Global ETD Search

41	Computer Assisted Coronary CT Angiography Analysis : Disease-centered Software Development Wang, Chunliang January 2009 (has links) The substantial advances of coronary CTA have resulted in a boost of use of this new technique in the last several years, which brings a big challenge to radiologists by the increasing number of exams and the large amount of data for each patient. The main goal of this study was to develop a computer tool to facilitate coronary CTA analysis by combining knowledge of medicine and image processing.Firstly, a competing fuzzy connectedness tree algorithm was developed to segment the coronary arteries and extract centerlines for each branch. The new algorithm, which is an extension of the “virtual contrast injection” method, preserves the low density soft tissue around the coronary, which reduces the possibility of introducing false positive stenoses during segmentation.Secondly, this algorithm was implemented in open source software in which multiple visualization techniques were integrated into an intuitive user interface to facilitate user interaction and provide good over¬views of the processing results. Considerable efforts were put on optimizing the computa¬tional speed of the algorithm to meet the clinical requirements.Thirdly, an automatic seeding method, that can automatically remove rib cage and recognize the aortic root, was introduced into the interactive segmentation workflow to further minimize the requirement of user interactivity during post-processing. The automatic procedure is carried out right after the images are received, which saves users time after they open the data. Vessel enhance¬ment and quantitative 2D vessel contour analysis are also included in this new version of the software. In our preliminary experience, visually accurate segmentation results of major branches have been achieved in 74 cases (42 cases reported in paper II and 32 cases in paper III) using our software with limited user interaction. On 128 branches of 32 patients, the average overlap between the centerline created in our software and the manually created reference standard was 96.0%. The average distance between them was 0.38 mm, lower than the mean voxel size. The automatic procedure ran for 3-5 min as a single-thread application in the background. Interactive processing took 3 min in average with the latest version of software. In conclusion, the presented software provides fast and automatic coron¬ary artery segmentation and visualization. The accuracy of the centerline tracking was found to be acceptable when compared to manually created centerlines. Coronary CTA vessel segmenation centerline tracking visualization Radiologi och bildbehandling Cardiac and Cardiovascular Systems Kardiologi
42	Atrial Fibrillation in the setting of Coronary Artery Disease : Risks and outcomes with different treatment options Batra, Gorav January 2017 (has links) Coronary artery disease (CAD) is the leading cause of mortality worldwide and atrial fibrillation (AF) is a prevalent arrhythmia associated with increased risk of mortality and morbidity. Despite improved outcome in both diseases, there is a need to further describe the prevalence, outcome and management of CAD in patients with concomitant AF. AF was a common finding among patients with MI, with 16% having new-onset, paroxysmal or chronic AF. Patients post-MI with concomitant AF, regardless of subtype, were at increased risk of composite cardiovascular outcome of mortality, MI or ischemic stroke, including mortality and ischemic stroke alone. No major difference in outcome was observed between AF subtypes. At discharge, an oral anticoagulant was prescribed to 27% of the patients with MI and AF undergoing percutaneous coronary intervention (PCI). Aspirin or clopidogrel plus warfarin versus dual antiplatelet therapy with aspirin plus clopidogrel were associated with similar 0-90-day and lower 91-365-day risk of cardiovascular outcome, without increased risk of major bleeding events. Triple therapy with aspirin, clopidogrel plus warfarin versus dual antiplatelet therapy was associated with non-significant lower risk of cardiovascular outcome, but with increased risk of bleeding events. Treatment with renin-angiotensin system (RAS) inhibitors post-MI was associated with lower risk of all-cause and cardiovascular mortality in patients with and without congestive heart failure and/or AF. However, RAS inhibition in patients without AF was not associated with lower risk of new-onset AF. Approximately 1 in 3 patients undergoing isolated coronary artery bypass grafting (CABG) had pre- or postoperative AF. Patients with AF, regardless of subtype, were at higher risk of all-cause mortality, cardiovascular mortality and congestive heart failure. Furthermore, postoperative AF was associated with higher risk of recurrent AF. In conclusion, AF was a common finding in the setting of MI and CABG. AF, irrespectively if in the setting of MI or CABG was associated with higher risk of ischemic events and mortality. Also, postoperative AF was associated with recurrent AF. Oral anticoagulants post-MI and PCI in patients with AF was underutilized, however, optimal antithrombotic therapy is still unknown. RAS inhibition post-MI seems beneficial, however, it was not associated with lower incidence of new-onset AF. atrial fibrillation coronary artery disease acute coronary syndrome myocardial infarction percutaneous coronary intervention coronary artery bypass grafting antithrombotic therapy angiotensin-converting enzyme inhibitors angiotensin II receptor blockers epidemiology Cardiac and Cardiovascular Systems Kardiologi
43	Ekokardiografi: jämförelse av erfarenhetens betydelse vid mätningar av strain och strain rate i vänster kammare / Echocardiography: a comparison of the significance of experience when measuring strain and strain rate in the left ventricle Baker, Sinan, Alcharif, Odai January 2019 (has links) Bakgrund: Ekokardiografi har en betydande roll i diagnostisering av vänster kammare. Genom undersökning av segmentell och global longitudinell strain samt strain rate kan regional och global kinetik bedömas. Vid kontraktion och relaxation deformeras myokardiet varvid segmentell strain mäter deformationen av respektive segment uttryckt i procent medan strain rate mäter hastigheten av deformationen. Genom summering av medelvärdet från alla segment erhålls global longitudinell strain. Syfte: Syftet med studien var att jämföra ultraljudbaserade segmentell och global strain samt strain rate i vänster kammare. Jämförelse har gjorts mellan mätningar utförd av erfaren biomedicinsk analytiker samt mindre erfarna biomedicinska analytikerstudenter. Metod: Kvantitativ studie där 10 testpersoner undersökts ekokardiografiskt. Bildtagningen och mätresultaten insamlades med Siemens Acuson SC2000. Sammanställning av insamlade mätvärden gjordes på Microsoft Excel och Microsoft Word i diagram och tabeller. För jämförelse av strain segmentellt och globalt samt strain rate har analysmetoden Related-Samples Wilcoxon Signed Rank Test använts. Resultat: Resultatet visade enbart en statistisk signifikant skillnad (p <0,05) vid segmentell strain i basala segmenten i apikala projektioner mellan erfaren biomedicinsk analytiker och student 1. Konklusion: Datamaterialet är inte tillräckligt för att kunna generalisera resultatet till en större population. Det behövs fortsatta studier inom området för att dra en mer säkerställd slutsats. / Background: Echocardiography has a major role for assessment of the left ventricle. By using segmental and global longitudinal strain and strain rate both regional and global kinetics can be assessed. Segmental strain measures deformation of the myocardium as strain rate measures the velocity of the deformation. By summing the average from all segments, global longitudinal strain is obtained. Purpose: To compare heart ultrasound-based segmental and global strain and strain rate in the left ventricle. Comparisons have been made between experienced biomedical laboratory scientist and less experienced biomedical laboratory scientist’s students. Method: Quantitative study were 10 test subjects have been examined echocardiographically. Imaging and measurements were collected with Siemens Acuson SC2000. Compilation of collected measurements were made on Microsoft Excel and Microsoft Word in charts and tables. For comparison of segmental and global strain and strain rate the analysis method Related-Samples Wilcoxon Signed Rank Test were used. Result: The result shows only one statistically significant difference (p <0.05) of segmental strain in the basal segments of apical projections between experienced biomedical laboratory scientist and student 1. Conclusion: The data material is not enough to generalize the result to a larger population. Further studies are needed to draw a more secure conclusion. Biomedical Laboratory Science/Technology Cardiac and Cardiovascular Systems Kardiologi
44	Kan en lågfetthaltig växtbaserad diet få kranskärlsjukdomar att stagnera eller reversera? / Can a Low-Fat Plant-Based Diet Make Coronary Artery Diseases Stagnate or Reverse? Teodorescu, Geanina January 2021 (has links) Enligt Socialstyrelsen år 2019 var hjärt-och kärlsjukdomar den vanligaste dödsanledningen i Sverige och svarade för 31 % av alla dödsfall i landet. Akut kranskärlssjukdom tillhör hjärt- och kärlsjukdomar och är en folksjukdom som drabbar både kvinnor och män i hela västvärlden med högst mortalitet till följd. Kliniska studier har visat att den västerländska kosten med för högt animaliskt proteinintag, för högt intag av raffinerat socker och fett är den primära bakomliggande orsaken till dödsfall i hjärt-kärlsjukdom. Största riskfaktorn för kranskärl-och andra hjärtsjukdomar är arterioskleros (åderförkalkning). En växtbaserad 10 % lågfetthaltig Whole Food Plant Based-diet (WFPB) har visat sig ha en positiv effekt på arteriosklerosprocessen och vidare på hjärt-kärlsjukdomars utveckling. Syftet med detta projekt var att genom en systematisk litteraturstudie undersöka om hjärtsjukdomar, framförallt kranskärlsjukdomar (CAD) kan stagneras och/eller reverseras med hjälp av en lågfetthaltig WFPB-diet. Studien är baserad på 10 vetenskapliga artiklar framtagna ur databaserna CINAHL, PubMed, Google Scholar samt från referenslistan på två av de redan utvalda artiklarna. Samtliga tio artiklar som inkluderats i litteraturstudien valdes genom datainsamling, relevansbedömning och kvalitetsgranskning. För att säkerställa artiklarnas kvalité kvalitetsgranskades de relevanta artiklarna utifrån frågor skapade från en mall från Statens beredning för medicinsk och social utvärdering, SBU. De analyserade mätparametrarna i artiklarna var bl. a. angiografiparametrar, lipidbiomarkörer, anginasymtom, Flödesmedierat vasodilatationstest (FMD) samt Positronemissions tomografi (PET). De flesta granskade studierna visade reversering av CAD, två artiklar visade både reversering och stagnering och en artikel kunde inte bedömas. Stagnering eller reversering av kranskärlsjukdomar kan åstadkommas antingen genom en kombination av dietintervention och andra livstilförändringar som komplement till lipidsänkande medicinsk behandling eller genom endast diet-och andra livstilförändringar. / According to the National Board of Health and Welfare in 2019, cardiovascular disease was the most common cause of death in Sweden and accounted for 31% of all deaths in the country. Acute coronary heart disease belongs to cardiovascular disease and is a common disease that affects both women and men throughout the Western world with the highest mortality as a result. Clinical studies have shown that the Western diet with too high animal protein intake, too high intake of refined sugar and fat is the primary underlying cause of death in cardiovascular disease. The biggest risk factor for coronary heart disease and other heart diseases is arteriosclerosis (atherosclerosis). A plant-based 10% low-fat Whole Food Plant Based Diet (WFPB) has been shown to have a positive effect on the arteriosclerosis process and further on the development of cardiovascular disease. The purpose of this project was to investigate through a systematic literature study whether heart disease, especially coronary heart disease (CAD) can be stagnated and / or reversed with the help of a low-fat WFPB diet. The study is based on 10 scientific articles produced from the databases CINAHL, PubMed, Google Scholar and from the reference list of two of the already selected articles. All ten articles included in the literature study were selected through data collection, relevance assessment and quality review. To ensure the quality of the articles, the relevant articles were quality examined on the basis of questions created from a template from the Swedish Agency for Medical and Social Evaluation, SBU. The analyzed measurement parameters in the articles were for example angiography parameters, lipid biomarkers, angina symptoms, Flow-mediated vasodilation test (FMD) and Positron emission tomography (PET). Most of the studies examined showed reversal of CAD, two articles showed both reversal and stagnation and one article could not be assessed. Stagnation or reversal of coronary heart disease can be achieved either through a combination of dietary intervention and other lifestyle changes in addition to lipid-lowering medical treatment or through dietary and other lifestyle changes only. Angina symptoms angiography parameters arteriosclerosis coronary heart disease lipidmarkers reversal stagnation Whole food plant based-diet Anginasymtom angiografiparametrar arterioskleros kranskärlsjukdomar lipidmarkörer reversering stagnering Whole food plant based–diet. Medical and Health Sciences Medicin och hälsovetenskap Nutrition and Dietetics Näringslära Cardiac and Cardiovascular Systems Kardiologi
45	Developing Automated Cell Segmentation Models Intended for MERFISH Analysis of the Cardiac Tissue by Deploying Supervised Machine Learning Algorithms / Utveckling av automatiserade cellsegmenteringsmodeller avsedda för MERFISH-analys av hjärtvävnad genom användning av övervakade maskininlärningsalgoritmer Rune, Julia January 2023 (has links) Följande studie behandlar utvecklandet av automatiserade cellsegmenteringsmodeller med avsikt att identifiera gränser mellan celler i hjärtvävnad. Syftet är att möjliggöra analys av data genererad från multiplexed error-robust in situ hybridization (MERFISH). MERFISH är en spatial transcriptomics-teknik som till skillnad från exempelvis single-cell RNA sequencing (ScRNA-seq) och single molecule fluorescence in situ hybridization (smFISH), möjliggör profilering av hundratals RNA-sekvenser hos enskilda celler utan att förlora dess rumsliga kontext. I Kosuri laboratoriet på Salk Institute of Biological Studies i San Diego tillämpas MERFISH på mushjärtan. Syftet är att få en djupare insikt i hur celler är organiserade i friska hjärtan, och hur denna struktur ändras i och med åldring och sjukdom. Att extrahera meningsfull information från MERFISH medför dock en betydande utmaning - en exakt cellsegmentering. Studien bidrar följaktligen till utvecklandet av segmenteringsmodeller för att kringgå de utmaningar som står i vägen för all efterföljande analys. Då klassiska segmenteringsalgoritmer är otillräckliga för att segmentera den komplexa vävnad som hjärtat utgörs av, tillämpades några av dagens mest avancerade och framstående maskininlärningsalgoritmer inom fältet, kallade Cellpose och Omnipose. Givet den täta och heterogena hjärtvävnaden, som härstammar från en bred distribution av celltyper och geometrier, utvecklades två separata modeller; en för att täcka både mindre celler och kardiomyocyter skurna på tvärsnittet; och en för att enbart segmentera kardiomyocyter skurna i longitudinell riktning. Den förstnämnda modellen utvecklades och tränades i Cellpose, och uppnådde en träffsäkerhet på 91.2%. Modellen för longitudinella kardiomyocyter utvecklades istället både i Cellpose och Omnipose för att utvärdera vilket nätverk som är bäst lämpat för ändamålet. Ingen av nätverken lyckades uppnå en tillräckligt hög träffsäkerhet för att vara applicerbar, och är därmed i behov av fortsatt träning. Modellen genererad i Omnipose bedöms dock vara mest lovande, givet dess mer heltäckande segmentering. Ytterligare utvecklingsområden för framtiden innefattar segmentering av celler i fibros-täta regioner, samt att utveckla en 3D-segmentering av hela hjärtat för att uppnå en mer komplett MERFISH-analys. Sammanfattningsvis har de genererade segmenteringsmodellerna banat väg för möjliggörandet av en rigorös MERFISH-analys av hjärtat. Genom att avslöja några av de strukturella och funktionella orsakerna till hjärtsvikt på en cellulär nivå, kan vi således på sikt bidra till utvecklingen av mer effektiva terapeutiska strategier. / The following study delves into the development of automated cell segmentation models, with the intention of identifying boundaries between cells in the cardiac tissue for analysing spatial transcriptomics data. Addressing the limitations of alternative techniques like single-cell RNA sequencing (ScRNA-seq) and single molecule fluorescence in situ hybridization (smFISH), the study underscores the innovative use of multiplexed error-robust fluorescence in situ hybridization (MERFISH) deployed by the Kosuri Lab at Salk Institute for Biological Studies. This advanced imaging-based technique allows for a single-cell transcriptome profiling of hundreds of different transcripts while retaining the spatial context of the tissue. The technique can accordingly reveal how the organization of cells within a healthy heart is altered during disease. However, the extraction of meaningful data from MERFISH poses a significant challenge - accurate cell segmentation. This thesis therefore presents the development of a robust model for cell boundary identification within cardiac tissue, leveraging some of the advanced supervised machine learning algorithms in the field, named Cellpose and Omnipose. Due to the dense and highly heterogeneous tissue- stemming from a wide distribution of cell types and shapes- two separate models had to be developed; one that covers the smaller cells and the cross-sectioned cardiomyocytes, and correspondingly one to cover the longitudinal cardiomyocytes. The cross-section model was successfully developed to achieve an accuracy of 91.2%, whereas the longitudinal model still needs further improvements before being implemented. The thesis acknowledges potential areas for improvement, emphasizing the need to further improve the segmentation of longitudinal cardiomyocytes, tackle the challenges with segmenting cells within fibrotic regions of the diseased heart, as well as achieving a precise 3D cell segmentation. Nonetheless, the generated models have paved the way towards enabling efficient downstream MERFISH analysis to ultimately understand the structural and functional dynamics of heart failure at a cellular level, aiding the development of more effective therapeutic strategies. Cell Segmentation Cellpose Supervised Machine Learning MERFISH Heart Failure Cellsegmentering Cellpose Övervakad Maskininlärning MERFISH Hjärtsvikt Bioinformatics (Computational Biology) Bioinformatik (beräkningsbiologi) Bioinformatics and Systems Biology Bioinformatik och systembiologi Cell and Molecular Biology Cell- och molekylärbiologi Cardiac and Cardiovascular Systems Kardiologi
46	Machine Learning personalizationfor hypotension prediction / Personalisering av maskininlärning förhypotoniförutsägelse Escorihuela Altaba, Clara January 2022 (has links) Perioperative hypotension (PH), commonly a side effect of anesthesia,is one of the main mortality causes during the 30 posterior days of asurgical procedure. Novel research lines propose combining machinelearning algorithms with the Arterial Blood Pressure (ABP) waveform tonotify healthcare professionals about the onset of a hypotensive event withtime advance and prevent its occurrence. Nevertheless, ABP waveformsare heterogeneous among patients, consequently, a general model maypresent different predictive capabilities per individual. This project aimsat improving the performance of an artificial neural network (ANN) topredict hypotension events with time advance by applying personalizedmachine learning techniques, like data grouping and domain adaptation. Wehypothesize its implementation will allow us to cluster patients with similardemographic and ABP discriminative characteristics and tailor the modelto each specific group, resulting in a worst overall but better individualperformance. Results present a slight but not clinical significant improvementwhen comparing AUROC values between the group-specific and the generalmodel. This suggests even though personalization could be a good approach todealing with patient heterogeneity, the clustering algorithm presented in thisthesis is not sufficient to make the ANN clinically feasible. / Perioperativ hypotoni (PH), vanligtvis en sidoeffekt av anestesi, är en av dehuvudsakliga dödsorsakerna under de första 30 dagarna efter ett kirurgiskt ingrepp. Nya forskningslinjer föreslår att kombinera maskininlärningsalgo-ritmer med vågformen av det arteriella blodtrycket (ABP) för att förvarna sjukvårdspersonalen om uppkomsten av en hypotensiv episod, and därmedförhindra förekomsten. ABP-vågformen är dock heterogen bland patienter,så en allmän modell kan ha olik prediktiv förmåga för olika individer.I det här projektet används personaliserade maskininlärningstekniker, somdatagruppering och domänanpassning, för att försöka förbättra ett artificielltneuralt nätverk (ANN) som förutspår hytotensiva episoder. Vår hypotes är attimplementeringen kommer låta oss klustra patienter med liknande demografioch ABP-karakteristik för att skräddarsy modellen till varje specifik grupp,vilket leder till en sämre övergripande men bättre individuell prestanda. Resultaten visar små men inte kliniskt signifikanta förbättringar när AUROC-värden jämförs mellan den gruppspecifika och den allmänna modellen. Detta tyder på att även fast personalisering kan vara en bra tillnärmning till patientersheterogenitet, är inte klusteralgoritmen som presenteras här tillräcklig förklinisk användning av ANN. Arterial blood pressure Hypotension prediction Machine learning personal- ization Domain adaptation Data grouping Arteriellt blodtryck Börutsägelse av hypotoni Personaliserad maskininlär- ning Domänanpassning Datagruppering. Medical Engineering Medicinteknik Cardiac and Cardiovascular Systems Kardiologi Anesthesiology and Intensive Care Anestesi och intensivvård
47	Feasibility of quantitative 99mTc-DPD scintigraphy SPECT/CT for assessing the burden of ATTR cardiac amyloidosis / Genomförbarhet av kvantitativ 99mTc-DPD-scintigrafi med SPECT/CT för att bedöma svårighetsgraden av ATTR hjärtamyloidos Khalaf, Sajad Kadhim January 2023 (has links) Background: Amyloid transthyretin (ATTR) cardiomyopathy is caused by the deposition of misfolded proteins, known as amyloid fibrils, in the myocardium. Quantitative Single Photon Emission Computed Tomography (QSPECT) utilizing 99mTc-DPD scintigraphy has the potential to assess ATTR-suspected cardiac amyloidosis (CA). This method could offer improved risk stratification and therapy response monitoring compared to the established Perugini score system. The primary objective of this study is to evaluate the feasibility of employing a quantitative approach and correlating various parameters with LVMI (left ventricular mass index). Method: Initially, planar and volumetric sensitivity measurements were conducted, followed by verification of accuracy measurements. Several torso phantom acquisitions were then performed to evaluate the accuracy and repeatability in terms of recovery coefficient (RC) and repeatability deviation (RD). This served as the foundation for the subsequent in vivo quantification. In this retrospective study, 10 patients underwent 99mTc-DPD scintigraphy, including SPECT/CT of the thorax and echocardiography examinations, as part of a clinical routine for suspected CA. The myocardial SUVmax was determined using a semi-automatic segmentation of the entire heart, excluding the descending and ascending aortas. The bone uptake was also quantified using the SUVmean parameter within the automatically delineated volume of all bones. This enabled the determination of the normalized uptake value nSUVmax, (SUVmax to SUVmean bone). Moreover, an attempt was made to apply an automatic segmentation of the myocardium based on 26% and 36% thresholds, which were developed from the torso phantom acquisitions. This approach allowed for the utilization of the injected dose (ID). Results: The planar calibration factor (CF) exceeded the volumetric cross-calibration factor (CCF) by 3.4%. The anthropomorphic phantom exhibited an underestimation of approximately 50% in the myocardium and around 21% in the kidneys. The average RD in the myocardium and kidneys was 2.3% and 1.6%, respectively. A significant quantitative separation was observed between the ATTR and control groups, comprising 6 and 4 patients, respectively (p<0.01 for SUVmax and nSUVmax, and p<0.02 for SUVmean bone). Correlation analysis revealed a weak positive correlation between SUVmax and LVMI; however, the correlation was not statistically significant (ρ = 0.31, p = 0.39). The ID in the 26% and 36% threshold-based segmented myocardium showed a relatively lower negative correlation with LVMI; although this was observed in the small ATTR cohort and was not statistically significant. The latter outcome resulted from the automatic-delineation method, which was unable to segment grade 0 and 1 patients. Conclusion: This study suggests that both CFs can be used in QSPECT. The phantom measurements indicate good repeatability and a significant quantitative underestimation, primarily due to the partial volume effect (PVE). Size and shape-specific PVE corrections, encompassing various activity concentrations of myocardium-to-blood pool ratios, are essential in QSPECT of the myocardium. Moreover, quantitative SPECT/CT utilizing 99mTc-DPD scintigraphy can effectively distinguish between patients with grade 0/1 and those with grade 2/3. This approach has the potential to enhance diagnostic accuracy and improve risk stratification. QSPECT Amyloidosis ATTR LVMI Recovery Coefficient SUV Calibration Cardiac and Cardiovascular Systems Kardiologi Other Physics Topics Annan fysik Radiologi och bildbehandling Medicinsk laboratorie- och mätteknik
48	How to create and analyze a Heart Failure Registry with emphasis on Anemia and Quality of Life Jonsson, Åsa January 2017 (has links) Background and aims Heart failure (HF) is a major cause of serious morbidity and death in the population and one of the leading medical causes of hospitalization among people older than 60 years. The aim of this thesis was to describe how to create and how to analyze a Heart Failure Registry with emphasis on Anemia and Quality of Life. (Paper I) We described the creation of the Swedish Heart Failure Registry (SwedeHF) as an instrument, which may help to optimize the handling of HF patients and show how the registry can be used to improve the management of patients with HF. (Paper II) In order to show how to analyze a HF registry we investigated the prevalence of anemia, its predictors, and its association with mortality and morbidity in a large cohort of unselected patients with HFrEF included in the SwedeHF, and to explore if there are subgroups of HF patients identifying high--‐risk patients in need of treatment. (Paper III) In order to show another way of analyzing a HF registry we assessed the prevalence of, associations with, and prognostic impact of anemia in patients with HFmrEF and HFpEF. (Paper IV) Finally we examined the usefulness of EQ--‐ 5D as a measure of patient--‐reported outcomes among HF patients using different analytical models and data from the SwedeHF, and comparing results about HRQoL for patients with HFpEF and HFrEF. Methods An observational study based on the SwedeHF database, consisting of about 70 variables, was undertaken to describe how a registry is created and can be used (Paper I). One comorbidity (anemia) was applied to different types of HF patients, HFrEF (EF <40%) (II) and HFmrEF (EF 40--‐49% ) or HFpEF (> 50%) (III) analyzing the data with different statistical methods. The usefulness of EQ--‐5D as measure of patient--‐ reported outcomes was studied and the results about HRQoL were compared for patients with HFpEF and HFrEF (IV). Results In the first paper (Paper I) we showed how to create a HF registry and presented some characteristics of the patients included, however not adjusted since this was not the purpose of the study. In the second paper (Paper II) we studied anemia in patients with HFrEF and found that the prevalence of anemia in HFrEF were 34 % and the most important independent predictors were higher age, male gender and renal dysfunction. One--‐year survival was 75 % with anemia vs. 81 % without (p<0,001). In the matched cohort after propensity score the hazard ratio associated with anemia was for all--‐cause death 1.34. Anemia was associated with greater risk with lower age, male gender, EF 30--‐39%, and NYHA--‐class I--‐II. In the third paper (Paper III) we studied anemia in other types of HF patients and found that the prevalence in the overall cohort in patients with EF > 40% was 42 %, in HFmrEF 38 % and in HFpEF (45%). Independent associations with anemia were HFpEF, male sex, higher age, worse New York Heart Association class and renal function, systolic blood pressure <100 mmHg, heart rate ≥70 bpm, diabetes, and absence of atrial fibrillation. One--‐year survival with vs. without anemia was 74% vs. 89% in HFmrEF and 71% vs. 84% in HFpEF (p<0.001 for all). Thus very similar results in paper II and III but in different types of HF patients. In the fourth paper (Paper IV) we studied the usefulness of EQ--‐5D in two groups of patients with HF (HFpEF and HFrEF)) and found that the mean EQ--‐5D index showed small reductions in both groups at follow--‐up. The patients in the HFpEF group reported worsening in all five dimensions, while those in the HFrEF group reported worsening in only three. The Paretian classification showed that 24% of the patients in the HFpEF group and 34% of those in the HFrEF group reported overall improvement while 43% and 39% reported overall worsening. Multiple logistic regressions showed that treatment in a cardiology clinic affected outcome in the HFrEF group but not in the HFpEF group (Paper IV). Conclusions The SwedeHF is a valuable tool for improving the management of patients with HF, since it enables participating centers to focus on their own potential for improving diagnoses and medical treatment, through the online reports (Paper I). Anemia is associated with higher age, male gender and renal dysfunction and increased risk of mortality and morbidity (II, III). The influence of anemia on mortality was significantly greater in younger patients in men and in those with more stable HF (Paper II, III). The usefulness of EQ--‐5D is dependent on the analytical method used. While the index showed minor differences between groups, analyses of specific dimensions showed different patterns of change in the two groups of patients (HFpEF and HFrEF). The Paretian classification identified subgroups that improved or worsened, and can therefore help to identify needs for improvement in health services (Paper IV). Heart failure reduced ejection fraction mid-‐range ejection fraction preserved ejection fraction anemia Health-‐related quality of life observational study outcomes Cardiac and Cardiovascular Systems Kardiologi Surgery Kirurgi Gastroenterology and Hepatology Gastroenterologi Rheumatology and Autoimmunity Reumatologi och inflammation
49	VO2peak/THV-ratio differ between heart failure patients with preserved ejection fraction and healthy controls Nilsson, Calle January 2017 (has links) Heart failure is a term for a group of complex symtoms characterized by reduced heart function. One of these syndromes, referred to as heart failure with preserved ejection fraction (HFpEF), has increased in prevalence compared to other types of heart failures during the recent years. A concern is the difficulty in diagnosing patients with HFpEF, since current tools are considered insufficient. The aim of this thesis was to examine Peak Oxygen Uptake (VO2peak) in relation to Total Heart Volume (THV) among heart failure patients with preserved ejection fraction (HFpEF, EF >40 %) compared to healthy controls. THV was acquired by delineating images acquired using cardiovascular magnetic resonance imaging, while VO2peak was measured in oxygen curves acquired from cardiopulmonary exercise tests. Ratios were calculated by dividing VO2peak with THV. In order to determine if blood hemoglobin concentration (b-Hb) could affect the ratio, ratios were adjusted to b-Hb using an adjusting factor. Mean THV was nearly 250 ml larger in HFpEF patients compared to the controls. Patients’ mean VO2peak was more than 1000 ml lower compared to the controls. Mean VO2peak/THV ratio calculated for the patients were less than half of that calculated for the controls. Adjusting the ratio to b-Hb did not affect the ratios significantly. The study was limited by the size of the test group, but the findings suggest that a VO2peak/THV ratio can be used to separate HFpEF patients from healthy controls. / Hjärtsvikt är ett begrepp för en grupp med komplexa symtom och kännetecknas av försämrad hjärtfunktion. Ett av dessa syndrom, hjärtsvikt med bevarad ejektionsfraktion (HFpEF), har ökat i prevalens jämfört med andra varianter av hjärtsvikt under de senaste åren. Ett problem är de svårigheter som finns med att diagnosticera patienter med HFpEF, då nuvarande verktyg inte är tillräckliga. Syftet med detta examensarbete var att undersöka maximalt syreupptag (VO2peak) i förhållande till total hjärtvolym (THV) bland hjärtsviktspatienter med bevarad ejektionsfraktion (HFpEF, EF >40 %) jämfört med friska kontroller. THV erhölls genom att utlinjera bilder tagna med hjälp av magnetisk resonanstomografi, medan VO2peak mättes i syrevolymkurvor som registrerats under ergospirometri-undersökningar. Index beräknades genom att dividera VO2peak med THV. För att undersöka huruvida halten hemoglobin i blodet (b-Hb) kunde påverka index justerades index mot b-Hb med hjälp av en justeringsfaktor. Medel-THV var nästan 250 ml större hos HFpEF-patienter jämfört med kontroller. Medel-VO2peak var mer än 1000 ml lägre hos patienterna jämfört med kontroller. Medel VO2peak/THV-index som beräknats för patienter var mindre än hälften så högt som index beräknat för kontroller. Att justera index mot b-Hb påverkade inte index signifikant. Studien begränsades av mängden deltagare, men fynden indikerar att VO2peak/THV-index kan användas för att skilja HFpEF-patienter från friska kontroller. Heart failure Magnetic Resonance Imaging Preserved Ejection Fraction Total Heart Volume Peak Oxygen Uptake VO2peak/THV ratio Hjärtsvikt magnetresonanstomografi kardiovaskulär magnetresonanstomografi bevarad ejektionsfraktion total hjärtvolym maximalt syreupptag VO2peak/THV -index Biomedical Laboratory Science/Technology Cardiac and Cardiovascular Systems Kardiologi
50	Preventing fatal effects of overworking : Product design solution Adawi, Rahim January 2018 (has links) “Overworking to death” is a phenomenon that has been noticeable in developing countries. The cause of death is mainly through ischemic strokes. While the victims’ occupations differed, they all shared a common characteristic, being positioned in a sedentary work, ranging from IT workers to doctors. This project’s aim was to develop a product that prevented or decreased the strokes that derived from sedentary overwork. This was mainly tackled by preventing one of the three causes of developing blood props, slowed blood flow. In order to gather rich data of the phenomenon, a qualitative study was conducted in China, during two months. By doing an extensive structured sampling, information rich data could be gathered during a short period of time. Data were derived from observations, questionnaires and an interview, which then was interpreted to customer needs and the final product specification. The final product became a trouser with an in built dynamic compression mechanic, that can compress the veins mostly during sitting activities, in order to prevent blood stasis. The compression mechanic works like the Chinese finger trap; compressing the calves while sitting and stretching the legs forward. It is made only out of polysaccharides fibres; cotton and corn. / "Guolaosi" eller död från överarbete är ett fenomen som i regel uppkommer bland utvecklingsländer. Dödsorsaken är huvudsakligen genom stroke. Offrens yrken varierar allt från professorer, IT-arbetare till läkare. De delar dock en sak gemensamt; att arbeta under långa perioder stillasittande. Projektets mål var att utveckla en produkt som minskar dödliga följderna av sedentära överarbete, genom att förebygga en av de tre orsakerna för att utveckla blodproppar; saktad blodström. Målgruppen var då kineser av de yrken som hade tidigare drabbats av fenomenet. För att samla informationsrika data om fenomenet genomfördes en kvalitativ studie i Kina under två månader. Genom att göra en omfattande strukturerad provtagning kunde informationsrika data samlas under en kort tidsperiod. Fältstudien bestod av observationer, frågeformulär och en intervju, som då tolkades till kundbehov och eventuellt produktspecifikationen. Den slutliga produkten kom att bli ett par byxor med en inbyggd dynamisk komprimeringsmekanism, som kan komprimera venerna under sittande aktiviteter, för att förhindra saktad blodström. Kompressionsmekanismen fungerar som den kinesiska fingerfällan. Den komprimerar blodkärlen medan personen sitter och sträcker benen framåt. Produkten är konstruerad på så sätt att den kan tillverkas endast av polysackariders tråd, från bomull och majs. Vilket är lämpligt för Kinas lokala resurser. stroke DVT overworking karoshi guolaosi prolonged inactivity sedentary death product design China Sweden Sida MFS field study trouser pants sampling observation questionnaire interview blood circulation stasis cardiovascular disease cotton corn agenda 2030 Chinese finger trap textile fibre yarn soil erosion muscle pump mechanism gradual compression stockings GECS PECS pressure distribution blood clot veins therapy stool chair PE PTS economy class syndrome methodology plastic sample concept sketch stroke DVT överarbete karoshi guolaosi förlängd inaktivitet stillasittande död produkt design Kina Sverige Sida MFS fältstudie byxa byxor provtagning observation frågeformulär intervju blodcirkulation stasis kardiovaskulär sjukdom bomull majs agenda 2030 kinesisk fingerfälla textil fiber garn jord erosion muskel pump mekanism gradvis komprimering strumpor stödstrumpa tryck kraft GECS PECS tryckfördelning blod blodproppar vener terapi pall stol PE PTS ekonomi klass syndrom metodik plast prov koncept skiss Design Design Pharmacology and Toxicology Farmakologi och toxikologi Occupational Therapy Arbetsterapi Cardiac and Cardiovascular Systems Kardiologi Environmental Sciences Miljövetenskap Medical Ergonomics Medicinsk ergonomi Textile, Rubber and Polymeric Materials Textil-, gummi- och polymermaterial Composite Science and Engineering Kompositmaterial och -teknik Medical Materials Medicinska material och protesteknik

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