1,559 results on '"I. Johansson"'
Search Results
2. Lipidomic signatures align with inflammatory patterns and outcomes in critical illness
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Junru Wu, Anthony Cyr, Danielle S. Gruen, Tyler C. Lovelace, Panayiotis V. Benos, Jishnu Das, Upendra K. Kar, Tianmeng Chen, Francis X. Guyette, Mark H. Yazer, Brian J. Daley, Richard S. Miller, Brian G. Harbrecht, Jeffrey A. Claridge, Herb A. Phelan, Brian S. Zuckerbraun, Matthew D. Neal, Pär I. Johansson, Jakob Stensballe, Rami A. Namas, Yoram Vodovotz, Jason L. Sperry, Timothy R. Billiar, and PAMPer study group
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Science - Abstract
Alterations in lipid metabolism and circulating lipid species have been reported in patients with acute critical illness. Here the authors show that selective rise in systemic phosphatidylethanolamine levels is a common feature of critical illness that associates with worse clinical outcomes.
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- 2022
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3. An explorative metabolomic analysis of the endothelium in pulmonary hypertension
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J. Carlsen, H. H. Henriksen, I. Marin de Mas, and P. I. Johansson
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Medicine ,Science - Abstract
Abstract Pulmonary hypertension (PH) is classified into five clinical diagnostic groups, including group 1 [idiopathic pulmonary arterial hypertension (IPAH) and connective tissue disease-associated PAH (CTD-aPAH)] and group 4 (chronic thromboembolic pulmonary hypertension (CTEPH)). PH is a progressive, life-threatening, incurable disease. The pathological mechanisms underlying PH remain elusive; recent evidence has revealed that abnormal metabolic activities in the endothelium may play a crucial role. This research introduces a novel approach for studying PH endothelial function, building on the genome-scale metabolic reconstruction of the endothelial cell (EC) to investigate intracellular metabolism. We demonstrate that the intracellular metabolic activities of ECs in PH patients cluster into four phenotypes independent of the PH diagnosis. Notably, the disease severity differs significantly between the metabolic phenotypes, suggesting their clinical relevance. The significant metabolic differences between the PH phenotypes indicate that they may require different therapeutic interventions. In addition, diagnostic capabilities enabling their identification is warranted to investigate whether this opens a novel avenue of precision medicine.
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- 2022
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4. Endotheliopathy is associated with slower liberation from mechanical ventilation: a cohort study
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Martin Schønemann-Lund, Theis S. Itenov, Johan E. Larsson, Birgitte Lindegaard, Pär I. Johansson, and Morten H. Bestle
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Platelet Endothelial Cell Adhesion Molecule-1 ,Syndecan-1 ,Thrombomodulin ,Respiratory insufficiency/physiopathology ,Endothelium ,Vascular ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Endotheliopathy is suggested as pivotal pathophysiology of sepsis and trauma-associated organ failure, but its role in acute respiratory failure is not yet determined. We investigated if endotheliopathy biomarkers at ICU admission are associated with illness severity and clinical outcomes in patients with acute respiratory failure requiring mechanical ventilation. Methods We conducted a prospective single-center cohort study including 459 mechanically ventilated adults at ICU admission. Plasma levels of three endotheliopathy biomarkers were measured at ICU admission: Syndecan-1, soluble Thrombomodulin (sTM), and Platelet Endothelial Cell Adhesion Molecule-1 (PECAM-1). The primary outcome was the rate of liberation from mechanical ventilation, which is presented together with the rate of the competing risk of death while still on mechanical ventilation. Secondary outcomes were PaO2/FiO2-ratios on admission and on last measurement in patients dying within five days, and 30-day all-cause mortality. The primary outcome and 30-day all-cause mortality were analyzed using Cox regression, controlled for gender, age, chronic obstructive pulmonary disease, septic shock, heart failure, PaO2/FiO2-ratio at admission, respiratory infection, acute kidney injury, and bilirubin. PaO2/FiO2-ratios were analyzed using linear regression, controlled for age, chronic obstructive pulmonary disease, respiratory infection, and shock. Results Patients with high sTM were liberated from mechanical ventilation at a lower rate (adjusted hazard ratio (HR) 0.71, for an increase from the 25th to the 75th percentile, 95% confidence interval (CI) 0.54–0.93, p = 0.01). Patients with high PECAM-1 were liberated from mechanical ventilation at a lower rate, but only during the first 5 days (adjusted HR 0.72, for an increase from the 25th to the 75th percentile, 95% CI 0.58–0.9, p
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- 2022
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5. A Protocol for the Automatic Construction of Highly Curated Genome-Scale Models of Human Metabolism
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Igor Marin de Mas, Helena Herand, Jorge Carrasco, Lars K. Nielsen, and Pär I. Johansson
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genome-scale metabolic model ,human metabolism ,model construction ,constraints-based modeling ,Technology ,Biology (General) ,QH301-705.5 - Abstract
Genome-scale metabolic models (GEMs) have emerged as a tool to understand human metabolism from a holistic perspective with high relevance in the study of many diseases and in the metabolic engineering of human cell lines. GEM building relies on either automated processes that lack manual refinement and result in inaccurate models or manual curation, which is a time-consuming process that limits the continuous update of reliable GEMs. Here, we present a novel algorithm-aided protocol that overcomes these limitations and facilitates the continuous updating of highly curated GEMs. The algorithm enables the automatic curation and/or expansion of existing GEMs or generates a highly curated metabolic network based on current information retrieved from multiple databases in real time. This tool was applied to the latest reconstruction of human metabolism (Human1), generating a series of the human GEMs that improve and expand the reference model and generating the most extensive and comprehensive general reconstruction of human metabolism to date. The tool presented here goes beyond the current state of the art and paves the way for the automatic reconstruction of a highly curated, up-to-date GEM with high potential in computational biology as well as in multiple fields of biological science where metabolism is relevant.
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- 2023
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6. ABO blood types and sepsis mortality
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Theis S. Itenov, Daniel I. Sessler, Ashish K. Khanna, Sisse R. Ostrowski, Pär I. Johansson, Christian Erikstrup, Ole B. Pedersen, Sofie L. Rygård, Lars B. Holst, Morten H. Bestle, Lars Hein, Anne Lindhardt, Hami Tousi, Mads H. Andersen, Thomas Mohr, Jens D. Lundgren, and Jens-Ulrik Jensen
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Anaesthesia ,Blood type ,Mortality ,Sepsis ,Septic shock ,Intensive care ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background We aimed to determine if the ABO blood types carry different risks of 30-day mortality, acute kidney injury (AKI), and endothelial damage in critically ill patients with sepsis. This was a retrospective cohort study of three independent cohorts of critically ill patients from the United States and Scandinavia consisting of adults with septic shock. We compared the 30-day mortality across the blood types within each cohort and pooled the results in a meta-analysis. We also estimated the incidence of AKI and degree of endothelial damage, as measured by blood concentrations of soluble thrombomodulin and syndecan-1. Results We included 12,342 patients with severe sepsis. In a pooled analysis blood type B carried a slightly lower risk of 30-day all-cause mortality compared to non-blood type B (adjusted HR 0.88; 95%-CI 0.79–0.98; p = 0.02). There was no difference in the risk of AKI. Soluble thrombomodulin and syndecan-1 concentrations were lower in patients with blood type B and O compared to blood type A, suggesting less endothelial damage. Conclusion Septic patients with blood type B had less endothelial damage, and a small reduction in mortality. The exposure is, however, unmodifiable.
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- 2021
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7. Endothelial Cell Phenotypes Demonstrate Different Metabolic Patterns and Predict Mortality in Trauma Patients
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Hanne H. Henriksen, Igor Marín de Mas, Lars K. Nielsen, Joseph Krocker, Jakob Stensballe, Sigurður T. Karvelsson, Niels H. Secher, Óttar Rolfsson, Charles E. Wade, and Pär I. Johansson
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trauma ,metabolomics ,endotheliopathy ,systems biology ,genome-scale metabolic model ,tricarboxylic acid cycle ,Biology (General) ,QH301-705.5 ,Chemistry ,QD1-999 - Abstract
In trauma patients, shock-induced endotheliopathy (SHINE) is associated with a poor prognosis. We have previously identified four metabolic phenotypes in a small cohort of trauma patients (N = 20) and displayed the intracellular metabolic profile of the endothelial cell by integrating quantified plasma metabolomic profiles into a genome-scale metabolic model (iEC-GEM). A retrospective observational study of 99 trauma patients admitted to a Level 1 Trauma Center. Mass spectrometry was conducted on admission samples of plasma metabolites. Quantified metabolites were analyzed by computational network analysis of the iEC-GEM. Four plasma metabolic phenotypes (A–D) were identified, of which phenotype D was associated with an increased injury severity score (p < 0.001); 90% (91.6%) of the patients who died within 72 h possessed this phenotype. The inferred EC metabolic patterns were found to be different between phenotype A and D. Phenotype D was unable to maintain adequate redox homeostasis. We confirm that trauma patients presented four metabolic phenotypes at admission. Phenotype D was associated with increased mortality. Different EC metabolic patterns were identified between phenotypes A and D, and the inability to maintain adequate redox balance may be linked to the high mortality.
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- 2023
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8. Shock-Driven Endotheliopathy in Trauma Patients Is Associated with Leucocyte Derived Extracellular Vesicles
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Romein W. G. Dujardin, Jeske E. C. Kisters, Mathijs R. Wirtz, Najat Hajji, Anita M. Tuip-de Boer, Jakob Stensballe, Pär I. Johansson, Karim Brohi, Ross A. Davenport, Christine Gaarder, Simon Stanworth, Marc Maegele, Rienk Nieuwland, Edwin van der Pol, and Nicole P. Juffermans
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endotheliopathy ,extracellular vesicles ,shock ,trauma ,Biology (General) ,QH301-705.5 ,Chemistry ,QD1-999 - Abstract
Endotheliopathy following trauma is associated with poor outcome, but the underlying mechanisms are unknown. This study hypothesized that an increased extracellular vesicle (EV) concentration is associated with endotheliopathy after trauma and that red blood cell (RBC) transfusion could further enhance endotheliopathy. In this post hoc sub study of a multicentre observational trial, 75 trauma patients were stratified into three groups based on injury severity score or shock. In patient plasma obtained at hospital admission and after transfusion of four RBC transfusions, markers for endotheliopathy were measured and EVs were labelled with anti CD41 (platelet EVs), anti CD235a (red blood cell EVs), anti CD45 (leucocyte EVs), anti CD144 (endothelial EVs) or anti CD62e (activated endothelial EVs) and EV concentrations were measured with flow cytometry. Statistical analysis was performed by a Kruskall Wallis test with Bonferroni correction or Wilcoxon rank test for paired data. In patients with shock, syndecan-1 and von Willebrand Factor (vWF) were increased compared to patients without shock. Additionally, patients with shock had increased red blood cell EV and leucocyte EV concentrations compared to patients without shock. Endotheliopathy markers correlated with leucocyte EVs (ρ = 0.263, p = 0.023), but not with EVs derived from other cells. Injury severity score had no relation with EV release. RBC transfusion increased circulating red blood cell EVs but did not impact endotheliopathy. In conclusion, shock is (weakly) associated with EVs from leucocytes, suggesting an immune driven pathway mediated (at least in part) by shock.
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- 2022
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9. Sex-specific mortality prediction by pro-C-type natriuretic peptide measurement in a prospective cohort of patients with ST-elevation myocardial infarction
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Jacob Eifer Moller, Pär I Johansson, Lene Holmvang, Ole Kristian Lerche Helgestad, Peter D Mark, Martin Frydland, Sisse R Ostrowski, Timothy Prickett, and Jens Peter Goetze
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Medicine - Published
- 2021
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10. Impact on Health-Related quality of life after wearing compression garment or not for six months in women with mild breast cancer-related arm lymphedema. A cross-sectional study
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Katarina Y. Blom, Karin I. Johansson, Lena B. Nilsson-Wikmar, Pia E. Klernäs, and Christina B. Brogårdh
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Oncology ,Radiology, Nuclear Medicine and imaging ,Hematology ,General Medicine - Published
- 2023
11. Exploratory Investigation of the Plasma Proteome Associated with the Endotheliopathy of Trauma
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Joseph D. Krocker, Kyung Hyun Lee, Hanne H. Henriksen, Yao-Wei Willa Wang, Erwin M. Schoof, Sigurdur T. Karvelsson, Óttar Rolfsson, Pär I. Johansson, Claudia Pedroza, and Charles E. Wade
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proteomics ,trauma ,syndecan-1 ,soluble thrombomodulin ,endothelium ,inflammation ,Biology (General) ,QH301-705.5 ,Chemistry ,QD1-999 - Abstract
Background: The endotheliopathy of trauma (EoT) is associated with increased mortality following injury. Herein, we describe the plasma proteome related to EoT in order to provide insight into the role of the endothelium within the systemic response to trauma. Methods: 99 subjects requiring the highest level of trauma activation were included in the study. Enzyme-linked immunosorbent assays of endothelial and catecholamine biomarkers were performed on admission plasma samples, as well as untargeted proteome quantification utilizing high-performance liquid chromatography and tandem mass spectrometry. Results: Plasma endothelial and catecholamine biomarker abundance was elevated in EoT. Patients with EoT (n = 62) had an increased incidence of death within 24 h at 21% compared to 3% for non-EoT (n = 37). Proteomic analysis revealed that 52 out of 290 proteins were differentially expressed between the EoT and non-EoT groups. These proteins are involved in endothelial activation, coagulation, inflammation, and oxidative stress, and include known damage-associated molecular patterns (DAMPs) and intracellular proteins specific to several organs. Conclusions: We report a proteomic profile of EoT suggestive of a surge of DAMPs and inflammation driving nonspecific activation of the endothelial, coagulation, and complement systems with subsequent end-organ damage and poor clinical outcome. These findings support the utility of EoT as an index of cellular injury and delineate protein candidates for therapeutic intervention.
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- 2022
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12. Plasma mitochondrial DNA and metabolomic alterations in severe critical illness
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Pär I. Johansson, Kiichi Nakahira, Angela J. Rogers, Michael J. McGeachie, Rebecca M. Baron, Laura E. Fredenburgh, John Harrington, Augustine M. K. Choi, and Kenneth B. Christopher
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Mitochondrial DNA ,Metabolite ,Metabolomics ,Homeostasis ,Critical illness ,Acylcarnitine ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Cell-free plasma mitochondrial DNA (mtDNA) levels are associated with endothelial dysfunction and differential outcomes in critical illness. A substantial alteration in metabolic homeostasis is commonly observed in severe critical illness. We hypothesized that metabolic profiles significantly differ between critically ill patients relative to their level of plasma mtDNA. Methods We performed a metabolomic study with biorepository plasma samples collected from 73 adults with systemic inflammatory response syndrome or sepsis at a single academic medical center. Patients were treated in a 20-bed medical ICU between 2008 and 2010. To identify key metabolites and metabolic pathways related to plasma NADH dehydrogenase 1 (ND1) mtDNA levels in critical illness, we first generated metabolomic data using gas and liquid chromatography-mass spectroscopy. We performed fold change analysis and volcano plot visualization based on false discovery rate-adjusted p values to evaluate the distribution of individual metabolite concentrations relative to ND1 mtDNA levels. We followed this by performing orthogonal partial least squares discriminant analysis to identify individual metabolites that discriminated ND1 mtDNA groups. We then interrogated the entire metabolomic profile using pathway overrepresentation analysis to identify groups of metabolite pathways that were different relative to ND1 mtDNA levels. Results Metabolomic profiles significantly differed in critically ill patients with ND1 mtDNA levels ≥ 3200 copies/μl plasma relative to those with an ND1 mtDNA level
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- 2018
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13. Traumatic brain injury is associated with increased syndecan-1 shedding in severely injured patients
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Erika Gonzalez Rodriguez, Jessica C. Cardenas, Charles S. Cox, Ryan S. Kitagawa, Jakob Stensballe, John B. Holcomb, Pär I. Johansson, and Charles E. Wade
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Endothelium ,Syndecan-1 ,Traumatic endotheliopathy ,Sympathoadrenal activation ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Introduction Head injury and exsanguination are the leading causes of death in trauma patients. Hemorrhagic shock triggers systemic endothelial glycocalyx breakdown, potentially leading to traumatic endotheliopathy (EoT). Levels of syndecan-1, a main glycocalyx component, have been used to assess the integrity of the glycocalyx. In TBI patients, it remains unclear whether syndecan-1 shedding occurs and its correlation with outcomes. We aimed to determine the frequency of EoT+, defined as a syndecan-1 level of 40 ng/ml or higher, after TBI in isolated and polytraumatic injury. We also investigated how the presence of EoT+ affected outcomes in TBI patients. Methods Severely injured trauma patients were enrolled. From blood samples collected upon patients’ arrival to the hospital, we measured syndecan-1 (main biomarker of EoT+), soluble thrombomodulin (sTM, endothelial activation) adrenaline and noradrenaline (sympathoadrenal activation), and assessed TBI patients’ coagulation capacity. Results Of the enrolled patients (n = 331), those with TBI and polytrauma (n = 68) had the highest rate of EoT+ compared to isolated TBI (n = 58) and Non-TBI patients (n = 205) (Polytrauma-TBI 55.9% vs. Isolated-TBI 20.0% vs. non-TBI polytrauma 40.0%; p = 0.001). TBI patients with EoT+ exhibited marked increases in sTM, adrenaline and noradrenaline levels, and physiological and coagulation derangements. In isolated TBI patients, increasing syndecan-1 levels (β for every 10 ng/ml increase: 0.14; 95% CI: 0.02, 0.26) and hypocoagulability were negatively associated with survival. Conclusions This study provides evidence of syndecan-1 shedding after TBI supporting the notion that breakdown of the glycocalyx contributes to the physiological derangements after TBI.
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- 2018
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14. High-dimensional proteomics identifies organ injury patterns associated with outcomes in human trauma
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Shimena R. Li, Hamed Moheimani, Brachman Herzig, Michael Kail, Neha Krishnamoorthi, Junru Wu, Sultan Abdelhamid, Jacob Scioscia, Eunseo Sung, Anna Rosengart, Jillian Bonaroti, Par I. Johansson, Jakob Stensballe, Matthew D. Neal, Jishnu Das, Upendra Kar, Jason Sperry, and Timothy R. Billiar
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Surgery ,Critical Care and Intensive Care Medicine - Published
- 2023
15. Thrombelastographic hypercoagulability and antiplatelet therapy after coronary artery bypass surgery (TEG-CABG trial): a randomized controlled trial
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Sulman Rafiq, Pär I. Johansson, Klaus F. Kofoed, Jens T. Lund, Peter S. Olsen, Simon Bentsen, and Daniel A. Steinbrüchel
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cabg ,coronary artery bypass surgery ,dual antiplatelet therapy ,hypercoagulable ,multiplate aggregometry ,teg ,Diseases of the blood and blood-forming organs ,RC633-647.5 - Abstract
A hypercoagulable state has, in observational studies, been associated with increased risk of thromboembolic events. The aim of this trial was to study whether dual antiplatelet therapy (DAPT) with clopidogrel in addition to aspirin could reduce the rate of graft occlusions, thromboembolic events, and death compared to aspirin monotherapy in hypercoagulable patients undergoing coronary artery bypass surgery. A total of 1683 patients were screened for eligibility, among which 165 patients were randomized and 133 patients underwent multislice computed tomography scan to evaluate their grafts. Thrombelastography (TEG) and multiplate aggregometry were performed before and after surgery, and again at three months follow up. TEG hypercoagulability was defined as the maximum amplitude above 69 mm. At three months follow up, 17 out of 66 (25.7%) DAPT patients and 15 of 67 (22.4%) aspirin patients had significant graft stenosis or occlusions (p = 0.839). Saphenous vein grafts (SVGs) were stenosed or occluded in 15 (22.7%) patients in the DAPT group and 7 (10.4%) in the aspirin group (p = 0.167). Thromboembolic events and death after the second postoperative day (when clopidogrel was started) were numerically, but not statistically, lower in the DAPT group, 3 (3.8%) vs. 8 (9.9%), p = 0.211. In univariate logistic regression analysis, only postoperative day 4 platelet response to aspirin measured with multiplate was correlated with graft occlusion, OR 1.020 [1.002–1.039], p = 0.033. This is the first trial to test the hypothesis of intensified antiplatelet therapy in hypercoagulable patients. Due to the low enrollment and high loss to follow up, our results can only be viewed as hypothesis generating. We found a high rate of graft occlusions in this patient population. Our results were not suggestive of that DAPT improved saphenous vein graft patency. A trend was observed in patients on DAPT toward fewer MI and deaths. Postoperative response to aspirin therapy was found to be associated with early SVG occlusion.
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- 2017
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16. Impact of high-dose glucocorticoid on endothelial damage after liver resection – a double-blinded randomized substudy
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Sandra E L T Pitter, Kristin J Steinthorsdottir, Pär I Johansson, Peter Nørgaard, Nicolai Schultz, Henrik Kehlet, and Eske K Aasvang
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Hepatology ,Gastroenterology - Published
- 2022
17. Thrombelastography (TEG® 6s) early amplitudes predict maximum amplitude in severely injured trauma patients
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Martin Vigstedt, Kjersti Baksaas-Aasen, Hanne H. Henriksen, Marc Maegele, Simon Stanworth, Nicole P. Juffermans, Knut M. Kolstadbråten, Pål A. Naess, Karim Brohi, Christine Gaarder, Jakob Stensballe, Pär I. Johansson, Intensive Care Medicine, and AII - Inflammatory diseases
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trauma ,thrombelastography ,Clinical Biochemistry ,hemostasis ,shock ,General Medicine ,Blood coagulation - Abstract
Severely injured trauma patients are often coagulopathic and early hemostatic resuscitation is essential. Previous studies have revealed linear relationships between thrombelastography (TEG®) five- and ten-min amplitudes (A5 and A10), and maximum amplitude (MA), using TEG® 5000 technology. We aimed to investigate the performance of A5 and A10 in predicting low MA in severely injured trauma patients and identify optimal cut-off values for hemostatic intervention based on early amplitudes, using the cartridge-based TEG® 6s technology. Adult trauma patients with hemorrhagic shock were included in the iTACTIC randomized controlled trial at six European Level I trauma centers between 2016 and 2018. After admission, patients were randomized to hemostatic therapy guided by conventional coagulation tests (CCT) or viscoelastic hemostatic assays (VHA). Patients with available admission-TEG® 6s data were included in the analysis, regardless of treatment allocation. Low MA was defined as
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- 2022
18. Prehospital tranexamic acid is associated with a dose-dependent decrease in syndecan-1 after trauma: A secondary analysis of a prospective randomized trial
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Danielle S Gruen, Joshua B Brown, Francis X. Guyette, Pär I. Johansson, Jakob Stensballe, Shimena R. Li, Christine M. Leeper, Brian J. Eastridge, Raminder Nirula, Gary A. Vercruysse, Terence O’Keeffe, Bellal Joseph, Matthew D. Neal, and Jason L. Sperry
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Surgery ,Critical Care and Intensive Care Medicine - Published
- 2023
19. iTACTIC – implementing Treatment Algorithms for the Correction of Trauma-Induced Coagulopathy: study protocol for a multicentre, randomised controlled trial
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Kjersti Baksaas-Aasen, Lewis Gall, Simon Eaglestone, Claire Rourke, Nicole. P. Juffermans, J. Carel Goslings, Paal Aksel Naess, Susan van Dieren, Sisse Rye Ostrowski, Jakob Stensballe, Marc Maegele, Simon J. Stanworth, Christine Gaarder, Karim Brohi, and Per I. Johansson
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Trauma ,Haemorrhage ,Trauma-induced coagulopathy ,Viscoelastic haemostatic assays ,Randomised control trial ,Conventional coagulation tests ,Medicine (General) ,R5-920 - Abstract
Abstract Background Traumatic injury is the fourth leading cause of death globally. Half of all trauma deaths are due to bleeding and most of these will occur within 6 h of injury. Haemorrhagic shock following injury has been shown to induce a clotting dysfunction within minutes, and this early trauma-induced coagulopathy (TIC) may exacerbate bleeding and is associated with higher mortality and morbidity. In spite of improved resuscitation strategies over the last decade, current transfusion therapy still fails to correct TIC during ongoing haemorrhage and evidence for the optimal management of bleeding trauma patients is lacking. Recent publications describe increasing the use of Viscoelastic Haemostatic Assays (VHAs) in trauma haemorrhage; however, there is insufficient evidence to support their superiority to conventional coagulation tests (CCTs). Methods/design This multicentre, randomised controlled study will compare the haemostatic effect of an evidence-based VHA-guided versus an optimised CCT-guided transfusion algorithm in haemorrhaging trauma patients. A total of 392 adult trauma patients will be enrolled at major trauma centres. Participants will be eligible if they present with clinical signs of haemorrhagic shock, activate the local massive haemorrhage protocol and initiate first blood transfusion. Enrolled patients will be block randomised per centre to either VHA-guided or CCT-guided transfusion therapy in addition to that therapy delivered as part of standard care, until haemostasis is achieved. Patients will be followed until discharge or 28 days. The primary endpoint is the proportion of subjects alive and free of massive transfusion (less than 10 units of red blood cells) at 24 h. Secondary outcomes include the effect of CCT- versus VHA-guided therapy on organ failure, total hospital and intensive care lengths of stay, health care resources needed and mortality. Surviving patients will be asked to complete a quality of life questionnaire (EuroQol EQ-5DTM) at day 90. Discussion CCTs have traditionally been used to detect TIC and monitor response to treatment in traumatic major haemorrhage. The use of VHAs is increasing, but limited evidence exists to support the superiority of these technologies (or comparatively) for patient-centred outcomes. This knowledge gap will be addressed by this trial. Trial registration ClinicalTrials.gov, ID: NCT02593877 . Registered on 15 October 2015. Trial sponsor Queen Mary University of London The contact person of the above sponsor organisation is: Dr. Sally Burtles, Director of Research Services and Business Development, Joint Research Management Office, QM Innovation Building, 5 Walden Street, London E1 2EF; phone: 020 7882 7260; Email: sponsorsrep@bartshealth.nhs.uk Trial sites Academic Medical Centre, Amsterdam, The Netherlands Kliniken der Stadt Köln gGmbH, Cologne, Germany Rigshospitalet (Copenhagen University Hospital), Copenhagen, Denmark John Radcliff Hospital, Oxford, United Kingdom Oslo University Hospital, Oslo, Norway The Royal London Hospital, London, United Kingdom Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, United Kingdom Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom Sites that are planning to start recruitment in mid/late 2017 Nottingham University Hospitals, Queen’s Medical Centre, Nottingham, United Kingdom University of Kansas Hospital (UKH), Kansas City, MO, USA Protocol version: 3.0/14.03.2017 (Additional file 1)
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- 2017
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20. The use of viscoelastic haemostatic assays in goal-directing treatment with allogeneic blood products – A systematic review and meta-analysis
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Mathilde Fahrendorff, Roberto S. Oliveri, and Pär I. Johansson
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Bleeding ,Mortality ,ROTEM ,TEG ,Thrombelastography ,Thrombelastometry ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Management of the critically bleeding patient can be encountered in many medical and surgical settings. Common for these patients is a high risk of dying from exsanguination secondary to developing coagulopathy. The purpose of this meta-analysis was to systematically review and assess randomised controlled trials (RCTs) performed on patients in acute need for blood transfusions due to bleeding to evaluate the effect of viscoelastic haemostatic assay (VHA) guidance on bleeding, transfusion requirements and mortality. Methods PubMed and EMBASE were searched for RCTs that 1) randomised patients into receiving transfusions based on either a VHA-guided (thromboelastography [TEG] or rotational thromboelastometry [ROTEM]) algorithm (intervention group) or at the clinician’s discretion and/or based on conventional coagulation tests (control group) and 2) adequately reported on the outcomes bleeding and/or transfusions and/or mortality. Data on bleeding, transfusions and mortality were extracted from each trial and included in a meta-analysis. Results Fifteen RCTs (n = 1238 patients) were included. Nine trials referred to cardiothoracic patients, one to liver transplantation, one to surgical excision of burn wounds and one to trauma. One trial was conducted with cirrhotic patients, one with patients undergoing scoliosis surgery while one trial randomised treatment in post-partum females presenting with bleeding. The amount of transfused red blood cells (RBCs), fresh frozen plasma (FFP) and bleeding volume was found to be significantly reduced in the VHA-guided groups, whereas no significant difference was found for platelet transfusion requirements or mortality.
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- 2017
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21. DBDS Genomic Cohort, a prospective and comprehensive resource for integrative and temporal analysis of genetic, environmental and lifestyle factors affecting health of blood donors
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David Westergaard, Piotr Jaroslaw Chmura, Kaspar Nielsen, Lise Thørner, Henrik Hjalgrim, Helene Paarup, Margit Anita Hørup Larsen, Mikkel Petersen, Poul Jennum, Steffen Andersen, Mette Nyegaard, Gregor Borut Ernst Jemec, Thomas Werge, Pär I Johansson, Erik Sørensen, and Kristoffer Sølvsten Burgdorf
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Medicine - Abstract
PurposeTo establish a cohort that enables identification of genomic factors that influence human health and empower increased blood donor health and safe blood transfusions. Human health is complex and involves several factors, a major one being the genomic aspect. The genomic era has resulted in many consortia encompassing large samples sizes, which has proven successful for identifying genetic factors associated with specific traits. However, it remains a big challenge to establish large cohorts that facilitate studies of the interaction between genetic factors, environmental and life-style factors as these change over the course of life. A major obstacle to such endeavours is that it is difficult to revisit participants to retrieve additional information and obtain longitudinal, consecutive measurements.ParticipantsBlood donors (n=110 000) have given consent to participate in the Danish Blood Donor Study. The study uses the infrastructure of the Danish blood banks.Findings to dateThe cohort comprises extensive phenotype data and whole genome genotyping data. Further, it is possible to retrieve additional phenotype data from national registries as well as from the donors at future visits, including consecutive measurements.Future plansTo provide new knowledge on factors influencing our health and thus provide a platform for studying the influence of genomic factors on human health, in particular the interaction between environmental and genetic factors.
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- 2019
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22. Perioperative management of patients declining transfusions of blood components—National survey of anaesthesiologists, abdominal surgeons and obstetricians in Denmark
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Kristian R. Jauho, Kamilla Skovmand, Pernille Cedergreen, Pär I. Johansson, and Kim Wildgaard
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Anesthesiology and Pain Medicine ,General Medicine - Published
- 2023
23. Hepcidin and Erythroferrone Complement the Athlete Biological Passport in the Detection of Autologous Blood Transfusion
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ANDREAS BREENFELDT ANDERSEN, JACOB BEJDER, THOMAS C. BONNE, HENRIK SØRENSEN, HELLE SØRENSEN, GRACE JUNG, TOMAS GANZ, ELIZABETA NEMETH, NIELS H. SECHER, PÄR I. JOHANSSON, and NIKOLAI BAASTRUP NORDSBORG
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Male ,Erythrocytes ,Transfusion ,Hepcidin ,Physical Therapy, Sports Therapy and Rehabilitation ,Complement System Proteins ,Biomarker ,Micro-dosing ,Athlete Biological Passport ,Blood Transfusion, Autologous ,Hepcidins ,Athletes ,Faculty of Science ,Humans ,Female ,Orthopedics and Sports Medicine ,Sex-specific ,Biomarkers ,Anti-doping ,Erythroferrone - Abstract
Purpose: We investigated whether hepcidin and erythroferrone (ERFE) could complement the Athlete Biological Passport (ABP) in indirectly detecting a 130 mL packed red blood cells (RBCs) autologous blood transfusion. Endurance performance was evaluated.Methods: Forty-eight healthy men (n = 24) and women (n = 24) participated. Baseline samples were collected weekly followed by randomization to a blood transfusion (BT, n = 24) or control group (CON, n = 24). Only the BT group donated 450 mL whole blood from which 130 mL RBCs was reinfused four weeks later. Blood samples were collected 3, 7, 14, 21 and 28 days after donation, and 3, 6, and 24 hours and 2, 3, and 6 days following reinfusion. In the CON group samples were collected with the same frequency. Endurance performance was evaluated by a 650-kCal time trial (n = 13) before and one and six days after reinfusion.Results: A time×treatment effect existed (P < 0.05) for hepcidin and ERFE. Hepcidin was increased (P < 0.01) ~110 and 89% six and 24 hours after reinfusion. Using an individual approach (99% specificity, e.g. allowing 1:100 false-positive), sensitivities, i.e. true positives, of 30% and 61% was found for hepcidin and ERFE, respectively. For the ABP, the most sensitive marker was Off-hr score ([Hb] (g·L-1) - 60 × √RET%) (P < 0.05) with a maximal sensitivity of ~58% and ~ 9% following donation and reinfusion, respectively. Combining the findings for hepcidin, ERFE and the ABP yielded a sensitivity across all time-points of 83% following reinfusion in BT. Endurance performance increased 24 hours (+6.4%, P < 0.01) and six days following reinfusion (+5.8%, P < 0.01).Conclusions: Hepcidin and ERFE may serve as biomarkers in an anti-doping context following an ergogenic, small-volume blood transfusion.
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- 2022
24. Formate overflow drives toxic folate trapping in MTHFD1 inhibited cancer cells
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Alanna C. Green, Petra Marttila, Nicole Kiweler, Christina Chalkiadaki, Elisée Wiita, Victoria Cookson, Antoine Lesur, Kim Eiden, François Bernardin, Karl S. A. Vallin, Sanjay Borhade, Maeve Long, Elahe Kamali Ghahe, Julio J. Jiménez-Alonso, Ann-Sofie Jemth, Olga Loseva, Oliver Mortusewicz, Marianne Meyers, Elodie Viry, Annika I. Johansson, Ondřej Hodek, Evert Homan, Nadilly Bonagas, Louise Ramos, Lars Sandberg, Morten Frödin, Etienne Moussay, Ana Slipicevic, Elisabeth Letellier, Jérôme Paggetti, Claus Storgaard Sørensen, Thomas Helleday, Martin Henriksson, and Johannes Meiser
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Cancer och onkologi ,Cellbiologi ,Physiology (medical) ,Endocrinology, Diabetes and Metabolism ,Cancer and Oncology ,Internal Medicine ,Cell Biology ,Cell and Molecular Biology - Abstract
Cancer cells fuel their increased need for nucleotide supply by upregulating one-carbon (1C) metabolism, including the enzymes methylenetetrahydrofolate dehydrogenase-cyclohydrolase 1 and 2 (MTHFD1 and MTHFD2). TH9619 is a potent inhibitor of dehydrogenase and cyclohydrolase activities in both MTHFD1 and MTHFD2, and selectively kills cancer cells. Here, we reveal that, in cells, TH9619 targets nuclear MTHFD2 but does not inhibit mitochondrial MTHFD2. Hence, overflow of formate from mitochondria continues in the presence of TH9619. TH9619 inhibits the activity of MTHFD1 occurring downstream of mitochondrial formate release, leading to the accumulation of 10-formyl-tetrahydrofolate, which we term a 'folate trap'. This results in thymidylate depletion and death of MTHFD2-expressing cancer cells. This previously uncharacterized folate trapping mechanism is exacerbated by physiological hypoxanthine levels that block the de novo purine synthesis pathway, and additionally prevent 10-formyl-tetrahydrofolate consumption for purine synthesis. The folate trapping mechanism described here for TH9619 differs from other MTHFD1/2 inhibitors and antifolates. Thus, our findings uncover an approach to attack cancer and reveal a regulatory mechanism in 1C metabolism.In this study, Green, Marttila, Kiweler et al. characterize one-carbon metabolism rewiring in response to a dual MTHFD1 and MTHFD2 inhibitor. This work provides insight into one-carbon fluxes, and reveals a previously uncharacterized vulnerability in cancer cells created by folate trapping.
- Published
- 2023
25. Order batching and time efficiency in kit preparation
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Robin Hanson, Lars Medbo, Mats I. Johansson, and Dr. Maurizio Faccio, Dr. Yuval Cohen
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- 2015
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26. Glucose-lowering therapy in patients undergoing percutaneous coronary intervention
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Edoardo Mannucci, Francesco Cosentino, Ilaria Dicembrini, and I. Johansson
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Acute coronary syndrome ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,MEDLINE ,Percutaneous coronary intervention ,medicine.disease ,Concomitant ,Heart failure ,Diabetes mellitus ,Intervention (counseling) ,medicine ,Risk factor ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine - Abstract
The number of individuals with diabetes and pre-diabetes is constantly increasing. These conditions are overrepresented in patients undergoing percutaneous coronary intervention and are associated with adverse prognosis. Optimal glycaemic control during an acute coronary syndrome is a relevant factor for the improvement of longer-term outcomes. In addition, the implementation of newer glucose-lowering drugs with proven cardiovascular benefits has a remarkable impact on recurrence of events, hospitalisations for heart failure and mortality. In this narrative review, we outline the current state-of-the art recommendations for glucose-lowering therapy in patients with diabetes undergoing coronary intervention. In addition, we discuss the most recent evidence-based indications for revascularisation in patients with diabetes as well as the targets for glycaemic control post revascularisation. Current treatment goals for concomitant risk factor control are also addressed. Lastly, we acknowledge the presence of knowledge gaps in need of future research.
- Published
- 2021
27. Soft X-ray Exposure Promotes Na Intercalation in Graphene Grown on Si-Face SiC
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Somsakul Watcharinyanon, Chao Xia, Yuran Niu, Alexei A. Zakharov, Leif I. Johansson, Rositza Yakimova, and Chariya Virojanadara
- Subjects
graphene on Si-face SiC ,intercalation of Na ,soft X-ray exposure ,electron exposure ,Technology ,Electrical engineering. Electronics. Nuclear engineering ,TK1-9971 ,Engineering (General). Civil engineering (General) ,TA1-2040 ,Microscopy ,QH201-278.5 ,Descriptive and experimental mechanics ,QC120-168.85 - Abstract
An investigation of how electron/photon beam exposures affect the intercalation rate of Na deposited on graphene prepared on Si-face SiC is presented. Focused radiation from a storage ring is used for soft X-ray exposures while the electron beam in a low energy electron microscope is utilized for electron exposures. The microscopy and core level spectroscopy data presented clearly show that the effect of soft X-ray exposure is significantly greater than of electron exposure, i.e., it produces a greater increase in the intercalation rate of Na. Heat transfer from the photoelectrons generated during soft X-ray exposure and by the electrons penetrating the sample during electron beam exposure is suggested to increase the local surface temperature and thus the intercalation rate. The estimated electron flux density is 50 times greater for soft X-ray exposure compared to electron exposure, which explains the larger increase in the intercalation rate from soft X-ray exposure. Effects occurring with time only at room temperature are found to be fairly slow, but detectable. The graphene quality, i.e., domain/grain size and homogeneity, was also observed to be an important factor since exposure-induced effects occurred more rapidly on a graphene sample prepared in situ compared to on a furnace grown sample.
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- 2015
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28. Factors associated with health-related quality of life in heart failure in 23,000 patients from 40 countries: results of the global congestive heart failure research program
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I Johansson, K Balasubramanian, S Bangdiwala, L Mielniczuk, C Hage, S K Sharma, K Branch, G Yonga, K Kragholm, K Sliwa, A Roy, S Stork, J J V McMurray, D Conen, and S Yusuf
- Subjects
Cardiology and Cardiovascular Medicine - Abstract
Background Poor health-related quality of life (HRQL) is common in heart failure (HF) and strongly predicts death and HF hospitalization in all regions of the world. Understanding facors associated with HRQL could therefore lead to improved prognosis in HF patients. Despite that the majority of HF occurs in low- and middle-income countries, there are limited data characterizing self-perceived health HRQL and its correlates in these settings. Purpose To examine clinical and social correlates of HRQL in patients with HF from high- (HIC), upper middle- (UMIC), lower middle-(LMIC) and low-income (LIC) countries. Methods Between 2017 and 2020, we enrolled 23,292 patients with HF (32% inpatients, 61% men) from 40 countries in the Global Congestive Heart Failure Study. We recorded HRQL at baseline using Kansas City Cardiomyopathy Questionnaire (KCCQ)-12. In a cross-sectional analysis, we compared age- and sex-adjusted mean KCCQ-12 summary scores (SS: 0–100, higher=better) between patients from different country income levels. We used multivariable linear regression examining correlations (estimates expressed as β-coefficients) of KCCQ-12-SS with sociodemographic-, comorbidity-, treatment- and symptom-covariates. The adjusted model (37 covariates) was informed by univariable findings, clinical importance and backward selection. We used partial R2-estimates to understand the contribution to the variability in KCCQ-12-SS of 4 different groups of covariates. (sociodemographic, comorbidities, treatments and signs and symptoms of congestion). Results Mean age was 63 years and 40% were in NYHA class III–IV. Average HRQL was 55± SD 0.5. It was 62.5 (95% CI 62.0–63.1) in HIC, 56.8 (56.1–57.4) in UMIC, 48.6 (48.0–49.3) in LMIC, and 38.5 (37.3–39.7) in LICs (p Conclusion The most important correlates of HRQL in HF patients relate to HF symptom severity, irrespective of country-income level. Improved symptom control may have a big impact on HRQL, especially in LICs. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Bayer AG
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- 2022
29. Phenotype Harmonization in the GLIDE2 Oral Health Genomics Consortium
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K. Divaris, S. Haworth, J.R. Shaffer, V. Anttonen, J.D. Beck, Y. Furuichi, B. Holtfreter, D. Jönsson, T. Kocher, S.M. Levy, P.K.E. Magnusson, D.W. McNeil, K. Michaëlsson, K.E. North, U. Palotie, P.N. Papapanou, P.J. Pussinen, D. Porteous, K. Reis, A. Salminen, A.S. Schaefer, T. Sudo, Y.Q. Sun, A.L. Suominen, T. Tamahara, S.M. Weinberg, P. Lundberg, M.L. Marazita, I. Johansson, Department of Oral and Maxillofacial Diseases, HUS Head and Neck Center, and Clinicum
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genome-wide association study ,data sciences ,DENTAL-CARIES ,GENETICS ,LOCI ,Oral Health ,Genomics ,Odontologi ,313 Dentistry ,dentition ,permanent ,DISEASE ,Phenotype ,Dentistry ,Genetics ,dental caries ,Humans ,WIDE ASSOCIATION ,GWAS ,epidemiology ,PERIODONTITIS ,Periodontitis ,General Dentistry ,Dental Caries/genetics - Abstract
Genetic risk factors play important roles in the etiology of oral, dental, and craniofacial diseases. Identifying the relevant risk loci and understanding their molecular biology could highlight new prevention and management avenues. Our current understanding of oral health genomics suggests that dental caries and periodontitis are polygenic diseases, and very large sample sizes and informative phenotypic measures are required to discover signals and adequately map associations across the human genome. In this article, we introduce the second wave of the Gene-Lifestyle Interactions and Dental Endpoints consortium (GLIDE2) and discuss relevant data analytics challenges, opportunities, and applications. In this phase, the consortium comprises a diverse, multiethnic sample of over 700,000 participants from 21 studies contributing clinical data on dental caries experience and periodontitis. We outline the methodological challenges of combining data from heterogeneous populations, as well as the data reduction problem in resolving detailed clinical examination records into tractable phenotypes, and describe a strategy that addresses this. Specifically, we propose a 3-tiered phenotyping approach aimed at leveraging both the large sample size in the consortium and the detailed clinical information available in some studies, wherein binary, severity-encompassing, and “precision,” data-driven clinical traits are employed. As an illustration of the use of data-driven traits across multiple cohorts, we present an application of dental caries experience data harmonization in 8 participating studies ( N = 55,143) using previously developed permanent dentition tooth surface–level dental caries pattern traits. We demonstrate that these clinical patterns are transferable across multiple cohorts, have similar relative contributions within each study, and thus are prime targets for genetic interrogation in the expanded and diverse multiethnic sample of GLIDE2. We anticipate that results from GLIDE2 will decisively advance the knowledge base of mechanisms at play in oral, dental, and craniofacial health and disease and further catalyze international collaboration and data and resource sharing in genomics research.
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- 2022
30. Thrombelastography (TEG
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Martin, Vigstedt, Kjersti, Baksaas-Aasen, Hanne H, Henriksen, Marc, Maegele, Simon, Stanworth, Nicole P, Juffermans, Knut M, Kolstadbråten, Pål A, Naess, Karim, Brohi, Christine, Gaarder, Jakob, Stensballe, and Pär I, Johansson
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Adult ,Benzeneacetamides ,Fibrinogen ,Humans ,Blood Coagulation Disorders ,Kaolin ,Hemostatics ,Piperidones ,Thrombelastography - Abstract
Severely injured trauma patients are often coagulopathic and early hemostatic resuscitation is essential. Previous studies have revealed linear relationships between thrombelastography (TEG
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- 2022
31. Plasma as a resuscitation fluid for volume‐depleted shock: Potential benefits and risks
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Nicole P. Juffermans, Philip C. Spinella, Jason L. Sperry, Kimberly A. Thomas, Shibani Pati, Pieter H. Sloos, Daan P. van den Brink, Jakob Stensballe, Derek J. B. Kleinveld, Pär I. Johansson, Intensive Care Medicine, AII - Infectious diseases, AII - Inflammatory diseases, Graduate School, and Surgery
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medicine.medical_specialty ,plasma derivatives ,Resuscitation ,Immunology ,Sepsis ,Endothelial activation ,Plasma ,FFP transfusion ,Endothelium/metabolism ,Internal medicine ,medicine ,Intravascular volume status ,Immunology and Allergy ,Animals ,Humans ,Resuscitation/methods ,Blood Transfusion ,Endothelium ,blood management ,Whole blood ,business.industry ,Septic shock ,Shock ,Hematology ,medicine.disease ,Plasma/chemistry ,Traumatic Shock ,Shock (circulatory) ,Blood Transfusion/methods ,Cardiology ,Commentary ,Wounds and Injuries ,Wounds and Injuries/blood ,medicine.symptom ,Volume expander ,Shock/blood ,business - Abstract
The clinical state of shock constitutes a relative or absolute deficiency of circulating volume for adequate oxygen delivery to meet the metabolic demands.1 Although shock states differ in epidemiology, etiology, and pathophysiologic pathways, a common denominator of shock is endothelial barrier dysfunction.2, 3 Different kinds of shock states, such as occurring after major surgery, trauma, and in sepsis, can result in strong pro‐inflammatory host responses with ensuing endothelial hyperpermeability.4, 5, 6 Loss of endothelial barrier results in leakage of fluid into surrounding tissue, contributing to edema, tissue hypoxia, and organ failure.6 This loss of fluids further aggravates the intravascular circulatory volume deficiency during shock. Obviously, septic and traumatic shock are different entities, with different etiologies and differences in initiation of host response and coagulation response. However, endothelial activation with loss of endothelial barrier integrity is a common finding in both shock states. In trauma‐induced shock, current resuscitation strategies consist of the early transfusion of whole blood or a balanced ratio of plasma, platelets, and red blood cells.7, 8 The aim of resuscitation is to ensure adequate oxygen delivery and to correct coagulopathy. Plasma transfusion may play a key role, as trials point toward improved survival with high dose or early use of plasma transfusion compared to standard care.9, 10, 11 Upon reaching surgical hemostasis, it is general practice to stop transfusion. However, as a result of ongoing inflammation and endothelial activation, patients can continue to be fluid dependent, which is often responded to with crystalloids. However, liberal use of crystalloids in traumatic hemorrhagic shock is associated with increased mortality and increased endothelial permeability, inflammation, and reduced perfusion of vital organs.12, 13, 14 In septic shock, the primary treatment of shock is volume resuscitation with crystalloid or colloids, as advocated in guidelines.15 However, comparable to traumatic hemorrhagic shock, use of a restrictive fluid balance reduces the occurrence of organ failure as well as mortality in sepsis.16, 17, 18 most likely, the association between the amount of infused volume and adverse outcome in shock states is related to increased shedding of the glycocalix, breakdown of adherent junctions, and tight junctions resulting in an increased gradient of leakage over the hyper permeable endothelium.19 Taken together, due to a relative or absolute deficiency of intravascular volume, patients with shock are likely to need volume expansion to maintain perfusion pressure. This poses a challenge to the treatment of shock, as fluid therapy is both a cornerstone of therapy as well as a foe. Different fluids may have differential effects on endothelial integrity. Low‐protein‐content fluids seem to aggravate shedding of glycocalix,20 whereas protein‐rich fluids such as plasma may be superior to normal saline in protecting the glycocalix and endothelial barrier function.21 Transfusion with plasma as a volume expander in shock may seem controversial at first, but one needs to consider that despite the fact that plasma is transfused in millions of patients annually, there currently is limited understanding of its mechanisms of action. In traumatic blood loss, transfusion of plasma may improve survival by decreasing exsanguination.7, 10 The common perception is that plasma is a pro‐coagulant blood product, by replenishing coagulation factors. However, as plasma contains coagulation factors but also anticoagulant proteins, the net effect of plasma on coagulation may be neutral. In line with this, plasma transfusion increases the amount of coagulation factors as well as levels of anti‐coagulant proteins,22 resulting in unchanged thrombin generation, at least in non‐bleeding critically ill patients with an inflammatory‐driven consumption coagulopathy. In patients with traumatic hemorrhagic shock, it is not apparent whether the mechanism of effect of plasma is directly related to the correction of coagulopathy.23 In rats with hemorrhagic shock, deranged thrombin formation was somewhat restored with resuscitation with plasma but not with crystalloids, but whether this relates to prevention of dilutional coagulopathy or to a specific pro‐coagulant effect of plasma is not clear.24, 25 Other mechanisms of the protective effect of plasma may be at hand. These may include preservation of the glycocalix, decreasing inflammation and decreasing endothelial leak. This review aims to discuss the potential of plasma as a resuscitation fluid in shock, with an emphasis on possible mechanisms of benefit on the activated endothelium. Studies comparing plasma with other fluids on (markers of) endothelial integrity have found effects both in (models of) trauma‐induced shock and in septic shock. As loss of endothelial integrity may be a common denominator of shock, we will discuss both these shock states.
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- 2021
32. Early intervention with compression garments prevents progression in mild breast cancer-related arm lymphedema: a randomized controlled trial
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Katarina Y. Blom, Karin I. Johansson, Lena B. Nilsson-Wikmar, and Christina B. Brogårdh
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Oncology ,Breast Cancer Lymphedema ,Compression Bandages ,Arm ,Humans ,Water ,Radiology, Nuclear Medicine and imaging ,Breast Neoplasms ,Female ,Hematology ,General Medicine ,Lymphedema ,Clothing - Abstract
Early diagnosis and compression treatment are important to prevent progression in breast cancer-related arm lymphedema (BCRAL). However, some mild BCRAL can be reversible, and therefore, compression treatment may not be needed. The aim of this study was to investigate the proportion of women with mild BCRAL showing progression/no progression of lymphedema after treatment with or without compression garments, differences in changes of lymphedema relative volume (LRV), local tissue water and subjective symptoms during 6 months. Also, adherence to self-care was examined.Seventy-five women diagnosed with mild BCRAL were randomized to a compression group (CG) or noncompression group (NCG). Both groups received self-care instructions, and the CG were treated with a standard compression garment (ccl 1). Women in the NCG who progressed in LRV ≥2%, or exceeded 10% dropped out, and received appropriate treatment. The proportion showing progression/no progression of LRV, and changes in LRV was measured by Water Displacement Method. Changes in local tissue water were measured by Tissue Dielectric Constant (TDC), subjective symptoms by Visual Analogue Scale, and self-care by a questionnaire.A smaller proportion of LRV progression was found in the CG compared to the NCG at 1, 2 and 6 months follow-up (Early treatment with compression garment can prevent progression in mild BCRAL.
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- 2022
33. 377-P: Exercise-Related Hypoglycemia Induces Hypercoagulable Changes in Patients with Type 1 Diabetes
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PER G. HAGELQVIST, ANDREAS ANDERSEN, KAISAR MAYTHAM, SUSANNE ENGBERG, ULRIK PEDERSEN-BJERGAARD, PÄR I. JOHANSSON, FILIP K. KNOP, and TINA VILSBØLL
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Endocrinology, Diabetes and Metabolism ,Internal Medicine - Abstract
Diabetes is a hypercoagulable state predisposing to cardiovascular disease. Physical exercise can improve cardiovascular health but may also cause hypoglycemia in insulin-treated patients. We compared hemostatic profiles of patients with type 1 diabetes (T1D) with healthy controls and delineated hemostatic changes of hypoglycemia, induced with or without exercise, in patients with T1D. Thromboelastography (TEG®6s) was used to compare hemostatic profiles of patients with T1D (N=15, (mean±SD) age 29.4±8.1 years, HbA1c 6.8±0.5%, diabetes duration 13.1±6.2 years, BMI 23.7±2.0 kg/m2) with individually matched healthy controls (N=15) . In addition, the patients with T1D underwent (randomized, crossover design) two separate hyperinsulinemic euglycemic-hypoglycemic clamp days. During decline in plasma glucose and the initial 15 min of hypoglycemia, the subjects were either resting or performing moderate-intensity exercise. TEG was performed at baseline euglycemia and after 15 min and 60 min of hypoglycemia. Compared with healthy controls, patients with T1D were more hypercoagulable with shorter R-time (P In conclusion, patients with T1D have a more hypercoagulable profile than healthy controls, and exercise-related hypoglycemia induces coagulation without a compensatory fibrinolytic activity, which may increase susceptibility for thrombosis. Disclosure P.G.Hagelqvist: None. A.Andersen: n/a. K.Maytham: None. S.Engberg: Employee; Novo Nordisk A/S. U.Pedersen-bjergaard: Advisory Panel; Novo Nordisk A/S, Sanofi. P.I.Johansson: None. F.K.Knop: Advisory Panel; Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk, Sanofi, ShouTi, Zucara Therapeutics, Consultant; AstraZeneca, Eli Lilly and Company, Novo Nordisk, Pharmacosmos A/S, Sanofi, ShouTi, Zealand Pharma A/S, Zucara Therapeutics, Research Support; AstraZeneca, Novo Nordisk, Sanofi, Zealand Pharma A/S, Speaker's Bureau; AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk, Sanofi, Stock/Shareholder; Antag Therapeutics. T.Vilsbøll: Consultant; AstraZeneca, Bristol-Myers Squibb Company, Eli Lilly and Company, Gilead Sciences, Inc., GlaxoSmithKline plc., Merck Sharp & Dohme Corp., Mundipharma, Novo Nordisk, Sun Pharmaceutical Industries Ltd. Funding Independent research fund Denmark (1030-00256B) Grosserer L.F. Foghts Fund (21.761)
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- 2022
34. Considerations when Modelling EV Battery Circularity Systems
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Martin Kurdve, Mats Zackrisson, Mats I. Johansson, Burcak Ebin, and Ulrika Harlin
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electric vehicle batteries ,circular economy ,recycling ,reuse ,remanufacturing ,second life ,modelling ,Production of electric energy or power. Powerplants. Central stations ,TK1001-1841 ,Industrial electrochemistry ,TP250-261 - Abstract
The electric vehicle market is expected to grow substantially in the coming years, which puts new requirements on the end-of-life phase and on the recycling systems. To a larger extent, the environmental footprint from these vehicles is related to raw material extraction and production, and, consequently, a material- and energy-efficient 3R system (reuse, remanufacturing, recycling) is urgently needed. The ability to understand and model the design and development of such a system therefore becomes important. This study contributes to this by identifying factors that affect 3R system design and performance, relating these factors to the various actors and processes of the system and categorising them according to time from implementation to impact. The above is achieved by applying a PEST analysis (political, economic, social and technological factors), differentiating between political, economic, social and technological factors. Data were gathered from literature, by interviews and by a number of workshops in the automotive industry and the 3R system and observations at meetings, etc. The study confirms some previous results on how vehicle battery 3R systems work and adds knowledge about the influencing factors, especially the timeframes and dynamics of the system, necessary for modelling the system and the influencing factors. For practitioners, the results indicate how to use appropriate models and which factors are most relevant to them.
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- 2019
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35. A randomised double-blind pilot trial comparing a mean arterial pressure target of 65 mm Hg versus 72 mm Hg after out-of-hospital cardiac arrest
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Christian Hassager, Johannes Grand, Jesper Kjaergaard, Sisse R. Ostrowski, Martin Frydland, Anna Sp Meyer, Jakob Hartvig Thomsen, Sebastian Wiberg, and Pär I. Johansson
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Male ,medicine.medical_specialty ,Resuscitation ,Mean arterial pressure ,Time Factors ,Randomization ,Endothelium ,Pilot Projects ,Critical Care and Intensive Care Medicine ,Double-Blind Method ,Internal medicine ,medicine ,Humans ,Arterial Pressure ,Vasoconstrictor Agents ,Coma ,business.industry ,Surrogate endpoint ,General Medicine ,Middle Aged ,Cardiopulmonary Resuscitation ,medicine.anatomical_structure ,Blood pressure ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Out-of-Hospital Cardiac Arrest ,Follow-Up Studies - Abstract
Background: After resuscitation from out-of-hospital cardiac arrest, mean arterial pressure below 65 mm Hg is avoided with vasopressors. A higher blood-pressure target could potentially improve outcome. The aim of this pilot trial was to investigate the effect of a higher mean arterial pressure target on biomarkers of organ injury. Methods: This was a single-centre, double-blind trial of 50 consecutive, comatose out-of-hospital cardiac arrest patients randomly assigned in a 1:1 ratio to a mean arterial pressure target of 65 mm Hg (MAP65) or 72 mm Hg (MAP72). Modified blood pressure modules with a –10% offset were used, enabling a double-blind study design. End-points were biomarkers of organ injury including markers of endothelial integrity (soluble trombomodulin) brain damage (neuron-specific enolase) and renal function (estimated glomerular filtration rate). Results: Mean arterial pressure was significantly higher in MAP72 with a mean difference of 5 mm Hg (pgroup=0.03). After 48 h, soluble trombomodulin (median (interquartile range)) was 8.2 (6.7–12.9) ng/ml and 8.3 (6.0–10.8) ng/ml (p=0.29), neuron-specific enolase was 20 (13–31 μg/l) and 18 (13–44 μg/l) p=0.79) and estimated glomerular filtration rate (mean (±standard deviation)) was 61±19 ml/min/1.73m2 and 48±22 ml/min/1.73 m2 (p=0.08) for the MAP72 and MAP65 groups, respectively. Renal replacement therapy was needed in eight patients (31%) in MAP65 and three patients (13%) in MAP72 (p=0.14). Conclusions: Double-blind allocation to different mean arterial pressure targets is feasible in comatose out-of-hospital cardiac arrest patients. A mean arterial pressure target of 72 mm Hg compared to 65 mm Hg did not result in improved biomarkers of organ injury. We observed a trend towards preserved renal function in the MAP72 group.
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- 2020
36. Targeted plasma metabolomics in resuscitated comatose out-of-hospital cardiac arrest patients
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Rasmus Paulin Beske, Hanne H. Henriksen, Laust Obling, Jesper Kjærgaard, John Bro-Jeppesen, Niklas Nielsen, Pär I. Johansson, and Christian Hassager
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Male ,Out-of-hospital cardiac arrest ,Tricarboxylic Acids ,Emergency Nursing ,Middle Aged ,Cardiopulmonary Resuscitation ,Lipid metabolites ,Oxygen ,Reperfusion Injury ,Emergency Medicine ,Metabolomics ,Humans ,Female ,Tricarboxylic acid ,Amino Acids ,Coma ,Cardiology and Cardiovascular Medicine ,Reactive Oxygen Species ,Out-of-Hospital Cardiac Arrest - Abstract
Background: Out-of-hospital cardiac arrest (OHCA) is a leading cause of death. Even if successfully resuscitated, mortality remains high due to ischemic and reperfusion injury (I/R). The oxygen deprivation leads to a metabolic derangement amplified upon reperfusion resulting in an uncontrolled generation of reactive oxygen species in the mitochondria triggering cell death mechanisms. The understanding of I/R injury in humans following OHCA remains sparse, with no existing treatment to attenuate the reperfusion injury. Aim: To describe metabolic derangement in patients following resuscitated OHCA. Methods: Plasma from consecutive resuscitated unconscious OHCA patients drawn at hospital admission were analyzed using ultra-performance-liquid-mass-spectrometry. Sixty-one metabolites were prespecified for quantification and studied. Results: In total, 163 patients were included, of which 143 (88%) were men, and the median age was 62 years (53–68). All measured metabolites from the tricarboxylic acid (TCA) cycle were significantly higher in non-survivors vs. survivors (180-days survival). Hierarchical clustering identified four clusters (A-D) of patients with distinct metabolic profiles. Cluster A and B had higher levels of TCA metabolites, amino acids and acylcarnitine species compared to C and D. The mortality was significantly higher in cluster A and B (A:62% and B:59% vs. C:21 % and D:24%, p < 0.001). Cluster A and B had longer time to return of spontaneous circulation (A:33 min (21–43), B:27 min (24–35), C:18 min (13–28), and D:18 min (12–25), p < 0.001). Conclusion: Circulating levels of metabolites from the TCA cycle best described the variance between survivors and non-survivors. Four different metabolic phenotypes with significantly different mortality were identified.
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- 2022
37. Real-life experiences with goal-directed prohemostatic therapy with fibrinogen concentrate, prothrombin complex concentrate, and recombinant factor VIIa: a retrospective study of 287 consecutive patients
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Martin Vigstedt, Hanne H. Henriksen, Hadi W. Chaachouh, Jakob Stensballe, and Pär I. Johansson
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Thromboembolism ,Clinical Biochemistry ,Fibrinogen ,Humans ,General Medicine ,Factor VIIa ,Goals ,Blood Coagulation Factors ,Hemostatics ,Recombinant Proteins ,Retrospective Studies - Abstract
The Danish Capital Region Blood Bank operates a 24/7 on-call service staffed with physicians specialized in hemostatic management to guide clinicians in hemostatic resuscitation, including administration of prohemostatic therapy (PHT). The outcome of patients who receive PHT as part of hemostatic resuscitation remains unanswered. The objective of this study was therefore to investigate clinical outcome of patients receiving PHT managed by the on-call service. We identified 287 patients who received PHT during 2015-16, of which 161 (59%) received fibrinogen concentrate (FC), 111 (39%) received prothrombin complex concentrate (PCC), and 15 (5%) received recombinant factor VIIa (rFVIIa) as the first product. Patients were critically ill with a 30-day mortality of 31%. Among FC recipients, cardiothoracic admission, non-trauma, and antithrombotics predicted survival. FC recipients had lower platelet count and thrombelastography clot strengths than the other PHT groups and within the group, these factors predicted mortality. The symptomatic thromboembolic event (TE) rate at 30 days was 5%. For PCC recipients, vitamin K antagonists predicted survival, while rivaroxaban predicted mortality. TE rate was 2%. We did not identify factors associated with survival in the small group of rFVIIa recipients. TE rate was 13%. In summary, trauma and coagulopathy predicted mortality in patients who received FC and our data suggest that optimization of PHT algorithms may be possible. Outcome of patients who received PCC was comparable to results reported elsewhere and its use may be safe in a setting as reported here. Recombinant FVIIa was rarely used but had the highest incidence of arterial thromboembolism.
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- 2022
38. Endothelial dysfunction and thromboembolism in children, adolescents, and young adults with acute lymphoblastic leukemia
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Rūta Semaškevičienė, Line Stensig Lynggaard, Birgitte Klug Albertsen, Thomas Frandsen, Kadri Saks, Rikke Linnemann Nielsen, Pär I. Johansson, Sonata Saulyte Trakymiene, Cecilie Utke Rank, Liv Andrés-Jensen, Ruta Tuckuviene, Olafur G. Jonsson, Petter Quist-Paulsen, Kathrine Grell, Kirsten Brunsvig Jarvis, and Kjeld Schmiegelow
- Subjects
Cancer Research ,medicine.medical_specialty ,GROWTH-FACTOR ,DISSEMINATED INTRAVASCULAR COAGULATION ,VON-WILLEBRAND-FACTOR ,Lymphoblastic Leukemia ,POSTTHROMBOTIC SYNDROME ,Thrombomodulin ,Gastroenterology ,L-ASPARAGINASE ,Internal medicine ,Antithrombotic ,medicine ,Risk factor ,Endothelial dysfunction ,Young adult ,THROMBIN GENERATION ,THROMBOMODULIN LEVEL ,RISK ,business.industry ,Hematology ,medicine.disease ,TNF-ALPHA ,Oncology ,Cohort ,cardiovascular system ,Early adolescents ,PROTEIN-C ,business - Abstract
Endothelial dysfunction has not previously been investigated as a thrombogenic risk factor among patients with acute lymphoblastic leukemia (ALL), known to be at high risk of thromboembolism. We retrospectively explored the association between three circulating biomarkers of endothelial dysfunction (thrombomodulin, syndecan-1, VEGFR-1) measured in prospectively collected blood samples and risk of thromboembolism in 55 cases and 165 time-matched controls, treated according to the NOPHO ALL2008 protocol. In age-, sex-, and risk group-adjusted analysis, increasing levels of thrombomodulin and VEGFR-1 were independently associated with increased odds of developing thromboembolism (OR 1.37 per 1 ng/mL [95% CI 1.20‒1.56, P 30 days before thromboembolic diagnosis. Thrombomodulin levels were on average 3.2 ng/mL (95% CI 2.6-8.2 ng/mL) higher in samples with measurable asparaginase activity (P
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- 2022
39. Blood levels of histone-complexed DNA fragments are associated with coagulopathy, inflammation and endothelial damage early after trauma
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Pär I Johansson, Nis A Windeløv, Lars S Rasmussen, Anne Marie Sørensen, and Sisse R Ostrowski
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Coagulopathy ,deoxyribonucleic acid ,histones ,nucleic acids ,tissue injury ,trauma ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Background: Tissue injury increases blood levels of extracellular histones and nucleic acids, and these may influence hemostasis, promote inflammation and damage the endothelium. Trauma-induced coagulopathy (TIC) may result from an endogenous response to the injury that involves the neurohumoral, inflammatory and hemostatic systems. Aims: To study the contribution of extracellular nucleic constituents to TIC, inflammation and endothelial damage. Setting and Design: Prospective observational study. Materials and Methods: We investigated histone-complexed DNA fragments (hcDNA) along with biomarkers of coagulopathy, inflammation and endothelial damage in plasma from 80 trauma patients admitted directly to the Trauma Centre from the scene of the accident. Blood was sampled a median of 68 min (IQR 48-88) post injury. Trauma patients with hcDNA levels >median or ≤median were compared. Results: Trauma patients with high plasma hcDNA had higher Injury Severity Score (ISS) and level of sympathoadrenal activation (higher adrenaline and noradrenaline) and a higher proportion of prolonged activated partial thromboplastin time (APTT) and higher D-dimer, tissue-type plasminogen activator (tPA), Annexin V and soluble CD40 ligand (sCD40L) concurrent with lower plasminogen activator inhibitor (PAI)-1) and prothrombin fragment (PF) 1 + 2 (all P < 0.05), all indicative of impaired thrombin generation, hyperfibrinolysis and platelet activation. Furthermore, patients with high hcDNA had enhanced inflammation and endothelial damage evidenced by higher plasma levels of terminal complement complex (sC5b-9), IL-6, syndecan-1, thrombomodulin and tissue factor pathway inhibitor (all P < 0.05). Conclusions: Excessive release of extracellular histones and nucleic acids seems to contribute to the hypocoagulability, inflammation and endothelial damage observed early after trauma.
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- 2013
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40. Managing complexity through integrative tactical planning in engineer-to-order environments: insights from four case studies
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Hafez Shurrab, Mats I. Johansson, and Patrik Jonsson
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021103 operations research ,Process management ,Computer science ,Build to order ,Strategy and Management ,05 social sciences ,0211 other engineering and technologies ,Tactical planning ,02 engineering and technology ,Management Science and Operations Research ,Industrial and Manufacturing Engineering ,Computer Science Applications ,Task (project management) ,Personalization ,0502 economics and business ,Complexity management ,Key (cryptography) ,Information system ,Dimension (data warehouse) ,050203 business & management - Abstract
Fulfilling customer orders in engineer-to-order (ETO) settings entails customization and, thus, greater complexity: detail and uncertainty. Tactical planning aims at demand–supply (DS) balancing by ensuring cross-functional integration (CFI), which incorporates coordination as one dimension. This study uses a case study approach to identify the key coordination mechanisms applied in the customer order fulfilment processes (COFPs) to mitigate the negative impact of complexity on DS balancing in four ETO-oriented settings. Within-case analyses identify the applied mechanisms, and a cross-case analysis elaborates on how they influence the detail and uncertainty in decision-making and problem-solving activities. Findings suggest a positive effect of formalized activity sequences, balanced team compositions, effective task designs and supportive information systems (ISs); and a positive (but contingent) effect of the other mechanisms. Future research may address other CFI dimensions (collaboration), statistically test the findings, or qualitatively deepen the understanding of the forms and impacts of individual mechanisms.
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- 2020
41. A tactical demand-supply planning framework to manage complexity in engineer-to-order environments: insights from an in-depth case study
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Hafez Shurrab, Mats I. Johansson, and Patrik Jonsson
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021103 operations research ,Computer science ,Build to order ,Strategy and Management ,05 social sciences ,0211 other engineering and technologies ,Tactical planning ,02 engineering and technology ,Management Science and Operations Research ,Industrial and Manufacturing Engineering ,Computer Science Applications ,Supply and demand ,Risk analysis (engineering) ,0502 economics and business ,Complexity management ,050203 business & management - Abstract
The challenging demand-supply balancing in engineer-to-order (ETO) environments is often attributed to complexity. This study expands the understanding of managing complexity to obtain demand-suppl...
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- 2020
42. Viscoelastic haemostatic assay augmented protocols for major trauma haemorrhage (ITACTIC): a randomized, controlled trial
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S. Chinna, Knut Magne Kolstadbraaten, Pär I. Johansson, R. Maroni, Nicola Curry, Lewis S. Gall, N. Schäfer, Mathijs R. Wirtz, J. C. Goslings, Nicole P. Juffermans, Simon S. Eaglestone, C Rourke, Ross Davenport, K. Holst Pedersen, Simon J. Stanworth, J. Murphy, Derek J. B. Kleinveld, Jakob Stensballe, Paul Vulliamy, Hanne H. Henriksen, M. Maegele, Adam Brooks, Karim Brohi, Christine Gaarder, Kjersti Baksaas-Aasen, Paal Aksel Naess, Scarlett Gillespie, Intensive Care Medicine, AII - Inflammatory diseases, Graduate School, AMS - Amsterdam Movement Sciences, AMS - Musculoskeletal Health, and Surgery
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medicine.medical_specialty ,Traumatic brain injury ,Psychological intervention ,Hemorrhage ,Critical Care and Intensive Care Medicine ,Trauma ,Hemostatics ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Coagulopathy ,law ,Internal medicine ,0502 economics and business ,Coagulation testing ,Humans ,Multicenter Studies as Topic ,Medicine ,050207 economics ,Adverse effect ,Hemostasis ,050208 finance ,Intention-to-treat analysis ,business.industry ,Major trauma ,Thromboelastometry ,05 social sciences ,030208 emergency & critical care medicine ,Blood Coagulation Disorders ,medicine.disease ,Thrombelastography ,3. Good health ,Haemorrhage ,030228 respiratory system ,Wounds and Injuries ,business - Abstract
Purpose: Contemporary trauma resuscitation prioritizes control of bleeding and uses major haemorrhage protocols (MHPs) to prevent and treat coagulopathy. We aimed to determine whether augmenting MHPs with Viscoelastic Haemostatic Assays (VHA) would improve outcomes compared to Conventional Coagulation Tests (CCTs). Methods: This was a multi-centre, randomized controlled trial comparing outcomes in trauma patients who received empiric MHPs, augmented by either VHA or CCT-guided interventions. Primary outcome was the proportion of subjects who, at 24 h after injury, were alive and free of massive transfusion (10 or more red cell transfusions). Secondary outcomes included 28-day mortality. Pre-specified subgroups included patients with severe traumatic brain injury (TBI). Results: Of 396 patients in the intention to treat analysis, 201 were allocated to VHA and 195 to CCT-guided therapy. At 24 h, there was no difference in the proportion of patients who were alive and free of massive transfusion (VHA: 67%, CCT: 64%, OR 1.15, 95% CI 0.76–1.73). 28-day mortality was not different overall (VHA: 25%, CCT: 28%, OR 0.84, 95% CI 0.54–1.31), nor were there differences in other secondary outcomes or serious adverse events. In pre-specified subgroups, there were no differences in primary outcomes. In the pre-specified subgroup of 74 patients with TBI, 64% were alive and free of massive transfusion at 24 h compared to 46% in the CCT arm (OR 2.12, 95% CI 0.84–5.34). Conclusion: There was no difference in overall outcomes between VHA- and CCT-augmented-major haemorrhage protocols.
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- 2020
43. Automated order picking systems and the links between design and performance: a systematic literature review
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Mats I. Johansson, Robin Hanson, and Yasmeen Jaghbeer
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0209 industrial biotechnology ,Order picking ,021103 operations research ,business.industry ,Computer science ,Strategy and Management ,0211 other engineering and technologies ,02 engineering and technology ,Management Science and Operations Research ,Data science ,Automation ,Industrial and Manufacturing Engineering ,020901 industrial engineering & automation ,Systematic review ,Content analysis ,business - Abstract
With new market developments and e-commerce, there is an increased use of and interest in automation for order picking. This paper presents a systematic review and content analysis of the literatur...
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- 2020
44. Links between kit quality and kit preparation design
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Mats I. Johansson, Lars Medbo, Robin Hanson, and Patrik Fager
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0209 industrial biotechnology ,Order picking ,Empirical data ,021103 operations research ,business.industry ,Computer science ,Strategy and Management ,media_common.quotation_subject ,0211 other engineering and technologies ,Automotive industry ,02 engineering and technology ,Work organisation ,Management Science and Operations Research ,Industrial and Manufacturing Engineering ,Manufacturing engineering ,020901 industrial engineering & automation ,Container (abstract data type) ,ComputingMilieux_COMPUTERSANDEDUCATION ,Information system ,Multiple case ,Quality (business) ,business ,media_common - Abstract
Kitting is a materials-feeding principle commonly used with mixed-model assembly, but literature is lacking with respect to how kit quality can be supported. The purpose of this paper is to create an understanding of the links between kit preparation design aspects and kit preparation error types, that can be useful to support kit quality. The paper draws on empirical data from a multiple case study in the automotive industry to study how typical kit errors are linked to eight kit preparation design aspects: location, work organisation, storage policy, batching policy, storage packaging, kit carrier and container, picking information system, and error communication. The findings suggest several opportunities related to kit preparation design aspects for preventing kit errors and facilitating kit error corrections. The paper extends earlier knowledge and can support kit quality of industrial kit preparation.
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- 2020
45. 'Endothelial Dysfunction in Resuscitated Cardiac Arrest (ENDO-RCA): Safety and efficacy of low-dose Iloprost, a prostacyclin analogue, in addition to standard therapy, as compared to standard therapy alone, in post-cardiac-arrest-syndrome patients.'
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Jesper Kjaergaard, Sisse R. Ostrowski, Hanne H. Henriksen, Martin Frydland, Christian Hassager, Martin A. S. Meyer, Anna Sina P. Meyer, Sebastian Wiberg, Jakob Hartvig Thomsen, and Per I. Johansson
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Male ,Time Factors ,Thrombomodulin ,Vasodilator Agents ,Pilot Projects ,Prostacyclin ,030204 cardiovascular system & hematology ,Body Temperature ,Norepinephrine ,chemistry.chemical_compound ,0302 clinical medicine ,030212 general & internal medicine ,Endothelial dysfunction ,Middle Aged ,Cadherins ,Nucleosomes ,Thrombelastography ,Vascular endothelial growth factor ,medicine.anatomical_structure ,Epinephrine ,cardiovascular system ,Cardiology ,Biomarker (medicine) ,Female ,Saline Solution ,E-Selectin ,Cardiology and Cardiovascular Medicine ,medicine.drug ,medicine.medical_specialty ,Endothelium ,Placebo ,03 medical and health sciences ,Double-Blind Method ,Antigens, CD ,Internal medicine ,medicine ,Humans ,Post-Cardiac Arrest Syndrome ,Iloprost ,Aged ,business.industry ,medicine.disease ,chemistry ,Sample Size ,Endothelium, Vascular ,Syndecan-1 ,business ,Biomarkers ,Out-of-Hospital Cardiac Arrest - Abstract
An increasingly recognized prognostic factor for out-of-hospital-cardiac-arrest (OHCA) patients is the ischemia-reperfusion injury after restored blood circulation. Endothelial injury is common in patients resuscitated from cardiac arrest and is associated with poor outcome. This study was designed to investigate if iloprost infusion, a prostacyclin analogue, reduces endothelial damage in OHCA patients.50 patients were randomized in a placebo controlled double-blinded trial and allocated 1:2 to 48-hours iloprost infusion, (1 ng/kg/min) or placebo (saline infusion). Endothelial biomarkers (soluble thrombomodulin (sTM), sE-selectin, syndecan-1, soluble vascular endothelial growth factor (sVEGF), vascular endothelial cadherine (VEcad), nucleosomes) and sympathoadrenal activation (epinephrine/norepinephrine) from baseline to 48 and 96-hours were evaluated.Iloprost infusion did not influence endothelial biomarkers by the 48-hour endpoint. A rebound effect was observed with higher biomarker plasma values in the iloprost group (sTM p=0.02; Syndecan p=0.004; nucleosomes p0.001; VEcad p0.03) after 96-hours. There was a significant difference in 180-day mortality in favor of placebo. There was no difference regarding total adverse events between groups (p=0.73). Two patients were withdrawn in the iloprost group due to hypotension.The administration of low-dose iloprost (1ng/kg/min) to OHCA patients did not significantly influence endothelial biomarkers as measured by the 48- hour endpoint. A rebound effect was however observed in the 96-hour statistical model, with increasing endothelial biomarker levels after cessation of the iloprost-infusion.
- Published
- 2020
46. Metabolic systems analysis identifies a novel mechanism contributing to shock in patients with endotheliopathy of trauma (EoT) involving thromboxane A2 and LTC4
- Author
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Hanne H. Henriksen, Igor Marín de Mas, Helena Herand, Joseph Krocker, Charles E. Wade, and Pär I. Johansson
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Histology ,Genome-scale metabolic model ,Genetics ,Biophysics ,Metabolomics ,Cell Biology ,Eicosanoid ,Systems biology ,Molecular Biology ,Biochemistry ,Endotheliopathy ,Trauma - Abstract
Purpose: Endotheliopathy of trauma (EoT), as defined by circulating levels of syndecan-1 ≥ 40 ng/mL, has been reported to be associated with significantly increased transfusion requirements and a doubled 30-day mortality. Increased shedding of the glycocalyx points toward the endothelial cell membrane composition as important for the clinical outcome being the rationale for this study. Results: The plasma metabolome of 95 severely injured trauma patients was investigated by mass spectrometry, and patients with EoT vs. non-EoT were compared by partial least square-discriminant analysis, identifying succinic acid as the top metabolite to differentiate EoT and non-EoT patients (VIP score = 3). EoT and non-EoT patients’ metabolic flux profile was inferred by integrating the corresponding plasma metabolome data into a genome-scale metabolic network reconstruction analysis and performing a functional study of the metabolic capabilities of each group. Model predictions showed a decrease in cholesterol metabolism secondary to impaired mevalonate synthesis in EoT compared to non-EoT patients. Intracellular task analysis indicated decreased synthesis of thromboxanA2 and leukotrienes, as well as a lower carnitine palmitoyltransferase I activity in EoT compared to non-EoT patients. Sensitivity analysis also showed a significantly high dependence of eicosanoid-associated metabolic tasks on alpha-linolenic acid as unique to EoT patients. Conclusions: Model-driven analysis of the endothelial cells’ metabolism identified potential novel targets as impaired thromboxane A2 and leukotriene synthesis in EoT patients when compared to non-EoT patients. Reduced thromboxane A2 and leukotriene availability in the microvasculature impairs vasoconstriction ability and may thus contribute to shock in EoT patients. These findings are supported by extensive scientific literature; however, further investigations are required on these findings.
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- 2022
47. Hemostatic resuscitation with plasma and platelets in trauma
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Pär I Johansson, Roberto S Oliveri, and Sisse R Ostrowski
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Coagulopathy ,damage control resuscitation ,FFP ,meta-analysis ,platelet concentrate ,RBC ,transfusion ratios ,trauma ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Background: Continued hemorrhage remains a major contributor of mortality in massively transfused patients and controversy regarding the optimal management exists although recently, the concept of hemostatic resuscitation, i.e., providing large amount of blood products to critically injured patients in an immediate and sustained manner as part of an early massive transfusion protocol has been introduced. The aim of the present review was to investigate the potential effect on survival of proactive administration of plasma and/or platelets (PLT) in trauma patients with massive bleeding. Materials and Methods: English databases were searched for reports of trauma patients receiving massive transfusion (10 or more red blood cell (RBC) within 24 hours or less from admission) that tested the effects of administration of plasma and/or PLT in relation to RBC concentrates on survival from January 2005 to November 2010. Comparison between highest vs lowest blood product ratios and 30-day mortality was performed. Results: Sixteen studies encompassing 3,663 patients receiving high vs low ratios were included. This meta-analysis of the pooled results revealed a substantial statistical heterogeneity (I 2 = 58%) and that the highest ratio of plasma and/or PLT or to RBC was associated with a significantly decreased mortality (OR: 0.49; 95% confidence interval: 0.43-0.57; P
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- 2012
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48. Heart failure and its complications in patients with diabetes: Mounting evidence for a growing burden
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Victor Aboyans, I. Johansson, Marc Ferrini, Service de cardiologie [centre hospitalier St-Joseph-et-St-Luc, Lyon], Centre hospitalier Saint Joseph - Saint Luc [Lyon], Karolinska Institutet [Stockholm], Neuroépidémiologie Tropicale (NET), CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), Service de cardiologie [CHU Limoges], and CHU Limoges
- Subjects
Risk ,medicine.medical_specialty ,Diabetic Cardiomyopathies ,Epidemiology ,Population ,Cardiomyopathy ,Disease ,030204 cardiovascular system & hematology ,Sudden cardiac death ,Diabetes Complications ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Diabetes mellitus ,Glycaemic control ,Atrial Fibrillation ,Prevalence ,medicine ,Humans ,Hypoglycemic Agents ,030212 general & internal medicine ,education ,Sodium-Glucose Transporter 2 Inhibitors ,Heart Failure ,education.field_of_study ,glucose-lowering drugs ,business.industry ,Diabetes ,Cardiovascular Agents ,Atrial fibrillation ,medicine.disease ,3. Good health ,Death, Sudden, Cardiac ,Heart failure ,Cardiology ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Hypertrophy, Left Ventricular ,Cardiology and Cardiovascular Medicine ,business - Abstract
International audience; Heart failure (HF) is one of the major challenges in the management of diabetes patients. Among subjects with diabetes, up to 20% could have HF. Conversely, diabetes prevalence in HF patients varies greatly from more than 10% up to 50%. When it is present, the risk of mortality and rehospitalization increases substantially. In addition, current evidence points to an increased risk of atrial fibrillation and sudden cardiac death in patients with diabetes. The inter-relation between diabetes cardiomyopathy, left ventricular hypertrophy, coronary artery disease and renal dysfunction indicates complex and intricate pathways. Despite the great value of clinical assessment and echocardiography, there is insufficient data to suggest systematic screening for HF in asymptomatic patients with diabetes. There is little evidence to indicate that improved glycaemic control improves HF outcome in this population. In the case of established HF, the general guidelines apply in diabetes patients. However, recent advances concerning glucose-lowering treatment in patients with cardiovascular disease suggest that the choice of glucose-lowering agent is of crucial interest and should be based on the patient’s phenotype. New drug classes, such as SGLT2 inhibitors, seem to be of particular benefit in these patients. In the future, new personalized strategies should aim at not only good control of the glycaemic level but also the reduction and possibly the prevention of HF onset.
- Published
- 2019
49. The effect of prostacyclin infusion on markers of endothelial activation and damage in mechanically ventilated patients with SARS-CoV-2 infection
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Martin Vigstedt, Peter Søe-Jensen, Morten H. Bestle, Niels E. Clausen, Klaus T. Kristiansen, Theis Lange, Jakob Stensballe, Anders Perner, and Pär I. Johansson
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Adult ,SARS-CoV-2 ,COVID-19 ,Humans ,Pilot Projects ,Endothelium, Vascular ,Syndecan-1 ,Critical Care and Intensive Care Medicine ,Epoprostenol ,Respiration, Artificial ,Biomarkers - Abstract
In a pilot study, we found a significant reduction in mean daily sequential organ failure assessment score in mechanically ventilated patients with COVID-19 who received prostacyclin, compared to placebo. We here investigate the effect on biomarkers of endothelial activation and damage.Post-hoc study of a randomized controlled trial in adult patients with confirmed SARS-CoV-2 infection, mechanically ventilated, with soluble thrombomodulin (sTM) plasma levels4 ng/mL. Patients received prostacyclin infusion (1 ng/kg/min) or placebo. Blood samples were collected at baseline and 24 h.Eighty patients were randomized (41 prostacyclin, 39 placebo). The median changes in syndecan-1 plasma levels at 24 h were -3.95 (IQR: -21.1 to 2.71) ng/mL in the prostacyclin group vs. 3.06 (IQR: -8.73 to 20.5) ng/mL in the placebo group (difference of the medians: -7.01 [95% CI: -22.3 to -0.231] ng/mL, corresponding to -3% [95% CI: -11% to 0%], p = 0.04). Changes in plasma levels of sTM, PECAM-1, p-selectin, and CD40L did not differ significantly between groups.Prostacyclin infusion, compared to placebo, resulted in a measurable decrease in endothelial glycocalyx shedding (syndecan-1) at 24 h, suggesting a protective effect on the endothelium, which may be related to the observed reduction in organ failure.
- Published
- 2021
50. Prostacyclin in Intubated Patients with COVID-19 and Severe Endotheliopathy: A Multicenter, Randomized Clinical Trial
- Author
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Klaus T. Kristiansen, Niels E Clausen, Theis Lange, Morten H. Bestle, Pär I. Johansson, Anders Perner, Jakob Stensballe, and Peter Søe-Jensen
- Subjects
Pulmonary and Respiratory Medicine ,Male ,medicine.medical_treatment ,Denmark ,Thrombomodulin ,Prostacyclin ,Critical Care and Intensive Care Medicine ,Placebo ,law.invention ,Randomized controlled trial ,law ,medicine ,Intubation, Intratracheal ,Humans ,Adverse effect ,Infusions, Intravenous ,Aged ,Mechanical ventilation ,business.industry ,Incidence (epidemiology) ,COVID-19 ,Middle Aged ,Epoprostenol ,Respiration, Artificial ,COVID-19 Drug Treatment ,Clinical trial ,Survival Rate ,Treatment Outcome ,Anesthesia ,Relative risk ,Female ,Endothelium, Vascular ,business ,Platelet Aggregation Inhibitors ,medicine.drug - Abstract
Rationale The mortality in SARS-CoV-2 infected patients requiring mechanical ventilation remains high and endotheliopathy has been implicated. Objective To determine the effect of prostacyclin infusion in mechanically ventilated SARS-CoV-2 infected patients with severe endotheliopathy. Methods We conducted a multicenter, randomized, clinical trial in COVID-19 infected adults requiring mechanical ventilation having a plasma level of thrombomodulin >4ng/ml who were randomized to 72-hours infusion of prostacyclin 1 ng/kg/min or placebo. Measurements The main outcome was the number of days alive and without mechanical ventilation within 28-days. Key secondary outcomes were 28-day mortality and serious adverse events within 7 days. Main Results Eighty patients were randomized (41 prostacyclin, 39 placebo). The number of days alive without mechanical ventilation at 28-days was 16.0 days (SD 12) versus 5.0 days (SD 10), [95% CI -21.0 to 5.0], P=0.07) in the prostacyclin and the placebo groups, respectively. The 28-day mortality was 21.9% versus 43.6% in the prostacyclin and the placebo groups, respectively (risk ratio 0.50 [95% CI 0.24 to 0.96] P=0.056). The incidence of serious adverse events within 7 days were 2.4% vs. 12,8% (risk ratio 0.19 [95% CI 0.001 to 1.11], P=0.10) in the prostacyclin and the placebo groups, respectively. Conclusions and relevance Prostacyclin were not associated with a significant reduction in the number of days alive and without mechanical ventilation within 28-days. The point estimates, however, favored the prostacyclin group in all analyses, including 28-day mortality, warranting further investigation in larger trials. Clinical trial registration available at www.clinicaltrials.gov, ID: NCT04420741. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).
- Published
- 2021
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