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1.
Mette Nissen Tiina‐Mari Ikheimo Jukka Huttunen Ville Leinonen Henna‐Kaisa Jyrkknen Mikael von und zu Fraunberg 《Neuromodulation》2021,24(1):102-111
ObjectiveSpinal cord stimulation (SCS) is an effective treatment in failed back surgery syndrome (FBSS). We studied the effect of preimplantation opioid use on SCS outcome and the effect of SCS on opioid use during a two-year follow-up period.Materials and methodsThe study cohort included 211 consecutive FBSS patients who underwent an SCS trial from January 1997 to March 2014. Participants were divided into groups, which were as follows: 1) SCS trial only (n = 47), 2) successful SCS (implanted and in use throughout the two-year follow-up period, n = 131), and 3) unsuccessful SCS (implanted but later explanted or revised due to inadequate pain relief, n = 29). Patients who underwent explantation for other reasons (n = 4) were excluded. Opioid purchase data from January 1995 to March 2016 were retrieved from national registries.ResultsHigher preimplantation opioid doses associated with unsuccessful SCS (ROC: AUC = 0.66, p = 0.009), with 35 morphine milligram equivalents (MME)/day as the optimal cutoff value. All opioids were discontinued in 23% of patients with successful SCS, but in none of the patients with unsuccessful SCS (p = 0.004). Strong opioids were discontinued in 39% of patients with successful SCS, but in none of the patients with unsuccessful SCS (p = 0.04). Mean opioid dose escalated from 18 ± 4 MME/day to 36 ± 6 MME/day with successful SCS and from 22 ± 8 MME/day to 82 ± 21 MME/day with unsuccessful SCS (p < 0.001).ConclusionsHigher preimplantation opioid doses were associated with SCS failure, suggesting the need for opioid tapering before implantation. With continuous SCS therapy and no explantation or revision due to inadequate pain relief, 39% of FBSS patients discontinued strong opioids, and 23% discontinued all opioids. This indicates that SCS should be considered before detrimental dose escalation. 相似文献
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A workshop report on the development of the Cow's Milk‐related Symptom Score awareness tool for young children 下载免费PDF全文
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Maria Fedchenko Zacharias Mandalenakis Helena Dellborg Grel Hultsberg‐Olsson Anna Bjrk Peter Eriksson Mikael Dellborg 《Congenital heart disease》2019,14(4):549-558
Background: The aging patient with adult congenital heart disease (ACHD) faces
the risk of developing atherosclerotic disease. Patients with coarctation of the aorta
(CoA) are especially vulnerable because of an inherent high risk of developing hy‐
pertension. However, data on the prevalence of other cardiovascular risk factors are
scarce. Therefore, this study aimed to describe the prevalence of traditional cardio‐
vascular risk factors (diabetes, hypertension, hyperlipidemia, smoking, obesity, and
sedentary lifestyle) in adult patients with CoA.
Methods: Patients with CoA who were registered at the ACHD clinic in Gothenburg were asked to participate in a comprehensive cardiovascular risk assessment. This assessment included a glucose tolerance test, cholesterol profile, ambulatory blood pressure measurements, and a lifestyle questionnaire.
Results: A total of 72 patients participated. The median age was 43.5 years and 58.3% were men. Sixty‐six (91.7%) patients had ≥one cardiovascular risk factor and 40.3% had ≥three risk factors. Three (4.2%) patients were newly diagnosed with diabetes or impaired glucose tolerance. More than half of the patients had hyperlipidemia (n = 42, 58.3%) and 35 patients (48.6%) were overweight or obese. Only three (4.2%) patients smoked regularly. Of the 60 patients who underwent 24‐hour ambulatory blood pressure measurement, 33 (55.0%) were hypertensive. Of the 30 patients with known hypertension only 9 (30.0%) had well‐controlled blood pressure on ambula‐ tory blood pressure measurement.
Conclusions: Cardiovascular risk factors among patients with CoA are prevalent. This may indicate a need for more aggressive screening strategies of traditional risk fac‐ tors to minimize the risk of these patients also developing atherosclerotic disease. 相似文献
Methods: Patients with CoA who were registered at the ACHD clinic in Gothenburg were asked to participate in a comprehensive cardiovascular risk assessment. This assessment included a glucose tolerance test, cholesterol profile, ambulatory blood pressure measurements, and a lifestyle questionnaire.
Results: A total of 72 patients participated. The median age was 43.5 years and 58.3% were men. Sixty‐six (91.7%) patients had ≥one cardiovascular risk factor and 40.3% had ≥three risk factors. Three (4.2%) patients were newly diagnosed with diabetes or impaired glucose tolerance. More than half of the patients had hyperlipidemia (n = 42, 58.3%) and 35 patients (48.6%) were overweight or obese. Only three (4.2%) patients smoked regularly. Of the 60 patients who underwent 24‐hour ambulatory blood pressure measurement, 33 (55.0%) were hypertensive. Of the 30 patients with known hypertension only 9 (30.0%) had well‐controlled blood pressure on ambula‐ tory blood pressure measurement.
Conclusions: Cardiovascular risk factors among patients with CoA are prevalent. This may indicate a need for more aggressive screening strategies of traditional risk fac‐ tors to minimize the risk of these patients also developing atherosclerotic disease. 相似文献
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Erik Smedler Christoph Ab Erik Plsson Martin Ingvar Mikael Landn 《Journal of psychiatry & neuroscience : JPN》2020,45(3):182
BackgroundThe CACNA1C gene encodes the 1C subunit of L-type voltage-gated calcium channels and has been associated with several psychiatric syndromes — including bipolar disorder — in many genome-wide association studies. Experimental and clinical studies have reported changes with respect to behaviour and biomarkers in risk allele carriers, corroborating the essential role of the CACNA1C gene in neurons, during development and in the mature brain. However, the association of this gene with regional cortical thickness has not been evaluated in patients with bipolar disorder.MethodsUsing magnetic resonance imaging, we measured the average cortical thickness of 68 brain regions in 87 patients genotyped for the single-nucleotide polymorphism rs1006737 in CACNA1C.ResultsWe found associations with the mean thickness of several cortical areas: the left lateral orbitofrontal and rostral anterior cingulate cortices, as well as other parts of the frontal and parietal cortices.Limitations: This cross-sectional cohort study could not fully differentiate correlation from causation.ConclusionThe CACNA1C polymorphism rs1006737 is associated with the mean thickness of cortical brain areas that have been shown to be altered in bipolar disorder. 相似文献
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