Læknaneminn - 01.01.2017, Blaðsíða 161

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Only two proteins assessed showed bands in the
western blot, total caveolin­1 and total Akt­1. They
showed no trends towards changes. A band was also
observed for GAPDH which showed that the loading
for the samples was uneven.
Conclusion: These results from the immuno­
fluorescence assay show that arteriovenous fistula
can be put under arterial conditions in the bioreactor
without their endothelium being destroyed. The
results from the western blot are unreliable but the
fact that there do not seem to be changes in the total
amount of caveolin­1 and Akt­1 also suggest that
the endothelium is preserved. No phosphorylated
proteins showed bands so no conclusions about
protein activation can be drawn. We conclude that
the bioreactor flow chamber model is viable for
further, exciting research into fistula maturation.
Kynáttunarvandi á Íslandi
1997 ­ 2015
Aldur, kynjadreifing, lífsvenjur,
lyfjameðferð, skurðaðgerðir og
notkun á annarri þjónustu
Steinunn Birna Sveinbjörnsdóttir1, Elsa
Bára Traustadóttir2, Óttar Guðmundsson2,
Arna Guðmundsdóttir3
1Læknadeild Háskóla Íslands, 2Geðdeild
Landspítala, 3Göngudeild innkirtlalækninga
Landspítala
Inngangur: Kynáttunarvandi er ástand þar sem
einstaklingur upplifir sig í röngu kyni. Þetta fólk
kallast transfólk. Líffræðilegar konur sem upplifa sig
sem menn kallast transmenn og líffræðilegir karlar
sem upplifa sig sem konur kallast transkonur. Á
Landspítala starfar teymi sem sérhæfir sig í greiningu
og meðferð transfólks. Á síðustu árum hefur orðið
fjölgun einstaklinga sem leita sér aðstoðar vegna
kynáttunarvanda. Markmið þessarar rannsóknar
var að skoða lýðfræði (e. demographiu) þessa hóps
og meðferð með von um að geta bætt þjónustu við
hópinn.
Efniviður og aðferðir: Lýsandi rannsókn sem tók til
allra einstaklinga með kynáttunarvanda sem komu til
transteymis Landspítalaárin frá 1997 til ársloka 2015.
Upplýsingar fengust úr sjúkraskrám.
Niðurstöður: Markmið rannsóknarinnar er að skoða
þennan hóp með tilliti til þess að hægt sé að bæta
þjónustu við hópinn. Alls leituðu 84 einstaklingar
til transteymisins á tímabilinu, þar af 49 transkonur
og 35 transmenn. Fjöldi þeirra sem hefur leitað sér
aðstoðar hefur aukist. Aldur transfólks sem leitar sér
aðstoðar virðist vera að lækka. Meðalaldur transmanna
var 23 ± 6 ár en meðalaldur transkvenna var 31 ± 11
ár. 25% transkvenna voru í sambandi, sambúð eða
í hjónabandi við fyrstu komu til transteymisins en
43% transmanna. Tæplega helmingur transkvenna
og rúmlega 70% transmanna voru við nám og/eða
í vinnu. Aðeins 4% transkvenna og 3% transmanna
höfðu lokið háskólamenntun. 29% transkvenna
og 26% transmanna reyktu á tímabilinu. 16%
transkvenna og 9% transmanna hafa átt við áfengis­
og/eða vímuefnavanda að stríða. Tæplega 60%
transkvenna og 30% transmanna nýttu sér þjónustu
talmeinafræðings.
Ályktanir: Álykta mætti frá niðurstöðunum að
transfólk á Íslandi er félagslega jaðarsettur hópur með
lélega menntun og stöðu. Það eru ekki allir sem nýta
sér þjónustu talmeinafræðings en hægt er að álykta
að þjónustan við þessa einstaklinga yrði betri ef fleiri
myndu nýta sér aðstoð talmeinafræðings.
The use of high­density EEG to
map out cortical motor activity
and reorganization following
lower­limb amputation
Valur Guðnason1, Ásgeir Alexandersson2,
Kyle Edmunds3, Kristleifur Kristjánsson2,
Þorvaldur Ingvarsson1,2, Paolo Gargiulo3,4
1University of Iceland, 2Össur, 3Reykjavik
University, 4The National University Hospital
of Iceland
Introduction: Studies have shown that after ampu­
tation, changes occur in the sensory and motor cortex.
These changes are called cortical reorganization,
where adjacent cortical areas occupy the cortical
area of the amputated limb. High­density electro­
encephalography (EEG) has been used to observe
cortical reorganization in the motor cortex following
upper limb amputation. The aim of this study was
to use high­density EEG to map out motor cortical
activity and cortical reorganization following lower
limb amputation.
Materials and methods: One healthy and one left
transfemoral amputee participated in the study. Using
a 256­electrode, high­density EEG system, EEG
signals were acquired while participants performed
sets of motor tasks. The amputated participant was
asked to try to voluntarily execute each movement for
the missing limb, not simply imagine the movement.
EMG data was acquired simultaneously. Participants
walked on a treadmill for four minutes while EEG and
EMG data was recorded. The EEG data was mapped
onto structural MRI brain images and motor activity
generated by each set of movement was localized
in the motor cortex. Additionally, diffusion tensor
imaging analysis of neural tracts was performed.
Results: By mapping the cortical surface potential
over time, cortical activity was observed in different
parts of the brain, e.g. the visual cortex, prefrontal
cortex and the motor cortex. For the amputated
participant, motor representations for movement
tasks were mapped out and showed additional cortical
activity located more laterally than expected from
somatotopic maps of the motor cortical homunculus.
This additional cortical activity was not observed for
the healthy participant.
Conclusion: The results indicate that motor cortical
activity and cortical reorganization following lower
limb amputation can be observed using high­
density EEG. More measurements and data analysis
is required, e.g. with the use of other processing
software. The diffusion tensor images show neural
tracts but further work is needed to evaluate whether
white matter changes associated with the amputation
can be observed. The method could be used to evaluate
the effects of high­tech myoelectric prostheses with
sensory feedback on cortical reorganization. It
would also be interesting to further investigate the
connection between cortical reorganization and
phantom limb pain.