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Biomedical subjects

H Jonsson

Publications and source records attributed to H Jonsson.

At least 37 records · Page 2Linked to original sources
PubMed1998

Re-used pacemakers--as safe as new? A retrospective case-control study.

UNLABELLED: Re-use of pacemakers is of interest in an era of declining health care resources if it is proven safe and without risks to the patients. In order to investigate the safety of re-use of pacemakers we performed a retrospective case-control study. One hundred patients, who received a re-used pacemaker, were matched for date of implantation and mode (AAI; VVI; DDD) to 100 others who received a newly manufactured pacemaker and were followed for a mean of 32 +/- 11 months for complications defined as infections and signs of pacemaker malfunction and pacemaker replacement earlier than anticipated due to battery depletion. Patients who received re-used pacemakers were significantly older than those who received new units (79 +/- 9 vs 68 +/- 21 years; P < 0.0001). The number of complications did not differ significantly between groups. There were no early replacements due to battery depletion in either of the two groups. A cost-benefit analysis revealed a substantial economical advantage. CONCLUSIONS: The re-use of pacemakers can be carried out without increased risk to the patients provided a proper routine for technical control and sterilization is followed. Re-use means substantial savings which possibly could make advanced pacemaker treatment available to all eligible patients irrespective of age. Whether re-use is feasible with implantable defibrillators remains to be determined.

Aged↗
PubMed1997

Neoadjuvant chemotherapy with cisplatin and 5-fluorouracil in advanced squamous cell carcinoma of the head and neck: a randomized phase III study.

BACKGROUND AND PURPOSE: In 1986 a prospective, randomized, multi-centre trial for evaluation of neoadjuvant chemotherapy with cisplatin and 5-fluorouracil in the treatment of advanced squamous cell carcinoma of the head and neck was initiated. As survival in this group of patients is poor the purpose was to find a possible survival benefit of the chemotherapy in addition to radiotherapy compared to radiotherapy only. METHODS: Four-hundred sixty-one patients from Denmark, Norway and Sweden with tumors in oral cavity, oropharynx, hypopharynx and larynx were randomized to receive either standard treatment (radiotherapy or radiotherapy followed by surgery) or neoadjuvant chemotherapy followed by standard treatment. Chemotherapy included three courses of cisplatin 100 mg/m2 i.v. infusion on day 1 followed by 5-fluorouracil 1000 mg/m2 per day continuous i.v. infusion for 120 hours. Radiotherapy 64-70 Gy in 2 Gy per fraction, 5 times/week, was given to patients in both treatment arms. RESULTS: Response rate was 71% for patients randomized to chemotherapy-radiotherapy and 66% for patients randomized to standard treatment (not statistically significant). Residual tumors were excised if possible. After surgery 62% of the patients randomized to chemotherapy-radiotherapy and 60% of the patients in the standard treatment group were clinically tumor free. CONCLUSIONS: No statistically significant benefit in survival was observed for patients treated with neoadjuvant chemotherapy followed by radiotherapy. Nor was there any impact of chemotherapy on the number of patients achieving loco-regional tumor control after primary treatment.

Adult↗
PubMed1997

Shot-gun phage display mapping of two streptococcal cell-surface proteins.

We have used a phage display shot-gun cloning technique to map the binding domains in two cell surface proteins from animal group C streptococci. The proteins, MAG and ZAG, have affinity for alpha (2)-macroglobulin (alpha (2)M), serum albumin and IgG. In this work, parts of cloned i mag and zag genes were randomly cloned into a phagemid vector, and recombinant phages expressing alpha (2)-M- or albumin-binding activity were isolated through panning against immobilized alpha (2)M or albumin. Analysis of the clones revealed two distinct alpha (2)M-binding sites in protein MAG and two slightly overlapping binding sites in protein ZAG. The minimal albumin-binding domain in protein ZAG, as deduced from the affinity selected clones, consisted of 42 amino acids. These results show that the phage display shot-gun cloning is a rapid and convenient way to characterize the binding site(s) in receptor proteins without any prior knowledge of their number, size, and localization.

Albumins↗
PubMed1997

Excess mortality from breast cancer in relation to mammography screening in northern Sweden.

OBJECTIVES: Previous randomised studies of mammography screening have shown a significant effect on breast cancer mortality, particularly in women aged 50-69 at randomisation. Breast cancer mortality has traditionally been studied by judgments on causes of death, either from cause of death registers or from medical records. In this study an alternative method was used, estimating the excess mortality associated with breast cancer. SETTING: In 1990 two counties of northern Sweden started population based mammography screening of women aged 40-74. The unscreened population in the two other counties of the same region were selected as controls. RESULTS: Excess mortality associated with breast cancer was lower in the screened population, and was discernible three to four years after the start of screening. The relative risk estimate, based on the cumulative excess number of deaths from breast cancer during 1990-95 in the screened versus the control population aged 40-74 (at diagnosis of breast cancer), was 0.72 (95% confidence interval (CI) 0.53 to 0.99). For women aged 50-69 it was 0.67 (95% CI 0.46 to 0.99). In the 50-69 age group the estimated excess number of deaths from breast cancer during 1995 was 17.0 per 100,000 women (95% CI 5.0 to 29.0) in the screened counties and 51.1 per 100,000 (95% CI 30.2 to 71.9) in the unscreened counties. CONCLUSIONS: Population based routine screening has substantial effects on breast cancer mortality in women aged 50-69. Estimation of excess mortality can be used in future studies to evaluate the effects of mammography screening on breast cancer mortality.

Adult↗
PubMed1997

Anticipating retirement: the formation of narratives concerning an occupational transition.

OBJECTIVE: This study is the first part of a longitudinal investigation of the retirement process. This stage of the inquiry concerned how older persons anticipate their retirement. METHOD: Thirty-two workers were randomly selected from all workers age 63 years in a suburb of Stockholm. They participated in semistructured interviews about their work and their expectations for retirement. RESULTS: The participants narratives illustrated the complex work of interpreting the past and expected meaning in one's occupational life. The narratives, which anticipated widely different future trajectories, revealed many of the challenges and dilemmas of anticipating retirement and the close association of work experience to expectations for retirement. In particular, the narratives highlighted the participants' concerns about maintaining the quality of experience in activity. The findings also demonstrate the process by which persons anticipate and make choices about life change. CONCLUSIONS: People anticipate retirement through volitional narratives in which they link together past, present, and future. Understanding this volitional process of interpreting, anticipating, and making choices is important to understanding how people adapt to life changes.

Adaptation, Psychological↗
PubMed1997

IgA rheumatoid factor correlates with changes in B and T lymphocyte subsets and disease manifestations in rheumatoid arthritis.

OBJECTIVE: To analyze the relationship between lymphocyte subsets, different rheumatoid factor (RF) isotypes, and clinical features in patients with rheumatoid arthritis (RA). METHODS: Patients with established RA (n = 95) were examined clinically and blood samples were collected for measurements of RF by ELISA and for analysis of lymphocyte subsets by flow cytometry. RESULTS: IgA RF positive patients had more severe disease and higher prevalence of extraarticular manifestations than the other patients. Patients with elevated IgA RF had a higher percentage of CD5+ B cells and of CD4+CD45RO+ T cells compared to the other patients with RA or controls. High percentage of CD4+CD45RO+ T cells was also significantly associated with extraarticular manifestations. Patients with the sicca syndrome had significantly higher ratio of CD5+ B cells than patients without or with other types of extraarticular manifestations. CONCLUSION: Different disease manifestations in RA may be associated not only with certain RF isotypes and RF isotype combinations but also with changes in lymphocyte subsets in the blood. The relative increase of CD4+CD45RO+ T cells in the blood of IgA RF positive patients with RA might reflect preferential recruitment of CD8+CD45RO+ T cells to inflammatory sites.

Adult↗
PubMed1996

A collagen binding protein from Lactobacillus reuteri is part of an ABC transporter system?

The gene coding for a collagen binding protein from Lactobacillus reuteri NCIB 11951 was cloned and sequenced. A genomic lambda library was constructed and recombinant plaques were screened using antisera raised against purified collagen binding proteins from the same L. reuteri strain. The positive plaques were subjected to sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western blot analysis, which revealed the expression of a 29 kDa protein, which reacted with the antisera and bound 125I-labelled type I collagen. The sequence of the corresponding gene, cnb showed that the collagen binding protein has sequence similarities to the solute binding component of bacterial ABC transporters.

Amino Acid Sequence↗
PubMed1996

Pulmonary artery abnormalities in tetralogy of Fallot and relation to late physical performance.

Preoperative angiograms were reviewed in 86 (52%) of 165 patients who underwent intracardiac repair of tetralogy of Fallot in 1966-1976. The median age at repair was 7 years (range 9 months-55 years). Hypoplasia, stenosis or atresia of the pulmonary and aortopulmonary collateral arteries were present in 58 patients (67%). Hypoplasia of the main pulmonary artery was associated with hypoplasia of the pulmonary artery branches. In patients who received a transannular patch the pulmonary arteries were smaller than in those without patch. Three of five pulmonary artery branch stenoses were located at the site of a previous palliative shunt. The postrepair right ventricular/left ventricular systolic pressure ratio (PRV/LV) measured in the operating room was compared with a predicted ratio based on pulmonary artery dimensions. High PRV/LV was associated with poor prognosis. In survivors the postrepair PRV/LV had fallen significantly 13-26 years later. Work capacity and pulmonary function at follow-up were not influenced by presence of pulmonary artery abnormalities. We conclude that such abnormalities, although common in patients with tetralogy of Fallot, did not per se influence physical performance in long-term survivors.

Adolescent↗
PubMed1996

Healthy houses--perspective on well-being in rural Cambodia.

In a remote area of north-east Cambodia, health is seen more as a matter of living in a spiritually favourable house than of preventing and controlling diseases in individuals. However, this way of seeing things is being influenced towards a more collective view on the one hand, and a more individualistic one on the other.

Attitude to Health↗
PubMed1995

Streptococcal protein MAG--a protein with broad albumin binding specificity.

Protein MAG is a cell surface protein from Streptococcus dysgalactiae which binds alpha 2-macroglobulin (alpha 2M), serum albumin and immunoglobulin G (IgG). In this work protein MAG was expressed in Escherichia coli, purified and analysed for its albumin-binding specificity. The binding of protein MAG to serum albumins of different species origin was studied in a dot-blot assay and compared with the binding of streptococcal protein G, so far the best studied bacterial albumin receptor. The albumin-binding of protein MAG was also characterized using real-time biospecific interaction analysis (BIA), and the ka, kd and the Kaff values for different albumins were determined. Amino acid sequence alignment revealed homology between the albumin-binding domain of protein MAG and earlier described streptococcal albumin receptors including protein G. However, the MAG protein was reactive with serum albumin from bovine, dog, goat, horse, human, mouse, pig, rat and sheep origin and therefore displays a broader albumin-binding profile than protein G concerning the albumins tested in this work. Comparison of the albumin-binding spectrum of protein MAG with the earlier described albumin receptors of various S. dysgalactiae strains and other streptococci, suggests that protein MAG is a new type of albumin receptor.

Amino Acid Sequence↗
PubMed1995

Work capacity and central hemodynamics thirteen to twenty-six years after repair of tetralogy of Fallot.

Exercise tests and cardiac catheterization were performed in 53 patients, 13 to 26 years after intracardiac repair of tetralogy of Fallot. At the time of repair, the median age was 7 years, and 60% of patients with cyanosis had had a previous palliative procedure. The right ventriculotomy was closed without a patch in 21 patients (40%), a patch restricted to the right ventricle was inserted in 18 patients (34%), and in 14 (26%) the patch extended across the pulmonary anulus. At follow-up, 94% of the patients were free of symptoms. Symptom-limited work capacity was 87% of the predicted value (95% confidence limits, 82% to 94%). Work capacity was inversely related to age at follow-up, to right ventricular systolic pressure at rest, and to presence of moderate or severe pulmonary valve regurgitation. Cardiac output in relation to oxygen uptake was reduced in 74% of patients during exercise. In 12 patients (23%), systolic pressure at rest in the right ventricle was 50 mm Hg or higher. Systolic pressure during exercise in the right ventricle was lower in patients without a patch than in those with a patch and was abnormally high in all groups compared with healthy subjects. The ratio of right to left ventricular pressure was significantly lower than measurements taken immediately after repair. An intracardiac left-to-right shunt was present in 6 patients (11%). Three patients required invasive treatment as a result of our follow-up. We conclude that work capacity was moderately reduced 13 to 26 years after repair of tetralogy of Fallot and was adversely influenced by right ventricular hypertension and pulmonary valve regurgitation. Intermittent lifelong surveillance is advocated, because patients without symptoms may have hemodynamic abnormalities that necessitate intervention.

Adolescent↗
PubMed1995

Echocardiographic findings in 83 patients 13-26 years after intracardiac repair of tetralogy of Fallot.

Doppler echocardiography was performed in 83 patients, 13-26 (median 19) years after repair of tetralogy of Fallot. Median age at repair was 7 years (range 9 months-42 years). An outflow patch restricted to the right ventricle was used in 29%, a transannular patch in 27% and the right ventricle was closed without a patch in 44%. Ninety-six percent of the patients were asymptomatic at follow-up. Patients with a transannular patch were younger, had a larger right ventricle and a higher right ventricle to pulmonary artery pressure difference than those without a patch. The average end-diastolic diameter of the right ventricle was larger than normal regardless of type of repair. The thickness of the right ventricular wall was increased in 50%. In 43% of the patients there was persistent hypertrophy of the right ventricular wall despite normalized systolic pressure. The average size and function of the left ventricle were normal although fractional shortening was reduced in 30% of the patients. The aortic root was abnormally large in 48%. Thirty-four percent had moderate or severe pulmonary valve regurgitation. Symptom-limited work capacity was 87% of predicted and was inversely related to age, systolic pressure in the right ventricle. E/A ratio of the left ventricle and use of the transannular patch. We conclude that right ventricular dysfunction and right ventricular outflow obstruction and/or incompetence were common even in asymptomatic long-term survivors after repair of tetralogy of Fallot.

Adolescent↗
PubMed1995

A protein G-related cell surface protein in Streptococcus zooepidemicus.

This work describes the cloning and sequencing of a gene encoding a plasma protein receptor from Streptococcus zooepidemicus. This receptor, termed protein ZAG, is a 45-kDa protein that binds alpha 2-macroglobulin (alpha 2M), serum albumin, and immunoglobulin G (IgG). The IgG-binding activity is located in the C-terminal part of the molecule and is mediated by two repeated domains highly homologous to each other as well as to the corresponding domains in streptococcal type III Fc receptors. The IgG-binding profile of protein ZAG is similar to that previously reported for S. zooepidemicus. Binding to serum albumin is mediated by a short amino acid sequence in the middle of the molecule. This domain shows homology to previously described albumin-binding proteins from streptococci, and the albumin-binding profile of protein ZAG is similar to that of streptococcal protein G. The N-terminal part of protein ZAG, which mediates binding to the plasma proteinase inhibitor alpha 2M, is composed of a unique stretch of amino acids. Protein ZAG competes for the same, or nearby, binding site(s) in alpha 2M as do two recently described Streptococcus dysgalactiae receptors, although the sequences of the alpha 2M-binding domains in these three receptors show only minor sequence similarities.

Amino Acid Sequence↗
PubMed1995

Survival and clinical results up to 26 years after repair of tetralogy of Fallot.

Repair of tetralogy of Fallot was performed on 165 patients (median age 7 years, range 4 months-54 years) in 1966-1976. The 30-day mortality rate was 15%. High postrepair right ventricular/left ventricular pressure ratio (P(RV/LV)) was a predictor of early mortality. Complete atrioventricular block of varying duration, though associated with 42% of the early deaths, was not an independent risk factor in multivariate analysis. The 20-year survival rate (excluding early deaths) was 84%. Reoperation was done in ten patients. Of the 16 late deaths, eight were sudden. Old age at repair and use of transannular patch correlated with risk of late death. Complete atrioventricular block, acyanosis, year of surgery, sex, and P(RV/LV) did not significantly influence long-term survival. Follow-up (median 19, range 13-26 years) comprised 110 survivors, 95% of whom were asymptomatic, 77% in employment, 65% had participated in school athletics and 58% regularly exercised, but 40% did not have regular medical examinations. Operation at age 3-5 years had the most favourable prognosis.

Adolescent↗
PubMed1995

Late sudden deaths after repair of tetralogy of Fallot. Electrocardiographic findings associated with survival.

Of 141 hospital survivors after intracardiac repair of tetralogy of Fallot, eight died suddenly 6-23 years later. Compared with the other 133 patients, these eight were older at operation, with higher post-repair systolic right ventricular pressure and more often complete atrioventricular block; ventricular arrhythmia was diagnosed before death in three cases. In follow-up totalling 2255 patient years, the linearized rate of sudden death was 0.35%/year. The instantaneous risk of sudden death showed continuous increase with the length of follow-up. Of 80 survivors electrocardiographically evaluated 13-26 (median 20) years postoperatively, none had complete block, but 79 had complete right bundle branch block, including seven with left anterior hemiblock. Ventricular extrasystoles were recorded in 1% at rest, in 34% during exercise and in 83% during 24-hour ambulatory monitoring, with Lown Grade > or = II in 27%. Old age and possibly presence of fibrosis and/or fibroelastosis in right ventricular outflow Lown Grade. A patient with Lown grade III died suddenly 2 years after our follow-up. Old age at repair thus was associated with increased risk of late sudden death and with frequent ventricular arrhythmia in long-term survivors.

Adolescent↗
PubMed1994

MAG, a novel plasma protein receptor from Streptococcus dysgalactiae.

The gene encoding a plasma protein receptor from Streptococcus dysgalactiae has been cloned and sequenced. The gene product, with a predicted molecular mass of approx. 44 kDa, binds alpha 2-macroglobulin (alpha 2 M), serum albumin and immunoglobulin G (IgG). By subcloning and expressing various parts of the gene as fusion proteins, we found that the three binding activities reside in discrete domains of the protein. The single IgG-binding domain, localized in the C-terminal part of the molecule, shows high homology to streptococcal type-III Fc receptors. In the middle of the molecule, there is a stretch of 50 amino acids (aa) mediating albumin binding. This region has partial homology with the albumin-binding domains of streptococcal protein G. The alpha 2 M-binding domain is located in the N terminus of the molecule and is composed of a unique aa sequence. We call this trifunctional plasma protein receptor, MAG (binds alpha 2 M, albumin and IgG).

Albumins↗