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  • 201.
    de Leede, E. M.
    et al.
    Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
    Sibinga Mulder, B. G.
    Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
    Bastiaannet, E.
    Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
    Poston, G. J.
    Department of Surgery, University Hospital Aintree, Liverpool, United Kingdom.
    Sahora, K.
    Department of Surgery and Comprehensive Cancer Centre, Medical University of Vienna/ABCSG Pancreatic Cancer Registry, Austria.
    Van Eycken, E.
    Belgian Cancer Registry, Brussels, Belgium.
    Valerianova, Z.
    Bulgarian National Cancer Registry/National Oncological Hospital, Sofia, Bulgaria.
    Mortensen, M. B.
    Department of Surgery, Odense University Hospital/Danish Pancreas Cancer Group, Denmark.
    Dralle, H.
    Department of Surgery, University of Halle-Wittenberg/Pancreatic Cancer Register, Halle, Germany.
    Primic-Zakelj, M.
    Epidemiology and Cancer Registry/Institute of Oncology, Ljubljana, Slovenia.
    Borras, J. M.
    Department of Clinical Sciences, University of Barcelona, Barcelona, Spain.
    Gasslander, Thomas
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US. Linköpings universitet, Medicinska fakulteten.
    Ryzhov, A.
    National Cancer Registry of Ukraine/National Institute of Cancer, Kiev, Ukraine.
    Lemmens, V. E.
    Department of Research, Netherlands Cancer Registry/Comprehensive Cancer Centre The Netherlands (IKNL), Eindhoven, The Netherlands.
    Mieog, J. S. D.
    Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
    Boelens, P. G.
    Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
    van de Velde, C. J. H.
    Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
    Bonsing, B. A.
    Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
    Common variables in European pancreatic cancer registries: The introduction of the EURECCA pancreatic cancer project2016Ingår i: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 42, nr 9, s. 1414-1419Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Quality assurance of cancer care is of utmost importance to detect and avoid under and over treatment. Most cancer data are collected by different procedures in different countries, and are poorly comparable at an international level. EURECCA, acronym for European Registration of Cancer Care, is a platform aiming to harmonize cancer data collection and improve cancer care by feedback. After the prior launch of the projects on colorectal, breast and upper GI cancer, EURECCAs newest project is collecting data on pancreatic cancer in several European countries. Methods: National cancer registries, as well as specific pancreatic cancer audits/registries, were invited to participate in EURECCA Pancreas. Participating countries were requested to share an overview of their collected data items. Of the received datasets, a shared items list was made which creates insight in similarities between different national registries and will enable data comparison on a larger scale. Additionally, first data was requested from the participating countries. Results: Over 24 countries have been approached and 11 confirmed participation: Austria, Belgium, Bulgaria, Denmark, Germany, The Netherlands, Slovenia, Spain, Sweden, Ukraine and United Kingdom. The number of collected data items varied between 16 and 285. This led to a shared items list of 25 variables divided into five categories: patient characteristics, preoperative diagnostics, treatment, staging and survival. Eight countries shared their first data. Conclusions: A list of 25 shared items on pancreatic cancer coming from eleven participating registries was created, providing a basis for future prospective data collection in pancreatic cancer treatment internationally.

  • 202.
    deKeyser, Linda
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet.
    Svedin, Carl Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    Agnafors, Sara
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet.
    Bladh, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Sydsjö, Gunilla
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Multi-informant reports of mental health in Swedish-born children of immigrants and children born to non-immigrants - the SESBiC-study2014Ingår i: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 14, s. 95-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:

    The European literature on mental health of the children of immigrants is limited. Therefore this study aims to investigate gender-specific mental health reported by teachers, parents and the children themselves in 12-year old children of immigrants and non-immigrants and also to study the level of agreement between the different informants.

    METHODS:

    This cross-sectional study is a part of the longitudinal South East Sweden Birth Cohort-study (the SESBiC-study) on children's health. All children born in town in the south of Sweden 1995-1996 were invited to take part. The mothers of 1723 children (88%) consented. In this part 87 Swedish-born 12-year old children of immigrants and 687 12-year old children of non-immigrants were investigated regarding gender-specific differences in mental health as reported by teachers (Teacher-report form), parents (Child behavior checklist), and children (Strengths and Difficulties Questionnaire) and the agreement reached between the informants.

    RESULTS:

    Parental immigrant status was not associated with mental health in any of the groups, but living arrangements and parental educational level were mainly found to have an effect on the health status of boys (TRF-Internalizing β = .77 95% CI = .02-1.52; TRF-Externalizing.β = 2.31 95% CI = .63-3.99; TRF-Total β = 6.22 95% CI = 2.27-10.18) The agreement between different informants was generally low, except for externalizing problems among boys (Boys of immigrant parents: Parent and teacher correlation ρ = .422 and Child teacher correlation ρ = .524, p-value < .05, respectively). The correlation between teachers and parents were lower in the index group compared to the reference group. In the index group, the correlations between teacher's and children's assessments were fairly high for boys but not for girls (ρ Total = .400, ρ Internalizing = .240 and ρ Externalizing = .524, p-value < .05 for Total and Externalizing).

    CONCLUSION:

    This study confirms previous findings that the mental health of children of immigrants is similar to that of children of non-immigrants. We found that family factors have a greater impact on the reported mental health than immigrant status does. This might be of clinical importance for healthcare workers to recognize when investigating and treating children from other cultures.

  • 203.
    Delisle, Christine
    et al.
    Karolinska Institute, Sweden.
    Sandin, Sven
    Karolinska Institute, Sweden.
    Forsum, Elisabet
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Henriksson, Hanna
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Karolinska Institute, Sweden.
    Trolle-Lagerros, Ylva
    Karolinska Institute, Sweden.
    Larsson, Christel
    University of Gothenburg, Sweden.
    Maddison, Ralph
    University of Auckland, New Zealand.
    Ortega, Francisco B.
    University of Granada, Spain.
    Ruiz, Jonatan R.
    University of Granada, Spain.
    Silfvernagel, Kristin
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Timpka, Toomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Löf, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Karolinska Institute, Sweden.
    A web- and mobile phone-based intervention to prevent obesity in 4-year-olds (MINISTOP): a population-based randomized controlled trial2015Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, nr 95Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Childhood obesity is an increasing health problem globally. Overweight and obesity may be established as early as 2-5 years of age, highlighting the need for evidence-based effective prevention and treatment programs early in life. In adults, mobile phone based interventions for weight management (mHealth) have demonstrated positive effects on body mass, however, their use in child populations has yet to be examined. The aim of this paper is to report the study design and methodology of the MINSTOP (Mobile-based Intervention Intended to Stop Obesity in Preschoolers) trial. Methods/Design: A two-arm, parallel design randomized controlled trial in 300 healthy Swedish 4-year-olds is conducted. After baseline measures, parents are allocated to either an intervention-or control group. The 6-month mHealth intervention consists of a web-based application (the MINSTOP app) to help parents promote healthy eating and physical activity in children. MINISTOP is based on the Social Cognitive Theory and involves the delivery of a comprehensive, personalized program of information and text messages based on existing guidelines for a healthy diet and active lifestyle in pre-school children. Parents also register physical activity and intakes of candy, soft drinks, vegetables as well as fruits of their child and receive feedback through the application. Primary outcomes include body fatness and energy intake, while secondary outcomes are time spent in sedentary, moderate, and vigorous physical activity, physical fitness and intakes of fruits and vegetables, snacks, soft drinks and candy. Food and energy intake (Tool for Energy balance in Children, TECH), body fatness (pediatric option for BodPod), physical activity (Actigraph wGT3x-BT) and physical fitness (the PREFIT battery of five fitness tests) are measured at baseline, after the intervention (six months after baseline) and at follow-up (12 months after baseline). Discussion: This novel study will evaluate the effectiveness of a mHealth program for mitigating gain in body fatness among 4-year-old children. If the intervention proves effective it has great potential to be implemented in child-health care to counteract childhood overweight and obesity.

  • 204.
    Delisle Nystrom, Christine
    et al.
    Novum, Sweden.
    Forsum, Elisabet
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Henriksson, Hanna
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Trolle-Lagerros, Ylva
    Karolinska Institute, Sweden.
    Larsson, Christel
    University of Gothenburg, Sweden.
    Maddison, Ralph
    University of Auckland, New Zealand.
    Timpka, Toomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Löf, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Novum, Sweden.
    A Mobile Phone Based Method to Assess Energy and Food Intake in Young Children: A Validation Study against the Doubly Labelled Water Method and 24 h Dietary Recalls2016Ingår i: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 8, nr 1, s. 50-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Mobile phones are becoming important instruments for assessing diet and energy intake. We developed the Tool for Energy Balance in Children (TECH), which uses a mobile phone to assess energy and food intake in pre-school children. The aims of this study were: (a) to compare energy intake (EI) using TECH with total energy expenditure (TEE) measured via doubly labelled water (DLW); and (b) to compare intakes of fruits, vegetables, fruit juice, sweetened beverages, candy, ice cream, and bakery products using TECH with intakes acquired by 24 h dietary recalls. Participants were 39 healthy, Swedish children (5.5 +/- 0.5 years) within the ongoing Mobile-based Intervention Intended to Stop Obesity in Preschoolers (MINISTOP) obesity prevention trial. Energy and food intakes were assessed during four days using TECH and 24 h telephone dietary recalls. Mean EI (TECH) was not statistically different from TEE (DLW) (5820 +/- 820 kJ/24 h and 6040 +/- 680kJ/24 h, respectively). No significant differences in the average food intakes using TECH and 24 h dietary recalls were found. All food intakes were correlated between TECH and the 24 h dietary recalls (r = 0.665-0.896, p &lt; 0.001). In conclusion, TECH accurately estimated the average intakes of energy and selected foods and thus has the potential to be a useful tool for dietary studies in pre-school children, for example obesity prevention trials.

  • 205.
    Delisle Nystrom, Christine
    et al.
    Karolinska Institute, Sweden.
    Henriksson, Pontus
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. PROmoting FITness and Health Phys Actv Research Grp PROFIT, Spain.
    Alexandrou, Christina
    Karolinska Institute, Sweden.
    Löf, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Karolinska Institute, Sweden.
    The Tanita SC-240 to Assess Body Composition in Pre-School Children: An Evaluation against the Three Component Model2016Ingår i: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 8, nr 6, s. 371-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Quick, easy-to-use, and valid body composition measurement options for young children are needed. Therefore, we evaluated the ability of the bioelectrical impedance (BIA) device, Tanita SC-240, to measure fat mass (FM), fat free mass (FFM) and body fatness (BF%) in 40 healthy, Swedish 5.5 years old children against the three component model (3C model). Average BF%, FM, and FFM for BIA were: 19.4% +/- 3.9%, 4.1 +/- 1.9 kg, and 16.4 +/- 2.4 kg and were all significantly different (p amp;lt; 0.001) from corresponding values for the 3C model (25.1% +/- 5.5%, 5.3 +/- 2.5 kg, and 15.2 +/- 2.0 kg). Bland and Altman plots had wide limits of agreement for all body composition variables. Significant correlations ranging from 0.81 to 0.96 (p amp;lt; 0.001) were found for BF%, FM, and FFM between BIA and the 3C model. When dividing the children into tertiles for BF%, 60% of children were classified correctly by means of BIA. In conclusion, the Tanita SC-240 underestimated BF% in comparison to the 3C model and had wide limits of agreement. Further work is needed in order to find accurate and easy-to-use methods for assessing body composition in pre-school children.

  • 206.
    DHaese, J. G.
    et al.
    Hospital University of Munich, Germany.
    Neumann, J.
    University of Munich, Germany.
    Weniger, M.
    Hospital University of Munich, Germany.
    Pratschke, S.
    Hospital University of Munich, Germany.
    Björnsson, Bergthor
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US. Linköpings universitet, Medicinska fakulteten.
    Ardiles, V.
    Italian Hospital Buenos Aires, Argentina.
    Chapman, W.
    Washington University, MO 63110 USA.
    Hernandez-Alejandro, R.
    University of Western Ontario, Canada.
    Soubrane, O.
    Beaujon Hospital, France.
    Robles-Campos, R.
    Virgen de la Arrixaca University Hospital, Spain.
    Stojanovic, M.
    University of Clin Centre, Serbia.
    Dalla Valle, R.
    Parma University Hospital, Italy.
    Chan, A. C. Y.
    University of Hong Kong, Peoples R China.
    Coenen, M.
    University of Munich, Germany.
    Guba, M.
    Hospital University of Munich, Germany.
    Werner, J.
    Hospital University of Munich, Germany.
    Schadde, E.
    University of Zurich, Switzerland.
    Angele, M. K.
    Hospital University of Munich, Germany.
    Should ALPPS be Used for Liver Resection in Intermediate-Stage HCC?2016Ingår i: Annals of Surgical Oncology, ISSN 1068-9265, E-ISSN 1534-4681, Vol. 23, nr 4, s. 1335-1343Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Extended liver resections in patients with hepatocellular carcinoma (HCC) are problematic due to hepatitis, fibrosis, and cirrhosis. Associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) has been promoted as a novel method to induce hypertrophy for patients with extensive colorectal liver metastases, but outcomes in HCC have not been well investigated. All patients registered in the international ALPPS Registry (http://www.alpps.org) from 2010 to 2015 were studied. Hypertrophy of the future liver remnant, perioperative morbidity and mortality, age, overall survival, and other parameters were compared between patients with HCC and patients with colorectal liver metastases (CRLM). The study compared 35 patients with HCC and 225 patients with CRLM. The majority of patients undergoing ALPPS for HCC fall into the intermediate-stage category of the Barcelona clinic algorithm. In this study, hypertrophy was rapid and extensive for the HCC patients, albeit lower than for the CRLM patients (47 vs. 76 %; p &lt; 0.002). Hypertrophy showed a linear negative correlation with the degrees of fibrosis. The 90-day mortality for ALPPS used to treat HCC was almost fivefold higher than for CRLM (31 vs. 7 %; p &lt; 0.001). Multivariate analysis showed that patients older than 61 years had a significantly reduced overall survival (p &lt; 0.004). The ALPPS approach induces a considerable hypertrophic response in HCC patients and allows resection of intermediate-stage HCC, albeit at the cost of a 31 % perioperative mortality rate. The use of ALPPS for HCC remains prohibitive for most patients and should be performed only for a highly selected patient population younger than 60 years with low-grade fibrosis.

  • 207.
    Di Saverio, Salomone
    et al.
    AUSL, Italy.
    Birindelli, Arianna
    University of Bologna, Italy.
    Kelly, Micheal D.
    Canberra Hospital, Australia.
    Catena, Fausto
    Maggiore Hospital Parma, Italy.
    Weber, Dieter G.
    Trauma and Gen Surgeon Royal Perth Hospital, Australia; University of Western Australia, Australia.
    Sartelli, Massimo
    Macerata Hospital, Italy.
    Sugrue, Michael
    Letterkenny Hospital, Ireland.
    De Moya, Mark
    Harvard Medical Sch, MA USA.
    Augusto Gomes, Carlos
    University of Gen Juiz de Fora, Brazil.
    Bhangu, Aneel
    University Hospital Birmingham NHS Fdn Trust, England.
    Agresta, Ferdinando
    Civil Hospital, Italy.
    Moore, Ernest E.
    Denver Health Medical Centre, CO USA.
    Soreide, Kjetil
    Stavanger University Hospital, Norway.
    Griffiths, Ewen
    University Hospital Birmingham NHS Fdn Trust, England.
    De Castro, Steve
    OLVG, Netherlands.
    Kashuk, Jeffry
    University of Jerusalem, Israel.
    Kluger, Yoram
    Rambam Health Care Campus, Israel.
    Leppaniemi, Ari
    University of Helsinki, Finland.
    Ansaloni, Luca
    Papa Giovanni XXIII Hospital, Italy.
    Andersson, Manne
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Coccolini, Federico
    Papa Giovanni XXIII Hospital, Italy.
    Coimbra, Raul
    UCSD Health Syst, CA USA.
    Gurusamy, Kurinchi S.
    UCL, England.
    Cesare Campanile, Fabio
    San Giovanni Decollato Andosilla Hospital, Italy.
    Biffl, Walter
    University of Hawaii, HI USA.
    Chiara, Osvaldo
    Osped Niguarda Ca Granda, Italy.
    Moore, Fred
    University of Florida, FL USA.
    Peitzman, Andrew B.
    University of Pittsburgh, PA USA.
    Fraga, Gustavo P.
    University of Estadual Campinas, Brazil.
    Costa, David
    Alicante, Spain.
    Maier, Ronald V.
    University of Washington, WA USA.
    Rizoli, Sandro
    St Michaels Hospital, Canada.
    Balogh, Zsolt J.
    John Hunter Hospital, Australia.
    Bendinelli, Cino
    John Hunter Hospital, Australia.
    Cirocchi, Roberto
    University of Perugia, Italy.
    Tonini, Valeria
    University of Bologna, Italy.
    Piccinini, Alice
    AUSL, Italy.
    Tugnoli, Gregorio
    AUSL, Italy.
    Jovine, Elio
    AUSL, Italy.
    Persiani, Roberto
    Catholic University, Italy.
    Biondi, Antonio
    University of Catania, Italy.
    Scalea, Thomas
    R Adams Cowley Trauma Centre, MD USA.
    Stahel, Philip
    Denver Health Medical Centre, CO USA.
    Ivatury, Rao
    Virginia Commonwealth University, VA USA.
    Velmahos, George
    Harvard Medical Sch, MA USA.
    Andersson, Roland
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis2016Ingår i: World Journal of Emergency Surgery, ISSN 1749-7922, E-ISSN 1749-7922, Vol. 11, nr 34Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the WSES, held in Jerusalem (Israel), a panel of experts including an Organizational Committee and Scientific Committee and Scientific Secretariat, participated to a Consensus Conference where eight panelists presented a number of statements developed for each of the eight main questions about diagnosis and management of AA. The statements were then voted, eventually modified and finally approved by the participants to The Consensus Conference and lately by the board of co-authors. The current paper is reporting the definitive Guidelines Statements on each of the following topics: 1) Diagnostic efficiency of clinical scoring systems, 2) Role of Imaging, 3) Non-operative treatment for uncomplicated appendicitis, 4) Timing of appendectomy and in-hospital delay, 5) Surgical treatment 6) Scoring systems for intra-operative grading of appendicitis and their clinical usefulness 7) Non-surgical treatment for complicated appendicitis: abscess or phlegmon 8) Pre-operative and post-operative antibiotics.

  • 208.
    Dillner, L
    et al.
    Microbiology and Tumor Biology Center, Karolinska Institute, Stockholm, Sweden.
    Zellbi, A
    Åvall-Lundqvist, Elisabeth
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Department of Gynecologic Oncology, Karolinska Hospital, Stockholm, Sweden.
    Heino, P
    Eklund, C
    Pettersson, C A
    Forslund, O
    Hansson, B G
    Grandien, M
    Bistoletti, P
    Association of serum antibodies against defined epitopes of human papillomavirus L1, E2, and E7 antigens and of HPV DNA with incident cervical cancer.1995Ingår i: Cancer Detection and Prevention, ISSN 0361-090X, E-ISSN 1873-443X, Vol. 19, nr 5, s. 381-93Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In order to provide a large-scale evaluation of the association with cervical cancer of antibodies against human papillomavirus (HPV) antigens, sera from 233 patients with primary, untreated cervical cancer and from 157 healthy age- and sex-matched blood donors were analyzed for IgG and IgA antibodies against HPV-derived peptide antigens and against bovine papillomavirus. Several serological responses were strongly associated with cervical cancer, notably the IgG response against the HPV 16 epitopes L1:13 (Relative risk [RR]: 5.3), E2:9 (RR: 2.9), and E7:5 (RR: 4.3), and the IgA response against an HPV 18 E2-derived antigen (245:18, RR: 3.1). HPV DNA in corresponding cervical tumors was analyzed by Southern blotting (SB) and polymerase chain reaction (PCR) in 47 patients. Sixty-six percent of the patients carried HPV DNA as determined by SB, 91% of patients analyzed by PCR. Neither the antibody responses, nor the presence of HPV DNA were significantly associated with the biological properties of the tumors.

  • 209.
    Ding, Zhen-Yu
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet.
    Liu, Gui-Hong
    Sichuan University, China.
    Olsson, Birgit
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Onkologi. Linköpings universitet, Hälsouniversitetet.
    Sun, Xiao-Feng
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Upregulation of the antiapoptotic factor Livin contributes to cisplatin resistance in colon cancer cells2013Ingår i: Tumor Biology, ISSN 1010-4283, E-ISSN 1423-0380, Vol. 34, nr 2, s. 683-693Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The antiapoptotic factor Livin has been considered critical for tumor progression and poor prognosis for variant types of tumors. However, there are only limited reports regarding its expression and biological functions in colon cancer. Here, we examined Livin expression in four colon cancer cell lines (HCT116, RKO, KM12C, and SW620) in the presence or absence of cisplatin that was used as a model reagent. We found the different response to cisplatin was related to endogenous Livin expression level. From among a panel of apoptosis-related factors (p53, Bcl-2, Bcl-XL, BAX, and survivin), the expression of Livin was upregulated after cisplatin treatment in a dose-dependent manner. Both immunocytochemistry and nuclear cytoplasmic fractionation indicated Livin remained in the cytoplasm after treatment with cisplatin. In an attempt to explore the mechanism, we found the elevated expression of Livin was not due to the decreased degradation by proteosome but was enhanced at the mRNA level. Besides, cisplatin treatment activated the mammalian target of rapamycin (mTOR) pathway as shown by increased phosphorylation of Akt1, mTOR, S6K, and 4E-BP1, together with the elevated Livin. The PI3K inhibitor LY294002 inhibited both the phosphorylation of mTOR and upregulation of Livin. The stable overexpression of Livin inhibited the activation of caspase-3 and led to resistance to cisplatin, while the knockdown of Livin by siRNA rendered colon cancer cells more sensitive to cisplatin. Our study, along with others, highlighted the potential of Livin for cancer therapy in colon cancer.

  • 210.
    Ding, Zhen-Yu
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet.
    Zhang, Hong
    University of Örebro, Sweden .
    Adell, Gunnar
    Karolinska University Hospital, Sweden .
    Olsson, Birgit
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Onkologi. Linköpings universitet, Hälsouniversitetet.
    Sun, Xiao-Feng
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Livin expression is an independent factor in rectal cancer patients with or without preoperative radiotherapy2013Ingår i: Radiation Oncology, ISSN 1748-717X, E-ISSN 1748-717X, Vol. 8, nr 281Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: This study was aimed to investigate the expression significance of Livin in relation to radiotherapy (RT), clinicopathological and biological factors of rectal cancer patients. Methods: This study included 144 primary rectal cancer patients who participated in a Swedish clinical trial of preoperative radiotherapy. Tissue microarray samples from the excised primary rectal cancers, normal mucosa and lymph node metastases were immunostained with Livin antibody. The proliferation of colon cancer cell lines SW620 and RKO was assayed after Livin knock-down. Results: The expression of Livin was significantly increased from adjacent (P = 0.051) or distant (P = 0.028) normal mucosa to primary tumors. 15.4% (2/13) and 39.7% (52/131) patients with Livin-negative and positive tumors died at 180 months after surgery, and the difference tended to be statistically significant (P = 0.091). In multivariate analyses, the difference achieved statistical significance, independent of TNM stage, local and distant recurrence, grade of differentiation, gender, and age (odds ratio = 5.09, 95% CI: 1.01-25.64, P = 0.048). The in vitro study indicated colon cancer cells with Livin knock-down exhibited decreased proliferation compared with controls after RT. Conclusions: The expression of Livin was was independently related to survival in rectal cancer patients, suggesting Livin as a useful prognostic factor for rectal cancer patients.

  • 211.
    Drott, Jenny
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Starkhammar, Hans
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Börjeson, Sussanne
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Berterö, Carina
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Oxaliplatin induced neurotoxicity among patients with colorectal cancer: documentation in medical records - a pilot study2014Ingår i: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 4, s. 265-274Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Patients with colorectal cancer (CRC) can have chemotherapy with oxaliplatin postoperatively.Oxaliplatin can cause acute and chronic neurotoxicity. It is important to be aware of neurotoxicside effects so they can be documented and action taken at an early stage. The study aimed toidentify and explore neurotoxic side effects documented in the medical records of patients withcolorectal cancer treated with oxaliplatin-based adjuvant chemotherapy. Data in this study weremedical records; presenting documentation about patients treated at the University Hospital inthe south of Sweden between 2009 and 2010. A summative content analysis approach was used toexplore the neurotoxic side effects. Identification and quantification of the content of medical recordswere carried out by using a study-specific protocol. “Cold sensitivity” and “tingling in thehands” were the most frequently documented neurotoxicity-related terms in the medical records.This identification was followed by interpretation. Three categories were identified in the interpretivepart of the study: acute, chronic, and degree of neurotoxicity. The results show the importanceof awareness of neurotoxic side effects so that they can be documented and action taken atan early stage. The documentation could be more reliable if patient-reported structured measurementswere used, combined with free descriptions in the medical records. Being able to followthe progression of the symptoms during and after treatment would improve patient’s safety andalso quality of life. The protocol that we developed and used in this review of medical records maybe helpful to structure the documentation in the electronic system for documentation of neurotoxicityside effects.

     

  • 212.
    Drott, Jenny
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Starkhammar, Hans
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Kjellgren, Karin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Berterö, Carina
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    The trajectory of neurotoxic side effects' impact on daily life: a qualitative study2016Ingår i: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 24, nr 8, s. 3455-3461Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE:

    The purpose of this study was to explore the experiences of oxaliplatin-induced neurotoxic side effects among patients with colorectal cancer (CRC) and how these side effects influenced their daily lives over time.

    METHODS:

    To assess neurotoxic side effects, ten patients were repeatedly interviewed. The patients were recruited from two hospitals in south of Sweden, had stage II-III CRC, and had been treated with adjuvant oxaliplatin postoperatively, from November 2013 to October 2015. They had received FOLFOX and XELOX, with a mean total dose of 791 mg oxaliplatin. After completed chemotherapy, at 3, 6, and 12 months into the post-treatment phase, 25 interviews were conducted and thematic analysis was used according to Braun and Clarke.

    RESULTS:

    Oxaliplatin-induced neurotoxicity affects patients in several ways in the long term. Four themes were identified: Expectation of cure, Dubiety, Normalization, and Learn to live with neurotoxicity. The findings of this study describe the trajectory of neurotoxicity and its impact on these patients' life situation. The findings confirmed that neurotoxicity is multi-faceted and that the experience of it changes over time.

    CONCLUSION:

    The desire to survive stimulates adaptations and strategies to manage daily life, and patients learn to live with the neurotoxic side effects. This study provides evidence that these patients need individual attention and support during the trajectory of neurotoxic side effects. Current care provision is inadequate due to a lack of knowledge of the ways in which neurotoxicity impacts the patient's daily life. This study provides insights that could be used to develop a more person-centered care.

  • 213.
    du Bois, A
    et al.
    Department of Gynecology & Gynecologic Oncology, Wiesbaden, Germany..
    Quinn, M
    Thigpen, T
    Vermorken, J
    Åvall-Lundqvist, Elisabeth
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet.
    Bookman, M
    Bowtell, D
    Brady, M
    Casado, A
    Cervantes, A
    Eisenhauer, E
    Friedlaender, M
    Fujiwara, K
    Grenman, S
    Guastalla, J P
    Harper, P
    Hogberg, T
    Kaye, S
    Kitchener, H
    Kristensen, G
    Mannel, R
    Meier, W
    Miller, B
    Neijt, J P
    Oza, A
    Ozols, R
    Parmar, M
    Pecorelli, S
    Pfisterer, J
    Poveda, A
    Provencher, D
    Pujade-Lauraine, E
    Randall, M
    Rochon, J
    Rustin, G
    Sagae, S
    Stehman, F
    Stuart, G
    Trimble, E
    Vasey, P
    Vergote, I
    Verheijen, R
    Wagner, U
    2004 consensus statements on the management of ovarian cancer: final document of the 3rd International Gynecologic Cancer Intergroup Ovarian Cancer Consensus Conference (GCIG OCCC 2004).2005Ingår i: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 16, nr 8, s. viii7-viii12Artikel i tidskrift (Refereegranskat)
  • 214.
    Dutta, Ravi Kumar
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för cellbiologi. Linköpings universitet, Medicinska fakulteten.
    Söderkvist, Peter
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för cellbiologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk patologi och klinisk genetik.
    Gimm, Oliver
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Genetics of primary hyperaldosteronism2016Ingår i: Endocrine-Related Cancer, ISSN 1351-0088, E-ISSN 1479-6821, Vol. 23, nr 10, s. R437-R454Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Hypertension is a common medical condition and affects approximately 20% of the population in developed countries. Primary aldosteronism is the most common form of secondary hypertension and affects 8-13% of patients with hypertension. The two most common causes of primary aldosteronism are aldosterone-producing adenoma and bilateral adrenal hyperplasia. Familial hyperaldosteronism types I, II and III are the known genetic syndromes, in which both adrenal glands produce excessive amounts of aldosterone. However, only a minority of patients with primary aldosteronism have one of these syndromes. Several novel susceptibility genes have been found to be mutated in aldosterone-producing adenomas: KCNJ5, ATP1A1, ATP2B3, CTNNB1, CACNA1D, CACNA1H and ARMC5. This review describes the genes currently known to be responsible for primary aldosteronism, discusses the origin of aldosterone-producing adenomas and considers the future clinical implications based on these novel insights.

  • 215.
    Dutta, Ravi Kumar
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för cellbiologi. Linköpings universitet, Hälsouniversitetet.
    Welander, Jenny
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för cellbiologi. Linköpings universitet, Hälsouniversitetet.
    Brauckhoff, Michael
    Haukeland University Hospital, Bergen; University of Bergen, Norway .
    Walz, Martin
    Klinikum Essen Mitte, Essen, Germany .
    Alesina, Piero
    Klinikum Essen Mitte, Essen, Germany .
    Arnesen, Thomas
    Haukeland University Hospital, Bergen; University of Bergen, Norway.
    Söderkvist, Peter
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för cellbiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Diagnostikcentrum, Klinisk patologi och klinisk genetik.
    Gimm, Oliver
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Complementary somatic mutations of KCNJ5, ATP1A1, and ATP2B3 in sporadic aldosterone producing adrenal adenomas2014Ingår i: Endocrine-Related Cancer, ISSN 1351-0088, E-ISSN 1479-6821, Vol. 21, nr 1, s. L1-L4Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    n/a

  • 216.
    Edström, Måns
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för inflammationsmedicin. Linköpings universitet, Hälsouniversitetet.
    Dahle, Charlotte
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för inflammationsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Diagnostikcentrum, Klinisk immunologi och transfusionsmedicin.
    Vrethem, Magnus
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neurovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    Gustafsson, Mika
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet.
    Benson, Mikael
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Allergicentrum US. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Barn- och ungdomskliniken i Linköping. Huddinge University Hospital.
    Jenmalm, Maria
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för inflammationsmedicin. Linköpings universitet, Hälsouniversitetet.
    Ernerudh, Jan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för inflammationsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Diagnostikcentrum, Klinisk immunologi och transfusionsmedicin.
    Regulatory T cells in Multiple Sclerosis – Indications of impaired function of suppressive capacity and a role for chemokines2014Manuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    BACKGROUND Regulatory T cells (Treg) are critical for immune regulation and homeostasis. In multiple sclerosis (MS), the function of these cells has been shown to be impaired, although the underlying mechanism has yet to be shown. In the current study, we aimed to characterize and assess the phenotypical, functional and transcriptional characteristics of memory and naïve Treg in MS patients and controls.

    MATERIAL AND METHODS 27 patients with relapsing-remitting disease were included, along with 29 healthy controls. Flow cytometry was used for detailed phenotyping of Treg subpopulations CD4+CD45RA+/- and CD4dimCD25++ and their expression of FOXP3, CD39 and HELIOS. CFSE (proliferation marker) and CD69 (activation marker) were used to investigate the functional capacity of Treg. A microarray was employed for genome-wide transcriptional characterization of isolated Treg.

    RESULTS CD4+CD45RA–CD25++ activated Treg displayed a higher expression of FOXP3 and CD39 than resting CD4+CD45RA+CD25+ Treg, while no significant phenotypical differences were observed in Treg subpopulations between patients and controls. However, a lower anti-proliferative capacity was observed in activated Treg of MS patients compared with those of controls (p<0.05), while suppression of activation was similar to controls. Gene set enrichment analysis (GSEA) of microarray data revealed enrichment for the GO gene set ‘chemokine receptor binding’ in MS Treg.

    CONCLUSION Although numerical phenotypical assessment of resting and activated Tregs did not reveal any significant difference between patients and controls, functional co-culturing experiments showed an impaired function in activated Treg of MS patients. Furthermore, GSEA revealed immune-related gene sets overexpressed in Treg of MS patients, possibly containing clues to the functional impairment. In particular over-activity in chemokine signalling in Treg would be of interest for further investigation.

  • 217.
    Ekbäck, Marie
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Barn- och ungdomskliniken i Linköping.
    Tedner, Michaela
    Pediatric Clinic, Täby, Stockholm, Sweden.
    Devenney, Irene
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Barn- och ungdomskliniken i Linköping.
    Oldaeus, Göran
    Pediatric Clinic, County Hospital Ryhov, Jönköping, Sweden.
    Norrman, Gunilla
    Pediatric Clinic, Hudiksvall, Sweden.
    Strömberg, Leif
    Östergötlands Läns Landsting, Barn- och kvinnocentrum, Barn- och ungdomskliniken i Norrköping.
    Fälth-Magnusson, Karin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Barn- och ungdomskliniken i Linköping.
    Severe Eczema in Infancy Can Predict Asthma Development. A Prospective Study to the Age of 10 Years2014Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, nr 6, s. e99609-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Children with atopic eczema in infancy often develop allergic rhinoconjunctivitis and asthma, but the term "atopic march has been questioned as the relations between atopic disorders seem more complicated than one condition progressing into another. Objective: In this prospective multicenter study we followed children with eczema from infancy to the age of 10 years focusing on sensitization to allergens, severity of eczema and development of allergic airway symptoms at 4.5 and 10 years of age. Methods: On inclusion, 123 children were examined. Hanifin-Rajka criteria and SCORAD index were used to describe the eczema. Episodes of wheezing were registered, skin prick tests and IgE tests were conducted and questionnaires were filled out. Procedures were repeated at 4.5 and 10 years of age with additional examinations for ARC and asthma. Results: 94 out of 123 completed the entire study. High SCORAD points on inclusion were correlated with the risk of developing ARC, (B = 9.86, P = 0.01) and asthma, (B = 10.17, P = 0.01). For infants with eczema and wheezing at the first visit, the OR for developing asthma was 4.05(P = 0.01). ARC at 4.5 years of age resulted in an OR of 11.28(P = 0.00) for asthma development at 10 years. Conclusion: This study indicates that infant eczema with high SCORAD points is associated with an increased risk of asthma at 10 years of age. Children with eczema and wheezing episodes during infancy are more likely to develop asthma than are infants with eczema alone. Eczema in infancy combined with early onset of ARC seems to indicate a more severe allergic disease, which often leads to asthma development. The progression from eczema in infancy to ARC at an early age and asthma later in childhood shown in this study supports the relevance of the term "atopic march, at least in more severe allergic disease.

  • 218.
    Ekholm, Maria
    et al.
    Lund University, Sweden; Ryhov County Hospital, Sweden.
    Bendahl, Par-Ola
    Lund University, Sweden.
    Ferno, Marten
    Lund University, Sweden.
    Nordenskjöld, Bo
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Stål, Olle
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Ryden, Lisa
    Lund University, Sweden.
    Two Years of Adjuvant Tamoxifen Provides a Survival Benefit Compared With No Systemic Treatment in Premenopausal Patients With Primary Breast Cancer: Long-Term Follow-Up (> 25 years) of the Phase III SBII:2pre Trial2016Ingår i: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 34, nr 19, s. 2232-+Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose The aim of this study was to evaluate the long-term effect of 2 years of adjuvant tamoxifen compared with no systemic treatment (control) in premenopausal patients with breast cancer over different time periods through long-term (amp;gt; 25 years) follow-up. Patients and Methods Premenopausal patients with primary breast cancer (N = 564) were randomly assigned to 2 years of tamoxifen (n = 276) or no systemic treatment (n = 288). Data regarding date and cause of death were obtained from the Swedish Cause of Death Register. End points were cumulative mortality (CM) and cumulative breast cancer-related mortality (CBCM). The median follow-up for the 250 patients still alive in April 2014 was 26.3 years (range, 22.7 to 29.7 years). Results In patients with estrogen receptor-positive tumors (n = 362), tamoxifen was associated with a marginal reduction in CM (hazard ratio [HR], 0.77; 95% CI, 0.58 to 1.03; P = .075) and a significant reduction in CBCM (HR, 0.73; 95% CI, 0.53 to 0.99; P = .046). The effect seemed to vary over time (CM years 0 to 5: HR, 1.05; 95% CI, 0.64 to 1.73; years amp;gt;5 to 15: HR, 0.58; 95% CI, 0.37 to 0.91; and after 15 years: HR, 0.82; 95% CI, 0.48 to 1.42; CBCM years 0 to 5: HR, 1.09; 95% CI, 0.65 to 1.82; years amp;gt;5 to 15: HR, 0.53; 95% CI, 0.33 to 0.86; and after 15 years: HR, 0.72; 95% CI, 0.36 to 1.44). Conclusion Two years of adjuvant tamoxifen resulted in a long-term survival benefit in premenopausal patients with estrogen receptor-positive primary breast cancer. (C) 2016 by American Society of Clinical Oncology. Creative Commons Attribution Non-Commercial No Derivatives 4.0 License: https://creativecommons.org/licenses/by-nc-nd/4.0/

  • 219.
    Eklund Rimsten, Anders
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet.
    Larsson, Mats
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet.
    "Det ger sig självt om man är en bra terapeut". En intervjustudie av hemuppgifter i familjeterapi.2014Självständigt arbete på avancerad nivå (yrkesexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [sv]

    Hemuppgiften är ett viktigt moment inom såväl Funktionell familjeterapi (FFT) som Dialektisk beteendeterapi (DBT). Målsättningen med denna uppsats var att utröna om, och i sådana fall på vilket sätt, hemuppgifter ges inom den familjeterapeutiska kontext som utgör ramen för FFT. En hypotes vid arbetets ingång var att de interaktionistiska hemuppgifterna kommit att ersättas av de mer beteendeorienterade som ingår i DBT.

    De personer som utgjort underlag för undersökningen arbetar alla på en öppenvårdsmottagning inom Barn- och ungdomspsykiatrin (BUP) i Uppsala, med antingen ovan nämnda Funktionella familjeterapi (n=3) eller med Dialektisk beteendeterapi (n=2).

    Syftet med studien var att, dels via en enkätundersökning dels via en intervju i fokusgruppform, försöka förstå mer av det psykoterapeutiska redskap som utgörs av hemuppgiften. Fokus låg på den relationella hemuppgift som familjeterapeuterna tillhörande nämnda team förväntas konstruera utifrån tillhandahållen FFT-manual.

    Resultatet visade på en relativt stor bredd när det gällde terapeuternas syn på och tillämpning av hemuppgiften, men det generella mönstret pekade på att terapeuterna i sitt praktiska arbete konstruerade såväl relationella som beteendeorienterade hemuppgifter. Vad som framkom är dock ett behov av och en önskan från familjeterapeuternas sida om en större tydlighet kring hur man går tillväga då man fastställer och ger en familj en relationellt orienterad hemuppgift. Det vi sluter oss till i vår uppsats är att ett sådant förtydligande inte låter sig göras med mindre än att man går till botten med och definierar vad funktionen av relationen innebär samt hur man använder sig av denna vid det som inom Funktionell familjeterapi kallas för relationsbedömningen.

  • 220.
    Ekstrom, Klas
    et al.
    Karolinska Hospital and Institute, Sweden.
    Pulkkinen, Mari-Anne
    Karolinska Hospital and Institute, Sweden; University of Helsinki, Finland.
    Carlsson-Skwirut, Christine
    Karolinska Hospital and Institute, Sweden.
    Brorsson, Anna-Lena
    Karolinska Hospital and Institute, Sweden.
    Ma, Zhulin
    Aarhus University, Denmark.
    Frystyk, Jan
    Aarhus University, Denmark.
    Bang, Peter
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Tissue IGF-I Measured by Microdialysis Reflects Body Glucose Utilization After rhIGF-I Injection in Type 1 Diabetes2015Ingår i: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 100, nr 11, s. 4299-4306Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Context: Type 1 diabetes is associated with portal insulin deficiency and disturbances in the GH-IGF axis including low circulating IGF-I and GH hypersecretion. Whether peripheral hyperinsulinemia and GH hypersecretion, which are relevant to the development of vascular complications, result in elevated tissue IGF-I remains unknown. Objective: The purpose of this study was to determine the relationship between whole-body glucose uptake and tissue IGF-I measured by microdialysis. Design: This was a single-blind placebo-controlled crossover study. Setting: The setting was a tertiary pediatric endocrine referral center. Participants: The participants were seven young male adults with type 1 diabetes. Intervention: After an overnight fast, a 6-h lasting euglycemic clamp was performed (constant insulin infusion at 0.5mU/kg x minute and variable glucose infusion rate [GIR]) and a subcutaneous injection of recombinant human (rh) IGF-I (120 mu g/kg) or saline was given after 2 hours. In parallel, tissue IGF-I levels were determined by microdialysis (md-IGF-I). Main Outcome Measures: md-IGF-I levels in muscle and subcutaneous fat, and GIR were determined. Results: md-IGF-I levels were detectable but unchanged after saline. After rhIGF-I, muscle and subcutaneous fat md-IGF-I increased during the second and third hour and then reached a plateau up to 10-fold higher than baseline (P less than .001). GIR was unchanged after saline, whereas it increased 2.5-fold concomitantly with the increase in md-IGF-I (P less than .0001). In contrast, serum IGF-I was increased already at 30 minutes after rhIGF-I and reached a plateau 2-fold above baseline (P less than .0001). Conclusion: We demonstrate that md-IGF-I measurements are valid and physiologically relevant by reflecting rhIGF-I-induced glucose uptake. Future studies should be conducted to elucidate the role of local tissue IGF-I in diabetic vascular complications.

  • 221.
    El Ouali, Mourad
    et al.
    University of Kiel, Germany.
    Fohlin, Helena
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Regionalt cancercentrum.
    Srivastav, Anand
    University of Kiel, Germany.
    A randomised approximation algorithm for the hitting set problem2014Ingår i: Theoretical Computer Science, ISSN 0304-3975, E-ISSN 1879-2294, Vol. 555, s. 23-34Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Let H = (V, epsilon) be a hypergraph with vertex set V and edge set epsilon, where n := vertical bar V vertical bar and m := vertical bar epsilon vertical bar. Let l be the maximum size of an edge and Delta be the maximum vertex degree. A hitting set (or vertex cover) in H is a subset of V in which all edges are incident. The hitting set problem is to find a hitting set of minimum cardinality. It is known that an approximation ratio of l can be achieved easily. On the other hand, for constant l, an approximation ratio better than l cannot be achieved in polynomial time under the unique games conjecture (Khot and Regev, 2008 [17]). Thus breaking the l-barrier for significant classes of hypergraphs is a complexity-theoretically and algorithmically interesting problem, which has been studied by several authors (Krivelevich, 1997 [18], Halperin, 2000 [12], Okun, 2005 [23]). We propose a randomised algorithm of hybrid type for the hitting set problem, which combines LP-based randomised rounding, graphs sparsening and greedy repairing and analyse it for different classes of hypergraphs. For hypergraphs with Delta = O(n1/4) and l = O (root n) we achieve an approximation ratio of l(1 - c/Delta), for some constant c greater than 0, with constant probability. For the case of hypergraphs where l and Delta are constants, we prove a ratio of l(1 - l-1/8 Delta). The latter is done by analysing the expected size of the hitting set and using concentration inequalities. Moreover, for quasi-regularisable hypergraphs, we achieve an approximation ratio of l(1 - n/8m). We show how and when our results improve over the results of Krivelevich, Halperin and Okun.

  • 222.
    El Ouali, Mourad
    et al.
    University of Kiel, Germany.
    Fohlin, Helena
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Region Östergötland, Centrum för hälso- och vårdutveckling, Regionalt cancercentrum. Linköpings universitet, Medicinska fakulteten.
    Srivastav, Anand
    University of Kiel, Germany.
    An approximation algorithm for the partial vertex cover problem in hypergraphs2016Ingår i: Journal of combinatorial optimization, ISSN 1382-6905, E-ISSN 1573-2886, Vol. 31, nr 2, s. 846-864Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Let be a hypergraph with set of vertices and set of (hyper-)edges . Let be the maximum size of an edge, be the maximum vertex degree and be the maximum edge degree. The -partial vertex cover problem in hypergraphs is the problem of finding a minimum cardinality subset of vertices in which at least hyperedges are incident. For the case of and constant it known that an approximation ratio better than cannot be achieved in polynomial time under the unique games conjecture (UGC) (Khot and Ragev J Comput Syst Sci, 74(3):335-349, 2008), but an -approximation ratio can be proved for arbitrary (Gandhi et al. J Algorithms, 53(1):55-84, 2004). The open problem in this context has been to give an -ratio approximation with , as small as possible, for interesting classes of hypergraphs. In this paper we present a randomized polynomial-time approximation algorithm which not only achieves this goal, but whose analysis exhibits approximation phenomena for hypergraphs with not visible in graphs: if and are constant, and , we prove for -uniform hypergraphs a ratio of , which tends to the optimal ratio 1 as tends to . For the larger class of hypergraphs where , is not constant, but is a constant, we show a ratio of . Finally for hypergraphs with non-constant , but constant , we get a ratio of for , leaving open the problem of finding such an approximation for k &lt; m/4(.)

  • 223.
    Elawa, Sherif
    et al.
    Östergötlands Läns Landsting, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Hallböök, Olof
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Myrelid, Pär
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Zdolsek, Johann
    Östergötlands Läns Landsting, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Intestinal obstruction following harvest of VRAM-flap for reconstruction of a large perineal defect2015Ingår i: Case Reports in Plastic Surgery and Hand Surgery, ISSN 2332-0885, Vol. 2, nr 3-4, s. 88-91Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A patient with locally advanced adenocarcinoma of the rectum was operated with abdominoperineal resection and perineal reconstruction with a vertical rectus abdominis musculocutaneous flap. Six days postoperatively, there was herniation of the small bowel, between the anterior and posterior rectus sheaths, to a subcutaneous location.

  • 224.
    Elenis, Evangelia
    et al.
    Uppsala University, Sweden.
    Skoog Svanberg, Agneta
    Uppsala University, Sweden.
    Lampic, Claudia
    Karolinska Institute, Sweden.
    Skalkidou, Alkistis
    Uppsala University, Sweden.
    Akerud, Helena
    Uppsala University, Sweden.
    Sydsjö, Gunilla
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Adverse obstetric outcomes in pregnancies resulting from oocyte donation: a retrospective cohort case study in Sweden2015Ingår i: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 15, nr 247Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Oocyte donation has been associated to gestational diabetes, hypertensive disorders, placental abnormalities, preterm delivery and increased rate of caesarean delivery while simultaneously being characterized by high rates of primiparity, advanced maternal age and multiple gestation constituting the individual risk of mode of conception difficult to assess. This study aims to explore obstetrical outcomes among relatively young women with optimal health status conceiving singletons with donated versus autologous oocytes (via IVF and spontaneously). Methods: National retrospective cohort case study involving 76 women conceiving with donated oocytes, 150 nulliparous women without infertility conceiving spontaneously and 63 women conceiving after non-donor IVF. Data on obstetric outcomes were retrieved from the National Birth Medical Register and the medical records of oocyte recipients from the treating University Hospitals of Sweden. Demographic and logistic regression analysis were performed to examine the association of mode of conception and obstetric outcomes. Results: Women conceiving with donated oocytes (OD) had a higher risk of hypertensive disorders [adjusted Odds Ratio (aOR) 2.84, 95 % CI (1.04-7.81)], oligohydramnios [aOR 12.74, 95 % CI (1.24-130.49)], postpartum hemorrhage [aOR 7.11, 95 % CI (2.02-24.97)] and retained placenta [aOR 6.71, 95 % CI (1.58-28.40)] when compared to women who conceived spontaneously, after adjusting for relevant covariates. Similar trends, though not statistically significant, were noted when comparing OD pregnant women to women who had undergone non-donor IVF. Caesarean delivery [aOR 2.95, 95 % CI (1.52-5.71); aOR 5.20, 95 % CI (2.21-12.22)] and induction of labor [aOR 3.00, 95 % CI (1.39-6.44); aOR 2.80, 95 % CI (1.10-7.08)] occurred more frequently in the OD group, compared to the group conceiving spontaneously and through IVF respectively. No differences in gestational length were noted between the groups. With regard to the indication of OD treatment, higher intervention was observed in women with diminished ovarian reserve but the risk for hypertensive disorders did not differ after adjustment. Conclusion: The selection process of recipients for medically indicated oocyte donation treatment in Sweden seems to be effective in excluding women with severe comorbidities. Nevertheless, oocyte recipients-despite being relatively young and of optimal health status-need careful counseling preconceptionally and closer monitoring prenatally for the development of hypertensive disorders.

  • 225.
    Elenis, Evangelia
    et al.
    Uppsala University, Sweden.
    Sydsjö, Gunilla
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Skalkidou, Alkistis
    Uppsala University, Sweden.
    Lampic, Claudia
    Karolinska Institute, Sweden.
    Skoog Svanberg, Agneta
    Uppsala University, Sweden.
    Neonatal outcomes in pregnancies resulting from oocyte donation: a cohort study in Sweden2016Ingår i: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 16, nr 170Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Pregnancies resulting through oocyte donation have been associated with increased risk for adverse outcomes for the mother, such as gestational hypertensive disorders. However, little is known about possible neonatal complications of such pregnancies. The purpose of this study was to evaluate the neonatal health outcomes among singleton pregnancies in a population of relatively young and healthy oocyte recipients in Sweden, taking into account the medical indication leading to treatment. Methods: This cohort study involved 76 women conceiving with donated oocytes, 149 age-matched nulliparous women conceiving spontaneously and 63 women conceiving after non-donor IVF. Participants were recruited during 2005-2008 and followed up until delivery. Data on neonatal outcomes were retrieved from the National Birth Medical Register and the medical records of oocyte recipients from seven Swedish University Hospitals with IVF clinics. Logistic regression analyses were performed to examine the association of mode of conception and neonatal outcomes, adjusted for maternal age and BMI, gestational age and delivery by cesarean section. Results: Infants conceived through oocyte donation had higher odds for premature delivery [OR 2.36, 95 % CI (1.02-5.45)], for being small for gestational age [OR 4.23, 95 % CI (1.03-17.42)] and having Apgar score below 7 at 5 min [OR 10.57, 95 % CI (1.21-92.20)] compared to spontaneously conceived infants. Similar trends were observed when comparing infants conceived through oocyte donation to those conceived by traditional IVF. Furthermore, donor oocyte infants had a lower mean birthweight and length compared to autologous oocyte neonates (p = 0.013); however no differences were noted among infants born at term. Neonatal outcomes were more favorable among women with diminished ovarian reserve compared to those with other indications for oocyte donation. Conclusions: Infants conceived after oocyte donation in Sweden have higher odds of being born prematurely and having lower mean birthweight in comparison to non-donor infants. It seems that these unfavorable neonatal outcomes are present despite the age, weight and health restrictions applied to recipients before oocyte donation treatment in Sweden.

  • 226.
    Elluru, Ramulu
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Kaveri, Srini V.
    Institute National Sante and Rech Med, France; University of Paris 06, France; University of Paris 05, France; France Indian Council Medical Research India, India.
    Bayry, Jagadeesh
    Institute National Sante and Rech Med, France; University of Paris 06, France; University of Paris 05, France; France Indian Council Medical Research India, India.
    The protective role of immunoglobulins in fungal infections and inflammation2015Ingår i: Seminars in Immunopathology, ISSN 1863-2297, E-ISSN 1863-2300, Vol. 37, nr 2, s. 187-197Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Increased incidence of fungal infections in the immunocompromised individuals and fungi-mediated allergy and inflammatory conditions in immunocompetent individuals is a cause of concern. Consequently, there is a need for efficient therapeutic alternatives to treat fungal infections and inflammation. Several studies have demonstrated that antibodies or immunoglobulins have a role in restricting the fungal burden and their clearance. However, based on the data from monoclonal antibodies, it is now evident that the efficacy of antibodies in fungal infections is dependent on epitope specificity, abundance of protective antibodies, and their isotype. Antibodies confer protection against fungal infections by multiple mechanisms that include direct neutralization of fungi and their antigens, inhibition of growth of fungi, modification of gene expression, signaling and lipid metabolism, causing iron starvation, inhibition of polysaccharide release, and biofilm formation. Antibodies promote opsonization of fungi and their phagocytosis, complement activation, and antibody-dependent cell toxicity. Passive administration of specific protective monoclonal antibodies could also prove to be beneficial in drug resistance cases, to reduce the dosage and associated toxic symptoms of anti-fungal drugs. The longer half-life of the antibodies and flexibilities to modify their structure/forms are additional advantages. The clinical data obtained with two monoclonal antibodies should incite interests in translating pre-clinical success into the clinics. The anti-inflammatory and immunoregulatory role of antibodies in fungal inflammation could be exploited by intravenous immunoglobulin or IVIg.

  • 227.
    Elmasry, Moustafa
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Suez Canal University, Egypt .
    Steinvall, Ingrid
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Östergötlands Läns Landsting, Sinnescentrum, Anestesi- och intensivvårdskliniken US.
    Letter: "Is the length of time in acute burn surgery associated with poorer outcomes?"2014Ingår i: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 40, nr 4, s. 772-773Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    n/a

  • 228.
    Elmasry, Moustafa
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Suez Canal Univ, Plast Surg Unit, Dept Surg, Ismailia, Egypt.
    Steinvall, Ingrid
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Thorfinn, Johan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Abbas, Ashraf H.
    Suez Canal University, Egypt.
    Abdelrahman, Islam
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Suez Canal University, Egypt.
    Adly, Osama A.
    Suez Canal University, Egypt.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken US.
    Treatment of Children With Scalds by Xenografts: Report From a Swedish Burn Centre2016Ingår i: Journal of Burn Care & Research, ISSN 1559-047X, E-ISSN 1559-0488, Vol. 37, nr 6, s. E586-E591Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Scalds are the most common type of burn in children, and one way to treat them is with xenografts with no topical antimicrobials in line with the recommendations of a recent review. However, this treatment has not been examined in detail. Our aim was to describe the treatment of such children when biological dressings (xenografts) were used without local antimicrobials. We reviewed the medical records of all children admitted to a Swedish National Burn Centre during the period 2010-2012 with scalds who were treated with xenografts. Percentage TBSA injured, age, length of hospital stay, number of operations, antibiotics given, duration of antibiotic treatment, and pain score during the first 3 days, application of xenografts, and clinical notes of wound infection were recorded. We studied 67 children, (43 of whom were boys), with a median (interquartile range [IQR]) age of 1 (1-2) year and median (IQR) TBSA% 6.2 (4-11). Twenty children (30%) required operation. Twelve (18%) developed a wound infection, 29 (43%) had other infections, and 26 (39%) were free from infection. The median (IQR) duration of systemic antibiotics was 10 (6-13) days. On the day that the xenografts were applied 10 of the children had a Face, Legs, Activity, Cry, and Consolability (FLACC) score between 3 and 7, and during the following 2 days, only four children scored in this range. The remaining 57 children had scores amp;lt;3 on the day that xenografts were applied and on the following 2 days. Median (IQR) length of stay/TBSA% was 0.7 (0.4-1.0). Treatment with xenografts was associated with median length of stay/TBSA% amp;lt; 1 and low pain scores. Despite a high rate of prescription of systemic antibiotics, most were for reasons other than wound infection.

  • 229.
    Elmasry, Moustafa
    et al.
    Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Plastic Surgery Unit, Department of Surgery, Suez Canal University, Egypt.
    Steinvall, Ingrid
    Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Thorfinn, Johan
    Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Olofsson, Pia
    Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Abbas, A.H.
    Plastic Surgery Unit, Department of Surgery, Suez Canal University, Egypt.
    Abdelrahman, Islam
    Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Plastic Surgery Unit, Department of Surgery, Suez Canal University, Egypt.
    Adly, O.A.
    Plastic Surgery Unit, Department of Surgery, Suez Canal University, Egypt.
    Sjöberg, Folke
    Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken US. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Temporary coverage of burns with a xenograft and sequential excision, compared with total early excision and autograft2016Ingår i: Annals of burns and fire disasters, ISSN 1592-9558, Vol. 29, nr 3, s. 196-201Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    During the 80s and 90s, early and total excision of full thickness burns followed by immediate autograft was the most common treatment, with repeated excision and grafting, mostly for failed grafts. It was hypothesized, therefore, that delayed coverage with an autograft preceded by a temporary xenograft after early and sequential smaller excisions would lead to a better wound bed with fewer failed grafts, a smaller donor site, and possibly also a shorter duration of stay in hospital. We carried out a case control study with retrospective analysis from our National Burn Centre registry for the period 1997-2011. Patients who had been managed with early total excision and autograft were compared with those who had had sequential smaller excisions covered with temporary xenografts until the burn was ready for the final autograft. The sequential excision and xenograft group (n=42) required one-third fewer autografts than patients in the total excision and autograft group (n=45), who needed more than one operation (p<0.001). We could not detect any differences in duration of stay in hospital / total body surface area burned% (duration of stay/TBSA%) (2.0 and 1.8) (p=0.83). The two groups showed no major differences in terms of adjusted duration of stay, but our findings suggest that doing early, smaller, sequential excisions using a xenograft for temporary cover can result in shorter operating times, saving us the trouble of making big excisions. However, costs tended to be higher when the burns were > 25% TBSA.

  • 230.
    Elmerstig, Eva
    et al.
    Malmö University, Sweden.
    Wijma, Barbro
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Sandell, Kerstin
    Lund University, Sweden.
    Berterö, Carina
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Sexual interaction or a solitary action: young Swedish men's ideal images of sexual situations in relationships and in one-night stands2014Ingår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 5, nr 3, s. 149-155Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective

    It seems that traditional gender norms influence young women's and men's sexuality differently. However, little attention has been paid to ideal images of sexual situations. This study identifies young heterosexual men's ideal images of sexual situations and their expectations of themselves in sexual situations.

    Study design

    The present study employs a qualitative design. Twelve Swedish men (aged 16–20) participated in individual in-depth qualitative interviews. The interviews were transcribed verbatim and analysed using the constant comparative method from grounded theory.

    Results

    Our study revealed that the young men's conceptions of normal sexual situations were divided into two parts: sexual situations in relationships, and sexual situations in one-night stands. Their ideal image, “a balanced state of emotional and physical pleasure”, was influenced by the presence/absence of intimacy, the partner's response, and their own performance. The greatest opportunities to experience intimacy and the partner's response were found during sexual situations in relationships. In one-night stands, the men wanted to make a good impression by performing well, and behaved according to masculine stereotypes.

    Conclusion

    Stereotyped masculinity norms regulate young heterosexual men's sexuality, particularly in one-night stands. Sexual health promotion should emphasize the presence of these masculinity norms, which probably involve costs in relation to young men's sexual wellbeing.

  • 231.
    Elmerstig, Eva
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet.
    Wijma, Barbro
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Swahnberg, Katarina
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet.
    Prioritizing the partners enjoyment: a population-based study on young Swedish women with experience of pain during vaginal intercourse2013Ingår i: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 34, nr 2, s. 82-89Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The present study examines the prevalence of women who continue to have vaginal intercourse (VIC) despite pain, avoid telling the partner, and feign enjoyment. It also considers the reasons for this behavior. A sample of 1566 female senior high school students (aged 18-22 years) completed a questionnaire concerning their experiences and attitudes toward their body and sexuality. Forty-seven percent (270/576) of those women who reported pain during VIC continued to have VIC despite the pain. The most common reasons were that they did not want to spoil sex for or hurt the partner by interrupting VIC. Feigning enjoyment and not telling the partner about their pain were reported by 22 and 33%, respectively. Continuing to have VIC despite pain was associated with feelings of being inferior to the partner during sex, dissatisfaction with their own sex lives and feigning enjoyment while having pain. Pain during VIC is reported by every third young Swedish woman, and almost half of those still continue to have VIC. The major reason given is noteworthy - prioritizing the partners enjoyment before their own - and indicates that young women who continue to have VIC despite pain take a subordinate position in sexual interactions.

  • 232.
    Elmerstig, Eva
    et al.
    Malmö University, Sweden.
    Wijma, Barbro
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Årestedt, Kristofer
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Linnaeus University, Sweden.
    Swahnberg, Katarina
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Linnaeus University, Sweden.
    Being "Good in Bed"Body Concerns, Self-Perceptions, and Gender Expectations Among Swedish Heterosexual Female and Male Senior High-School Students2017Ingår i: Journal of sex & marital therapy, ISSN 0092-623X, E-ISSN 1521-0715, Vol. 43, nr 4, s. 326-342Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We investigated gender differences regarding body perceptions, self-perceptions, values and expectations in sexual situations, and factors associated with expectations, among Swedish heterosexual female and male high-school students. A total of 2,765 students (aged 18 to 22) completed questionnaires. Women reported lower satisfaction with themselves and their body appearance (p amp;lt; 0.001), and felt more inferior to their partner (p amp;lt; 0.001). Men felt more superior to their partner, and felt higher expectations (p amp;lt; 0.001). Male sex, difficulty saying no to sex, dissatisfaction with the body, feeling inferior or superior to partner, and considering partners satisfaction as more important, were all associated with feeling expectations during sex.

  • 233.
    Engerström, Lars
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland. Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken VIN.
    Kramer, Andrew A.
    Prescient Healthcare Consulting, Charlottesville, VA.
    Nolin, Thomas
    The Swedish Intensive Care Registry, Karlstad, Sweden.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Karlström, Göran
    The Swedish Intensive Care Registry, Karlstad, Sweden.
    Fredrikson, Mats
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Academic Research Center, Linköping University, Linköping, Sweden.
    Walther, Sten M
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    Comparing Time-Fixed Mortality Prediction Models and Their Effect on ICU Performance Metrics Using the Simplified Acute Physiology Score 3.2016Ingår i: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 44, nr 11Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To examine ICU performance based on the Simplified Acute Physiology Score 3 using 30-day, 90-day, or 180-day mortality as outcome measures and compare results with 30-day mortality as reference.

    DESIGN: Retrospective cohort study of ICU admissions from 2010 to 2014.

    SETTING: Sixty-three Swedish ICUs that submitted data to the Swedish Intensive Care Registry.

    PATIENTS: The development cohort was first admissions to ICU during 2011-2012 (n = 53,546), and the validation cohort was first admissions to ICU during 2013-2014 (n = 57,729).

    INTERVENTIONS: None.

    MEASUREMENTS AND MAIN RESULTS: Logistic regression was used to develop predictive models based on a first level recalibration of the original Simplified Acute Physiology Score 3 model but with 30-day, 90-day, or 180-day mortality as measures of outcome. Discrimination and calibration were excellent for the development dataset. Validation in the more recent 2013-2014 database showed good discrimination (C-statistic: 0.85, 0.84, and 0.83 for the 30-, 90-, and 180-d models, respectively), and good calibration (standardized mortality ratio: 0.99, 0.99, and 1.00; Hosmer-Lemeshow goodness of fit H-statistic: 66.4, 63.7, and 81.4 for the 30-, 90-, and 180-d models, respectively). There were modest changes in an ICU's standardized mortality ratio grouping (< 1.00, not significant, > 1.00) when follow-up was extended from 30 to 90 days and 180 days, respectively; about 11-13% of all ICUs.

    CONCLUSIONS: The recalibrated Simplified Acute Physiology Score 3 hospital outcome prediction model performed well on long-term outcomes. Evaluation of ICU performance using standardized mortality ratio was only modestly sensitive to the follow-up time. Our results suggest that 30-day mortality may be a good benchmark of ICU performance. However, the duration of follow-up must balance between what is most relevant for patients, most affected by ICU care, least affected by administrative policies and practically feasible for caregivers.

  • 234.
    Engstrand, Christina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Krevers, Barbro
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Nylander, Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Hand function and quality of life before and after fasciectomy for Dupuytren contracture2014Ingår i: Journal of Hand Surgery-American Volume, ISSN 0363-5023, E-ISSN 1531-6564, Vol. 39, nr 7, s. 1333-1343Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE:

    To describe changes in joint motion, sensibility, and scar pliability and to investigate the patients' expectations, self-reported recovery, and satisfaction with hand function, disability, and quality of life after surgery and hand therapy for Dupuytren disease.

    METHODS:

    This prospective cohort study collected measurements before surgery and 3, 6, and 12 months after surgery and hand therapy. Ninety patients with total active extension deficits of 60° or more from Dupuytren contracture were included. Outcomes measures were range of motion; sensibility; scar pliability; self-reported outcomes on expectations, recovery, and satisfaction with hand function; Disabilities of the Arm, Shoulder, and Hand scores; safety and social issues of hand function; physical activity habits; and quality of life with the Euroqol.

    RESULTS:

    The extension deficit decreased, and there was a transient decrease in active finger flexion during the first year after surgery. Sensibility remained unaffected. Generally, patients with surgery on multiple fingers had worse scar pliability. The majority of the patients had their expectations met, and at 6 months, 32% considered hand function as fully recovered, and 73% were satisfied with their hand function. Fear of hurting the hand and worry about not trusting the hand function were of greatest concern among safety and social issues. The Disability of the Arm, Shoulder, and Hand score and the Euroqol improved over time.

    CONCLUSIONS:

    After surgery and hand therapy, disability decreased independent of single or multiple operated fingers. The total active finger extension improved enough for the patients to reach a functional range of motion despite an impairment of active finger flexion still present 12 months after treatment.

  • 235.
    Ericsson, Elin
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Tesselaar, Erik
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Effect of Electrode Belt and Body Positions on Regional Pulmonary Ventilation- and Perfusion-Related Impedance Changes Measured by Electric Impedance Tomography2016Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, nr 6, s. e0155913-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Ventilator-induced or ventilator-associated lung injury (VILI/VALI) is common and there is an increasing demand for a tool that can optimize ventilator settings. Electrical impedance tomography (EIT) can detect changes in impedance caused by pulmonary ventilation and perfusion, but the effect of changes in the position of the body and in the placing of the electrode belt on the impedance signal have not to our knowledge been thoroughly evaluated. We therefore studied ventilation-related and perfusion-related changes in impedance during spontaneous breathing in 10 healthy subjects in five different body positions and with the electrode belt placed at three different thoracic positions using a 32-electrode EIT system. We found differences between regions of interest that could be attributed to changes in the position of the body, and differences in impedance amplitudes when the position of the electrode belt was changed. Ventilation-related changes in impedance could therefore be related to changes in the position of both the body and the electrode belt. Perfusion-related changes in impedance were probably related to the interference of major vessels. While these findings give us some insight into the sources of variation in impedance signals as a result of changes in the positions of both the body and the electrode belt, further studies on the origin of the perfusion-related impedance signal are needed to improve EIT further as a tool for the monitoring of pulmonary ventilation and perfusion.

  • 236.
    Eriksson, Hanna
    et al.
    Department of Oncology-Pathology, Karolinska Institutet, and Deptartment of Oncology, Karolinska University Hospital, Stockholm, Sweden.
    Lyth, Johan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Andersson, Therese M-L
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    The proportion cured of patients diagnosed with Stage III-IV cutaneous malignant melanoma in Sweden 1990-2007: A population-based study.2016Ingår i: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 138, nr 12Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The survival in cutaneous malignant melanoma (CMM) is highly dependent on the stage of the disease. Stage III-IV CMM patients are at high risk of relapse with a heterogeneous outcome, but not all experience excess mortality due to their disease. This group is referred to as the cure proportion representing the proportion of patients who experience the same mortality rate as the general population. The aim of this study was to estimate the cure proportion of patients diagnosed with Stage III-IV CMM in Sweden. From the population-based Swedish Melanoma Register, we included 856 patients diagnosed with primary Stage III-IV CMM, 1990-2007, followed-up through 2013. We used flexible parametric cure models to estimate cure proportions and median survival times (MSTs) of uncured by sex, age, tumor site, ulceration status (in Stage III patients) and disease stage. The standardized (over sex, age and site) cure proportion was lower in Stage IV CMMs (0.15, 95% CI 0.09-0.22) than non-ulcerated Stage III CMMs (0.48, 95% CI 0.41-0.55) with a statistically significant difference of 0.33 (95% CI = 0.24-0.41). Ulcerated Stage III CMMs had a cure proportion of 0.27 (95% CI 0.21-0.32) with a statistically significant difference compared to non-ulcerated Stage III CMMs (difference 0.21; 95% CI = 0.13-0.30). The standardized MST of uncured was approximately 9-10 months longer for non-ulcerated versus ulcerated Stage III CMMs. We could demonstrate a significantly better outcome in patients diagnosed with non-ulcerated Stage III CMMs compared to ulcerated Stage III CMMs and Stage IV disease after adjusting for age, sex and tumor site.

  • 237.
    Eriksson, Hanna
    et al.
    Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden.
    Lyth, Johan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland. Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Regionalt cancercentrum.
    Månsson-Brahme, Eva
    Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden.
    Frohm-Nilsson, Margareta
    Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden.
    Ingvar, Christian
    Lund University, Sweden.
    Lindholm, Christer
    Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Regionalt cancercentrum.
    Naredi, Peter
    Sahlgrenska Academy, Gothenburg, Sweden.
    Stierner, Ulrika
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Carstensen, John
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Hansson, Johan
    Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden.
    Later stage at diagnosis and worse survival in cutaneous malignant melanoma among men living alone: a nationwide population-based study from Sweden2014Ingår i: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 32, nr 13, s. 1356-1364Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE:

    To investigate the association between cohabitation status, clinical stage at diagnosis, and disease-specific survival in cutaneous malignant melanoma (CMM).

    METHODS:

    This nationwide population-based study included 27,235 patients from the Swedish Melanoma Register diagnosed with a primary invasive CMM between 1990 and 2007 and linked data to nationwide, population-based registers followed up through 2012.

    RESULTS:

    After adjustment for age at diagnosis, level of education, living area, period of diagnosis, and tumor site, the odds ratios (ORs) of higher stage at diagnosis were significantly increased among men living alone versus men living with a partner (stage II v stage I: OR, 1.42; 95% CI, 1.29 to 1.57; stage III or IV v stage I: OR, 1.43; 95% CI, 1.14 to 1.79). The OR for stage II versus stage I disease was also increased among women living alone (OR, 1.15; 95% CI, 1.04 to 1.28). After adjustments for the factors listed earlier, the CMM-specific survival was significantly decreased among men living alone (hazard ratio [HR] for death, 1.48; 95% CI, 1.33 to 1.65; P < .001). After additional adjustments for all potential and established prognostic factors, CMM-specific survival among men living alone versus men living with a partner remained significantly decreased (HR, 1.31; 95% CI, 1.18 to 1.46; P < .001), suggesting a residual adverse effect on survival not accounted for by these parameters.

    CONCLUSION:

    In all age groups among men, living alone is significantly associated with reduced CMM-specific survival, partially attributed to a more advanced stage at diagnosis. This emphasizes the need for improved prevention and early detection strategies for this group.

  • 238.
    Ermund, Anna
    et al.
    University of Gothenburg, Sweden .
    Gustafsson, Jenny K.
    University of Gothenburg, Sweden .
    Hansson, Gunnar C.
    University of Gothenburg, Sweden .
    Keita, Åsa
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet.
    Mucus Properties and Goblet Cell Quantification in Mouse, Rat and Human Ileal Peyers Patches2013Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, nr 12, s. 83688-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Peyers patches (PPs) are collections of lymphoid follicles in the small intestine, responsible for scanning the intestinal content for foreign antigens such as soluble molecules, particulate matter as well as intact bacteria and viruses. The immune cells of the patch are separated from the intestinal lumen by a single layer of epithelial cells, the follicle-associated epithelium (FAE). This epithelium covers the dome of the follicle and contains enterocyte-like cells and M cells, which are particularly specialized in taking up antigens from the gut. However, the presence and number of goblet cells as well as the presence of mucus on top of the FAE is controversial. When mouse ileal PPs were mounted in a horizontal Ussing-type chamber, we could observe a continuous mucus layer at mounting and new, easily removable mucus was released from the villi on the patch upon stimulation. Confocal imaging using fluorescent beads revealed a penetrable mucus layer covering the domes. Furthermore, immunostaining of FAE from mice, rats and humans with a specific antibody against the main component of intestinal mucus, the MUC2 mucin, clearly identify mucin-containing goblet cells. Transmission electron micrographs further support the identification of mucus releasing goblet cells on the domes of PPs in these species.

  • 239.
    Ernvik, Ulrika
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet.
    Anknytningsbeteenden i familjer tillhörande ett ursprungsfolk.2014Självständigt arbete på avancerad nivå (yrkesexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [sv]

    Jag har genom observationer studerat anknytningsbeteenden i sju familjer tillhörande ett av världens ursprungsfolk – karener.  Familjerna bor i en by i bergen i norra Thailand. Mitt syfte var att observera och beskriva hur anknytningsbeteenden och samspel kan se ut i familjer där barnen lever väldigt nära sina föräldrar, och där flera generationer ofta bor tillsammans. Min frågeställning var: ”Hur knyter familjemedlemmarna i en karenfamilj an till varandra?” Jag studerade samspelet mellan barn och vuxna, mellan föräldrarna, och ibland även mellan mor/farföräldrar och övriga familjemedlemmar. Observationerna kompletterades med frågor till föräldrarna.

    I studien blev det tydligt att kultur, fysiska förutsättningar som hur man bor, samt socio-ekonomiska faktorer som hur man får sin försörjning, påverkar anknytningsbeteenden. Familjerna i studien är alla självförsörjande småbönder, vilket gör det möjligt för barnen att vara med sina föräldrar en stor del av dygnet. Familjerna lever nära tidigare generationer, och barnen har ofta flera anknytningspersoner. Barnen använder långt upp i åldern sina anknytningspersoner som en tydlig trygg bas, samtidigt som de har stor frihet att utforska världen. Föräldrarna har en tydlig medvetenhet om att barn behöver mycket tid och närhet till sina föräldrar. Eftersom alla sitter och arbetar på golvet har barnen enkelt tillgång till vuxna. Samtal, leenden och skratt är viktiga i anknytningen mellan familjemedlemmarna. Den fysiska närheten mellan barn och vuxna är stor.  Mellan föräldrarna är ett av det starkaste anknytningsbanden det faktum att de behöver varandra.

  • 240.
    Ernvik, Ulrika
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet.
    Anknytningsbeteenden i familjer tillhörande ett urspungsfolk2014Självständigt arbete på avancerad nivå (yrkesexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [sv]

    Jag har genom observationer studerat anknytningsbeteenden i sju familjer tillhörande ett av världens ursprungsfolk – karener.  Familjerna bor i en by i bergen i norra Thailand. Mitt syfte var att observera och beskriva hur anknytningsbeteenden och samspel kan se ut i familjer där barnen lever väldigt nära sina föräldrar, och där flera generationer ofta bor tillsammans. Min frågeställning var: ”Hur knyter familjemedlemmarna i en karenfamilj an till varandra?” Jag studerade samspelet mellan barn och vuxna, mellan föräldrarna, och ibland även mellan mor/farföräldrar och övriga familjemedlemmar. Observationerna kompletterades med frågor till föräldrarna.

    I studien blev det tydligt att kultur, fysiska förutsättningar som hur man bor, samt socio-ekonomiska faktorer som hur man får sin försörjning, påverkar anknytningsbeteenden. Familjerna i studien är alla självförsörjande småbönder, vilket gör det möjligt för barnen att vara med sina föräldrar en stor del av dygnet. Familjerna lever nära tidigare generationer, och barnen har ofta flera anknytningspersoner. Barnen använder långt upp i åldern sina anknytningspersoner som en tydlig trygg bas, samtidigt som de har stor frihet att utforska världen. Föräldrarna har en tydlig medvetenhet om att barn behöver mycket tid och närhet till sina föräldrar. Eftersom alla sitter och arbetar på golvet har barnen enkelt tillgång till vuxna. Samtal, leenden och skratt är viktiga i anknytningen mellan familjemedlemmarna. Den fysiska närheten mellan barn och vuxna är stor.  Mellan föräldrarna är ett av det starkaste anknytningsbanden det faktum att de behöver varandra.

  • 241.
    Evert, Jasmine
    et al.
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Pathak, Surajit
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Faculty of Allied Health Sciences, Chettinad Academy of Research and Education, Kelambakkam, India.
    Sun, Xiao-Feng
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Zhang, Hong
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    A Study on Effect of Oxaliplatin in MicroRNA Expression in Human Colon Cancer2018Ingår i: Journal of Cancer, ISSN 1837-9664, E-ISSN 1837-9664, Vol. 9, nr 11, s. 2046-2053Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Colorectal cancer is a commonly diagnosed malignancy and also the major cause of death worldwide. Chemotherapy is the primary therapy for advanced colorectal cancer. Although oxaliplatin has potential effect in colorectal cancer therapy, the molecular mechanisms involved in its cytotoxic effects are not well elucidated. This study outlines the regulatory effects of oxaliplatin on miRNAs expression in colon cancer cells and correlates it with the changing microRNA expression with p53 and p73 expression status in cells. HCT116(p53+/+) and HCT116(p53-/-) cells were exposed to oxaliplatin, and the cellular viability was determined by XTT. p73 was knocked down using siRNA and the tumor cells were then treated with oxaliplatin. The expression profile of 384 miRNAs was determined by TaqMan (R) human miRNA array and calculated by the Delta Delta C-t method. Cellular viability was found to decrease after the treatment with oxaliplatin in a dose-dependent manner. The wild-type p53 cells were found to be more sensitive than the null-p53 derivatives. A selective set of miRNAs were either up-regulated or down-regulated in response to the oxaliplatin treatment with a presumable role of p53 and p73 proteins. The miRNAs expression is known to influence the pharmacodynamic mechanisms of oxaliplatin and these effects have been observed to be regulated by p53 and p73. Our results may therefore provide more evidence for identifying a suitable biomarker for the diagnosis of colon cancer.

  • 242.
    Falk, Magnus
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Sjödahl, Rune
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US. Region Östergötland, Centrum för hälso- och vårdutveckling, Patientsäkerhet.
    Wiréhn, Ann-Britt
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys.
    Lagerfelt, Marie
    Region Östergötland, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Woisetschläger, Mischa
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Röntgenkliniken i Linköping.
    Ahlström, Ulla
    Vårdcentralen Kungsgatan Linköping, Sweden Region Östergötland, Sweden.
    Myrelid, Pär
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Modifierad brittisk modell kortade ledtid till datortomografi av kolon2015Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112Artikel i tidskrift (Refereegranskat)
    Abstract [sv]

    Vid misstanke om kolorektal cancer är det angeläget att patienter där misstankegraden är hög får genomgå snar utredning och diagnostik. På många håll i landet föreligger oönskat långa väntetider för sådan utredning.

    Användningen av ett evidensbaserat beslutsstöd för kolonutredning, baserat på riktlinjer från brittiska NICE (National Institute for Health and Care Excellence), implementerades på 8 vårdcentraler i Östergötland.

    Efter implementeringen förkortades ledtider till datortomografi av kolon, diagnos och behandling.

    Beslutsstödet bidrog till att patienter där graden av misstanke om kolorektal cancer var låg kunde styras om till att genomgå datortomografi av buken i stället för av kolon.

  • 243.
    Fan, C-W
    et al.
    Sichuan University, Peoples R China .
    Chen, T
    Sichuan University, Peoples R China .
    Shang, Y-N
    Sichuan University, Peoples R China .
    Gu, Y-Z
    Sichuan University, Peoples R China .
    Zhang, S-L
    Sichuan University, Peoples R China .
    Lu, R
    Sichuan University, Peoples R China .
    OuYang, S-R
    Sichuan University, Peoples R China .
    Zhou, X
    Sichuan University, Peoples R China .
    Li, Y
    Sichuan University, Peoples R China .
    Meng, W-T
    Sichuan University, Peoples R China .
    Hu, J-K
    Sichuan University, Peoples R China .
    Lu, Y
    Sichuan University, Peoples R China .
    Sun, Xiao-Feng
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Bu, H
    Sichuan University, Peoples R China .
    Zhou, Z-G
    Sichuan University, Peoples R China .
    Mo, X-M
    Sichuan University, Peoples R China .
    Cancer-initiating cells derived from human rectal adenocarcinoma tissues carry mesenchymal phenotypes and resist drug therapies2013Ingår i: Cell Death and Disease, ISSN 2041-4889, E-ISSN 2041-4889, Vol. 4, s. e828-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Accumulating evidence indicates that cancer-initiating cells (CICs) are responsible for cancer initiation, relapse, and metastasis. Colorectal carcinoma (CRC) is typically classified into proximal colon, distal colon, and rectal cancer. The gradual changes in CRC molecular features within the bowel may have considerable implications in colon and rectal CICs. Unfortunately, limited information is available on CICs derived from rectal cancer, although colon CICs have been described. Here we identified rectal CICs (R-CICs) that possess differentiation potential in tumors derived from patients with rectal adenocarcinoma. The R-CICs carried both CD44 and CD54 surface markers, while R-CICs and their immediate progenies carried potential epithelial–mesenchymal transition characteristics. These R-CICs generated tumors similar to their tumor of origin when injected into immunodeficient mice, differentiated into rectal epithelial cells in vitro, and were capable of self-renewal both in vitro and in vivo. More importantly, subpopulations of R-CICs resisted both 5-fluorouracil/calcium folinate/oxaliplatin (FolFox) and cetuximab treatment, which are the most common therapeutic regimens used for patients with advanced or metastatic rectal cancer. Thus, the identification, expansion, and properties of R-CICs provide an ideal cellular model to further investigate tumor progression and determine therapeutic resistance in these patients.

  • 244.
    Fernlund, Eva
    et al.
    Region Östergötland, Barn- och kvinnocentrum, Barn- och ungdomskliniken i Linköping. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Skåne University Hospital, Sweden; Lund University, Sweden.
    Liuba, P.
    Skåne University Hospital, Sweden; Lund University, Sweden.
    Carlson, J.
    Lund University, Sweden; Skåne University Hospital, Sweden.
    Platonov, P. G.
    Lund University, Sweden; Skåne University Hospital, Sweden.
    Schlegel, T. T.
    Karolinska University Hospital, Sweden; Karolinska Institute, Sweden; Nicollier Schlegel SARL, Switzerland.
    MYBPC3 hypertrophic cardiomyopathy can be detected by using advanced ECG in children and young adults2016Ingår i: Journal of Electrocardiology, ISSN 0022-0736, E-ISSN 1532-8430, Vol. 49, nr 3, s. 392-400Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: The conventional ECG is commonly used to screen for hypertrophic cardiomyopathy (HCM), but up to 25% of adults and possibly larger percentages of children with HCM have no distinctive abnormalities on the conventional ECG, whereas 5 to 15% of healthy young athletes do. Recently, a 5-min resting advanced 12-lead ECG test ("A-ECG score") showed superiority to pooled criteria from the strictly conventional ECG in correctly identifying adult HCM. The purpose of this study was to evaluate whether in children and young adults, A-ECG scoring could detect echocardiographic HCM associated with the MYBPC3 genetic mutation with greater sensitivity than conventional ECG criteria and distinguish healthy young controls and athletes from persons with MYBPC3 HCM with greater specificity. Methods: Five-minute 12-lead ECGs were obtained from 15 young patients (mean age 13.2 years, range 0-30 years) with MYBPC3 mutation and phenotypic HCM. The conventional and A-ECG results of these patients were compared to those of 198 healthy children and young adults (mean age 13.2, range 1 month-30 years) with unremarkable echocardiograms, and to those of 36 young endurance-trained athletes, 20 of whom had athletic (physiologic) left ventricular hypertrophy. Results: Compared with commonly used, age-specific pooled criteria from the conventional ECG, a retrospectively generated A-ECG score incorporating results from just 2 derived vectorcardiographic parameters (spatial QRS-T angle and the change in the vectorcardiographic QRS azimuth angle from the second to the third eighth of the QRS interval) increased the sensitivity of ECG for identifying MYBPC3 HCM from 46% to 87% (p amp;lt; 0.05). Use of the same score also demonstrated superior specificity in a set of 198 healthy controls (94% vs. 87% for conventional ECG criteria; p amp;lt; 0.01) including in a subset of 36 healthy, young endurance-trained athletes (100% vs. 69% for conventional ECG criteria, p amp;lt; 0.001). Conclusions: In children and young adults, a 2-parameter 12-lead A-ECG score is retrospectively significantly more sensitive and specific than pooled, age-specific conventional ECG criteria for detecting MYBPC3-HCM and in distinguishing such patients from healthy controls, including endurance-trained athletes. (C) 2016 Elsevier Inc. All rights reserved.

  • 245.
    Flejmer, Anna M.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Radiation burden from modern radiation therapy techniques including proton therapy for breast cancer treatment - clinical implications2016Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The purpose of this thesis was to study the clinical implications of modern radiotherapy techniques for breast cancer treatment. This was investigated in several individual studies.

    Study I investigated the implications of using the analytical anisotropic algorithm (AAA) from the perspective of clinical recommendations for breast cancer radiotherapy. Pencil beam convolution plans of 40 breast cancer patients were recalculated with AAA. The latter plans had a significantly worse coverage of the planning target volume (PTV) with the 93% isodose, higher maximum dose in hotspots, higher volumes of the ipsilateral lung receiving doses below 25 Gy and smaller volumes with doses above 25 Gy. AAA also predicted lower doses to the heart.

    Study II investigated the implications of using the irregular surface compensator (ISC), an electronic compensation algorithm, in comparison to three‐dimensional conformal radiotherapy (3D‐CRT) for breast cancer treatment. Ten breast cancer patients were planned with both techniques. The ISC technique led to better coverage of the clinical target volume of the tumour bed (CTV‐T) and PTV in almost all patients with significant improvement in homogeneity.

    Study III investigated the feasibility of using scanning pencil beam proton therapy for regional and loco‐regional breast cancer with comparison of ISC photon planning. Ten patients were included in the study, all with dose heterogeneity in the target and/or hotspots in the normal tissues outside the PTV. The proton plans showed comparable or better CTV‐T and PTV coverage, with large reductions in the mean doses to the heart and the ipsilateral lung.

    Study IV investigated the added value of enhanced inspiration gating (EIG) for proton therapy. Twenty patients were planned on CT datasets acquired during EIG and freebreathing (FB) using photon 3D‐CRT and scanning proton therapy. Proton spot scanning has a high potential to reduce the irradiation of organs‐at‐risk for most patients, beyond what could be achieved with EIG and photon therapy, especially in terms of mean doses to the heart and the left anterior descending artery.

    Study V investigated the impact of physiological breathing motion during proton radiotherapy for breast cancer. Twelve thoracic patients were planned on CT datasets during breath‐hold at inhalation phase and breath‐hold at exhalation phase. Between inhalation and exhalation phase there were very small differences in dose delivered to the target and cardiovascular structures, with very small clinical implication.

    The results of these studies showed the potential of various radiotherapy techniques to improve the quality of life for breast cancer patients by limiting the dose burden for normal tissues.

    Delarbeten
    1. Analytical Anisotropic Algorithm versus Pencil Beam Convolution for treatment planning of breast cancer: implications for target coverage and radiation burden of normal tissue
    Öppna denna publikation i ny flik eller fönster >>Analytical Anisotropic Algorithm versus Pencil Beam Convolution for treatment planning of breast cancer: implications for target coverage and radiation burden of normal tissue
    Visa övriga...
    2015 (Engelska)Ingår i: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 35, nr 5, s. 2841-2848Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Aim: The present study aimed to investigate the implications of using the analytical anisotropic algorithm (AAA) for calculation of target coverage and radiation burden of normal tissues. Most model parameters, recommendations and planning guidelines associated with a certain outcome are from the era of pencil beam convolution (PBC) calculations on relatively simple assumptions of energy transport in media. Their relevance for AAA calculations that predict more realistic dose distributions needs to be evaluated. Patients and Methods: Forty patients with left-sided breast cancer receiving 3D conformal radiation therapy were planned using PBC with a standard protocol with 50 Gy in 25 fractions according to existing re-commendations. The plans were subsequently recalculated with the AAA and relevant dose parameters were determined and compared to their PBC equivalents. Results: The majority of the AAA-based plans had a significantly worse coverage of the planning target volume and also a higher maximum dose in hotspots near sensitive structures, suggesting that these criteria could be relaxed for AAA-calculated plans. Furthermore, the AAA predicts higher volumes of the ipsilateral lung will receive doses below 25 Gy and smaller volume doses above 25 Gy. These results indicate that lung tolerance criteria might also have to be relaxed for AAA planning in order to maintain the level of normal tissue toxicity. The AAA also predicts lower doses to the heart, thus indicating that this organ might be more sensitive to radiation than thought from PBC-based calculations. Conclusion: The AAA should be preferred over the PBC algorithm for breast cancer radiotherapy as it gives more realistic dose distributions. Guidelines for plan acceptance might have to be re-evaluated to account for differences in dose predictions in order to maintain the current levels of control and complication rates. The results also suggest an increased radiosensitivity of the heart, thus indicating that a revision of the current models for cardiovascular complications may be needed.

    Ort, förlag, år, upplaga, sidor
    International Institute of Anticancer Research, 2015
    Nyckelord
    breast radiotherapy, dose calculation algorithm, analytical anisotropic algorithm, pencil beam convolution, planning guidelines
    Nationell ämneskategori
    Cancer och onkologi
    Identifikatorer
    urn:nbn:se:liu:diva-117854 (URN)000354267200045 ()25964565 (PubMedID)
    Tillgänglig från: 2015-05-11 Skapad: 2015-05-11 Senast uppdaterad: 2017-12-04
    2. Clinical implications of the ISC technique for breast cancer radiotherapy and comparison with clinical recommendations
    Öppna denna publikation i ny flik eller fönster >>Clinical implications of the ISC technique for breast cancer radiotherapy and comparison with clinical recommendations
    Visa övriga...
    2014 (Engelska)Ingår i: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 34, nr 7, s. 3563-3568Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Purpose: The project studied the implications of using the irregular surface compensator (ISC) technique in comparison to three-dimensional conformal radiation therapy (3D-CRT) for breast cancer treatment. ISC is an electronic compensation algorithm that modulates the fluence across the radiation fields to compensate for irregularly shaped surfaces and deliver a homogeneous dose to a compensation plane. Methods: Ten breast cancer patients (five left- and five right-sided) were planned with both techniques. The planning was done for 50 Gy in 25 fractions with 2 Gy per fraction in all patients. Physical parameters such as doses to the clinical target volume (CTV-T) and the planned target volume (PTV), heterogeneity index and doses to lung and heart were determined and compared for the treatment plans. Results: The ISC technique led to significantly better coverage of the CTV-T and PTV in almost all patients with statistically significant better homogeneity of the dose distribution. The contralateral lung and the heart receive the same doses with both ISC and 3D-CRT plans. However, ISC showed a trend towards decreasing the volumes of the ipsilateral lung irradiated with high doses. Consequently this led to better compliance with the national recommendations for breast radiotherapy. Conclusion: The ISC technique leads to an improvement of the target coverage and the radiation burden of the ipsilateral lung thus allowing better compliance with the national recommendations and increasing the potential for improved quality of life for breast cancer patients. It should therefore be preferred over 3D-CRT for breast cases with difficult dose homogeneity to the PTV or CTV-T.

    Ort, förlag, år, upplaga, sidor
    International Institute of Anticancer Research, 2014
    Nyckelord
    breast radiotherapy, irregular surface compensator, fractionated radiotherapy, irradiation technique
    Nationell ämneskategori
    Cancer och onkologi
    Identifikatorer
    urn:nbn:se:liu:diva-106944 (URN)000338780300044 ()24982370 (PubMedID)
    Tillgänglig från: 2014-05-28 Skapad: 2014-05-28 Senast uppdaterad: 2017-12-05Bibliografiskt granskad
    3. Potential benefit of scanned proton beam versus photons as adjuvant radiation therapy in breast cancer
    Öppna denna publikation i ny flik eller fönster >>Potential benefit of scanned proton beam versus photons as adjuvant radiation therapy in breast cancer
    Visa övriga...
    2015 (Engelska)Ingår i: International Journal of Particle Therapy, ISSN 2331-5180, Vol. 1, nr 4, s. 845-855Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Purpose: To investigate the feasibility of using scanned proton beams as adjuvant radiation therapy for breast cancer. Long-term cardiopulmonary complications may worsen the quality of life and reduce the positive contribution of radiation therapy, which has been known to improve long-term control of locoregional disease as well as the long-term survival for these patients.

    Materials and Methods: Ten patients with stage I-III cancer (either after mastectomy or lumpectomy, left- or right-sided) were included in the study. The patients were identified from a larger group where dose heterogeneity in the target and/or hotspots in the normal tissues qualified them for irregular surface compensator planning with photons. The patients underwent planning with 2 scanned proton beam planning techniques, single-field uniform dose and intensity-modulated proton therapy, and the results were compared with those from irregular surface compensator. All volumes of interest were delineated and reviewed by experienced radio-oncologists. The patients were prescribed 50 GyRBE in 25 fractions. Dosimetric parameters of interest were compared with a paired, 2-tailed Student t test.

    Results: The proton plans showed comparable or better target coverage than the original photon plans. There were also large reductions with protons in mean doses to the heart (0.2 versus 1.3 GyRBE), left anterior descending artery (1.4 versus 6.4 GyRBE), and the ipsilateral lung (6.3 versus 7.7 GyRBE). This reduction is important from the point of view of the quality of life of the patients after radiation therapy. No significant differences were found between single-field uniform dose and intensity-modulated proton therapy plans.

    Conclusion: Spot scanning technique with protons may improve target dose homogeneity and further reduce doses to the organs at risk compared with advanced photon techniques. The results from this study indicate a potential for protons as adjuvant radiation therapy in breast cancer and a further step toward the individualization of treatment based on anatomic and comorbidity characteristics.

    Nyckelord
    breast radiation therapy, proton radiation therapy, pencil beam scanning, irregular surface compensator, fractionated radiation therapy
    Nationell ämneskategori
    Cancer och onkologi
    Identifikatorer
    urn:nbn:se:liu:diva-112949 (URN)10.14338/IJPT-14-00013.1 (DOI)
    Tillgänglig från: 2014-12-31 Skapad: 2014-12-31 Senast uppdaterad: 2016-04-27
    4. Respiratory gating for proton beam scanning versus photon 3D-CRT for breast cancer radiotherapy
    Öppna denna publikation i ny flik eller fönster >>Respiratory gating for proton beam scanning versus photon 3D-CRT for breast cancer radiotherapy
    Visa övriga...
    2016 (Engelska)Ingår i: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 55, nr 5, s. 577-583Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background Respiratory gating and proton therapy have both been proposed to reduce the cardiopulmonary burden in breast cancer radiotherapy. This study aims to investigate the additional benefit of proton radiotherapy for breast cancer with and without respiratory gating.

    Material and methods Twenty left-sided patients were planned on computed tomography (CT)-datasets acquired during enhanced inspiration gating (EIG) and free-breathing (FB), using photon three-dimensional conformal radiation therapy (3D-CRT) and scanned proton beams. Ten patients received treatment to the whole breast only (WBO) and 10 were treated to the breast and the regional lymph nodes (BRN). Dosimetric parameters characterizing the coverage of target volumes and the cardiopulmonary burden were compared using a paired, two-tailed Student’s t-test.

    Results Protons ensured comparable or better target coverage than photons in all patients during both EIG and FB. The heterogeneity index decreased from 12% with photons to about 5% with protons. The mean dose to the ipsilateral lung was reduced in BRN patients from 12 Gy to 7 Gy (RBE) in EIG and from 14 Gy to 6-7 Gy (RBE) in FB, while for WBO patients all values were about 5-6 Gy (RBE). The mean dose to heart decreased by a factor of four in WBO patients [from 1.1 Gy to 0.3 Gy (RBE) in EIG and from 2.1 Gy to 0.5 Gy (RBE) in FB] and 10 in BRN patients [from 2.1 Gy to 0.2 Gy (RBE) in EIG and from 3.4 Gy to 0.3 Gy (RBE) in FB]. Similarly, the mean and the near maximum dose to left anterior descending artery (LAD) were significantly lower (p<0.05) with protons in comparison with photons.

    Conclusion Proton spot scanning has a high potential to reduce the irradiation of organs at risk and other normal tissues for most patients, beyond what could be achieved with EIG and photon therapy. The largest dose sparing has been seen for BRN patients, both in terms of cardiopulmonary burden and integral dose.

    Nationell ämneskategori
    Cancer och onkologi
    Identifikatorer
    urn:nbn:se:liu:diva-123274 (URN)10.3109/0284186X.2015.1120883 (DOI)000375566700008 ()
    Anmärkning

    Funding agencies:  LiU Cancer research network at Linkoping University; Region Ostergotland; ALF Grants from Region Ostergotland (Sweden)

    Tillgänglig från: 2015-12-09 Skapad: 2015-12-09 Senast uppdaterad: 2017-04-24
    5. Impact of physiological breathing motion for breast cancer radiotherapy with proton beam scanning: An in silico study
    Öppna denna publikation i ny flik eller fönster >>Impact of physiological breathing motion for breast cancer radiotherapy with proton beam scanning: An in silico study
    Visa övriga...
    2017 (Engelska)Ingår i: Physica medica (Testo stampato), ISSN 1120-1797, E-ISSN 1724-191X, Vol. 39, s. 88-94Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    This study investigates the impact of breathing motion on proton breast treatment plans. Twelve patients with CT datasets acquired during breath-hold-at-inhalation (BHI), breath-hold-at-exhalation (BHE) and in free-breathing (FB) were included in the study. Proton plans were designed for the left breast for BHI and subsequently recalculated for BHE or designed for FB and recalculated for the extreme breath-hold phases. The plans were compared from the point of view of their target coverage and doses to organs-at-risk. The median amplitude of breathing motion determined from the positions of the sternum was 4.7 mm (range 0.5-14.6 mm). Breathing motion led to a degradation of the dose coverage of the target (heterogeneity index increased from 4-7% to 8-11%), but the degraded values of the dosimetric parameters of interest fulfilled the clinical criteria for plan acceptance. Exhalation decreased the lung burden [average dose 3.1-4.5 Gy (RBE)], while inhalation increased it [average dose 5.8-6.8 Gy (RBE)]. The individual values depended on the field arrangement. Smaller differences were seen for the heart [average dose 0.1-0.2 Gy (RBE)] and the LAD [1.9-4.6 Gy (RBE)]. Weak correlations were generally found between changes in dosimetric parameters and respiratory motion. The differences between dosimetric parameters for various breathing phases were small and their expected clinical impact is consequently quite small. The results indicated that the dosimetric parameters of the plans corresponding to the extreme breathing phases are little affected by breathing motion, thus suggesting that this motion might have little impact for the chosen beam orientations with scanned proton beams.

    Ort, förlag, år, upplaga, sidor
    Elsevier, 2017
    Nationell ämneskategori
    Cancer och onkologi
    Identifikatorer
    urn:nbn:se:liu:diva-127369 (URN)10.1016/j.ejmp.2017.06.001 (DOI)000405493200012 ()28606833 (PubMedID)
    Anmärkning

    Funding agencies: LiU Cancer research network at Linkoping University and Region Ostergotland (Sweden)

    Tillgänglig från: 2016-04-23 Skapad: 2016-04-23 Senast uppdaterad: 2018-05-02Bibliografiskt granskad
  • 246.
    Flejmer, Anna M.
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Dohlmar, Frida
    Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Radiofysikavdelningen US. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper.
    Nilsson, Mats
    Futurum - Academy for Health and Care, Jönköping.
    Stenmarker, Margaretha
    Futurum - Academy for Health and Care, Jönköping.
    Dasu, Alexandru
    Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Radiofysikavdelningen US. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper.
    Analytical Anisotropic Algorithm versus Pencil Beam Convolution for treatment planning of breast cancer: implications for target coverage and radiation burden of normal tissue2015Ingår i: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 35, nr 5, s. 2841-2848Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: The present study aimed to investigate the implications of using the analytical anisotropic algorithm (AAA) for calculation of target coverage and radiation burden of normal tissues. Most model parameters, recommendations and planning guidelines associated with a certain outcome are from the era of pencil beam convolution (PBC) calculations on relatively simple assumptions of energy transport in media. Their relevance for AAA calculations that predict more realistic dose distributions needs to be evaluated. Patients and Methods: Forty patients with left-sided breast cancer receiving 3D conformal radiation therapy were planned using PBC with a standard protocol with 50 Gy in 25 fractions according to existing re-commendations. The plans were subsequently recalculated with the AAA and relevant dose parameters were determined and compared to their PBC equivalents. Results: The majority of the AAA-based plans had a significantly worse coverage of the planning target volume and also a higher maximum dose in hotspots near sensitive structures, suggesting that these criteria could be relaxed for AAA-calculated plans. Furthermore, the AAA predicts higher volumes of the ipsilateral lung will receive doses below 25 Gy and smaller volume doses above 25 Gy. These results indicate that lung tolerance criteria might also have to be relaxed for AAA planning in order to maintain the level of normal tissue toxicity. The AAA also predicts lower doses to the heart, thus indicating that this organ might be more sensitive to radiation than thought from PBC-based calculations. Conclusion: The AAA should be preferred over the PBC algorithm for breast cancer radiotherapy as it gives more realistic dose distributions. Guidelines for plan acceptance might have to be re-evaluated to account for differences in dose predictions in order to maintain the current levels of control and complication rates. The results also suggest an increased radiosensitivity of the heart, thus indicating that a revision of the current models for cardiovascular complications may be needed.

  • 247.
    Flejmer, Anna M.
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US. Linköpings universitet, Medicinska fakulteten.
    Edvardsson, Anneli
    Lund University, Sweden.
    Dohlmar, Frida
    Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Radiofysikavdelningen US. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Josefsson, Dan
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Radiofysikavdelningen US.
    Nilsson, Mats
    Futurum - Academy for Health and Care, Jönköping, Sweden.
    Witt Nyström, Petra
    Uppsala University Hospital, Sweden.
    Dasu, Alexandru
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Radiofysikavdelningen US.
    Respiratory gating for proton beam scanning versus photon 3D-CRT for breast cancer radiotherapy2016Ingår i: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 55, nr 5, s. 577-583Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Respiratory gating and proton therapy have both been proposed to reduce the cardiopulmonary burden in breast cancer radiotherapy. This study aims to investigate the additional benefit of proton radiotherapy for breast cancer with and without respiratory gating.

    Material and methods Twenty left-sided patients were planned on computed tomography (CT)-datasets acquired during enhanced inspiration gating (EIG) and free-breathing (FB), using photon three-dimensional conformal radiation therapy (3D-CRT) and scanned proton beams. Ten patients received treatment to the whole breast only (WBO) and 10 were treated to the breast and the regional lymph nodes (BRN). Dosimetric parameters characterizing the coverage of target volumes and the cardiopulmonary burden were compared using a paired, two-tailed Student’s t-test.

    Results Protons ensured comparable or better target coverage than photons in all patients during both EIG and FB. The heterogeneity index decreased from 12% with photons to about 5% with protons. The mean dose to the ipsilateral lung was reduced in BRN patients from 12 Gy to 7 Gy (RBE) in EIG and from 14 Gy to 6-7 Gy (RBE) in FB, while for WBO patients all values were about 5-6 Gy (RBE). The mean dose to heart decreased by a factor of four in WBO patients [from 1.1 Gy to 0.3 Gy (RBE) in EIG and from 2.1 Gy to 0.5 Gy (RBE) in FB] and 10 in BRN patients [from 2.1 Gy to 0.2 Gy (RBE) in EIG and from 3.4 Gy to 0.3 Gy (RBE) in FB]. Similarly, the mean and the near maximum dose to left anterior descending artery (LAD) were significantly lower (p<0.05) with protons in comparison with photons.

    Conclusion Proton spot scanning has a high potential to reduce the irradiation of organs at risk and other normal tissues for most patients, beyond what could be achieved with EIG and photon therapy. The largest dose sparing has been seen for BRN patients, both in terms of cardiopulmonary burden and integral dose.

  • 248.
    Flejmer, Anna M.
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet.
    Josefsson, Dan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Radiofysikavdelningen US.
    Nilsson, Mats
    Futurum - Academy for Health and Care, Jönköping.
    Stenmarker, Margaretha
    Futurum - Academy for Health and Care, Jönköping.
    Dasu, Alexandru
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Radiofysikavdelningen US.
    Clinical implications of the ISC technique for breast cancer radiotherapy and comparison with clinical recommendations2014Ingår i: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 34, nr 7, s. 3563-3568Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: The project studied the implications of using the irregular surface compensator (ISC) technique in comparison to three-dimensional conformal radiation therapy (3D-CRT) for breast cancer treatment. ISC is an electronic compensation algorithm that modulates the fluence across the radiation fields to compensate for irregularly shaped surfaces and deliver a homogeneous dose to a compensation plane. Methods: Ten breast cancer patients (five left- and five right-sided) were planned with both techniques. The planning was done for 50 Gy in 25 fractions with 2 Gy per fraction in all patients. Physical parameters such as doses to the clinical target volume (CTV-T) and the planned target volume (PTV), heterogeneity index and doses to lung and heart were determined and compared for the treatment plans. Results: The ISC technique led to significantly better coverage of the CTV-T and PTV in almost all patients with statistically significant better homogeneity of the dose distribution. The contralateral lung and the heart receive the same doses with both ISC and 3D-CRT plans. However, ISC showed a trend towards decreasing the volumes of the ipsilateral lung irradiated with high doses. Consequently this led to better compliance with the national recommendations for breast radiotherapy. Conclusion: The ISC technique leads to an improvement of the target coverage and the radiation burden of the ipsilateral lung thus allowing better compliance with the national recommendations and increasing the potential for improved quality of life for breast cancer patients. It should therefore be preferred over 3D-CRT for breast cases with difficult dose homogeneity to the PTV or CTV-T.

  • 249.
    Flejmer, Anna M.
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Witt Nyström, Petra
    Uppsala University Hospital.
    Dohlmar, Frida
    Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Radiofysikavdelningen US. Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper.
    Josefsson, Dan
    Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Radiofysikavdelningen US. Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper.
    Dasu, Alexandru
    Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Radiofysikavdelningen US. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Hälsouniversitetet.
    Potential benefit of scanned proton beam versus photons as adjuvant radiation therapy in breast cancer2015Ingår i: International Journal of Particle Therapy, ISSN 2331-5180, Vol. 1, nr 4, s. 845-855Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: To investigate the feasibility of using scanned proton beams as adjuvant radiation therapy for breast cancer. Long-term cardiopulmonary complications may worsen the quality of life and reduce the positive contribution of radiation therapy, which has been known to improve long-term control of locoregional disease as well as the long-term survival for these patients.

    Materials and Methods: Ten patients with stage I-III cancer (either after mastectomy or lumpectomy, left- or right-sided) were included in the study. The patients were identified from a larger group where dose heterogeneity in the target and/or hotspots in the normal tissues qualified them for irregular surface compensator planning with photons. The patients underwent planning with 2 scanned proton beam planning techniques, single-field uniform dose and intensity-modulated proton therapy, and the results were compared with those from irregular surface compensator. All volumes of interest were delineated and reviewed by experienced radio-oncologists. The patients were prescribed 50 GyRBE in 25 fractions. Dosimetric parameters of interest were compared with a paired, 2-tailed Student t test.

    Results: The proton plans showed comparable or better target coverage than the original photon plans. There were also large reductions with protons in mean doses to the heart (0.2 versus 1.3 GyRBE), left anterior descending artery (1.4 versus 6.4 GyRBE), and the ipsilateral lung (6.3 versus 7.7 GyRBE). This reduction is important from the point of view of the quality of life of the patients after radiation therapy. No significant differences were found between single-field uniform dose and intensity-modulated proton therapy plans.

    Conclusion: Spot scanning technique with protons may improve target dose homogeneity and further reduce doses to the organs at risk compared with advanced photon techniques. The results from this study indicate a potential for protons as adjuvant radiation therapy in breast cancer and a further step toward the individualization of treatment based on anatomic and comorbidity characteristics.

  • 250.
    Floodeen, H
    et al.
    Örebro University Hospital, Sweden .
    Hallböök, Olof
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Rutegard, J
    Umeå University Hospital, Sweden .
    Sjödahl, Rune
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Matthiessen, P
    Örebro University Hospital, Sweden .
    Early and late symptomatic anastomotic leakage following low anterior resection of the rectum for cancer: are they different entities?2013Ingår i: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 15, nr 3, s. 334-340Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim The aim of the study was to compare patients with symptomatic anastomotic leakage following low anterior resection of the rectum (LAR) for cancer diagnosed during the initial hospital stay with those in whom leakage was diagnosed after hospital discharge. Method Forty-five patients undergoing LAR (n=234) entered into a randomized multicentre trial (NCT 00636948), who developed symptomatic anastomotic leakage, were identified. A comparison was made between patients diagnosed during the initial hospital stay on median postoperative day 8 (early leakage, EL; n=27) and patients diagnosed after hospital discharge at median postoperative day 22 (late leakage, LL; n=18). Patient characteristics, operative details, postoperative course and anatomical localization of the leakage were analysed. Results Leakage from the circular stapler line of an end-to-end anastomosis was more common in EL, while leakage from the stapler line of the efferent limb of the J-pouch or side-to-end anastomosis tended to be more frequent in LL (P=0.057). Intra-operative blood loss (P=0.006) and operation time (P=0.071) were increased in EL compared with LL. On postoperative day 5, EL performed worse than LL with regard to temperature (P=0.021), oral intake (P=0.006) and recovery of bowel activity (P=0.054). Anastomotic leakage was diagnosed most often by a rectal contrast study in EL and by CT scan in LL. The median initial hospital stay was 28days for EL and 10days for LL (Pandlt;0.001). Conclusion The present study has demonstrated that symptomatic anastomotic leakage can present before and after hospital discharge and raises the question of whether early and late leakage after LAR may be different entities.

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