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  • 1. Aapro, Matti
    et al.
    Beguin, Yves
    Birgegård, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Gascon, Pere
    Hedenus, Michael
    Österborg, Anders
    Too-Low Iron Doses and Too Many Dropouts in Negative Iron Trial?2011In: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 29, no 17, E525-E526 p.Article in journal (Refereed)
  • 2. Aapro, Matti S.
    et al.
    Birgegård, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Bokemeyer, Carsten
    Cornes, Paul
    Foubert, Jan
    Gascon, Pere
    Glaspy, John
    Hellström-Lindberg, Eva
    Link, Hartmut
    Ludwig, Heinz
    Österborg, Anders
    Repetto, Lazzaro
    Soubeyran, Pierre
    Erythropoietins should be used according to guidelines2008In: The Lancet Oncology, ISSN 1470-2045, E-ISSN 1474-5488, Vol. 9, no 5, 412-3 p.Article in journal (Refereed)
  • 3. Aardal, S
    et al.
    Aardal, NP
    Larsen, TH
    Angeletti, RH
    Stridsberg, M
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
    Taupenot, L
    Aunis, D
    Helle, KB
    Human pheochromocytoma: different patterns of catecholamine and chromogranins in the intact tumour, urine and serum in clinically unsuspected cases1996In: Scand J clin Lab Invest, Vol. 56, 511- p.Article in journal (Refereed)
  • 4.
    Aare, Sudhakar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Clinical Neurophysiology.
    Ochala, Julien
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Clinical Neurophysiology.
    Norman, Holly S
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Clinical Neurophysiology.
    Radell, Peter
    Eriksson, Lars I
    Göransson, Hanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Chen, Yi-Wen
    Hoffman, Eric P
    Larsson, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Clinical Neurophysiology.
    Mechanisms underlying the sparing of masticatory versus limb muscle function in an experimental critical illness model2011In: Physiological Genomics, ISSN 1094-8341, E-ISSN 1531-2267, Vol. 43, no 24, 1334-1350 p.Article in journal (Refereed)
    Abstract [en]

    Acute quadriplegic myopathy (AQM) is a common debilitating acquired disorder in critically ill intensive care unit (ICU) patients which is characterized by tetraplegia/generalized weakness of limb and trunk muscles. Masticatory muscles, on the other hand, are typically spared or less affected, yet the mechanisms underlying this striking muscle-specific difference remain unknown. This study aims to evaluate physiological parameters and the gene expression profiles of masticatory and limb muscles exposed to factors suggested to trigger AQM, such as mechanical ventilation, immobilization, neuromuscular blocking agents (NMBA), corticosteroids (CS) and sepsis for five days by using a unique porcine model mimicking the ICU conditions. Single muscle fiber cross-sectional area and force-generating capacity, i.e., maximum force normalized to fiber cross-sectional area (specific force), revealed maintained masseter single muscle fiber cross-sectional area and specific-force after five days exposure to all triggering factors. This is in sharp contrast to observations in limb and trunk muscles, showing a dramatic decline in specific force in response to five days exposure to the triggering factors. Significant differences in gene expression were observed between craniofacial and limb muscles, indicating a highly complex and muscle specific response involving transcription and growth factors, heat shock proteins, matrix metalloproteinase inhibitor, oxidative stress responsive elements and sarcomeric proteins underlying the relative sparing of cranial versus spinal nerve innervated muscles during exposure to the ICU intervention.

  • 5.
    Abdeldaim, Guma
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Bacteriology.
    Herrmann, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Bacteriology.
    Korsgaard, J.
    Köpenhamns Universitet.
    Olcén, P.
    Örebro Universitet, klinisk mikrobiologi.
    Blomberg, Jonas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Virology.
    Strålin, Kristoffer
    Örebro Universitet, klinisk mikrobiologi.
    Is quantitative PCR for the pneumolysin (ply) gene useful for detection of pneumococcal lower respiratory tract infection?2009In: Clinical Microbiology and Infection, ISSN 1198-743X, E-ISSN 1469-0691, Vol. 15, no 6, 565-570 p.Article in journal (Refereed)
    Abstract [en]

    The pneumolysin (ply) gene is widely used as a target in PCR assays for Streptococcus pneumoniae in respiratory secretions. However, false-positive results with conventional ply-based PCR have been reported. The aim here was to study the performance of a quantitative ply-based PCR for the identification of pneumococcal lower respiratory tract infection (LRTI). In a prospective study, fibreoptic bronchoscopy was performed in 156 hospitalized adult patients with LRTI and 31 controls who underwent bronchoscopy because of suspicion of malignancy. Among the LRTI patients and controls, the quantitative ply-based PCR applied to bronchoalveolar lavage (BAL) fluid was positive at >/=10(3) genome copies/mL in 61% and 71% of the subjects, at >/=10(5) genome copies/mL in 40% and 58% of the subjects, and at >/=10(7) genome copies/mL in 15% and 3.2% of the subjects, respectively. Using BAL fluid culture, blood culture, and/or a urinary antigen test, S. pneumoniae was identified in 19 LRTI patients. As compared with these diagnostic methods used in combination, quantitative ply-based PCR showed sensitivities and specificities of 89% and 43% at a cut-off of 10(3) genome copies/mL, of 84% and 66% at a cut-off of 10(5) genome copies/mL, and of 53% and 90% at a cut-off of 10(7) genome copies/mL, respectively. In conclusion, a high cut-off with the quantitative ply-based PCR was required to reach acceptable specificity. However, as a high cut-off resulted in low sensitivity, quantitative ply-based PCR does not appear to be clinically useful. Quantitative PCR methods for S. pneumoniae using alternative gene targets should be evaluated.

  • 6.
    Abdeldaim, Guma
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Bacteriology.
    Herrmann, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Bacteriology.
    Mölling, Paula
    Holmberg, Hans
    Blomberg, Jonas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Virology.
    Olcén, Per
    Strålin, Kristoffer
    Usefulness of real-time PCR for lytA, ply, and Spn9802 on plasma samples for the diagnosis of pneumococcal pneumonia2010In: Clinical Microbiology and Infection, ISSN 1198-743X, E-ISSN 1469-0691, Vol. 16, no 8, 1135-1141 p.Article in journal (Refereed)
    Abstract [en]

    In the present study, we evaluated rapid real-time PCR assays for ply, Spn9802, and lytA applied to plasma samples for the detection of Streptococcus pneumoniae in patients with community-acquired pneumonia (CAP). In a prospective study of CAP aetiology, an EDTA plasma sample was collected together with blood culture in 92 adult CAP patients and 91 adult controls. Among the 92 CAP patients, lytA PCR was positive in eight (9%), Spn9802 PCR was positive in 11 (12%) and ply PCR was positive in 19 (21%) cases. Of 91 controls, the ply PCR was positive in eight cases (9%), but no positive cases were noted by Spn9802 or lytA PCRs. Ten CAP patients had pneumococcal bacteraemia. Compared to blood culture, PCR for lytA, Spn9802 and ply had sensitivities of 70% (7/10), 60% (6/10) and 70% (7/10), and specificities of 96% (79/82), 94% (77/82) and 85% (70/82) respectively. With blood culture and/or culture of representative sputum, and/or urinary antigen detection, S. pneumoniae was identified in 31 CAP patients. Compared to these tests in combination, PCR for lytA, Spn9802 and ply showed sensitivities of 26% (8/31), 32% (10/31) and 42% (13/31), and specificities of 100% (61/61), 98% (60/61) and 90% (55/61) respectively. We conclude that Spn9802 and lytA PCRs may be useful for the rapid detection of bacteraemic pneumococcal pneumonia, whereas ply PCR is not specific enough for routine use and blood PCR with small plasma volumes is not useful for the detection of nonbacteraemic pneumococcal pneumonia.

  • 7.
    Abdeldaim, Guma M. K.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    PCR detection of Streptococcus pneumoniae and Haemophilus influenzae in pneumonia patients2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    PCR is a rapid, reproducible method for nucleic acid detection. However, this technology displays significant deficiencies when applied in clinical microbiology. This work’s aim was to improve current diagnostics and provide sensitive and quantitative real-time PCRs.

    Paper I describes the development of a sensitive and specific quantitative real-time PCR for the detection of Streptococcus pneumoniae, based on the Spn9802 DNA fragment. Applied to nasopharyngeal aspirates from 166 pneumonia patients, Spn9802 PCR had a sensitivity of 94% and a specificity of 98%.

    In Paper II the performance of a ply gene PCR for identification of pneumococcal lower respiratory tract infection (LRTI) was evaluated on bronchoalveloar lavage fluids. At the detection limit 103 genome copies/mL, 89% sensitivity but only 43% specificity was achieved.

    Paper III shows that S. pneumoniae DNA is detectable in plasma from acutely febrile patients. Sensitivities were low (26-42%) for detection of pneumococcal pneumonia, for bacteraemic pneumococcal pneumonia they were 60-70%.

    Paper IV describes evaluation of four PCR targets for Haemophilus influenzae detection. A real-time PCR based on the P6 gene was developed and applied to 166 CAP patients, using cut-off of 104 genome copies/mL the assay had a sensitivity of 97% and a specificity of 96%.

    In paper V, the two real-time PCRs presented in papers I and IV were combined with a PCR for detection of Neisseriae meningitidis. The analytical sensitivity of this multiplex real-time PCR was not affected by using a mixture of reagents and a combined DNA standard (S. pneumoniae/H. influenzae) in single tubes. Applied to 156 LRTI patients, this PCR had sensitivities over 90% for S. pneumoniae and H. influenzae, and specificities of 89% and 96%, respectively.

    In conclusion, real-time PCR assays are useful for the diagnosis of S. pneumoniae and H. influenzae. They enable detection after antibiotic installation, and quantification increases the etiological specificity of pneumonia.

    List of papers
    1. Toward a quantitative DNA-based definition of pneumococcal pneumonia: a comparison of Streptococcus pneumoniae target genes, with special reference to the Spn9802 fragment
    Open this publication in new window or tab >>Toward a quantitative DNA-based definition of pneumococcal pneumonia: a comparison of Streptococcus pneumoniae target genes, with special reference to the Spn9802 fragment
    Show others...
    2008 (English)In: Diagnostic microbiology and infectious disease, ISSN 0732-8893, E-ISSN 1879-0070, Vol. 60, no 2, 143-150 p.Article in journal (Refereed) Published
    Abstract [en]

    The current shift from phenotypically toward genotypically based microbial diagnosis is not unproblematic. A novel quantitative real-time polymerase chain reaction (PCR) assay based on the Spn9802 DNA fragment was therefore developed for detection of Streptococcus pneumoniae. Out of 44 bacterial species, only S. pneumoniae and Streptococcus pseudopneumoniae were positive in Spn9802 PCR. In an evaluation on nasopharyngeal aspirates from 166 patients with community-acquired pneumonia, the assay was positive in 49 of 50 culture-positive cases. Of 19 culture-negative but Spn9802 PCR-positive cases, 12 were confirmed as S. pneumoniae by rnpB sequence analysis. With an expanded reference standard, including culture and rnpB sequencing, Spn9802 had a sensitivity of 94% and a specificity of 98%. A cutoff for clinically significant positivity was 10(4) DNA copies/mL, giving 71% sensitivity and 100% specificity. In conclusion, Spn9802 real-time PCR is highly sensitive and specific. The quantification it provides enables differentiation between pneumococcal pathogenicity and commensalism.

    Keyword
    S. pneumoniae, Pneumonia, Real-time PCR, Spn9802
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-11875 (URN)10.1016/j.diagmicrobio.2007.08.010 (DOI)000252915100002 ()17916422 (PubMedID)
    Available from: 2008-12-02 Created: 2008-12-02 Last updated: 2017-12-11Bibliographically approved
    2. Is quantitative PCR for the pneumolysin (ply) gene useful for detection of pneumococcal lower respiratory tract infection?
    Open this publication in new window or tab >>Is quantitative PCR for the pneumolysin (ply) gene useful for detection of pneumococcal lower respiratory tract infection?
    Show others...
    2009 (English)In: Clinical Microbiology and Infection, ISSN 1198-743X, E-ISSN 1469-0691, Vol. 15, no 6, 565-570 p.Article in journal (Refereed) Published
    Abstract [en]

    The pneumolysin (ply) gene is widely used as a target in PCR assays for Streptococcus pneumoniae in respiratory secretions. However, false-positive results with conventional ply-based PCR have been reported. The aim here was to study the performance of a quantitative ply-based PCR for the identification of pneumococcal lower respiratory tract infection (LRTI). In a prospective study, fibreoptic bronchoscopy was performed in 156 hospitalized adult patients with LRTI and 31 controls who underwent bronchoscopy because of suspicion of malignancy. Among the LRTI patients and controls, the quantitative ply-based PCR applied to bronchoalveolar lavage (BAL) fluid was positive at >/=10(3) genome copies/mL in 61% and 71% of the subjects, at >/=10(5) genome copies/mL in 40% and 58% of the subjects, and at >/=10(7) genome copies/mL in 15% and 3.2% of the subjects, respectively. Using BAL fluid culture, blood culture, and/or a urinary antigen test, S. pneumoniae was identified in 19 LRTI patients. As compared with these diagnostic methods used in combination, quantitative ply-based PCR showed sensitivities and specificities of 89% and 43% at a cut-off of 10(3) genome copies/mL, of 84% and 66% at a cut-off of 10(5) genome copies/mL, and of 53% and 90% at a cut-off of 10(7) genome copies/mL, respectively. In conclusion, a high cut-off with the quantitative ply-based PCR was required to reach acceptable specificity. However, as a high cut-off resulted in low sensitivity, quantitative ply-based PCR does not appear to be clinically useful. Quantitative PCR methods for S. pneumoniae using alternative gene targets should be evaluated.

    Keyword
    Bronchoalveolar lavage, PCR, pneumolysin, pneumonia, Streptococcus pneumoniae
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-102538 (URN)10.1111/j.1469-0691.2009.02714.x (DOI)000268261300011 ()19416297 (PubMedID)
    Available from: 2009-05-07 Created: 2009-05-07 Last updated: 2017-12-13Bibliographically approved
    3. Usefulness of real-time PCR for lytA, ply, and Spn9802 on plasma samples for the diagnosis of pneumococcal pneumonia
    Open this publication in new window or tab >>Usefulness of real-time PCR for lytA, ply, and Spn9802 on plasma samples for the diagnosis of pneumococcal pneumonia
    Show others...
    2010 (English)In: Clinical Microbiology and Infection, ISSN 1198-743X, E-ISSN 1469-0691, Vol. 16, no 8, 1135-1141 p.Article in journal (Refereed) Published
    Abstract [en]

    In the present study, we evaluated rapid real-time PCR assays for ply, Spn9802, and lytA applied to plasma samples for the detection of Streptococcus pneumoniae in patients with community-acquired pneumonia (CAP). In a prospective study of CAP aetiology, an EDTA plasma sample was collected together with blood culture in 92 adult CAP patients and 91 adult controls. Among the 92 CAP patients, lytA PCR was positive in eight (9%), Spn9802 PCR was positive in 11 (12%) and ply PCR was positive in 19 (21%) cases. Of 91 controls, the ply PCR was positive in eight cases (9%), but no positive cases were noted by Spn9802 or lytA PCRs. Ten CAP patients had pneumococcal bacteraemia. Compared to blood culture, PCR for lytA, Spn9802 and ply had sensitivities of 70% (7/10), 60% (6/10) and 70% (7/10), and specificities of 96% (79/82), 94% (77/82) and 85% (70/82) respectively. With blood culture and/or culture of representative sputum, and/or urinary antigen detection, S. pneumoniae was identified in 31 CAP patients. Compared to these tests in combination, PCR for lytA, Spn9802 and ply showed sensitivities of 26% (8/31), 32% (10/31) and 42% (13/31), and specificities of 100% (61/61), 98% (60/61) and 90% (55/61) respectively. We conclude that Spn9802 and lytA PCRs may be useful for the rapid detection of bacteraemic pneumococcal pneumonia, whereas ply PCR is not specific enough for routine use and blood PCR with small plasma volumes is not useful for the detection of nonbacteraemic pneumococcal pneumonia.

    Keyword
    lytA gene, plasma, ply gene, pneumococcal pneumonia, real-time PCR, Spn9802 fragment, Streptococcus pneumoniae
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-125332 (URN)10.1111/j.1469-0691.2009.03069.x (DOI)000280359900015 ()19832718 (PubMedID)
    Available from: 2010-05-17 Created: 2010-05-17 Last updated: 2017-12-12Bibliographically approved
    4. Detection of Haemophilus influenzae in respiratory secretions from pneumonia patients by quantitative real-time polymerase chain reaction
    Open this publication in new window or tab >>Detection of Haemophilus influenzae in respiratory secretions from pneumonia patients by quantitative real-time polymerase chain reaction
    Show others...
    2009 (English)In: Diagnostic microbiology and infectious disease, ISSN 0732-8893, E-ISSN 1879-0070, Vol. 64, no 4, 366-373 p.Article in journal (Refereed) Published
    Abstract [en]

    A quantitative real-time polymerase chain reaction (PCR) based on the omp P6 gene was developed to detect Haemophilus influenzae. Its specificity was determined by analysis of 29 strains of 11 different Haemophilus spp. and was compared with PCR assays having other target genes: rnpB, 16S rRNA, and bexA. The method was evaluated on nasopharyngeal aspirates from 166 adult patients with community-acquired pneumonia. When 104 DNA copies/mL was used as cutoff limit for the method, P6 PCR had a sensitivity of 97.5% and a specificity of 96.0% compared with the culture. Of 20 culture-negative but P6 PCR-positive cases, 18 were confirmed by fucK PCR as H. influenzae. Five (5.9%) of 84 nasopharyngeal aspirates from adult controls tested PCR positive. We conclude that the P6 real-time PCR is both sensitive and specific for identification of H. influenzae in respiratory secretions. Quantification facilitates discrimination between disease-causing H. influenzae strains and commensal colonization.

    Place, publisher, year, edition, pages
    Elsevier, 2009
    Keyword
    H. influenzae, Pneumonia, Real-time PCR, Outer membrane protein P6, fucK, rnpB
    National Category
    Microbiology in the medical area
    Research subject
    Microbiology
    Identifiers
    urn:nbn:se:uu:diva-106189 (URN)10.1016/j.diagmicrobio.2009.03.030 (DOI)000269337900002 ()19446978 (PubMedID)
    Available from: 2009-06-17 Created: 2009-06-17 Last updated: 2018-01-13Bibliographically approved
    5. Multiplex quantitative PCR for detection of lower respiratory tract infection and meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis
    Open this publication in new window or tab >>Multiplex quantitative PCR for detection of lower respiratory tract infection and meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis
    Show others...
    2010 (English)In: BMC Microbiology, ISSN 1471-2180, E-ISSN 1471-2180, Vol. 10, 310- p.Article in journal (Refereed) Published
    Abstract [en]

    Background. Streptococcus pneumoniae and Haemophilus influenzae cause pneumonia and as Neisseria meningitidis they are important agents of meningitis. Although several PCR methods have been described for these bacteria the specificity is an underestimated problem. Here we present a quantitative multiplex real-time PCR (qmPCR) for detection of S. pneumoniae (9802 gene fragment), H. influenzae (omp P6 gene) and N. meningitidis (ctrA gene). The method was evaluated on bronchoalveolar lavage (BAL) samples from 156 adults with lower respiratory tract infection (LRTI) and 31 controls, and on 87 cerebrospinal fluid (CSF) samples from meningitis patients.

    Results. The analytical sensitivity was not affected by using a combined mixture of reagents and a combined DNA standard (S. pneumoniae/H. influenzae/N. meningitidis) in single tubes. By blood- and BAL-culture and S. pneumoniae urinary antigen test, S. pneumoniae and H. influenzae were aetiological agents in 21 and 31 of the LTRI patients, respectively. These pathogens were identified by qmPCR in 52 and 72 of the cases, respectively, yielding sensitivities and specificities of 95% and 75% for S. pneumoniae, and 90% and 65% for H. influenzae, respectively. When using a cut-off of 105 genome copies/mL for clinical positivity the sensitivities and specificities were 90% and 80% for S. pneumoniae, and 81% and 85% for H. influenzae, respectively. Of 44 culture negative but qmPCR positive for H. influenzae, 41 were confirmed by fucK PCR as H. influenzae. Of the 103 patients who had taken antibiotics prior to sampling, S. pneumoniae and H. influenzae were identified by culture in 6% and 20% of the cases, respectively, and by the qmPCR in 36% and 53% of the cases, respectively. In 87 CSF samples S. pneumoniae and N. meningitidis were identified by culture and/or 16 S rRNA in 14 and 10 samples and by qmPCR in 14 and 10 samples, respectively, giving a sensitivity of 100% and a specificity of 100% for both bacteria.

    Conclusions. The PCR provides increased sensitivity and the multiplex format facilitates diagnosis of S. pneumoniae, H. influenzae and N. meningitidis and the assay enable detection after antibiotic treatment has been installed. Quantification increases the specificity of the etiology for pneumonia.

    Keyword
    S. pneumoniae, H. influenzae, N. meningitidis, quantitative multiplex PCR, lower respiratory tract infection
    National Category
    Medical and Health Sciences
    Research subject
    Clinical Bacteriology
    Identifiers
    urn:nbn:se:uu:diva-107967 (URN)10.1186/1471-2180-10-310 (DOI)000285888900001 ()21129171 (PubMedID)
    Available from: 2009-09-02 Created: 2009-09-02 Last updated: 2017-12-13Bibliographically approved
  • 8.
    Abdeldaim, Guma M. K.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology and Infectious Medicine, Clinical Bacteriology.
    Herrmann, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology and Infectious Medicine, Clinical Bacteriology.
    PCR detection of haemophilus influenzae from respiratory specimens2013In: PCR Detection of Microbial Pathogens / [ed] Mark Wilks, Humana Press, 2013, 2, 115-123 p.Chapter in book (Refereed)
    Abstract [en]

    The detection of Haemophilus influenzae by conventional methods like culture is time-consuming and may give false-negative results, especially during ongoing antibiotic treatment. Therefore, non-culture based methods that are sensitive, specific, and rapid are valuable for early diagnosis and effective therapy. Here we describe a quantitative real-time PCR assay based on the outer membrane P6 gene omp6, to detect H. influenzae and its application on respiratory tract specimens.

  • 9.
    Abdeldaim, Guma M. K.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology and Infectious Medicine, Clinical Bacteriology.
    Stralin, Kristoffer
    Olcen, Per
    Blomberg, Jonas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology and Infectious Medicine, Clinical Virology.
    Molling, Paula
    Herrmann, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology and Infectious Medicine, Clinical Bacteriology.
    Quantitative fucK gene polymerase chain reaction on sputum and nasopharyngeal secretions to detect Haemophilus influenzae pneumonia2013In: Diagnostic microbiology and infectious disease, ISSN 0732-8893, E-ISSN 1879-0070, Vol. 76, no 2, 141-146 p.Article in journal (Refereed)
    Abstract [en]

    A quantitative polymerase chain reaction (PCR) for the fucK gene was developed for specific detection of Haemophilus influenzae. The method was tested on sputum and nasopharyngeal aspirate (NPA) from 78 patients with community-acquired pneumonia (CAP). With a reference standard of sputum culture and/or serology against the patient's own nasopharyngeal isolate, H. influenzae etiology was detected in 20 patients. Compared with the reference standard, fucK PCR (using the detection limit 10(5) DNA copies/mL) on sputum and NPA showed a sensitivity of 95.0% (19/20) in both cases, and specificities of 87.9% (51/58) and 89.5% (52/58), respectively. In a receiver operating characteristic curve analysis, sputum fucK PCR was found to be significantly superior to sputum P6 PCR for detection of H. influenzae CAP. NPA fucK PCR was positive in 3 of 54 adult controls without respiratory symptoms. In conclusion, quantitative fucK real-time PCR provides a sensitive and specific identification of H. influenzae in respiratory secretions.

  • 10.
    Abdeldaim, Guma M. K.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Bacteriology.
    Strålin, Kristoffer
    Department of Infectious Diseases, Örebro University Hospital.
    Kirsebom, Leif A.
    Uppsala University, Disciplinary Domain of Science and Technology, Biology, Department of Cell and Molecular Biology, Microbiology.
    Olcén, Per
    Department of Clinical Microbiology, Örebro University Hospital.
    Blomberg, Jonas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Virology.
    Herrmann, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Bacteriology.
    Detection of Haemophilus influenzae in respiratory secretions from pneumonia patients by quantitative real-time polymerase chain reaction2009In: Diagnostic microbiology and infectious disease, ISSN 0732-8893, E-ISSN 1879-0070, Vol. 64, no 4, 366-373 p.Article in journal (Refereed)
    Abstract [en]

    A quantitative real-time polymerase chain reaction (PCR) based on the omp P6 gene was developed to detect Haemophilus influenzae. Its specificity was determined by analysis of 29 strains of 11 different Haemophilus spp. and was compared with PCR assays having other target genes: rnpB, 16S rRNA, and bexA. The method was evaluated on nasopharyngeal aspirates from 166 adult patients with community-acquired pneumonia. When 104 DNA copies/mL was used as cutoff limit for the method, P6 PCR had a sensitivity of 97.5% and a specificity of 96.0% compared with the culture. Of 20 culture-negative but P6 PCR-positive cases, 18 were confirmed by fucK PCR as H. influenzae. Five (5.9%) of 84 nasopharyngeal aspirates from adult controls tested PCR positive. We conclude that the P6 real-time PCR is both sensitive and specific for identification of H. influenzae in respiratory secretions. Quantification facilitates discrimination between disease-causing H. influenzae strains and commensal colonization.

  • 11.
    Abdeldaim, Guma M. K.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Bacteriology.
    Strålin, Kristoffer
    Olcén, Per
    Blomberg, Jonas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Virology.
    Herrmann, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Bacteriology.
    Toward a quantitative DNA-based definition of pneumococcal pneumonia: a comparison of Streptococcus pneumoniae target genes, with special reference to the Spn9802 fragment2008In: Diagnostic microbiology and infectious disease, ISSN 0732-8893, E-ISSN 1879-0070, Vol. 60, no 2, 143-150 p.Article in journal (Refereed)
    Abstract [en]

    The current shift from phenotypically toward genotypically based microbial diagnosis is not unproblematic. A novel quantitative real-time polymerase chain reaction (PCR) assay based on the Spn9802 DNA fragment was therefore developed for detection of Streptococcus pneumoniae. Out of 44 bacterial species, only S. pneumoniae and Streptococcus pseudopneumoniae were positive in Spn9802 PCR. In an evaluation on nasopharyngeal aspirates from 166 patients with community-acquired pneumonia, the assay was positive in 49 of 50 culture-positive cases. Of 19 culture-negative but Spn9802 PCR-positive cases, 12 were confirmed as S. pneumoniae by rnpB sequence analysis. With an expanded reference standard, including culture and rnpB sequencing, Spn9802 had a sensitivity of 94% and a specificity of 98%. A cutoff for clinically significant positivity was 10(4) DNA copies/mL, giving 71% sensitivity and 100% specificity. In conclusion, Spn9802 real-time PCR is highly sensitive and specific. The quantification it provides enables differentiation between pneumococcal pathogenicity and commensalism.

  • 12.
    Abdeldaim, Guma
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Bacteriology.
    Strålin, Kristoffer
    Department of Infectious Diseases, Örebro University Hospital, Örebro.
    Korsgaard, Jens
    Department of Chest Diseases, Aarhus University Hospital, Aalborg, Denmark.
    Blomberg, Jonas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Virology.
    Herrmann, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Bacteriology.
    Multiplex quantitative PCR for detection of lower respiratory tract infection and meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis2010In: BMC Microbiology, ISSN 1471-2180, E-ISSN 1471-2180, Vol. 10, 310- p.Article in journal (Refereed)
    Abstract [en]

    Background. Streptococcus pneumoniae and Haemophilus influenzae cause pneumonia and as Neisseria meningitidis they are important agents of meningitis. Although several PCR methods have been described for these bacteria the specificity is an underestimated problem. Here we present a quantitative multiplex real-time PCR (qmPCR) for detection of S. pneumoniae (9802 gene fragment), H. influenzae (omp P6 gene) and N. meningitidis (ctrA gene). The method was evaluated on bronchoalveolar lavage (BAL) samples from 156 adults with lower respiratory tract infection (LRTI) and 31 controls, and on 87 cerebrospinal fluid (CSF) samples from meningitis patients.

    Results. The analytical sensitivity was not affected by using a combined mixture of reagents and a combined DNA standard (S. pneumoniae/H. influenzae/N. meningitidis) in single tubes. By blood- and BAL-culture and S. pneumoniae urinary antigen test, S. pneumoniae and H. influenzae were aetiological agents in 21 and 31 of the LTRI patients, respectively. These pathogens were identified by qmPCR in 52 and 72 of the cases, respectively, yielding sensitivities and specificities of 95% and 75% for S. pneumoniae, and 90% and 65% for H. influenzae, respectively. When using a cut-off of 105 genome copies/mL for clinical positivity the sensitivities and specificities were 90% and 80% for S. pneumoniae, and 81% and 85% for H. influenzae, respectively. Of 44 culture negative but qmPCR positive for H. influenzae, 41 were confirmed by fucK PCR as H. influenzae. Of the 103 patients who had taken antibiotics prior to sampling, S. pneumoniae and H. influenzae were identified by culture in 6% and 20% of the cases, respectively, and by the qmPCR in 36% and 53% of the cases, respectively. In 87 CSF samples S. pneumoniae and N. meningitidis were identified by culture and/or 16 S rRNA in 14 and 10 samples and by qmPCR in 14 and 10 samples, respectively, giving a sensitivity of 100% and a specificity of 100% for both bacteria.

    Conclusions. The PCR provides increased sensitivity and the multiplex format facilitates diagnosis of S. pneumoniae, H. influenzae and N. meningitidis and the assay enable detection after antibiotic treatment has been installed. Quantification increases the specificity of the etiology for pneumonia.

  • 13.
    Abdeldaim, Guma
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology and Infectious Medicine, Clinical Bacteriology. Benghazi Univ, Fac Med, Dept Med Microbiol & Parasitol, Benghazi, Libya..
    Svensson, Erik
    Statens Serum Inst, Int Reference Lab Mycobacteriol, Copenhagen, Denmark..
    Blomberg, Jonas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology and Infectious Medicine, Clinical Virology.
    Herrmann, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology and Infectious Medicine, Clinical Bacteriology.
    Duplex detection of the Mycobacterium tuberculosis complex and medically important non-tuberculosis mycobacteria by real-time PCR based on the rnpB gene2016In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 124, no 11, 991-995 p.Article in journal (Refereed)
    Abstract [en]

    A duplex real-time PCR based on the rnpB gene was developed for Mycobacterium spp. The assay was specific for the Mycobacterium tuberculosis complex (MTB) and also detected all 19 tested species of non-tuberculous mycobacteria (NTM). The assay was evaluated on 404 clinical samples: 290 respiratory samples and 114 from tissue and other nonrespiratory body sites. M. tuberculosis was detected by culture in 40 samples and in 30 samples by the assay. The MTB assay showed a sensitivity similar to Roche Cobas Amplicor MTB-PCR (Roche Molecular Systems, Pleasanton, CA, USA). There were only nine samples with non-tuberculous mycobacteria detected by culture. Six of them were detected by the PCR assay.

  • 14.
    Abdelgadir, M
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
    Elbagir, M
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
    Eltom, A
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
    Eltom, M
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
    Berne, C
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
    Factors affecting perinatal morbidity and mortality in pregnanciescomplicated by diabetes mellitus in Sudan.2003In: Diabetes Res Clin Pract, Vol. 60, 41- p.Article in journal (Refereed)
  • 15.
    Abdelgadir, M
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
    Elbagir, M
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
    Eltom, M
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
    Berne, C
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
    Ahren, B
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
    Reduced leptin concentrations in subjects with type 2 diabetes mellitus in Sudan.2002In: Metabolism, Vol. 51, 304- p.Article in journal (Refereed)
  • 16.
    Abdelgadir, Moawia
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
    Clinical and Biochemical Features of Adult Diabetes Mellitus in Sudan2006Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The high prevalence of diabetes mellitus among the Sudanese population is linked to obesity, poor glycaemic control and a high rate of complications. This study investigated 1/ Leptin hormone and its correlations with different biochemical characteristics in Sudanese diabetic subjects, 2/ The impact of glycaemic control on pregnancy outcome in pregnancies with diabetes, 3/ The glycaemic response to Sudanese traditional carbohydrate foods, 4/ The influence of glucose self-monitoring on the glycaemic control among this population, 5/ The health related quality of life in Sudanese subjects with diabetes-related lower limb amputation.

    Leptin was significantly lower in diabetic subjects compared with controls of same BMI in both females (P =0.0001) and males (P =0.019). In diabetic subjects, serum leptin correlated positively with the homeostatic assessment (HOMA) of both beta-cell function (P =0.018) and insulin resistance (P =.038). In controls, leptin correlated only with insulin resistance. Pregnancy complications were higher among diabetic compared with control women (P<0.0001) and varied with the type of diabetes. Infants of diabetic mothers had a higher incidence of neonatal complications than those of non-diabetic women (P<0.0001). In six Sudanese traditional carbohydrate meals over all differences in incremental AUCs were significant for both plasma glucose (P = 0.0092) and insulin (P = 0.0001). Millet porridge and wheat pancakes displayed significantly lower post-prandial glucose and insulin responses, whereas maize porridge induced a higher post-prandial glucose and insulin response. In type 2 diabetic subjects SMBG or SMUG was not related to glycaemic control. In type 1 diabetic subjects, SMBG was significantly associated with better glycaemic control, as assessed by HbA1c (P=0.02) and blood glucose at clinic visits (P=<0.0001), similar associations were found for SMUG respectively. Neither glycaemic control nor glucose self-monitoring was associated with education level. Diabetic subjects with LLA had significantly poorer HRQL compared to a reference diabetic group (P=<0.0001). Duration of diabetes and amputation had negative impact on HRQL in subjects with LLA (P=<0.0001) respectively. Diabetic subjects with LLA had decreased sense of coherence and high presence of symptoms. Improving health services at the primary level is important to reduce the complications and burden of disease in the Sudanese population.

    List of papers
    1. leptin concentrations in subjects with type 2 diabetes mellitus in Sudan
    Open this publication in new window or tab >>leptin concentrations in subjects with type 2 diabetes mellitus in Sudan
    Show others...
    2002 In: Metabolism, Vol. 51, no 3, 304-6 p.Article in journal (Refereed) Published
    Identifiers
    urn:nbn:se:uu:diva-94368 (URN)
    Available from: 2006-05-04 Created: 2006-05-04Bibliographically approved
    2. Factors affecting perinatal morbidity and mortality in pregnancies complicated by diabetes mellitus in Sudan
    Open this publication in new window or tab >>Factors affecting perinatal morbidity and mortality in pregnancies complicated by diabetes mellitus in Sudan
    Show others...
    2003 In: Diabetes Res Clin Pract, Vol. 60, no 1, 41-7 p.Article in journal (Refereed) Published
    Identifiers
    urn:nbn:se:uu:diva-94369 (URN)
    Available from: 2006-05-04 Created: 2006-05-04Bibliographically approved
    3. Glycaemic and insulin responses of six traditional Sudanese carbohydrate-rich meals in subjects with Type 2 diabetes mellitus
    Open this publication in new window or tab >>Glycaemic and insulin responses of six traditional Sudanese carbohydrate-rich meals in subjects with Type 2 diabetes mellitus
    Show others...
    Article in journal (Refereed) Published
    Identifiers
    urn:nbn:se:uu:diva-94370 (URN)
    Available from: 2006-05-04 Created: 2006-05-04Bibliographically approved
    4. The influence of glucose self-monitoring on glycaemic control in patients with diabetes mellitus in Sudan
    Open this publication in new window or tab >>The influence of glucose self-monitoring on glycaemic control in patients with diabetes mellitus in Sudan
    2006 (English)In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 74, no 1, 90-94 p.Article in journal (Refereed) Published
    Abstract [en]

    Objective: To investigate the influence of self-monitoring of glucose on the glycaemic control in Sudanese diabetic subjects.

    Subjects and methods: A group of 193 consecutive type 2 and type I diabetic subjects (95 men, 98 women) were studied. In 104 subjects with type 2 diabetes fasting blood glucose was measured using a glucose meter and blood was obtained for serum glucose measurement in the laboratory. In the remaining 89 diabetic subjects random blood glucose was measured using the same glucose meter and a whole blood sample was drawn for laboratory assessment of HbA1c. Data on self-monitoring and other clinical and personal characteristics were recorded.

    Results: More than 75% of either type I and type 2 diabetic patients never self-monitored blood or urine glucose. In type 2 diabetic subjects self-monitoring of blood or urine glucose was not related to glycaemic control. In type I diabetic subjects, however, self-monitoring of blood glucose was significantly associated with better glycaemic control, as assessed by HbA1c (P = 0.02) and blood glucose at clinic visits (P < 0.0001), and similar associations were found for urine glucose self-monitoring (P = 0.04 and 0.02) respectively. Neither glycaemic control nor glucose self-monitoring was associated with education level.

    Conclusions: Self-monitoring of blood glucose was not found to be associated to better glycaemic control in Sudanese subjects with type 2 diabetes. In contrast, self-monitoring of both blood and urine glucose was significantly associated with glycaemic control in subjects with type I diabetes. Self-monitoring of urine glucose could be useful where measurement of blood glucose is not available or affordable.

    Keyword
    diabetes mellitus, self-monitoring, Sudan
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-94371 (URN)10.1016/j.diabres.2006.03.003 (DOI)000240801400013 ()16621118 (PubMedID)
    Available from: 2006-05-04 Created: 2006-05-04 Last updated: 2017-12-14Bibliographically approved
    5. Health related quality of life and sense of coherence in Sudanese diabetic subjects with lower limb amputation
    Open this publication in new window or tab >>Health related quality of life and sense of coherence in Sudanese diabetic subjects with lower limb amputation
    Show others...
    2009 (English)In: Tohoku journal of experimental medicine, ISSN 0040-8727, E-ISSN 1349-3329, Vol. 217, no 1, 45-50 p.Article in journal (Refereed) Published
    Abstract [en]

    Quality of life is an important outcome measure in diabetic patients with lower limb amputation (LLA). The aim of this study was to investigate the influence of lower limb amputation on health-related quality of life (HRQOL) in Sudanese diabetic subjects. Additionally the Sense of Coherence scale (SOC-13) and a symptom check list was used in subjects with LLA. A total of 60 (M/F; 40/20) diabetic subjects with LLA and 60 (M/F; 23/37) diabetic reference subjects without LLA, were studied. For both groups HRQOL was measured using The Medical Outcomes Study questionnaire (MOS). Subjects with LLA had significantly poorer HRQOL compared to the reference group in most HRQOL domains (p < 0.0001). Duration of diabetes had the greatest negative impact on HRQOL in both groups, those with LLA (p < 0.0001), and in those without LLA (p < 0.0001), although subjects who were amputated earlier had poorer HRQOL than recently amputated (p < 0.0001). Higher SOC scores were recorded in LLA patients who have greater ratings of positive feelings, family satisfaction and sleep in the HRQOL examination (p < 0.0001). In conclusion, Sudanese diabetic subjects with LLA have a poor quality of life. The triad of diabetes duration, symptoms and amputations, has turned to be important risk factor for poorer HRQOL. Functional and mobility status were suggested to be an important determinant of HRQOL among this population. As the Sudanese population has coherent social relationships, this poor performance of the diabetic subjects will certainly increase the burden on the whole family, in both integrity and economical status. Nevertheless, these deep-rooted social interrelations together with increasing diabetes awareness have substantially improved the family satisfaction among our patients.

    Keyword
    Diabetes mellitus, Lower limb amputation, Quality of life, Sense of coherence, Sudan
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-94372 (URN)10.1620/tjem.217.45 (DOI)000262897800007 ()19155607 (PubMedID)
    Available from: 2006-05-04 Created: 2006-05-04 Last updated: 2017-12-14Bibliographically approved
  • 17.
    Abdelgadir, Moawia
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences. Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
    Abbas, M
    Jarvi, A
    Elbagir, M
    Eltom, M
    Berne, Christian
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences. Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
    Glycaemic and insulin responses of six traditional Sudanese carbohydrate-rich meals in subjects with Type 2 diabetes mellitus.2005In: Diabet Med, ISSN 0742-3071, Vol. 22, no 2, 213-217 p.Article in journal (Refereed)
  • 18.
    Abdelgadir, Moawia
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
    Abbas, Mazahir
    Järvi, Anette
    Elbagir, Murtada
    Eltom, Mohamed
    Berne, Christian
    Glycaemic and insulin responses of six traditional Sudanese carbohydrate-rich meals in subjects with Type 2 diabetes mellitusArticle in journal (Refereed)
  • 19.
    Abdelgadir, Moawia
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
    Elbagir, Murtada
    Eltom, Aboud
    Eltom, Mohamed
    Berne, Christian
    Factors affecting perinatal morbidity and mortality in pregnancies complicated by diabetes mellitus in Sudan2003In: Diabetes Res Clin Pract, Vol. 60, no 1, 41-7 p.Article in journal (Refereed)
  • 20.
    Abdelgadir, Moawia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Elbagir, Murtada
    Eltom, Mohamed
    Berne, Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    The influence of glucose self-monitoring on glycaemic control in patients with diabetes mellitus in Sudan2006In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 74, no 1, 90-94 p.Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the influence of self-monitoring of glucose on the glycaemic control in Sudanese diabetic subjects.

    Subjects and methods: A group of 193 consecutive type 2 and type I diabetic subjects (95 men, 98 women) were studied. In 104 subjects with type 2 diabetes fasting blood glucose was measured using a glucose meter and blood was obtained for serum glucose measurement in the laboratory. In the remaining 89 diabetic subjects random blood glucose was measured using the same glucose meter and a whole blood sample was drawn for laboratory assessment of HbA1c. Data on self-monitoring and other clinical and personal characteristics were recorded.

    Results: More than 75% of either type I and type 2 diabetic patients never self-monitored blood or urine glucose. In type 2 diabetic subjects self-monitoring of blood or urine glucose was not related to glycaemic control. In type I diabetic subjects, however, self-monitoring of blood glucose was significantly associated with better glycaemic control, as assessed by HbA1c (P = 0.02) and blood glucose at clinic visits (P < 0.0001), and similar associations were found for urine glucose self-monitoring (P = 0.04 and 0.02) respectively. Neither glycaemic control nor glucose self-monitoring was associated with education level.

    Conclusions: Self-monitoring of blood glucose was not found to be associated to better glycaemic control in Sudanese subjects with type 2 diabetes. In contrast, self-monitoring of both blood and urine glucose was significantly associated with glycaemic control in subjects with type I diabetes. Self-monitoring of urine glucose could be useful where measurement of blood glucose is not available or affordable.

  • 21.
    Abdelgadir, Moawia
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
    Elbagir, Murtada
    Eltom, Mohamed
    Berne, Christian
    Ahren, Bo
    leptin concentrations in subjects with type 2 diabetes mellitus in Sudan2002In: Metabolism, Vol. 51, no 3, 304-6 p.Article in journal (Refereed)
  • 22.
    Abdelgadir, Moawia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrinology, Diabetes and Metabolism.
    Karlsson, Anders F.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrinology, Diabetes and Metabolism.
    Berglund, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Berne, Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrinology, Diabetes and Metabolism.
    Low serum adiponectin concentrations are associated with insulin sensitivity independent of obesity in Sudanese subjects with type 2 diabetes mellitus2013In: Diabetology and Metabolic Syndrome, ISSN 1758-5996, E-ISSN 1758-5996, Vol. 5, 15- p.Article in journal (Refereed)
    Abstract [en]

    Aims: Prevalence of Type 2 diabetes mellitus among Sudanese population was found to be 3.4% and associated with high rates of complications and obesity. Different adipocytokines are secreted from adipose tissues, among them adiponectin, which was shown to have insulins ensitizing properties and anti-inflammatory, anti-atherogenic effect. The aim of this study was to characterize type 2 diabetes in Sudanese diabetic subjects and controls in respect to hormones influencing or influenced by glucose metabolism. Methods: 104 type 2 diabetic patients (45 men and 59 women), and 75 matched control subjects (34 men and 41 women) were studied. Fasting serum samples were used to measure adiponectin, leptin, insulin, proinsulin, ghrelin and glucose. Body mass index, insulin/proinsulin ratio and (HOMA) insulin resistance and beta cell function were also calculated. Results: Adiponectin serum concentrations were significantly lower in subjects with type 2 diabetes compared with controls subjects (P = 0.002), comparison between males and females did not reach significant levels in both diabetic (P = 0.06) or controls (P = 0.16) groups. In the diabetic group adiponectin correlated positively with serum glucose, negatively with serum proinsulin and HOMA beta cell function (P = 0.03) respectively and serum ghrelin (P = 0.003), but not with BMI, HOMA insulin resistance, insulin or leptin. In controls serum adiponectin correlated negatively with BMI (P = 0.002) but not with other variables. Conclusions: The findings of this study suggest that, adiponectin concentrations independent on BMI as a measure of adiposity, were mostly linked to insulin sensitivity and not to insulin resistance in Sudanese type 2 diabetic subjects, where race specific regulation mechanisms or different type 2 diabetes phenotype suggested being a major contributory factor in clarification the findings of this study.

  • 23.
    Abdelgadir, Moawia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Shebeika, Wafaa
    Eltom, Mohamed
    Berne, Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Wikblad, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Health related quality of life and sense of coherence in Sudanese diabetic subjects with lower limb amputation2009In: Tohoku journal of experimental medicine, ISSN 0040-8727, E-ISSN 1349-3329, Vol. 217, no 1, 45-50 p.Article in journal (Refereed)
    Abstract [en]

    Quality of life is an important outcome measure in diabetic patients with lower limb amputation (LLA). The aim of this study was to investigate the influence of lower limb amputation on health-related quality of life (HRQOL) in Sudanese diabetic subjects. Additionally the Sense of Coherence scale (SOC-13) and a symptom check list was used in subjects with LLA. A total of 60 (M/F; 40/20) diabetic subjects with LLA and 60 (M/F; 23/37) diabetic reference subjects without LLA, were studied. For both groups HRQOL was measured using The Medical Outcomes Study questionnaire (MOS). Subjects with LLA had significantly poorer HRQOL compared to the reference group in most HRQOL domains (p < 0.0001). Duration of diabetes had the greatest negative impact on HRQOL in both groups, those with LLA (p < 0.0001), and in those without LLA (p < 0.0001), although subjects who were amputated earlier had poorer HRQOL than recently amputated (p < 0.0001). Higher SOC scores were recorded in LLA patients who have greater ratings of positive feelings, family satisfaction and sleep in the HRQOL examination (p < 0.0001). In conclusion, Sudanese diabetic subjects with LLA have a poor quality of life. The triad of diabetes duration, symptoms and amputations, has turned to be important risk factor for poorer HRQOL. Functional and mobility status were suggested to be an important determinant of HRQOL among this population. As the Sudanese population has coherent social relationships, this poor performance of the diabetic subjects will certainly increase the burden on the whole family, in both integrity and economical status. Nevertheless, these deep-rooted social interrelations together with increasing diabetes awareness have substantially improved the family satisfaction among our patients.

  • 24.
    Abdsaleh, Shahin
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology.
    Astrom, Gunnar
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology.
    Brenning, Gunilla
    Department of Medical Sciences.
    Ahlstrom, Håkan
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology.
    MR Imaging in Diagnosis of Primary Lymphedema.1996In: 1996 Scientific Program RSNA, 419- p.Article, book review (Other scientific)
  • 25.
    Abdul Qadhr, Göran
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Molin, Daniel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Oncology.
    Åström, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Oncology.
    Suurküla, Madis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Johansson, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Hagberg, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Oncology.
    Ahlström, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Whole-body diffusion-weighted imaging compared with FDG-PET/CT in staging of lymphoma patients2011In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 52, no 2, 173-180 p.Article in journal (Refereed)
    Abstract [en]

    Background:

    Diffusion-weighted imaging (DWI) has become increasingly valuable in lymph node imaging, yet the clinical utility of this technique in the staging of lymphoma has not been established.

    Purpose:

    To compare whole-body DWI with FDG-PET/CT in the staging of lymphoma patients.

    Material and Methods:

    Thirty-one patients, eight with Hodgkin lymphoma (HL) and 23 with non-Hodgkin's lymphoma (18 aggressive and five indolent) underwent both whole-body DWI, whole-body MRI (T1W and T2W-STIR) and FDG-PET/CT. Lesions on whole-body DWI were only considered positive if they correlated with lesions on T1W and T2W-STIR images. The staging given by each technique was compared, according to the Ann Arbor staging system. Differences in staging were solved using biopsy results, and clinical and CT follow-ups as standard of reference.

    Results:

    The staging was the same for DWI and FDG-PET/CT in 28 (90.3%) patients and different in three (9.7%). Of the 28 patients with the same staging, 11 had stage IV in both techniques and 17 had stages 0-III. No HL or aggressive non-Hodgkin's lymphoma patients had different staging. Three indolent small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL) lymphoma had higher staging with DWI when compared with FDG-PET/CT. One small subcutaneous breast lymphoma was not seen but all other extranodal sites were detected by both techniques.

    Conclusion:

    Whole-body DWI is a promising technique for staging of both (aggressive and indolent) non-Hodgkin's lymphoma and HL.

  • 26. Abedini, Sadollah
    et al.
    Holme, Ingar
    Fellström, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Jardine, Alan
    Cole, Ed
    Maes, Bart
    Holdaas, Hallvard
    Cerebrovascular events in renal transplant recipients2009In: Transplantation, ISSN 0041-1337, E-ISSN 1534-6080, Vol. 87, no 1, 112-7 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The incidence of stroke and risk factors for different subtypes of cerebrovascular (CBV) events in renal transplant recipients have not been examined in any large prospective controlled trial. METHODS: The Assessment of Lescol in Renal Transplantation was a randomized, double-blind, placebo-controlled study of the effect of fluvastatin (40-80 mg) daily on cardiovascular, and renal outcomes in renal transplant recipients. Patients initially randomized to fluvastatin or placebo in the 5 to 6 year trial was offered open-label fluvastatin in a 2-year extension to the original study. We investigated the incidence of stroke and risk factors for ischemic and hemorrhagic CBV events in 2102 renal graft recipients participating in the Assessment of Lescol in Renal Transplantation core and extension trial with a mean follow-up of 6.7 years. RESULTS: The incidence and type of CBV events did not differ between the lipid lowering arm and the placebo arm. A total of 184 (8.8%, 95% confidence interval 4.6-12.9) of 2102 patients experienced a CBV event during follow-up, corresponding to an incidence of 1.3% CBV event per year. The mortality for patients experiencing a hemorrhagic stroke was 48% (13 of 27), whereas the mortality for ischemic strokes was 6.0% (8 of 133). Diabetes mellitus, previous CBV event, age, and serum creatinine were independent risk factors for cerebral ischemic events. The risk of a hemorrhagic cerebral event was increased by diabetes mellitus, polycystic kidney disease, left ventricular hypertrophy, and systolic blood pressure. INTERPRETATION: Risk factors for CBV events in renal transplant recipients differ according to subtype.

  • 27. Abedini, Sadollah
    et al.
    Holme, Ingar
    März, Winfried
    Weihrauch, Gisela
    Fellström, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Jardine, Alan
    Cole, Edward
    Maes, Bart
    Neumayer, Hans-Hellmut
    Grönhagen-Riska, Carola
    Ambühl, Patrice
    Holdaas, Halvard
    Inflammation in renal transplantation2009In: Journal of the American Society of Nephrology, ISSN 1046-6673, E-ISSN 1533-3450, Vol. 4, no 7, 1246-1254 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVES: Renal transplant recipients experience premature cardiovascular disease and death. The association of inflammation, all-cause mortality, and cardiovascular events in renal transplant recipients has not been examined in a large prospective controlled trial. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: ALERT was a randomized, double-blind, placebo-controlled study of the effect of fluvastatin on cardiovascular and renal outcomes in 2102 renal transplant recipients. Patients initially randomized to fluvastatin or placebo in the 5- to 6-yr trial were offered open-label fluvastatin in a 2-yr extension to the original study. The association between inflammation markers, high-sensitivity C-reactive protein (hsCRP), and IL-6 on cardiovascular events and all-cause mortality was investigated. RESULTS: The baseline IL-6 value was 2.9 +/- 1.9 pg/ml (n = 1751) and that of hsCRP was 3.8 +/- 6.7 mg/L (n = 1910). After adjustment for baseline values for established risk factors, the hazard ratios for a major cardiac event and all-cause mortality for IL-6 were 1.08 [95% confidence interval (CI), 1.01 to 1.15, P = 0.018] and 1.11 (95% CI, 1.05 to 1.18, P < 0.001), respectively. The adjusted hazard ratio for hsCRP for a cardiovascular event was 1.10 (95% CI, 1.01 to 1.20, P = 0.027) and for all-cause mortality was 1.15 (95% CI, 1.06 to 1.1.25, P = 0.049). CONCLUSIONS: The inflammation markers IL-6 and hsCRP are independently associated with major cardiovascular events and all-cause mortality in renal transplant recipients.

  • 28. Abedini, Sadollah
    et al.
    Meinitzer, Andreas
    Holme, Ingar
    März, Winfried
    Weihrauch, Gisela
    Fellström, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Jardine, Alan
    Holdaas, Halvard
    Asymmetrical dimethylarginine is associated with renal and cardiovascular outcomes and all-cause mortality in renal transplant recipients2010In: Kidney International, ISSN 0085-2538, E-ISSN 1523-1755, Vol. 77, no 1, 44-50 p.Article in journal (Refereed)
    Abstract [en]

    Increased plasma levels of asymmetric dimethylarginine (ADMA) are associated with endothelial dysfunction and predict the progression to dialysis and death in patients with chronic kidney disease. The effects of these increased ADMA levels in renal transplant recipients, however, are unknown. We used the data from ALERT, a randomized, double-blind, placebo-controlled study of the effect of fluvastatin on cardiovascular and renal outcomes in 2102 renal transplant recipients with stable graft function on enrollment. Patients who were initially randomized to fluvastatin or placebo in the 5- to 6-year trial were offered open-label fluvastatin in a 2-year extension of the original study. After adjustment for baseline values for established factors in this post hoc analysis, ADMA was found to be a significant risk factor for graft failure or doubling of serum creatinine (hazard ratio 2.78), major cardiac events (hazard ratio 2.61), cerebrovascular events (hazard ratio 6.63), and all-cause mortality (hazard ratio 4.87). In this trial extension, the number of end points increased with increasing quartiles of plasma ADMA levels. All end points were significantly increased in the fourth compared to the first quartile. Our study shows that elevated plasma levels of ADMA are associated with increased morbidity, mortality, and the deterioration of graft function in renal transplant recipients.

  • 29. Abelsson, J
    et al.
    Merup, M
    Birgegård, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Haematology.
    WeisBjerrum, O
    Brinch, L
    Brune, M
    Johansson, P
    Kauppila, M
    Lenhoff, S
    Liljeholm, M
    Malm, C
    Remes, K
    Vindelöv, L
    Andréasson, B
    The outcome of allo-HSCT for 92 patients with myelofibrosis in the Nordic countries2012In: Bone Marrow Transplantation, ISSN 0268-3369, E-ISSN 1476-5365, Vol. 47, no 3, 380-386 p.Article in journal (Refereed)
    Abstract [en]

    Between 1982 and 2009 a total of 92 patients with myelofibrosis (MF) in chronic phase underwent allo-SCT in nine Nordic transplant centers. Myeloablative conditioning (MAC) was given to 40 patients, and reduced intensity conditioning (RIC) was used in 52 patients. The mean age in the two groups at transplantation was 46±12 and 55±8 years, respectively (P<0.001). When adjustment for age differences was made, the survival of the patients treated with RIC was significantly better (P=0.003). Among the RIC patients, the survival was significantly (P=0.003) better for the patients with age <60 years (a 10-year survival close to 80%) than for the older patients. The type of stem cell donor did not significantly affect the survival. No significant difference was found in TRM at 100 days between the MAC- and the RIC-treated patients. The probability of survival at 5 years was 49% for the MAC-treated patients and 59% in the RIC group (P=0.125). Patients treated with RIC experienced significantly less aGVHD compared with patients treated with MAC (P<0.001). The OS at 5 years was 70, 59 and 41% for patients with Lille score 0, 1 and 2, respectively (P=0.038, when age adjustment was made). Twenty-one percent of the patients in the RIC group were given donor lymphocyte infusion because of incomplete donor chimerism, compared with none of the MAC-treated patients (P<0.002). Nine percent of the patients needed a second transplant because of graft failure, progressive disease or transformation to AML, with no significant difference between the groups. Our conclusions are (1) allo-SCT performed with RIC gives a better survival compared with MAC. (2) age over 60 years is strongly related to a worse outcome and (3) patients with higher Lille score had a shorter survival.

  • 30. Abelsson, Johanna
    et al.
    Andreasson, Bjorn
    Samuelsson, Jan
    Hultcrantz, Malin
    Ejerblad, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Haematology.
    Johansson, Berit
    Emanuel, Robyn
    Mesa, Ruben
    Johansson, Peter
    Patients with polycythemia vera have worst impairment of quality of life among patients with newly diagnosed myeloproliferative neoplasms2013In: Leukemia and Lymphoma, ISSN 1042-8194, E-ISSN 1029-2403, Vol. 54, no 10, 2226-2230 p.Article in journal (Refereed)
    Abstract [en]

    The quality of life (QoL) at the time of diagnosis of myeloproliferative neoplasm (MPN) has, to date, not been studied. One hundred and seventy-nine patients with MPN: 80 with essential thrombocythemia (ET), 73 with polycythemia vera (PV), 22 with primary myelofibrosis (PMF) and four with MPN undifferentiated, were included in this study. European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC-QLQC30) and the MPN-Symptom Assessment Form (MPN-SAF) were used to evaluate QoL. Fatigue was the most reported symptom in these patients. Patients with PV reported significantly higher mean scores for inactivity, dizziness, cough, itching, depression and lower total QoL compared to patients with ET. Patients with PV had significantly more headache and itching compared to patients with PMF. When the newly diagnosed patients with MPN were compared with a cohort of patients with MPN with mean disease duration of 7.8 years, the differences were most striking for patients with PMF, with significantly more fatigue, abdominal discomfort, concentration problems, insomnia, fever, weight loss and lower overall QoL developed over time.

  • 31. Aberg, H
    et al.
    Morlin, C
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
    Lithell, Hans
    Department of Public Health and Caring Sciences.
    Different long-term metabolic effects of enalapril and atenolol in patients with mild hypertension. EGTA Group1995In: J Hum Hypertens, Vol. 9, 149- p.Article in journal (Refereed)
  • 32.
    Aberg, Mikael
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Coagulation and inflammation science.
    Eriksson, Oskar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Coagulation and inflammation science.
    Siegbahn, Agneta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Coagulation and inflammation science.
    Tissue Factor Noncoagulant Signaling: Mechanisms and Implications for Cell Migration and Apoptosis2015In: Seminars in Thrombosis and Hemostasis, ISSN 0094-6176, E-ISSN 1098-9064, Vol. 41, no 7, 691-699 p.Article in journal (Refereed)
    Abstract [en]

    Tissue factor (TF) is a 47-kDa transmembrane glycoprotein and the main initiator of the blood coagulation cascade. Binding to its ligand factor VIIa (FVIIa) also initiates noncoagulant signaling with broad biological implications. In this review, we discuss how TF interacts with other cell-surface proteins, which affect biological functions such as cell migration and cell survival. A vast number of publications have demonstrated the importance of TF-induced activation of protease-activated receptors, but recently published research has indicated a more complicated picture. As it has been discovered that TF interacts with integrins and receptor tyrosine kinases, novel signaling mechanisms for the TF/FVIIa complex have been presented. The knowledge of these new aspects of TF signaling may, for instance, facilitate the development of new treatment strategies for cancer and acute coronary syndromes, two examples of diseases characterized by aberrant TF expression and signaling.

  • 33.
    Ablikim, M.
    et al.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Achasov, M. N.
    GI Budker Inst Nucl Phys SB RAS BINP, Novosibirsk 630090, Russia..
    Ahmed, S.
    Helmholtz Inst Mainz, D-55099 Mainz, Germany..
    Ai, X. C.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Albayrak, O.
    Carnegie Mellon Univ, Pittsburgh, PA 15213 USA..
    Albrecht, M.
    Ruhr Univ Bochum, D-44780 Bochum, Germany..
    Ambrose, D. J.
    Univ Rochester, Rochester, NY 14627 USA..
    Amoroso, A.
    GI Budker Inst Nucl Phys SB RAS BINP, Novosibirsk 630090, Russia.;Helmholtz Inst Mainz, D-55099 Mainz, Germany.;Johannes Gutenberg Univ Mainz, D-55099 Mainz, Germany.;Chinese Acad Sci, Beijing 100049, Peoples R China.;Univ Hawaii, Honolulu, HI 96822 USA.;Univ Punjab, Lahore 54590, Pakistan.;Univ Turin, I-10125 Turin, Italy.;INFN, I-10125 Turin, Italy..
    An, F. F.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    An, Q.
    Univ Sci & Technol China, Hefei 230026, Peoples R China..
    Bai, J. Z.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Ferroli, R. Baldini
    INFN Lab Nazl Frascati, I-00044 I- Frascati, Italy..
    Ban, Y.
    Peking Univ, Beijing 100871, Peoples R China..
    Bennett, D. W.
    Indiana Univ, Bloomington, IN 47405 USA..
    Bennett, J. V.
    Carnegie Mellon Univ, Pittsburgh, PA 15213 USA..
    Berger, N. B.
    Johannes Gutenberg Univ Mainz, D-55099 Mainz, Germany..
    Bertani, M.
    INFN Lab Nazl Frascati, I-00044 I- Frascati, Italy..
    Bettoni, D.
    INFN, Sez Ferrara, I-44122 Ferrara, Italy..
    Bian, J. M.
    Univ Minnesota, Minneapolis, MN 55455 USA..
    Bianchi, F.
    Univ Turin, I-10125 Turin, Italy.;INFN, I-10125 Turin, Italy..
    Boger, E.
    Joint Inst Nucl Res, Dubna 141980, Moscow Region, Russia..
    Boyko, I.
    Joint Inst Nucl Res, Dubna 141980, Moscow Region, Russia..
    Briere, R. A.
    Carnegie Mellon Univ, Pittsburgh, PA 15213 USA..
    Cai, H.
    Wuhan Univ, Wuhan 430072, Peoples R China..
    Cai, X.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Cakir, O.
    Ankara Univ, TR-06100 Ankara, Turkey..
    Calcaterra, A.
    INFN Lab Nazl Frascati, I-00044 I- Frascati, Italy.;Johannes Gutenberg Univ Mainz, D-55099 Mainz, Germany.;Chinese Acad Sci, Beijing 100049, Peoples R China.;Univ Turin, I-10125 Turin, Italy.;INFN, I-10125 Turin, Italy..
    Cao, G. F.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Cetin, S. A.
    Istanbul Bilgi Univ, TR-34060 Istanbul, Turkey..
    Chang, J. F.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Chelkov, G.
    Joint Inst Nucl Res, Dubna 141980, Moscow Region, Russia..
    Chen, G.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Chen, H. S.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Chen, H. Y.
    Beihang Univ, Beijing 100191, Peoples R China..
    Chen, J. C.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Chen, M. L.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Chen, S.
    Chinese Acad Sci, Beijing 100049, Peoples R China..
    Chen, S. J.
    Nanjing Univ, Nanjing 210093, Peoples R China..
    Chen, X.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Chen, X. R.
    Lanzhou Univ, Lanzhou 730000, Peoples R China..
    Chen, Y. B.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Cheng, H. P.
    Huangshan Coll, Huangshan 245000, Peoples R China..
    Chu, X. K.
    Peking Univ, Beijing 100871, Peoples R China..
    Cibinetto, G.
    INFN, Sez Ferrara, I-44122 Ferrara, Italy..
    Dai, H. L.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Dai, J. P.
    Shanghai Jiao Tong Univ, Shanghai 200240, Peoples R China..
    Dbeyssi, A.
    Helmholtz Inst Mainz, D-55099 Mainz, Germany..
    Dedovich, D.
    Joint Inst Nucl Res, Dubna 141980, Moscow Region, Russia..
    Deng, Z. Y.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Denig, A.
    Johannes Gutenberg Univ Mainz, D-55099 Mainz, Germany..
    Denysenko, I.
    Joint Inst Nucl Res, Dubna 141980, Moscow Region, Russia..
    Destefanis, M.
    Univ Turin, I-10125 Turin, Italy.;INFN, I-10125 Turin, Italy..
    De Mori, F.
    Liaoning Univ, Shenyang 110036, Peoples R China..
    Ding, Y.
    Liaoning Univ, Shenyang 110036, Peoples R China..
    Dong, C.
    Nankai Univ, Tianjin 300071, Peoples R China..
    Dong, J.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Dong, L. Y.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Dong, M. Y.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Dou, Z. L.
    Nanjing Univ, Nanjing 210093, Peoples R China..
    Du, S. X.
    Zhengzhou Univ, Zhengzhou 450001, Peoples R China..
    Duan, P. F.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Fan, J. Z.
    Tsinghua Univ, Beijing 100084, Peoples R China..
    Fang, J.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Fang, S. S.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Fang, X.
    Univ Sci & Technol China, Hefei 230026, Peoples R China..
    Fang, Y.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Farinelli, R.
    INFN, Sez Ferrara, I-44122 Ferrara, Italy.;Univ Ferrara, I-44122 Ferrara, Italy..
    Fava, L.
    Univ Piemonte Orientale, I-15121 Alessandria, Italy.;INFN, I-10125 Turin, Italy..
    Fedorov, O.
    Joint Inst Nucl Res, Dubna 141980, Moscow Region, Russia..
    Feldbauer, F.
    Johannes Gutenberg Univ Mainz, D-55099 Mainz, Germany..
    Felici, G.
    INFN Lab Nazl Frascati, I-00044 I- Frascati, Italy..
    Feng, C. Q.
    Univ Sci & Technol China, Hefei 230026, Peoples R China..
    Fioravanti, E.
    INFN, Sez Ferrara, I-44122 Ferrara, Italy..
    Fritsch, M.
    Helmholtz Inst Mainz, D-55099 Mainz, Germany.;Johannes Gutenberg Univ Mainz, D-55099 Mainz, Germany..
    Fu, C. D.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Gao, Q.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Gao, X. L.
    Univ Sci & Technol China, Hefei 230026, Peoples R China..
    Gao, X. Y.
    Beihang Univ, Beijing 100191, Peoples R China..
    Gao, Y.
    Tsinghua Univ, Beijing 100084, Peoples R China..
    Gao, Z.
    Univ Sci & Technol China, Hefei 230026, Peoples R China..
    Garzia, I.
    INFN, Sez Ferrara, I-44122 Ferrara, Italy..
    Goetzen, K.
    GSI Helmholtzcentre Heavy Ion Res GmbH, D-64291 Darmstadt, Germany..
    Gong, L.
    Nankai Univ, Tianjin 300071, Peoples R China..
    Gong, W. X.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Gradl, W.
    Johannes Gutenberg Univ Mainz, D-55099 Mainz, Germany..
    Greco, M.
    Univ Turin, I-10125 Turin, Italy.;INFN, I-10125 Turin, Italy..
    Gu, M. H.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Gu, Y. T.
    Guangxi Univ, Nanning 530004, Peoples R China..
    Guan, Y. H.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Guo, A. Q.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Guo, L. B.
    Nanjing Normal Univ, Nanjing 210023, Peoples R China..
    Guo, R. P.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Guo, Y.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Guo, Y. P.
    Johannes Gutenberg Univ Mainz, D-55099 Mainz, Germany..
    Haddadi, Z.
    Univ Groningen, KVI CART, NL-9747 AA Groningen, Netherlands..
    Hafner, A.
    Johannes Gutenberg Univ Mainz, D-55099 Mainz, Germany..
    Han, S.
    Wuhan Univ, Wuhan 430072, Peoples R China..
    Hao, X. Q.
    Henan Normal Univ, Xinxiang 453007, Peoples R China..
    Harris, F. A.
    Univ Hawaii, Honolulu, HI 96822 USA..
    He, K. L.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Heinsius, F. H.
    Ruhr Univ Bochum, D-44780 Bochum, Germany..
    Held, T.
    Ruhr Univ Bochum, D-44780 Bochum, Germany..
    Heng, Y. K.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Holtmann, T.
    Ruhr Univ Bochum, D-44780 Bochum, Germany..
    Hou, Z. L.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Hu, C.
    Nanjing Normal Univ, Nanjing 210023, Peoples R China..
    Hu, H. M.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Hu, J. F.
    Univ Turin, I-10125 Turin, Italy.;INFN, I-10125 Turin, Italy..
    Hu, T.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Hu, Y.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Huang, G. S.
    Univ Sci & Technol China, Hefei 230026, Peoples R China..
    Huang, J. S.
    Henan Normal Univ, Xinxiang 453007, Peoples R China..
    Huang, X. T.
    Shandong Univ, Jinan 250100, Peoples R China..
    Huang, X. Z.
    Nanjing Univ, Nanjing 210093, Peoples R China..
    Huang, Y.
    Nanjing Univ, Nanjing 210093, Peoples R China..
    Huang, Z. L.
    Liaoning Univ, Shenyang 110036, Peoples R China..
    Hussain, T.
    Univ Punjab, Lahore 54590, Pakistan..
    Ji, Q.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Ji, Q. P.
    Nankai Univ, Tianjin 300071, Peoples R China..
    Ji, X. B.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Ji, X. L.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Jiang, L. W.
    Wuhan Univ, Wuhan 430072, Peoples R China..
    Jiang, X. S.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Jiang, X. Y.
    Nankai Univ, Tianjin 300071, Peoples R China..
    Jiao, J. B.
    Shandong Univ, Jinan 250100, Peoples R China..
    Jiao, Z.
    Huangshan Coll, Huangshan 245000, Peoples R China..
    Jin, D. P.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Jin, S.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Johansson, T
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Julin, A.
    Univ Minnesota, Minneapolis, MN 55455 USA..
    Kalantar-Nayestanaki, N.
    Univ Groningen, KVI CART, NL-9747 AA Groningen, Netherlands..
    Kang, X. L.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Kang, X. S.
    Nankai Univ, Tianjin 300071, Peoples R China..
    Kavatsyuk, M.
    Univ Groningen, KVI CART, NL-9747 AA Groningen, Netherlands..
    Ke, B. C.
    Carnegie Mellon Univ, Pittsburgh, PA 15213 USA..
    Kiese, P.
    Johannes Gutenberg Univ Mainz, D-55099 Mainz, Germany..
    Kliemt, R.
    Helmholtz Inst Mainz, D-55099 Mainz, Germany..
    Kloss, B.
    Johannes Gutenberg Univ Mainz, D-55099 Mainz, Germany..
    Kolcu, O. B.
    Istanbul Bilgi Univ, TR-34060 Istanbul, Turkey..
    Kopf, B.
    Ruhr Univ Bochum, D-44780 Bochum, Germany..
    Kornicer, M.
    Univ Hawaii, Honolulu, HI 96822 USA..
    Kupsc, Andrzej
    Uppsala University, The Svedberg Laboratory. Uppsala University, Disciplinary Domain of Science and Technology, Physics, Department of Physics and Astronomy, Nuclear Physics.
    Khn, W.
    Justus Liebig Univ Giessen, Phys Inst 2, D-35392 Giessen, Germany..
    Lange, J. S.
    Justus Liebig Univ Giessen, Phys Inst 2, D-35392 Giessen, Germany..
    Lara, M.
    Indiana Univ, Bloomington, IN 47405 USA..
    Larin, P.
    Helmholtz Inst Mainz, D-55099 Mainz, Germany..
    Leithoff, H.
    Johannes Gutenberg Univ Mainz, D-55099 Mainz, Germany..
    Leng, C.
    INFN, I-10125 Turin, Italy..
    Li, Cui
    Uppsala University, Disciplinary Domain of Science and Technology, Physics, Department of Physics and Astronomy, Nuclear Physics.
    Li, Cheng
    Univ Sci & Technol China, Hefei 230026, Peoples R China..
    Li, D. M.
    Zhengzhou Univ, Zhengzhou 450001, Peoples R China..
    Li, F.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Li, F. Y.
    Peking Univ, Beijing 100871, Peoples R China..
    Li, G.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Li, H. B.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Li, H. J.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Li, J. C.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Li, Jin
    Seoul Natl Univ, Seoul 151747, South Korea..
    Li, K.
    Hangzhou Normal Univ, Hangzhou 310036, Peoples R China.;Shandong Univ, Jinan 250100, Peoples R China..
    Li, Lei
    Beijing Inst Petrochem Technol, Beijing 102617, Peoples R China..
    Li, P. R.
    Chinese Acad Sci, Beijing 100049, Peoples R China..
    Li, Q. Y.
    Shandong Univ, Jinan 250100, Peoples R China..
    Li, T.
    Shandong Univ, Jinan 250100, Peoples R China..
    Li, W. D.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Li, W. G.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Li, X. L.
    Shandong Univ, Jinan 250100, Peoples R China..
    Li, X. M.
    Guangxi Univ, Nanning 530004, Peoples R China..
    Li, X. N.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Li, X. Q.
    Nankai Univ, Tianjin 300071, Peoples R China..
    Li, Y. B.
    Beihang Univ, Beijing 100191, Peoples R China..
    Li, Z. B.
    Sun Yat Sen Univ, Guangzhou 510275, Guangdong, Peoples R China..
    Liang, H.
    Univ Sci & Technol China, Hefei 230026, Peoples R China..
    Liang, J. J.
    Guangxi Univ, Nanning 530004, Peoples R China..
    Liang, Y. F.
    Sichuan Univ, Chengdu 610064, Peoples R China..
    Liang, Y. T.
    Justus Liebig Univ Giessen, Phys Inst 2, D-35392 Giessen, Germany..
    Liao, G. R.
    Guangxi Normal Univ, Guilin 541004, Peoples R China..
    Lin, D. X.
    Helmholtz Inst Mainz, D-55099 Mainz, Germany..
    Liu, B.
    Shanghai Jiao Tong Univ, Shanghai 200240, Peoples R China..
    Liu, B. J.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Liu, C. X.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Liu, D.
    Univ Sci & Technol China, Hefei 230026, Peoples R China..
    Liu, F. H.
    Shanxi Univ, Taiyuan 030006, Peoples R China..
    Liu, Fang
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Liu, Feng
    Cent China Normal Univ, Wuhan 430079, Peoples R China..
    Liu, H. B.
    Guangxi Univ, Nanning 530004, Peoples R China..
    Liu, H. H.
    Inst High Energy Phys, Beijing 100049, Peoples R China.;Henan Univ Sci & Technol, Luoyang 471003, Peoples R China..
    Liu, H. M.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Liu, J.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Liu, J. B.
    Univ Sci & Technol China, Hefei 230026, Peoples R China..
    Liu, J. P.
    Wuhan Univ, Wuhan 430072, Peoples R China..
    Liu, J. Y.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Liu, K.
    Tsinghua Univ, Beijing 100084, Peoples R China..
    Liu, K. Y.
    Liaoning Univ, Shenyang 110036, Peoples R China..
    Liu, L. D.
    Peking Univ, Beijing 100871, Peoples R China..
    Liu, P. L.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Liu, Q.
    Chinese Acad Sci, Beijing 100049, Peoples R China..
    Liu, S. B.
    Univ Sci & Technol China, Hefei 230026, Peoples R China..
    Liu, X.
    Lanzhou Univ, Lanzhou 730000, Peoples R China..
    Liu, Y. B.
    Nankai Univ, Tianjin 300071, Peoples R China..
    Liu, Y. Y.
    Nankai Univ, Tianjin 300071, Peoples R China..
    Liu, Z. A.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Liu, Zhiqing
    Johannes Gutenberg Univ Mainz, D-55099 Mainz, Germany..
    Loehner, H.
    Univ Groningen, KVI CART, NL-9747 AA Groningen, Netherlands..
    Lou, X. C.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Lu, H. J.
    Huangshan Coll, Huangshan 245000, Peoples R China..
    Lu, J. G.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Lu, Y.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Lu, Y. P.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Luo, C. L.
    Nanjing Normal Univ, Nanjing 210023, Peoples R China..
    Luo, M. X.
    Zhejiang Univ, Hangzhou 310027, Zhejiang, Peoples R China..
    Luo, T.
    Univ Hawaii, Honolulu, HI 96822 USA..
    Luo, X. L.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Lyu, X. R.
    Chinese Acad Sci, Beijing 100049, Peoples R China..
    Ma, F. C.
    Liaoning Univ, Shenyang 110036, Peoples R China..
    Ma, H. L.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Ma, L. L.
    Shandong Univ, Jinan 250100, Peoples R China..
    Ma, M. M.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Ma, Q. M.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Ma, T.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Ma, X. N.
    Nankai Univ, Tianjin 300071, Peoples R China..
    Ma, X. Y.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Ma, Y. M.
    Shandong Univ, Jinan 250100, Peoples R China..
    Maas, F. E.
    Helmholtz Inst Mainz, D-55099 Mainz, Germany..
    Maggiora, M.
    Univ Turin, I-10125 Turin, Italy.;INFN, I-10125 Turin, Italy..
    Malik, Q. A.
    Univ Punjab, Lahore 54590, Pakistan..
    Mao, Y. J.
    Peking Univ, Beijing 100871, Peoples R China..
    Mao, Z. P.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Marcello, S.
    Univ Turin, I-10125 Turin, Italy.;INFN, I-10125 Turin, Italy..
    Messchendorp, J. G.
    Univ Groningen, KVI CART, NL-9747 AA Groningen, Netherlands..
    Mezzadri, G.
    Univ Ferrara, I-44122 Ferrara, Italy..
    Min, J.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Mitchell, R. E.
    Indiana Univ, Bloomington, IN 47405 USA..
    Mo, X. H.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Mo, Y. J.
    Cent China Normal Univ, Wuhan 430079, Peoples R China..
    Morales, C. Morales
    Helmholtz Inst Mainz, D-55099 Mainz, Germany..
    Muchnoi, N. Yu.
    GI Budker Inst Nucl Phys SB RAS BINP, Novosibirsk 630090, Russia..
    Muramatsu, H.
    Univ Minnesota, Minneapolis, MN 55455 USA..
    Musiol, P.
    Ruhr Univ Bochum, D-44780 Bochum, Germany..
    Nefedov, Y.
    Joint Inst Nucl Res, Dubna 141980, Moscow Region, Russia..
    Nerling, F.
    Helmholtz Inst Mainz, D-55099 Mainz, Germany..
    Nikolaev, I. B.
    GI Budker Inst Nucl Phys SB RAS BINP, Novosibirsk 630090, Russia..
    Ning, Z.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Nisar, S.
    COMSATS Inst Informat Technol, Lahore 54000, Pakistan..
    Niu, S. L.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Niu, X. Y.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Olsen, S. L.
    Seoul Natl Univ, Seoul 151747, South Korea..
    Ouyang, Q.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Pacetti, S.
    INFN, I-06100 Perugia, Italy.;Univ Perugia, I-06100 Perugia, Italy..
    Pan, Y.
    Univ Sci & Technol China, Hefei 230026, Peoples R China..
    Patteri, P.
    INFN Lab Nazl Frascati, I-00044 I- Frascati, Italy..
    Pelizaeus, M.
    Ruhr Univ Bochum, D-44780 Bochum, Germany..
    Peng, H. P.
    Univ Sci & Technol China, Hefei 230026, Peoples R China..
    Peters, K.
    GSI Helmholtzcentre Heavy Ion Res GmbH, D-64291 Darmstadt, Germany..
    Pettersson, Jean
    Uppsala University, Disciplinary Domain of Science and Technology, Chemistry, Department of Chemistry - BMC, Analytical Chemistry.
    Ping, J. L.
    Nanjing Normal Univ, Nanjing 210023, Peoples R China..
    Ping, R. G.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Poling, R.
    Univ Minnesota, Minneapolis, MN 55455 USA..
    Prasad, V.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Qi, H. R.
    Beihang Univ, Beijing 100191, Peoples R China..
    Qi, M.
    Nanjing Univ, Nanjing 210093, Peoples R China..
    Qian, S.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Qiao, C. F.
    Chinese Acad Sci, Beijing 100049, Peoples R China..
    Qin, L. Q.
    Shandong Univ, Jinan 250100, Peoples R China..
    Qin, N.
    Wuhan Univ, Wuhan 430072, Peoples R China..
    Qin, X. S.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Qin, Z. H.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Qiu, J. F.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Rashid, K. H.
    Univ Punjab, Lahore 54590, Pakistan..
    Redmer, C. F.
    Johannes Gutenberg Univ Mainz, D-55099 Mainz, Germany..
    Ripka, M.
    Johannes Gutenberg Univ Mainz, D-55099 Mainz, Germany..
    Rong, G.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Rosner, Ch.
    Helmholtz Inst Mainz, D-55099 Mainz, Germany..
    Ruan, X. D.
    Guangxi Univ, Nanning 530004, Peoples R China..
    Sarantsev, A.
    Joint Inst Nucl Res, Dubna 141980, Moscow Region, Russia..
    Savrie, M.
    Univ Ferrara, I-44122 Ferrara, Italy..
    Schnier, C.
    Ruhr Univ Bochum, D-44780 Bochum, Germany..
    Schönning, Karin
    Uppsala University, Disciplinary Domain of Science and Technology, Physics, Department of Physics and Astronomy, Nuclear Physics. Uppsala University, The Svedberg Laboratory.
    Schumann, S.
    Johannes Gutenberg Univ Mainz, D-55099 Mainz, Germany..
    Shan, W.
    Peking Univ, Beijing 100871, Peoples R China..
    Shao, M.
    Univ Sci & Technol China, Hefei 230026, Peoples R China..
    Shen, C. P.
    Beihang Univ, Beijing 100191, Peoples R China..
    Shen, P. X.
    Nankai Univ, Tianjin 300071, Peoples R China..
    Shen, X. Y.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Sheng, H. Y.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Shi, M.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Song, W. M.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Song, X. Y.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Sosio, S.
    Univ Turin, I-10125 Turin, Italy.;INFN, I-10125 Turin, Italy..
    Spataro, S.
    Univ Turin, I-10125 Turin, Italy.;INFN, I-10125 Turin, Italy..
    Sun, G. X.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Sun, J. F.
    Henan Normal Univ, Xinxiang 453007, Peoples R China..
    Sun, S. S.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Sun, X. H.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Sun, Y. J.
    Univ Sci & Technol China, Hefei 230026, Peoples R China..
    Sun, Y. Z.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Sun, Z. J.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Sun, Z. T.
    Indiana Univ, Bloomington, IN 47405 USA..
    Tang, C. J.
    Sichuan Univ, Chengdu 610064, Peoples R China..
    Tang, X.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Tapan, I.
    Uludag Univ, TR-16059 Bursa, Turkey..
    Thorndike, E. H.
    Univ Rochester, Rochester, NY 14627 USA..
    Tiemens, M.
    Univ Groningen, KVI CART, NL-9747 AA Groningen, Netherlands..
    Uman, I.
    Near East Univ, Nicosia 10, Turkey..
    Varner, G. S.
    Univ Hawaii, Honolulu, HI 96822 USA..
    Wang, B.
    Nankai Univ, Tianjin 300071, Peoples R China..
    Wang, B. L.
    Chinese Acad Sci, Beijing 100049, Peoples R China..
    Wang, D.
    Peking Univ, Beijing 100871, Peoples R China..
    Wang, D. Y.
    Peking Univ, Beijing 100871, Peoples R China..
    Wang, K.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Wang, L. L.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Wang, L. S.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Wang, M.
    Shandong Univ, Jinan 250100, Peoples R China..
    Wang, P.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Wang, P. L.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Wang, S. G.
    Peking Univ, Beijing 100871, Peoples R China..
    Wang, W.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Wang, W. P.
    Univ Sci & Technol China, Hefei 230026, Peoples R China..
    Wang, X. F.
    Tsinghua Univ, Beijing 100084, Peoples R China..
    Wang, Y.
    Soochow Univ, Suzhou 215006, Peoples R China..
    Wang, Y. D.
    Helmholtz Inst Mainz, D-55099 Mainz, Germany..
    Wang, Y. F.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Wang, Y. Q.
    Johannes Gutenberg Univ Mainz, D-55099 Mainz, Germany..
    Wang, Z.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Wang, Z. G.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Wang, Z. H.
    Univ Sci & Technol China, Hefei 230026, Peoples R China..
    Wang, Z. Y.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Weber, T.
    Johannes Gutenberg Univ Mainz, D-55099 Mainz, Germany..
    Wei, D. H.
    Guangxi Normal Univ, Guilin 541004, Peoples R China..
    Wei, J. B.
    Peking Univ, Beijing 100871, Peoples R China..
    Weidenkaff, P.
    Johannes Gutenberg Univ Mainz, D-55099 Mainz, Germany..
    Wen, S. P.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Wiedner, U.
    Ruhr Univ Bochum, D-44780 Bochum, Germany..
    Wolke, Magnus
    Uppsala University, Disciplinary Domain of Science and Technology, Physics, Department of Physics and Astronomy, Nuclear Physics.
    Wu, L. H.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Wu, L. J.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Wu, Z.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Xia, L.
    Univ Sci & Technol China, Hefei 230026, Peoples R China..
    Xia, L. G.
    Tsinghua Univ, Beijing 100084, Peoples R China..
    Xia, Y.
    Hunan Univ, Changsha 410082, Peoples R China..
    Xiao, D.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Xiao, H.
    Univ South China, Hengyang 421001, Peoples R China..
    Xiao, Z. J.
    Nanjing Normal Univ, Nanjing 210023, Peoples R China..
    Xie, Y. G.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Xiu, Q. L.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Xu, G. F.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Xu, J. J.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Xu, L.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Xu, Q. J.
    Hangzhou Normal Univ, Hangzhou 310036, Peoples R China..
    Xu, Q. N.
    Chinese Acad Sci, Beijing 100049, Peoples R China..
    Xu, X. P.
    Soochow Univ, Suzhou 215006, Peoples R China..
    Yan, L.
    Univ Turin, I-10125 Turin, Italy.;INFN, I-10125 Turin, Italy..
    Yan, W. B.
    Univ Sci & Technol China, Hefei 230026, Peoples R China..
    Yan, W. C.
    Univ Sci & Technol China, Hefei 230026, Peoples R China..
    Yan, Y. H.
    Hunan Univ, Changsha 410082, Peoples R China..
    Yang, H. J.
    Shanghai Jiao Tong Univ, Shanghai 200240, Peoples R China..
    Yang, H. X.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Yang, L.
    Wuhan Univ, Wuhan 430072, Peoples R China..
    Yang, Y. X.
    Guangxi Normal Univ, Guilin 541004, Peoples R China..
    Ye, M.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Ye, M. H.
    China Ctr Adv Sci & Technol, Beijing 100190, Peoples R China..
    Yin, J. H.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Yu, B. X.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Yu, C. X.
    Nankai Univ, Tianjin 300071, Peoples R China..
    Yu, J. S.
    Lanzhou Univ, Lanzhou 730000, Peoples R China..
    Yuan, C. Z.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Yuan, W. L.
    Nanjing Univ, Nanjing 210093, Peoples R China..
    Yuan, Y.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Yuncu, A.
    Istanbul Bilgi Univ, TR-34060 Istanbul, Turkey..
    Zafar, A. A.
    Univ Punjab, Lahore 54590, Pakistan..
    Zallo, A.
    INFN Lab Nazl Frascati, I-00044 I- Frascati, Italy..
    Zeng, Y.
    Hunan Univ, Changsha 410082, Peoples R China..
    Zeng, Z.
    Univ Sci & Technol China, Hefei 230026, Peoples R China..
    Zhang, B. X.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zhang, B. Y.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zhang, C.
    Nanjing Univ, Nanjing 210093, Peoples R China..
    Zhang, C. C.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zhang, D. H.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zhang, H. H.
    Sun Yat Sen Univ, Guangzhou 510275, Guangdong, Peoples R China..
    Zhang, H. Y.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zhang, J.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zhang, J. J.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zhang, J. L.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zhang, J. Q.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zhang, J. W.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zhang, J. Y.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zhang, J. Z.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zhang, K.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zhang, L.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zhang, S. Q.
    Nankai Univ, Tianjin 300071, Peoples R China..
    Zhang, X. Y.
    Shandong Univ, Jinan 250100, Peoples R China..
    Zhang, Y.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zhang, Y. H.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zhang, Y. N.
    Chinese Acad Sci, Beijing 100049, Peoples R China..
    Zhang, Y. T.
    Univ Sci & Technol China, Hefei 230026, Peoples R China..
    Zhang, Yu
    Chinese Acad Sci, Beijing 100049, Peoples R China..
    Zhang, Z. H.
    Cent China Normal Univ, Wuhan 430079, Peoples R China..
    Zhang, Z. P.
    Univ Sci & Technol China, Hefei 230026, Peoples R China..
    Zhang, Z. Y.
    Wuhan Univ, Wuhan 430072, Peoples R China..
    Zhao, G.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zhao, J. W.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zhao, J. Y.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zhao, J. Z.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zhao, Lei
    Univ Sci & Technol China, Hefei 230026, Peoples R China..
    Zhao, Ling
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zhao, M. G.
    Nankai Univ, Tianjin 300071, Peoples R China..
    Zhao, Q.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zhao, Q. W.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zhao, S. J.
    Zhengzhou Univ, Zhengzhou 450001, Peoples R China..
    Zhao, T. C.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zhao, Y. B.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zhao, Z. G.
    Univ Sci & Technol China, Hefei 230026, Peoples R China..
    Zhemchugov, A.
    Joint Inst Nucl Res, Dubna 141980, Moscow Region, Russia..
    Zheng, B.
    Univ South China, Hengyang 421001, Peoples R China..
    Zheng, J. P.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zheng, W. J.
    Shandong Univ, Jinan 250100, Peoples R China..
    Zheng, Y. H.
    Chinese Acad Sci, Beijing 100049, Peoples R China..
    Zhong, B.
    Nanjing Normal Univ, Nanjing 210023, Peoples R China..
    Zhou, L.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zhou, X.
    Wuhan Univ, Wuhan 430072, Peoples R China..
    Zhou, X. K.
    Univ Sci & Technol China, Hefei 230026, Peoples R China..
    Zhou, X. R.
    Univ Sci & Technol China, Hefei 230026, Peoples R China..
    Zhou, X. Y.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zhu, K.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zhu, K. J.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zhu, S.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zhu, S. H.
    Univ Sci & Technol Liaoning, Anshan 114051, Peoples R China..
    Zhu, X. L.
    Tsinghua Univ, Beijing 100084, Peoples R China..
    Zhu, Y. C.
    Univ Sci & Technol China, Hefei 230026, Peoples R China..
    Zhu, Y. S.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zhu, Z. A.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zhuang, J.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zotti, L.
    Univ Turin, I-10125 Turin, Italy.;INFN, I-10125 Turin, Italy..
    Zou, B. S.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Zou, J. H.
    Inst High Energy Phys, Beijing 100049, Peoples R China..
    Amplitude analysis of D0 -> K -π+π+π-2017In: Physical Review D: covering particles, fields, gravitation, and cosmology, ISSN 2470-0010, E-ISSN 2470-0029, Vol. 95, no 7, 072010Article in journal (Refereed)
    Abstract [en]

    We present an amplitude analysis of the decay D-0 -> K- pi(+)pi(+)pi(-) based on a data sample of 2.93 fb(-1) acquired by the BESIII detector at the psi(3770) resonance. With a nearly background free sample of about 16000 events, we investigate the substructure of the decay and determine the relative fractions and the phases among the different intermediate processes. Our amplitude model includes the two-body decays D-0 -> (K) over bar*(0)rho(0), D-0 -> K- a(1)(+) (1260) and D-0 -> K-1(-)(1270)pi(+), the three-body decays D-0 -> K-1(-)*(0)pi(+)pi(-) and D-0 -> K- pi(+)rho(0), as well as the four-body nonresonant decay D-0 -> K- pi(+)pi(+)pi(-). The dominant intermediate process is D-0 -> K(-)a(1)(+)(1260)accounting for a fit fraction of 54.6%.

  • 34. Abraham-Nordling, Mirna
    et al.
    Byström, Kristina
    Törring, Ove
    Lantz, Mikael
    Berg, Gertrud
    Calissendorff, Jan
    Nyström, Helena Filipsson
    Jansson, Svante
    Jörneskog, Gun
    Karlsson, F Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Nyström, Ernst
    Ohrling, Hans
    Orn, Thomas
    Hallengren, Bengt
    Wallin, Göran
    Incidence of hyperthyroidism in Sweden2011In: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 165, no 6, 899-905 p.Article in journal (Refereed)
    Abstract [en]

    Introduction The incidence of hyperthyroidism has been reported in various countries to be 23-93/100 000 inhabitants per year. This extended study has evaluated the incidence for ∼40% of the Swedish population of 9 million inhabitants. Sweden is considered to be iodine sufficient country. Methods All patients including children, who were newly diagnosed with overt hyperthyroidism in the years 2003-2005, were prospectively registered in a multicenter study. The inclusion criteria are as follows: clinical symptoms and/or signs of hyperthyroidism with plasma TSH concentration below 0.2 mIE/l and increased plasma levels of free/total triiodothyronine and/or free/total thyroxine. Patients with relapse of hyperthyroidism or thyroiditis were not included. The diagnosis of Graves' disease (GD), toxic multinodular goiter (TMNG) and solitary toxic adenoma (STA), smoking, initial treatment, occurrence of thyroid-associated eye symptoms/signs, and demographic data were registered. Results A total of 2916 patients were diagnosed with de novo hyperthyroidism showing the total incidence of 27.6/100 000 inhabitants per year. The incidence of GD was 21.0/100 000 and toxic nodular goiter (TNG=STA+TMNG) occurred in 692 patients, corresponding to an annual incidence of 6.5/100 000. The incidence was higher in women compared with men (4.2:1). Seventy-five percent of the patients were diagnosed with GD, in whom thyroid-associated eye symptoms/signs occurred during diagnosis in every fifth patient. Geographical differences were observed. Conclusion The incidence of hyperthyroidism in Sweden is in a lower range compared with international reports. Seventy-five percent of patients with hyperthyroidism had GD and 20% of them had thyroid-associated eye symptoms/signs during diagnosis. The observed geographical differences require further studies.

  • 35. Abrahamsson, Christina
    et al.
    Ahlund, Catherine
    Nordlander, Margareta
    Lind, Lars
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
    A method for heart rate-corrected estimation of baroreflex sensitivity.2003In: J Hypertens, ISSN 0263-6352, Vol. 21, no 11, 2133-40 p.Article in journal (Refereed)
  • 36.
    Abrahamsson, Niclas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    On the Impact of Bariatric Surgery on Glucose Homeostasis2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Obesity has grown to epidemic proportions, and in lack of efficient life-style and medical treatments, the bariatric surgeries are performed in rising numbers. The most common surgery is the Gastric Bypass (GBP) surgery, with the Biliopancreatic diversion with duodenal switch (DS) as an option for the most extreme cases with a BMI>50 kg/m2.

    In paper I 20 GBP-patients were examined during the first post-operative year regarding the natriuretic peptide, NT-ProBNP, which is secreted from the cardiac ventricles. Levels of NT-ProBNP quickly increased during the first post-surgery week, and later established itself on a higher level than pre-surgery.

    In paper II we report of 5 patient-cases after GBP-surgery with severe problems with postprandial hypoglycaemia that were successfully treated with GLP-1-analogs. The effect of treatment could be observed both symptomatically and in some cases using continuous glucose measuring systems (CGMS).

    In paper III three groups of subjects; 15 post-GBP patients, 15 post-DS, and 15 obese controls were examined for three days using CGMS during everyday life. The post-GBP group had high glucose variability as measured by MAGE and CONGA, whereas the post-DS group had low variability. Both post-operative groups exhibited significant time in hypoglycaemia, about 40 and 80 minutes per day <3.3mmol/l and 20 and 40 minutes < 2.8mmol/l, respectively, longer time for DS-group. Remarkably, only about 20% of these hypoglycaemic episodes were accompanied with symptoms.

    In Paper IV the hypoglycaemia counter regulatory system was investigated; 12 patients were examined before and after GBP-surgery with a stepped hypoglycaemic hyperinsulinemic clamp. The results show a downregulation of symptoms, counter regulatory hormones (glucagon, cortisol, epinephrine, norepinephrine, growth hormone), incretin hormones (GLP-1 and GIP), and sympathetic nervous response.

    In conclusion patients post bariatric surgery exhibit a downregulated counter regulatory response to hypoglycaemia, accompanied by frequent asymptomatic hypoglycaemic episodes in everyday life. Patients suffering from severe hypoglycaemic episodes can often be treated successfully with GLP-1-analogues.

    List of papers
    1. Gastric Bypass Surgery Elevates NT-ProBNP Levels
    Open this publication in new window or tab >>Gastric Bypass Surgery Elevates NT-ProBNP Levels
    2013 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 23, no 9, 1421-1426 p.Article in journal (Refereed) Published
    Abstract [en]

    Background

    Brain natriuretic peptide (BNP) is produced in the heart in response to stretching of the myocardium. BNP levels are negatively correlated to obesity, and in obese subjects, a reduced BNP responsiveness has been described. Diet-induced weight loss has been found to lower or to have no effect on BNP levels, whereas gastric banding and gastric bypass have reported divergent results. We studied obese patients undergoing gastric bypass (GBP) surgery during follow-up of 1 year.

    Methods

    Twenty patients, 18 women, mean 41 (SD 9.5) years old, with a mean preoperative BMI of 44.6 (SD 5.5) kg/m2 were examined. N-terminal pro-brain natriuretic peptide (NT-ProBNP), glucose and insulin were measured preoperatively, at day 6 and months 1, 6 and 12. In 14 of the patients, samples were also taken at days 1, 2 and 4.

    Results

    The NT-ProBNP levels showed a marked increase during the postoperative week (from 54 pg/mL preop to 359 pg/mL on day 2 and fell to 155 on day 6). At 1 year, NT-ProBNP was 122 pg/mL (125 % increase, p = 0.01). Glucose, insulin and HOMA indices decreased shortly after surgery without correlation to NT-ProBNP change. Mean BMI was reduced from 44.6 to 30.5 kg/m2 at 1 year and was not related to NT-ProBNP change.

    Conclusions

    The data indicate that GBP surgery rapidly alters the tone of BNP release, by a mechanism not related to weight loss or to changes in glucometabolic parameters. The GBP-induced conversion of obese subjects, from low to high NT-ProBNP responders, is likely to influence the evaluation of cardiac function in GBP operated individuals.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-199870 (URN)10.1007/s11695-013-0889-z (DOI)000322494800011 ()23456799 (PubMedID)
    Available from: 2013-05-17 Created: 2013-05-17 Last updated: 2017-12-06Bibliographically approved
    2. GLP1 analogs as treatment of postprandial hypoglycemia following gastric bypass surgery: a potential new indication?
    Open this publication in new window or tab >>GLP1 analogs as treatment of postprandial hypoglycemia following gastric bypass surgery: a potential new indication?
    2013 (English)In: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 169, no 6, 885-889 p.Article in journal (Refereed) Published
    Abstract [en]

    Objective: The number of morbidly obese subjects submitted to bariatric surgery is rising worldwide. In a fraction of patients undergoing gastric bypass (GBP), episodes with late postprandial hypoglycemia (PPHG) develop 1-3 years after surgery. The pathogenesis of this phenomenon is not fully understood; meal-induced rapid and exaggerated increases of circulating incretins and insulin appear to be at least partially responsible. Current treatments include low-carbohydrate diets, inhibition of glucose intestinal uptake, reduction of insulin secretion with calcium channel blockers, somatostatin analogs, or diazoxide, a KATP channel opener. Even partial pancreatectomy has been advocated. In type 2 diabetes, GLP1 analogs have a well-documented effect of stabilizing glucose levels without causing hypoglycemia. Design: We explored GLP1 analogs as open treatment in five consecutive GBP cases seeking medical attention because of late postprandial hypoglycemic symptoms. Results: Glucose measured in connection with the episodes in four of the cases had been 2.7, 2.5, 1.8, and 1.6 mmol/l respectively. The patients consistently described that the analogs eliminated their symptoms, which relapsed in four of the five patients when treatment was reduced/discontinued. The drug effect was further documented in one case by repeated 24-h continuous glucose measurements. Conclusion: These open, uncontrolled observations suggest that GLP1 analogs might provide a new treatment option in patients with problems of late PPHG.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-213465 (URN)10.1530/EJE-13-0504 (DOI)000327539100021 ()
    Available from: 2014-01-02 Created: 2013-12-23 Last updated: 2017-12-06Bibliographically approved
    3. Hypoglycemia in everyday life after gastric bypass and duodenal switch
    Open this publication in new window or tab >>Hypoglycemia in everyday life after gastric bypass and duodenal switch
    2015 (English)In: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 173, no 1, 91-100 p.Article in journal (Refereed) Published
    Abstract [en]

    Design: Gastric bypass (GBP) and duodenal switch (DS) in morbid obesity are accompanied by marked metabolic improvements, particularly in glucose control. In recent years, episodes of severe late postprandial hypoglycemia have been increasingly described in GBP patients; data in DS patients are scarce. We recruited three groups of subjects; 15 GBP, 15 DS, and 15 non-operated overweight controls to examine to what extent hypoglycemia occurs in daily life. Methods: Continuous glucose monitoring (CGM) was used during 3 days of normal activity. The glycemic variability was measured by mean amplitude of glycemic excursion and continuous overall net glycemic action. Fasting blood samples were drawn, and the patients kept a food and symptom log throughout the study. Results: The GBP group displayed highly variable CGM curves, and 2.9% of their time was spent in hypoglycemia (< 3.3 mmol/l, or 60 mg/dl). The DS group had twice as much time in hypoglycemia (5.9%) and displayed CGM curves with little variation as well as lower HbA1c levels (29.3 vs 35.9 mmol/mol, P < 0.05). Out of a total of 72 hypoglycemic episodes registered over the 3-day period, 70 (97%) occurred in the postprandial state and only about one-fifth of the hypoglycemic episodes in the GBP and DS groups were accompanied by symptoms. No hypoglycemias were seen in controls during the 3-day period. Conclusion: Both types of bariatric surgery induce marked, but different, changes in glucose balance accompanied by frequent, but mainly unnoticed, hypoglycemic episodes. The impact and mechanism of hypoglycemic unawareness after weight-reduction surgery deserves to be clarified.

    National Category
    Endocrinology and Diabetes
    Identifiers
    urn:nbn:se:uu:diva-261313 (URN)10.1530/EJE-14-0821 (DOI)000358947700018 ()25899582 (PubMedID)
    Available from: 2015-09-03 Created: 2015-09-01 Last updated: 2017-12-04Bibliographically approved
    4. Gastric bypass reduces symptoms and hormonal responses to hypoglycemia
    Open this publication in new window or tab >>Gastric bypass reduces symptoms and hormonal responses to hypoglycemia
    Show others...
    2016 (English)In: Diabetes, ISSN 0012-1797, E-ISSN 1939-327X, Vol. 65, no 9, 2667-2675 p.Article in journal (Refereed) Published
    Abstract [en]

    Gastric bypass (GBP) surgery, one of the most common bariatric procedures, induces weight loss and metabolic effects. The mechanisms are not fully understood, but reduced food intake and effects on gastrointestinal hormones are thought to contribute. We recently observed that GBP patients have lowered glucose levels and frequent asymptomatic hypoglycemic episodes. Here, we subjected patients before and after undergoing GBP surgery to hypoglycemia and examined symptoms and hormonal and autonomic nerve responses. Twelve obese patients without diabetes (8 women, mean age 43.1 years [SD 10.8] and BMI 40.6 kg/m(2) [SD 3.1]) were examined before and 23 weeks (range 19-25) after GBP surgery with hyperinsulinemic-hypoglycemic clamp (stepwise to plasma glucose 2.7 mmol/L). The mean change in Edinburgh Hypoglycemia Score during clamp was attenuated from 10.7 (6.4) before surgery to 5.2 (4.9) after surgery. There were also marked postsurgery reductions in levels of glucagon, cortisol, and catecholamine and the sympathetic nerve responses to hypoglycemia. In addition, growth hormone displayed a delayed response but to a higher peak level. Levels of glucagon-like peptide 1 and gastric inhibitory polypeptide rose during hypoglycemia but rose less postsurgery compared with presurgery. Thus, GBP surgery causes a resetting of glucose homeostasis, which reduces symptoms and neurohormonal responses to hypoglycemia. Further studies should address the underlying mechanisms as well as their impact on the overall metabolic effects of GBP surgery.

    Keyword
    Gastric bypass, hypoglycemia
    National Category
    Endocrinology and Diabetes
    Identifiers
    urn:nbn:se:uu:diva-276380 (URN)10.2337/db16-0341 (DOI)000382099800021 ()27313315 (PubMedID)
    Funder
    Swedish Diabetes Association
    Available from: 2016-02-12 Created: 2016-02-12 Last updated: 2017-11-30Bibliographically approved
  • 37.
    Abrahamsson, Niclas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrinology, Diabetes and Metabolism.
    Engström, Britt Edén
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrinology, Diabetes and Metabolism.
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Karlsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrinology, Diabetes and Metabolism.
    Gastric Bypass Surgery Elevates NT-ProBNP Levels2013In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 23, no 9, 1421-1426 p.Article in journal (Refereed)
    Abstract [en]

    Background

    Brain natriuretic peptide (BNP) is produced in the heart in response to stretching of the myocardium. BNP levels are negatively correlated to obesity, and in obese subjects, a reduced BNP responsiveness has been described. Diet-induced weight loss has been found to lower or to have no effect on BNP levels, whereas gastric banding and gastric bypass have reported divergent results. We studied obese patients undergoing gastric bypass (GBP) surgery during follow-up of 1 year.

    Methods

    Twenty patients, 18 women, mean 41 (SD 9.5) years old, with a mean preoperative BMI of 44.6 (SD 5.5) kg/m2 were examined. N-terminal pro-brain natriuretic peptide (NT-ProBNP), glucose and insulin were measured preoperatively, at day 6 and months 1, 6 and 12. In 14 of the patients, samples were also taken at days 1, 2 and 4.

    Results

    The NT-ProBNP levels showed a marked increase during the postoperative week (from 54 pg/mL preop to 359 pg/mL on day 2 and fell to 155 on day 6). At 1 year, NT-ProBNP was 122 pg/mL (125 % increase, p = 0.01). Glucose, insulin and HOMA indices decreased shortly after surgery without correlation to NT-ProBNP change. Mean BMI was reduced from 44.6 to 30.5 kg/m2 at 1 year and was not related to NT-ProBNP change.

    Conclusions

    The data indicate that GBP surgery rapidly alters the tone of BNP release, by a mechanism not related to weight loss or to changes in glucometabolic parameters. The GBP-induced conversion of obese subjects, from low to high NT-ProBNP responders, is likely to influence the evaluation of cardiac function in GBP operated individuals.

  • 38.
    Abrahamsson, Niclas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Engström, Britt Edén
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrinology and mineral metabolism.
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Karlsson, Anders F.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    GLP1 analogs as treatment of postprandial hypoglycemia following gastric bypass surgery: a potential new indication?2013In: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 169, no 6, 885-889 p.Article in journal (Refereed)
    Abstract [en]

    Objective: The number of morbidly obese subjects submitted to bariatric surgery is rising worldwide. In a fraction of patients undergoing gastric bypass (GBP), episodes with late postprandial hypoglycemia (PPHG) develop 1-3 years after surgery. The pathogenesis of this phenomenon is not fully understood; meal-induced rapid and exaggerated increases of circulating incretins and insulin appear to be at least partially responsible. Current treatments include low-carbohydrate diets, inhibition of glucose intestinal uptake, reduction of insulin secretion with calcium channel blockers, somatostatin analogs, or diazoxide, a KATP channel opener. Even partial pancreatectomy has been advocated. In type 2 diabetes, GLP1 analogs have a well-documented effect of stabilizing glucose levels without causing hypoglycemia. Design: We explored GLP1 analogs as open treatment in five consecutive GBP cases seeking medical attention because of late postprandial hypoglycemic symptoms. Results: Glucose measured in connection with the episodes in four of the cases had been 2.7, 2.5, 1.8, and 1.6 mmol/l respectively. The patients consistently described that the analogs eliminated their symptoms, which relapsed in four of the five patients when treatment was reduced/discontinued. The drug effect was further documented in one case by repeated 24-h continuous glucose measurements. Conclusion: These open, uncontrolled observations suggest that GLP1 analogs might provide a new treatment option in patients with problems of late PPHG.

  • 39.
    Abrahamsson, Niclas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Engström, Britt Edén
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrinology and mineral metabolism.
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Karlsson, Anders F.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Hypoglycemia in everyday life after gastric bypass and duodenal switch2015In: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 173, no 1, 91-100 p.Article in journal (Refereed)
    Abstract [en]

    Design: Gastric bypass (GBP) and duodenal switch (DS) in morbid obesity are accompanied by marked metabolic improvements, particularly in glucose control. In recent years, episodes of severe late postprandial hypoglycemia have been increasingly described in GBP patients; data in DS patients are scarce. We recruited three groups of subjects; 15 GBP, 15 DS, and 15 non-operated overweight controls to examine to what extent hypoglycemia occurs in daily life. Methods: Continuous glucose monitoring (CGM) was used during 3 days of normal activity. The glycemic variability was measured by mean amplitude of glycemic excursion and continuous overall net glycemic action. Fasting blood samples were drawn, and the patients kept a food and symptom log throughout the study. Results: The GBP group displayed highly variable CGM curves, and 2.9% of their time was spent in hypoglycemia (< 3.3 mmol/l, or 60 mg/dl). The DS group had twice as much time in hypoglycemia (5.9%) and displayed CGM curves with little variation as well as lower HbA1c levels (29.3 vs 35.9 mmol/mol, P < 0.05). Out of a total of 72 hypoglycemic episodes registered over the 3-day period, 70 (97%) occurred in the postprandial state and only about one-fifth of the hypoglycemic episodes in the GBP and DS groups were accompanied by symptoms. No hypoglycemias were seen in controls during the 3-day period. Conclusion: Both types of bariatric surgery induce marked, but different, changes in glucose balance accompanied by frequent, but mainly unnoticed, hypoglycemic episodes. The impact and mechanism of hypoglycemic unawareness after weight-reduction surgery deserves to be clarified.

  • 40.
    Abrahamsson, Niclas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Lau Börjesson, Joey
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology.
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Wiklund, Urban
    Umea Univ, Biomed Engn, Dept Radiat Sci, Umea, Sweden.
    Karlsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Eriksson, Jan W.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Gastric bypass reduces symptoms and hormonal responses to hypoglycemia2016In: Diabetes, ISSN 0012-1797, E-ISSN 1939-327X, Vol. 65, no 9, 2667-2675 p.Article in journal (Refereed)
    Abstract [en]

    Gastric bypass (GBP) surgery, one of the most common bariatric procedures, induces weight loss and metabolic effects. The mechanisms are not fully understood, but reduced food intake and effects on gastrointestinal hormones are thought to contribute. We recently observed that GBP patients have lowered glucose levels and frequent asymptomatic hypoglycemic episodes. Here, we subjected patients before and after undergoing GBP surgery to hypoglycemia and examined symptoms and hormonal and autonomic nerve responses. Twelve obese patients without diabetes (8 women, mean age 43.1 years [SD 10.8] and BMI 40.6 kg/m(2) [SD 3.1]) were examined before and 23 weeks (range 19-25) after GBP surgery with hyperinsulinemic-hypoglycemic clamp (stepwise to plasma glucose 2.7 mmol/L). The mean change in Edinburgh Hypoglycemia Score during clamp was attenuated from 10.7 (6.4) before surgery to 5.2 (4.9) after surgery. There were also marked postsurgery reductions in levels of glucagon, cortisol, and catecholamine and the sympathetic nerve responses to hypoglycemia. In addition, growth hormone displayed a delayed response but to a higher peak level. Levels of glucagon-like peptide 1 and gastric inhibitory polypeptide rose during hypoglycemia but rose less postsurgery compared with presurgery. Thus, GBP surgery causes a resetting of glucose homeostasis, which reduces symptoms and neurohormonal responses to hypoglycemia. Further studies should address the underlying mechanisms as well as their impact on the overall metabolic effects of GBP surgery.

  • 41. Abrahamsson, P
    et al.
    Andersen, K
    Grip, L
    Wallentin, L
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
    Dellborg, M
    Early assessment of long-term risk with continuous ST-segment monitoringamong patients with unstable coronary syndromes. Results from 1-yearfollow-up in the TRIM study.2001In: J Electrocardiol, Vol. 34, 103- p.Article in journal (Refereed)
  • 42. Abramsson-Zetterberg, Lilianne
    et al.
    Ilbäck, Nils-Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
    The synthetic food colouring agent Allura Red AC (E129) is not genotoxic in a flow cytometry-based micronucleus assay in vivo2013In: Food and Chemical Toxicology, ISSN 0278-6915, E-ISSN 1873-6351, Vol. 59, 86-89 p.Article in journal (Refereed)
    Abstract [en]

    The safety of several azo colouring agents, used as food additives, has during the years been questioned. Allura Red AC (E129) has in some publications been classified as genotoxic. In fact, in the European Union, Allura Red is permitted as a food additive in human food, but, surprisingly, it was not acceptable as an additive for use in animal feed. In this study we have evaluated whether Allura Red is genotoxic using a flow cytometer-based micronucleus assay in peripheral blood of mice. Male FVB mice were given a single intra-peritoneal injection of various doses of Allura Red and sacrificed at 46 h after treatment. The tested doses were 0, 100, 200, 400, 600, 800, 1000, 1500, and 2000 mg/kg body weight (b.w.). Each dose group constituted three mice, except for in the dose group of 1000 mg/kg b.w., which constituted four mice. Blood samples were collected and the frequency of micronucleated polychromatic erythrocytes (fMNPCE) and the cell proliferation (%PCE) was determined. The analyses did not show any significant difference in the %PCE or in the fMNPCE. Consequently, under the testing circumstances one can conclude that Allura Red is not genotoxic.

  • 43. Abrink, M
    et al.
    Gobl, Anders
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
    Huang, R
    Nilsson, K
    Hellman, L
    The human cell lines U-937, THP-1 and MonoMac 6, represent relatively immature cells of the monocyte cell lineage1994In: Leukemia, Vol. 8, 1579- p.Article in journal (Refereed)
  • 44.
    Abrink, Magnus
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Larsson, Erik
    Department of Genetics and Pathology.
    Gobl, Anders
    Department of Medical Sciences.
    Hellman, Lars
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Expression of lactoferrin in the kidney:implications for innate immunity and iron metabolism2000In: Kidney Int, Vol. 57, 2004- p.Article in journal (Refereed)
  • 45.
    Abu Hamdeh, Sami
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
    Lytsy, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology and Infectious Medicine, Clinical Bacteriology.
    Ronne-Engström, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
    Surgical site infections in standard neurosurgery procedures-a study of incidence, impact and potential risk factors2014In: British Journal of Neurosurgery, ISSN 0268-8697, E-ISSN 1360-046X, Vol. 28, no 2, 270-275 p.Article in journal (Refereed)
    Abstract [en]

    Objectives. Surgical site infections (SSIs) may be devastating for the patient and they carry high economic costs. Studies of SSI after neurosurgery report an incidence of 1 - 11%. However, patient material, follow-up time and definition of SSI have varied. In the present study we prospectively recorded the prevalence of SSI 3 months after standard intracranial neurosurgical procedures. The incidence, impact and risk factors of SSI were analysed. Methods. We included patients admitted during 2010 to our unit for postoperative care after standard neurosurgical procedures. SSI was defined as evident with positive cultures from surgical samples or CSF, and/or purulent discharge during reoperation. Follow-up was done after 3 and 12 months and statistics was obtained after 3 months. The predictive values on the outcome of demographic and clinical factors describing the surgical procedure were evaluated using linear regression. Results. A total of 448 patients were included in the study and underwent a total of 466 procedures. Within 3 and 12 months, 33 and 88 patients, respectively, had died. Of the surviving patients, 20 (4.3% of procedures) developed infections within 3 months and another 3 (4.9% of procedures) within 12 months. Risk factors for SSI were meningioma, longer operation time, craniotomy, dural substitute, and staples in wound closure. Patients with SSI had significantly longer hospital stay. Multivariate analysis showed that factors found significant in univariate analysis frequently occur together. Discussion. We studied the prevalence of SSI after 3 and 12 months in a prospective 1-year material with standard neurosurgical procedures and found it to be 4.3% and 4.9%, respectively. The analysis of the results showed that a combination of parameters indicating a longer and more complicated procedure predicted the development of SSI. Our conclusion is that the prevention of SSI has to be done at many levels, especially with patients undergoing long surgical procedures.

  • 46. Accinelli, Cesare
    et al.
    Saccà, Maria Ludovica
    Fick, Jerker
    Mencarelli, Mariangela
    Lindberg, Richard
    Olsen, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
    Dissipation and removal of oseltamivir (Tamiflu) in different aquatic environments2010In: Chemosphere, ISSN 0045-6535, E-ISSN 1879-1298, Vol. 79, no 8, 891-897 p.Article in journal (Refereed)
    Abstract [en]

    The antiviral drug oseltamivir (Tamiflu) has received recent attention due to the potential use as a first-line defense against H5N1 and H1N1 influenza viruses. Research has shown that oseltamivir is not removed during conventional wastewater treatments, thus having the potential to enter surface water bodies. A series of laboratory experiments investigated the fate and the removal of oseltamivir in two surface water ecosystems of Japan and in a municipal wastewater treatment plant located in Northern Italy. Persistence of oseltamivir in surface water ranged from non-detectable degradation to a half-life of 53 d. After 40 d, <3% of radiolabeled oseltamivir evolved as (CO2)-C-14. The presence of sediments (5%) led to a significant increase of oseltamivir degradation and mineralization rates. A more intense mineralization was observed in samples of the wastewater treatment plant when applying a long incubation period (40 d). More precisely, 76% and 37% of the initial radioactivity applied as C-14-oseltamivir was recovered as (CO2)-C-14 from samples of the biological tank and effluent water, respectively. Two bacterial strains growing on oseltamivir as sole carbon source were isolated and used for its removal from synthetic medium and environmental samples, including surface water and wastewater. Inoculation of water and wastewater samples with the two oseltamivir-degrading strains showed that mineralization of oseltamivir was significantly higher in both inoculated water and wastewater, than in uninoculated controls. Denaturing gradient gel electrophoresis and quantitative PCR analysis showed that Tamiflu would not affect the microbial population of surface water and wastewater.

  • 47. Accordini, S
    et al.
    Corsico, A
    Cerveri, I
    Gislason, D
    Gulsvik, A
    Janson, C
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Jarvis, D
    Marcon, A
    Pin, I
    Vermeire, P
    Almar, E
    Bugiani, M
    Cazzoletti, L
    Duran-Tauleria, E
    Jõgi, R
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Marinoni, A
    Martínez-Moratalla, J
    Leynaert, B
    de Marco, R
    The socio-economic burden of asthma is substantial in Europe2008In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 63, no 1, 116-124 p.Article in journal (Other academic)
    Abstract [en]

    BACKGROUND: Few data are available on the asthma burden in the general population. We evaluated the level and the factors associated with the asthma burden in Europe. METHODS: In 1999-2002, 1152 adult asthmatics were identified in the European Community Respiratory Health Survey (ECRHS)-II and the socio-economic burden (reduced activity days and hospital services utilization in the past 12 months) was assessed. RESULTS: The asthmatics with a light burden (only a few reduced activity days) were 13.2% (95% CI: 11.4-15.3%), whereas those with a heavy burden (many reduced activity days and/or hospital services utilization) were 14.0% (95% CI: 12.1-16.1%). The burden was strongly associated with disease severity and a lower quality of life. Obese asthmatics had a significantly increased risk of a light [relative risk ratio (RRR) = 2.17; 95% CI: 1.18-4.00] or a heavy burden (RRR = 2.77; 95% CI: 1.52-5.05) compared with normal/underweight subjects. The asthmatics with frequent respiratory symptoms showed a threefold (RRR = 2.74; 95% CI: 1.63-4.61) and sixfold (RRR = 5.76; 95% CI: 3.25-10.20) increased risk of a light or a heavy burden compared with asymptomatic asthmatics, respectively. Moreover, the lower the forced expiratory volume in 1 s % predicted, the higher the risk of a heavy burden. The coexistence with chronic cough/phlegm only increased the risk of a heavy burden (RRR = 1.88; 95% CI: 1.16-3.06). An interaction was found between gender and IgE sensitization, with nonatopic asthmatic females showing the highest risk of a heavy burden (21.6%; 95% CI: 16.9-27.1%). CONCLUSIONS: The asthma burden is substantial in Europe. A heavy burden is more common in asthmatics with obesity, frequent respiratory symptoms, low lung function, chronic cough/phlegm and in nonatopic females.

  • 48. Accordini, Simone
    et al.
    Corsico, Angelo G.
    Braggion, Marco
    Gerbase, Margaret W.
    Gislason, David
    Gulsvik, Amund
    Heinrich, Joachim
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Jarvis, Deborah
    Jõgi, Rain
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Pin, Isabelle
    Schoefer, Yvonne
    Bugiani, Massimiliano
    Cazzoletti, Lucia
    Cerveri, Isa
    Marcon, Alessandro
    de Marco, Roberto
    The Cost of Persistent Asthma in Europe: An International Population-Based Study in Adults2013In: International Archives of Allergy and Immunology, ISSN 1018-2438, E-ISSN 1423-0097, Vol. 160, no 1, 93-101 p.Article in journal (Refereed)
    Abstract [en]

    Background: This study is aimed at providing a real-world evaluation of the economic cost of persistent asthma among European adults according to the degree of disease control [as defined by the 2006 Global Initiative for Asthma (GINA) guidelines]. Methods: A prevalence-based cost-of-illness study was carried out on 462 patients aged 30-54 years with persistent asthma (according to the 2002 GINA definition), who were identified in general population samples from 11 European countries and examined in clinical settings in the European Community Respiratory Health Survey II between 1999 and 2002. The cost estimates were computed from the societal perspective following the bottom-up approach on the basis of rates, wages and prices in 2004 (obtained at the national level from official sources), and were then converted to the 2010 values. Results: The mean total cost per patient was EUR 1,583 and was largely driven by indirect costs (i.e. lost working days and days with limited, not work-related activities 62.5%). The expected total cost in the population aged 30-54 years of the 11 European countries was EUR 4.3 billion (EUR 19.3 billion when extended to the whole European population aged from 15 to 64 years). The mean total cost per patient ranged from EUR 509 (controlled asthma) to EUR 2,281 (uncontrolled disease). Chronic cough or phlegm and having a high BMI significantly increased the individual total cost. Conclusions: Among European adults, the cost of persistent asthma drastically increases as disease control decreases. Therefore, substantial cost savings could be obtained through the proper management of adult patients in Europe.

  • 49. Accordini, Simone
    et al.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Svanes, Cecilie
    Jarvis, Deborah
    The Role of Smoking in Allergy and Asthma: Lessons from the ECRHS2012In: Current Allergy and Asthma Reports, ISSN 1529-7322, E-ISSN 1534-6315, Vol. 12, no 3, 185-191 p.Article, review/survey (Refereed)
    Abstract [en]

    The European Community Respiratory Health Survey is an international multicenter cohort study of asthma, allergy, and lung function that began in the early-1990s with recruitment of population-based samples of 20- to 44-year-old adults, mainly in Europe. The aims of the study are broad ranging but include assessment of the role of in utero exposure to tobacco smoke, exposure to environmental tobacco smoke, and active smoking on the incidence, prevalence, and prognosis of allergy and asthma. Cross-sectional and longitudinal analyses looking at these associations have been conducted, sometimes only using information collected in one country, and on other occasions using information collected in all the participating centers. This article summarizes the results from these various publications from this large epidemiologic study.

  • 50. Achenbach, Stephan
    et al.
    Friedrich, Matthias G.
    Nagel, Eike
    Kramer, Christopher M.
    Kaufmann, Philip A.
    Farkhooy, Amir
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Dilsizian, Vasken
    Flachskampf, Frank A.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    CV Imaging: What Was New in 2012?2013In: JACC Cardiovascular Imaging, ISSN 1936-878X, E-ISSN 1876-7591, Vol. 6, no 6, 714-734 p.Article in journal (Refereed)
    Abstract [en]

    Echocardiography, single-photon emission computed tomography (SPECT), positron emission tomography (PET), cardiac magnetic resonance, and cardiac computed tomography can be used for anatomic and functional imaging of the heart. All 4 methods are subject to continuous improvement. Echocardiography benefits from the more widespread availability of 3-dimensional imaging, strain and strain rate analysis, and contrast applications. SPECT imaging continues to provide very valuable prognostic data, and PET imaging, on the one hand, permits quantification of coronary flow reserve, a strong prognostic predictor, and, on the other hand, can be used for molecular imaging, allowing the analysis of extremely small-scale functional alterations in the heart. Magnetic resonance is gaining increasing importance as a stress test, mainly through perfusion imaging, and continues to provide very valuable prognostic information based on late gadolinium enhancement. Magnetic resonance coronary angiography does not substantially contribute to clinical cardiology at this point in time. Computed tomography imaging of the heart mainly concentrates on the imaging of coronary artery lumen and plaque and has made substantial progress regarding outcome data. In this review, the current status of the 5 imaging techniques is illustrated by reviewing pertinent publications of the year 2012. 

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