, Thomas
    Capio Lundby Hosp, Gothenburg, Sweden.
    Ahlgren, Åsa Ryden
    Lund University.
    Länne, Toste
    Linköping University.
    Increased cardiovascular risk without generalized arterial dilating diathesis in persons who do not have abdominal aortic aneurysm but who are first-degree relatives of abdominal aortic aneurysm patients2015In: Clinical and experimental pharmacology & physiology, ISSN 0305-1870, E-ISSN 1440-1681, Vol. 42, no 6, p. 576-581Article in journal (Refereed)
    Abstract [en]

    There is a strong genetic predisposition towards abdominal aortic aneurysm (AAA), but it is unknown whether persons without AAA but with first-degree relatives who are AAA patients have a generalized dilating diathesis, defect arterial wall mechanics, or increased cardiovascular risk. The aim of the study was to investigate arterial diameters and wall mechanics at multiple arterial sites in these subjects and compare them with controls without a family history of AAA. This study included 118 first-degree relatives of patients with AAA and 66 controls (age: 40-80years). The abdominal aorta, common carotid artery, common femoral artery, and popliteal artery were investigated by echo-tracking ultrasound. The relatives had no arterial dilatation, but they did tend to have smaller diameters than controls. Relatives had a higher heart rate, diastolic blood pressure, and mean arterial pressure than controls. The distensibility coefficient and the compliance coefficient were decreased in all arteries in male relatives, adjusted for age and smoking; these coefficients were normalized after adjustment for mean arterial pressure and heart rate. Female relatives had a lower compliance coefficient in the abdominal aorta, adjusted for age and smoking. After adjustment for mean arterial pressure and heart rate, the difference disappeared. No general arterial dilatation in relatives without AAA was found, supporting the hypothesis that the dilating diathesis is linked to the aneurysmal manifestation in the abdominal aorta. Although the threat of aneurysmal dilatation and rupture seems to be lacking in these subjects, heart rate, blood pressure, and arterial wall stiffness were all increased, which may indicate a higher risk of developing cardiovascular morbidity and mortality.

  • 5.
    Ekström, Jörgen
    et al.
    Section of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
    Aras, Hülya Çevik
    Sayardoust, Shariel
    Department of Pharmacology, Sahlgrenska Academy Göteborg University, Göteborg, Sweden.
    Neural- and Hormonal-induced Protein Synthesis and Mitotic Activity in the Rat Parotid Gland and the Dependence on NO-generation2007In: Journal of Oral Biosciences, ISSN 1349-0079, Vol. 49, no 1, p. 31-38Article in journal (Refereed)
    Abstract [en]

    Nitric oxide (NO) is a likely parasympathetic nonadrenergic, noncholinergic transmitter in parotid glands, since parasympathetic nerves contain NO-synthase. Parasympathetic stimulation (30 min, atropine + phentolamine + propranolol) increased the protein synthesis ([3H] leucine uptake) by 142% (10 Hz) and 200% (40 Hz). Surprisingly, neither the neuronal type NO-synthase inhibitor N-PLA, nor the unspecific inhibitor L-NAME reduced the response. Moreover, the parasympathetic nonadrenergic, noncholinergic (40 Hz, 30 min)-evoked increase (65%) in mitotic activity ([3H] thymidine uptake) was unaffected by the NO-synthase inhibitors. Sympathetic nerves lack NO-synthase, yet inhibition of NO-generation reduced the β-adrenoceptor mediated response to sympathetic stimulation. Whereas the protein synthesis increased by 192% to stimulation (50 Hz, 1s every tenth s for 30 min) under just α-adrenoceptor blockade, the response was more than halved in the presence of N-PLA to 86%) or L-NAME to 91%). Furthermore, the β-adrenoceptor mediated increase in mitotic activity 122%) to sympathetic stimulation 20 Hz, 4 min every fifth min for 30 min), under α-adrenoceptor blockade, was reduced to 49% N-PLA) and 47% (L-NAME). Pentagastrin (20 µg/kg, I. V. infused for one h) increased the protein synthesis by 17%. N-PLA prevented this increase but did not affect the basal protein, while cholecystokinin receptor blockers reduced both the basal protein synthesis (by 20%), and the pentagastrin-induced increase. Thus, implying that strong rather than weak stimuli of the cholecystokinin receptors activate neuronal type NO-synthase. Despite being of the neuronal type, the NO-synthase generating NO in response to stimulation of β-adrenoceptors or cholecystokinin receptors was probably of parenchymal origin. 

  • 6.
    Nilsson, Håkan
    Högskolan i Skövde, Institutionen för teknik och samhälle.
    Hjärnans signalsystem metodologi och funktion2007In: Neurodidaktik: Om hjärnvägar och knutpunkter / [ed] Aadu Ott & Carl E. Olivestam, Göteborg: Institutionen för pedagogik och didaktik, Neurodidaktiska kollegiet, Göteborgs universitet , 2007, p. 19-29Chapter in book (Other academic)
  • 7.
    Nyberg, Gisela
    et al.
    Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden.
    Norman, Åsa
    Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden.
    Sundblom, Elinor
    Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden.
    Zeebari, Zangin
    Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden.
    Elinder, Liselotte S.
    Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden.
    Effectiveness of a universal parental support programme to promote health behaviours and prevent overweight and obesity in 6-year-old children in disadvantaged areas, the Healthy School Start Study II, a cluster-randomised controlled trial2016In: International Journal of Behavioral Nutrition and Physical Activity, ISSN 1479-5868, E-ISSN 1479-5868, Vol. 13, no 1, article id 4Article in journal (Refereed)
    Abstract [en]

    Background: There is increasing evidence for the effectiveness of parental support programmes to promote healthy behaviours and prevent obesity in children, but only few studies have been conducted among groups with low socio-economic status. The aim of this study was to develop and evaluate the effectiveness of a parental support programme to promote healthy dietary and physical activity habits and to prevent overweight and obesity in six-year-old children in disadvantaged areas.

    Methods: A cluster-randomised controlled trial was carried out in disadvantaged areas in Stockholm. Participants were six-year-old children (n = 378) and their parents. Thirty-one school classes from 13 schools were randomly assigned to intervention (n = 16) and control groups (n = 15). The intervention lasted for 6 months and included: 1) Health information for parents, 2) Motivational Interviewing with parents and 3) Teacher-led classroom activities with children. Physical activity was measured by accelerometry, dietary intake and screen time with a questionnaire, body weight and height were measured and BMI standard deviation score was calculated. Measurements were conducted at baseline, post-intervention and at 5months follow-up. Group effects were examined using Mixed-effect Regression analyses adjusted for sex, parental education and baseline values.

    Results: Fidelity to all three intervention components was satisfactory. Significant intervention effects were found regarding consumption of unhealthy foods (p = 0.01) and unhealthy drinks (p = 0.01). At follow-up, the effect on intake of unhealthy foods was sustained for boys (p = 0.03). There was no intervention effect on physical activity. Further, the intervention had no apparent effect on BMI sds for the whole sample, but a significant difference between groups was detected among children who were obese at baseline (p = 0.03) which was not sustained at follow-up.

    Conclusions: The Healthy School Start study shows that it is possible to influence intake of unhealthy foods and drinks and weight development in obese children by providing individual parental support in a school context. However, the effects were short-lived. Therefore, the programme needs to be prolonged and/or intensified in order to obtain stronger and sustainable effects. This study is an important contribution to the further development of evidence-based parental support programmes to prevent overweight and obesity in children in disadvantaged areas.

  • 8.
    Sayardoust, Shariel
    et al.
    Department of Pharmacology, Sahlgrenska Academy Göteborg University, Göteborg, Sweden.
    Ekström, J.
    Department of Pharmacology, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
    Nitric oxide-dependent protein synthesis in parotid and submandibular glands of anaesthetized rats upon sympathetic stimulation or isoprenaline administration2004In: Experimental Physiology, ISSN 0958-0670, E-ISSN 1469-445X, Vol. 89, no 2, p. 219-227Article in journal (Refereed)
    Abstract [en]

    In anaesthetized female rats, the β-adrenoceptor agonist isoprenaline was intravenously infused (20 μg kg-1 min-1) for 30 min or the ascending cervical sympathetic nerve trunk was intermittently stimulated (50 Hz, 1 s every tenth second) on one side for 30 min. The incorporation of [3H]leucine into trichloroacetic acid (TCA)-insoluble material was used as an index of protein synthesis. In response to isoprenaline, the [3H]leucine incorporation increased by 79% in the parotid glands and by 82% in the submandibular glands. The neuronal type NO-synthase inhibitor N-PLA, reduced (P < 0.001) this response to 26% and 20%, respectively. Sympathetic stimulation under α-adrenoceptor blockade increased the [3H]leucine incorporation by 192% in the parotid glands and by 35% in the submandibular glands. N-PLA reduced the corresponding percentage figures to 86% (P < 0.01) and 8% (P < 0.05). When tested in the parotid glands, the non-selective NO-synthase inhibitor L-NAME reduced (P < 0.01) the nerve-evoked response to 91%. The increase in [3H]leucine incorporation in response to sympathetic stimulation under β-adrenoceptor blockade was not affected by N-PLA in the parotid (139% versus 144%) and submandibular glands (39% versus 34%). In non-stimulated glands, the [3H]leucine incorporation was not influenced by the NO-synthase inhibitors. In conclusion, β-adrenoceptor mediated salivary gland protein synthesis is largely dependent on NO generation by neuronal type NO-synthase, most likely of parenchymal origin. 

  • 9.
    Sayardoust, Shariel
    et al.
    Department of Pharmacology, Sahlgrenska Academy Göteborg University, Göteborg, Sweden.
    Ekström, Jörgen
    Department of Pharmacology, Sahlgrenska Academy Göteborg University, Göteborg, Sweden.
    Nitric oxide-dependent in vitro secretion of amylase from innervated or chronically denervated parotid glands of the rat in response to isoprenaline and vasoactive intestinal peptide2003In: Experimental Physiology, ISSN 0958-0670, E-ISSN 1469-445X, Vol. 88, no 3, p. 381-387Article in journal (Refereed)
    Abstract [en]

    The basal in vitro release of amylase was similar from rat parotid lobules of innervated and chronically denervated glands and was unaffected by the inhibitors used in this study. The secretion of amylase induced by isoprenaline or vasoactive intestinal peptide (VIP) was reduced by one-third to one-half from the lobules of the innervated glands and even more so from the lobules of the denervated glands by ODQ, an inhibitor of soluble guanyl cyclase which is activated by nitric oxide (NO) and catalyses the cGMP production. The use of Nω-propyl-L-arginine (N-PLA) revealed that the evoked secretion of amylase in the denervated glands depended on the activity of neuronal type NO synthase to synthesize NO. Since the denervated gland is virtually devoid of NO synthase-containing nerve fibres, the neuronal type NO synthase was most probably of a non-neuronal source. NO-dependent amylase secretion was agonist related, since amylase secretion evoked by bethanechol and neuropeptide Y was not reduced by ODQ or N-PLA. Hence, under physiological conditions, activation of β-adrenoceptors (sympathetic activity) and VIP receptors (parasympathetic activity) is likely to cause secretion of parotid amylase partly through a NO/cGMP-dependent intracellular pathway involving the activity of neuronal type NO synthase, possibly of acinar origin.

  • 10.
    Schmekel, Birgitta
    et al.
    Division of Clinical Physiology, Department of Medicine and Health, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Blomstrand, Peter
    Jönköping University, School of Health and Welfare, HHJ. Biomedical Platform.
    Venge, Per
    Department of Medical Sciences, University of Uppsala, Uppsala, Sweden.
    Serum lysozyme – a surrogate marker of pulmonary microvascular injury in smokers?2013In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 33, no 4, p. 307-312Article in journal (Refereed)
    Abstract [en]

    Progression rate of disease processes in smoke-induced lung injuries varies greatly. Diverse pathophysiological mechanisms may trigger these divergences. The aim of this study was to evaluate whether circulating markers of monocytes/macrophages and/or neutrophil [i.e. lysozyme (LZM) or myeloperoxidase (MPO)] were associated with reduced values of diffusion capacity (DL,CO), which is considered to serve as a mirror of pulmonary microvascular derangement and an early sign of tissue remodelling in smokers. Data obtained from 134 smokers (GOLD stage ≤1) and 24 matched healthy non-smoking volunteers were evaluated in a cross-sectional study design. Lung function tests as well as single breath test of DL,CO were assessed according to ATS/ERS guidelines. Biomarkers were measured in serum by means of sensitive immunoassays. A subgroup of smokers with normal lung function was created to minimize confounding, by excluding datasets showing significant airflow limitation and abnormally high values of carboxy haemoglobin (COHb), the latter indicating recent smoking. The capacity of serum lysozyme to correctly identify abnormally low values of DL,CO (i.e. <1·9SD units), tended to be higher than that of Myeloperoxidase as assessed by analyses of receiver operated curves (ROC; AUC 0·81, 95%CI: 0·69–0·89 versus AUC 0·67, 95%CI: 0·60–0·81). It is concluded that serum levels of lysozyme, reflecting mainly activated monocytes/macrophages but also neutrophils, were significantly associated with isolated decrements of DL,CO in smokers with normal lung function tests. This suggests monocytes/macrophages to have a significant mechanistic role in early phases of the disease process and/or pulmonary microvascular damage.

  • 11.
    Starck, Sven-Åke
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine.
    Rosendahl, Lene
    Cty Hosp Ryhov, Dept Clin Physiol, S-55185 Jönköping, Sweden.
    Evaluation and optimization of administered activity, scanning parameters and hydration at 99m Tc hydroxymethylene diphosphonate adult whole-body bone imaging2012In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 32, no 6, p. 431-436Article in journal (Refereed)
    Abstract [en]

    Purpose: To find out the method of optimal activity administration and scanning parameters to fulfil guidelines and diagnostic reference levels and to reach a maximal contrast-to-noise ratio (CNR) in bone imaging. We also investigate the influence on CNR and bladder activity in well-hydrated patients.

    Methods: A total of 225 patients were included. The first group of 101 patients was used to find out the optimal method to administer activity in terms of optimized CNR. The next two groups with 62 patients each were hydrated with 1500 ml water in two different time periods. CNR, bladder area and content were calculated.

    Results: An administrated activity per metre body height gave the highest CNR (5.43). A standard activity had the lowest percentage (2%) of images with <1.5 million counts. Early hydration decreased CNR from 5.41 to 4.85 (P = 0.06), with late hydration to 5.29 (NS). Studies with too few pulses were increased from 2 to 11% to a level of 15-26% and 11-21%, respectively. Early hydration reduced the bladder activity from 20.7 to 10.1 MBq (P<0.01), late hydration to 14.8 MBq (P = 0.08). The bladder size was enlarged from the no hydrated group (1406 mm2) to the early hydrated group (2406 mm2, P<0.000) and between the early and late hydrated group (3183 mm2, P<0.05).

    Conclusion: A standard activity in sufficient quantity is the most practical method, in addition to have the lowest percentage of images with too few pulses. A high fluid intake is not recommended because of problems with disturbing bladder content.

  • 12. Westholm, Carl
    et al.
    Bjällmark, Anna
    KTH, Medicinsk teknik.
    Larsson, Matilda
    KTH, Medicinsk teknik.
    Jacobsen, Per
    Brodin, Lars-Åke
    KTH, Medicinsk teknik.
    Winter, Reidar
    Velocity tracking, a new and user independent method for detecting regional function of the left ventricle2009In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 29, no 1, p. 24-31Article in journal (Refereed)
    Abstract [en]

    The use of two-dimensional echocardiography (2D echo) for detection of ischaemia is limited due to high user dependency. Longitudinal motion is sensitive for ischaemia and usable for quantitative measurement of longitudinal myocardial function but time consuming. Velocity tracking (VeT) is a new method that gives an easy three-dimensional understanding of both systolic and diastolic regional motion, using colour coded bull's eye presentation of longitudinal velocity, derived from colour coded tissue Doppler. The aim of this study was to test the accuracy of VeT in detecting ischaemia in non-ST-segment elevation myocardial infarction (NSTEMI) patients bedside. Twenty patients with NSTEMI and 10 controls were included. Echocardiography was performed within 24 h of symptoms and prior to coronary angiography. Bull's eye plots presenting the peak systolic velocity (PSV) and the sum of PSV and the E-wave-velocity (PSV+E) were created using our developed software. VeT was compared to expert wall motion scoring (WMS) and bedside echo. We used the clinical conclusion based on ECG, angiography and clinical picture as 'gold standard'. Sensitivity for ischaemia with VeT (PSV+E) was 85% and specificity 60%. The corresponding sensitivities for expert WMS were 75% (specificity 40%). For regional analysis VeT and WMS showed comparable results with correct regional outcome in 11/20 of patients both superior to bedside echo. Velocity tracking is a promising technique that provides an easily understandable three-dimensional bull's eye plot for assessment of regional left ventricular longitudinal velocity with great potential for detection of regional dysfunction and myocardial ischaemia.

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