Eating problems and nutritional status were studied in a consecutive series of 104 stroke patients admitted to emergency hospital care. During their stay in hospital eating problems were observed in 46 patients. Certain common types of eating problems were identified: aberrant eating behaviour as regards chewing,lokalization or swallowing, eating small amounts, hoarding of food in the mouth, leakage of food from the mouth and unawareness of eating problems. Poor nutritional status occurred in 16 % of the patients on admission and in 22 % on discharge from the stroke unit. A subgroup of 32 patients hospitalized for 21 days or longer was studied for three weeks. On at least one occasion during these three weeks a poor nutritional status was observed in 18 patients, of whom 17 had eating problems. All subjects who had eating problems during their hospital stay, plus those patients without eating problems but with neurological deficits and those living in a nursing home one year after the stroke (n=36) were selected for a longitudinal study 18 months after the onset of stroke. Eating problems were identified in 23 of these patients during their hospital stay while 21 had such problems when they were followed up. Two patients who could not eat due to severe dysphagia (after a stroke) for three years and 18 months respectively, were successfully trained to eat normally. One patient exhibited impaired oral and hypopharyngeal function and the other impaired hypo- pharyngeal function and a spastic crico-pharyngeal muscle. In both patients training in swallowing was the main remedical measure and one of them also had a myotomy of the spastic muscle. / <p>[2] s., s. 1-45: sammanfattning, s. 49-130: Härtill 6 uppsatser</p> / digitalisering@umu

A retrospective study of invasive pneumococcal disease in patients from Greater Göteborg in 1964- 1980 identified 125 cases of meningitis, 305 of pneumonia, 61 of septicemia with unknown focus, and 17 with other manifestations, all verified by cultures from normally sterile body fluids. The incidence was several times higher in infants and in the elderly than in any other age-group. A wide variety of underlying conditions were present in 23% of the infants, 34% of the children, and 81% of the adults. In adults alcoholism was known in one third of the cases. The case fatality rate was 24% among patients with underlying conditions and 9% among previously healthy individuals. The case fatality rate was 50% in patients with hospital-acquired infection. Twohundred-fifteen pneumococcal strains, isolated from blood or CSF from 1971 to 1983 at the laboratories of clinical bacteriology of Göteborg, Malmö, and Umeå were serotyped by coagglutination (COA). Of all isolates, 89% belonged to serotypes represented in the 23-valent vaccine. In a separate study COA was compared with counterimmunoelectrophoresis (CIE). COA was found to have several advantages; rapidity, lower cost, and ability to disclose serotypes with neutral charge, which constituted 19% of all strains. In a prospective study the etiology was determined in 196 hospitalized patients with pneumonia, most of them community-acquired. Culture of specimens from blood, transtracheal aspirate (TTA), sputum, and nasopharynx, assays of antigen in sputum, urine, and TTA, and assays of pneumococcal antibodies to capsular polysaccharide, C-polysaccharide, and pneumolysin in paired sera were performed. The etiology was established in 64% of the patients. Streptococcus pneumoniae was the most common agent (32%). In a serological study of patients with pneumococcal infection, diagnosed by culture of CSF, TTA, or blood, IgG antibodies against C-polysaccharide and pneumolysin were determined by ELISA. The diagnostic sensitivity was only 51% and 60%, respectively. In conclusion, invasive pneumococcal disease is strongly overrepresented at tender and high age and in patients with concomitant conditions, notably alcoholism. S. pneumoniae remains a predominant causative agent of community-acquired pneumonia in adults needing hospitalization. Due to the low sensitivity and/or specificity of individual microbiological techniques, a combined use of several techniques is necessary when trying to assess the relative importance of pneumococci and other agents in pneumonia. Extended use of the currently available pneumococcal vaccine and development of improved pneumococcal vaccines seem highly warranted. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1993, härtill 5 uppsatser.</p> / digitalisering@umu.se

Colorectal cancer (CRC) is one of the most common cancer types and leading causes of cancer death worldwide. Since CRC is a heterogenic disease, there is a demand for increased knowledge of the underlying genetic and epigenetic mechanisms. The aim of this thesis was to investigate heredity and potential tumour markers in relation to prognosis. In paper I, survival of patients with CRC and a positive family history of CRC in first-degree relatives was analysed. Patients with colon cancer and positive family history of CRC had improved survival compared to patients with negative family history. This improvement in survival could not be explained by known clinico-pathological factors. In paper II, we investigated the prognostic value of Tryptophanyl t-RNA synthetase (TrpRS) in tissues from patients operated for CRC. Low protein expression of TrpRS in primary tumour tissues correlated with increased risk of recurrence and poorer survival. In paper III, the prognostic value of microsatellite instability (MSI) and the correlation to heredity for CRC in first-degree relatives was investigated. Patients with proximal colon cancer and MSI had improved cancer specific survival. There were no correlation between MSI and heredity. In paper IV, we evaluated the potential use of proximity ligation assay (SP-PLA) in patients with CRC, by simultaneous analysis of 35 proteins in only 5 μl plasma. SP-PLA is a suitable method for protein detection and might give valuable guidance in pursuing new prognostic and predictive tumour markers. However, none of the markers selected for present SP-PLA analyses gave better prognostic information than CEA. In conclusion, heredity is related to better survival independent of MSI in patients with CRC and MSI is associated with better prognosis in proximal colon cancer. Detection and increased knowledge of molecular mechanism in CRC is important, however it needs to be further investigated and validated in clinical use.

Summary: Low back pain is the most common reason for referral to musculoskeletal care in the Canadian military. With healthcare seeking for musculoskeletal care rising over the past five years, and healthcare easily accessible for all military personnel, it is important to investigate factors that may contribute to high usage of the military healthcare system. Objective: To explore the association between LBP prognostic factors and musculoskeletal healthcare seeking for LBP in Canadian military population Methods: Historical cohort study, using data linkage. Results: In our exploratory analysis, fear of movement/(re)injury, Veterans Affairs compensation status, post-traumatic stress disorder, previous high use of musculoskeletal services, history of LBP, and military duty status were associated with healthcare seeking. For our confirmatory analysis, pain-related fear had an independent association with healthcare seeking in this population. Conclusion: Psychological and social factors are associated with the rate of musculoskeletal healthcare seeking in this military population.

Aim: To assess the ability of critical flicker frequency (CFF) and optimal reading speed (ORS) to predict the potential vision in patients with cataract with and without ocular comorbidity. Methods: The two novel tests were compared with two well established potential vision tests (PVTs), the potential acuity meter (PAM) and the laser interferometer (LI). Measurements were made preoperatively in 1 eye of 88 subjects using the battery of 4 PVTs. Postoperative measurements were made with the CFF and the ORS. The subjects studied were consecutive cases over a 12-month period who fulfilled the inclusion and exclusion criteria, and agreed to participate in this study. Results: CFF was the PVT most resistant to the presence of cataract. Both CFF and ORS give a similar predictive precision in the presence of cataract and ocular comorbidity, although CFF seems more precise when the cataract is dense. Conclusions: The PAM and the LI showed a limited clinical capability in predicting postoperative visual acuity, particularly with dense opacities. The CFF shows the most promise as a PVT, particularly with dense cataract. Further evaluation is required for both CFF and ORS.

Ovarian cancer is a significant concern for women’s health as it is the most lethal of all gynaecological malignancies. One of the reasons for the high mortality of this disease is that traditionally used chemotherapeutic treatments tend to have poor initial or sustained efficacy against ovarian tumours. Resistance to such treatments may in part be mediated by autophagy, a cell survival process in which unnecessary or damaged components of the cytoplasm are engulfed within a double-membraned vesicle known as an autophagosome and ultimately degraded upon fusion of the autophagosome with a lysosome. Autophagy has been shown to be employed by cells to aid in their survival under stresses such as nutrient deprivation, hypoxia, chemotherapy treatment, and growth factor withdrawal. As these stresses are commonly encountered by ovarian cancer cells, it is possible that autophagy promotes ovarian cancer cell survival. This thesis aims to investigate which stimuli induce autophagy in ovarian cancer cells and whether or not this induction can promote cell survival. In addition, there is a particular focus on the comparison of autophagy utilization between subtypes of ovarian cancer, as the subtypes are in fact considered different diseases and may vary in their usage of autophagy. The first chapter of this thesis provides relevant background information on autophagy as well as ovarian cancer and its subtypes. In the second chapter, I describe studies in which tumours from a large cohort of patients with ovarian cancer are assessed for LC3A, a marker of autophagy, in addition to markers of other cellular processes including hypoxia. Here I found that LC3A was significantly associated with poor patient survival in patients with the clear cell subtype of ovarian cancer, but not other subtypes. I also found that LC3A expression was associated with markers of hypoxia in the clear cell patient tumours and that clear cell carcinoma cell lines preferentially induced autophagy in response to hypoxia in vitro as compared to cell lines of the high-grade serous subtype. These results indicate that clear cell ovarian tumours are uniquely dependent upon autophagy in response to hypoxia. In the third chapter, I investigated the autophagic response to treatment with the standard ovarian cancer chemotherapy drugs carboplatin and paclitaxel in a syngeneic mouse model of ovarian cancer. I found that these drugs did indeed induce autophagy and that the cancer cells utilized autophagy to promote resistance to these chemotherapeutics. In addition, when the tumour cells were grown in syngeneic mice, treatment with the autophagy inhibitor hydroxychloroquine resulted in a significant suppression of tumour growth. Together, my findings indicate that further investigation into the use of autophagy inhibitors in ovarian cancer patients is warranted and that different specific rational drug combinations for each subtype will likely yield optimal results. / Graduate

Tillverkning mot kundorder kräver oftast att hålla ett förrådslager med råmaterial. Ökade kundkrav på korta leveranstider kräver att material skall finnas tillgängligt i lager. Detta ger upphov till ökade lager hos ett företag som i sin tur gör att de binder mer kapital och samtidigt leder till en sämre av­kastning. För att undvika att hålla för stora förrådslager men samtidigt hålla en god servicenivå krävs en effektiv lagerstyrning. Syftet med detta projekt är att ta reda på hur efterfrågan ser ut hos företaget i dagsläget samt kunna ta fram en lämplig prognosmetod och beräkningsmodell mot en viss takt för lagerstyrningen. Prognos­metoderna skall vara ett underlag för inköp vid beställning av material. Detta skall ligga till grund för att standardisera arbetssättet och underlätta exempelvis arbetet för nyanställda. Syftet med arbetet är också att med hjälp av en prognosmetod kunna hålla kapitalbindningen av råmateriallagret på en lämplig nivå. De metoderna som behandlas i detta arbete är ABC-analys, be­räkning av säkerhetslager och prognosmetoder. Resultatet från detta arbete skall besvara målen som projektet strävar efter. Detta skall genom olika analyser och experiment undersöka vilken typ av prognosmetod som företaget bör använda. Metoderna och teorierna som tas upp i rapporten har även syftet att kunna användas av liknande företag. Den valda prognosmetoden skall även resultera i ett bättre underlag för att komma närmre den verkliga efterfrågan som är en del för att uppnå en förbättrad lagerstyrning. Detta har i största möjliga mån satts i relation till det arbetssätt som används på företaget idag. En del av arbetet har gått ut på att ta reda på hur mycket efterfrågan varierarat från beställning tills materialet står i råmaterialslagret. Detta har även använts för att jämföra prognosmetoderna mot det nuvarande arbetssättet. Eftersom företaget vill expandera sin produktion har även en beräkningsmodell tagits fram. Denna modell anger lagernivån inklusive säkerhetslager mot en önskad takt. / Production to customer order usually requires keeping a supply warehouse. Increased customer demands for short lead-times require that materials must be in stock. This result in increasing stock levels in a company leads to more capital tied up and simultaneously leads to poorer yields. To avoid keeping a large storage warehouse whilst keeping a good service requires an effective inventory control. The purpose of this project is to find out how the demand looks like in the current situation of the company and to develop an appropriate forecasting method and calculation model against a certain pace for inventory control. The methods mentioned in this work are the ABC analysis, calculation of safety stock and forecasting methods. The results from this work will answer the objectives of the project aims. A variety of analyzes and experiments shall be used to investigate what type of forecasting method that the company should use. The methods and theories raised in the report also aims to be used by similar companies. The aim of the selected forecasting method is also to lead to a better base, from which better forecast precision is one part in order to improve the inventory management. This has, as far as possible, been put in relation to the working methods used in the company today. Some of the work has been to find out how much demand changes during the lead times, i.e. from the ordering of raw material until the material is in the raw material stock. This has also been used to compare forecasting methods against the present approach. Because the company wants to expand its production, a calculation model has also been developed. This model indicates the inventory level to a desired pace, i.e. demand level.

Glioblastoma (GBM) is the most common primary brain tumor in adults. This study attempted to identify the genes potentially regulated by promoter methylation in GBM. Therefore, we analyzed the expression of COX7A1, SPINT1, AREG, NPTX2, and KRT81 in glioblastomas and human brain tissue and investigated if there were any associations between the expression and methylation of these genes. Moreover, we aimed to determine the methylation frequency of 11 genes (AREG, CASP8, CD81, DcR1, DR4, GATA4, GATA6, hMLH1, NPTX2, TES, and TFPI2) promoters in 100 patients with glioblastoma multiforme and to evaluate the associations between patients’ clinical characteristics and prognostic value. The methylation status of the following 4 gene promoters was significantly related to patients’ survival after surgery: AREG, CASP8, GATA6 and TFPI2. Identification of the methylation status of these genes could be one of the objective criteria in the prognosis of disease course in patients with glioblastoma and could supplement the list of already known epigenetic markers. The methylation status of a combination of 6 genes (AREG, CASP8, DR4, GATA4, GATA6, and TFPI2) was found to be a more accurate independent prognostic factor associated with patients’ survival after surgery when compared with the methylation status of individual genes. The molecular classification of GBM according to the methylation profile of a combination of these 6 genes could help clinicians tailor an appropriate treatment... [to full text] / Glioblastoma (GBM) yra vienas labiausiai paplitusių ir agresyviausių pirminių galvos smegenų auglių. Siekiant nustatyti molekulinius žymenis, susijusius su GBM vystymusi, diagnoze ir prognoze, buvo atlikta 14 genų (AREG, CASP8, CD81, COX7A1, DcR1, DR4, GATA4, GATA6, hMLH1, KRT81, NPTX2, SPINT1, TES ir TFPI2) promotorių metilinimo analizė. Buvo nustatyti naviką slopinančių genų promotorių metilinimo dažniai, ryšiai su klinikinėmis sergančiųjų GBM charakteristikomis ir prognozinė vertė. Disertacinio darbo metu nustatyta, kad AREG ir NTPX2 genų raiška susijusi su šių genų promotorių metilinimu, tuo tarpu COX7A1, KRT81 ir SPINT1 genų raiškos skirtumai nėra susiję su šių genų promotorių metilinimu. Naujų epigenetinių žymenų tyrimai 100 GBM pavyzdžių parodė navikų epigenetinį heterogeniškumą ir įvairų tirtų genų promotorių metilinimo dažnį. Nustatyta, kad AREG, CASP8, GATA6 ir TFPI2 genų promotorių metilinimas statistiškai patikimai susijęs su išgyvenimo trukme po operacijos. Šių genų promotoriaus metilinimo nustatymas gali būti vienas iš objektyvių kriterijų prognozuojant pacientų ligos eigą ir papildyti jau nustatytų epigenetinių žymenų sąrašą. Buvo sudarytas, suminis šešių genų (AREG, CASP8, DR4, GATA4, GATA6 ir TFPI2) derinys, kuris yra tikslesnis nepriklausomas prognozinis veiksnys, susijęs su išgyvenimo trukme po operacijos lyginant su atskirų genų promotorių metilinimu. GBM molekulinis tipavimas pagal šių šešių genų derinį galėtų padėti parenkant gydymo strategiją.

Es gibt Fälle von Exitus letalis nach erfolgreich reponierter Dislocatio abomasi. Deren Ursache sowie prognostische Indikatoren zu ermitteln, war das Ziel vorliegender Arbeit. Zunächst wurden alle Rinder mit Exitus letalis zwischen 1990 und 2000 analysiert, die meisten litten an rechtsseitiger oder linksseitiger Disloactio abomasi. Bei diesen Tieren wurden die Befunde der Aufnahmeuntersuchung und der letzten Untersuchung vor dem Exitus letalis erfaßt, analysiert und mit den Befunden von nach linksseitiger oder rechtsseitiger Dislocatio abomasi geheilt entlassenen Tieren verglichen. Die Heilungsaussichten sinken bei rechtsseitiger und linksseitiger Dislocatio abomasi durch geringeren zeitlichen Abstand zur Kalbung, schlechteren Kreislaufzustand, geringere Pansenbewegungen, Hyperbilirubinämie und das Auftreten von Begleiterkrankungen. Bei rechtsseitiger Dislocatio abomasi waren weiterhin Hyponaträmie und Hypokalämie, bei linksseitiger Dislocatio abomasi erhöhte BHB-Konzentrationen, Hypocholsterolämie und Azidosen mit einer schlechten Prognose verbunden.

Typescript. / Thesis (Ph. D.)--University of Hawaii at Manoa, 1989. / Microfiche. / 2 v. leaves, bound ill 29 cm