Coming theses from other universities
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Underneath The Obvious : The markers of disease not yet manifested : Evaluation of cardiovascular risk markers in patients with type 2 diabetes and the role of plasma biomarkers in patients presenting to the emergency department with chest pain and/or...
Link: http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-209952
Cardiovascular disease (CVD) is the leading cause of death globally, and diabetes mellitus (DM) is increasingly prevalent worldwide. People with DM are at a higher risk of developing heart-related complications that can lead to serious health issues and death. Chest pain (CP) and shortness of breath (SOB) are common manifestations of cardiopulmonary disorders. These symptoms often prompt people to seek emergency medical care.
Risk stratification involves assessing a patient's probability of experiencing complications and premature death. Determining the necessary interventions to improve the patients' health outcomes is essential. Healthcare professionals encounter daily challenges in risk stratification. Identifying new and clinically relevant markers for improved risk stratification is crucial.
This thesis aims to assess whether blood biomarkers could predict the risk of adverse events and prognosis in emergency care patients with CP and/or SOB. Additionally, this work evaluates risk markers for identifying patients with higher risk of CVD and premature death in type 2 diabetes (T2DM) patients.
Papers I and II assessed the predictive values of copeptin, mid-regional pro-adrenomedullin (MRproADM), and mid-regional pro-atrial natriuretic peptide (MRproANP) as potential markers for risk stratification in emergency departments (ED). These studies were based on the ABBA population, a single-center observational study conducted at the Linköping Hospital ED.
In Paper I, age, sex, oxygen saturation, heart rate, National Early Warning Score (NEWS) category, and copeptin were found to be associated with admission to a hospital ward from the ED. Copeptin was found to have an added predictive value for admission compared to NEWS alone.
In Paper II, MRproADM levels >0.75 nmol/L and multimorbidity were significantly associated with readmission and/or death within 90 days. MRproADM improved the predictive value of readmission and/or death within 90 days compared to age, sex, and multimorbidity combined.
Papers III, IV, and V were based on CARDIPP, a research program aimed at identifying markers for CVD in T2DM patients. This population-based study involved primary care patients aged 55−65, with a baseline survey conducted between 2005 and 2008. The cohort was monitored for CVD morbidity and mortality from a national registry.
In Paper III, patients with T2DM and low toe brachial index (TBI) had an increased risk of major adverse cardiovascular events (MACE) independent of arterial stiffness.
In Paper IV, we found that an increasing copeptin level was significantly associated with MACE. Patients with copeptin levels ≥5.6 pmol/L had an unfavorable risk for MACE, independent of traditional CVD risk factors and left ventricular mass index.
Paper V found that copeptin was associated with TBI and aortic pulse wave velocity (aPWV), both markers of arterial disorders, independent of traditional CVD risk factors.
In conclusion, early analysis of copeptin may be helpful for patient risk assessments. MRproADM and multimorbidity may predict the risk of readmission and/or death within 90 days. In patients with T2DM, low TBI, and elevated copeptin levels may serve as important indicators for increased risk of MACE. Copeptin may be a helpful surrogate for identifying individuals at higher risk of arterial disorders.
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Advanced crosslinking for keratoconus and low-grade myopia
Link: http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-231668
Corneal crosslinking (CXL) is an established treatment for progressive keratoconus (KC). In this thesis, Advanced CXL refers to a further development of conventional CXL, which aims to improve the treatment outcomes in KC and can also be used as a refractive treatment for low-grade myopia (near-sightedness). Transepithelial (epi-on) CXL with high oxygen has emerged as an approach to reduce the post-treatment inconveniences. The aim of the three prospective, randomized, intra-individually compared, single-masked studies in this thesis was to continue developing advanced CXL for KC and low-grade myopia.
Studies I and II sought to assess the treatment effects and subjective ocular discomforts in epi-on photorefractive intrastromal crosslinking (PiXL) in high oxygen as a refractive treatment for low-grade myopia using three different illumination protocols. In Study I, 23 healthy subjects (46 eyes) were randomized to a central 4.0 mm homogeneous illumination zone (area) in one eye and a 4.0 mm annular zone with a central 2.0 mm sparing (ring) in the fellow eye. Both protocols improved uncorrected distance visual acuity (UDVA) and manifest refractive spherical equivalent (MRSE) at 1 month, which remained stable throughout 24 months. The ring protocol was reported to cause less ocular discomfort at 1 week. In Study II, 27 healthy subjects (54 eyes) were randomized to the previous ring protocol in one eye and a 3.5 mm annular protocol with a central 1.5 mm sparing (small ring) in the fellow eye. The small ring rendered less ocular discomfort the first day post-treatment and slightly better improvements in UDVA and MRSE, but there was a transient reduction in low-contrast visual acuity (LCVA). In both Studies I and II, no changes in endothelial cell count (ECC) and best corrected visual acuity (BCVA) were seen and no adverse events were registered.
Study III aimed to compare the treatment effect and subjective ocular discomfort scores of customized topography-guided epi-on CXL in high oxygen with customized topography-guided epi-off CXL in room air for KC. At 24 months, both treatments had halted the disease progressions and had improved UDVA and BCVA. LCVA at 10% contrast improved for both protocols, but LCVA at 2.5% contrast improved for epi-on CXL only. No changes were seen in ECC, and no adverse events were registered. The epi-on eyes were reported to have less ocular discomfort throughout the first week post-treatment.
In conclusion, advanced CXL can be used to improve vision and halt progressive KC, and it also improves uncorrected vision and reduces low-grade myopia in healthy eyes. In low-grade myopia, the initial ocular discomfort may be reduced with a ring illumination PiXL protocol. A larger treatment effect may be seen with a smaller treatment zone, but likely at the expense of a transient decrease in LCVA. In KC, customized topography-guided epi-on CXL in high oxygen is a viable alternative to customized topography-guided epi-off CXL in room air, with faster improvements in BCVA and LCVA and less early ocular discomfort.
- The extent to which neurodevelopmental disorders are associated with functional and physical outcomes, and why? Link: http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-117316