Heart failure is a common disorder and a major cause of illness and death in the population, creating an enormous health-care burden. It is a complex condition, representing the end-point of many cardiovascular diseases. In general heart failure progresses slowly over time and once it is diagnosed it has a poor prognosis which is comparable with that of many types of cancer. The heart has an ability to adapt in response to long lasting increases in hemodynamic demand; the heart conforms its shape and size in order to maintain adequate cardiac output. This process is called remodeling and can be triggered by pathologies such as hypertension or valvular disease. When the myocardial remodeling is maintained chronically it becomes maladaptive and is associated with an increased risk of heart failure. In many cases, heart failure is associated with left bundle branch block (LBBB). This electrical disturbance leads to dyssynchronous left ventricular (LV) contraction and relaxation which may contribute to cardiac dysfunction and ultimately heart failure. Mechanical dyssynchrony can be treated with cardiac resynchronization therapy (CRT). However, many heart failure patients do not demonstrate clinical improvement despite CRT. Blood flow plays an important role in the normal development of the fetal heart. However, flow-induced forces may also induce changes in the heart cells that could lead to pathological remodeling in the adult heart. Until recently, measurement tools have been inadequate in describing the complex three-dimensional and time-varying characteristics of blood flow within the beating heart. 4D (3D + time) flow cardiovascular magnetic resonance (CMR) enables acquisition of three-dimensional, three-directional, time-resolved velocity data from which visualization and quantification of the blood flow patterns over a complete cardiac cycle can be performed. In this thesis, novel 4D Flow CMR based methods are used to study the intraventricular blood flow in healthy subjects and heart failure patients with and without ventricular dyssynchrony in order to gain new knowledge of the ventricular function. Different flow components were assessed in normal heart ventricles. It was found that inflowing blood that passes directly to outflow during the same heartbeat (the Direct Flow component) was larger and possessed more kinetic energy (KE) than other flow components. Diastolic flow through the normal heart appears to create favorable conditions for effective systolic ejection. This organized blood flow pattern within the normal LV is altered in heart failure patients and is associated with decreased preservation of KE which might be unfavorable for efficient LV ejection. Inefficient flow of blood through the heart may influence diastolic wall stress, and thus contribute to pathological myocardial remodeling. In dyssynchronous LVs of heart failure patients with LBBB, Direct Flow showed even more reduced preservation of KE compared to similarly remodeled LVs without LBBB. Furthermore, in LBBB patients, LV filling hemodynamic forces, acting on the myocardium, were more orthogonal to the main flow direction compared to patients without LBBB. Deviation of LV flow forces and reduction of KE preservation and may reflect impairment of LV diastolic function and less efficient ensuing ejection related to dyssynchrony in these failing ventricles. Blood flow patterns were also studied with respect to fluctuations of the velocity of the flow (turbulent flow) in normal and failing LVs. In failing hearts, turbulent kinetic energy (TKE) was higher during diastole than in healthy subjects. TKE is a cause of energy loss and can thus be seen as a measure of flow inefficiency. Elucidating the transit of multidimensional blood flow through the heart chambers is fundamental in understanding the physiology of the heart and to detect abnormalities in cardiac function. The 4D Flow CMR parameters presented in this thesis can be utilized to detect altered intracardiac blood flow and may be used as markers of deteriorating cardiac function, pathological remodeling and mechanical dyssynchrony in heart failure.

Electrodes are used in medicine for detection of biological signals and for stimulating tissue, e.g. in deep brain stimulation (DBS). For both applications, an understanding of the functioning of the electrode, and its interface and interaction with the target tissue involved is necessary. To date, there is no standardized method for medical electrode evaluation that allows transferability of acquired data. In this thesis, a physical axon (Paxon) potential generator was developed as a device to facilitate standardized comparisons of different electrodes. The Paxon generates repeatable, tuneable and physiological-like action potentials from a peripheral nerve. It consists of a testbed comprising 40 software controlled 20 μm gold wires embedded in resin, each wire mimicking a node of Ranvier. ECG surface Ag-AgCl electrodes were systematically tested with the Paxon. The results showed small variations in orientation (rotation) and position (relative to axon position) which directly impact the acquired signal. Other electrode types including DBS electrodes can also be evaluated with the Paxon. A theoretical comparison of a single cable neuronal model with an alternative established double cable neuron model was completed. The output with regards to DBS was implemented to comparing the models. These models were configured to investigate electrode stimulation activity, and in turn to assess the activation distance by DBS for changes in axon diameter (1.5-10 μm), pulse shape (rectangular biphasic and rectangular, triangular and sinus monophasic) and drive strength (1-5 V or mA). As both models present similar activation distances, sensitivity to input shape and computational time, the neuron model selection for DBS could be based on model complexity and axon diameter flexibility. An application of the in-house neuron model for multiple DBS lead designs, in a patient-specific simulation study, was completed. Assessments based on the electric field along multiple sample planes of axons support previous findings that a fixed electric field isolevel is sufficient for assessments of tissue activation distances for a predefined axon diameter and pulse width in DBS. / Elektroder används inom sjukvården, både för att mäta biologiska signaler, t.ex. hjärtats aktivitet med EKG, eller för att stimulera vävnad, t.ex. vid djup hjärnstimulering (DBS). För båda användningsområdena är det viktigt med en grundläggande förståelse av elektrodens interaktion med vävnaden. Det finns ingen standardiserad metod för att utvärdera medicinsk elektroders dataöverföringsfunktion. I den här avhandlingen presenteras en metod för att underlätta elektrodtestning. En hårdvarumodell av ett axon (Paxon) har utvecklats. Paxon kan programmeras för att efterlikna repeterbara aktionspotentialer från en perifer nerv. Längs axonet finns 40 noder, vilka var och en består av en tunn (20 μm) guldtråd inbäddad i harts och därefter kopplad till elektronik. Denna testbädd har använts för att undersöka EKG elektroders egenskaper. EKG elektroderna visade på variationer i orientering och position i relation till Paxon. Detta har en direkt inverkan på den registrerade signalen. Även andra elektrotyper kan testas i Paxon, t.ex. DBS elektroder. En teoretisk jämförelse mellan två neuronmodeller med olika komplexitet, anpassade för användning vid DBS studier, har utförts. Modellerna konfigurerades för att studera inverkan på aktiveringsavstånd från olika axondiametrar, stimulationspuls och stimulationsstyrka. Då båda modellerna visade likvärdiga aktiveringsavstånd och beräkningstid så förordas den enklare neuronmodellen för DBS simuleringar. En enklare modell kan lättare introduceras i klinisk verksamhet. Simuleringarna stöder tidigare resultat som visat att det elektriska fältet är en bra parameter för presentation av resultat vid simulering av DBS. Metoden exemplifieras vid simulering av aktiveringsavstånd och elektriska fältets utbredning för olika typer av DBS elektroder i en patient-specifik studie.

Underdiagnosis of intestinal parasites in patients with diarrhea A compilation from the Swedish public health authority indicates that infections caused by Cryptosporidium spp. increased in Sweden from 47 cases in 2004 to 594 cases in 2016 and Giardia intestinalis causes around 1300 infections per year. The primary aim of this study was to investigate the prevalence of parasites in patients with diarrhea. Furthermore, the study investigated whether samples taken with E-swab could be analyzed with real-time polymerase chain reaction (PCR) for detection of Cryptosporidium spp., Dientamoeba fragilis, Entamoeba histolytica/dispar and G. intestinalis rather than Sodium acetate-acetic acid-formaline fixative (SAF-fixative). Prevalence of parasites in fecal samples was collected from 200 samples from patients with bacterial issue ordered. For evaluation of E-swab, 22 frozen, unfixed samples that were positive for intestinal parasites was used. Twelve positive E-swab samples was used as comparative positive controls. This was analyzed using real-time PCR. Bacteria was counted for 9.5% of the infections whilst parasites counted for 14% of the infections. The conclusion was that E-swab could replace SAF-fixative in the diagnosis of intestinal parasites and that there is that an underdiagnosis of intestinal parasites. Keywords: Cryptosporidium spp, Dientamoeba fragilis, Entamoeba histolytica, Entamoeba dispar, Giardia intestinalis, real-time PCR, E-swab, prevalence.

Introduction: Immune therapy plays a larger role in cancer treatment these days, but in order to find new therapies and improve already existing ones, more knowledge about the immune system is needed. The peripheral blood contains many different cell types, some extensively studied, some less well-known. By using multicolor flow cytometry, the immune status of an individual can be displayed in relatively short time. Aim: The aim of this study was to develop a multicolor flow cytometry method in order to examine the distribution of 31 cell types, with a focus on immune regulatory cells, in peripheral blood in healthy donors, as well as examine the impact of cryopreservation on the different subsets. Methods: After isolating the mononuclear cells from peripheral blood using Ficoll separation, each sample (n = 19) were analyzed with three flow cytometry panels. The remaining cells were cryopreserved in -190°C and later thawed and analyzed the same way as the fresh samples were. Results: The cell distribution in fresh samples were mostly consistent with other studies. While the percentage of many cell types remained unchanged after thawing, the total percentage of T helper cells and some subsets were decreased in frozen samples, leading to a decrease in total T cells. Furthermore, the percentage of total monocytes were increased and the distribution of monocyte subsets were altered in frozen samples, among others. Conclusion: This study confirms the results of other studies of the human immune system and provides valuable knowledge about the impact of cryopreservation.

Etylenglykol (EG) är ett toxiskt ämne som kan orsaka livsfarliga komplikationer. Syftet med studien var att genom systematiska litteratursökningar göra en sammanställning och en jämförelse av metoder som används för direkt kvantifiering av EG i patientprov. Studien utfördes med en systematisk litteraturstudiemetod, genom litteratursökning i två databaser: PubMed och MEDLINE. Datasökningens resultat var 12 vetenskapliga artiklar som validerade fyra direkta kvantifieringsmetoder. De kvantifieringsmetoderna av EG delades upp i fyra grupper: enzymatiska, gaskromatografi med flammajoniserings detektor (GC-FID), gaskromatografi masspektrometri (GC-MS) och vätskekromatografi-tandem-masspektrometri (LC–MS-MS). De fyra metoderna jämfördes för att bestämma vilken metod som har bäst sensitivitet och specificitet. Däremot kunde denna jämförelse inte utföras i GC-MS och LC–MS-MS på grund av avsaknad data för vissa sensitivitet och specificitet parametrar och därav så jämfördes endast enzymatisk metoder och GC-FID mot varandra. Slutsatsen av jämförelsen mellan GC-FID och enzymatiska metoder har antytt på att den termiska desorption-gaskromatografi med flammajoniserings detektor (TDC-GC-FID), som var en ny utveckling av GC-FID, var den bästa metoden utifrån dens sensitivitet och specificitet. Det behövs dock utföras studier där alla fyra metoder testas för samma parametrar för att bestämma den absoluta bästa metoden för direkt kvantifiering av EG. / Ethylene glycol (EG) is a toxic substance that can cause life threatening complications. The aim of this study was through systematic literature searches create a summary and comparison between methods used for direct quantification of EG in patient samples. The study performed a literature study in the databases: PubMed and MEDLINE. The data search resulted in 12 scientific articles that validated four direct quantification methods.  Those methods were: enzymatic, gas chromatography with flame ionizing detector (GC-FID), gas chromatography mass spectrometry (GC-MS) and liquid chromatography tandem mass spectrometry (LC-MS-MS). The four methods were compared to decide which method had the best specificity and sensitivity. This comparison could not be done in GC-MS and LC-MS-MS due to missing data for certain specificity and sensitivity parameters and therefore only GC-FID and enzymatic methods were compared to each other. The conclusion of the comparison between GC-FID and enzymatic methods have resulted in that the thermal desorption gas chromatography with flame ionizing detector (TDC-GC-FID), that was a newly developed GC-FID, was the best method due to its specificity and sensitivity. Future studies where all four methods are tested for the same parameters to decide the absolute best method for direct quantification of EG is needed.

Bakgrund: Endoplasmatiskt retikulum upprätthåller proteinhomeostasen genom syntes och degradering av proteiner. Tre signalvägar reglerar processen via ”unfolded protein response” på olika sätt. Inositol-requiring enzyme 1 alpha är en signalväg aktiverad av en störd proteinhomeostas. Stressen uppstår om cellen utsätts för kemiska substanser t.ex. i samband med djurförsök vid framtagning av läkemedel. Den aktiverade signalvägens respons leder bl.a. till splicing av X-box-binding Protein 1 mRNA. Syfte: Projektets syfte är att minska behovet av djurförsök genom att möjliggöra ökad implementering av 3R-principen. Frågeställningen är om den fluorescerande plasmiden pEGFP-XBP1∆dDBD-STOP-tagRFPt som binder till X-box binding protein 1 mRNA kan användas för detektion av celler vars endoplasmatiska retikulum är stressat. Metod: Plasmid pEGFP-XBP1∆dDBD-STOP-tagRFPt renades ur DH5-Alpha Escherichia coli med JETstar 2.0 Plasmid Purification Midiprep Kit. Humana epiteliala njurceller 293 transfekterades med plasmiden varpå de doserades med tunicamycin. Kontrollen utgjordes av dimetylsulfoxid. Mikroskopering skedde i fluorescensmikroskopet Zeiss Axiovert 200. Mjukvaran AxioVision Ver. 4.8.1.0. Carl Zeiss Imaging Solutions framställde cellerna på dataskärm. Resultat: Hypotestestets signifians bestämdes till p < 0,05. Resultatet antyder att antalet ER- stressade celler ökar med ökande inkubationstid (p = 0,001 – 0,966). En mindre antydan finns också mot en ökande koncentration av tunicamycin (p = 0,096 – 0,690). Slutsats: En rimlig slutsats kan inte dras då antalet utförda analyser är för få. / Background: Endoplasmic reticulum maintains protein homeostasis by protein synthesis and degradation. Three signal paths regulates the process by ”unfolded protein response” in different ways. Inositol-requiring enzyme 1 alpha is one path activated by a disturbed protein homeostasis. Stress starts if the cell is exposed to chemical substances as in connection with scientific animal experiments when pharmaceuticals are developed. The response of the activated signal path leads e.g. to splicing of X-box-binding protein 1 mRNA. Object: The object of the project is to reduce the need of scientific animal experiments by enabling increased implementation of the 3R principle. The question is if the fluorescent plasmid pEGFP-XBP1∆dDBD-STOP-tagRFPt binding to X-box binding protein 1 mRNA can be used for detection of cells whose endoplasmatic reticulum is stressed. Method: Plasmid pEGFP-XBP1 ∆ dDBD-STOP-tagRFPt was purified from DH5-Alpha Escherichia coli with JETstar 2.0 Plasmid Purification Midiprep Kit. Human epithelial kidney cells 293 were transfected with the plasmid whereupon they were dosed with tunicamycin. The control was made off dimethylsulfoxide. Microscopy was done in the fluorescence microscope Zeiss Axiovert 200. The software AxioVision Ver. 4.8.1.0. Carl Zeiss Imaging Solutions imaged cells on the computer screen. Result: The significans of the hypothesis test was set to p < 0,05. The result suggests that the number of ER-stressed cells increase with increasing incubation time (p = 0,001 – 0,966). A smaller hint is also pointing toward increasing concentrations of tunicamycin (p = 0,096 – 0,690). Conclusion: A reasonable conclusion cannot be made because of too few tests.

Leber’s hereditary optic neuropathy (LHON) is a genetic disease that causes the patients to become blind, first in one eye and then the other, around the ages of 10-75 years. The disease is caused by mutations in the mitochondrial DNA, which disturbs the respiratory chain leading to the deterioration of the retinal ganglion cells. This study’s aim is to optimize a multiplex amplification-refractory mutation system PCR for detection of three primary mutations causing LHON. This was done through a series of PCRs, including PCR aimed at the ß-globin gene, conventional simplex PCR and a simplex ARMS-PCR aimed at the three primary mutations causing LHON. This study was, however, terminated prematurely due the Covid-19 outbreak and the optimization of the ARMS-PCR could therefore not be done. This study’s aim was adapted to the new circumstances to instead provide guidance on how to perform the optimization using the results from the PCRs that were done before the termination. The results found that for the ARMS-PCR 2 mM of magnesium would suffice as a start point overall and the need to solve the problems with the two 14484 plasmids was evident. The ARMS-PCR is one of many methods that can be used to the detect single nucleotide polymorphism, but its availability and robustness makes this a method worth optimizing. To continue with the optimization of the ARMS-PCR several factors would have to be tested, including annealing temperature, primer concentrations and magnesium concentration.

The pig production in Sweden is divided into conventional and organic production, with the organic production divided into EU organic and KRAV production. Pigs are divided into different age categories: weaned pigs, growing pigs, fattening pigs, gilts/sows before farrowing and dry sows. Roundworm, nodular worm, whipworm, coccidia, red stomach worm, threadworm and lungworm are common parasites in pigs affecting growth, feed conversion and economy. Organic pigs are more exposed to parasites because of outdoor stay and deworming could help if used with care. The aim of this project was to investigate parasites in pig herds with organic production. The investigation would increase the knowledge of parasites in different age categories in currently used production systems and contribute to good recommendations about parasite control and treatment. A modified McMaster technique was used to identify and quantify parasite eggs with microscope. Larval culturing and microscopy were used to distinguish eggs from nodular worm and red stomach worm. Roundworm, nodular worm, whipworm and coccidia were found in all age categories. Threadworm was only identified in dry sows and gilts/sows before farrowing. Nodular worm and coccidia showed highest quantity of positive samples at herd and sample level followed by roundworm and whipworm. Roundworm and nodular worm had highest quantity of eggs per gram faeces followed by whipworm and threadworm. The results corresponded to previous studies in parasite occurrence despite new conditions. More samples, herds and environmental factors should be investigated in conjunction with parasite occurrence to get broader knowledge and to give good recommendations in parasite control and treatment.

Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) has revolutionized the field of bacterial diagnostics and is also used for routine analysis in smaller clinical laboratories. For identification of moulds, pre-analytical steps are more complicated and time consuming than for bacteria, and the choice of reference library has a big impact on the utility of MALDI-TOF MS. The aim of this study was to investigate if MALDI-TOF MS is applicable for identification of moulds belonging to the genus Aspergillus at the hospital laboratory in Gävle. Therefore, strains belonging to the genus Aspergillus and Penicillium, were analysed with MALDI-TOF MS after 2, 4 and 7 days of incubation. Two different extraction protocols were used and compared. Mass spectra were compared to reference spectra in two different databases: MSI-2 and RUO Compass library/BDAL (Bruker). Of the strains included, 97 % were correctly identified to species complex level with MSI-2. Only 25 % were identified to species level with RUO Compass library/BDAL (Bruker). However, totally 56 % were correctly identified to species complex level if a lower score value limit than recommended for identification, were applied. Significantly raised score values were observed with one of the protein extraction protocols used. Although, in most cases, the strains were considered identified to species complex level with either method. This pilot study conveys the feasibility of MALDI-TOF MS for identification of Aspergillus species in a clinical laboratory. While there are still issues to address, applying MALDI-TOF MS has the potential to allow for quicker and more precise identification, also in this specific clinical setting.

Hudens normalflora består av lågpatogena bakterier där stafylokockerna är de vanligaste förekommande bakterierna. Studier visar att antimikrobiella medel kan förändra hudbakteriepopulationer och att dessa förändringar kan leda till kritiska konsekvenser för hudens försvar. Propylenglykol är en substans som klassas som antimikrobiell och bakteriedödande. Propylenglykol har ett brett användningsområde och används ofta som hjälpmedel i en mängd olika läkemedel. Den finns bland annat i kosmetika såsom hudprodukter där den fungerar som fuktbindande och som konserveringsmedel. Vanliga koncentrationer av propylenglykol som fuktighetsbevarande ämne i topikaler är cirka 15 % och i kosmetika finns propylenglykol i koncentrationerna <0,1 % - >50 %. Det saknas i nuläget forskning om propylenglykols effekt på hudens bakterieflora. Syftet med studien var att med olika koncentrationer av propylenglykol bestämma MIC (minsta hämmande koncentration) och MBC (minsta baktericida koncentration) på vanliga stafylokocker (S. epidermidis, S. aureus, S. hominis och S. capitis) som ingår i hudens normalflora. För att bestämma MIC och MBC användes buljongspädningsmetoden där propylenglykol späddes ut i olika koncentrationer med buljong i en mikrotiterplatta. Sedan tillsattes valda testbakterier och OD600 mättes i 24 timmar. Resultatet visade att MIC och MBC för propylenglykol var 12,5 % respektive 25 % på vanliga stafylokocker som finns på huden. Vid koncentrationer av propylenglykol på 12,5 % hämmades synlig bakterietillväxt av S. epidermidis, S. aureus, S. hominis och S. capitis och vid 25 % uppstod en baktericid effekt på bakterierna. Mer forskning behövs dock för att få reda på hur hudens bakterier påverkas av propylenglykol och konsekvenserna av det. / The normal flora of the human skin is consisting of low pathogen bacteria, where the staphylococci are the most common bacteria. Studies show that antimicrobial substances can alter populations of skin bacteria and that these alterations can lead to critical consequences for the resistance of the skin. Propylene glycol is a substance that is classified as antimicrobial and bactericidal and the substance has a wide area of use and is frequently used as a supportive substance in various pharmaceuticals. Propylene glycol can be found in cosmetics and skincare products where it functions as moisture-binding and preservative. Normal concentrations of propylene glycol as moisture-binding substance in topicals is approximately 15 % and in cosmetics the concentration of propylene glycol is <0,1 % - >50 %. As of today, there are few scientific studies regarding the effects of propylene glycol to the bacterial flora of the human skin. The purpose of this study was to determine MIC (minimum inhibitory concentration) and MBC (minimum bactericidal concentration) for normal staphylococci (S. epidermidis, S. aureus, S. hominis och S. capitis) included in the normal flora of the skin using various concentrations of propylene glycol. To be able to determine MIC and MBC the broth dilution method was used, where propylene glycol was diluted in various concentrations with broth in a microtiter plate. Hereafter, selected test bacteria were added and OD600 was measured during 24 hours. The results implicated that MIC and MBC for propylene glycol were 12,5 % and 25 % for common staphylococci located on the skin. At concentrations of propylene glycol of 12,5 %, visible bacterial growth of S. epidermidis, S. aureus, S. hominis and S. capitis was inhibited and at 25 % a bactericidal effect occurred on the bacteria. It shall be noted that further research is needed to find out how the skin's bacteria are affected by propylene glycol and its consequences.