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Wikström T, Kuusela P, Jacobsson B, Hagberg H, Lindgren P, Svensson M, Wennerholm U, Valentin L. Cost-effectiveness of cervical length screening and progesterone treatment to prevent spontaneous preterm delivery in Sweden. Ultrasound Obstet Gynecol 2022; 59:778-792. [PMID: 35195310 PMCID: PMC9327505 DOI: 10.1002/uog.24884] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/04/2022] [Accepted: 02/11/2022] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To estimate the cost-effectiveness of strategies to prevent spontaneous preterm delivery (PTD) in asymptomatic singleton pregnancies, using prevalence and healthcare cost data from the Swedish healthcare context. METHODS We designed a decision analytic model based on the Swedish CERVIX study to estimate the cost-effectiveness of strategies to prevent spontaneous PTD in asymptomatic women with a singleton pregnancy. The model was constructed as a combined decision-tree model and Markov model with a time horizon of 100 years. Four preventive strategies, namely 'Universal screening', 'High-risk-based screening' (i.e. screening of high-risk women only), 'Low-risk-based screening' (i.e. treatment of high-risk population and screening of remaining women) and 'Nullipara screening' (i.e. treatment of high-risk population and screening of nulliparous women only), included second-trimester cervical length (CL) screening by transvaginal ultrasound followed by vaginal progesterone treatment in the case of a short cervix. A fifth preventive strategy involved vaginal progesterone treatment of women with previous spontaneous PTD or late miscarriage but no CL screening ('No screening, treat high-risk group'). For comparison, we used a sixth strategy implying no specific intervention to prevent spontaneous PTD, reflecting the current situation in Sweden ('No screening'). Probabilities for a short cervix (CL ≤ 25 mm; base-case) and for spontaneous PTD at < 33 + 0 weeks and at 33 + 0 to 36 + 6 weeks were derived from the CERVIX study, and probabilities for stillbirth, neonatal mortality and long-term morbidity (cerebral palsy) from Swedish health data registers. Costs were based on Swedish data, except costs for cerebral palsy, which were based on Danish data. We assumed that vaginal progesterone reduces spontaneous PTD before 33 weeks by 30% and spontaneous PTD at 33-36 weeks by 10% (based on the literature). All analyses were from a societal perspective. We expressed the effectiveness of each strategy as gained quality-adjusted life years (QALYs) and presented cost-effectiveness as average (ACER; average cost per gained QALY compared with 'No screening') and incremental (ICER; difference in costs divided by the difference in QALYs for each of two strategies being compared) cost-effectiveness ratios. We performed deterministic and probabilistic sensitivity analysis. The results of the latter are shown as cost-effectiveness acceptability curves. Willingness-to-pay was set at a maximum of 500 000 Swedish krona (56 000 US dollars (USD)), as suggested by the Swedish National Board of Health and Welfare. RESULTS All interventions had better health outcomes than did 'No screening', with fewer screening-year deaths and more lifetime QALYs. The best strategy in terms of improved health outcomes was 'Low-risk-based screening', irrespective of whether screening was performed at 18 + 0 to 20 + 6 weeks (Cx1) or at 21 + 0 to 23 + 6 weeks (Cx2). 'Low-risk-based screening' at Cx1 was cost-effective, while 'Low-risk-based screening' at Cx2 entailed high costs compared with other alternatives. The ACERs were 2200 USD for 'Low-risk-based screening' at Cx1 and 36 800 USD for 'Low-risk-based screening' at Cx2. Cost-effectiveness was particularly sensitive to progesterone effectiveness and to productivity loss due to sick leave during pregnancy. The probability that 'Low-risk-based screening' at Cx1 is cost-effective compared with 'No screening' was 71%. CONCLUSION Interventions to prevent spontaneous PTD in asymptomatic women with a singleton pregnancy, including CL screening with progesterone treatment of cases with a short cervix, may be cost-effective in Sweden. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- T. Wikström
- Centre of Perinatal Medicine and Health, Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of ObstetricsGothenburgSweden
| | | | - B. Jacobsson
- Centre of Perinatal Medicine and Health, Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of ObstetricsGothenburgSweden
| | - H. Hagberg
- Centre of Perinatal Medicine and Health, Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of ObstetricsGothenburgSweden
| | - P. Lindgren
- Department of Clinical Science, Intervention and Technology, Karolinska InstitutetStockholmSweden
- Centre for Fetal MedicineKarolinska University HospitalStockholmSweden
| | - M. Svensson
- School of Public Health and Community Medicine, Institute of MedicineUniversity of GothenburgGothenburgSweden
| | - U.‐B. Wennerholm
- Centre of Perinatal Medicine and Health, Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of ObstetricsGothenburgSweden
| | - L. Valentin
- Department of Obstetrics and GynecologySkåne University HospitalMalmöSweden
- Department of Clinical Sciences MalmöLund UniversityMalmöSweden
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Alkmark M, Wennerholm UB, Saltvedt S, Bergh C, Carlsson Y, Elden H, Fadl H, Jonsson M, Ladfors L, Sengpiel V, Wesström J, Hagberg H, Svensson M. Induction of labour at 41 weeks of gestation versus expectant management and induction of labour at 42 weeks of gestation: a cost-effectiveness analysis. BJOG 2021; 129:2157-2165. [PMID: 34534404 DOI: 10.1111/1471-0528.16929] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/07/2021] [Accepted: 05/19/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the cost-effectiveness of induction of labour (IOL) at 41 weeks of gestation compared with expectant management until 42 weeks of gestation. DESIGN A cost-effectiveness analysis alongside the Swedish Post-term Induction Study (SWEPIS), a multicentre, randomised controlled superiority trial. SETTING Fourteen Swedish hospitals during 2016-2018. POPULATION Women with an uncomplicated singleton pregnancy with a fetus in cephalic position were randomised at 41 weeks of gestation to IOL or to expectant management and induction at 42 weeks of gestation. METHODS Health benefits were measured in life years and quality-adjusted life years (QALYs) for mother and child. Total cost per birth was calculated, including healthcare costs from randomisation to discharge after delivery, for mother and child. Incremental cost-effectiveness ratios (ICERs) were calculated by dividing the difference in mean cost between the trial arms by the difference in life years and QALYs, respectively. Sampling uncertainty was evaluated using non-parametric bootstrapping. MAIN OUTCOME MEASURES The cost per gained life year and per gained QALY. RESULTS The differences in life years and QALYs gained were driven by the difference in perinatal mortality alone. The absolute risk reduction in mortality was 0.004 (from 6/1373 to 0/1373). Based on Swedish life tables, this gives a mean gain in discounted life years and QALYs of 0.14 and 0.12 per birth, respectively. The mean cost per birth was €4108 in the IOL group (n = 1373) and €4037 in the expectant management group (n = 1373), with a mean difference of €71 (95% CI -€232 to €379). The ICER for IOL compared with expectant management was €545 per life year gained and €623 per QALY gained. Confidence intervals were relatively wide and included the possibility that IOL had both lower costs and better health outcomes. CONCLUSIONS Induction of labour at 41 weeks of gestation results in a better health outcome and no significant difference in costs. IOL is cost-effective compared with expectant management until 42 weeks of gestation using standard threshold values for acceptable cost per life year/QALY. TWEETABLE ABSTRACT Induction of labour at 41 weeks of gestation is cost-effective compared with expectant management until 42 weeks of gestation.
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Affiliation(s)
- M Alkmark
- Department of Obstetrics and Gynaecology, Centre of Perinatal Medicine & Health, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynaecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - U-B Wennerholm
- Department of Obstetrics and Gynaecology, Centre of Perinatal Medicine & Health, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynaecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - S Saltvedt
- Department of Women's and Children's Health, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - C Bergh
- Department of Obstetrics and Gynaecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Y Carlsson
- Department of Obstetrics and Gynaecology, Centre of Perinatal Medicine & Health, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynaecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - H Elden
- Department of Obstetrics and Gynaecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Health and Caring Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - H Fadl
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - M Jonsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - L Ladfors
- Department of Obstetrics and Gynaecology, Centre of Perinatal Medicine & Health, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynaecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - V Sengpiel
- Department of Obstetrics and Gynaecology, Centre of Perinatal Medicine & Health, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynaecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - J Wesström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Center for Clinical Research Dalarna, Falu Hospital, Falun, Sweden
| | - H Hagberg
- Department of Obstetrics and Gynaecology, Centre of Perinatal Medicine & Health, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynaecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - M Svensson
- School of Public Health & Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Kuusela P, Jacobsson B, Hagberg H, Fadl H, Lindgren P, Wesström J, Wennerholm UB, Valentin L. Second-trimester transvaginal ultrasound measurement of cervical length for prediction of preterm birth: a blinded prospective multicentre diagnostic accuracy study. BJOG 2020; 128:195-206. [PMID: 32964581 PMCID: PMC7821210 DOI: 10.1111/1471-0528.16519] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 08/21/2020] [Accepted: 09/07/2020] [Indexed: 11/28/2022]
Abstract
Objective To estimate the diagnostic performance of sonographic cervical length for the prediction of preterm birth (PTB). Design Prospective observational multicentre study. Setting Seven Swedish ultrasound centres. Sample A cohort of 11 456 asymptomatic women with a singleton pregnancy. Methods Cervical length was measured with transvaginal ultrasound at 18–20 weeks of gestation (C×1) and at 21–23 weeks of gestation (C×2, optional). Staff and participants were blinded to results. Main outcome measures Area under receiver operating characteristic curve (AUC), sensitivity, specificity, positive and negative predictive values (PPV and NPV), positive and negative likelihood ratios (LR+ and LR−), number of false‐positive results per true‐positive result (FP/TP), number needed to screen to detect one PTB (NNS) and prevalence of ‘short’ cervix. Results Spontaneous PTB (sPTB) at <33 weeks of gestation occurred in 56/11 072 (0.5%) women in the C×1 population (89% white) and in 26/6288 (0.4%) in the C×2 population (92% white). The discriminative ability of shortest endocervical length was better the earlier the sPTB occurred and was better at C×2 than at C×1 (AUC to predict sPTB at <33 weeks of gestation 0.76 versus 0.65, difference in AUC 0.11, 95% CI 0.01–0.23). At C×2, the shortest endocervical length of ≤25 mm (prevalence 4.4%) predicted sPTB at <33 weeks of gestation with sensitivity 38.5% (10/26), specificity 95.8% (5998/6262), PPV 3.6% (10/274), NPV 99.7% (5988/6014), LR+ 9.1, LR− 0.64, FP/TP 26 and NNS 629. Conclusions Second‐trimester sonographic cervical length can identify women at high risk of sPTB. In a population of mainly white women with a low prevalence of sPTB its diagnostic performance is at best moderate. Tweetable abstract Cervical length screening to predict preterm birth in a white low‐risk population has moderate performance. Cervical length screening to predict preterm birth in a white low‐risk population has moderate performance.
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Affiliation(s)
- P Kuusela
- Department of Obstetrics and Gynaecology, Centre of Perinatal Medicine and Health, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Södra Älvsborg Hospital, Borås, Sweden
| | - B Jacobsson
- Department of Obstetrics and Gynaecology, Centre of Perinatal Medicine and Health, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics, Region Vastra Gotaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - H Hagberg
- Department of Obstetrics and Gynaecology, Centre of Perinatal Medicine and Health, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics, Region Vastra Gotaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - H Fadl
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - P Lindgren
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.,Centre for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - J Wesström
- Centre for Clinical Research Dalarna, Falun Hospital, Falun, Sweden
| | - U-B Wennerholm
- Department of Obstetrics and Gynaecology, Centre of Perinatal Medicine and Health, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics, Region Vastra Gotaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - L Valentin
- Department of Obstetrics and Gynaecology, Skåne University Hospital, Malmö, Sweden.,Department of Medical Sciences Malmö, Lund University, Lund, Sweden
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Wennerholm UB, Saltvedt S, Wessberg A, Alkmark M, Bergh C, Brismar Wendel S, Fadl H, Jonsson M, Ladfors L, Sengpiel V, Wesström J, Wennergren G, Wikström AK, Elden H, Stephansson O, Hagberg H. Induction of labour at 41 weeks versus expectant management and induction of labour at 42 weeks (SWEdish Post-term Induction Study, SWEPIS): multicentre, open label, randomised, superiority trial. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- UB Wennerholm
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital
| | - S Saltvedt
- Department of Women’s and Children’s Health, Karolinska Institutet, Karolinska University Hospital
| | - A Wessberg
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University
| | - M Alkmark
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital
| | - C Bergh
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital
| | - S Brismar Wendel
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital
| | - H Fadl
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health, Örebro University
| | - M Jonsson
- Department of Women’s and Children’s Health, Uppsala University
| | - L Ladfors
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital
| | - V Sengpiel
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg University
| | - J Wesström
- Center for Clinical Research Dalarna, Uppsala University
| | - G Wennergren
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital
| | - AK Wikström
- Department of Women’s and Children’s Health, Uppsala University
| | - H Elden
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University
| | - O Stephansson
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet
| | - H Hagberg
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital
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Menter T, Tzankov A, Zucca E, Kimby E, Vanazzi A, Østenstad B, Mey U, Rauch D, Wahlin B, Hitz F, Hernberg M, Johansson A, de Nully Brown P, Hagberg H, Hawle H, Hayoz S, Dirnhofer S. PROGNOSTIC IMPLICATIONS OF THE MICROENVIRONMENT IN FOLLICULAR LYMPHOMA UNDER RITUXIMAB AND RITUXIMAB+LENALIDOMIDE THERAPY. A TRANSLATIONAL STUDY OF THE SAKK35/10 TRIAL. Hematol Oncol 2019. [DOI: 10.1002/hon.107_2629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- T. Menter
- Institute of Pathology and Medical Genetics; University Hospital Basel; Basel Switzerland
| | - A. Tzankov
- Institute of Pathology and Medical Genetics; University Hospital Basel; Basel Switzerland
| | - E. Zucca
- Division of Medical Oncology; Oncology Institute of Southern Switzerland; Bellinzona Switzerland
| | - E. Kimby
- Division of Hematology; Department of Medicine at Huddinge, Karolinska Institutet; Stockholm Sweden
| | - A. Vanazzi
- Clinical Haemato-Oncology; Istituto Europeo di Oncologia; Milan Italy
| | - B. Østenstad
- Department of Oncology; Oslo University Hospital; Oslo Norway
| | - U.J. Mey
- Medical Oncology and Hematology; Kantonsspital Graubünden; Chur Switzerland
| | - D. Rauch
- Division of Oncology; Spital Thun Simmenthal; Thun Switzerland
| | - B. Wahlin
- Division of Hematology; Department of Medicine at Huddinge, Karolinska Institutet; Stockholm Sweden
| | - F. Hitz
- Oncology/Hematology; Kantonsspital St.Gallen; St. Gallen Switzerland
| | - M. Hernberg
- Department of Oncology; Comprehensive Cancer Center, Helsinki University Hospital; Helsinki Finland
| | - A. Johansson
- Department of Oncology; Norrlands Universitetssjukhus; Umea Sweden
| | | | - H. Hagberg
- Oncology; Uppsala University Hospital; Uppsala Sweden
| | - H. Hawle
- Coordinating Center; SAKK; Bern Switzerland
| | - S. Hayoz
- Coordinating Center; SAKK; Bern Switzerland
| | - S. Dirnhofer
- Institute of Pathology and Medical Genetics; University Hospital Basel; Basel Switzerland
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Nyman R, Rehn S, Glimelius B, Hagberg H, Hemmingsson A, Jung B, Simonsson B, Sundström C. Magnetic Resonance Imaging in Diffuse Malignant Bone Marrow Diseases. Acta Radiol 2016. [DOI: 10.1177/028418518702800214] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Twenty-four patients with malignant bone marrow involvement or polycythemia vera, 8 patients with reactive bone marrow and 7 healthy individuals were examined with spin-echo magnetic resonance imaging at 0.35 T and 0.5 T. Signs of an increased longitudinal relaxation time, T1, were found when normal bone marrow was replaced by malignant cells, polycythemia vera or reactive marrow. A shortened T1 was indicated in 4 patients in bone marrow regions treated by radiation therapy; the marrow was most likely hypocellular in these cases. The estimated T1 relaxation times were highly correlated to the cellularity of the bone marrow as assessed by histology. Among patients with close to 100 per cent cellularity neither T1 nor T2 discriminated between the various malignancies or between malignant and reactive, non-malignant bone marrow. Characterization of tissues in terms of normalized image intensities was also attempted, the motive being to avoid approximations and uncertainties in the assessment of T1 and T2. The normalization was carried out with respect to the image of highest intensity, i.e. the proton density weighted image. The results were in agreement with those for T1 and T2. It was concluded that MRI is valuable for assesssing bone marrow cellularity, but not for differentiating between various bone marrow disorders having a similar degree of cellularity.
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Nyman R, Rehn S, Glimelius B, Hagberg H, Hemmingsson A, Jung B. Magnetic Resonance Imaging for Assessment of Treatment Effects in Mediastinal Hodgkin's Disease. Acta Radiol 2016. [DOI: 10.1177/028418518702800203] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Six patients with mediastinal involvement of Hodgkin's disease were examined with magnetic resonance imaging (MRI) at 0.35 T before and/or at various stages of therapy, with the sequences TR/TE: 500/35, 500/70, 1600/35 and 1600/70. Before therapy the image intensity of tumour involved lymph nodes deviated considerably from fat and muscle, but no clear difference was discerned between histopathologic subtypes or tumour localizations. After efficient therapy, the tumour image intensities and relaxation rates approached those of muscle and fibrous tissue, but remained at pre-therapy values when the patient was not in full remission. A similar pattern was found in a ‘normal-tissue’—‘tumour’ plot, based on vector analysis of the original sets of 4 images. It is concluded that persistent tumour involvement in the mediastinum may be distinguished from fibrosis and that MRI may thus be of value in the follow-up of patients with Hodgkin's disease.
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Nyman R, Rhen S, Ericsson A, Glimelius B, Hagberg H, Hemmingsson A, Sundström C. An Attempt to Characterize Malignant Lymphoma in Spleen, Liver and Lymph Nodes with Magnetic Resonance Imaging. Acta Radiol 2016. [DOI: 10.1177/028418518702800506] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An attempt was made to explore whether relaxation times and/or normalized image intensities obtained from magnetic resonance imaging (MRI) can separate malignant and non-malignant lymphomatous tissue. Spin-echo (SE) techniques with repetition times of 500 and 1500 ms and echo times of 35 and 70 ms were used for estimating T1 and T2. Estimation of T1 and T2 with such a low number of spin-echo sequences resulted in considerable variation in the data especially when T1 was long. Similar information was also extracted by normalizing the image intensities to the ‘proton density’ image (1500/35), and the spread of the data was then markedly reduced. Therefore, the method of normalizing was considered a more appropriate way of handling the image data when only a few sequences were available. No significant difference could be discerned in the MRI parameters between normal spleens and spleens infiltrated with malignant lymphoma, between normal livers and livers in patients with malignant lymphoma and between lymph nodes with low or high grade non-Hodgkin lymphoma. Lymphomatous tissue had similar MRI characteristics irrespectively of whether the cells were malignant or not, or located in spleens or in lymph nodes. The main biologic explanation for variation in data seems to be mostly the variable amounts of fibrosis, necrosis, oedema and/or iron content.
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Nyman R, Rehn S, Glimelius B, Hagberg H, Hemmingsson A, Lindgren PG, Magnusson A. Magnetic Resonance Imaging, Chest Radiography, Computed Tomography and Ultrasonography in Malignant Lymphoma. Acta Radiol 2016. [DOI: 10.1177/028418518702800306] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Magnetic resonance imaging (MRI) was compared with chest radiography, computed tomography (CT) and ultrasonography (US) for demonstration of spleen and liver engagement and enlarged lymph nodes in patients with malignant lymphoma. The investigation comprised 24 patients with Hodgkin's disease (HD) and 39 with non-Hodgkin lymphoma (NHL). MRI demonstrated enlarged lymph nodes, distinctly separated from vessels, fat, muscle, liver and occasionally also pancreas without any contrast medium. The distinction between lymph nodes and spleen was, however, poor in the images. In the mediastinum, MRI was superior to chest radiography and had an accuracy similar to that of CT. In the abdomen and the pelvis MRI had slight advantages over CT in detection of enlarged lymph nodes. Compared with US the MRI results were similar in the abdomen and somewhat better in the pelvis. MRI and US were better than CT in revealing HD infiltrates in the spleen. Infiltration of NHL in the spleen was slightly better disclosed at US than at CT and MRI; most of the NHL infiltration, confirmed at histopathology, could, however, not be revealed with any of the modalities, except when the size of the spleen was considered. Regions in the spleen, displayed with low image intensity in the T2 weighted image, were most likely due to increased amount of fibrotic tissue in the lymphomatous lesions. Good demonstration of lymph nodes and lymphomatous lesions in the spleen with MRI required two sequences; one with short TR and TE (T1 weighted image) and one with long TR and TE (T2 weighted image).
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Lönnemark M, Hemmingsson A, Bach-Gansmo T, Hagberg H, Magnusson A, Gundersen HG, Nyman R. Superparamagnetic Particles as Oral Contrast Medium in MR Imaging of Malignant Lymphoma. Acta Radiol 2016. [DOI: 10.1177/028418519103200309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Non-biodegradable superparamagnetic particles, in plain and viscous aqueous suspensions, were used as an oral contrast medium in 34 patients with known or suspected malignant lymphoma. The contrast effect, the occurrence of artifacts, and the distribution were evaluated in the plain and the viscous aqueous suspensions, and the diagnostic information received from abdominal MR examinations performed without bowel contrast medium was compared with that of post-contrast examinations. Magnetic particles in the concentration of 0.5 g/l displayed a good contrast effect at 0.5 T, and helped in differentiating the intestine from adjacent tissues, resulting in increased diagnostic information in abdominal MR imaging. In the patients given the viscous aqueous suspension the occurrence of artifacts caused by the magnetic particles decreased considerably, and the distribution was homogeneous and improved compared with that in patients given the plain aqueous suspension.
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Magnusson A, Andersson T, Larsson B, Hagberg H, Sundström C. Contrast Enhancement of Pathologic Lymph Nodes Demonstrated by Computed Tomography. Acta Radiol 2016. [DOI: 10.1177/028418518903000317] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Enlarged mediastinal, retroperitoneal and pelvic lymph nodes are often difficult to differentiate from vascular structures. Contrast medium is therefore used to help to discriminate arteries and veins from lymph nodes. This study was undertaken to investigate the degree to which pathologic lymph nodes become enhanced after an intravenous bolus injection of contrast medium. Computed tomography was performed in 25 patients with enlargement of retroperitoneal lymph nodes due to primary lymphoproliferative disease or metastases. A dynamic sequence of a well delineated lymph node was obtained over a period of two minutes. Contrast enhancement was seen in all lymph nodes, but of varying degree. The enhancement was correlated to that observed in the inferior vena cava. Most examined lymph nodes showed slight or moderate enhancement, but in five instances strong enhancement, more than 75 per cent of that of the vena cava, was found. These nodes could possibly have been misinterpreted as blood vessels.
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Abstract
Gd-DTPA-enhanced MR imaging of 15 patients with primary mediastinal Hodgkin's disease was done before, during and after treatment. A total of 43 MR examinations were performed. After successful treatment, 13 patients had residual masses with reduced signal intensity (SI) ratio in the T2-weighted images. The majority of these also had decreased contrast enhancement as compared with the corresponding primary tumour. There was a significant positive correlation between the contrast enhancement and the SI ratios in the T2-weighted images of the primary tumours and/or the residual masses. Necrosis was seen in 3 of the primary tumours and one patient had a cystic residual mass. These necrotic/cystic lesions were easier to detect with the use of Gd-DTPA. Low SI ratio in the T2-weighted image and low contrast enhancement of the residual mass seem to indicate residual inactivity. Gd-DTPA facilitates the differentiation between cystic/necrotic and solid lesions.
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13
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Hagberg H, Ek C. Targeting the vasculature for cerebroprotection in the immature brain. Exp Neurol 2014; 261:551-2. [DOI: 10.1016/j.expneurol.2014.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 08/05/2014] [Indexed: 11/29/2022]
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14
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Järlestedt K, Naylor AS, Dean J, Hagberg H, Mallard C. Decreased survival of newborn neurons in the dorsal hippocampus after neonatal LPS exposure in mice. Neuroscience 2013; 253:21-8. [PMID: 23994184 PMCID: PMC3824076 DOI: 10.1016/j.neuroscience.2013.08.040] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 08/21/2013] [Accepted: 08/22/2013] [Indexed: 11/29/2022]
Abstract
Neonatal inflammation reduces the survival of dividing neurons and astrocytes. Neonatal inflammation does not affect the survival of post-mitotic cells. Decrease in cell survival was specific for the granule cells of the dorsal blade of the hippocampus.
Experimental studies show that inflammation reduces the regenerative capacity in the adult brain. Less is known about how early postnatal inflammation affects neurogenesis, stem cell proliferation, cell survival and learning and memory in young adulthood. In this study we examined if an early-life inflammatory challenge alters cell proliferation and survival in distinct anatomical regions of the hippocampus and whether learning and memory were affected. Lipopolysaccharide (LPS, 1 mg/kg) was administered to mice on postnatal day (P) 9 and proliferation and survival of hippocampal cells born either prior to (24 h before LPS), or during the inflammatory insult (48 h after LPS) was evaluated. Long-term cell survival of neurons and astrocytes was determined on P 41 and P 60 in the dorsal and ventral horns of the hippocampus. On day 50 the mice were tested in the trace fear conditioning (TFC) paradigm. There was no effect on the survival of neurons and astrocytes that were born before LPS injection. In contrast, the number of neurons and astrocytes that were born after LPS injection were reduced on P 41. The LPS-induced reduction in cell numbers was specific for the dorsal hippocampus. Neither early (48 h after LPS) or late (33 days after LPS) proliferation of cells was affected by neonatal inflammation and neonatal LPS did not alter the behavior of young adult mice in the TFC test. These data highlight that neonatal inflammation specifically affects survival of dividing neurons and astrocytes, but not post-mitotic cells. The reduction in cell survival could be attributed to less cell survival in the dorsal hippocampus, but had no effect on learning and memory in the young adult.
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Affiliation(s)
- K Järlestedt
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Wästerlid T, Brown PN, Hagberg O, Hagberg H, Pedersen LM, D'Amore F, Jerkeman M. Impact of chemotherapy regimen and rituximab in adult Burkitt lymphoma: a retrospective population-based study from the Nordic Lymphoma Group. Ann Oncol 2013; 24:1879-1886. [PMID: 23446093 DOI: 10.1093/annonc/mdt058] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Standard treatment of adult Burkitt lymphoma is not defined due to the lack of randomised trials. In this situation, population-based data may represent a useful contribution in order to identify an optimal treatment strategy. PATIENTS AND METHODS The aims of this study were to investigate the outcome for adult HIV-negative BL with different chemotherapy regimens, and to assess possible improvement within the time frame of the study. The study population was identified through the Swedish and Danish lymphoma registries 2000-2009. RESULTS A total of 258 patients were identified. Since 2000, overall survival (OS) improved significantly only for younger patients (<65 years). Intensive regimens such as the Berlin-Frankfurt-Münster, hyper-fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper-CVAD) and cyclophosphamide, vincristine, doxorubicin, methotrexate, ifosfamide, etoposide, and cytarabine (CODOX-M/IVAC) were associated with a favourable 2-year OS of 82%, 83%, and 69%, respectively. The low-intensive CHOP/CHOEP regimens achieved a 2-year OS of 38.8%, confirming their inadequacy for the treatment of BL. In a multivariate analysis, rituximab was not significantly associated with improved OS. CONCLUSIONS In this population-based retrospective series of adult BL, intensive chemotherapy regimens were associated with favourable outcome. The impact of the addition of rituximab remains uncertain and warrants further investigation.
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Affiliation(s)
- T Wästerlid
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - P N Brown
- Department of Haematology, Rigshospitalet, Copenhagen, Denmark
| | - O Hagberg
- Department of Tumour Epidemiology, Skåne University Hospital, Lund
| | - H Hagberg
- Department of Oncology, Akademiska University Hospital, Uppsala, Sweden
| | - L M Pedersen
- Department of Haematology, Roskilde Hospital, Roskilde
| | - F D'Amore
- Department of Haematology, Århus University Hospital, Århus, Denmark
| | - M Jerkeman
- Department of Oncology, Skåne University Hospital, Lund, Sweden.
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Vontell R, Supramaniam V, Thornton C, Wyatt-Ashmead J, Mallard C, Gressens P, Rutherford M, Hagberg H. Toll-like receptor 3 expression in glia and neurons alters in response to white matter injury in preterm infants. Dev Neurosci 2013; 35:130-9. [PMID: 23548575 PMCID: PMC3826123 DOI: 10.1159/000346158] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 11/20/2012] [Indexed: 12/11/2022] Open
Abstract
Toll-like receptors (TLRs) are members of the pattern recognition receptor family that detect components of foreign pathogens or endogenous molecules released in response to injury. Recent studies demonstrate that TLRs also have a functional role in regulating neuronal proliferation in the developing brain. This study investigated cellular expression of TLR3 using immunohistochemistry on human brain tissue. The tissue sections analysed contained anterior and lateral periventricular white matter from the frontal and parietal lobes in post-mortem neonatal cases with a postmenstrual age range of 23.6-31.4 weeks. In addition to preterm brains without overt pathology (control), preterm pathology cases with evidence of white matter injuries (WMI) were also examined. In order to identify TLR-positive cells, we utilized standard double-labelling immunofluorescence co-labelling techniques and confocal microscopy to compare co-expression of TLR3 with a neuronal marker (NeuN) or with glial markers (GFAP for astrocytes, Iba-1 for microglia and Olig2 for oligodendrocytes). We observed an increase in the neuronal (28 vs. 17%) and astroglial (38 vs. 21%) populations in the WMI group compared to controls in the anterior regions of the periventricular white matter in the frontal lobe. The increase in neurons and astrocytes in the WMI cases was associated with an increase in TLR3 immunoreactivity. This expression was significantly increased in the astroglia. The morphology of the TLR3 signal in the control cases was globular and restricted to the perinuclear region of the neurons and astrocytes, whilst in the cases of WMI, both neuronal, axonal and astroglial TLR3 expression was more diffuse (i.e., a different intracellular distribution) and could be detected along the extensions of the processes. This study demonstrates for the first time that neurons and glial cells in human neonatal periventricular white matter express TLR3 during development. The patterns of TLR3 expression were altered in the presence of WMI, which might influence normal developmental processes within the immature brain. Identifying changes in TLR3 expression during fetal development may be key to understanding the reduced volumes of grey matter and impaired cortical development seen in preterm infants.
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Affiliation(s)
- R Vontell
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, King's College London St. Thomas' Hospital, London, UK
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Tsiartas P, Holst RM, Wennerholm UB, Hagberg H, Hougaard DM, Skogstrand K, Pearce BD, Thorsen P, Kacerovsky M, Jacobsson B. Prediction of spontaneous preterm delivery in women with threatened preterm labour: a prospective cohort study of multiple proteins in maternal serum. BJOG 2012. [DOI: 10.1111/j.1471-0528.2012.03490.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Hardell L, Liljegren G, Lindstrom G, Vanbavel B, Broman K, Fredrikson M, Hagberg H, Nordstrom M, Johansson B. Increased concentrations of chlordane in adipose tissue from non-Hodgkin's lymphoma patients compared with controls without a malignant disease. Int J Oncol 2012; 9:1139-42. [PMID: 21541622 DOI: 10.3892/ijo.9.6.1139] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Chlordane is a pesticide which is lipophilic, bioaccumulates, and may cause immunological impairment in exposed subjects. The aim of this study was to determine the concentrations of chlordane and its metabolites in cases with NHL and surgical controls without a malignant disease. Adipose tissue was obtained from the abdominal wall and analysis was performed using gas chromatograph coupled to mass spectrometer. The study included 27 NHL cases of the B-cell type and 17 controls. Significantly increased concentrations were found in NHL patients versus (vs) controls of trans-nonachlor, mean 98.9 vs 47.0, range 24.9-389 vs 16.3-88.2 ng/g lipid (p = 0.002), cis-nonachlor, mean 17.1 vs 7.4, range 4.1-68.3 vs 1.7-13.6 (p = 0.010), oxy-chlordane, mean 39.7 vs 24.5, range 8.5-144 vs 8.9-49.0, (p = 0.028) nonachlor III, mean 18.4 vs 8.7, range 6.3-67.6 vs 3.0-19.3 (p = 0.002) and sum of chlordanes, 180 vs 92.8, range 48.3-678 vs 37.0-164 ng/g lipid (p = 0.002). For cases with a concentration higher than the median for all subjects significantly increased odds ratios (OR) and 95% confidence intervals (CI) were calculated for trans-nonachlor (OR = 4.1, CI = 1.1-15), nonachlor LII (OR = 6.5, CI = 1.7-25), and sum of chlordanes (OR = 4.1, CI = 1.1-15); median concentrations were 61.2, 11.3, and 119 ng/g lipid, respectively.
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Affiliation(s)
- L Hardell
- OREBRO MED CTR HOSP,DEPT SURG,S-70185 OREBRO,SWEDEN. UMEA UNIV,DEPT ENVIRONM CHEM,S-90187 UMEA,SWEDEN. LINKOPING UNIV HOSP,DEPT ENVIRONM & OCCUPAT MED,S-58185 LINKOPING,SWEDEN. UNIV UPPSALA HOSP,DEPT ONCOL,S-75185 UPPSALA,SWEDEN
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Lehmann A, Hagberg H, Huxtable RJ, Sandberg M. Reduction of brain taurine: Effects on neurotoxic and metabolic actions of kainate. Neurochem Int 2012; 10:265-74. [PMID: 20501095 DOI: 10.1016/0197-0186(87)90099-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/1986] [Accepted: 09/18/1986] [Indexed: 11/28/2022]
Abstract
The effects of chronic administration of 2-guanidinoethane sulfonic acid on the levels of intra- and extracellular amino acids in the rat hippocampus were studied. The tissue content of taurine was selectively reduced by almost one third after 9 days of peroral administration of 1% 2-guanidinoethane sulfonate. Extracellular levels of amino acids were monitored with the brain microdialysis method. The taurine concentration in the extracellular fluid was depressed in relation to the decrease in intracellular taurine. Unexpectedly, extracellular (but not intracellular) glutamate was doubled in 2-guanidinoethane sulfonate treated animals. The kainic acid evoked release of taurine was suppressed in the 2-guanidinoethane sulfonate group, whereas the kainate stimulated efflux of glutamate was elevated after 2-guanidinoethane sulfonate administration. The acute metabolic effects of kainate were studied by measuring the efflux of the adenosine triphosphate breakdown products hypoxanthine, xanthine, inosine and adenosine. No differences were found between control and 2-guanidinoethane sulfonate treated rats with respect to basal or kainic acid evoked release of purine catabolites. Also, the neuronal loss caused by kainate injection into the hippocampus was not modified by 2-guanidinoethane sulfonate treatment, suggesting that endogenous taurine does not affect these responses. We conclude that chronic administration of 2-guanidinoethane sulfonate does not sensitize central neurons to the metabolic and toxic actions of kainate.
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Affiliation(s)
- A Lehmann
- Institute of Neurobiology, University of Göteborg, Göteborg, Sweden; Department of Zoophysiology, University of Göteborg, Göteborg, Sweden
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Tsiartas P, Holst RM, Wennerholm UB, Hagberg H, Hougaard DM, Skogstrand K, Pearce BD, Thorsen P, Kacerovsky M, Jacobsson B. Prediction of spontaneous preterm delivery in women with threatened preterm labour: a prospective cohort study of multiple proteins in maternal serum. BJOG 2012; 119:866-73. [PMID: 22530716 DOI: 10.1111/j.1471-0528.2012.03328.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- P Tsiartas
- Department of Obstetrics and Gynaecology, Papageorgiou University Hospital, Thessaloniki, Greece.
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21
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Chauvier D, Renolleau S, Holifanjaniaina S, Ankri S, Bezault M, Schwendimann L, Rousset C, Casimir R, Hoebeke J, Smirnova M, Debret G, Trichet AP, Carlsson Y, Wang X, Bernard E, Hébert M, Rauzier JM, Matecki S, Lacampagne A, Rustin P, Mariani J, Hagberg H, Gressens P, Charriaut-Marlangue C, Jacotot E. Targeting neonatal ischemic brain injury with a pentapeptide-based irreversible caspase inhibitor. Cell Death Dis 2011; 2:e203. [PMID: 21881605 PMCID: PMC3186905 DOI: 10.1038/cddis.2011.87] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Brain protection of the newborn remains a challenging priority and represents a totally unmet medical need. Pharmacological inhibition of caspases appears as a promising strategy for neuroprotection. In a translational perspective, we have developed a pentapeptide-based group II caspase inhibitor, TRP601/ORPHA133563, which reaches the brain, and inhibits caspases activation, mitochondrial release of cytochrome c, and apoptosis in vivo. Single administration of TRP601 protects newborn rodent brain against excitotoxicity, hypoxia-ischemia, and perinatal arterial stroke with a 6-h therapeutic time window, and has no adverse effects on physiological parameters. Safety pharmacology investigations, and toxicology studies in rodent and canine neonates, suggest that TRP601 is a lead compound for further drug development to treat ischemic brain damage in human newborns.
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Affiliation(s)
- D Chauvier
- Theraptosis Research Laboratory, Theraptosis SA, Pasteur BioTop, Institut Pasteur, Paris 75015, France
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Gisselbrecht C, Glass B, Laurent G, Gill DS, Linch MD, Trneny M, Bron D, Shpilberg O, Hagberg H, Bargetzi M, Ma D, Briere J, Moskowitz C, Schmitz N. Maintenance with rituximab after autologous stem cell transplantation in relapsed patients with CD20 diffuse large B-cell lymphoma (DLBCL): CORAL final analysis. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kaye SB, Colombo N, Monk BJ, Tjulandin S, Kong B, Roy M, Chan S, Filipczyk-Cisarz E, Hagberg H, Vergote I, Lebedinsky C, Parekh T, Santabárbara P, Park YC, Nieto A, Poveda A. Trabectedin plus pegylated liposomal doxorubicin in relapsed ovarian cancer delays third-line chemotherapy and prolongs the platinum-free interval. Ann Oncol 2011; 22:49-58. [PMID: 20643863 PMCID: PMC3003617 DOI: 10.1093/annonc/mdq353] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 05/10/2010] [Accepted: 05/12/2010] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND OVA-301 is a large randomized trial that showed superiority of trabectedin plus pegylated liposomal doxorubicin (PLD; CentoCor Ortho Biotech Products L.P., Raritan, NJ, USA). over single-agent PLD in 672 patients with relapsed ovarian cancer, particularly in the partially platinum-sensitive subgroup [platinum-free interval (PFI) of 6-12 months]. This superiority has been suggested to be due to the differential impact of subsequent (platinum) therapy. PATIENTS AND METHODS a detailed analysis of subsequent therapies and survival outcomes in the overall population and in the subsets according to platinum sensitivity was therefore conducted. RESULTS similar proportions of patients received subsequent therapy in each arm (76% versus 77%), including further platinum-based regimens (49% versus 55%). Patients in the trabectedin/PLD arm received subsequent chemotherapy at a later time (median delay 2.5 months versus PLD arm). Overall survival from subsequent platinum was significantly prolonged in the partially platinum-sensitive disease subset (hazard ratio = 0.63; P = 0.0357). CONCLUSION the superiority of trabectedin/PLD over single-agent PLD in OVA-301 cannot be explained by differences in the extent or nature of subsequent therapies administered to these patients. On the other hand, these exploratory analyses support the hypothesis that the enhanced survival benefits in the partially platinum-sensitive subset might be due to an extended PFI leading to longer survival with subsequent platinum.
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Affiliation(s)
- S B Kaye
- Section of Medicine, Institute of Cancer Research, The Royal Marsden Hospital, Sutton, Surrey, UK.
| | - N Colombo
- Medical Gynecologic Oncology Unit, European Institute of Oncology, Milan, Italy
| | - B J Monk
- Division of Gynecological Oncology, Department of Obstetrics and Gynecology, University of California Irvine Medical Center, Orange, CA, USA
| | - S Tjulandin
- Department of Clinical Pharmacology and Chemotherapy, Russian Cancer Research Center, Moscow, Russia
| | - B Kong
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, Shandong, China
| | - M Roy
- Department of Gynecologic Oncology, University Hospital Center, Quebec, Canada
| | - S Chan
- Department of Clinical Oncology, Nottingham University Hospital, Nottingham, UK
| | | | - H Hagberg
- Department of Oncology, Akademiska Sjukhuset, Uppsala, Sweden
| | - I Vergote
- Division of Gynecological Oncology, Department of Obstetrics and Gynecology, University Hospital, Leuven, Belgium
| | - C Lebedinsky
- Clinical R&D and Medical Affairs Department, Pharma Mar, Madrid, Spain
| | - T Parekh
- Johnson & Johnson Pharmaceutical Research & Development, L.L.C., Raritan, NJ, USA
| | - P Santabárbara
- Clinical R&D and Medical Affairs Department, Pharma Mar, Madrid, Spain
| | - Y C Park
- Johnson & Johnson Pharmaceutical Research & Development, L.L.C., Raritan, NJ, USA
| | - A Nieto
- Clinical R&D and Medical Affairs Department, Pharma Mar, Madrid, Spain
| | - A Poveda
- Department of Medical Oncology, Valencian Institute of Oncology, Valencia, Spain
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Poveda A, Vergote I, Tjulandin S, Kong B, Roy M, Chan S, Filipczyk-Cisarz E, Hagberg H, Kaye SB, Colombo N, Lebedinsky C, Parekh T, Gómez J, Park YC, Alfaro V, Monk BJ. Trabectedin plus pegylated liposomal doxorubicin in relapsed ovarian cancer: outcomes in the partially platinum-sensitive (platinum-free interval 6-12 months) subpopulation of OVA-301 phase III randomized trial. Ann Oncol 2011; 22:39-48. [PMID: 20643862 PMCID: PMC3003616 DOI: 10.1093/annonc/mdq352] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 05/25/2010] [Accepted: 05/25/2010] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND OVA-301 is a large randomized trial that showed superiority of trabectedin plus pegylated liposomal doxorubicin (PLD) over PLD alone in relapsed ovarian cancer. The optimal management of patients with partially platinum-sensitive relapse [6-12 months platinum-free interval (PFI)] is unclear. PATIENTS AND METHODS within OVA-301, we therefore now report on the outcomes for the 214 cases in this subgroup. RESULTS Trabectedin/PLD resulted in a 35% risk reduction of disease progression (DP) or death [hazard ratio (HR) = 0.65, 95% confidence interval (CI), 0.45-0.92; P = 0.0152; median progression-free survival (PFS) 7.4 versus 5.5 months], and a significant 41% decrease in the risk of death (HR = 0.59; 95% CI, 0.43-0.82; P = 0.0015; median survival 23.0 versus 17.1 months). The safety of trabectedin/PLD in this subset mimicked that of the overall population. Similar proportions of patients received subsequent therapy in each arm (76% versus 77%), although patients in the trabectedin/PLD arm had a slightly lower proportion of further platinum (49% versus 55%). Importantly, patients in the trabectedin/PLD arm survived significantly longer after subsequent platinum (HR = 0.63; P = 0.0357; median 13.3 versus 9.8 months). CONCLUSION This hypothesis-generating analysis demonstrates that superior benefits with trabectedin/PLD in terms of PFS and survival in the overall population appear particularly enhanced in patients with partially sensitive disease (PFI 6-12 months).
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Affiliation(s)
- A Poveda
- Area of Gynecologic Oncology, Valencian Institute of Oncology, Valencia, Spain.
| | - I Vergote
- Division of Gynecological Oncology, Department of Obstetrics and Gynecology, University Hospital, Leuven, Belgium
| | - S Tjulandin
- Department of Clinical Pharmacology and Chemotherapy, Russian Cancer Research Center, Moscow, Russia
| | - B Kong
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, Shandong, China
| | - M Roy
- Department of Gynecologic Oncology, University Hospital Center, Quebec, Canada
| | - S Chan
- Department of Clinical Oncology, Nottingham University Hospital, Nottingham, UK
| | | | - H Hagberg
- Department of Oncology, Akademiska Sjukhuset, Uppsala, Sweden
| | - S B Kaye
- Department of Cancer Medicine, The Royal Mardsen Hospital, Sutton, Surrey, UK
| | - N Colombo
- Medical Gynecologic Oncology Unit, European Institute of Oncology, Milan, Italy
| | - C Lebedinsky
- Clinical R&D and Medical Affairs Department, Pharma Mar, Madrid, Spain
| | - T Parekh
- Johnson & Johnson Pharmaceutical Research & Development, L.L.C., Raritan, NJ
| | - J Gómez
- Clinical R&D and Medical Affairs Department, Pharma Mar, Madrid, Spain
| | - Y C Park
- Johnson & Johnson Pharmaceutical Research & Development, L.L.C., Raritan, NJ
| | - V Alfaro
- Clinical R&D and Medical Affairs Department, Pharma Mar, Madrid, Spain
| | - B J Monk
- Division of Gynecological Oncology, Department of Obstetrics and Gynecology, University of California Irvine Medical Center, Orange, CA, USA
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Holst RM, Hagberg H, Wennerholm UB, Skogstrand K, Thorsen P, Jacobsson B. Prediction of microbial invasion of the amniotic cavity in women with preterm labour: analysis of multiple proteins in amniotic and cervical fluids. BJOG 2010; 118:240-9. [DOI: 10.1111/j.1471-0528.2010.02765.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Poveda A, Tjulandin S, Kong B, Roy M, Chan S, Filipczyk-Cisarz E, Hagberg H, Lebedinsky C, Parekh TV, Monk BJ. Extending platinum-free interval (PFI) in partially platinum-sensitive (PPS) patients (pts) with recurrent ovarian cancer (ROC) treated with trabectedin (Tr) plus pegylated liposomal doxorubicin (Tr+PLD) versus PLD alone: Results from a PPS cohort of a phase III study. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Dean J, Farrag D, Zahkouk S, El Zawahry E, Hagberg H, Kjellmer I, Mallard C. Cerebellar white matter injury following systemic endotoxemia in preterm fetal sheep. Neuroscience 2009; 160:606-15. [DOI: 10.1016/j.neuroscience.2009.02.071] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Revised: 02/24/2009] [Accepted: 02/26/2009] [Indexed: 10/21/2022]
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Elden H, Fagevik-Olsen M, Ostgaard HC, Stener-Victorin E, Hagberg H. Acupuncture as an adjunct to standard treatment for pelvic girdle pain in pregnant women: randomised double-blinded controlled trial comparing acupuncture with non-penetrating sham acupuncture. BJOG 2008; 115:1655-68. [PMID: 18947338 DOI: 10.1111/j.1471-0528.2008.01904.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate whether acupuncture has a greater treatment effect than non-penetrating sham acupuncture in women with pelvic girdle pain (PGP) during pregnancy. DESIGN Randomised double-blinded controlled trial. SETTING East Hospital, Gothenburg, and 25 antenatal primary care units in the region of Västra Götaland, Sweden. POPULATION A total of 115 pregnant women with a clinical diagnosis of PGP who scored > or =50 on a 100-mm visual analogue scale (VAS). METHOD Women were randomly allocated to standard treatment plus acupuncture or to standard treatment plus non-penetrating sham acupuncture for 8 weeks. MAIN OUTCOME MEASURES Main outcome measure was pain. Secondary outcomes were frequency of sick leave, functional status, discomfort of PGP, health-related quality of life and recovery of severity of PGP as assessed by the independent examiner. RESULTS After treatment, median pain decreased from 66 to 36 in the acupuncture group and from 69 to 41 in the non-penetrating sham group (P = 0.493) as assessed on a VAS. Women in the acupuncture group were in regular work to a higher extent than women in the sham group (n = 28/57 versus 16/57, P = 0.041). The acupuncture group had superior ability to perform daily activities measured with the disability rating index (DRI) (44 versus 55, P = 0.001). There were no significant differences in quality of life, discomfort of PGP and recovery from severity of PGP between the groups. CONCLUSIONS Acupuncture had no significant effect on pain or on the degree of sick leave compared with non-penetrating sham acupuncture. There was some improvement in performing daily activities according to DRI. The data imply that needle penetration contributes to a limited extent to the previously reported beneficial effects of acupuncture.
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Affiliation(s)
- H Elden
- Perinatal Center, Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, East Hospital, Göteborg, Sweden.
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Jacobsson B, Ahlin K, Francis A, Hagberg G, Hagberg H, Gardosi J. Cerebral palsy and restricted growth status at birth: population-based case-control study. BJOG 2008; 115:1250-5. [PMID: 18715410 DOI: 10.1111/j.1471-0528.2008.01827.x] [Citation(s) in RCA: 195] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the association between growth status at birth and subsequent development of cerebral palsy in preterm and term infants. DESIGN Population-based case-controlled study. SETTING Cerebral palsy register in Western Sweden. Subjects Cohort of 334 singletons born between 1983 and 1990, with cerebral palsy diagnosed from age 4, and 668 singletons matched for gestation, gender and delivery unit. METHOD Growth status at birth was determined using small for gestational age (SGA) categories, with customised birthweight percentiles (SGAcust) based on the Swedish population. MAIN OUTCOME MEASURES Proportion of babies that were SGAcust, comparing cases and controls in three gestational age categories: early preterm (24-33 weeks), late preterm (34-36 weeks) and term (37+ weeks). RESULTS Of the 334 children with cerebral palsy, 87 (26.6%) were born early preterm, 27 (8.1%) late preterm and 218 (66%) at term. Children who had been born at term were more likely to have been SGA <1st customised percentile (SGAcust1) than their matched controls (OR 6.6, 95% CI 2.3-18.6). In contrast, children with cerebral palsy born preterm were not more likely to have been SGAcust1 (OR 0.9, 95% CI 0.4-1.9), and this applied to early preterm as well as late preterm births. For less severely small babies (SGA between 1st and 5th customised percentiles), the association with cerebral palsy remained significant for term births (OR 5.2, 95% CI 2.7-10.1) but was again not significant for preterm births. CONCLUSIONS Term singletons with severely SGA birthweights had a five- to seven-fold risk of developing cerebral palsy compared with gestational age-matched infants with birthweights within normal limits. For children born preterm, SGA was not more likely to be present in cases than in controls. These findings support the concept of cerebral palsy as a multifactorial condition and highlight the importance of antenatal surveillance of fetal growth.
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Affiliation(s)
- B Jacobsson
- Perinatal Center, Department of Obstetrics and Gynaecology, Institute for the Health of Women and Children, Sahlgrenska University Hospital, Sweden
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Elden H, Hagberg H, Olsen MF, Ladfors L, Ostgaard HC. Regression of pelvic girdle pain after delivery: follow-up of a randomised single blind controlled trial with different treatment modalities. Acta Obstet Gynecol Scand 2008; 87:201-8. [PMID: 18231889 DOI: 10.1080/00016340701823959] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE An earlier publication showed that acupuncture and stabilising exercises as an adjunct to standard treatment was effective for pelvic girdle pain during pregnancy, but the post-pregnancy effects of these treatment modalities are unknown. The aim of this follow-up study was to describe regression of pelvic girdle pain after delivery in these women. DESIGN A randomised, single blind, controlled trial. SETTING East Hospital and 27 maternity care centres in Göteborg, Sweden. POPULATION Some 386 pregnant women with pelvic girdle pain. METHODS Participants were randomly assigned to standard treatment plus acupuncture (n=125), standard treatment plus specific stabilising exercises (n=131) or to standard treatment alone (n=130). MAIN OUTCOME MEASURES PRIMARY OUTCOME MEASURES pain intensity (Visual Analogue Scale). SECONDARY OUTCOME MEASURE assessment of the severity of pelvic girdle pain by an independent examiner 12 weeks after delivery. RESULTS Approximately three-quarters of all the women were free of pain 3 weeks after delivery. There were no differences in recovery between the 3 treatment groups. According to the detailed physical examination, pelvic girdle pain had resolved in 99% of the women 12 weeks after delivery. CONCLUSIONS This study shows that irrespective of treatment modality, regression of pelvic girdle pain occurs in the great majority of women within 12 weeks after delivery.
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Affiliation(s)
- H Elden
- Perinatal Center, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Göteborg University, Sweden.
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Abstract
ST waveform analysis of fetal electrocardiogram (ECG) for intrapartum surveillance (STAN) is a newly introduced method for fetal surveillance. The purpose of this commentary is to assist in the proper use of fetal ECG in combination with cardiotocography (CTG) during labour. Guidelines and recommendations concerning CTG and ST waveform interpretation and classification are stated that were agreed on by the European experts on ST waveform analysis for intrapartum surveillance during a meeting in Utretcht, the Netherlands in January 2007.
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Affiliation(s)
- I Amer-Wahlin
- Section of Obstetrics, Department of Obstetrics and Gynaecology, Karolinska University Hospital, Stockholm, Sweden.
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Bertéus Forslund H, Klingström S, Hagberg H, Löndahl M, Torgerson JS, Lindroos AK. Should snacks be recommended in obesity treatment? a 1-year randomized clinical trial. Eur J Clin Nutr 2007; 62:1308-17. [PMID: 17700649 DOI: 10.1038/sj.ejcn.1602860] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To study the effect to recommend no snacks vs three snacks per day on 1-year weight loss. The hypothesis was that it is easier to control energy intake and lose weight if snacks in between meals are omitted. SUBJECTS/METHOD In total 140 patients (36 men, 104 women), aged 18-60 years and body mass index>30 kg/m(2) were randomized and 93 patients (27 men, 66 women) completed the study. A 1-year randomized intervention trial was conducted with two treatment arms with different eating frequencies; 3 meals/day (3M) or 3 meals and 3 snacks/day (3+3M). The patients received regular and individualized counseling by dieticians. Information on eating patterns, dietary intake, weight and metabolic variables was collected at baseline and after 1 year. RESULTS Over 1 year the 3M group reported a decrease in the number of snacks whereas the 3+3M group reported an increase (-1.1 vs +0.4 snacks/day, respectively, P<0.0001). Both groups decreased energy intake and E% (energy percent) fat and increased E% protein and fiber intake but there was no differences between the groups. Both groups lost weight, but there was no significant difference in weight loss after 1 year of treatment (3M vs 3+3M=-4.1+/-6.1 vs -5.9+/-9.4 kg; P=0.31). Changes in metabolic variables did not differ between the groups, except for high-density lipoprotein that increased in the 3M group but not in 3+3M group (P<0.033 for group difference). CONCLUSION Recommending snacks or not between meals does not influence 1-year weight loss.
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Affiliation(s)
- H Bertéus Forslund
- Department of Metabolism and Cardiovascular Research, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
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Northington FJ, Zelaya ME, O'Riordan DP, Blomgren K, Flock DL, Hagberg H, Ferriero DM, Martin LJ. Failure to complete apoptosis following neonatal hypoxia-ischemia manifests as "continuum" phenotype of cell death and occurs with multiple manifestations of mitochondrial dysfunction in rodent forebrain. Neuroscience 2007; 149:822-33. [PMID: 17961929 DOI: 10.1016/j.neuroscience.2007.06.060] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Revised: 06/22/2007] [Accepted: 07/11/2007] [Indexed: 10/23/2022]
Abstract
Controversy surrounds proper classification of neurodegeneration occurring acutely following neonatal hypoxia-ischemia (HI). By ultrastructural classification, in the first 24 h after neonatal hypoxia-ischemia in the 7-day-old (p7) rat, the majority of striatal cells die having both apoptotic and necrotic features. There is formation of a functional apoptosome, and activation of caspases-9 and -3 occurring simultaneously with loss of structurally intact mitochondria to 34.7+/-25% and loss of mitochondrial cytochrome c oxidase activity to 34.7+/-12.7% of control levels by 3 h after hypoxia-ischemia. There is also loss of the mitochondrial motor protein, kinesin. This combination of activation of apoptosis pathways simultaneous with significant mitochondrial dysfunction may cause incomplete packaging of nuclear and cytoplasmic contents and a hybrid of necrotic and apoptotic features. Evidence for an intermediate biochemistry of cell death including expression of the 17 kDa isoform of caspase-3 in dying neurons lacking a classic apoptotic morphology and degradation of the neuronal cytoskeletal protein spectrin by caspase-3 and calcium-activated calpains yielding 120 kDa and 145/150 kDa fragments, respectively, is also found. In summary, neonatal hypoxia-ischemia triggers apoptotic cascades, and simultaneously causes mitochondrial structural and functional failure. The presence of a "continuum" phenotype of cell death that varies on a cell-by-cell basis suggests that the phenotype of cell death is dependent on the energy available to drive the apoptotic pathways to completion.
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Affiliation(s)
- F J Northington
- Department of Pediatrics, CMSC 6-104, The Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287, USA.
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Björkholm M, Hagberg H, Holte H, Kvaloy S, Teerenhovi L, Anderson H, Cavallin-Ståhl E, Myhre J, Pertovaara H, Ost A, Nilsson B, Osby E. Central nervous system occurrence in elderly patients with aggressive lymphoma and a long-term follow-up. Ann Oncol 2007; 18:1085-9. [PMID: 17363838 DOI: 10.1093/annonc/mdm073] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Secondary central nervous system (CNS) involvement by aggressive lymphoma is a well-known and dreadful clinical complication. The incidence and risk factors for CNS manifestation were studied in a large cohort of elderly (>60 years) patients with aggressive lymphoma. PATIENTS AND METHODS In all, 444 previously untreated patients were randomized to receive 3-weekly combination chemotherapy with cyclophosphamide, doxorubicin, vincristine and prednisone or cyclophosphamide, mitoxantrone, vincristine and prednisone (CNOP) (doxorubicin substituted by mitoxantrone) chemotherapy with or without filgrastim. Prophylactic intrathecal methotrexate was given to patients with lymphoma involvement of bone marrow, testis and CNS near sites. RESULTS In all 29 of 444 (6.5%) developed CNS disease after a median observation time of 115 months. CNS was the only site of progression/relapse in 13 patients while part of a systemic disease manifestation in 16 patients. In univariate risk factor analysis, CNS occurrence was associated with extranodal involvement of testis (P = 0.002), advanced clinical stage (P = 0.005) and increased age-adjusted International Prognostic Index score (aaIPI; P = 0.035). In multivariate analysis, initial involvement of testis remained significant and clinical stage was of borderline significance. The median survival time was 2 months after presentation of CNS disease. CONCLUSION A significant proportion of elderly patients with advanced aggressive lymphoma will develop CNS disease. CNS occurrence is related to testis involvement, advanced clinical stage and high aaIPI and the prognosis is dismal.
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Affiliation(s)
- M Björkholm
- Department of Medicine, Karolinska University Hospital, Stockholm, Sweden.
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Hagberg H, Gisselbrecht C. Randomised phase III study of R-ICE versus R-DHAP in relapsed patients with CD20 diffuse large B-cell lymphoma (DLBCL) followed by high-dose therapy and a second randomisation to maintenance treatment with rituximab or not: an update of the CORAL study. Ann Oncol 2006; 17 Suppl 4:iv31-2. [PMID: 16702182 DOI: 10.1093/annonc/mdj996] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The multicentre phase III CORAL study aims to guide choice of salvage chemotherapy in diffuse large B-cell lymphoma (DLBCL) and assess the role of rituximab maintenance after autologous stem cell transplantation (ASCT). Patients are first randomised between ICE (ifosfamide, carboplatin, etoposide) and DHAP (dexamethasone, ara-C and cisplatin), both combined with rituximab (R-ICE or R-DHAP). After three courses, responders are treated by ASCT with BEAM. A second randomisation then allocates patients to maintenance treatment with rituximab 375 mg/m(2), one injection every 2 months six times, or observation. Accrual to the study is now proceeding well and the planned 400 patients are likely to be enrolled within the next 1.5 years. Results to date are very preliminary but suggest encouraging rates of response. However, they also indicate that initial exposure to rituximab may increase the difficulty of salvaging patients who fail first-line therapy.
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MESH Headings
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal, Murine-Derived
- Antigens, CD20/metabolism
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Carboplatin/administration & dosage
- Carmustine/administration & dosage
- Cisplatin/administration & dosage
- Combined Modality Therapy
- Cytarabine/administration & dosage
- Dexamethasone/administration & dosage
- Disease-Free Survival
- Dose-Response Relationship, Drug
- Etoposide/administration & dosage
- Hodgkin Disease/drug therapy
- Hodgkin Disease/pathology
- Humans
- Ifosfamide/administration & dosage
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Melphalan/administration & dosage
- Middle Aged
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/therapy
- Podophyllotoxin/administration & dosage
- Remission Induction
- Rituximab
- Salvage Therapy
- Stem Cell Transplantation
- Survival Rate
- Transplantation, Autologous
- Treatment Outcome
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Affiliation(s)
- H Hagberg
- Department of Oncology, Akademiska Sjukhuset, Uppsala, Sweden.
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Holst RM, Jacobsson B, Hagberg H, Wennerholm UB. Cervical length in women in preterm labor with intact membranes: relationship to intra-amniotic inflammation/microbial invasion, cervical inflammation and preterm delivery. Ultrasound Obstet Gynecol 2006; 28:768-74. [PMID: 17042035 DOI: 10.1002/uog.3837] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Intra-amniotic infection, diagnosed by microbial invasion of the amniotic cavity (MIAC) and/or the presence of intra-amniotic inflammation (IAI), is related to adverse perinatal outcome in women with preterm labor. Due to the subclinical nature of IAI, a correct diagnosis depends on amniocentesis, which is an invasive method not performed as a clinical routine. The aim of this study was to evaluate if cervical length measured by transvaginal sonography could assist in the identification of women at high risk for IAI. METHODS Cervical length was assessed by transvaginal sonography in 87 women with singleton pregnancies in preterm labor (<34 weeks of gestation). Cervical (n=87) and amniotic (n=55) fluids were collected. Polymerase chain reactions for Ureaplasma urealyticum and Mycoplasma hominis, and culture for aerobic and anaerobic bacteria, were performed. Interleukin (IL)-6 and IL-8 were analyzed by enzyme-linked immunosorbent assay. RESULTS IAI was present in 25/55 (45%) of the patients presenting with preterm labor who underwent amniocentesis. Women with IAI had a significantly shorter cervical length (median, 10 (range, 0-34) mm) than had those without IAI (median, 21 (range, 11-43) mm) (P<0.0001). Receiver-operating characteristics curve analysis showed that a cervical length (cut-off of 15 mm) predicted IAI (relative risk, 3.6; CI, 1.9-10.0) with a sensitivity of 72%, specificity of 83%, positive predictive value of 78% and negative predictive value of 78%. Cervical length was also significantly associated with preterm birth up to 7 days from sampling and at <or=34 weeks. CONCLUSION Cervical length assessed by transvaginal sonography predicts IAI as well as preterm birth and could thereby be a useful clinical tool in the management of patients in preterm labor.
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Affiliation(s)
- R-M Holst
- Perinatal Center, Department of Obstetrics and Gynecology, Institute for the Health of Women and Children, Sahlgrenska Academy, Sahlgrenska University Hospital/East, Göteborg, Sweden.
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Zhu C, Wang X, Huang Z, Qiu L, Xu F, Vahsen N, Nilsson M, Eriksson PS, Hagberg H, Culmsee C, Plesnila N, Kroemer G, Blomgren K. Apoptosis-inducing factor is a major contributor to neuronal loss induced by neonatal cerebral hypoxia-ischemia. Cell Death Differ 2006; 14:775-84. [PMID: 17039248 DOI: 10.1038/sj.cdd.4402053] [Citation(s) in RCA: 157] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Nine-day-old harlequin (Hq) mice carrying the hypomorphic apoptosis-inducing factor (AIF)(Hq) mutation expressed 60% less AIF, 18% less respiratory chain complex I and 30% less catalase than their wild-type (Wt) littermates. Compared with Wt, the infarct volume after hypoxia-ischemia (HI) was reduced by 53 and 43% in male (YX(Hq)) and female (X(Hq)X(Hq)) mice, respectively (P<0.001). The Hq mutation did not inhibit HI-induced mitochondrial release of cytochrome c or activation of calpain and caspase-3. The broad-spectrum caspase inhibitor quinoline-Val-Asp(OMe)-CH(2)-PH (Q-VD-OPh) decreased the activation of all detectable caspases after HI, both in Wt and Hq mice. Q-VD-OPh reduced the infarct volume equally in Hq and in Wt mice, and the combination of Hq mutation and Q-VD-OPh treatment showed an additive neuroprotective effect. Oxidative stress leading to nitrosylation and lipid peroxidation was more pronounced in ischemic brain areas from Hq than Wt mice. The antioxidant edaravone decreased oxidative stress in damaged brains, more pronounced in the Hq mice, and further reduced brain injury in Hq but not in Wt mice. Thus, two distinct strategies can enhance the neuroprotection conferred by the Hq mutation, antioxidants, presumably compensating for a defect in AIF-dependent redox detoxification, and caspase inhibitors, presumably interrupting a parallel pathway leading to cellular demise.
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Affiliation(s)
- C Zhu
- Institute of Neuroscience and Physiology, Göteborg University, Göteborg, Sweden.
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Zhu C, Wang X, Xu F, Bahr BA, Shibata M, Uchiyama Y, Hagberg H, Blomgren K. The influence of age on apoptotic and other mechanisms of cell death after cerebral hypoxia-ischemia. Cell Death Differ 2005; 12:162-76. [PMID: 15592434 DOI: 10.1038/sj.cdd.4401545] [Citation(s) in RCA: 310] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Unilateral hypoxia-ischemia (HI) was induced in C57/BL6 male mice on postnatal day (P) 5, 9, 21 and 60, corresponding developmentally to premature, term, juvenile and adult human brains, respectively. HI duration was adjusted to obtain a similar extent of brain injury at all ages. Apoptotic mechanisms (nuclear translocation of apoptosis-inducing factor, cytochrome c release and caspase-3 activation) were several-fold more pronounced in immature than in juvenile and adult brains. Necrosis-related calpain activation was similar at all ages. The CA1 subfield shifted from apoptosis-related neuronal death at P5 and P9 to necrosis-related calpain activation at P21 and P60. Oxidative stress (nitrotyrosine formation) was also similar at all ages. Autophagy, as judged by the autophagosome-related marker LC-3 II, was more pronounced in adult brains. To our knowledge, this is the first report demonstrating developmental regulation of AIF-mediated cell death as well as involvement of autophagy in a model of brain injury.
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Affiliation(s)
- C Zhu
- Department of Physiology, Göteborg University, Göteborg, Sweden.
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Hagberg H, Pettersson M, Bjerner T, Enblad G. Treatment of a Patient with a Nodal Peripheral T-Cell Lymphoma (Angioimmunoblastic T-Cell Lymphoma) with a Human Monoclonal Antibody Against the CD4 Antigen (HuMax-CD4). Med Oncol 2005; 22:191-4. [PMID: 15965283 DOI: 10.1385/mo:22:2:191] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A patient with a CD4+ refractory peripheral T-cell lymphoma (PTL), subtype angioimmunoblastic T-cell lymphoma (AILD), was treated with a human monoclonal anti-CD4 antibody (HuMax-CD4) iv once weekly for 10 wk. Early during treatment all palpable enlarged lymph nodes disappeared. A decline of normal CD4+ T-cells in the blood mirrored the treatment effect. Shortly after stopping treatment the patient relapsed with new enlarged lymph nodes. This time no antitumor effect was seen when HuMax-CD4 treatment was reinstituted. No severe side effects were observed during the antibody treatment. This case report is the first describing that HuMax-CD4 has antilymphoma activity in PTL and is an interesting drug to study further in patients with CD4+ PTL.
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Affiliation(s)
- H Hagberg
- Department of Oncology, Akademiska sjukhuset, Uppsala, Sweden.
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Abstract
An education programme for individuals with Parkinson's disease. People with Parkinson's disease (PD) have to face a lot of ongoing sickness - depending on limitations in daily life and society. Ability for optimal living demands knowledge about the sickness, medications, side-effects and knowledge about the best way to go on living with PD. In this study, 43 persons with PD participated in an outpatient programme based on the structure of connection model. The programme consisted of two weekly 2-h sessions for 5 weeks. Each session consisted of 1 h of dialogue and 1 h of physical performance. The two teachers in the programme were registered nurse and registered physiotherapist. The programme was evaluated with focus on participants' psychosocial situation, mobility and activity in daily living. Participating in the programme gave these individuals an improved psychosocial situation and improved mobility pattern. However, these improvements were not transferred to habitual daily life, which suggests that task-oriented training provides the best solution.
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Affiliation(s)
- H Sunvisson
- Department of Clinical Neuroscience, Occupational Therapy, and Elderly Care Research, Division of Geriatric Medicine, Karolinska Institutet, Sweden.
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Sävman K, Blennow M, Hagberg H, Tarkowski E, Thoresen M, Whitelaw A. Cytokine response in cerebrospinal fluid from preterm infants with posthaemorrhagic ventricular dilatation. Acta Paediatr 2003; 91:1357-63. [PMID: 12578295 DOI: 10.1111/j.1651-2227.2002.tb02834.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Posthaemorrhagic ventricular dilatation (PHVD) is closely associated with white matter damage and neurological disability in the preterm infant. Proinflammatory cytokines have been implicated in the pathogenesis of white matter injury and subsequent cerebral palsy. The aim of this study was to determine the levels of proinflammatory cytokines in cerebrospinal fluid (CSF) from preterm infants with PHVD and to correlate the levels to white matter damage and neurodevelopmental outcome. METHODS CSF samples were obtained from 24 preterm infants with expanding PHVD and 19 preterm infants with normal ultrasound. Tumour necrosis factor-alphaa (TNF-alpha ), interleukin-1beta (IL-1beta), interleukin-8 (IL-8) and interferon-gamma (IFN-gamma) in CSF were measured by enzyme-linked immunosorbent assay, and IL-6 was measured by bioassay. RESULTS The concentrations of TNF-alpha, IL-1beta, IL-6 and IL-8 were significantly elevated in CSF from infants with PHVD. TNF-alpha was detected in 43% of PHVD infants and 11% of controls (p = 0.04). IL-1beta was detected in 67% of PHVD infants and 0% of controls (p < 0.0001). The concentrations of IL-6 were 368 (145-460) pg ml(-1) in the PHVD group and 30 (25-41) pg ml(-1) in the control group (p < 0.0001), and those of IL-8 were 3000 (1620-3400) pg ml(-1) in the PHVD group and 35 (0-230) pg ml(-1) in the control group (p < 0.0001). Cytokine concentrations did not correlate with white matter lesions on ultrasound, shunt dependence or neurological outcome within the PHVD group. CONCLUSION There was an intense and prolonged inflammatory reaction in CSF from preterm infants with PHVD and a high risk for subsequent white matter injury and permanent neurological impairment.
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Affiliation(s)
- K Sävman
- Perinatal Center, Department of Pediatrics, Göteborg University, The Queen Silvia Children's Hospital, SE-416 85 Göteborg, Sweden.
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Jacobsson B, Hagberg G, Hagberg B, Ladfors L, Niklasson A, Hagberg H. Cerebral palsy in preterm infants: a population-based case-control study of antenatal and intrapartal risk factors. Acta Paediatr 2003; 91:946-51. [PMID: 12222720 DOI: 10.1080/080352502760148685] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
UNLABELLED Previous studies have indicated that foetomaternal infection increases the risk of spastic cerebral palsy (CP) in term infants, whereas this association appears to be less evident in preterm infants. The aim of this study was to analyse infection-related risk factors for spastic CP in preterm infants. A population-based series of preterm infants with spastic CP, 91 very preterm (<32 wk) and 57 moderately preterm (32-36 wk), born in 1983-90, were included and matched with a control group (n = 296). In total, 154 maternal, antenatal and intrapartal variables were retrieved from obstetric records. In the entire group, histological chorioamnionitis/pyelonephritis, long interval between rupture of membranes and birth, admission-delivery interval <4 h and Apgar scores of <7 at 1 min just significantly increased the risk of CP, and Apgar scores of <7 at 5 and 10 min were strongly associated with an increased risk. Abruptio placentae, Apgar scores <7 at 1 min and pathological non-stress test (reason for delivery) were significant risk factors of CP only in the moderately preterm and hemiplegic groups, whereas fever before delivery was a significant risk factor in the very preterm and spastic diplegic groups. Antibiotics during pregnancy was associated with CP only in the spastic diplegic CP group. CONCLUSION Antenatal infections marginally increased the risk of CP. Low Apgar score and abruptio placentae were associated with CP, especially in moderately preterm infants with hemiplegic CP.
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Affiliation(s)
- B Jacobsson
- Perinatal Center, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Göteborg, Sweden.
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Osby E, Taube A, Cavallin-Ståhl E, Hagberg H, Björkholm M. Reproducibility of tumor response evaluation in patients with high-grade malignant non-Hodgkin's lymphoma. Med Oncol 2002; 18:137-40. [PMID: 11778759 DOI: 10.1385/mo:18:2:137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2000] [Accepted: 06/13/2000] [Indexed: 11/11/2022]
Abstract
Estimation of complete response (CR) and partial response (PR) in patients with non-Hodgkin's lymphoma (NHL) is associated with a number of potential sources of error. The aim of this study was to define the reproducibility of response evaluation performed by an independent review committee (RC). In a phase III study of patients >60 yr with aggressive NHL, 60 patients who were already evaluated by the independent review committee (RC 1) for response were randomized to three groups and re-evaluated (RC 2). The assessment was classified into one of seven mutually exclusive categories, where the important borderlines with regard to one of the major end-points of the study, the CR rate, were between CR, "CR uncertain" (CR(U)), and PR. A discrepancy between RC 1 and 2 was found in 8/60 patients (13.3%), influencing the CR/CR(U) status in four of these patients. Two CR and two PR patients were reclassified as CR(U). Thus, CR/CR(U) was changed in 4/60 (6.7%). The reports of the local investigators were compared with that of RC 1 in 254 patients. The CR/CR(U) status was affected in 41 of these patients (16.1%). It is concluded that an independent RC is a major prerequisite for a uniform response evaluation in phase III clinical trials. However, the good RC reproducibility does not motivate a second assessment. Moreover, in the phase III setting end-points other than the CR rate, such as time to treatment failure, cause specific and overall survival are preferred.
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Affiliation(s)
- E Osby
- Department of Medicine, Division of Hematology, Karolinska Hospital and Institute, Stockholm, Sweden
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Abstract
The aim of this study was to evaluate the involvement of mitochondrial membrane permeability transition (MPT) after hypoxia-ischemia (HI) in 7-day-old rats. [14C]2-deoxyglucose (DOG) was administered to controls, and at various time points after HI. MPT in the cerebral cortex was measured as entrapment of DOG-6-P in mitochondria. Another group of rats was treated with the MPT inhibitor cyclosporin A (CsA; 10-50 mg/kg i.p.) or vehicle before and after HI, and the effect on brain injury and mitochondrial respiration was evaluated. A significant increase in DOG-6-P entrapment in mitochondria indicated that MPT occurred in two phases: a primary MPT after 0-1.5 h and a secondary MPT after 6.5-8 h of reperfusion. However, CsA did not affect brain injury or mitochondrial respiration. The data suggest that MPT occurred after HI but does not provide evidence for its involvement in the development of injury.
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Affiliation(s)
- M Puka-Sundvall
- Department of Anatomy and Cell Biology, Perinatal Center, Göteborg University, Sweden.
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Jacobsson B, Holst RM, Bokstrom H, Andersch B, Mattsby-Baltzer I, Wennerholm UB, Hagberg H. 212 Relationship between amniotic IL-18 and preterm delivery in patients with preterm labor and preterm prelabor rupture of the membranes. Am J Obstet Gynecol 2001. [DOI: 10.1016/s0002-9378(01)80247-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
The introduction of first alpha-interferon and later the purine analogues has revolutionized the treatment of hairy cell leukaemia (HCL). However, there are still some patients that initially or eventually fail to respond and, thus, there is a need for alternative treatment modalities. We have treated 11 HCL patients (eight relapsing and three newly diagnosed) with a chimaeric monoclonal antibody, rituximab, in a dose of 375 mg/m2 once a week for 4 weeks. The response rate was seven out of eleven (64%) with six complete remissions and one partial remission, all which have lasted between 0 and 34 months (median 14 months). Rituximab appears promising in the treatment of HCL and warrants further studies.
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Affiliation(s)
- H Hagberg
- Department of Oncology, Akademiska sjukhuset, Uppsala, Sweden.
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Abstract
We examined if the adenosine A(1) receptor agonist adenosine amine congener (ADAC, 100 microg/kg i.p.) is neuroprotective in 7-day-old rats subjected to hypoxic ischemia. Brain damage, evaluated as weight deficit and gross morphology, was not affected by ADAC treatment. Nonetheless, ADAC (100 microg/kg i.p.) reduced heart rate by 44% (p<0.0001), indicating that the dose given was pharmacologically active. Adenosine A(1) receptors were determined by [(3)H] 1,3-dipropyl-8-cyclopentylxanthine (DPCPX)-binding and levels were 23% of the adult levels. GTP did not affect [(3)H] DPCPX-binding in the cerebral cortex at postnatal day 7 whereas there was strong enhancement of [(3)H] DPCPX-binding in the heart. This suggested a poor G-protein coupling at postnatal day 7 in the brain, which also was confirmed using GTP [gamma-(35)S]-binding in the presence of an adenosine A(1) receptor agonist. Thus, the lack of a neuroprotective effect of ADAC may be explained by the fact that adenosine A(1) receptors are not part of a functional unit in the 7-day-old rat brain.
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Affiliation(s)
- U Adén
- Department of Physiology and Pharmacology, Karolinska Institutet, S-171 77 Stockholm, Sweden.
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Amer-Wåhlin I, Hellsten C, Norén H, Hagberg H, Herbst A, Kjellmer I, Lilja H, Lindoff C, Månsson M, Mårtensson L, Olofsson P, Sundström A, Marsál K. Cardiotocography only versus cardiotocography plus ST analysis of fetal electrocardiogram for intrapartum fetal monitoring: a Swedish randomised controlled trial. Lancet 2001; 358:534-8. [PMID: 11520523 DOI: 10.1016/s0140-6736(01)05703-8] [Citation(s) in RCA: 240] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Previous studies indicate that analysis of the ST waveform of the fetal electrocardiogram provides information on the fetal response to hypoxia. We did a multicentre randomised controlled trial to test the hypothesis that intrapartum monitoring with cardiotocography combined with automatic ST-waveform analysis results in an improved perinatal outcome compared with cardiotocography alone. METHODS At three Swedish labour wards, 4966 women with term fetuses in the cephalic presentation entered the trial during labour after a clinical decision had been made to apply a fetal scalp electrode for internal cardiotocography. They were randomly assigned monitoring with cardiotocography plus ST analysis (CTG+ST group) or cardiotocography only (CTG group). The main outcome measure was rate of umbilical-artery metabolic acidosis (pH <7.05 and base deficit >12 mmol/L). Secondary outcomes included operative delivery for fetal distress. Results were first analysed according to intention to treat, and secondly after exclusion of cases with severe malformations or with inadequate monitoring. FINDINGS The CTG+ST group showed significantly lower rates of umbilical-artery metabolic acidosis than the cardiotocography group (15 of 2159 [0.7%] vs 31 of 2079 [2%], relative risk 0.47 [95% CI 0.25-0.86], p=0.02) and of operative delivery for fetal distress (193 of 2519 [8%] vs 227 of 2447 [9%], 0.83 [0.69-0.99], p=0.047) when all cases were included according to intention to treat. The differences were more pronounced after exclusion of 291 in the CTG+ST group and 283 in the CTG group with malformations or inadequate recording. INTERPRETATION Intrapartum monitoring with cardiotocography combined with automatic ST-waveform analysis increases the ability of obstetricians to identify fetal hypoxia and to intervene more appropriately, resulting in an improved perinatal outcome.
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Affiliation(s)
- I Amer-Wåhlin
- Department of Obstetrics and Gynaecology, University Hospital Lund, Lund, Sweden
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Abstract
Caspase-3 is a major effector protease in several apoptotic pathways, but its role in hypoxic-ischemic (HI) brain injury is incompletely understood. Cerebral HI was induced in 7-day-old rats by unilateral carotid artery ligation and exposure to 7.7% oxygen for 55 min. Caspase-3-like activity was significantly increased at 1 h (208%), peaked at 24 h (2,563%) and was still increased 6 days after HI (169%) in the ipsilateral cerebral cortex. Concomitantly, cleavage of the caspase-3 proform (31/33 kD) was detected on immunoblots, producing 29- and 17-kD fragments. Furthermore, significant degradation of the endogenous caspase-3 substrates inhibitor of caspase-activated DNase (DNA fragmentation factor 45), poly(ADP-ribose) polymerase and fodrin occurred. In conclusion, caspase-3 is activated extensively in the immature brain after HI. The subsequent cleavage of proteins involved in cellular homeostasis and repair may contribute to the process of brain injury.
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Affiliation(s)
- X Wang
- Perinatal Center, Department of Physiology, Göteborg University, Göteborg, Sweden
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