Publications by authors named "Morten Eriksen"

43 Publications

Factors associated with emergency-onset diagnosis, time to treatment and type of treatment in colorectal cancer patients in Norway.

BMC Cancer 2021 Jun 30;21(1):757. Epub 2021 Jun 30.

Department of Registration, Cancer Registry of Norway, Postboks 5313 Majorstuen, 0304, Oslo, Norway.

Background: International differences in survival among colorectal cancer (CRC) patients may partly be explained by differences in emergency presentations (EP), waiting times and access to treatment.

Methods: CRC patients registered in 2015-2016 at the Cancer Registry of Norway were linked with the Norwegian Patient Registry and Statistics Norway. Multivariable logistic regressions analysed the odds of an EP and access to surgery, radiotherapy and systemic anticancer treatment (SACT). Multivariable quantile regression analysed time from diagnosis to treatment.

Results: Of 8216 CRC patients 29.2% had an EP before diagnosis, of which 81.4% were admitted to hospital with a malignancy-related condition. Higher age, more advanced stage, more comorbidities and colon cancer were associated with increased odds of an EP (p < 0.001). One-year mortality was 87% higher among EP patients (HR=1.87, 95%CI:1.75-2.02). Being married or high income was associated with 30% reduced odds of an EP (p < 0.001). Older age was significantly associated with increased waiting time to treatment (p < 0.001). Region of residence was significantly associated with waiting time and access to treatment (p < 0.001). Male (OR = 1.30, 95%CI:1.03,1.64) or married (OR = 1.39, 95%CI:1.09,1.77) colon cancer patients had an increased odds of SACT. High income rectal cancer patients had an increased odds (OR = 1.48, 95%CI:1.03,2.13) of surgery.

Conclusion: Patients who were older, with advanced disease or more comorbidities were more likely to have an emergency-onset diagnosis and less likely to receive treatment. Income was not associated with waiting time or access to treatment among CRC patients, but was associated with the likelihood of surgery among rectal cancer patients.
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http://dx.doi.org/10.1186/s12885-021-08415-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8244161PMC
June 2021

Cerebral perfusion and metabolism with mean arterial pressure 90 vs. 60 mmHg in a porcine post cardiac arrest model with and without targeted temperature management.

Resuscitation 2021 Jun 21. Epub 2021 Jun 21.

Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.

Aim: To determine whether targeting a mean arterial pressure of 90 mmHg (MAP90) would yield improved cerebral blood flow and less ischaemia compared to MAP 60 mmHg (MAP60) with and without targeted temperature management at 33 °C (TTM33) in a porcine post-cardiac arrest model.

Methods: After 10 min of cardiac arrest, 41 swine of either sex were resuscitated until return of spontaneous circulation (ROSC). They were randomised to TTM33 or no-TTM, and MAP60 or MAP90; yielding four groups. Temperatures were managed with intravasal cooling and blood pressure targets with noradrenaline, vasopressin and nitroprusside, as appropriate. After 30 min of stabilisation, animals were observed for two hours. Cerebral perfusion pressure (CPP), cerebral blood flow (CBF), pressure reactivity index (PRx), brain tissue pCO (PbtCO) and tissue intermediary metabolites were measured continuously and compared using mixed models.

Results: Animals randomised to MAP90 had higher CPP (p < 0.001 for both no-TTM and TTM33) and CBF (no-TTM, p < 0.03; TH, p < 0.001) compared to MAP60 during the 150 min observational period post-ROSC. We also observed higher lactate and pyruvate in MAP60 irrespective of temperature, but no significant differences in PbtCO and lactate/pyruvate-ratio. We found lower PRx (indicating more intact autoregulation) in MAP90 vs. MAP60 (no-TTM, p = 0.04; TTM33, p = 0.03).

Conclusion: In this porcine cardiac arrest model, targeting MAP90 led to better cerebral perfusion and more intact autoregulation, but without clear differences in ischaemic markers, compared to MAP60.

Institutional Protocol Number: FOTS, id 8442.
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http://dx.doi.org/10.1016/j.resuscitation.2021.06.011DOI Listing
June 2021

Live Tissue Training on Anesthetized Pigs for Air Ambulance Crews.

Air Med J 2021 Jan-Feb;40(1):60-64. Epub 2020 Nov 7.

Air Ambulance Department, Oslo University Hospital, Oslo, Norway; Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway.

Objective: Patients with life- or limb-threatening severe injuries pose a challenge to prehospital services. Time-critical decision making and treatment are challenging because of occasional incomplete information, limited resources, adverse environments, and a range of basic and advanced technical skills available. To prepare for these infrequent critical situations, medical personnel from the helicopter emergency medical service at Oslo University Hospital developed a 1-day advanced trauma training course focusing on individual skills and teamwork during resuscitative procedures.

Methods: Participants were trained under supervision in teams on an established live tissue model with anesthetized pigs. A questionnaire-based evaluation was conducted before and after training to measure the feasibility of covering the allocated learning objectives in the time allotted and participants' perception of any change in their skills as a result of the course.

Results: The self-reported skill level in all learning objectives improved significantly. Combining all learning objectives, the median self-reported skill level was significantly increased from 4 to 6 points (P < .001).

Conclusion: Experienced prehospital physicians and other health staff reported an increased level of skill and competence in lifesaving and limb-saving procedures after completing a brief, intense 1-day course using living anesthetized pigs and cadaver models.
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http://dx.doi.org/10.1016/j.amj.2020.10.003DOI Listing
November 2020

Patient and tumour characteristics associated with inclusion in Cancer patient pathways in Norway in 2015-2016.

BMC Cancer 2020 May 30;20(1):488. Epub 2020 May 30.

Department of Registration, Cancer Registry of Norway, Oslo, Norway.

Background: Cancer patient pathways (CPPs) were implemented in 2015 to reduce waiting time, regional variation in waiting time, and to increase the predictability of cancer care for the patients. The aims of this study were to see if the national target of 70% of all cancer patients being included in a CPP was met, and to identify factors associated with CPP inclusion.

Methods: All patients registered with a colorectal, lung, breast or prostate cancer diagnosis at the Cancer Registry of Norway in the period 2015-2016 were linked with the Norwegian Patient Registry for CPP information and with Statistics Norway for sociodemographic variables. Multivariable logistic regression examined if the odds of not being included in a CPP were associated with year of diagnosis, age, sex, tumour stage, marital status, education, income, region of residence and comorbidity.

Results: From 2015 to 2016, 30,747 patients were diagnosed with colorectal, lung, breast or prostate cancer, of whom 24,429 (79.5%) were included in a CPP. Significant increases in the probability of being included in a CPP were observed for colorectal (79.1 to 86.2%), lung (79.0 to 87.3%), breast (91.5 to 97.2%) and prostate cancer (62.2 to 76.2%) patients (p < 0.001). Increasing age was associated with an increased odds of not being included in a CPP for lung (p < 0.001) and prostate cancer (p < 0.001) patients. Colorectal cancer patients < 50 years of age had a two-fold increase (OR = 2.23, 95% CI: 1.70-2.91) in the odds of not being included in a CPP. The odds of no CPP inclusion were significantly increased for low income colorectal (OR = 1.24, 95%CI: 1.00-1.54) and lung (OR = 1.52, 95%CI: 1.16-1.99) cancer patients. Region of residence was significantly associated with CPP inclusion (p < 0.001) and the probability, adjusted for case-mix ranged from 62.4% in region West among prostate cancer patients to 97.6% in region North among breast cancer patients.

Conclusions: The national target of 70% was met within 1 year of CPP implementation in Norway. Although all patients should have equal access to CPPs, a prostate cancer diagnosis, older age, high level of comorbidity or low income were significantly associated with an increased odds of not being included in a CPP.
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http://dx.doi.org/10.1186/s12885-020-06979-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7260744PMC
May 2020

Mechanical Effects on Right Ventricular Function From Left Bundle Branch Block and Cardiac Resynchronization Therapy.

JACC Cardiovasc Imaging 2020 07 15;13(7):1475-1484. Epub 2020 Jan 15.

Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. Electronic address:

Objectives: The purpose of this study was to investigate how LBBB and CRT modify RV free wall function by direct ventricular interaction.

Background: Right ventricular (RV) function influences prognosis in patients with left bundle branch block (LBBB) and cardiac resynchronization therapy (CRT). There is, however, limited insight into how LBBB and CRT affect RV function.

Methods: In 24 patients with LBBB with nonischemic cardiomyopathy, RV and left ventricular (LV) strain by speckle-tracking echocardiography was measured before and after CRT. Underlying mechanisms were studied in 16 anesthetized dogs with ultrasonic dimension crystals and micromanometers.

Results: Patients with LBBB demonstrated distinct early systolic shortening in the RV free wall, which coincided with the typical abnormal early systolic septal shortening. In animals, this RV free wall contraction pattern resulted in reduced myocardial work as a large portion of the shortening occurred against low pressure during early systole, coinciding with abnormal leftward septal motion. RV systolic function was maintained by vigorous contraction in the late-activated LV lateral wall, which pushed the septum toward the RV. CRT reduced abnormal septal motion and increased RV free wall work because there was less inefficient shortening against low pressure.

Conclusions: LBBB reduces workload on the RV free wall because of abnormal septal motion and delayed activation of the LV lateral wall. Restoring septal and LV function by CRT increases workload in RV free wall and may explain why patients with RV failure respond poorly to CRT. (Contractile Reserve in Dyssynchrony: A Novel Principle to Identify Candidates for Cardiac Resynchronization Therapy [CRID-CRT]; NCT02525185).
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http://dx.doi.org/10.1016/j.jcmg.2019.11.016DOI Listing
July 2020

Measuring diaphragm movement and respiratory frequency using a novel ultrasound device in healthy volunteers.

J Ultrasound 2021 Mar 6;24(1):15-22. Epub 2019 Nov 6.

Department of Pulmonary Medicine, Oslo University Hospital, Kirkeveien 166, 0450, Oslo, Norway.

Purpose: To evaluate the ability of a novel ultrasound (US) device, DiaMon, to monitor diaphragm movement via its proxy liver movement, and compare it with the respired flow measured with a flowmeter, in awake and healthy volunteers. We wanted to (1) establish the optimal anatomical position for attaching the DiaMon device to the abdominal wall, and (2) evaluate the accuracy of continuous monitoring of respiratory frequency.

Methods: Thirty healthy subjects were recruited. The DiaMon probe was applied subcostally in four different positions with the subjects in five different postures. The subjects breathed tidal volumes into a spirometer for 30-60 s with the DiaMon recording simultaneously.

Results: The device detected a readable signal in 83-100% of the position/posture-combinations. The technical correlation between the two signals was highest in the anterior axillary-supine position (mean ± SD: 0.95 ± 0.03), followed by paramidline-supine (0.90 ± 0.09) and midclavicular-supine (0.89 ± 0.12). The frequency measurements yielded a mean difference of 0.03 (95% limits of agreement - 0.11, 0.16) breaths per minute in the anterior axillary-supine position.

Conclusion: The DiaMon device is able to detect liver movement in most subjects, and it measures breathing frequency accurately.
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http://dx.doi.org/10.1007/s40477-019-00412-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7925735PMC
March 2021

Left ventricular end-systolic volume is a more sensitive marker of acute response to cardiac resynchronization therapy than contractility indices: insights from an experimental study.

Europace 2019 Feb;21(2):347-355

Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway.

Aims: There are conflicting data and no consensus on how to measure acute response to cardiac resynchronization therapy (CRT). This study investigates, which contractility indices are best markers of acute CRT response.

Methods And Results: In eight anaesthetized dogs with left bundle branch block, we measured left ventricular (LV) pressure by micromanometer and end-diastolic volume (EDV) and end-systolic volume (ESV) by sonomicrometry. Systolic function was measured as LV ejection fraction (EF), peak rate of LV pressure rise (LV dP/dtmax) and as a gold standard of contractility, LV end-systolic elastance (Ees), and volume axis intercept (V0) calculated from end-systolic pressure-volume relations (ESPVR). Responses to CRT were compared with inotropic stimulation by dobutamine. Both CRT and dobutamine caused reduction in ESV (P < 0.01) and increase in LV dP/dtmax (P < 0.05). Both interventions shifted the ESPVR upwards indicating increased contractility, but CRT which reduced V0 (P < 0.01), caused no change in Ees. Dobutamine markedly increased Ees, which is the typical response to inotropic stimulation. Preload (EDV) was decreased (P < 0.01) by CRT, and there was no change in EF. When adjusting for the reduction in preload, CRT increased EF (P = 0.02) and caused a more marked increase in LV dP/dtmax (P < 0.01).

Conclusion: Increased contractility by CRT could not be identified by Ees, which is a widely used reference method for contractility. Furthermore, reduction in preload by CRT attenuated improvement in contractility indices such as EF and LV dP/dtmax. These results suggest that changes in LV volume may be more sensitive markers of acute CRT response than conventional contractility indices.
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http://dx.doi.org/10.1093/europace/euy221DOI Listing
February 2019

Dysfunction of the systemic right ventricle after atrial switch: physiological implications of altered septal geometry and load.

J Appl Physiol (1985) 2018 11 6;125(5):1482-1489. Epub 2018 Sep 6.

Institute for Surgical Research, Oslo University Hospital , Oslo , Norway.

Atrial switch operation in patients with transposition of the great arteries (TGA) leads to leftward shift and changes the geometry of the interventricular septum. By including the implications of regional work and septal curvature, this study investigates if changes in septal function and geometry contribute to reduced function of the systemic right ventricle (RV) in adult TGA patients. Regional myocardial work estimation has been possible by applying a recently developed method for noninvasive work calculation based on echocardiography. In 14 TGA patients (32 ± 6 yr, means ± SD) and 14 healthy controls, systemic ventricular systolic strains were measured by speckle tracking echocardiography and regional work was calculated by pressure-strain analysis. In TGA patients, septal longitudinal strain was reduced to -14 ± 2 vs. -20 ± 2% in controls ( P < 0.01) and septal work was reduced from 2,046 ± 318 to 1,146 ± 260 mmHg·% ( P < 0.01). Septal circumferential strain measured in a subgroup of patients was reduced to -11 ± 3 vs. -27 ± 3% in controls ( P < 0.01), and a reduction of septal work (540 ± 273 vs. 2,663 ± 459 mmHg·%) was seen ( P < 0.01). These reductions were in part attributed to elevated afterload due to increased radius of curvature of the leftward shifted septum. To conclude, in this mechanistic study we demonstrate that septal dysfunction contributes to failure of the systemic RV after atrial switch in TGA patients. This is potentially a long-term response to increased afterload due to a flatter septum and suggests that medical therapy that counteracts septal flattening may improve function of the systemic RV. NEW & NOTEWORTHY We have demonstrated that transposition of the great arteries patients with systemic right ventricles (RVs) have reduced function of the interventricular septum (IVS). Since the IVS is constructed to eject into the systemic circulation, it may seem unexpected that it does not maintain function when being part of the systemic RV. By applying the principles of regional work, wall tension, and geometry, we have identified unfavorable working conditions for the IVS when the RV adapts to systemic pressures.
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http://dx.doi.org/10.1152/japplphysiol.00255.2018DOI Listing
November 2018

Haemodynamic outcomes during piston-based mechanical CPR with or without active decompression in a porcine model of cardiac arrest.

Scand J Trauma Resusc Emerg Med 2018 Apr 24;26(1):31. Epub 2018 Apr 24.

Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway.

Background: Experimental active compression-decompression (ACD) CPR is associated with increased haemodynamic outcomes compared to standard mechanical chest compressions. Since no clinically available mechanical chest compression device is capable of ACD-CPR, we modified the LUCAS 2 (Physio-Control, Lund, Sweden) to deliver ACD-CPR, hypothesising it would improve haemodynamic outcomes compared with standard LUCAS CPR on pigs with cardiac arrest.

Methods: The modified LUCAS delivering 5 cm compressions with or without 2 cm active decompression above anatomical chest level was studied in a randomized crossover design on 19 Norwegian domestic pigs. VF was electrically induced and untreated for 2 min. Each pig received ACD-CPR and standard mechanical CPR in three 180-s. phases. We measured aortic, right atrial, coronary perfusion, intracranial and oesophageal pressure, cerebral and carotid blood flow and cardiac output. Two-sided paired samples t-test was used for continuous parametric data and Wilcoxon test for non-parametric data. P < 0.05 was considered significant.

Results: Due to injuries/device failure, the experimental protocol was completed in nine of 19 pigs. Cardiac output (l/min, median, (25, 75-percentiles): 1.5 (1.1, 1.7) vs. 1.1 (0.8, 1.5), p < 0.01), cerebral blood flow (AU, 297 vs. 253, mean difference: 44, 95% CI; 14-74, p = 0.01), and carotid blood flow (l/min, median, (25, 75-percentiles): 97 (70, 106) vs. 83 (57, 94), p < 0.01) were higher during ACD-CPR compared to standard mechanical CPR. Coronary perfusion pressure (CPP) trended towards higher in end decompression phase.

Conclusion: Cardiac output and brain blood flow improved with mechanical ACD-CPR and CPP trended towards higher during end-diastole compared to standard LUCAS CPR.
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http://dx.doi.org/10.1186/s13049-018-0496-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937838PMC
April 2018

Regional Dysfunction After Myocardial Infarction in Rats.

Circ Cardiovasc Imaging 2017 Sep;10(9)

From the Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Norway (E.K.S.E., J.M.A., O.M.S., L.Z., I.S.); Bjørknes College, Oslo, Norway (J.M.A.); and Respinor AS, Oslo, Norway (M.E.).

Background: Detailed understanding of regional function after myocardial infarction (MI) is currently incomplete. We aimed at investigating regional myocardial strain and work in post-MI rats with and without heart failure.

Methods And Results: Six weeks after induction of MI, 62 male Wistar-Hannover rats with a range of infarct sizes, plus 14 sham-operated rats, were examined by cine and phase-contrast magnetic resonance imaging. After magnetic resonance imaging, the rats were catheterized, and left ventricular pressures were recorded. Regional strain and work were calculated from the magnetic resonance imaging and pressure data. On the basis of end-diastolic left ventricular pressure, 34 MI rats were classified as nonfailing (MI) and 28 MI rats as failing (MI). In the region remote to the infarct, the MI rats exhibited preserved strain and increased work compared with sham, whereas MI had reduced longitudinal strain and no increase in work in this region. In the noninfarcted region adjacent to the infarct, MI demonstrated substantially reduced work because of high levels of negative work.

Conclusions: We have demonstrated a distinct difference in regional work between nonfailing and failing hearts after MI and offer novel insight into the relation between regional function and presence of congestion. Work analysis provided significant added value over strain analysis alone.
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http://dx.doi.org/10.1161/CIRCIMAGING.116.005997DOI Listing
September 2017

How Many Deaths from Colorectal Cancer Can Be Prevented by 2030? A Scenario-Based Quantification of Risk Factor Modification, Screening, and Treatment in Norway.

Cancer Epidemiol Biomarkers Prev 2017 09 16;26(9):1420-1426. Epub 2017 Jun 16.

Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Majorstuen, Oslo, Norway.

Colorectal cancer mortality can be reduced through risk factor modification (adherence to lifestyle recommendations), screening, and improved treatment. This study estimated the potential of these three strategies to modify colorectal cancer mortality rates in Norway. The potential reduction in colorectal cancer mortality due to risk factor modification was estimated using the software Prevent, assuming that 50% of the population in Norway-who do not adhere to the various recommendations concerning prevention of smoking, physical activity, body weight, and intake of alcohol, red/processed meat, and fiber-started to follow the recommendations. The impact of screening was quantified assuming implementation of national flexible sigmoidoscopy screening with 50% attendance. The reduction in colorectal cancer mortality due to improved treatment was calculated assuming that 50% of the linear (positive) trend in colorectal cancer survival would continue to persist in future years. Risk factor modification would decrease colorectal cancer mortality by 11% (corresponding to 227 prevented deaths: 142 men, 85 women) by 2030. Screening and improved treatment in Norway would reduce colorectal cancer mortality by 7% (149 prevented deaths) and 12% (268 prevented deaths), respectively, by 2030. Overall, the combined effect of all three strategies would reduce colorectal cancer mortality by 27% (604 prevented deaths) by 2030. Risk factor modification, screening, and treatment all have considerable potential to reduce colorectal cancer mortality by 2030, with the largest potential reduction observed for improved treatment and risk factor modification. The estimation of these health impact measures provides useful information that can be applied in public health decision-making. .
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http://dx.doi.org/10.1158/1055-9965.EPI-17-0265DOI Listing
September 2017

Preoperative chemoradiotherapy for rectal cancer and impact on outcomes - A population-based study.

Radiother Oncol 2017 06 5;123(3):446-453. Epub 2017 May 5.

Department of Oncology and K.G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, Oslo, Norway.

Background And Purpose: Preoperative (chemo)radiotherapy ((C)RT) for rectal cancer is, in Norway, restricted to patients with cT4-stage or threatened circumferential resection margin. This nationwide population-based study assessed the use of preoperative (C)RT in Norway and its impact on treatment outcomes.

Patients And Methods: Data from The Norwegian Colorectal Cancer Registry were used to identify all stage I-III rectal cancers treated with major resection (1997-2011: n=9193). Cumulative risk of local recurrence, distant metastasis, and relative survival was estimated for patients in 2007-2011 (n=3179). Multivariate regression-models were used to compare outcomes following preoperative (C)RT and surgery versus surgery alone.

Results: The proportion of patients given preoperative (C)RT increased from 5% to 49% during 1997-2011. Preoperative (C)RT was associated with reduced risk of local recurrence (hazard ratio (HR)=0.55; 95% CI=0.29-1.04) and a tendency of improved survival (excess HR=0.75; 95% CI=0.52-1.08) with significant effects in patients aged ≥70years (local recurrence: HR=0.35; 95% CI=0.13-0.91; survival: excess HR=0.58; 95% CI=0.35-0.95).

Conclusions: This study indicates that when use of preoperative (C)RT is restricted to selected high-risk rectal cancers, preoperative (C)RT is associated with improved local recurrence, and possibly improved survival, when studied on a population-based level.
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http://dx.doi.org/10.1016/j.radonc.2017.04.012DOI Listing
June 2017

The Norwegian dietary guidelines and colorectal cancer survival (CRC-NORDIET) study: a food-based multicentre randomized controlled trial.

BMC Cancer 2017 01 30;17(1):83. Epub 2017 Jan 30.

Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.

Background: Colorectal cancer survivors are not only at risk for recurrent disease but also at increased risk of comorbidities such as other cancers, cardiovascular disease, diabetes, hypertension and functional decline. In this trial, we aim at investigating whether a diet in accordance with the Norwegian food-based dietary guidelines and focusing at dampening inflammation and oxidative stress will improve long-term disease outcomes and survival in colorectal cancer patients.

Methods/design: This paper presents the study protocol of the Norwegian Dietary Guidelines and Colorectal Cancer Survival study. Men and women aged 50-80 years diagnosed with primary invasive colorectal cancer (Stage I-III) are invited to this randomized controlled, parallel two-arm trial 2-9 months after curative surgery. The intervention group (n = 250) receives an intensive dietary intervention lasting for 12 months and a subsequent maintenance intervention for 14 years. The control group (n = 250) receives no dietary intervention other than standard clinical care. Both groups are offered equal general advice of physical activity. Patients are followed-up at 6 months and 1, 3, 5, 7, 10 and 15 years after baseline. The study center is located at the Department of Nutrition, University of Oslo, and patients are recruited from two hospitals within the South-Eastern Norway Regional Health Authority. Primary outcomes are disease-free survival and overall survival. Secondary outcomes are time to recurrence, cardiovascular disease-free survival, compliance to the dietary recommendations and the effects of the intervention on new comorbidities, intermediate biomarkers, nutrition status, physical activity, physical function and quality of life.

Discussion: The current study is designed to gain a better understanding of the role of a healthy diet aimed at dampening inflammation and oxidative stress on long-term disease outcomes and survival in colorectal cancer patients. Since previous research on the role of diet for colorectal cancer survivors is limited, the study may be of great importance for this cancer population.

Trial Registration: ClinicalTrials.gov Identifier: NCT01570010 .
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http://dx.doi.org/10.1186/s12885-017-3072-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5282711PMC
January 2017

Electromagnetic inductance plethysmography is well suited to measure tidal breathing in infants.

ERJ Open Res 2016 Oct 24;2(4). Epub 2016 Nov 24.

Dept of Pediatrics, Haukeland University Hospital, Bergen, Norway; Dept of Clinical Science, Faculty of Medicine and Odontology, University of Bergen, Bergen, Norway.

Reliable, accurate and noninvasive methods for measuring lung function in infants are desirable. Electromagnetic inductance plethysmography has been used to perform infant spirometry and VoluSense Pediatrics (VSP) (VoluSense, Bergen, Norway) represents an updated version of this technique. We aimed to examine its accuracy compared to a validated system measuring airflow a facemask using an ultrasonic flowmeter. We tested 30 infants with postmenstrual ages between 36 to 43 weeks and weights from 2.3 to 4.8 kg, applying both methods simultaneously and applying VSP alone. Agreement between the methods was calculated using Bland-Altman analyses and we also estimated the effect of applying the mask. Mean differences for all breathing parameters were within ±5.5% and limits of agreement between the two methods were acceptable, except perhaps for peak tidal expiratory flow (PTEF). Application of the facemask significantly increased tidal volume, minute ventilation, PTEF, the ratio of inspiratory to expiratory time and the ratio of expiratory flow at 50% of expired volume to PTEF. VSP accurately measured tidal breathing parameters and seems well suited for tidal breathing measurements in infants under treatment with equipment that precludes the use of a facemask.
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http://dx.doi.org/10.1183/23120541.00062-2016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5152798PMC
October 2016

Nationwide implementation of laparoscopic surgery for colon cancer: short-term outcomes and long-term survival in a population-based cohort.

Surg Endosc 2016 11 23;30(11):4853-4864. Epub 2016 Feb 23.

Department of Gastrointestinal Surgery, Stavanger University Hospital, P.O. Box 8100, 4068, Stavanger, Norway.

Background: Randomized trials show similar outcomes after open surgery and laparoscopy for colon cancer, and confirmation of outcomes after implementation in routine practice is important. While some studies have reported long-term outcomes after laparoscopic surgery from single institutions, data from large patient cohorts are sparse. We investigated short- and long-term outcomes of laparoscopic and open surgery for treating colon cancer in a large national cohort.

Methods: We retrieved data from the Norwegian Colorectal Cancer Registry for all colon cancer resections performed in 2007-2010. Five-year relative survival rates following laparoscopic and open surgeries were calculated, including excess mortality rates associated with potential predictors of death.

Results: Among 8707 patients with colon cancer that underwent major resections, 16 % and 36 % received laparoscopic procedures in 2007 and 2010, respectively. Laparoscopic procedures were most common in elective surgeries for treating stages I-III, right colon, or sigmoid tumours. The conversion rate of laparoscopic procedures was 14.5 %. Among all patients, laparoscopy provided higher 5-year relative survival rates (70 %) than open surgery (62 %) (P = 0.040), but among the largest group of patients electively treated for stages I-III disease, the approaches provided similar relative survival rates (78 vs. 81 %; P = 0.535). Excess mortality at 2 years post-surgery was lower after laparoscopy than after open surgery (excess hazard ratio, 0.7; P = 0.013), but similar between groups during the last 3 years of follow-up. Major predictors of death were stage IV disease, tumour class pN+, age > 80 years, and emergency procedures (excess hazard ratios were 5.3, 2.4, 2.1, and 2.0, respectively; P < 0.001).

Conclusion: Nationwide implementation of laparoscopic colectomy for colon cancer was safe and achieved results comparable to those from previous randomized trials.
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http://dx.doi.org/10.1007/s00464-016-4819-8DOI Listing
November 2016

Acoustic Cluster Therapy: In Vitro and Ex Vivo Measurement of Activated Bubble Size Distribution and Temporal Dynamics.

Ultrasound Med Biol 2016 May 29;42(5):1145-66. Epub 2016 Jan 29.

Inven2 AS, Oslo, Norway.

Acoustic cluster technology (ACT) is a two-component, microparticle formulation platform being developed for ultrasound-mediated drug delivery. Sonazoid microbubbles, which have a negative surface charge, are mixed with micron-sized perfluoromethylcyclopentane droplets stabilized with a positively charged surface membrane to form microbubble/microdroplet clusters. On exposure to ultrasound, the oil undergoes a phase change to the gaseous state, generating 20- to 40-μm ACT bubbles. An acoustic transmission technique is used to measure absorption and velocity dispersion of the ACT bubbles. An inversion technique computes bubble size population with temporal resolution of seconds. Bubble populations are measured both in vitro and in vivo after activation within the cardiac chambers of a dog model, with catheter-based flow through an extracorporeal measurement flow chamber. Volume-weighted mean diameter in arterial blood after activation in the left ventricle was 22 μm, with no bubbles >44 μm in diameter. After intravenous administration, 24.4% of the oil is activated in the cardiac chambers.
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http://dx.doi.org/10.1016/j.ultrasmedbio.2015.12.011DOI Listing
May 2016

Regional variations in cancer survival: Impact of tumour stage, socioeconomic status, comorbidity and type of treatment in Norway.

Int J Cancer 2016 May 21;138(9):2190-200. Epub 2016 Jan 21.

Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Majorstuen, Oslo, Norway.

Cancer survival varies by place of residence, but it remains uncertain whether this reflects differences in tumour, patient and treatment characteristics (including tumour stage, indicators of socioeconomic status (SES), comorbidity and information on received surgery and radiotherapy) or possibly regional differences in the quality of delivered health care. National population-based data from the Cancer Registry of Norway were used to identify cancer patients diagnosed in 2002-2011 (n = 258,675). We investigated survival from any type of cancer (all cancer sites combined), as well as for the six most common cancers. The effect of adjusting for prognostic factors on regional variations in cancer survival was examined by calculating the mean deviation, defined by the mean absolute deviation of the relative excess risks across health services regions. For prostate cancer, the mean deviation across regions was 1.78 when adjusting for age and sex only, but decreased to 1.27 after further adjustment for tumour stage. For breast cancer, the corresponding mean deviations were 1.34 and 1.27. Additional adjustment for other prognostic factors did not materially change the regional variation in any of the other sites. Adjustment for tumour stage explained most of the regional variations in prostate cancer survival, but had little impact for other sites. Unexplained regional variations after adjusting for tumour stage, SES indicators, comorbidity and type of treatment in Norway may be related to regional inequalities in the quality of cancer care.
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http://dx.doi.org/10.1002/ijc.29967DOI Listing
May 2016

Nationwide improvement of rectal cancer treatment outcomes in Norway, 1993-2010.

Acta Oncol 2015 Nov 30;54(10):1714-22. Epub 2015 Apr 30.

m Department of Gastrointestinal Surgery , St. Olavs Hospital, Trondheim University Hospital , Trondheim , Norway.

Background: The Norwegian Rectal Cancer Project was initated in 1993 with the aims of improving surgery, decreasing local recurrence rates, improving survival, and establishing a national rectal cancer registry. Here we present results from the Norwegian Colorectal Cancer Registry (NCCR) from 1993 to 2010.

Material And Methods: A total of 15 193 patients were diagnosed with rectal cancer in Norway 1993-2010, and were registered with clinical data regarding diagnosis, treatment, locoregional recurrences and distant metastases. Of these, 10 796 with non-metastatic disease underwent tumour resection. The results were stratified into five time periods, and the treatment outcomes were compared. Recurrence rates are presented for the 9785 patients who underwent curative major resection (R0/R1).

Results: Among all 15 193 patients, relative five-year survival increased from 54.1% in 1993-1997 to 63.4% in 2007-2010 (p < 0.001). Among the 10 796 patients with stage I-III disease who underwent tumour resection, from 1993-1997 to 2007-2010, relative five-year survival improved from 71.2% to 80.6% (p < 0.001). An increasing proportion of these patients underwent surgery at large-volume hospitals; and 30- and 100-day mortality rates, respectively, decreased from 3.0% to 1.4% (p < 0.001) and from 5.1% to 3.0% (p < 0.011). Use of preoperative chemoradiotherapy increased from 6.5% in 1993 to 39.0% in 2010 (p < 0.001). Estimated local recurrence rate after major resection (R0/R1) decreased from 14.5% in 1993-1997 to 5.0% in 2007-2009 (p < 0.001), and distant recurrence rate decreased from 26.0% to 20.2% (p < 0.001).

Conclusion: Long-term outcomes from a national population-based rectal cancer registry are presented. Improvements in rectal cancer treatment have led to decreased recurrence rates of 5% and increased survival on a national level.
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http://dx.doi.org/10.3109/0284186X.2015.1034876DOI Listing
November 2015

Non-invasive myocardial work index identifies acute coronary occlusion in patients with non-ST-segment elevation-acute coronary syndrome.

Eur Heart J Cardiovasc Imaging 2015 Nov 6;16(11):1247-55. Epub 2015 Apr 6.

Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, Oslo 0424, Norway Department of Cardiology, Oslo University Hospital, Oslo, Norway Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway

Aims: Acute coronary artery occlusion (ACO) occurs in ∼30% of patients with non-ST-segment elevation-acute coronary syndrome (NSTE-ACS). We investigated the ability of a regional non-invasive myocardial work index (MWI) to identify ACO.

Methods And Results: Segmental strain analysis was performed before coronary angiography in 126 patients with NSTE-ACS. Left ventricular (LV) pressure was estimated non-invasively using a standard waveform fitted to valvular events and scaled to systolic blood pressure. MWI was calculated as the area of the LV pressure-strain loop. Empirical cut-off values were set to identify segmental systolic dysfunction for MWI (<1700 mmHg %) and strain (more than -14%). The number of dysfunctional segments was used in ROC analysis to identify ACO. The presence of ≥4 adjacent dysfunctional segments assessed by MWI was significantly better than both global strain and ejection fraction at detecting the occurrence of ACO (P < 0.05). Regional MWI had a higher sensitivity (81 vs. 78%) and especially specificity (82 vs. 65%) compared with regional strain. Logistic regression demonstrated that elevated systolic blood pressure significantly decreased the probability of actual ACO in a patient with an area of impaired regional strain.

Conclusion: The presence of a region of reduced MWI in patients with NSTE-ACS identified patients with ACO and was superior to all other parameters. The regional MWI was able to account for the influence of systolic blood pressure on regional contraction. We therefore propose that MWI may serve as an important clinical tool for selecting patients in need of prompt invasive treatment.
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http://dx.doi.org/10.1093/ehjci/jev078DOI Listing
November 2015

Assessment of regional myocardial work in rats.

Circ Cardiovasc Imaging 2015 Feb;8(2):e002695

From the Institute for Experimental Medical Research (E.K.S.E., J.M.A., G.S.E., L.Z., I.S.) and Center for Cardiological Innovation (O.A.S., T.E., M.E.), Oslo University Hospital and University of Oslo, Oslo, Norway; KG Jebsen Cardiac Research Center and Center for Heart Failure Research, University of Oslo, Oslo, Norway (E.K.S.E., G.S.E., L.Z., I.S.); Bjørknes College, Oslo, Norway (J.M.A.); Norwegian Institute of Public Health, Oslo, Norway (G.S.E.); and Department of Cardiology (O.A.S., T.E.) and Institute for Surgical Research (O.A.S., T.E., M.E.), Oslo University Hospital, Rikshospitalet, Oslo, Norway.

Background: Left ventricular (LV) motion and deformation is dependent on mechanical load and do therefore not reflect myocardial energy consumption directly. Regional myocardial work, however, constitutes a more complete assessment of myocardial function.

Methods And Results: Strain was measured using high-resolution phase-contrast MRI in 9 adult male rats with myocardial infarction (MI) and in 5 sham-operated control animals. Timing of LV valvular events and LV dimensions were evaluated by cine MRI. A separate cohort of 14 animals (MI/sham=9/5) underwent measurement of LV pressure concurrent with identification of valvular events by Doppler-echocardiography for the purpose of generating a standard LV pressure curve, normalized to valvular events. The infarctions were localized to the anterolateral LV wall. Combining strain with timing of valvular events and a measurement of peak arterial pressure, regional myocardial work could be calculated by applying the standard LV pressure curves. Cardiac output and stroke work was preserved in the MI hearts, suggesting a compensatory redistribution of myocardial work from the infarcted region to the viable tissue. In the septum, regional work was indeed increased in MI rats compared with sham (median work per unit long-axis length in a mid-ventricular slice: 241.2 [224.1-271.2] versus 137.2 [127.0-143.8] mJ/m; P<0.001). Myocardial work in infarcted regions was zero. Additionally, eccentric work was increased in the MI hearts.

Conclusions: Phase-contrast MRI, in combination with measurement of peak arterial pressure and MRI-derived timing of valvular events, represent a noninvasive approach for estimation of regional myocardial work in rodents.
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http://dx.doi.org/10.1161/CIRCIMAGING.114.002695DOI Listing
February 2015

β-blockade abolishes the augmented cardiac tPA release induced by transactivation of heterodimerised bradykinin receptor-2 and β2-adrenergic receptor in vivo.

Thromb Haemost 2014 Nov 31;112(5):951-9. Epub 2014 Jul 31.

Trude Aspelin, Institute for Experimental Medical Research, Oslo University Hospital, Ullevål, Postbox 4956 Nydalen, 0424 Oslo, Norway, Tel.: +47 22119685, Fax: +47 23016799, E-mail:

Bradykinin (BK) receptor-2 (B2R) and β2-adrenergic receptor (β2AR) have been shown to form heterodimers in vitro. However, in vivo proofs of the functional effects of B2R-β2AR heterodimerisation are missing. Both BK and adrenergic stimulation are known inducers of tPA release. Our goal was to demonstrate the existence of B2R-β2AR heterodimerisation in myocardium and to define its functional effect on cardiac release of tPA in vivo. We further investigated the effects of a non-selective β-blocker on this receptor interplay. To investigate functional effects of B2R-β2AR heterodimerisation (i. e. BK transactivation of β2AR) in vivo, we induced serial electrical stimulation of cardiac sympathetic nerves (SS) in normal pigs that underwent concomitant BK infusion. Both SS and BK alone induced increases in cardiac tPA release. Importantly, despite B2R desensitisation, simultaneous BK infusion and SS (BK+SS) was characterised by 2.3 ± 0.3-fold enhanced tPA release compared to SS alone. When β-blockade (propranolol) was introduced prior to BK+SS, tPA release was inhibited. A persistent B2R-β2AR heterodimer was confirmed in BK-stimulated and non-stimulated left ventricular myocardium by immunoprecipitation studies and under non-reducing gel conditions. All together, these results strongly suggest BK transactivation of β2AR leading to enhanced β2AR-mediated release of tPA. Importantly, non-selective β-blockade inhibits both SS-induced release of tPA and the functional effects of B2R-β2AR heterodimerisation in vivo, which may have important clinical implications.
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http://dx.doi.org/10.1160/TH14-01-0059DOI Listing
November 2014

Assessment of wasted myocardial work: a novel method to quantify energy loss due to uncoordinated left ventricular contractions.

Am J Physiol Heart Circ Physiol 2013 Oct 26;305(7):H996-1003. Epub 2013 Jul 26.

Institute for Surgical Research and Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway, and Medical Faculty, University of Oslo, Oslo, Norway; and.

Left ventricular (LV) dyssynchrony reduces myocardial efficiency because work performed by one segment is wasted by stretching other segments. In the present study, we introduce a novel noninvasive clinical method that quantifies wasted energy as the ratio between work consumed during segmental lengthening (wasted work) divided by work during segmental shortening. The wasted work ratio (WWR) principle was studied in 6 anesthetized dogs with left bundle branch block (LBBB) and in 28 patients with cardiomyopathy, including 12 patients with LBBB and 10 patients with cardiac resynchronization therapy. Twenty healthy individuals served as controls. Myocardial strain was measured by speckle tracking echocardiography, and LV pressure (LVP) was measured by micromanometer and a previously validated noninvasive method. Segmental work was calculated by multiplying strain rate and LVP to get instantaneous power, which was integrated to give work as a function of time. A global WWR was also calculated. In dogs, WWR by estimated LVP and strain showed a strong correlation (r = 0.94) and good agreement with WWR by the LV micromanometer and myocardial segment length by sonomicrometry. In patients, noninvasive WWR showed a strong correlation (r = 0.96) and good agreement with WWR using the LV micromanometer. Global WWR was 0.09 ± 0.03 in healthy control subjects, 0.36 ± 0.16 in patients with LBBB, and 0.21 ± 0.09 in cardiomyopathy patients without LBBB. Cardiac resynchronization therapy reduced global WWR from 0.36 ± 0.16 to 0.17 ± 0.07 (P < 0.001). In conclusion, energy loss due to incoordinated contractions can be quantified noninvasively as the LV WWR. This method may be applied to evaluate the mechanical impact of dyssynchrony.
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http://dx.doi.org/10.1152/ajpheart.00191.2013DOI Listing
October 2013

Excess mortality after curative surgery for colorectal cancer changes over time and differs for patients with colon versus rectal cancer.

Acta Oncol 2013 Jun 29;52(5):933-40. Epub 2012 Oct 29.

Department of Surgery, Stavanger University Hospital, Stavanger, Norway.

Background: Improved management of colorectal cancer patients has resulted in better five-year survival for rectal cancer compared with colon cancer. We compared excess mortality rates in various time intervals after surgery in patients with colon and rectal cancer.

Material And Methods: We analysed all patients with curative resection of colorectal cancers reported in the Cancer Registry of Norway before (1994-1996) and after (2001-2003) national treatment guidelines were introduced. Excess mortality was analysed in different postoperative time intervals within the five-year follow-up periods for patients treated in 1994-1996 vs. 2001-2003.

Results: A total of 11 437 patients that underwent curative resection were included. For patients treated from 1994 to 1996, excess mortality was similar in colon and rectal cancer patients in all time intervals. For those treated from 2001 to 2003, excess mortality was significantly lower in rectal cancer patients than in colon cancer patients perioperatively (in the first 60 days: excess mortality ratio = 0.46, p = 0.007) and during the first two postoperative years (2-12 months: excess mortality ratio = 0.54, p = 0.010; 1-2 years: excess mortality ratio = 0.60, p = 0.009). Excess mortality in rectal cancer patients was significantly greater than in colon cancer patients 4-5 years postoperatively (excess mortality ratio = 2.18, p = 0.003).

Conclusion: Excess mortality for colon and rectal cancer changed substantially after the introduction of national treatment guidelines. Short-term excess mortality rates was higher in colon cancer compared to rectal cancer for patients treated in 2001-2003, while excess mortality rates for rectal cancer patients was significantly higher later in the follow-up period. This suggests that future research should focus on these differences of excess mortality in patients curatively treated for cancer of the colon and rectum.
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http://dx.doi.org/10.3109/0284186X.2012.731522DOI Listing
June 2013

Different cardiac tissue plasminogen activator release patterns by local stimulation of the endothelium and sympathetic nerves in pigs.

Blood Coagul Fibrinolysis 2012 Dec;23(8):714-22

Department of Medical Biochemistry, Oslo University Hospital, Ullevål, Sweden.

Myocardial ischemia induces cardiac tissue plasminogen activator (tPA) release, declining by repeated periods of ischemia. However, the mechanisms and cellular sources are unknown. Sympathetic nerve stimulation (SS) and bradykinin (BK), an endogenous inducer of endothelial tPA release, may play roles, potentially involving different sources or mechanisms revealed by different release patterns. Therefore, we compared the cardiac tPA release patterns during repeated coronary BK infusions and SS, both with an ensuing period of local myocardial ischemia/reperfusion (I/R). Nine pigs were subjected to four periods of coronary BK infusion (4 min) and another nine animals to four periods of SS (4 min). Finally, 10 min of I/R was induced in both groups. The single-peaked BK-induced tPA release declined toward baseline by repeated infusions, but tPA release reappeared during I/R. In contrast, total tPA release during repeated SS and subsequent I/R was more stable, and SS-induced total tPA and norepinephrine (NE) releases were strongly correlated. Surprisingly, the instantaneous SS-induced tPA release was biphasic with a stable first peak, and a second peak declining toward baseline by repeated stimulations. The fluctuations in cardiac release of plasminogen activator inhibitor-1 and the endogenous BK inhibitor angiotensin-converting enzyme, could not explain the diverging tPA release patterns. Different tPA release patterns were demonstrated during SS and BK stimulation, as well as diverging responses to repeated stimulations and subsequent I/R. This study demonstrates strong association between tPA and NE during SS and possibly two different sources or mechanisms for SS-induced tPA release.
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http://dx.doi.org/10.1097/MBC.0b013e328357d388DOI Listing
December 2012

A novel clinical method for quantification of regional left ventricular pressure-strain loop area: a non-invasive index of myocardial work.

Eur Heart J 2012 Mar 6;33(6):724-33. Epub 2012 Feb 6.

Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway.

Aims: Left ventricular (LV) pressure-strain loop area reflects regional myocardial work and metabolic demand, but the clinical use of this index is limited by the need for invasive pressure. In this study, we introduce a non-invasive method to measure LV pressure-strain loop area.

Methods And Results: Left ventricular pressure was estimated by utilizing the profile of an empiric, normalized reference curve which was adjusted according to the duration of LV isovolumic and ejection phases, as defined by timing of aortic and mitral valve events by echocardiography. Absolute LV systolic pressure was set equal to arterial pressure measured invasively in dogs (n = 12) and non-invasively in patients (n = 18). In six patients, myocardial glucose metabolism was measured by positron emission tomography (PET). First, we studied anaesthetized dogs and observed an excellent correlation (r = 0.96) and a good agreement between estimated LV pressure-strain loop area and loop area by LV micromanometer and sonomicrometry. Secondly, we validated the method in patients with various cardiac disorders, including LV dyssynchrony, and confirmed an excellent correlation (r = 0.99) and a good agreement between pressure-strain loop areas using non-invasive and invasive LV pressure. Non-invasive pressure-strain loop area reflected work when incorporating changes in local LV geometry (r = 0.97) and showed a strong correlation with regional myocardial glucose metabolism by PET (r = 0.81).

Conclusions: The novel non-invasive method for regional LV pressure-strain loop area corresponded well with invasive measurements and with directly measured myocardial work and it reflected myocardial metabolism. This method for assessment of regional work may be of clinical interest for several patients groups, including LV dyssynchrony and ischaemia.
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http://dx.doi.org/10.1093/eurheartj/ehs016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3303715PMC
March 2012

Mechanical chest compressions with trapezoidal waveform improve haemodynamics during cardiac arrest.

Resuscitation 2011 Feb 19;82(2):213-8. Epub 2010 Nov 19.

Institute for Experimental Medical Research, Oslo University Hospital, Oslo, Norway.

Background: During manual chest compressions for cardiac arrest the waveforms of chest compressions are generally sinusoidal, whereas mechanical chest compression devices can have different waveforms, including trapezoidal. We studied the haemodynamic differences of such waveforms in a porcine model of cardiac arrest.

Methods: Eight domestic pigs (weight 31±3kg) were anaesthetised and instrumented to continuously monitor aortic (AP) and right atrial pressure (RAP), carotid (CF) and cerebral cortical microcirculation blood flow (CCF). Coronary perfusion pressure (CPP) was calculated as the maximal difference between AP and RAP during diastole or decompression phase. After 4 min of electrically induced ventricular fibrillation, mechanical chest compressions were performed with four different waveforms in a factorial design, and in randomized sequence for 3 min each. Resulting differences are presented as mean with 95% confidence intervals.

Results: Mean AP and RAP were higher with trapezoid than sinusoid chest compressions, difference 5.7 (0.7, 11) and 6.3 (2.1, 11)mmHg, respectively. Flow measured as CF and CCF was also improved with trapezoidal waveform, difference 14 (2.8, 26)ml/min and 11 (5.6, 17)% of baseline, respectively, with a parallel, non-significant (P=0.08) trend for CPP. Active vs. passive decompression to zero level improved CF, but without even a trend for CPP.

Conclusion: Trapezoid chest compressions and active decompression to zero level improved blood flow to the brain. The compression waveform is an additional factor to consider when comparing mechanical and manual chest compressions and when comparing different compression devices.
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http://dx.doi.org/10.1016/j.resuscitation.2010.10.009DOI Listing
February 2011

Short- and long-term results of secondary anterior sphincteroplasty in 33 patients with obstetric injury.

Acta Obstet Gynecol Scand 2010 Nov;89(11):1466-72

Department of Gastroenterological Surgery, Oslo University Hospital, Ullevål, Norway.

Objective: To study short- and long-term improvement in obstetric anal incontinence after secondary overlapping sphincteroplasty and repeat repairs.

Design: A prospective analysis based on incontinence scores and patient satisfaction.

Setting: Department of Gastroenterological Surgery, Oslo University Hospital, a tertiary unit also dealing with sphincter repair.

Population: Of 40 obstetric patients operated consecutively from February 1996 to April 2004, 33 (83%) patients with median age of 36 years were eligible for evaluation.

Methods: Wexner's and St. Mark's incontinence score, clinical examination, anal ultrasonography and manometry, and neurophysiological examination when indicated. Patient satisfaction to treatment was recorded. The patients had anterior overlapping sphincteroplasty. Five had repeat operations, four sphincteroplasty and two post-anal repair.

Main Outcome Measures: Anal incontinence, patient satisfaction.

Results: The 33 patients were examined after median 7 (range 2-62) months and 103 (62-162) months. Median incontinence scores preoperatively and after short- and long-term follow-up were 12 (5-20), 7 (5-20) (p < 0.01) and 9 (0-18) (p < 0.05), respectively. Three patients (9%) had normalized anal incontinence (score ≤1) after short- and long-term follow-up. Corresponding numbers for improved anal incontinence were 22 (67%) and 16 (49%), respectively. Improvement in incontinence scores and patients' satisfaction were concordant. Symptom duration (n = 7), pudendal neuropathy (n = 6), repeat repair (n = 5) and instrument delivery (n = 3) were associated with adverse outcome.

Conclusions: Improvement in anal incontinence at short-term follow-up is attenuated at long-term follow-up. Stoma formation, sacral nerve stimulation and neo-sphincter formation must be considered in compliant patients.
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http://dx.doi.org/10.3109/00016349.2010.519019DOI Listing
November 2010

Predicting cardiotoxicity propensity of the novel iodinated contrast medium GE-145: Ventricular fibrillation during left coronary arteriography in pigs.

Acta Radiol 2010 Nov;51(9):1007-13

Dept. of Clinical Sciences/Medical Radiology, Lund Univeristy, Lund, Sweden.

Background: Severe side effects caused by iodinated radiographic contrast media (CM) are rare, but can occur in high risk patients and during percutaneous coronary intervention. To minimize this risk a new nonionic CM with low inherent osmolality has been designed, giving room for a relatively high concentration of favorable electrolytes in the isotonic formulation.

Purpose: To test a new radiographic CM (GE-145) in a pig model of cardiotoxicity by comparing its ventricular fibrillation (VF) propensity and hemodynamic effects to that of iodixanol.

Material And Methods: Test agents were injected into the left anterior descending coronary artery (LAD) of pigs through an inflated balloon catheter (injection volume 25 ml, injection rate 0.4 ml/s, maximum injection time 62.5 s). Series 1: GE-145 (338 mg I/ml) + 45 mM NaCl and iodixanol (321 mg I/ml) + 19 mM NaCl were injected in five pigs. Series 2: GE-145 (320 mg I/ml) + 45 mM NaCl + 0.1, 0.3, or 0.7 mM CaCl₂ and iodixanol (320 mg I/ml) + 19 mM NaCl + 0.3 mM CaC₂ (Visipaque) were injected in six pigs.

Results: Iodixanol + NaCl caused VF in 6 of 13 injections (46%) after 60.3±7.5 s (mean ± SD). GE-145 + NaCl did not cause any VF in 13 injections (0%) (P<0.05). Iodixanol + 19 mM NaCl + 0.3 mM CaCl₂ caused VF in 9 of 9 injections (100%) after 61±4 s. GE-145 + 45 mM NaCl + 0.1, 0.3, or 0.7 mM CaCl₂ did not cause any VF during or after 9 injections of each agent (0%) (P<0.05). The least hemodynamic effects were seen with GE-145 + 45 mM NaCl + 0.7 mM CaCl₂.

Conclusion: In this model of direct administration of CM into the LAD of anesthetized pigs, the tested GE-145 formulations had a significantly lower propensity to induce VF than iodixanol with electrolytes. Favorable hemodynamic properties of GE-145 can be achieved by optimizing concentrations of sodium and calcium.
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http://dx.doi.org/10.3109/02841851.2010.504743DOI Listing
November 2010

Comparison of polyacetylene content in organically and conventionally grown carrots using a fast ultrasonic liquid extraction method.

J Agric Food Chem 2010 Jul;58(13):7673-9

Department of Food Chemistry, National Food Institute, Technical University of Denmark, Mørkhøj Bygade 19, DK-2860 Søborg, Denmark.

A rapid and sensitive analytical method for quantification of polyacetylenes in carrot roots was developed. The traditional extraction method (stirring) was compared to a new ultrasonic liquid processor (ULP)-based methodology using high-performance liquid chromatography-ultraviolet (HPLC-UV) and mass spectrometry (MS) for identification and quantification of three polyacetylenes. ULP was superior because a significant reduction in extraction time and improved extraction efficiencies were obtained. After optimization, the ULP method showed good selectivity, precision [relative standard deviations (RSDs) of 2.3-3.6%], and recovery (93% of falcarindiol) of the polyacetylenes. The applicability of the method was documented by comparative analyses of carrots grown organically or conventionally in a 2 year field trial study. The average concentrations of falcarindiol, falcarindiol-3-acetate, and falcarinol in year 1 were 222, 30, and 94 mug of falcarindiol equiv/g of dry weight, respectively, and 3-15% lower in year 2. The concentrations were not significantly influenced by the growth system, but a significant year-year variation was observed for falcarindiol-3-acetate.
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http://dx.doi.org/10.1021/jf101921vDOI Listing
July 2010

Discriminating the effect of accelerated compression from accelerated decompression during high-impulse CPR in a porcine model of cardiac arrest.

Resuscitation 2010 Apr 1;81(4):488-92. Epub 2010 Feb 1.

Institute for Experimental Medical Research and Centre for Heart Failure Research, Oslo University Hospital - Ullevål, Oslo, Norway.

Aim Of The Study: Piston based mechanical chest compression devices deliver compressions and decompressions in an accelerated pattern, resulting in superior haemodynamics compared to manual compression in animal studies. The present animal study compares haemodynamics during two different hybrid compression patterns to a standard compression pattern resembling that of modern mechanical chest compression devices.

Method: In 12 anaesthetized domestic pigs in ventricular fibrillation, coronary perfusion pressures (CPP) and cerebral cortical blood flow (CCBF) was measured, and transesophageal echocardiography (TEE) was performed. Two hybrid compression patterns, one with accelerated trapezoid compression and slower sinusoid decompression (TrS), and one with slower sinusoid compression and accelerated trapezoid decompression (STr), were tested against a standard accelerated trapezoid compression-decompression pattern (TrTr) in a cross-over randomised setup.

Results: There were 7% (1, 14, p=0.046) lower CCBF and 3 mmHg (1, 5, p=0.017) lower CPP with the TrS compared to TrTr pattern. No significant difference between STr and TrTr pattern in either CCBF, 6% (-3, 15, p=0.176) or CPP, 0 mmHg (-2, 3, p=0.703) was present. Our TEE recordings were insufficient for haemodynamic comparison between the different compression-decompression patterns. Despite standardized sternal piston position and placement of the pigs, TEE revealed varying degree of asymmetrical heart chamber compression in the animals.

Conclusion: Both cardiac and cerebral perfusion benefited from accelerated decompression, while accelerated compression did not improve haemodynamics. The evolution of mechanical CPR is dependent on further research on mechanisms generating forward blood flow during external chest compressions.
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http://dx.doi.org/10.1016/j.resuscitation.2009.12.028DOI Listing
April 2010
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