37 results on '"Thorsell M"'
Search Results
2. Tuning composition in graded AlGaN channel HEMTs toward improved linearity for low-noise radio-frequency amplifiers.
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Papamichail, A., Persson, A. R., Richter, S., Kühne, P., Stanishev, V., Persson, P. O. Å., Ferrand-Drake Del Castillo, R., Thorsell, M., Hjelmgren, H., Paskov, P. P., Rorsman, N., and Darakchieva, V.
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LOW noise amplifiers ,MODULATION-doped field-effect transistors ,SCANNING transmission electron microscopy ,METAL organic chemical vapor deposition ,CHEMICAL vapor deposition ,ELECTRON density ,ELECTRON energy loss spectroscopy - Abstract
Compositionally graded channel AlGaN/GaN high electron mobility transistors (HEMTs) offer a promising route to improve device linearity, which is necessary for low-noise radio-frequency amplifiers. In this work, we demonstrate different grading profiles of a 10-nm-thick Al
x Ga1−x N channel from x = 0 to x = 0.1 using hot-wall metal-organic chemical vapor deposition (MOCVD). The growth process is developed by optimizing the channel grading and the channel-to-barrier transition. For this purpose, the Al-profiles and the interface sharpness, as determined from scanning transmission electron microscopy combined with energy-dispersive x-ray spectroscopy, are correlated with specific MOCVD process parameters. The results are linked to the channel properties (electron density, electron mobility, and sheet resistance) obtained by contactless Hall and terahertz optical Hall effect measurements coupled with simulations from solving self-consistently Poisson and Schrödinger equations. The impact of incorporating a thin AlN interlayer between the graded channel and the barrier layer on the HEMT properties is investigated and discussed. The optimized graded channel HEMT structure is found to have similarly high electron density (∼ 9 × 10 12 cm−2 ) as the non-graded conventional structure, though the mobility drops from ∼ 2360 cm2 /V s in the conventional to ∼ 960 cm2 /V s in the graded structure. The transconductance gm of the linearly graded channel HEMTs is shown to be flatter with smaller g m ′ and g m ″ as compared to the conventional non-graded channel HEMT implying improved device linearity. [ABSTRACT FROM AUTHOR]- Published
- 2023
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3. Longitudinal study of vascular structure and function during normal pregnancy
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Ghossein‐Doha, Chahinda, Khalil, Asma, Lees, Christoph, Iacobaeus, C., Andolf, E., Thorsell, M., Bremme, K., Jörneskog, G., Östlund, E., and Kahan, T.
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- 2017
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4. Stereological assessment of placental morphology in intrahepatic cholestasis of pregnancy
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Wikström Shemer, E., Thorsell, M., Östlund, E., Blomgren, B., and Marschall, H.-U.
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- 2012
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5. Starting time for induction of labor and the risk for night-time delivery
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Thorsell, M., Lyrenäs, S., Andolf, E., and Kaijser, M.
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- 2011
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6. Caesarean section and risk for endometriosis: a prospective cohort study of Swedish registries
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Andolf, E, Thorsell, M, and Källén, K
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- 2013
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7. Large fetal size in early pregnancy associated with macrosomia
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THORSELL, M., KAIJSER, M., ALMSTRÖM, H., and ANDOLF, E.
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- 2010
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8. Expected day of delivery from ultrasound dating versus last menstrual period—obstetric outcome when dates mismatch
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Thorsell, M, Kaijser, M, Almström, H, and Andolf, E
- Published
- 2008
9. Longitudinal study of vascular structure and function during normal pregnancy.
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Iacobaeus, C., Andolf, E., Thorsell, M., Bremme, K., Jörneskog, G., Östlund, E., and Kahan, T.
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PREGNANCY ,VASODILATION ,BRACHIAL artery ,NITROGLYCERIN ,ENDOTHELIUM ,ACETYLCHOLINE ,PHYSIOLOGY ,CAROTID artery ,FETAL ultrasonic imaging ,FOREARM ,LONGITUDINAL method ,MICROCIRCULATION - Abstract
Objective: To examine alterations in maternal vascular structure and function during normal pregnancy.Methods: We assessed brachial and central blood pressure, pulse-wave velocity and augmentation index (by pulse-wave analysis and applanation tonometry), common carotid artery structure (by ultrasonography) and endothelial function in the brachial artery (by postischemic hyperemia-induced flow-mediated vasodilatation by glyceryl trinitrate) and in the forearm skin microcirculation (by laser Doppler perfusion imaging during iontophoretic administration of acetylcholine and sodium nitroprusside) in 52 healthy nulliparous women at 14, 24 and 34 weeks' gestation, and at 9 months postpartum.Results: During pregnancy, brachial and central systolic and diastolic blood pressures initially decreased but subsequently increased (all P < 0.05). Flow-mediated vasodilatation in the brachial artery increased during early pregnancy (P < 0.05), whereas non-specific vasodilatation by glyceryl trinitrate decreased (P < 0.01), indicating improved endothelial function. Thus, endothelial function index (forearm blood flow/glyceryl trinitrate) increased during pregnancy (0.30 ± 0.18 in the non-pregnant state at 9 months postpartum and 0.51 ± 0.19, 0.61 ± 0.39 and 0.49 ± 0.30 in the first, second and third trimesters, respectively) (P < 0.001). Endothelium-dependent skin microvascular reactivity to acetylcholine also increased (P < 0.01). Carotid-femoral pulse-wave velocity decreased during pregnancy (5.88 ± 0.91 m/s in the non-pregnant state and 5.55 ± 0.67, 5.12 ± 0.66 and 5.62 ± 0.74 m/s in the first, second and third trimesters, respectively) (P < 0.001).Conclusion: During normal pregnancy, the blood volume expansion necessary for sufficient fetal growth is accommodated by early and marked changes in the matvascular system. This seems to be dependent on normal adaptive endothelial and vascular function. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]- Published
- 2017
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10. Fetal growth is associated with first-trimester maternal vascular function.
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Iacobaeus, C., Kahan, T., Jörneskog, G., Bremme, K., Thorsell, M., and Andolf, E.
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FETAL growth disorders ,FIRST trimester of pregnancy ,PREGNANCY complications ,HYPEREMIA ,VASODILATION ,SODIUM nitroferricyanide ,ACETYLCHOLINE ,BRACHIAL artery ,BIRTH weight ,CARDIOVASCULAR disease diagnosis ,FOREARM ,MATERNAL age ,MICROCIRCULATION ,NITROGLYCERIN ,FETAL development ,CROSS-sectional method ,PHARMACODYNAMICS ,PHYSIOLOGY - Abstract
Objective: To investigate the relationship between maternal endothelial function in the first trimester, assessed in both the brachial artery and the forearm skin microcirculation, and fetal growth.Methods: Vascular function was assessed in 56 pregnant women during gestational weeks 11-14. Vascular reactivity in the brachial artery was evaluated by postischemic hyperemia-induced flow-mediated vasodilatation (FMD) and by vasodilatation following administration of sublingual glyceryl trinitrate (GTN). Forearm skin microcirculation was investigated by laser Doppler perfusion imaging during iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP) to assess endothelium-dependent and -independent microvascular vasodilatation, respectively. Fetal growth was measured at study inclusion and birth-weight centile was calculated after delivery.Results: FMD and GTN-induced vasodilatation were both associated with birth-weight centile. On multivariate analysis (adjusted for brachial artery diameter at rest, blood pressure, maternal age and heart rate), for FMD β = 1.7 (95% CI, 0.06-3.34), r2 = 0.26 and P = 0.042, and for GTN-induced vasodilatation β = 2.6 (95% CI, 0.44-4.68), r2 = 0.15 and P = 0.02. Endothelium-dependent and -independent microvascular reactivity were also associated with birth-weight centile: for ACh β = 7.82 (95% CI, 1.81-13.83), r2 = 0.12 and P = 0.029, and for SNP β = 6.27 (95% CI, 1.20-11.34), r2 = 0.11 and P = 0.016.Conclusion: First-trimester maternal vascular dilatation capacity (rather than endothelial function alone) is associated with fetal growth. These findings were consistent in both the brachial artery and the forearm skin microcirculation. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]- Published
- 2016
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11. High frequency electromagnetic detection by nonlinear conduction modulation in graphene nanowire diodes.
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Winters, M., Thorsell, M., Strupiński, W., and Rorsman, N.
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ELECTROMAGNETISM , *GRAPHENE , *NANOWIRES , *ELECTRIC conductivity , *MICROWAVE diodes - Abstract
We present graphene nanowires implemented as dispersion free self switched microwave diode detectors. The microwave properties of the detectors are investigated using vector corrected large signal measurements in order to determine the detector responsivity and noise equivalent power (NEP) as a function of frequency, input power, and device geometry. We identify two distinct conductance nonlinearities which generate detector responsivity: an edge effect nonlinearity near zero bias due to lateral gating of the nanowire structures, and a velocity saturation nonlinearity which generates current compression at high power levels. The scaling study shows that detector responsivity obeys an exponential scaling law with respect to nanowire width, and a peak responsivity (NEP) of 250 V/W (50 pW/√Hz) is observed in detectors of the smallest width. The results are promising as the devices exhibit responsivities which are comparable to state of the art self switched detectors in semiconductor technologies. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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12. O686 PLANNED INDUCTION OF LABOR IN GESTATIONAL WEEKS 37–39 IN WOMEN WITH INTRAHEPATIC CHOLESTASIS OF PREGNANCY: A RETROSPECTIVE HOSPITAL-BASED COHORT STUDY
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Shemer, E.A. Wikström, Thorsell, M., Marschall, H.-U., and Kaijser, M.
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- 2012
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13. PP037. Family history of cardiovascular disease and maternal vascular function during early pregnancy
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Iacobaeus, C., Jörneskog, G., Kahan, T., Thorsell, M., and Andolf, Ellika
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- 2012
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14. OS083. Fetal growth and maternal vascular function in early pregnancy
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Iacobaeus, C., Jörneskog, G., Kahan, T., Thorsell, M., and Andolf, Ellika
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- 2012
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15. O937 Induction of labor associated with risk for acute cesarean section in nulliparous and multiparous women
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Thorsell, M., Andolf, E., Lyrenas, S., and Kaijser, M.
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- 2009
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16. O50 Long term effects of caesarean section – risk of endometriosis – a nested case control study
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Andolf, E., Thorsell, M., Larsson, C., and Kallen, K.
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- 2009
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17. GWAS meta-analysis of intrahepatic cholestasis of pregnancy implicates multiple hepatic genes and regulatory elements.
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Dixon PH, Levine AP, Cebola I, Chan MMY, Amin AS, Aich A, Mozere M, Maude H, Mitchell AL, Zhang J, Chambers J, Syngelaki A, Donnelly J, Cooley S, Geary M, Nicolaides K, Thorsell M, Hague WM, Estiu MC, Marschall HU, Gale DP, and Williamson C
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- Bile Acids and Salts, Female, Genome-Wide Association Study, Humans, Infant, Newborn, Pregnancy, Cholestasis, Intrahepatic genetics, Pregnancy Complications genetics, Premature Birth
- Abstract
Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disorder affecting 0.5-2% of pregnancies. The majority of cases present in the third trimester with pruritus, elevated serum bile acids and abnormal serum liver tests. ICP is associated with an increased risk of adverse outcomes, including spontaneous preterm birth and stillbirth. Whilst rare mutations affecting hepatobiliary transporters contribute to the aetiology of ICP, the role of common genetic variation in ICP has not been systematically characterised to date. Here, we perform genome-wide association studies (GWAS) and meta-analyses for ICP across three studies including 1138 cases and 153,642 controls. Eleven loci achieve genome-wide significance and have been further investigated and fine-mapped using functional genomics approaches. Our results pinpoint common sequence variation in liver-enriched genes and liver-specific cis-regulatory elements as contributing mechanisms to ICP susceptibility., (© 2022. The Author(s).)
- Published
- 2022
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18. Knowledge, challenges, and standard of care of young women with ADHD at Swedish youth clinics.
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Klint Carlander AK, Thorsell M, Demetry Y, Nikodell S, Kopp Kallner H, and Skoglund C
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- Adolescent, Contraceptive Agents, Female, Humans, Pregnancy, Standard of Care, Sweden, Attention Deficit Disorder with Hyperactivity, Contraception psychology
- Abstract
Objectives: Sexual risk-taking and its consequences for young women with ADHD(attention deficit hyperactivity disorder) including sexually transmitted diseases, teenage pregnancies and underage parenthood constitute substantial challenges for individuals and midwives. The aim was to investigate current knowledge and specific challenges in reproductive health and contraceptive counselling for women with ADHD at Swedish youth clinics., Method: Inductive qualitative interview study of ten midwives at six youth health clinics in Stockholm and Uppsala County. We used a semi-structured interview guide. The interviews were transcribed verbatim and analyzed with the NVivo 12 qualitative data analysis software., Results: Three main categories were identified: (1) challenges in provision of care of young women with ADHD, (2) standard of care and active adaptations towards women with ADHD and (3) organizational readiness for change;. Several challenges and frustrations, such as difficulties with attention with or without concomitant impulsivity and overactivity, in provision of reproductive health and contraceptive counselling for young women with ADHD were identified. Midwives reported high organizational readiness for improvement of standard of care., Conclusions: Inadequate contraceptive counseling or lack of knowledge on specific challenges in the sexual and reproductive health of young women with ADHD may contribute to this group failing to access, inadequately respond to, or act upon counseling at youth clinics. Support for midwives with evidence-based interventions specifically developed for these women are imperative. Development of such tools should be a priority for research., (Copyright © 2022. Published by Elsevier B.V.)
- Published
- 2022
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19. Alcohol and illicit and non-medical prescription drug use before and during pregnancy in Stockholm, Sweden: A cross-sectional study.
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Persson A, Lindmark S, Petersson K, Gabriel E, Thorsell M, Lindström K, Göransson M, Cardell G, and Magnusson Å
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- Alcohol Drinking epidemiology, Cross-Sectional Studies, Female, Humans, Nonprescription Drugs, Parturition, Pregnancy, Prevalence, Sweden epidemiology, Prescription Drugs
- Abstract
Objectives: To provide current estimates of alcohol and drug use among pregnant women attending antenatal care lectures in preparation for childbirth in Stockholm, Sweden., Study Design: A cross-sectional study. Data was collected anonymously among women attending lectures in preparation for childbirth., Main Outcome Measures: The prevalence of alcohol and illicit and non-medical prescription drug use among pregnant women attending antenatal care lectures in preparation for childbirth., Results: Nine hundred and thirty-six pregnant women attending lectures in preparation for childbirth participated. Among those answering all questions about alcohol use during pregnancy, 4.2 percent reported use (95% confidence interval (CI), 3.0-5.7%) and among those answering all questions about illicit or non-medical prescription drug use during pregnancy, 0.5 percent reported such use (95% CI, 0.1-1.3%). The prevalences of binge drinking during pregnancy and alcohol and drug use before pregnancy are presented. Comparisons of anonymously and non-anonymously collected data are included., Conclusions: Approximately one in 25 women reported using alcohol and approximately one in 200 reported using illicit or non-medical prescription drugs while pregnant. Alcohol use during pregnancy may have decreased in Stockholm, Sweden., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)
- Published
- 2021
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20. Potentially traumatic events, fear of childbirth and posttraumatic stress disorder during pregnancy in Stockholm, Sweden: A cross-sectional study.
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Persson A, Lindmark S, Petersson K, Gabriel E, Thorsell M, Lindström K, Göransson M, Cardell G, and Magnusson Å
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- Adult, Cross-Sectional Studies, Female, Humans, Pregnancy, Prenatal Care, Surveys and Questionnaires, Sweden epidemiology, Exposure to Violence statistics & numerical data, Fear psychology, Parturition psychology, Pregnant Women psychology, Stress Disorders, Post-Traumatic epidemiology, Stress, Psychological epidemiology
- Abstract
Objectives: To estimate the prevalence of potentially traumatic events (PTEs), fear of childbirth (FOC), and support for it as well as posttraumatic stress disorder (PTSD) among pregnant women attending maternal care in Stockholm, Sweden., Methods: A cross-sectional study was conducted. Pregnant women attending lectures in preparation for childbirth at the major hospitals in Stockholm were asked to complete questionnaires anonymously. Main outcome measures were the prevalence of PTEs, FOC, support for FOC and PTSD., Results: One thousand one hundred fifty-seven women in late pregnancy attending lectures in preparation for childbirth at hospitals in Stockholm, Sweden, were asked to participate, 945 chose to participate, resulting in a response rate of 81.7 percent. Most pregnant women, 78.5 percent (95% confidence interval (CI) 75.6-81.3), reported having experienced at least one PTE. The prevalence of having experienced different types of violence is presented. FOC was found among 28.8 percent (95% CI 25.7-32.0) of pregnant women, while only 10.9 percent (95% CI 10.5-11.2) received support for FOC. The prevalence of current PTSD was 4.1 percent (95% CI 2.8-5.8)., Conclusions: The majority of pregnant women had experienced PTEs, and experiences of violence were common, as was FOC. Approximately one in 25 women attending general maternal care in Stockholm, Sweden, was estimated to have current PTSD. This highlights the need to prevent violence, find pregnant women suffering from FOC or PTSD, to develop an evidence-based treatment for FOC and to provide such treatment for PTSD., (Copyright © 2020 Elsevier B.V. All rights reserved.)
- Published
- 2020
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21. Reply.
- Author
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Iacobaeus C, Andolf E, Thorsell M, Bremme K, Östlund E, and Kahan T
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- Female, Humans, Heart physiology, Pregnancy physiology
- Published
- 2018
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22. Colposcopy telemedicine: live versus static swede score and accuracy in detecting CIN2+, a cross-sectional pilot study.
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Taghavi K, Banerjee D, Mandal R, Kallner HK, Thorsell M, Friis T, Kocoska-Maras L, Strander B, Singer A, and Wikström E
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- Adult, Cross-Sectional Studies, Diagnostic Techniques, Obstetrical and Gynecological, Female, Humans, India, Middle Aged, Pilot Projects, Retrospective Studies, Sensitivity and Specificity, Biopsy methods, Colposcopy methods, Precancerous Conditions diagnosis, Telemedicine methods, Uterine Cervical Neoplasms diagnosis, Uterine Cervical Neoplasms pathology, Uterine Cervical Dysplasia diagnosis
- Abstract
Background: This cross-sectional pilot study evaluates diagnostic accuracy of live colposcopy versus static image Swede-score evaluation for detecting significant precancerous cervical lesions greater than, or equal to grade 2 severity (CIN2+)., Methods: VIA or HrHPV positive women were examined using a mobile colposcope, in a rural clinic in Kolkata, India. Live versus static Swede-score colposcopy assessments were made independently. All assessments were by gynecologists, junior or expert. Static image assessors were blinded to live scoring, patient information and final histopathology result. Primary outcome was the ability to detect CIN2+ lesions verified by directed biopsies. Diagnostic accuracy was calculated for live versus static Swede-score in detecting CIN2+ lesions, as well as for interclass correlation., Results: 495 images from 94 VIA positive women were evaluated in this study. Thirteen women (13.9%) had CIN2+ on biopsy. No significant difference was found in the detection of CIN2+ lesions between live and static assessors (area under curve = 0.69 versus 0.71, p = 0.63). A Swede-score of 4+, had a sensitivity of 76.9% (95% CI 46.2-95.0%) and 84.6% (95% CI 54.6-98.1%), for live- and static-image assessment respectively. The corresponding positive predictive values were found to be 90.9% (95% CI 75.7-98.1%) and 92.6% (95% CI 75.7-99.1%). The interclass correlation was good (kappa statistic = 0.60) for the senior static assessors., Conclusions: Swede-score evaluation of static colposcopy images was found to reliably detect CIN2+ lesions in this study. Larger studies are needed to further develop the colposcopy telemedicine concept which may offer reliable guidance in management where direct specialist input is not available., Trial Registration: Ethical approval of the study was obtained by the Chittaranjan National Cancer Institute (CNCI) Human Research Ethics Committee (4.311/27/2014). The trial was retrospectively registered in the Clinical Trails Registry of India CTRI/2018/03/012470 .
- Published
- 2018
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23. Cardiac function, myocardial mechano-energetic efficiency, and ventricular-arterial coupling in normal pregnancy.
- Author
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Iacobaeus C, Andolf E, Thorsell M, Bremme K, Östlund E, and Kahan T
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- Adaptation, Physiological, Adult, Atrial Function, Cardiac Output, Diastole, Female, Heart Rate, Humans, Organ Size, Postpartum Period, Pregnancy Trimesters physiology, Systole, Young Adult, Arteries physiology, Heart Atria anatomy & histology, Heart Ventricles anatomy & histology, Pregnancy physiology, Ventricular Function, Left
- Abstract
Objective: To assess cardiac function, myocardial mechanoenergetic efficiency (MEE), and ventricular-arterial coupling (VAC) longitudinally during normal pregnancy, and to study if there was an association between cardiac structure and function, and fetal growth., Methods: Cardiac structure and function, MEE, and ventricular-arterial coupling was assessed longitudinally in 52 healthy nulliparous women at 14, 24, and 34 weeks' gestation and 9-month postpartum., Results: Left atrial diameter increased during pregnancy (30.41 ± 3.59 mm in the nonpregnant state and 31.02 ± 3.91, 34.06 ± 3.58, and 33.9 ± 2.97 mm in the first, second, and third trimesters, P < 0.001). Left ventricular mass increased 117.12 ± 45.0 g in the nonpregnant state and 116.5 ± 33.0, 126.9 ± 34.5, 128.4 ± 36 g in the first, second, and third trimesters (P < 0.001). Cardiac output increased from 3.4 ± 1.2 l/min to 4.3 ± 0.7 l/min in the second and third trimesters (P < 0.001). Diastolic function decreased as both E/A and e'/a' decreased during pregnancy (P < 0.05 and P < 0.001, respectively). MEE and VAC were retained during pregnancy. Heart rate was associated with birth weight centile in the first (r = 0.41, P = 0.002) and second (r = 0.46, P = 0.002) trimester., Conclusion: The increase in cardiac output during normal pregnancy is obtained by an increase in heart rate, followed by structural cardiac changes. The impaired systolic function is accomplished by a deteriorated diastolic function. Despite these rapid changes, the myocardium manages to work efficient with a preserved MEE. Cardiac and arterial adaption to pregnancy seems to appear parallel as evidenced by a preserved VAC.
- Published
- 2018
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24. Good clinical and radiographic outcome of cementless metal metaphyseal sleeves in total knee arthroplasty.
- Author
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Thorsell M, Hedström M, Wick MC, and Weiss RJ
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- Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Prosthesis Failure, Retrospective Studies, Treatment Outcome, Arthroplasty, Replacement, Knee instrumentation, Arthroplasty, Replacement, Knee methods, Knee Prosthesis
- Abstract
Background and purpose - The number of revision total knee arthroplasties (TKA) is continuously increasing, leading to a growing need for reliable management of metaphyseal bone loss. We evaluated patients operated with a TKA using metal metaphyseal sleeves for bone defects with a minimum 5-year follow-up. Patients and methods - 37 patients had been operated on. 3 patients died and 3 patients were lost during follow-up. Of the 31 remainders (20 women), 9 had been operated on with a primary TKA and 22 with a revision TKA at the index surgery. The mean age at surgery was 69 (54-89) years and the mean follow-up time was 7.4 (5-12) years. Bone defects were classified according to the Anderson Orthopaedic Research Institute classification (tibia: type I n = 9, type II n = 5 and type III n = 17; femur: type I n = 12, type II n = 3 and type III n = 16). Results - At final follow-up one-third experienced an improvement concerning walking aids and walking distance. Except for 1 patient, all had full extension and a mean knee flexion of 110 (90-140) degrees. VAS pain at rest was 13 (SD 25) and on movement 30 (SD 31). 7 patients were reoperated due to: infection (n = 4), periprosthetic fracture (n = 1), skin necrosis (n = 1), and wound rupture (n = 1). The cumulative 5-year survival rate for reoperation was 77% (CI 63-92) and for revision 97% (CI 91-100). At the time of final follow-up, the sleeves showed good osseointegration with no signs of progressive radiolucency or migration. Interpretation - Titanium sleeves are a promising option in managing difficult cases with metaphyseal bone defects in TKA, providing a stable construct with good medium-term radiographic outcome.
- Published
- 2018
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25. Intrahepatic cholestasis of pregnancy and cancer, immune-mediated and cardiovascular diseases: A population-based cohort study.
- Author
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Wikström Shemer EA, Stephansson O, Thuresson M, Thorsell M, Ludvigsson JF, and Marschall HU
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- Cardiovascular Diseases epidemiology, Cholestasis, Intrahepatic epidemiology, Female, Humans, Incidence, Infant, Newborn, Pregnancy, Pregnancy Complications epidemiology, Pregnancy Complications, Neoplastic epidemiology, Pregnancy Outcome, Retrospective Studies, Risk Factors, Sweden epidemiology, Cardiovascular Diseases etiology, Cholestasis, Intrahepatic complications, Population Surveillance methods, Pregnancy Complications, Neoplastic etiology, Registries
- Abstract
Background & Aims: Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disease in pregnancy. It is associated with hepatobiliary diseases that might predispose to cancer and also with gestational diabetes and preeclampsia. In this study, we examined associations between ICP and cancer, and immune-mediated and cardiovascular diseases., Methods: By linking the Swedish Medical Birth Register and the Swedish Patient Register, we identified 11,388 women with ICP and 113,893 matched women without ICP who gave birth between 1973 and 2009. Diagnoses of cancer and immune-mediated and cardiovascular diseases both before and after delivery were obtained from the Patient Register. The main outcome measures were hazard ratios (HRs), calculated through Cox regression, for the indicated diseases after delivery., Results: ICP was not associated with later overall cancer (HR 1.07, 95% confidence interval [CI] 0.94-1.21), but it was associated with later liver and biliary tree cancer (HR 3.61, 95% CI 1.68-7.77, and 2.62, 95% CI 1.26-5.46, respectively). ICP was also associated with later immune-mediated diseases (HR 1.28, 95% CI 1.19-1.38), and specifically diabetes mellitus (HR 1.47, 95% CI 1.26-1.72), thyroid disease (HR 1.30, 95% CI 1.14-1.47), psoriasis (HR 1.27, 95% CI 1.07-1.51), inflammatory polyarthropathies (HR 1.32, 95% CI 1.11-1.58) and Crohn's disease (HR 1.55, 95% CI 1.14-2.10), but not ulcerative colitis (HR 1.21, 95% CI 0.93-1.58). Women with ICP also had a small increased risk of later cardiovascular disease (HR 1.12, 95% CI 1.06-1.19)., Conclusions: Women with ICP have increased risk of later hepatobiliary cancer and immune-mediated and cardiovascular diseases., (Copyright © 2015 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)
- Published
- 2015
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26. Diagnostic colposcopic accuracy by the gynocular and a stationary colposcope.
- Author
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Kallner HK, Persson M, Thuresson M, Altman D, Shemer I, Thorsell M, and Shemer EA
- Subjects
- Adult, Biopsy, Cross-Over Studies, Female, Humans, Sensitivity and Specificity, Sweden, Colposcopy instrumentation, Uterine Cervical Diseases diagnosis, Uterine Cervical Diseases pathology
- Abstract
Objectives: The aim of this study was to evaluate the diagnostic accuracy of sensitivity and specificity of cervical lesions by the low-cost, portable Gynocular colposcope and a stationary colposcope, in women referred for colposcopy with abnormal cervical cytology., Methods: A randomized cross-over clinical trial for evaluating the diagnostic accuracy in detecting cervical lesions by the Gynocular and a stationary colposcope. The Swede score systematic colposcopy system was used for evaluation of colposcopic abnormalities. Directed punch biopsy and excisional cone biopsy were used as the "gold-standard" by histologically confirmed high grade cervical lesions CIN2+ (CIN2, CIN3, CIN3+). In total, 123 women referred for colposcopy due to abnormal cervical cytology were recruited at the Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden. The percentage agreement and the kappa statistic were calculated for Swede score by the Gynocular and a stationary colposcope. Swede scores were compared with the results from directed punch biopsy and excisional cone biopsy., Results: The Gynocular and the stationary colposcope had a high agreement of Swede scores with a Kappa statistic of 0.947, p < .0001. Punch biopsy diagnosed CIN2+ (CIN2, CIN3, and invasive cancer) in 44 (35.7 percent) women while cytology detected CIN2+ in 34 (27.6 percent) women. There were no significant differences of the sensitivity and specificity for different Swede scores by the Gynocular or a stationary colposcope in detecting CIN 2+., Conclusions: There were no significant differences in sensitivity or specificity in detecting cervical lesions by the Gynocular or stationary colposcope. The Gynocular is as accurate in diagnosing cervical lesions as a stationary colposcope.
- Published
- 2015
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27. 2- to 9-year outcome of stemmed total knee arthroplasty. Similar failure rates in patients when used primary or as a revision.
- Author
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Weiss RJ, Thorsell M, Stark A, Nyvang J, and Hedström M
- Subjects
- Adult, Aged, Aged, 80 and over, Arthralgia etiology, Arthralgia mortality, Arthroplasty, Replacement, Knee methods, Arthroplasty, Replacement, Knee mortality, Follow-Up Studies, Humans, Middle Aged, Prosthesis-Related Infections etiology, Prosthesis-Related Infections mortality, Retrospective Studies, Treatment Outcome, Arthroplasty, Replacement, Knee adverse effects, Knee Prosthesis adverse effects, Prosthesis Failure etiology, Reoperation methods
- Abstract
Background and Purpose: There is an increase in demand for primary and revision total knee joint procedures. We studied implant survival and functional outcome of patients operated with a constrained condylar knee (CCK) or a rotating hinge implant (RH) as a primary or a revision total knee arthoplasty (TKA)., Patients and Methods: We evaluated clinically and radiographically 65 surgical procedures with a mean follow-up time of 5 (2-9) years (40 CCK and 25 RH). There were 24 primary TKAs-due to instability-and 41 revision TKAs, mostly due to aseptic loosening. Mean age at the index operation was 68 (31-88) years., Results: Overall, there were 12 failures, including 8 reoperations due to deep infection. The overall 5-year survival rate with reoperation as the endpoint was 82% (95% CI: 72-99). Radiolucent lines on either the femoral or the tibial side were seen in 36 cases. When comparing the cases that were operated as a primary TKA or as a revision TKA, function, health-related quality of life, and survival were similar. However, after primary TKA the patients generally had less pain and a higher proportion of patients were very satisfied or satisfied., Interpretation: Although a high rate of severe complications was observed, most patients improved in function after surgery regardless of whether it was a primary or a revision TKA. We found narrow radiolucent lines-mainly on the tibial side-in nearly half of the cases, but none of the implants were loose radiographically. Overall patient satisfaction and health-related quality of life were high, and a minority had problems with persistent pain.
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- 2014
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28. Evaluation of the accuracy in detecting cervical lesions by nurses versus doctors using a stationary colposcope and Gynocular in a low-resource setting.
- Author
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Nessa A, Roy JS, Chowdhury MA, Khanam Q, Afroz R, Wistrand C, Thuresson M, Thorsell M, Shemer I, and Wikström Shemer EA
- Subjects
- Adult, Cross-Over Studies, Diagnostic Techniques, Obstetrical and Gynecological instrumentation, Equipment Design, Female, Health Resources, Humans, Reproducibility of Results, Colposcopes, Nurses, Physicians, Uterine Cervical Diseases pathology
- Abstract
Objectives: Evaluation of the performance of VIA (visual inspection with acetic acid) trained nurses to learn colposcopy and the Swede score method to detect cervical lesions by using stationary colposcope or a portable, hand-held colposcope; the Gynocular, as compared to doctors., Design: A crossover randomised clinical trial., Setting: The Colposcopy Clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh., Participants: 932 women attending the clinic as either screening naïve for VIA screening (404) or women referred as VIA positive (528) from other VIA screening centres in the Dhaka region., Intervention: VIA trained nurses were trained on-site in colposcopy and in the Swede score systematic colposcopy method. The Swede score grade cervical acetowhiteness, margins plus surface. vessel pattern, lesion size and iodine staining. The women were randomised to start the examination by either a stationary colposcope or the Gynocular. Swede scores were first obtained by a nurse and the same patient was equally evaluated by a doctor., Primary and Secondary Outcome Measures: Agreement between nurses and doctors in Swede scores was evaluated using the weighted κ statistic for the Gynocular and standard colposcope. The ability to predict CIN 2+ (CIN 2, CIN 3 and invasive cervical cancer) using Swede scores was evaluated using receiver-operating characteristic curves., Results: The Swede scores obtained by nurses and doctors using the Gynocular and stationary colposcope showed high agreement with a κ statistic of 0.858 and 0.859, respectively, and no difference in detecting cervical lesions in biopsy. Biopsy detected CIN 2+ in 39 (4.2%) women., Conclusions: Our study showed that VIA nurses can perform colposcopy. There was no significant differences compared to doctors in detecting cervical lesions by stationary colposcope or the Gynocular using the Swede score system. Swede scores obtained by nurses using the Gynocular could offer an accurate cervical diagnostic approach in low resource settings., Trial Registration Number: ISRCTN53264564., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)
- Published
- 2014
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- View/download PDF
29. Evaluation of stationary colposcope and the Gynocular, by the Swede score systematic colposcopic system in VIA positive women: a crossover randomized trial.
- Author
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Nessa A, Wistrand C, Begum SA, Thuresson M, Shemer I, Thorsell M, and Shemer EA
- Subjects
- Acetic Acid, Adult, Cross-Over Studies, Female, Humans, Colposcopy instrumentation, Uterine Cervical Neoplasms diagnosis, Uterine Cervical Dysplasia diagnosis
- Abstract
Objective: This study aimed to evaluate cervical lesions by the Swede coloscopy system, histologic finding, liquid-based cytology, and human papillomavirus (HPV) in women who resulted positive for visual inspection of the cervix with acetic acid (VIA) by using a pocket-sized battery-driven colposcope, the Gynocular (Gynius AB, Sweden)., Methods: This study was a crossover, randomized clinical trial at the colposcopy clinic of Bangabandhu Sheikh Mujib Medical University in Dhaka, Bangladesh, with 540 VIA-positive women. Swede scores were obtained by the Gynocular and stationary colposcope, as well as samples for liquid-based cytology, HPV, and cervical biopsies. The Swede scores were compared against the histologic diagnosis and used as criterion standard. The percentage agreement and the κ statistic for the Gynocular and standard colposcope were also calculated., Results: The Gynocular and stationary colposcope showed high agreement in Swede scores with a κ statistic of 0.998, P value of less than 0.0001, and no difference in detecting cervical lesions in biopsy. Biopsy detected cervical intraepithelial neoplasia (CIN) 2+ (CIN2, CIN3, and invasive cancer) in 38 (7%) of the women, whereas liquid-based cytology detected CIN2+ in 13 (2.5%) of the women. Forty-four (8.6%) women who were tested resulted positive for HPV; 20 (3.9%) women had HPV-16, 2 (0.4%) had HPV-18, and 22 (4.3%) had other high-risk HPV., Conclusions: Our study showed that few VIA-positive women had CIN2+ lesions or HPV infection. Colposcopy by Swede score identified significantly more CIN2+ lesions than liquid-based cytology and could offer a more accurate screening and selection for immediate treatment of cervical lesions in low-resource settings.
- Published
- 2014
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30. Agreement of colposcope and gynocular in assessment of cervical lesions by swede score: a randomized, crossover pilot trial.
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Ngonzi J, Bajunirwe F, Wistrand C, Mayanja R, Altman D, Thorsell M, and Wikström Shemer EA
- Subjects
- Adolescent, Adult, Cross-Over Studies, Female, Humans, Middle Aged, Pilot Projects, Young Adult, Colposcopy methods, Diagnostic Equipment, Uterine Cervical Neoplasms diagnosis
- Abstract
Objective: This study aimed to determine if criterion standard colposcopy could be provided by a pocket-sized battery-driven colposcope, the Gynocular., Materials and Methods: The study was a randomized, crossover, pilot clinical trial for evaluating agreement of diagnosis of cervical lesions by colposcopy using a standard colposcope and a pocket-sized battery-driven colposcope, the Gynocular, in 69 women positive for visual inspection with acetic acid. Swede scores were used at the time of colposcopy and compared with the final histological diagnosis after directed cervical biopsy. To test the level of agreement between the colposcopy and Gynocular, we calculated the percentage agreement and the κ statistic. We calculated the detection rates of cervical lesions of the Gynocular and a standard colposcope using biopsy results as criterion standards. All included patients also underwent a Pap smear., Results: The level of agreement of Swede score between the Gynocular and colposcope was 70.1% and the κ statistic was 0.65 (p < .001). Biopsy identified 4 women (6.7%) with cervical intraepithelial neoplasia 1 (CIN 1) and 1 woman (1.7%) with CIN 2; 2 women (3.4%) had CIN 3, and 2 women had invasive cervical cancer (CIN 3+). Pap smear detected 2 women (3.1%) with CIN 1 but did not identify any high-grade cervical lesion. Cervicitis was present in 17 (27.4%) of the Pap smears and in 34 (57.6%) of the biopsies., Conclusions: The study shows that in visual inspection with acetic acid-positive women, a battery-driven, pocket-sized colposcope has a significant level of agreement with stationary colposcopy in assessing cervical lesions.
- Published
- 2013
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31. Caesarean section and risk for endometriosis: a prospective cohort study of Swedish registries.
- Author
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Andolf E, Thorsell M, and Källén K
- Subjects
- Adult, Cesarean Section statistics & numerical data, Cicatrix epidemiology, Cicatrix etiology, Cohort Studies, Delivery, Obstetric, Endometriosis etiology, Female, Follow-Up Studies, Humans, Maternal Age, Parity, Pregnancy, Prospective Studies, Registries, Risk Factors, Smoking, Sweden epidemiology, Cesarean Section adverse effects, Cicatrix pathology, Endometriosis epidemiology
- Abstract
Objective: To investigate the association between caesarean section and later endometriosis., Design: A prospective cohort study., Setting: The Swedish Patient Register (PAR) and the Swedish Medical Birth Registry (MBR)., Sample: Women who were delivered in Sweden between 1986 and 2004., Methods: Women with the diagnosis of endometriosis, defined as codes 617 (International Classification of Diseases, ninth revision, ICD-9) or N80 (ICD-10), were retrieved from the PAR. Obstetric outcome was assessed through linkage with the MBR. Out of 709,090 women, 3110 were treated as inpatients with a first diagnosis of endometriosis after their first delivery. Women with a diagnosis of endometriosis before their first delivery were excluded. Cox analyses were performed to obtain hazard ratios for endometriosis and adjusted for maternal age at first delivery, body mass index, maternal smoking, and years of involuntary childlessness at study entry. Kaplan-Meier estimates were performed to calculate the risk according to time elapsed., Main Outcome: In-hospital diagnosis of endometriosis., Results: The Cox analyses yielded a hazard ratio of 1.8 (95% CI 1.7-1.9) for endometriosis in women who had had a previous caesarean section compared with women with vaginal deliveries only. The risk of endometriosis increased over time: one additional case of endometriosis was found for every 325 women undergoing caesarean section within 10 years. No increase in risk could be seen after two caesarean deliveries. The risk of caesarean scar endometrioma was 0.1%., Conclusion: In addition to the recognised risk of scar endometrioma, we found an association between caesarean section and general pelvic endometriosis. Further studies are needed to confirm our findings., (© 2013 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2013 RCOG.)
- Published
- 2013
- Full Text
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32. PP001. The vascular tree during pregnancy and at follow-up - A longitudinal study of maternal vascular function.
- Author
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Andolf E, Kahan T, Iacobaeus C, Jörneskog G, Thorsell M, and Bremme K
- Abstract
Introduction: Normal maternal vascular function and optimal cardiovascular adaptation to the increasing demands of pregnancy is a prerequisite for a successful outcome of pregnancy. How different levels of the vascular tree react and interact during pregnancy has not been fully investigated previously but may be determined by genetic as well as maternal, fetal and environmental factors., Objective: To investigate how different levels of vascular function change during the course of pregnancy and relate these levels to each other., Methods: Healthy non smoking women with singleton pregnancies and a viable embryo recorded at the ultrasound departments of UltraGyn Stockholm, Sweden were recruited. The following cardiovascular examinations were performed: examination of structural changes of the heart: Echocardiography of the heart with Doppler examination and tissue Doppler. Examination of macrocirculation, vessel structure and function plus endothelial function: Intima-media thickness of the common carotid artery, pulse wave velocity, central blood pressure and flow mediated vasodilation. Examination of microvascular function in the skin and endothelial function: total circulation of the skin and capillary flow in nails. The microcirculation before, during and after iontophoresis with nitroprussid and acetylcholine. The investigations were performed in gestational week 11-14, 22-24, 36 and 9 months post partum., Results: In total 35 participants had a normal course of pregnancy. Curves of the development of the various cardiovascular variables will be presented according to gestational age and their place in the vascular tree., Conclusions: These curves will be used to investigate how various determinants such as blood pressure, fetal growth and body mass index, as well as fetal sex affects and are affected by cardiovascular function in pregnancy., (Copyright © 2013. Published by Elsevier B.V.)
- Published
- 2013
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33. Risks of emergency cesarean section and fetal asphyxia after induction of labor in intrahepatic cholestasis of pregnancy: a hospital-based retrospective cohort study.
- Author
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Wikström Shemer EA, Thorsell M, Marschall HU, and Kaijser M
- Subjects
- Adult, Case-Control Studies, Cohort Studies, Female, Hospitals, Humans, Infant, Newborn, Pregnancy, Pregnancy Complications, Retrospective Studies, Risk Factors, Sweden, Asphyxia Neonatorum etiology, Cesarean Section, Cholestasis, Intrahepatic complications, Fetal Hypoxia etiology, Labor, Induced adverse effects, Obstetric Labor Complications, Postpartum Hemorrhage etiology
- Abstract
Objectives: Intrahepatic cholestasis of pregnancy (ICP) is the most common pregnancy liver-specific disease. Induction of labor in gestational weeks 37-39 is commonly performed with the perspective to avoid the complication of stillbirth. We aimed to study whether this practice increases the risks of emergency cesarean section (CS) and fetal asphyxia., Study Design: We assessed the risk of emergency CS and fetal asphyxia in ICP among women with spontaneous and induced onset of labor in comparison to women without ICP. We performed a hospital based retrospective cohort study with 25,870 singleton pregnancies, 333 with ICP (1.3%), of which 231 gave birth in weeks 37-39. Obstetric outcome was assessed through linkage of the Swedish Medical Birth Registry and a local obstetrical database based on the patient's medical files., Main Outcome Measure: Risk for emergency CS; fetal asphyxia and postpartum hemorrhage., Results: The risk of emergency CS in ICP with spontaneous onset of labor (12.5%) did not differ from non ICP women with spontaneous onset of labor (9.3%; aOR, 1.33; 95% CI 0.60-2.96). When labor was induced, risk of emergency CS was significantly lower among women with ICP than among without ICP (aOR, 0.47; 95% CI 0.26-0.86). Exclusion of women with preeclampsia, gestational hypertension or diabetes mellitus did not alter the result. The risk for fetal asphyxia was not significantly associated with ICP status., Conclusion: Induction of labor in women with ICP gestational weeks 37-39 did not increase the risks of emergency CS or fetal asphyxia., (Copyright © 2012 Elsevier B.V. All rights reserved.)
- Published
- 2013
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34. Induction of labor and the risk for emergency cesarean section in nulliparous and multiparous women.
- Author
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Thorsell M, Lyrenäs S, Andolf E, and Kaijser M
- Subjects
- Adult, Analysis of Variance, Body Mass Index, Cesarean Section methods, Cohort Studies, Confidence Intervals, Emergencies, Female, Gestational Age, Humans, Infant, Newborn, Labor, Induced adverse effects, Maternal Age, Multivariate Analysis, Odds Ratio, Pregnancy, Registries, Retrospective Studies, Risk Assessment, Sweden, Young Adult, Cesarean Section statistics & numerical data, Infant, Postmature, Labor, Induced methods, Parity, Pregnancy Outcome
- Abstract
Objective: To assess the risk for emergency cesarean section among women in whom labor was induced in gestational week ≥41 and to evaluate if parity and mode of induction affected this association., Design: Hospital-based retrospective cohort study., Population: Singleton pregnancies delivered after ≥41 gestational weeks at Danderyd Hospital, Stockholm, Sweden, during 2002-2006., Material and Methods: Of 23 030 singleton pregnancies meeting the entry criteria, 881 were induced with a Bishop score of <7. Obstetric outcome was assessed through linkage with the Swedish Medical Birth Registry and a local obstetrical database containing information from patients' medical files. Results were adjusted for body mass index, age and the use of epidural analgesia., Main Outcome Measure: Risk for emergency cesarean section., Results: Among women who were induced, the proportions delivered by emergency cesarean section were 42% for nulliparous and 14% for multiparous. Compared to spontaneous onset, this corresponded to a more than threefold increase in risk for nulliparous women (OR 3.34, 95%CI 2.77-4.04) and an almost twofold increase in risk for multiparous women (OR 1.94, 95%CI 1.24-3.02). There was no significant difference in risk for emergency cesarean section between the two methods of induction (PGE(2) and transcervical catheter)., Conclusions: Compared to spontaneous onset of delivery, induction of labor is associated with an increased risk for emergency cesarean section both among nulliparous and multiparous women. When labor is induced, the high risk for emergency cesarean must be kept in mind., (© 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2011 Nordic Federation of Societies of Obstetrics and Gynecology.)
- Published
- 2011
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35. Cesarean delivery and risk for postoperative adhesions and intestinal obstruction: a nested case-control study of the Swedish Medical Birth Registry.
- Author
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Andolf E, Thorsell M, and Källén K
- Subjects
- Adult, Case-Control Studies, Female, Humans, Odds Ratio, Parity, Pregnancy, Registries, Regression Analysis, Smoking adverse effects, Sweden, Cesarean Section adverse effects, Intestinal Obstruction etiology, Risk Assessment, Tissue Adhesions etiology
- Abstract
Objective: The objective of the study was to estimate the risk for postoperative adhesions and intestinal obstruction after cesarean delivery and to estimate whether the rate remains stable over time., Study Design: Women who had the aforementioned diagnoses in the Swedish Hospital Discharge Registry were linked to the Swedish Medical Birth Registry. Women with diagnoses increasing the risk for adhesions were excluded. More than 900,000 women were investigated. Risks were calculated and were adjusted for age, parity, body mass index, and smoking., Results: Women delivered by cesarean delivery had an increased risk of adhesions: adjusted odds ratio, 2.1 (95% confidence interval, 1.8-2.4) and intestinal obstruction: adjusted odds ratio, 2.0 (95% confidence interval, 1.7-2.4). The number needed to harm was 360. Multiple caesarean deliveries increased the risk of adhesions. The risk did not increase over time., Conclusion: The absolute risk of postoperative adhesions and intestinal obstruction after cesarean section are low but should be included when counseling women requesting cesarean delivery., (Copyright © 2010 Mosby, Inc. All rights reserved.)
- Published
- 2010
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36. Pain control after total knee arthroplasty: a prospective study comparing local infiltration anesthesia and epidural anesthesia.
- Author
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Thorsell M, Holst P, Hyldahl HC, and Weidenhielm L
- Subjects
- Aged, Female, Humans, Incidence, Male, Prospective Studies, Sweden epidemiology, Treatment Outcome, Anesthesia, Epidural, Anesthesia, Local, Arthralgia epidemiology, Arthralgia prevention & control, Arthroplasty, Replacement, Knee methods, Pain, Postoperative epidemiology, Pain, Postoperative prevention & control
- Abstract
Postoperative pain control after total knee arthroplasty (TKA) is a well-known clinical problem. Efforts to treat it with the use of local anesthesia have been made, but the results have been contradictive. In the late 1990s, an infiltrated solution of ropivacaine/ketorolac/adrenaline was shown to be effective for this purpose, and this technique has since spread over the world. The purpose of this study was to compare the local infiltration anesthesia technique with epidural anesthesia, which has been the most widely used technique in Sweden.Eighty-five patients received either local infiltration anesthesia or epidural anesthesia for postoperative pain relief. Postoperative morphine consumption, range of motion, walking ability, patient satisfaction, hospital stay, and time in the recovery room were measured. The groups were followed equally. The patients in the local infiltration anesthesia group were mobilized 24 hours earlier. On postoperative day one, 22 of 33 patients in the local infiltration anesthesia group could get in and out of bed without assistance. Only 1 of 31 patients in the epidural anesthesia group could manage this. On postoperative day two, 28 of 33 patients in the local infiltration anesthesia group could walk without assistance, compared to 5 of 31 in the epidural anesthesia group. Seventy-six percent of the local infiltration anesthesia patients were "very satisfied" with their postoperative pain control method, compared to 40% of the epidural anesthesia patients.The local infiltration anesthesia technique is better for postoperative pain relief in TKA than epidural anesthesia. It offers equal pain relief, faster mobilization, and more satisfied patients. No negative side effects were seen during the study., (Copyright 2010, SLACK Incorporated.)
- Published
- 2010
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37. Expected day of delivery from ultrasound dating versus last menstrual period--obstetric outcome when dates mismatch.
- Author
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Thorsell M, Kaijser M, Almström H, and Andolf E
- Subjects
- Cohort Studies, Female, Humans, Infant, Newborn, Pre-Eclampsia diagnostic imaging, Pregnancy, Pregnancy Outcome, Pregnancy Trimester, First, Retrospective Studies, Risk Assessment, Time Factors, Delivery, Obstetric statistics & numerical data, Fetal Growth Retardation diagnostic imaging, Infant, Small for Gestational Age, Menstruation physiology, Obstetric Labor, Premature diagnostic imaging, Ultrasonography, Prenatal methods
- Abstract
Objective: To analyse the association between fetal size at time of dating ultrasound and risk for preterm delivery and small-for-gestational-age (SGA) birth and to evaluate if timing of ultrasound, that is before 14 weeks of gestation or after 16 weeks affects this association., Design: Retrospective cohort study., Setting: Ultrasound departments of Ultragyn, Stockholm, Sweden., Population: A total of 28,776 singleton pregnancies dated between 1998 and 2004., Methods: Obstetric outcome was assessed through linkage of the cohort to the Swedish Medical Birth Register., Main Outcome Measures: Risks of preterm delivery, low birthweight for gestational age, pre-eclampsia, asphyxia, respiratory distress, instrumental delivery, caesarean section, and postterm birth were calculated for the groups dated early and late., Results: When the expected date of delivery was postponed after ultrasound dating by 7 days or more, there was an increased risk for preterm delivery and pre-eclampsia in the late dating group (OR 1.49, 95% CI 1.27-1.73 and OR 1.27, 95% CI 1.02-1.60, respectively) but not in the early dating group. In both dating groups, there was an increased risk for SGA birth (OR 1.77, 95% CI 1.13-2.78 and OR 2.09, 95% CI 1.59-2.73, respectively) There was no increased risk for any of the other diagnoses., Conclusion: Our study gives further support to the notion that intrauterine growth restriction may be present as early as the first trimester. Accordingly, our study also suggests that surveillance of pregnancies with postponed estimated date of delivery may provide means for increased detection of fetal growth restriction.
- Published
- 2008
- Full Text
- View/download PDF
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