Syftet med denna studie var att tillverka och mäta koncentration, diameter och storleksfördelning för mikrodroppar under olika temperaturer och omrörningstider. Datainsamlingen kom från flera observationer vilket bidrog till en grundlig förståelse för dess egenskaper under olika omständigheter. Ett av de viktigaste resultaten var att temperaturen hade en viktig roll för koncentrationen av mikrodroppar. En minskning av koncentrationsnivåerna observerades vid lägre temperaturer. Vidare noterades att omrörningstiden också spelade en roll, betydande minskningar av det totala antalet mikrodroppar observerades under längre omrörningstider. Mikrodropparnas medeldiameter hade storlekar som låg inom acceptabla intervaller i alla prov. De medeldiametrar som observerades låg inom ett intervall på 3,98 μm till 8,18 μm men större enskilda mikrodroppar med diameter över 10 μm kunde också hittas. Resultaten gav vägledande faktorer för ytterligare undersökningar för att fastställa dess medicinska tillämpningar. Framtida studier bör fortsätta att analysera dessa parametrar för att ytterligare optimera mikrodroppar för användning inom områden som ultraljudsavbildning eller läkemedelsleverans. / The aim of this study was to fabricate and measure the concentration, diameter, size distribution of microdroplets under different temperatures and stirring times. The data collection came from several observations which provided a thorough understanding of its properties under different circumstances. One of the key findings was that the temperature had an important role in the concentration of microdroplets. A decrease in concentration levels was observed at lower temperatures. Furthermore, it was noted that stirring time also played a role, leading to significant reductions in the total number of microdroplets when observed for longer stirring times. The mean diameters of the microdroplets had sizes that were within acceptable ranges in all samples. The mean diameters observed ranged from sizes between 3.98 μm and 8.18 μm but single microdroplets with diameters greater than 10 μm could also be found and observed. The results provided guiding factors for further investigations to determine its medical applications. Future studies should continue to analyze these parameters to further optimize microdroplets for use in areas such as ultrasound imaging or drug delivery.

Background  Maximum voluntary bite force (BF) and hand grip strength (HS) serve as muscle strength markers from the jaw motor system and hand motor system.   Aim  To investigate i) differences in maximum BF and HS between dominant and non-dominant sides, ii) differences between repeated tests in the same session and iii) correlation between BF and HS.     Methods Fifteen resistance trained adults (n=6 women, mean age 24 (SD 1.04) years and n=9 men, mean age 27 (SD 4.06) years) were tested with electronic BF and HS devices, with three repeated tests per side. Paired sample T-test was used to detect differences in BF and HS between sides and whether there was a difference between repeated tests. Pearson test was used to determine correlation between BF and HS. P-value <0.05 was considered statistically significant.    Results HS showed differences between dominant and non-dominant sides in three tests (T1 P=<0.0001, T2 P=0.0002 and T3 P=0.0011). BF showed differences between repeated tests in the same session for T1-T2 (P=0.007), T1-T3 (P<0.0001) and T2-T3 (P=0.028) on dominant side and between T1-T2 (P=0.014), T1-T3 (P=0.010) on non-dominant side. Correlation between BF and HS showed r=0.41 for merged data (dominant + non-dominant side) (P=0.02).   Conclusions  In the context of resistance trained adults, the findings showed that BF did not alter between sides while HS did, with higher force production for the dominant hand. Repeated tests showed differences between tests for BF, but not for HS. A weak to moderate correlation could be observed when comparing BF to HS.

SAMMANFATTNING Bakgrund: Varje år drabbas cirka 110,000 patienter i Sverige av en vårdskada. Av dessa är en betydande del postoperativa sårinfektioner. Uppkomsten av postoperativa sårinfektioner är beroende av många olika faktorer och det infektionspreventiva arbetet är komplext. Utvecklandet av nya förband och förbandsmaterial sker kontinuerligt. Ett av dessa är förband med negativt undertryck som ska verka för en optimal sårläkningsmiljö. Syfte: Att undersöka om undertrycksförband minskar risken för postoperativa sårinfektioner jämfört med traditionella förband utan negativt undertryck. Metod: En systematisk litteraturstudie med kvantitativ ansats. Resultatet uppnåddes genom tabulering och narrativ syntes. Resultat: 19 studier inkluderades i den slutgiltiga syntesen. Sex av dessa visade på en statistiskt signifikant minskning av postoperativa sårinfektioner i interventionsgruppen. Det fanns en betydande heterogenitet och risk för bias i de inkluderade studierna. Slutsats: Det går ej att dra slutsatsen att undertrycksförband minskar förekomsten av postoperativa sårinfektioner i alla patientgrupper. Fler stora, väldesignade studier med fokus på att minska risken för bias samt fler studier som undersöker iNPWT-förbandens effektivitet hos specifika patientgrupper, behöver utföras. / ABSTRACT Background: In Sweden 110,000 patients every year suffer from healthcare associated injuries. A significant number of these consists of surgical site infections. The cause of surgical site infections is multifactorial, rendering its prevention a complex and multifaceted process. New surgical dressings and materials are continuously being developed. One such dressing is the incisional negative pressure wound therapy dressing (iNPWT), applied to wounds with the aim of optimizing wound healing. Objective: to evaluate the effectiveness of iNPWT dressings in reducing surgical site infections. Method: A systematic review of quantitative research studies with tabulation and narrative synthesis. Results: 19 studies were included in the final synthesis, 6 of which showed a statistically significant reduced risk of surgical site infection in the iNPWT group compared to the control group. There was a notable heterogeneity among the studies and a moderate to high risk of bias across all included studies. Conclusion: It cannot be concluded that iNPWT dressings lower the risk of surgical site infection in all populations. Larger, well-designed studies focused on lowering the risk of bias, as well as more studies looking at the effectiveness of iNPWT dressings in specific patient groups,  need to be conducted.

Although vasovagal syncope (VVS) is a common clinical condition the mechanisms behind VVS remain elusive. Upright posture is the major trigger of VVS and lower limb blood pooling affecting cardiac output has been proposed as a major determinant. The overall aim of this thesis was twofold. First, to develop new methodology for calculating limb venous compliance. Second, to study lower limb venous volume load and cardiovascular responses during hypovolemic circulatory stress caused by lower body negative pressure (LBNP) in healthy women and women with VVS, emphasizing compensatory mechanisms to maintain central blood volume. Net fluid filtration was associated with an underestimation ofvenous compliance. This could be accounted for with a correctionmodel. Further, a new venous wall model made it possible to adopt thevenous pressure-volume curve through the entire pressure range andthus provide a valid characterization of venous compliance. Calf blood pooling was similar between the groups and was not associated with tolerance to hypovolemic circulatory stress. Venous compliance was reduced at low venous pressures in VVS and correlated with decreased tolerance to circulatory stress. VVS women displayed attenuated sympathetic vasoconstrictor responses during graded circulatory stress, and mobilization of arm capacitance blood as well as capillary fluid absorption from extra- to intravascular space were reduced. Accordingly, more pronounced reductions in cardiac output were found in VVS. Thus, reduced compensatory mechanisms to maintain cardiac output could contribute to the pathogenesis oforthostatic VVS. In healthy women, rapid pooling in the lower limb was associated with higher tolerance to circulatory stress and more efficient cardiovascular responses, in part due to speed-dependent baroreflex-mediated sympathetic activation. In VVS however, rapid lower limb blood pooling was associated with lower tolerance and deficient cardiovascular responses. No speed-dependent baroreflexmediated sympathetic activation was found in VVS, indicating welldefined differences in cardiovascular regulation already in the initial responses to orthostatic stress.

No description available.

Bakgrund: Hjärtsjukdom är den vanligaste dödsorsaken i västvärlden. De senaste åren har forskare upptäckt kopplingar mellan D-vitaminbrist och en ökad risk att insjukna i hjärt-och kärlsjukdom. Ny forskning tyder på att D-vitamin är oerhört viktigt del i immunförsvaret och för vår hälsa på många olika områden. Idag pågår ett stort antal studier som undersöker om D-vitaminbrist kan vara en riskfaktor för att drabbas av olika sjukdomar såsom ökad infektionskänslighet, cancer, depression, diabetes samt hjärt- och kärlsjukomar etc. Den rekommenderade dosen D-vitamin har varit omdiskuterad de senaste åren och myndigheter höjer rekommendationerna i takt med nya upptäcker inom forskningen. Syfte: Att undersöka om D-vitamintillskott kan användas som en kortsiktig behandling mot hjärtsvikt orsakad av hypertoni eller kardiohypertrofi. Metod: Detta examensarbete är en litteraturstudie där vetenskapliga artiklar har sökts via databasen PubMed med sökorden: “Vitamin D”,“heart failure”,”heart disease”. Av de artiklar som kunde erhållas så inkluderades sökresultaten till observationsstudier och kliniska studier. I de kliniska studierna varierade doserna mellan 100-400 g/dag. Slutligen valdes 6st studier ut och granskades noggrant. Dessa studier är sammanfattade i Tabell VI & Tabell VII. Resultat: Det kliniska randomiserade studierna visade att D-vitamin hade en statistisk signifikant reducerande effekt på det systoliska blodtrycket, parathormon (PTH), aldosteron koncentrationen, Brain natriuretic peptide (BNP) och C-reaktivt protein (CRP). Observationsstudierna visade att D-vitaminbrist kan leda till hypertoni, hjärt -och kärlrelaterade sjukdomar och kardiohypertrofi. Enligt observationsstudierna är D-vitaminbrist en oberoende markör för ökad mortalitet. D-vitaminbrist visade sig även kunna leda till en längre sjukhusvistelse hos både HF patienter och övrig population. De upptäckte även att HF patienter i regel har lägre D-vitamin koncentration än övrig population.   Diskussion: De kliniska randomiserade studierna har många brister i sin studiedesign. Det är inte tillräckligt stora med enbart 23-100st deltagare. Alla deltagare hade ej en uttalad D-vitaminbrist från studiens början, effekt av behandling blir därför svår att utreda. Observationsstudierna har sina redan kända brister och det är svårt att utreda ett orsakssamband. Det har gjorts för få studier för att säkert kunna besvara frågan om D-vitamins koppling till uppkomst av hjärt- och kärlsjukdom. Ännu fler, större, längre och noggrannare studier behövs. D-vitamins verkningsmekanism i kroppen behöver också utredas vidare. Studierna visade på en viss koppling mellan D-vitaminbrist och risken att drabbas av hjärt-och kärlsjukdom. Även om vissa samband kan observeras så har denna eventuella effekt idag ännu inte kunnat bekräftas i kliniska studier. Då vetenskapliga bevis fortfarande saknas kan D-vitamintillskott ännu inte rekommenderas som behandling mot hjärt-och kärlsjukdom. / Background: Heart disease is the leading cause of death among people in the northern countries. It is also very common with vitamin D deficiency. The geographical position affects the availability of UVB radiation and people avoid sunlight because of the risk of getting malign melanoma and other types of skin cancer. New research have shown that vitamin D is very important for us and vitamin D deficiency may play a role in many diseases such as depression, infection, autoimmune and cardiovascular diseases. This particular subject is still unexplored and more research have to be done to investigate vitamin D role in these diseases. The Vitamin D recommended dose have been questioned for many years and the agencies have been raising the recommended dose and is still investigating the subject. Objective: The aim of this study is to investigate if vitamin D supplements may decrease the risk of heart failure (HF). Methods: This bachelor thesis is a literature review. Article search is made in the database PubMed in February 2017 by using the keywords “vitamin D/heart disease/heart failure”. Inclusion criteria were clinical, controlled, randomized trials on human and observation studies, written in English.  Results: Six studies were chosen for this bachelor thesis, three of the studies are clinical randomized and three of the studies are observation studies. The doses given in the clinical studies varies between 100-400 g/daily. The clinical studies did find some statistic significant reduced effect comparing baseline with after treatment with vitamin D in the systolic blood pressure, aldosterone, PTH, EF%, CRP and BNP. The observation studies did find a correlation between vitamin D deficiency and a decreased risk getting hypertension and cardio hypertrophy. They also observed that vitamin D deficiency was common in HF patients. The observation studies also found that vitamin D deficiency is an independent predictor of increased mortality in patients with HF.     Conclusion: In the clinical studies the population was small and the time for the treatment was highly limited only 4 or 6 months. The treatment dose of Vitamin D was not a standard dose because it varied between the studies which made it hard to compare the results. The observation studies have its known limitations. It is hard to tell if patients with HF have vitamin D deficiency because they spend more time inside than healthy people. May the sickness cause some reaction in the body that leading to vitamin D deficiency or does vitamin D deficiency cause HF. Because lack of good quality in these six studies they have failed to show convincing results and correlation between vitamin D deficiency and HF. It is necessary with larger controlled, study over long time, randomized trials to investigate whether vitamin D deficiency can cause heart failure. More research has to be done.

Trigger finger is one of the most common hand conditions, with a prevalence of almost 3%. The aetiology remains unclear even though many causes have been suggested. The prevailing paradigm is that the pathogenesis of trigger finger is ascribed to primary changes in the first fibrous condensation of the tendon sheath (A1-pulley). Several studies have investigated pathology in the pulley, but few have investigated the tendon. The general aim of this thesis was to find out if there is pathology in the trigger finger tendon and to define it. We first looked at trigger finger tendon biopsies in a light microscope, and found that they were histologically different from healthy tendons. They showed signs of micro-ruptures, collagen degradation, increased amounts of ground substance, both hyper- and hypo-cellular areas, round active cell nuclei and absence of inflammatory cells, all similar to tendinosis. The histological picture was further assessed by using a scoring system for Achilles tendinosis. The trigger finger tendons scored high, suggesting a similar histopathology. Next, we performed a quantitative real-time polymerase chain reaction (qPCR) on trigger finger tendons. We assessed the mRNA expression of 10 genes, which have been described to be differently expressed in Achilles tendinosis (collagen 1 and 3, versican, decorin, biglycan, aggrecan, MMP-2, MMP-3, ADAMTS-5, and TIMP-3). The overall expression pattern agreed with previous studies on Achilles tendinosis, suggesting that the cellular function in trigger finger tendons is disturbed in a similar way as in Achilles tendinosis. Recent experimental and observational research has suggested potential side effects of statin treatment on tendons, but firm evidence was lacking. We performed an epidemiological study on two large population-based cohorts. Statin use was found to increase the risk of both trigger finger and tendinosis in the shoulder and Achilles tendons, especially among men. This suggests a similar pathology in trigger finger and tendinosis. We have also studied the time to treatment effect after a single injection of glucocorticoid in trigger finger. Our results suggest that 60-80% of patients can expect resolution of the triggering within 14 days, and half of them within seven days. This result allows correct information to be given to the patient and proper planning of follow-ups. In conclusion, the pathology in trigger finger tendons is similar to tendinosis in other tendons.

No description available.

Dysfunction of the limbic-hypothalamic-pituitary-adrenal (LHPA) axis is a common finding in advanced dementia. In this study, the function of the LHPA axis at different levels was investigated in patients with dementia and in healthy elderly. A subtle disturbance in the feedback regulation of the LHPA axis was found in patients with early (i.e., mild to moderate) Alzheimer’s disease (AD). After 0.5 mg dexamethasone, serum cortisol levels were less suppressed in AD patients and plasma adrenocorticotropin (ACTH) levels were lower as compared with healthy elderly. After stimulation with human corticotropin-releasing hormone a blunted ACTH response was found in AD patients while relative serum cortisol, dehydroepiandrosterone, and androstenedione responses were increased. Significant correlations were found between low plasma ACTH levels and temporal lobe atrophy and between low peak plasma ACTH levels and hippocampal atrophy measured with computer tomography. Patients with advanced AD and multi-infarct dementia had lower basal levels of dehydroepiandrosterone sulphate in combination with no difference in cortisol levels, resulting in a high cortisol/DHAS ratio. The difference persisted after adjustments for age and sex in a multivariate analysis. In patients with early AD, basal serum levels of dehydroepiandrosterone and androstenedione were increased, and this increase was accentuated after stimulation with ACTH. Peripheral glucocorticoid sensitivity was examined by skin vasoconstrictor blanching tests. Patients with AD and patients treated with glucocorticoids showed skin blanching at higher clobetasol concentrations than healthy elderly. These findings justify further investigations on the role of LHPA axis dysfunction in Alzheimer’s disease and its possible importance for the pathophysiology of the disease. / digitalisering@umu

The diagnostic accuracy attained with the use of transbronchial fine needle aspiration biopsy, aspiration of bronchial secretion, bronchial washing, brush biopsy and forceps biopsy via a flexible fiberoptic bronchoscope was compared in patients with carcinoma of the lung. In endoscopic visible tumours the sensitivity of forceps biopsy was higher than that of the other methods. When forceps biopsy was combined with bronchial washing the overall diagnostic accuracy was significantly higher than that of any of the single methods, while no appreciable increase was obtained by adding additional methods. Selective brush biopsy from every segment bronchus has been established as a method in the search for occult bronchial carcinoma. The extent of respiratory mucosal damage and wound healing after brush biopsy was therefore studied in rabbits. Large differences in the extension and depth of the damage was observed. The basement membrane was often penetrated. Regeneration started during the first day after brush biopsy and a normal ciliated epithelium was restored within three weeks. To determine if the bronchoscope itself damaged the respiratory epithelium, bronchial mucosa was studied in the pig after examination with a flexible fiberoptic bronchoscope. The columnar epithelial cells were torn off in areas where the bronchoscope had rubbed against the airway wall but the basement membrane was not damaged. Since the function of the respiratory epithelium is to remove inhaled particles from the airways, mucociliary clearance was studied in man after fiberoptic bronchoscopy. The study suggests that the tracheobronchial clearance system has a large reserve for mechanical trauma. Mucociliary clearance can however be decreased after fiberoptic bronchoscopy in some patients. An increasing number of patients with impaired cardiopulmonary function are today subjected to examination with flexible fiberoptic broncoscopy. The haemodynamic effects of fiberoptic bronchoscopy performed under topical anaesthesia were therefore studied in patients with restrictive lung disease. The procedure induced marked haemodynamic changes during passage of the larynx and during suctioning. A slight fall in arterial oxygen tension was observed during bronchial suctioning and in the post-bronchoscopic period. Three of ten patients developed ST-T-segment changes during bronchial suctioning. / <p>S. 1-48: sammanfattning, s. 49-126: 5 uppsatser</p> / digitalisering@umu.se