1
|
Nilsson K, Klevebro F, Sunde B, Rouvelas I, Lindblad M, Szabo E, Halldestam I, Smedh U, Wallner B, Johansson J, Johnsen G, Aahlin EK, Johannessen HO, Alexandersson von Döbeln G, Hjortland GO, Wang N, Shang Y, Borg D, Quaas A, Bartella I, Bruns C, Schröder W, Nilsson M. Oncological outcomes of standard versus prolonged time to surgery after neoadjuvant chemoradiotherapy for oesophageal cancer in the multicentre, randomised, controlled NeoRes II trial. Ann Oncol 2023; 34:1015-1024. [PMID: 37657554 DOI: 10.1016/j.annonc.2023.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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] [Received: 06/01/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND The optimal time to surgery (TTS) after neoadjuvant chemoradiotherapy (nCRT) for oesophageal cancer is unknown and has traditionally been 4-6 weeks in clinical practice. Observational studies have suggested better outcomes, especially in terms of histological response, after prolonged delay of up to 3 months after nCRT. The NeoRes II trial is the first randomised trial to compare standard to prolonged TTS after nCRT for oesophageal cancer. PATIENTS AND METHODS Patients with resectable, locally advanced oesophageal cancer were randomly assigned to standard delay of surgery of 4-6 weeks or prolonged delay of 10-12 weeks after nCRT. The primary endpoint was complete histological response of the primary tumour in patients with adenocarcinoma (AC). Secondary endpoints included histological tumour response, resection margins, overall and progression-free survival in all patients and stratified by histologic type. RESULTS Between February 2015 and March 2019, 249 patients from 10 participating centres in Sweden, Norway and Germany were randomised: 125 to standard and 124 to prolonged TTS. There was no significant difference in complete histological response between AC patients allocated to standard (21%) compared to prolonged (26%) TTS (P = 0.429). Tumour regression, resection margins and number of resected lymph nodes, total and metastatic, did not differ between the allocated interventions. The first quartile overall survival in patients allocated to standard TTS was 26.5 months compared to 14.2 months after prolonged TTS (P = 0.003) and the overall risk of death during follow-up was 35% higher after prolonged delay (hazard ratio 1.35, 95% confidence interval 0.94-1.95, P = 0.107). CONCLUSION Prolonged TTS did not improve histological complete response or other pathological endpoints, while there was a strong trend towards worse survival, suggesting caution in routinely delaying surgery for >6 weeks after nCRT.
Collapse
Affiliation(s)
- K Nilsson
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm; Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm
| | - F Klevebro
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm; Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm
| | - B Sunde
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm; Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm
| | - I Rouvelas
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm; Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm
| | - M Lindblad
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm; Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm
| | - E Szabo
- Department of Surgery, Faculty of Medicine and Health, Örebro University Hospital, Örebro
| | | | - U Smedh
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg
| | - B Wallner
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå
| | - J Johansson
- Department of Surgery, Skåne University Hospital, Lund, Sweden
| | - G Johnsen
- Department of Gastrointestinal Surgery, St. Olav's Hospital, Trondheim University Hospital, Trondheim
| | - E K Aahlin
- Department of GI and HPB Surgery, University Hospital of Northern Norway, Tromsø
| | - H-O Johannessen
- Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
| | - G Alexandersson von Döbeln
- Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm; Medical Unit of Head, Neck, Lung and Skin Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - G O Hjortland
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - N Wang
- Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm
| | - Y Shang
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm
| | - D Borg
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - A Quaas
- Institute of Pathology, University of Cologne, Cologne
| | - I Bartella
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany
| | - C Bruns
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany
| | - W Schröder
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany
| | - M Nilsson
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm; Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm.
| |
Collapse
|
2
|
Uchai S, Andersen LF, Johansson J, Hopstock LA, Hjartåker A. Dual-Energy X-Ray Absorptiometry Derived Adiposity Measures and Pre-Frailty/Frailty among Norwegian Adults: The Tromsø Study 2007-2015. J Nutr Health Aging 2023; 27:403-410. [PMID: 37357322 DOI: 10.1007/s12603-023-1920-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 02/07/2023] [Accepted: 04/06/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVES Aging is associated with changes in body composition. Excess adiposity among older adults has been linked with metabolic syndromes and aggravated age-associated decline in physical functioning. Few longitudinal studies have explored the association between dual-energy X-ray absorptiometry (DXA)-derived total as well as central adiposity measures and frailty. We examined the association of DXA-derived total and central adiposity with pre-frailty/frailty among Norwegian adults after 8 years of follow-up. DESIGN Prospective observational study. SETTING Community-dwelling adults from Tromsø, Norway. MEASUREMENTS Adiposity was defined by fat mass index (FMI) and visceral adipose tissue (VAT) mass assessed using DXA measures. Frailty status was assessed by low grip strength, slow walking speed, exhaustion, unintentional weight loss and low physical activity level. Pre-frail and frail participants at baseline were excluded. Sex-stratified multivariable logistic regression models were used to investigate the association. RESULTS Participants comprised 234 women (mean age 68 years) and 146 men (mean age 69 years) attending the population-based Tromsø Study in 2007-2008 (Tromsø6) and 2015-2016 (Tromsø7). At the end of follow-up, 25.6% of the women and 27.4% of the men were pre-frail/frail. Compared with women in the lowest tertiles, those in the highest tertile of baseline FMI (odds ratio [OR] 4.42, 95% confidence interval [CI] 1.88-10.35) and VAT mass (OR 2.47, 95% CI 1.10-5.50), respectively had higher odds for pre-frailty/frailty at follow-up. CONCLUSION We found a higher likelihood of pre-frailty/frailty in later years among women with general and central adiposity in adulthood, highlighting the importance of preventing excess adiposity for healthy aging.
Collapse
Affiliation(s)
- S Uchai
- Shreeshti Uchai, Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Norway, Postbox: 1046, Blindern, 0317 Oslo, Norway
| | | | | | | | | |
Collapse
|
3
|
Fu L, Gilham D, Stotz S, Sarsons C, Rakai B, Tsujikawa L, Wasiak S, Johansson J, Sweeney M, Wong N, Kulikowski E. Apabetalone, a BET inhibitor, attenuates inflammation induced by viral RNA mimetic and reduces SARS-CoV-2 spike protein binding regardless of variants. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Hyperinflammatory responses to SARS-CoV-2 can cause myocarditis and cardiac dysfunction including congestive heart failure [1]. SARS-CoV-2 RNA induces type I interferon (IFN-I), activating IFN regulatory factors (IRFs) and downstream IFN stimulated genes (ISGs) to initiate inflammatory processes. SARS-CoV-2 variants may develop immune escape, undercutting benefits of vaccinations. These challenges highlight the need of variant-independent therapies to improve COVID-19 outcomes. Apabetalone is an epigenetic BD2-selective BET inhibitor in phase 3 trials for cardiovascular disease [2]. Apabetalone has the potential to treat COVID-19. It counters inflammatory signals caused by cytokine storm (CS), preventing cardiac dysfunction associated with severe COVID-19 symptoms in cardiac organoids [3]. It also downregulates angiotensin-converting enzyme 2 (ACE2) expression, the main host cell receptor for SARS-CoV-2 spike protein thus impeding propagation of wild-type SARS-CoV-2 [3,4].
Purpose
1) Evaluate apabetalone's effect on inflammatory processes induced by viral-RNA mimetic in human lung cells; 2) Assess apabetalone's ability to prevent binding of the highly contagious delta variant spike protein to human lung cells.
Methods
Inflammatory gene expression was examined by real-time PCR in apabetalone treated human bronchial epithelial cells (Calu-3) stimulated with poly I:C, a well-accepted viral RNA mimetic that elicits inflammatory signals similar to SARS-CoV-2 RNA [5]. Binding of SARS-CoV-2 delta or wild-type spike protein to apabetalone treated Calu-3 cells was determined by flow cytometry.
Results
In Calu-3 cells, apabetalone dose-dependently downregulated poly I:C induced transcription of key COVID-19 associated cytokines (IL6, CXCL10, CCL2) to a similar extent as baricitinib (up to 86%, p<0.0001), an anti-inflammatory agent in emergency use for COVID-19 treatment. Moreover, apabetalone but not baricitinib diminished IL1B mRNA levels (up to 66%, p<0.0001). Apabetalone and baricitinib opposed poly I:C induced expression of IFNB1 (an IFN-I), IRF1 and IRF9 (upstream regulators) as well as IFIT1 and IFIT2 (downstream ISGs that regulate CXCL10 expression; up to 90%, p<0.0001). Clinically relevant doses of apabetalone did not alter expression of anti-viral IFITM2, an ISG that blocks SARS-CoV-2, particularly omicron, endosomal entry [6]. Therefore, apabetalone counters the expression of inflammatory factors with roles in CS and IFN-I signaling in response to poly I:C. Additionally, apabetalone reduced delta and wild-type spike protein binding to unstimulated Calu-3 cells (up to 72%, p<0.0001).
Conclusions
Apabetalone's dual anti-viral and anti-inflammatory mechanism positions it as a variant-independent COVID-19 therapeutic. Together with an established safety profile from >2000 treatment-years with apabetalone, the data provide rationale for an ongoing clinical trial (NCT04894266) which includes analysis of cardiac damage.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Resverlogix Corp
Collapse
Affiliation(s)
- L Fu
- Resverlogix Corp. , Calgary , Canada
| | - D Gilham
- Resverlogix Corp. , Calgary , Canada
| | - S Stotz
- Resverlogix Corp. , Calgary , Canada
| | - C Sarsons
- Resverlogix Corp. , Calgary , Canada
| | - B Rakai
- Resverlogix Corp. , Calgary , Canada
| | | | - S Wasiak
- Resverlogix Corp. , Calgary , Canada
| | | | - M Sweeney
- Resverlogix Corp. , Calgary , Canada
| | - N Wong
- Resverlogix Corp. , Calgary , Canada
| | | |
Collapse
|
4
|
Leshchenko ED, Johansson J. Interfacial profile of axial nanowire heterostructures in the nucleation limited regime. CrystEngComm 2022. [DOI: 10.1039/d2ce01337a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We report thermodynamic modeling of the formation of axial III–V nanowire heterostructures grown by the self-catalyzed and Au-catalyzed vapor–liquid–solid methods.
Collapse
Affiliation(s)
- E. D. Leshchenko
- Solid State Physics and NanoLund, Lund University, P O Box 118, SE-221 00 Lund, Sweden
| | - J. Johansson
- Solid State Physics and NanoLund, Lund University, P O Box 118, SE-221 00 Lund, Sweden
| |
Collapse
|
5
|
Linder G, Klevebro F, Edholm D, Johansson J, Lindblad M, Hedberg J. Burden of in-hospital care in oesophageal cancer: national population-based study. BJS Open 2021; 5:6271348. [PMID: 33960365 PMCID: PMC8103496 DOI: 10.1093/bjsopen/zrab037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/07/2021] [Accepted: 03/11/2021] [Indexed: 12/19/2022] Open
Abstract
Background Oesophageal cancer management requires extensive in-hospital care. This cohort study aimed to quantify in-hospital care for patients with oesophageal cancer in relation to intended treatment, and to analyse factors associated with risk of spending a large proportion of survival time in hospital. Methods All patients with oesophageal cancer in three nationwide registers over a 10-year period were included. In-hospital care during the first year after diagnosis was evaluated, and the proportion of survival time spent in hospital, stratified by intended treatment (curative, palliative or best supportive care), was calculated. Associations between relevant factors and a greater proportion of survival time in hospital were analysed by multivariable logistic regression. Results In-hospital care was provided for a median of 39, 26, and 15 days in the first year after diagnosis of oesophageal cancer in curative, palliative, and best supportive care groups respectively. Patients receiving curatively intended treatment spent a median of 12 per cent of their survival time in hospital during the first year after diagnosis, whereas those receiving palliative or best supportive care spent 19 and 23 per cent respectively. Factors associated with more in-hospital care included older age, female sex, being unmarried, and chronic obstructive pulmonary disease. Conclusion The burden of in-hospital care during the first year after diagnosis of oesophageal cancer was substantial. Important clinical and socioeconomic factors were identified that predisposed to a greater proportion of survival time spent in hospital.
Collapse
Affiliation(s)
- G Linder
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - F Klevebro
- Department of Clinical Science, Intervention and Technology, Centre for Upper Gastrointestinal Cancer, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - D Edholm
- Department of Surgery, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - J Johansson
- Department of Surgery, Lund University, Lund, Sweden
| | - M Lindblad
- Department of Clinical Science, Intervention and Technology, Centre for Upper Gastrointestinal Cancer, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - J Hedberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
6
|
Pickering KA, Gilroy K, Cassidy JW, Fey SK, Najumudeen AK, Zeiger LB, Vincent DF, Gay DM, Johansson J, Fordham RP, Miller B, Clark W, Hedley A, Unal EB, Kiel C, McGhee E, Machesky LM, Nixon C, Johnsson AE, Bain M, Strathdee D, van Hoof SR, Medema JP, Anderson KI, Brachmann SM, Stucke VM, Malliri A, Drysdale M, Turner M, Serrano L, Myant K, Campbell AD, Sansom OJ. A RAC-GEF network critical for early intestinal tumourigenesis. Nat Commun 2021; 12:56. [PMID: 33397922 PMCID: PMC7782582 DOI: 10.1038/s41467-020-20255-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 11/17/2020] [Indexed: 01/29/2023] Open
Abstract
RAC1 activity is critical for intestinal homeostasis, and is required for hyperproliferation driven by loss of the tumour suppressor gene Apc in the murine intestine. To avoid the impact of direct targeting upon homeostasis, we reasoned that indirect targeting of RAC1 via RAC-GEFs might be effective. Transcriptional profiling of Apc deficient intestinal tissue identified Vav3 and Tiam1 as key targets. Deletion of these indicated that while TIAM1 deficiency could suppress Apc-driven hyperproliferation, it had no impact upon tumourigenesis, while VAV3 deficiency had no effect. Intriguingly, deletion of either gene resulted in upregulation of Vav2, with subsequent targeting of all three (Vav2-/- Vav3-/- Tiam1-/-), profoundly suppressing hyperproliferation, tumourigenesis and RAC1 activity, without impacting normal homeostasis. Critically, the observed RAC-GEF dependency was negated by oncogenic KRAS mutation. Together, these data demonstrate that while targeting RAC-GEF molecules may have therapeutic impact at early stages, this benefit may be lost in late stage disease.
Collapse
Affiliation(s)
- K A Pickering
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK
| | - K Gilroy
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK
| | - J W Cassidy
- CRUK Cambridge Institute, University of Cambridge, Robinson Way, Cambridge, CB2 ORE, UK
| | - S K Fey
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK
- Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Glasgow, G61 1QH, UK
| | - A K Najumudeen
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK
| | - L B Zeiger
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK
- Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Glasgow, G61 1QH, UK
| | - D F Vincent
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK
| | - D M Gay
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK
| | - J Johansson
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK
| | - R P Fordham
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK
| | - B Miller
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK
| | - W Clark
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK
| | - A Hedley
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK
| | - E B Unal
- EMBL/CRG Systems Biology Research Unit, Centre for Genomic Regulation (CRC), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), 08003, Barcelona, Spain
- Institute for Theoretical Biology, Humboldt Universität zu Berlin, Berlin, Germany
| | - C Kiel
- EMBL/CRG Systems Biology Research Unit, Centre for Genomic Regulation (CRC), Barcelona, Spain
| | - E McGhee
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK
| | - L M Machesky
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK
- Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Glasgow, G61 1QH, UK
| | - C Nixon
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK
| | - A E Johnsson
- The Babraham Institute, Babraham Hall, Babraham, Cambridge, CB22 3AT, UK
| | - M Bain
- IBAHCM and School of Veterinary Medicine, 464 Bearsden Road, Bearsden, Glasgow, G61 1QH, UK
| | - D Strathdee
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK
| | - S R van Hoof
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental Molecular Medicine (CEMM) and Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
- Oncode Institute, Academic Medical Center, Amsterdam, The Netherlands
| | - J P Medema
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental Molecular Medicine (CEMM) and Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
- Oncode Institute, Academic Medical Center, Amsterdam, The Netherlands
| | - K I Anderson
- The Francis Crick Institute, Mill Hill Laboratory, London, NW7 1AA, UK
| | - S M Brachmann
- Novartis Institutes for BioMedical Research, Klybeckstrasse, 141, 4002, Basel, Switzerland
| | - V M Stucke
- Novartis Institutes for BioMedical Research, Klybeckstrasse, 141, 4002, Basel, Switzerland
| | - A Malliri
- CRUK Manchester Institute, 553 Wilmslow Road, Manchester, M20 4BX, UK
| | - M Drysdale
- Broad Institute, 415 Main St, Cambridge, MA, 02142, United States
| | - M Turner
- The Babraham Institute, Babraham Hall, Babraham, Cambridge, CB22 3AT, UK
| | - L Serrano
- EMBL/CRG Systems Biology Research Unit, Centre for Genomic Regulation (CRC), Barcelona, Spain
| | - K Myant
- Edinburgh Research Centre, The Institute of Genetics and Molecular Medicine, Crewe Road South, Edinburgh, EH4 2XR, UK.
| | - A D Campbell
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK.
| | - O J Sansom
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK.
- Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Glasgow, G61 1QH, UK.
| |
Collapse
|
7
|
Kung CH, Jestin Hannan C, Linder G, Johansson J, Nilsson M, Hedberg J, Lindblad M. Impact of surgical resection rate on survival in gastric cancer: nationwide study. BJS Open 2020; 5:6043682. [PMID: 33688944 PMCID: PMC7944854 DOI: 10.1093/bjsopen/zraa017] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 07/19/2020] [Accepted: 09/07/2020] [Indexed: 12/24/2022] Open
Abstract
Background There are marked geographical variations in the proportion of patients undergoing resection for gastric cancer. This study investigated the impact of resection rate on survival. Methods All patients with potentially curable gastric cancer between 2006 and 2017 were identified from the Swedish National Register of Oesophageal and Gastric Cancer. The annual resection rate was calculated for each county per year. Resection rates in all counties for all years were grouped into tertiles and classified as low, intermediate or high. Survival was analysed using the Cox proportional hazards model. Results A total of 3465 patients were diagnosed with potentially curable gastric cancer, and 1934 (55.8 per cent) were resected. Resection rates in the low (1261 patients), intermediate (1141) and high (1063) tertiles were 0–50.0, 50.1–62.5 and 62.6–100 per cent respectively. The multivariable Cox analysis revealed better survival for patients diagnosed in counties during years with an intermediate versus low resection rate (hazard ratio (HR) 0.81, 95 per cent c.i. 0.74 to 0.90; P < 0.001) and high versus low resection rate (HR 0.80, 0.73 to 0.88; P < 0.001). Conclusion This national register study showed large regional variation in resection rates for gastric cancer. A higher resection rate appeared to be beneficial with regard to overall survival for the entire population.
Collapse
Affiliation(s)
- C-H Kung
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Skellefteå County Hospital, Skellefteå, Sweden
| | - C Jestin Hannan
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - G Linder
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - J Johansson
- Department of Surgery, Lund University, Lund, Sweden
| | - M Nilsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Digestive Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - J Hedberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - M Lindblad
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Digestive Surgery, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
8
|
Pellevoisin C, Cottrez F, Johansson J, Pedersen E, Coleman K, Groux H. Pre-validation of SENS-IS assay for in vitro skin sensitization of medical devices. Toxicol In Vitro 2020; 71:105068. [PMID: 33301901 DOI: 10.1016/j.tiv.2020.105068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 11/23/2020] [Accepted: 12/06/2020] [Indexed: 11/25/2022]
Abstract
According to ISO 10993-1:2018, the skin sensitization potential of all medical devices must be evaluated, and for this endpoint ISO 10993-10:2010 recommends the use of in vivo assays. The goal of the present study was to determine if the in vitro SENS-IS assay could be a suitable alternative to the current in vivo assays. The SENS-IS assay uses the Episkin Large and SkinEthic RHE reconstructed human epidermis models to evaluate marker genes. In our study, the SENS-IS assay correctly identified 13 sensitizers spiked in a non-polar solvent. In a subsequent analysis six medical device silicone samples previously impregnated with sensitizers were extracted with polar and non-polar solvents. The SENS-IS assay correctly identified five of these extracts, while a sixth extract, which contained the weak sensitizer phenyl benzoate, was classified as negative. However, when this extract was concentrated, or a longer exposure time was used, the assay was able to detect phenyl benzoate. The SENS-IS assay was transferred to a naïve laboratory which correctly identified sensitizers in six blinded silicone samples, including the one containing phenyl benzoate. In light of these results, we conclude that the SENS-IS assay is able to correctly identify the presence of sensitizers in medical devices extracts.
Collapse
Affiliation(s)
| | - F Cottrez
- ImmunoSearch, Les Cyclades, Chemin de Camperousse, Grasse, France
| | - J Johansson
- RISE Research Institutes of Sweden AB, Borås, Sweden
| | - E Pedersen
- RISE Research Institutes of Sweden AB, Borås, Sweden
| | | | - H Groux
- ImmunoSearch, Les Cyclades, Chemin de Camperousse, Grasse, France
| |
Collapse
|
9
|
Johansson J, Berthold Lindstedt M, Borg K. Vision therapy as part of neurorehabilitation after acquired brain injury - a clinical study in an outpatient setting. Brain Inj 2020; 35:82-89. [PMID: 33297770 DOI: 10.1080/02699052.2020.1858495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Oculomotor (OM) functions may be affected by acquired brain injury (ABI). The ability to benefit from rehabilitation or to perform daily activities may be affected by OM dysfunctions and associated symptoms. The purpose of this study was to investigate the effects of vision therapy (VT) as part of neurorehabilitation after ABI.Materials and Methods: The study included two groups of outpatients (median 49.5-52.0 years, range 27-67) admitted to neurorehabilitation due to moderate to severe ABI. One group received VT while the other group served as controls to monitor the course of OM dysfunctions without VT.Results: The intervention group showed significant improvements in convergence (Z = 2.26, p = .02), vergence facility (Z = -2.16, p = .03) and vergence reserves (Z = -2.44, p < .01 and t = -4.47, DF = 15, p < .01) along with a significant reduction in vision-related symptoms (Z = 2.97, p < .01).Discussion: We conclude that OM issues were frequent and that targeted VT, as part of neurorehabilitation, can be an efficient treatment resulting in improved functions and reduced symptoms. Further study will be required to understand how improved functions link to performance and satisfaction with everyday activities.
Collapse
Affiliation(s)
- J Johansson
- Department of Clinical Neuroscience, Eye and Vision, Karolinska Institute, Stockholm, Sweden
| | - M Berthold Lindstedt
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden.,Department of Clinical Sciences, Division of Rehabilitation Medicine, Karolinska Institute, Stockholm, Sweden
| | - K Borg
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden.,Department of Clinical Sciences, Division of Rehabilitation Medicine, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
10
|
Jestin Hannan C, Linder G, Kung CH, Johansson J, Lindblad M, Hedberg J. Geographical differences in cancer treatment and survival for patients with oesophageal and gastro-oesophageal junctional cancers. Br J Surg 2020; 107:1500-1509. [PMID: 32484241 DOI: 10.1002/bjs.11671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/31/2020] [Accepted: 04/14/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Only around one-quarter of patients with cancer of the oesophagus and the gastro-oesophageal junction (GOJ) undergo surgical resection. This population-based study investigated the rates of treatment with curative intent and resection, and their association with survival. METHODS Patients diagnosed with oesophageal and GOJ cancer between 2006 and 2015 in Sweden were identified from the National Register for Oesophageal and Gastric Cancer (NREV). The NREV was cross-linked with several national registries to obtain information on additional exposures. The annual proportion of patients undergoing treatment with curative intent and surgical resection in each county was calculated, and the counties divided into groups with low, intermediate and high rates. Treatment with curative intent was defined as definitive chemoradiation therapy or surgery, with or without neoadjuvant oncological treatment. Overall survival was analysed using a multilevel model based on county of residence at the time of diagnosis. RESULTS Some 5959 patients were included, of whom 1503 (25·2 per cent) underwent surgery. Median overall survival after diagnosis was 7·7, 8·8 and 11·1 months respectively in counties with low, intermediate and high rates of treatment with curative intent. Corresponding survival times for the surgical resection groups were 7·4, 9·3 and 11·0 months. In the multivariable analysis, a higher rate of treatment with curative intent (time ratio 1·17, 95 per cent c.i. 1·05 to 1·30; P < 0·001) and a higher resection rate (time ratio 1·24, 1·12 to 1·37; P < 0·001) were associated with improved survival after adjustment for relevant confounders. CONCLUSION Patients diagnosed in counties with higher rates of treatment with curative intent and higher rates of surgery had better survival.
Collapse
Affiliation(s)
- C Jestin Hannan
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - G Linder
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - C-H Kung
- Department of Clinical Science, Intervention and Technology Karolinska Institutet, Stockholm, Sweden.,Departments of Surgery, Skellefteå County Hospital, Skellefteå, Sweden
| | | | - M Lindblad
- Department of Clinical Science, Intervention and Technology Karolinska Institutet, Stockholm, Sweden
| | - J Hedberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
11
|
Galan-Acosta L, Sierra C, Leppert A, Pouliopoulos AN, Kwon N, Noel RL, Tambaro S, Presto J, Nilsson P, Konofagou EE, Johansson J. Recombinant BRICHOS chaperone domains delivered to mouse brain parenchyma by focused ultrasound and microbubbles are internalized by hippocampal and cortical neurons. Mol Cell Neurosci 2020; 105:103498. [PMID: 32389804 DOI: 10.1016/j.mcn.2020.103498] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 11/06/2019] [Revised: 04/30/2020] [Accepted: 05/02/2020] [Indexed: 02/08/2023] Open
Abstract
The BRICHOS domain is found in human precursor proteins associated with cancer, dementia (Bri2) and amyloid lung disease (proSP-C). Recombinant human (rh) proSP-C and Bri2 BRICHOS domains delay amyloid-β peptide (Aβ) fibril formation and reduce associated toxicity in vitro and their overexpression reduces Aβ neurotoxicity in animal models of Alzheimer's disease. After intravenous administration in wild-type mice, rh Bri2, but not proSP-C, BRICHOS was detected in the brain parenchyma, suggesting that Bri2 BRICHOS selectively bypasses the blood-brain barrier (BBB). Here, our objective was to increase the brain delivery of rh proSP-C (trimer of 18 kDa subunits) and Bri2 BRICHOS (monomer to oligomer of 15 kDa subunits) using focused ultrasound combined with intravenous microbubbles (FUS + MB), which enables targeted and transient opening of the BBB. FUS + MB was targeted to one hemisphere of wild type mice and BBB opening in the hippocampal region was confirmed by magnetic resonance imaging. Two hours after FUS + MB brain histology showed no signs of tissue damage and immunohistochemistry showed abundant delivery to the brain parenchyma in 13 out of 16 cases given 10 mg/kg of proSP-C or Bri2 BRICHOS domains. The Bri2, but not proSP-C BRICHOS domain was detected also in the non-targeted hemisphere. ProSP-C and Bri2 BRICHOS domains were taken up by a subset of neurons in the hippocampus and cortex, and were detected to a minor extent in early endosomes. These results indicate that rh Bri2, but not proSP-C, BRICHOS, can be efficiently delivered into the mouse brain parenchyma and that both BRICHOS domains can be internalized by cell-specific mechanisms.
Collapse
Affiliation(s)
- L Galan-Acosta
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Neurogeriatrics, Karolinska Institutet, 141 83 Huddinge, Sweden
| | - C Sierra
- Ultrasound and Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, NY, New York, USA
| | - A Leppert
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Neurogeriatrics, Karolinska Institutet, 141 83 Huddinge, Sweden
| | - A N Pouliopoulos
- Ultrasound and Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, NY, New York, USA
| | - N Kwon
- Ultrasound and Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, NY, New York, USA
| | - R L Noel
- Ultrasound and Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, NY, New York, USA
| | - S Tambaro
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Neurogeriatrics, Karolinska Institutet, 141 83 Huddinge, Sweden
| | - J Presto
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Neurogeriatrics, Karolinska Institutet, 141 83 Huddinge, Sweden
| | - P Nilsson
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Neurogeriatrics, Karolinska Institutet, 141 83 Huddinge, Sweden
| | - E E Konofagou
- Ultrasound and Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, NY, New York, USA; Department of Radiology, Columbia University, NY, New York, USA
| | - J Johansson
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Neurogeriatrics, Karolinska Institutet, 141 83 Huddinge, Sweden.
| |
Collapse
|
12
|
Kung CH, Tsai JA, Lundell L, Johansson J, Nilsson M, Lindblad M. Nationwide study of the impact of D2 lymphadenectomy on survival after gastric cancer surgery. BJS Open 2020; 4:424-431. [PMID: 32129948 PMCID: PMC7260415 DOI: 10.1002/bjs5.50270] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Received: 12/10/2019] [Accepted: 02/03/2020] [Indexed: 12/13/2022] Open
Abstract
Background Gastrectomy including D2 lymphadenectomy is regarded as the standard curative treatment for advanced gastric cancer in Asia. This procedure has also been adopted gradually in the West, despite lack of support from RCTs. This study sought to investigate any advantage for long‐term survival following D2 lymphadenectomy in routine gastric cancer surgery in a Western nationwide population‐based cohort. Methods All patients who had a gastrectomy for cancer in Sweden in 2006–2017 were included in the study. Prospectively determined data items were retrieved from the National Register of Oesophageal and Gastric Cancer. Extent of lymphadenectomy was categorized as D1+/D2 or the less extensive D0/D1 according to the Japanese Gastric Cancer Association classification. Overall survival was analysed and, in addition, a variety of possible confounders were introduced into the Cox proportional hazards regression model. Results A total of 1677 patients underwent gastrectomy, of whom 471 (28·1 per cent) were classified as having a D1+/D2 and 1206 (71·9 per cent) a D0/D1 procedure. D1+/D2 lymphadenectomy was not associated with higher 30‐ or 90‐day postoperative mortality. Median overall survival for D1+/D2 lymphadenectomy was 41·5 months with a 5‐year survival rate of 43·7 per cent, compared with 38·5 months and 38·5 per cent respectively for D0/D1 (P = 0·116). After adjustment for confounders, in multivariable analysis survival was significantly higher after D1+/D2 than following D0/D1 lymphadenectomy (hazard ratio 0·81, 95 per cent c.i. 0·68 to 0·95; P = 0·012). Conclusion This national registry study showed that long‐term survival after gastric cancer surgery was improved after gastrectomy involving D1+/D2 lymphadenectomy compared with D0/D1 dissection.
Collapse
Affiliation(s)
- C-H Kung
- Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Skellefteå County Hospital, Skellefteå, Sweden
| | - J A Tsai
- Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institutet, Stockholm, Sweden
| | - L Lundell
- Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Odense University Hospital, Odense, Denmark
| | - J Johansson
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Surgery, Skåne University Hospital, Lund, Sweden
| | - M Nilsson
- Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Digestive Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - M Lindblad
- Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Digestive Surgery, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
13
|
Logothetis A, Pantelis E, Zoros E, Pappas EP, Dimitriadis A, Paddick I, Garding J, Johansson J, Kollias G, Karaiskos P. Dosimetric evaluation of the Leksell GammaPlan ™ Convolution dose calculation algorithm. Phys Med Biol 2020; 65:045011. [PMID: 31860889 DOI: 10.1088/1361-6560/ab64b7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The dosimetric accuracy of the Leksell GammaPlan Convolution calculation algorithm was evaluated through comparison with corresponding Monte Carlo (MC) dosimetric results. MC simulations were based on generated sector phase space files for the 4 mm, 8 mm and 16 mm collimator sizes, using a previous comprehensive Gamma Knife Perfexion™ source model and validated using film dosimetry. Test cases were designed for the evaluation of the Convolution algorithm involving irradiation of homogeneous and inhomogeneous phantom geometries mimicking clinical cases, with radiation fields created using one sector (single sector), all sectors with the same (single shot) or different (composite shot) collimator sizes. Dose calculations using the Convolution algorithm were found to be in excellent agreement (gamma pass rate greater than 98%, applying 1%/1 mm local dose difference and distance agreement criteria), with corresponding MC calculations, indicating the accuracy of the Convolution algorithm in homogeneous and heterogeneous model geometries. While of minor clinical importance, large deviations were observed for the voxels laying inside air media. The calculated beam on times using the Convolution algorithm were found to increase (up to 7%) relative to the TMR 10 algorithm currently used in clinical practice, especially in a test case mimicking a brain metastasis close to the skull, in excellent agreement with corresponding MC calculations.
Collapse
Affiliation(s)
- A Logothetis
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Zebialowicz Ahlström J, Massaro F, Mikolka P, Feinstein R, Perchiazzi G, Basabe-Burgos O, Curstedt T, Larsson A, Johansson J, Rising A. Synthetic surfactant with a recombinant surfactant protein C analogue improves lung function and attenuates inflammation in a model of acute respiratory distress syndrome in adult rabbits. Respir Res 2019; 20:245. [PMID: 31694668 PMCID: PMC6836435 DOI: 10.1186/s12931-019-1220-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 06/22/2019] [Accepted: 10/17/2019] [Indexed: 02/06/2023] Open
Abstract
AIM In acute respiratory distress syndrome (ARDS) damaged alveolar epithelium, leakage of plasma proteins into the alveolar space and inactivation of pulmonary surfactant lead to respiratory dysfunction. Lung function could potentially be restored with exogenous surfactant therapy, but clinical trials have so far been disappointing. These negative results may be explained by inactivation and/or too low doses of the administered surfactant. Surfactant based on a recombinant surfactant protein C analogue (rSP-C33Leu) is easy to produce and in this study we compared its effects on lung function and inflammation with a commercial surfactant preparation in an adult rabbit model of ARDS. METHODS ARDS was induced in adult New Zealand rabbits by mild lung-lavages followed by injurious ventilation (VT 20 m/kg body weight) until P/F ratio < 26.7 kPa. The animals were treated with two intratracheal boluses of 2.5 mL/kg of 2% rSP-C33Leu in DPPC/egg PC/POPG, 50:40:10 or poractant alfa (Curosurf®), both surfactants containing 80 mg phospholipids/mL, or air as control. The animals were subsequently ventilated (VT 8-9 m/kg body weight) for an additional 3 h and lung function parameters were recorded. Histological appearance of the lungs, degree of lung oedema and levels of the cytokines TNFα IL-6 and IL-8 in lung homogenates were evaluated. RESULTS Both surfactant preparations improved lung function vs. the control group and also reduced inflammation scores, production of pro-inflammatory cytokines, and formation of lung oedema to similar degrees. Poractant alfa improved compliance at 1 h, P/F ratio and PaO2 at 1.5 h compared to rSP-C33Leu surfactant. CONCLUSION This study indicates that treatment of experimental ARDS with synthetic lung surfactant based on rSP-C33Leu improves lung function and attenuates inflammation.
Collapse
Affiliation(s)
- J Zebialowicz Ahlström
- Division for Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - F Massaro
- Anesthesia and Intesive Care, Villa Anthea Hospital, Bari, Italy
| | - P Mikolka
- Division for Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Biomedical Center Martin and Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - R Feinstein
- Department of Pathology, The Swedish National Veterinary Institute, Uppsala, Sweden
| | - G Perchiazzi
- Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - O Basabe-Burgos
- Division for Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - T Curstedt
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - A Larsson
- Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - J Johansson
- Division for Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - A Rising
- Division for Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden. .,Department of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, Uppsala, Sweden.
| |
Collapse
|
15
|
Klevebro F, Nilsson K, Lindblad M, Ekman S, Johansson J, Lundell L, Ndegwa N, Hedberg J, Nilsson M. Association between time interval from neoadjuvant chemoradiotherapy to surgery and complete histological tumor response in esophageal and gastroesophageal junction cancer: a national cohort study. Dis Esophagus 2019; 33:5610874. [PMID: 31676895 PMCID: PMC7203996 DOI: 10.1093/dote/doz078] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/24/2019] [Accepted: 08/04/2019] [Indexed: 12/11/2022]
Abstract
The optimal time interval from neoadjuvant therapy to surgery in the treatment of esophageal cancer is not known. The aim of this study was to investigate if a prolonged interval between completed neoadjuvant chemoradiotherapy and surgery was associated with improved histological response rates and survival in a population-based national register cohort. The population-based cohort study included patients treated with neoadjuvant chemoradiotherapy and esophagectomy due to cancer in the esophagus or gastroesophageal junction. Patients were divided into two groups based on the median time from completed neoadjuvant treatment to surgery. The primary outcome was complete histological response. Secondary outcomes were lymph node tumor response, postoperative complications, R0 resection rate, 90-day mortality, and overall survival. In total, 643 patients were included, 344 (54%) patients underwent surgery within 49 days, and 299 (47%) after 50 days or longer. The groups were similar concerning baseline characteristics except for a higher clinical tumor stage (P = 0.009) in the prolonged time to surgery group. There were no significant differences in complete histological response, R0 resection rate, postoperative complications, 90-day mortality, or overall survival. Adjusted odds ratio for ypT0 in the prolonged time to surgery group was 0.99 (95% confidence interval: 0.64-1.53). Complete histological response in the primary tumor (ypT0) was associated with significantly higher overall survival: adjusted hazard ratio: 0.55 (95% CI 0.41-0.76). If lymph node metastases were present in these patients, the survival was, however, significantly lower: adjusted hazard ratio for ypT0N1: 2.30 (95% CI 1.21-4.35). In this prospectively collected, nationwide cohort study of esophageal and junctional type 1 and 2 cancer patients, there were no associations between time to surgery and histological complete response, postoperative outcomes, or overall survival. The results suggest that it is safe for patients to postpone surgery at least 7 to 10 weeks after completed chemoradiotherapy, but no evidence was seen in favor of recommending a prolonged time to surgery after neoadjuvant chemoradiotherapy for esophageal cancer. A definitive answer to this question requires a randomized controlled trial of standard vs. prolonged time to surgery.
Collapse
Affiliation(s)
- F Klevebro
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institute, and Esophageal and Gastric Cancer Unit, Karolinska University Hospital, Stockholm, Sweden,Address correspondence to: Dr. Fredrik Klevebro, Karolinska University Hospital Huddinge, K42 14186 Stockholm, Sweden. E-mail:
| | - K Nilsson
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institute, and Esophageal and Gastric Cancer Unit, Karolinska University Hospital, Stockholm, Sweden
| | - M Lindblad
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institute, and Esophageal and Gastric Cancer Unit, Karolinska University Hospital, Stockholm, Sweden
| | - S Ekman
- Department of Oncology, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | - J Johansson
- Department of Surgery, Skåne University Hospital, Lund University, Sweden
| | - L Lundell
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institute, and Esophageal and Gastric Cancer Unit, Karolinska University Hospital, Stockholm, Sweden
| | - N Ndegwa
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institute, and Esophageal and Gastric Cancer Unit, Karolinska University Hospital, Stockholm, Sweden,Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - J Hedberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - M Nilsson
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institute, and Esophageal and Gastric Cancer Unit, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
16
|
Jeremiasen M, Linder G, Hedberg J, Lundell L, Björ O, Lindblad M, Johansson J. Improvements in esophageal and gastric cancer care in Sweden-population-based results 2007-2016 from a national quality register. Dis Esophagus 2019; 33:5585604. [PMID: 31608927 PMCID: PMC7672200 DOI: 10.1093/dote/doz070] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 05/23/2019] [Accepted: 06/29/2019] [Indexed: 12/11/2022]
Abstract
The Swedish National Register for Esophageal and Gastric cancer was launched in 2006 and contains data with adequate national coverage and of high internal validity on patients diagnosed with these tumors. The aim of this study was to describe the evolution of esophageal and gastric cancer care as reflected in a population-based clinical registry. The study population was 12,242 patients (6,926 with esophageal and gastroesophageal junction (GEJ) cancers and 5,316 with gastric cancers) diagnosed between 2007 and 2016. Treatment strategies, short- and long-term mortality, gender aspects, and centralization were investigated. Neoadjuvant oncological treatment became increasingly prevalent during the study period. Resection rates for both esophageal/GEJ and gastric cancers decreased from 29.4% to 26.0% (P = 0.022) and from 38.8% to 33.3% (P = 0.002), respectively. A marked reduction in the number of hospitals performing esophageal and gastric cancer surgery was noted. In gastric cancer patients, an improvement in 30-day mortality from 4.2% to 1.6% (P = 0.005) was evident. Overall 5-year survival after esophageal resection was 38.9%, being higher among women compared to men (47.5 vs. 36.6%; P < 0.001), whereas no gender difference was seen in gastric cancer. During the recent decade, the analyses based on the Swedish National Register for Esophageal and Gastric cancer database demonstrated significant improvements in several important quality indicators of care for patients with esophagogastric cancers. The Swedish National Register for Esophageal and Gastric cancer offers an instrument not only for the control and endorsement of quality of care but also a unique tool for population-based clinical research.
Collapse
Affiliation(s)
- M Jeremiasen
- Department of Clinical Sciences, Surgery, Lund University, Skane University Hospital, Lund, Sweden,Address correspondence to: Martin Jeremiasen, MD, Department of Surgery, Lund University, Skåne University Hospital, S-221 85 Lund, Sweden.
| | - G Linder
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - J Hedberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - L Lundell
- Division of Surgery, Department of Clinical Science, Intervention and Technology Karolinska Institutet (CLINTEC), Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden,Department of Surgery, Odense University Hospital, Odense, Denmark
| | - O Björ
- Department of Radiation Science, Oncology, Umea University, Umea, Sweden
| | - M Lindblad
- Division of Surgery, Department of Clinical Science, Intervention and Technology Karolinska Institutet (CLINTEC), Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - J Johansson
- Department of Clinical Sciences, Surgery, Lund University, Skane University Hospital, Lund, Sweden
| |
Collapse
|
17
|
Ray KK, Nicholls SJ, Sweeney M, Johansson J, Wong N, Kulikowski E, Toth P, Ginsberg H, Kalantar-Zadeh K, Schwartz GG. P4608BET-inhibition with Apabetalone in Post-ACS Patients with Diabetes: Design and Baseline Characteristics of the BETonMACE trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Diabetes (DM) is associated with increased risk of macro/microvascular disease and cognitive decline. Inflammation and vascular calcification may be contributing factors. Bromodomain and extraterminal (BET) proteins coordinate gene transcription and modify the transcriptional response to hyperglycemia, and inflammation. Apabetalone competitively and selectively inhibits binding between BET proteins and acetyl-lysine marks on histone tails: normalizing transcriptional profiles to physiological levels; reducing in vitro alkaline phosphatase (ALP) transcription and in vivo plasma ALP in a dose-dependent manner. Phase 2 trials with apabetalone show improved renal function in the chronic kidney disease (CKD) subgroups. Furthermore, treatment showed a 55% reduction in CVD events with more pronounced benefit among patients with DM, low HDL-cholesterol (HDL-C) and high sensitivity C-reactive protein (hsCRP).
Methods
The double-blind, placebo controlled phase 3 BETonMACE trial is testing the hypothesis that apabetalone 100 mg b.i.d., added to standard care, reduces major adverse cardiovascular events (MACE: CV death, non-fatal myocardial infarction or stroke) in patients with DM, acute coronary syndrome (ACS) within the preceding 7–90 days, low HDL-C (<40 mg/dL in men; <45 mg/dL in women), and estimated glomerular filtration rate (eGFR) >30 mL/min/1.7m2. The trial will continue until at least 250 MACE, providing 80% power to detect a 30% reduction. Secondary endpoints include changes in eGFR in patients with baseline eGFR 30 to <60 mL/min/1.7m2, inflammatory markers, lipids, and ALP. In addition the Montreal Cognition Assessment (MoCA) test was performed in patients ≥70 years of age at baseline and annually.
Results
Enrollment of 2425 patients across 13 countries and 195 centers is now complete. Baseline characteristics [median (IQR)] include LDL-C 65.0 (36) mg/dL, HDL-C 33.0 (7) mg/dL, HbA1c 7.3 (2.3) %, hsCRP 2.8 (4.9) mg/L, mean blood pressure 129/76 mmHg, and CKD in 266 patients (10.8%). Background care was based on guideline recommendations. Diabetes medications include metformin (79%), insulin (36%), sulfonylureas (28%), DPP4 inhibitors (11%), SGLT2 inhibitors (9.7%) and GLP1 receptor agonists (0.3%). The CKD subpopulation vs. total population differed significantly from the whole population with regard to age (71 vs. 62 y. o.), male sex (58% vs. 75%), history of hypertension (46% vs. 88%), history of stroke (1.5% vs. 7.5%), and current smokers (6.1% vs. 13%). In the 70 year and older (n=466, 19%) population 54% (n=243) showed a baseline MoCA score 25 and lower suggesting cognitive impairment.
Summary
The BETonMACE trial is testing the hypothesis that selective BET-inhibition with apabetalone, added to established, evidence-based treatment, reduces MACE in high-risk patients with DM, recent ACS, and low HDL-C. The study will also assess apabetalone's effect on renal function and cognition.
Collapse
Affiliation(s)
- K K Ray
- Imperial College London, London, United Kingdom
| | - S J Nicholls
- Monash University, Monash Cardiovascular Research Centre, Melbourne, Australia
| | - M Sweeney
- Resverlogix Inc., San Francisco, United States of America
| | - J Johansson
- Resverlogix Inc., San Francisco, United States of America
| | - N Wong
- Resverlogix Inc., San Francisco, United States of America
| | - E Kulikowski
- Resverlogix Inc., San Francisco, United States of America
| | - P Toth
- Johns Hopkins University of Baltimore, Baltimore, United States of America
| | - H Ginsberg
- Columbia University, New York, United States of America
| | - K Kalantar-Zadeh
- University of California at Irvine, Irvine, United States of America
| | - G G Schwartz
- University of Colorado School of Medicine, Cardiology, Aurora, United States of America
| |
Collapse
|
18
|
Borg D, Sundberg J, Brun E, Kjellén E, Petersson K, Hermansson M, Johansson J, Eberhard J, Johnsson A. PALAESTRA: A phase II trial with short-course radiotherapy followed by chemotherapy as palliative treatment in esophageal adenocarcinoma. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.097] [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: 11/15/2022] Open
|
19
|
Tsujikawa L, Kulikowski E, Rakai B, Fu L, Das S, Halliday C, Sarsons C, Daze E, Wasiak S, Gilham D, Johansson J, Sweeney M, Wong CW N. Apabetalone (Rvx-208) Attenuates Inflammatory Milieu Underlying Adhesion Of Monocytes To Endothelial Cells In Type 2 Diabetes Mellitus With Cardiovascular Disease Patients. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.775] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
20
|
Johansson J, Curstedt T. Synthetic surfactants with SP-B and SP-C analogues to enable worldwide treatment of neonatal respiratory distress syndrome and other lung diseases. J Intern Med 2019; 285:165-186. [PMID: 30357986 DOI: 10.1111/joim.12845] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Treatment of neonatal respiratory distress syndrome (RDS) using animal-derived lung surfactant preparations has reduced the mortality of handling premature infants with RDS to a 50th of that in the 1960s. The supply of animal-derived lung surfactants is limited and only a part of the preterm babies is treated. Thus, there is a need to develop well-defined synthetic replicas based on key components of natural surfactant. A synthetic product that equals natural-derived surfactants would enable cost-efficient production and could also facilitate the development of the treatments of other lung diseases than neonatal RDS. Recently the first synthetic surfactant that contains analogues of the two hydrophobic surfactant proteins B (SP-B) and SP-C entered clinical trials for the treatment of neonatal RDS. The development of functional synthetic analogues of SP-B and SP-C, however, is considerably more challenging than anticipated 30 years ago when the first structural information of the native proteins became available. For SP-B, a complex three-dimensional dimeric structure stabilized by several disulphides has necessitated the design of miniaturized analogues. The main challenge for SP-C has been the pronounced amyloid aggregation propensity of its transmembrane region. The development of a functional non-aggregating SP-C analogue that can be produced synthetically was achieved by designing the amyloidogenic native sequence so that it spontaneously forms a stable transmembrane α-helix.
Collapse
Affiliation(s)
- J Johansson
- Department of Neurobiology, Care Sciences and Society, Section for Neurogeriatrics, Karolinska Institutet, Huddinge, Sweden
| | - T Curstedt
- Laboratory for Surfactant Research, Department of Molecular Medicine and Surgery, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
21
|
Martikainen IK, Kemppainen N, Johansson J, Teuho J, Helin S, Liu Y, Helisalmi S, Soininen H, Parkkola R, Ngandu T, Kivipelto M, Rinne JO. Brain β-Amyloid and Atrophy in Individuals at Increased Risk of Cognitive Decline. AJNR Am J Neuroradiol 2018; 40:80-85. [PMID: 30545837 DOI: 10.3174/ajnr.a5891] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 10/12/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE The relationship between brain β-amyloid and regional atrophy is still incompletely understood in elderly individuals at risk of dementia. Here, we studied the associations between brain β-amyloid load and regional GM and WM volumes in older adults who were clinically evaluated as being at increased risk of cognitive decline based on cardiovascular risk factors. MATERIALS AND METHODS Forty subjects (63-81 years of age) were recruited as part of a larger study, the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability. Neuroimaging consisted of PET using 11C Pittsburgh compound-B and T1-weighted 3D MR imaging for the measurement of brain β-amyloid and GM and WM volumes, respectively. All subjects underwent clinical, genetic, and neuropsychological evaluations for the assessment of cognitive function and the identification of cardiovascular risk factors. RESULTS Sixteen subjects were visually evaluated as showing cortical β-amyloid (positive for β-amyloid). In the voxel-by-voxel analyses, no significant differences were found in GM and WM volumes between the samples positive and negative for β-amyloid. However, in the sample positive for β-amyloid, increases in 11C Pittsburgh compound-B uptake were associated with reductions in GM volume in the left prefrontal (P = .02) and right temporal lobes (P = .04). CONCLUSIONS Our results show a significant association between increases in brain β-amyloid and reductions in regional GM volume in individuals at increased risk of cognitive decline. This evidence is consistent with a model in which increases in β-amyloid incite neurodegeneration in memory systems before cognitive impairment manifests.
Collapse
Affiliation(s)
- I K Martikainen
- From the Department of Radiology (I.K.M.), Medical Imaging Center, Tampere University Hospital, Tampere, Finland
| | - N Kemppainen
- Division of Clinical Neurosciences (N.K., J.O.R.), Turku University Hospital, Turku, Finland.,Turku PET Centre (N.K., J.J., J.T., S. Helin, J.O.R.), University of Turku, Turku, Finland
| | - J Johansson
- Turku PET Centre (N.K., J.J., J.T., S. Helin, J.O.R.), University of Turku, Turku, Finland
| | - J Teuho
- Turku PET Centre (N.K., J.J., J.T., S. Helin, J.O.R.), University of Turku, Turku, Finland
| | - S Helin
- Turku PET Centre (N.K., J.J., J.T., S. Helin, J.O.R.), University of Turku, Turku, Finland
| | - Y Liu
- Department of Neurology (Y.L., S. Helisalmi, H.S., M.K.), University of Eastern Finland, Kuopio, Finland.,Neurocenter (Y.L., H.S., M.K.), Neurology, Kuopio University Hospital, Kuopio, Finland
| | - S Helisalmi
- Department of Neurology (Y.L., S. Helisalmi, H.S., M.K.), University of Eastern Finland, Kuopio, Finland
| | - H Soininen
- Department of Neurology (Y.L., S. Helisalmi, H.S., M.K.), University of Eastern Finland, Kuopio, Finland.,Neurocenter (Y.L., H.S., M.K.), Neurology, Kuopio University Hospital, Kuopio, Finland
| | - R Parkkola
- Department of Radiology (R.P.), University of Turku and Turku University Hospital, Turku, Finland
| | - T Ngandu
- Department of Public Health Solutions (T.N., M.K.), Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki, Finland.,Division of Clinical Geriatrics (T.N., M.K.), Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - M Kivipelto
- Department of Neurology (Y.L., S. Helisalmi, H.S., M.K.), University of Eastern Finland, Kuopio, Finland.,Neurocenter (Y.L., H.S., M.K.), Neurology, Kuopio University Hospital, Kuopio, Finland.,Department of Public Health Solutions (T.N., M.K.), Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki, Finland.,Division of Clinical Geriatrics (T.N., M.K.), Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - J O Rinne
- Division of Clinical Neurosciences (N.K., J.O.R.), Turku University Hospital, Turku, Finland.,Turku PET Centre (N.K., J.J., J.T., S. Helin, J.O.R.), University of Turku, Turku, Finland
| |
Collapse
|
22
|
Busweiler LAD, Jeremiasen M, Wijnhoven BPL, Lindblad M, Lundell L, van de Velde CJH, Tollenaar RAEM, Wouters MWJM, van Sandick JW, Johansson J, Dikken JL. International benchmarking in oesophageal and gastric cancer surgery. BJS Open 2018; 3:62-73. [PMID: 30734017 PMCID: PMC6354189 DOI: 10.1002/bjs5.50107] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 06/16/2018] [Accepted: 08/24/2018] [Indexed: 01/03/2023] Open
Abstract
Background Benchmarking on an international level might lead to improved outcomes at a national level. The aim of this study was to compare treatment and surgical outcome data from the Swedish National Register for Oesophageal and Gastric Cancer (NREV) and the Dutch Upper Gastrointestinal Cancer Audit (DUCA). Methods All patients with primary oesophageal or gastric cancer who underwent a resection and were registered in NREV or DUCA between 2012 and 2014 were included. Differences in 30‐day mortality were analysed using case mix‐adjusted multivariable logistic regression. Results In total, 4439 patients underwent oesophagectomy (2509 patients) or gastrectomy (1930 patients). Estimated resection rates were comparable. Swedish patients were older but had less advanced disease and less co‐morbidity than Dutch patients. Neoadjuvant treatment rates were lower in Sweden than in the Netherlands, both for patients who underwent oesophagectomy (68·6 versus 90·0 per cent respectively; P < 0·001) and for those having gastrectomy (38·3 versus 56·6 per cent; P < 0·001). In Sweden, transthoracic oesophagectomy was performed in 94·7 per cent of patients, whereas in the Netherlands, a transhiatal approach was undertaken in 35·8 per cent. Higher annual procedural volumes per hospital were observed in the Netherlands. Adjusted 30‐day and/or in‐hospital mortality after gastrectomy was statistically significantly lower in Sweden than in the Netherlands (odds ratio 0·53, 95 per cent c.i. 0·29 to 0·95). Conclusion For oesophageal and gastric cancer, there are differences in patient, tumour and treatment characteristics between Sweden and the Netherlands. Postoperative mortality in patients with gastric cancer was lower in Sweden.
Collapse
Affiliation(s)
- L A D Busweiler
- Dutch Institute for Clinical Auditing Leiden the Netherlands.,Department of Surgery, Leiden University Medical Centre Leiden the Netherlands
| | - M Jeremiasen
- Department of Surgery, Skåne University Hospital Lund Sweden.,Faculty of Medicine, Department of Clinical Sciences, Lund University Lund Sweden
| | - B P L Wijnhoven
- Department of Surgery, Erasmus University Medical Centre Rotterdam the Netherlands
| | - M Lindblad
- Department of Surgery, Centre for Digestive Diseases, Karolinska University Hospital, CLINTEC, Karolinska Institutet Stockholm Sweden
| | - L Lundell
- Department of Surgery, Centre for Digestive Diseases, Karolinska University Hospital, CLINTEC, Karolinska Institutet Stockholm Sweden
| | - C J H van de Velde
- Department of Surgery, Leiden University Medical Centre Leiden the Netherlands
| | - R A E M Tollenaar
- Dutch Institute for Clinical Auditing Leiden the Netherlands.,Department of Surgery, Leiden University Medical Centre Leiden the Netherlands
| | - M W J M Wouters
- Dutch Institute for Clinical Auditing Leiden the Netherlands.,Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital Amsterdam the Netherlands
| | - J W van Sandick
- Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital Amsterdam the Netherlands
| | - J Johansson
- Department of Surgery, Skåne University Hospital Lund Sweden.,Faculty of Medicine, Department of Clinical Sciences, Lund University Lund Sweden
| | - J L Dikken
- Department of Surgery, Leiden University Medical Centre Leiden the Netherlands
| |
Collapse
|
23
|
Claassen YHM, Dikken JL, Hartgrink HH, de Steur WO, Slingerland M, Verhoeven RHA, van Eycken E, de Schutter H, Johansson J, Rouvelas I, Johnson E, Hjortland GO, Jensen LS, Larsson HJ, Allum WH, Portielje JEA, Bastiaannet E, van de Velde CJH. North European comparison of treatment strategy and survival in older patients with resectable gastric cancer: A EURECCA upper gastrointestinal group analysis. Eur J Surg Oncol 2018; 44:1982-1989. [PMID: 30343998 DOI: 10.1016/j.ejso.2018.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 05/10/2018] [Revised: 09/14/2018] [Accepted: 09/21/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND As older gastric cancer patients are often excluded from randomized clinical trials, the most appropriate treatment strategy for these patients remains unclear. The current study aimed to gain more insight in treatment strategies and relative survival of older patients with resectable gastric cancer across Europe. METHODS Population-based cohorts from Belgium, Denmark, The Netherlands, Norway, and Sweden were combined. Patients ≥70 years with resectable gastric cancer (cT1-4a, cN0-2, cM0), diagnosed between 2004 and 2014 were included. Resection rates, administration of chemotherapy (irrespective of surgery), and relative survival within a country according to stage were determined. RESULTS Overall, 6698 patients were included. The percentage of operated patients was highest in Belgium and lowest in Sweden for both stage II (74% versus 56%) and stage III disease (57% versus 25%). For stage III, chemotherapy administration was highest in Belgium (44%) and lowest in Sweden (2%). Three year relative survival for stage I, II, and III disease in Belgium was 67.8% (95% CI:62.8-72.6), 41.2% (95% CI:37.3-45.2), 17.8% (95% CI:12.5-24.0), compared with 56.7% (95% CI:51.5-61.7), 31.3% (95% CI:27.6-35.2), 8.2% (95% CI:4.4-13.4) in Sweden. There were no significant differences in treatment strategies of patients with stage I disease. CONCLUSION Substantial treatment differences are observed across North European countries for patients with stages II and III resectable gastric cancer aged 70 years or older. In the present comparison, treatment strategies with a higher proportion of patients undergoing surgery seemed to be associated with higher survival rates for patients with stages II or III disease.
Collapse
Affiliation(s)
- Y H M Claassen
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
| | - J L Dikken
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - H H Hartgrink
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - W O de Steur
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - M Slingerland
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - R H A Verhoeven
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), the Netherlands
| | | | | | - J Johansson
- Department of Surgery, Lund University, Lund, Sweden
| | - I Rouvelas
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Surgery, Karolinska Institute, Stockholm, Sweden; Section of Esophagogastric Surgery, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - E Johnson
- Institute of Clinical Medicine, University of Oslo, Norway; Department of Gastroenterological and Pediatric Surgery, Oslo University Hospital, Oslo, Norway
| | - G O Hjortland
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - L S Jensen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - H J Larsson
- The Danish National Registries, a National Quality Improvement Programme (RKKP), Aarhus, Denmark
| | - W H Allum
- Department of Surgery, Royal Marsden NHS Foundation Trust, London, Great Britain, UK
| | - J E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - E Bastiaannet
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands; Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - C J H van de Velde
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
24
|
Tydén J, Larsson N, Lehtipalo S, Herwald H, Hultin M, Walldén J, Behndig AF, Johansson J. Heparin-binding protein in ventilator-induced lung injury. Intensive Care Med Exp 2018; 6:33. [PMID: 30203380 PMCID: PMC6131685 DOI: 10.1186/s40635-018-0198-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/04/2018] [Accepted: 09/03/2018] [Indexed: 12/26/2022] Open
Abstract
Background Although mechanical ventilation is often lifesaving, it can also cause injury to the lungs. The lung injury is caused by not only high pressure and mechanical forces but also by inflammatory processes that are not fully understood. Heparin-binding protein (HBP), released by activated granulocytes, has been indicated as a possible mediator of increased vascular permeability in the lung injury associated with trauma and sepsis. We investigated if HBP levels were increased in the bronchoalveolar lavage fluid (BALF) or plasma in a pig model of ventilator-induced lung injury (VILI). We also investigated if HBP was present in BALF from healthy volunteers and in intubated patients in the intensive care unit (ICU). Methods Anaesthetized pigs were randomized to receive ventilation with either tidal volumes of 8 ml/kg (controls, n = 6) or 20 ml/kg (VILI group, n = 6). Plasma and BALF samples were taken at 0, 1, 2, 4, and 6 h. In humans, HBP levels in BALF were sampled from 16 healthy volunteers and from 10 intubated patients being cared for in the ICU. Results Plasma levels of HBP did not differ between pigs in the control and VILI groups. The median HBP levels in BALF were higher in the VILI group after 6 h of ventilation compared to those in the controls (1144 ng/ml (IQR 359–1636 ng/ml) versus 89 ng/ml (IQR 33–191 ng/ml) ng/ml, respectively, p = 0.02). The median HBP level in BALF from healthy volunteers was 0.90 ng/ml (IQR 0.79–1.01 ng/ml) as compared to 1959 ng/ml (IQR 612–3306 ng/ml) from intubated ICU patients (p < 0.001). Conclusions In a model of VILI in pigs, levels of HBP in BALF increased over time compared to controls, while plasma levels did not differ between the two groups. HBP in BALF was high in intubated ICU patients in spite of the seemingly non-harmful ventilation, suggesting that inflammation from other causes might increase HBP levels. Electronic supplementary material The online version of this article (10.1186/s40635-018-0198-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jonas Tydén
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Critical Care Medicine (Östersund), Umeå University, Umeå, Sweden. .,Anestesiläkaravdelningen, Östersund Hospital, 831 32, Östersund, Sweden.
| | - N Larsson
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Critical Care Medicine (Umeå), Umeå University, Umeå, Sweden
| | - S Lehtipalo
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Critical Care Medicine (Umeå), Umeå University, Umeå, Sweden
| | - H Herwald
- Department of Cell and Molecular Biology, Lund University, Lund, Sweden
| | - M Hultin
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Critical Care Medicine (Umeå), Umeå University, Umeå, Sweden
| | - J Walldén
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Critical Care Medicine (Sundsvall), Umeå University, Umeå, Sweden
| | - A F Behndig
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - J Johansson
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Critical Care Medicine (Östersund), Umeå University, Umeå, Sweden
| |
Collapse
|
25
|
Loera-Valencia R, Piras A, Ismail MAM, Manchanda S, Eyjolfsdottir H, Saido TC, Johansson J, Eriksdotter M, Winblad B, Nilsson P. Targeting Alzheimer's disease with gene and cell therapies. J Intern Med 2018; 284:2-36. [PMID: 29582495 DOI: 10.1111/joim.12759] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Alzheimer's disease (AD) causes dementia in both young and old people affecting more than 40 million people worldwide. The two neuropathological hallmarks of the disease, amyloid beta (Aβ) plaques and neurofibrillary tangles consisting of protein tau are considered the major contributors to the disease. However, a more complete picture reveals significant neurodegeneration and decreased cell survival, neuroinflammation, changes in protein and energy homeostasis and alterations in lipid and cholesterol metabolism. In addition, gene and cell therapies for severe neurodegenerative disorders have recently improved technically in terms of safety and efficiency and have translated to the clinic showing encouraging results. Here, we review broadly current data within the field for potential targets that could modify AD through gene and cell therapy strategies. We envision that not only Aβ will be targeted in a disease-modifying treatment strategy but rather that a combination of treatments, possibly at different intervention times may prove beneficial in curing this devastating disease. These include decreased tau pathology, neuronal growth factors to support neurons and modulation of neuroinflammation for an appropriate immune response. Furthermore, cell based therapies may represent potential strategies in the future.
Collapse
Affiliation(s)
- R Loera-Valencia
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Solna, Sweden
| | - A Piras
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Solna, Sweden
| | - M A M Ismail
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Solna, Sweden.,Theme Neuro, Diseases of the Nervous System Patient Flow, Karolinska University Hospital, Huddinge, Sweden
| | - S Manchanda
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Solna, Sweden
| | - H Eyjolfsdottir
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Theme Aging, Karolinska University Hospital, Huddinge, Sweden
| | - T C Saido
- RIKEN Brain Science Institute, Wako, Saitama, Japan
| | - J Johansson
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Solna, Sweden
| | - M Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Theme Aging, Karolinska University Hospital, Huddinge, Sweden
| | - B Winblad
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Solna, Sweden.,Theme Aging, Karolinska University Hospital, Huddinge, Sweden
| | - P Nilsson
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Solna, Sweden
| |
Collapse
|
26
|
Laaksonen L, Kallioinen M, Långsjö J, Laitio T, Scheinin A, Scheinin J, Kaisti K, Maksimow A, Kallionpää RE, Rajala V, Johansson J, Kantonen O, Nyman M, Sirén S, Valli K, Revonsuo A, Solin O, Vahlberg T, Alkire M, Scheinin H. Comparative effects of dexmedetomidine, propofol, sevoflurane, and S-ketamine on regional cerebral glucose metabolism in humans: a positron emission tomography study. Br J Anaesth 2018; 121:281-290. [PMID: 29935583 DOI: 10.1016/j.bja.2018.04.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2017] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The highly selective α2-agonist dexmedetomidine has become a popular sedative for neurointensive care patients. However, earlier studies have raised concern that dexmedetomidine might reduce cerebral blood flow without a concomitant decrease in metabolism. Here, we compared the effects of dexmedetomidine on the regional cerebral metabolic rate of glucose (CMRglu) with three commonly used anaesthetic drugs at equi-sedative doses. METHODS One hundred and sixty healthy male subjects were randomised to EC50 for verbal command of dexmedetomidine (1.5 ng ml-1; n=40), propofol (1.7 μg ml-1; n=40), sevoflurane (0.9% end-tidal; n=40) or S-ketamine (0.75 μg ml-1; n=20) or placebo (n=20). Anaesthetics were administered using target-controlled infusion or vapouriser with end-tidal monitoring. 18F-labelled fluorodeoxyglucose was administered 20 min after commencement of anaesthetic administration, and high-resolution positron emission tomography with arterial blood activity samples was used to quantify absolute CMRglu for whole brain and 15 brain regions. RESULTS At the time of [F18]fluorodeoxyglucose injection, 55% of dexmedetomidine, 45% of propofol, 85% of sevoflurane, 45% of S-ketamine, and 0% of placebo subjects were unresponsive. Whole brain CMRglu was 63%, 71%, 71%, and 96% of placebo in the dexmedetomidine, propofol, sevoflurane, and S-ketamine groups, respectively (P<0.001 between the groups). The lowest CMRglu was observed in nearly all brain regions with dexmedetomidine (P<0.05 compared with all other groups). With S-ketamine, CMRglu did not differ from placebo. CONCLUSIONS At equi-sedative doses in humans, potency in reducing CMRglu was dexmedetomidine>propofol>ketamine=placebo. These findings alleviate concerns for dexmedetomidine-induced vasoconstriction and cerebral ischaemia. CLINICAL TRIAL REGISTRATION NCT02624401.
Collapse
Affiliation(s)
- L Laaksonen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland; Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland.
| | - M Kallioinen
- Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
| | - J Långsjö
- Department of Intensive Care, Tampere University Hospital, Tampere, Finland
| | - T Laitio
- Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
| | - A Scheinin
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland; Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
| | - J Scheinin
- Department of Anaesthesiology, Kuopio University Hospital, Kuopio, Finland
| | - K Kaisti
- Department of Anaesthesiology and Intensive Care, Oulu University Hospital, Oulu, Finland
| | - A Maksimow
- Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
| | - R E Kallionpää
- Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland; Department of Psychology and Speech-Language Pathology, Turku Brain and Mind Center, University of Turku, Turku, Finland
| | - V Rajala
- Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
| | - J Johansson
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland; Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - O Kantonen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland; Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland; University of California, Irvine, CA, USA
| | - M Nyman
- Department of Radiology, Turku University Hospital, Turku, Finland
| | - S Sirén
- Institute of Biomedicine, University of Turku, Unit of Clinical Pharmacology, Turku University Hospital, Turku, Finland
| | - K Valli
- Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland; Department of Psychology and Speech-Language Pathology, Turku Brain and Mind Center, University of Turku, Turku, Finland; Department of Cognitive Neuroscience and Philosophy, School of Bioscience, University of Skövde, Sweden
| | - A Revonsuo
- Department of Psychology and Speech-Language Pathology, Turku Brain and Mind Center, University of Turku, Turku, Finland; Department of Cognitive Neuroscience and Philosophy, School of Bioscience, University of Skövde, Sweden
| | - O Solin
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - T Vahlberg
- Department of Clinical Medicine, Biostatistics, University of Turku and Turku University Hospital, Turku, Finland
| | - M Alkire
- University of California, Irvine, CA, USA
| | - H Scheinin
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland; Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland; Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
| |
Collapse
|
27
|
Ljung K, Andersson M, Floderus L, Nordling K, Corbascio M, Johansson J, Grinnemo KH, Osterholm C, Rising A. P459Human fetal cardiac mesenchymal stromal cells on a novel spider silk 3D scaffold form vessel-like structures and deposit laminins. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.318] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Ljung
- Karolinska Institute, Department of Molecular Medicine and Surgery, Stockholm, Sweden
| | - M Andersson
- Swedish University of Agricultural Sciences, Department of Anatomy, Physiology and Biochemistry, Uppsala, Sweden
| | - L Floderus
- Swedish University of Agricultural Sciences, Department of Anatomy, Physiology and Biochemistry, Uppsala, Sweden
| | - K Nordling
- Swedish University of Agricultural Sciences, Department of Anatomy, Physiology and Biochemistry, Uppsala, Sweden
| | - M Corbascio
- Karolinska Institute, Department of Molecular Medicine and Surgery, Stockholm, Sweden
| | - J Johansson
- Karolinska Institute, Department of Neurobiology, Care Sciences and Society (NVS), Stockholm, Sweden
| | - K H Grinnemo
- Karolinska Institute, Department of Molecular Medicine and Surgery, Stockholm, Sweden
| | - C Osterholm
- Karolinska Institute, Department of Molecular Medicine and Surgery, Stockholm, Sweden
| | - A Rising
- Karolinska Institute, Department of Neurobiology, Care Sciences and Society (NVS), Stockholm, Sweden
| |
Collapse
|
28
|
Jaakkola E, Joutsa J, Mäkinen E, Johansson J, Kaasinen V. Ventral striatal dopaminergic defect is associated with hallucinations in Parkinson's disease. Eur J Neurol 2017; 24:1341-1347. [PMID: 28834102 DOI: 10.1111/ene.13390] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 04/14/2017] [Accepted: 06/27/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND PURPOSE Visual hallucinations (VHs) are a common complication of Parkinson's disease (PD). The pathogenesis of VHs in PD is still largely unclear. The aim of this study was to investigate the dopaminergic mechanisms of VHs and specifically whether the degree of striatal dopamine transporter (DAT) function or extrastriatal serotonin transporter (SERT) function can predict the appearance of VHs in patients with PD. METHODS Twenty-two PD patients scanned with [123 I]FP-CIT single photon emission computed tomography at an early stage of their disease who later developed VHs were identified and compared with 48 non-hallucinating PD patients. The groups were matched for age, medication, disease duration and motor symptom severity. Clinical follow-up after the scan was a median (range) of 6.9 (3.8-9.6) years. Imaging analyses were performed with both regions-of-interest-based and voxel-based (Statistical Parametric Mapping) methods for the striatal and extrastriatal regions. RESULTS The median interval between the scan and the emergence of VHs was 4.8 years. Patients who developed VHs had 18.4% lower DAT binding in the right ventral striatum (P = 0.009), 16.7% lower binding in the left ventral striatum (P = 0.02) and 18.8% lower binding in the right putamen (P = 0.03) compared to patients who did not develop VHs. CONCLUSIONS Low striatal DAT function may predispose PD patients to VHs, and the regional distribution of the findings suggests a particular role of the ventral striatum. This is in line with non-PD research that has implicated ventral striatal dysfunction in psychosis.
Collapse
Affiliation(s)
- E Jaakkola
- Department of Neurology, University of Turku, Turku, Finland.,Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland.,Department of Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - J Joutsa
- Department of Neurology, University of Turku, Turku, Finland.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.,Turku PET Centre, Turku University Hospital, Turku, Finland
| | - E Mäkinen
- Department of Neurology, University of Turku, Turku, Finland.,Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland.,Department of Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - J Johansson
- Turku PET Centre, Turku University Hospital, Turku, Finland
| | - V Kaasinen
- Department of Neurology, University of Turku, Turku, Finland.,Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland.,Turku PET Centre, Turku University Hospital, Turku, Finland
| |
Collapse
|
29
|
Kulikowski E, Wasiak S, Tsujikawa L, Gilham D, Halliday C, Rakai B, Jahagirdar R, Kalantar-Zadeh K, Sweeney M, Johansson J, Wong N, Robson R. P6483Apabetalone (RVX-208) impacts key biomarkers and pathways associated with cardiovascular disease in patients with severe renal impairment. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6483] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
30
|
Nicholls S, Kulikowski E, Halliday C, Lebioda K, Johansson J, Sweeney M, Kalantar-Zadeh K. P1769Lowering the neutrophil to lymphocyte ratio by the BET inhibitor, apabetalone: potential implications for cardiovascular events in high risk patients. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1769] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
31
|
Tydén J, Herwald H, Hultin M, Walldén J, Johansson J. Heparin-binding protein as a biomarker of acute kidney injury in critical illness. Acta Anaesthesiol Scand 2017; 61:797-803. [PMID: 28585315 DOI: 10.1111/aas.12913] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 04/11/2017] [Accepted: 05/05/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is no biomarker with high sensitivity and specificity for the development of acute kidney injury (AKI) in a mixed intensive care unit (ICU) population. Heparin-binding protein (HBP) is released from granulocytes and causes increased vascular permeability which plays a role in the development of AKI in sepsis and ischemia. The aim of this study was to investigate whether plasma levels of HBP on admission can predict the development of AKI in a mixed ICU population and in the subgroup with sepsis. METHODS Longitudinal observational study with plasma HBP levels from 245 patients taken on admission to ICU. Presence and severity of AKI was scored daily for 1 week. RESULTS Mean (95% CI) plasma concentrations of log HBP (ng/ml) in the groups developing different stages of AKI were: stage 0 (n = 175), 3.5 (3.4-3.7); stage 1 (n = 33), 3.7 (3.5-4.0), stage 2 (n = 20), 4.4 (3.5-4.8); and stage 3 (n = 17), 4.6 (3.8-5.2). HBP levels were significantly higher in patients developing AKI stage 3 (P < 0.01) compared to AKI stage 0 and 1. The area under the curve (AUC) for HBP to discriminate the group developing AKI stage 2-3 was 0.70 (CI: 0.58-0.82) and in the subgroup with severe sepsis 0.88 (CI: 0.77-0.99). CONCLUSION Heparin-binding protein levels on admission to ICU are associated with the development of severe kidney injury. The relationship between HBP and AKI needs to be further validated in larger studies.
Collapse
Affiliation(s)
- J. Tydén
- Department of Surgical and Perioperative Sciences; Anaesthesiology and Intensive Care Medicine; Umeå University; Umeå Sweden
- Department of Anaesthesia and Intensive Care Östersund; Umeå University; Östersund Sweden
| | - H. Herwald
- Department of Cell and Molecular Biology; Lund University; Lund Sweden
| | - M. Hultin
- Department of Surgical and Perioperative Sciences; Anaesthesiology and Intensive Care Medicine; Umeå University; Umeå Sweden
- Department of Anaesthesia and Intensive Care Sunderbyn; Umeå University; Luleå Sweden
| | - J. Walldén
- Department of Surgical and Perioperative Sciences; Anaesthesiology and Intensive Care Medicine; Umeå University; Umeå Sweden
- Department of Anaesthesia and Intensive Care Sundsvall; Umeå University; Sundsvall Sweden
| | - J. Johansson
- Department of Surgical and Perioperative Sciences; Anaesthesiology and Intensive Care Medicine; Umeå University; Umeå Sweden
- Department of Anaesthesia and Intensive Care Östersund; Umeå University; Östersund Sweden
| |
Collapse
|
32
|
Johansson J, Azhar S, Bittner S, Bielicki J. P180Atherosclerosis reduction and improved glucose control the ABCA1 agonist CS6253. In vitro and in vivo mechanism of action studies. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p180] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
33
|
Goobar A, Amanullah R, Kulkarni SR, Nugent PE, Johansson J, Steidel C, Law D, Mörtsell E, Quimby R, Blagorodnova N, Brandeker A, Cao Y, Cooray A, Ferretti R, Fremling C, Hangard L, Kasliwal M, Kupfer T, Lunnan R, Masci F, Miller AA, Nayyeri H, Neill JD, Ofek EO, Papadogiannakis S, Petrushevska T, Ravi V, Sollerman J, Sullivan M, Taddia F, Walters R, Wilson D, Yan L, Yaron O. iPTF16geu: A multiply imaged, gravitationally lensed type Ia supernova. Science 2017; 356:291-295. [PMID: 28428419 DOI: 10.1126/science.aal2729] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 03/24/2017] [Indexed: 11/02/2022]
Abstract
We report the discovery of a multiply imaged, gravitationally lensed type Ia supernova, iPTF16geu (SN 2016geu), at redshift z = 0.409. This phenomenon was identified because the light from the stellar explosion was magnified more than 50 times by the curvature of space around matter in an intervening galaxy. We used high-spatial-resolution observations to resolve four images of the lensed supernova, approximately 0.3 arc seconds from the center of the foreground galaxy. The observations probe a physical scale of ~1 kiloparsec, smaller than is typical in other studies of extragalactic gravitational lensing. The large magnification and symmetric image configuration imply close alignment between the lines of sight to the supernova and to the lens. The relative magnifications of the four images provide evidence for substructures in the lensing galaxy.
Collapse
Affiliation(s)
- A Goobar
- Oskar Klein Centre, Department of Physics, Stockholm University, Albanova University Center, SE 106 91 Stockholm, Sweden.
| | - R Amanullah
- Oskar Klein Centre, Department of Physics, Stockholm University, Albanova University Center, SE 106 91 Stockholm, Sweden
| | - S R Kulkarni
- Cahill Center for Astrophysics, California Institute of Technology, Pasadena, CA 91125, USA
| | - P E Nugent
- Department of Astronomy, University of California, Berkeley, CA 94720, USA.,MS 50B-4206, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - J Johansson
- Department of Particle Physics and Astrophysics, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - C Steidel
- Cahill Center for Astrophysics, California Institute of Technology, Pasadena, CA 91125, USA
| | - D Law
- Space Telescope Science Institute, Baltimore, MD 21218, USA
| | - E Mörtsell
- Oskar Klein Centre, Department of Physics, Stockholm University, Albanova University Center, SE 106 91 Stockholm, Sweden
| | - R Quimby
- Department of Astronomy, San Diego State University, San Diego, CA 92182, USA.,Kavli IPMU (WPI), University of Tokyo Institutes for Advanced Study, Kashiwa, Chiba 277-8583, Japan
| | - N Blagorodnova
- Cahill Center for Astrophysics, California Institute of Technology, Pasadena, CA 91125, USA
| | - A Brandeker
- Department of Astronomy, Stockholm University, Albanova, SE 10691 Stockholm, Sweden
| | - Y Cao
- eScience Institute and Department of Astronomy, University of Washington, Seattle, WA 98195, USA
| | - A Cooray
- Department of Physics and Astronomy, University of California, Irvine, CA 92697, USA
| | - R Ferretti
- Oskar Klein Centre, Department of Physics, Stockholm University, Albanova University Center, SE 106 91 Stockholm, Sweden
| | - C Fremling
- Oskar Klein Centre, Department of Astronomy, Stockholm University, Albanova University Center, SE 106 91 Stockholm, Sweden
| | - L Hangard
- Oskar Klein Centre, Department of Physics, Stockholm University, Albanova University Center, SE 106 91 Stockholm, Sweden
| | - M Kasliwal
- Cahill Center for Astrophysics, California Institute of Technology, Pasadena, CA 91125, USA
| | - T Kupfer
- Cahill Center for Astrophysics, California Institute of Technology, Pasadena, CA 91125, USA
| | - R Lunnan
- Cahill Center for Astrophysics, California Institute of Technology, Pasadena, CA 91125, USA.,Department of Astronomy, Stockholm University, Albanova, SE 10691 Stockholm, Sweden
| | - F Masci
- Infrared Processing and Analysis Center, California Institute of Technology, Pasadena, CA 91125, USA
| | - A A Miller
- Center for Interdisciplinary Exploration and Research in Astrophysics and Department of Physics and Astronomy, Northwestern University, Evanston, IL 60208, USA.,Adler Planetarium, Chicago, IL 60605, USA
| | - H Nayyeri
- Department of Physics and Astronomy, University of California, Irvine, CA 92697, USA
| | - J D Neill
- Cahill Center for Astrophysics, California Institute of Technology, Pasadena, CA 91125, USA
| | - E O Ofek
- Department of Particle Physics and Astrophysics, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - S Papadogiannakis
- Oskar Klein Centre, Department of Physics, Stockholm University, Albanova University Center, SE 106 91 Stockholm, Sweden
| | - T Petrushevska
- Oskar Klein Centre, Department of Physics, Stockholm University, Albanova University Center, SE 106 91 Stockholm, Sweden
| | - V Ravi
- Cahill Center for Astrophysics, California Institute of Technology, Pasadena, CA 91125, USA
| | - J Sollerman
- Oskar Klein Centre, Department of Astronomy, Stockholm University, Albanova University Center, SE 106 91 Stockholm, Sweden
| | - M Sullivan
- Department of Physics and Astronomy, University of Southampton, Southampton SO17 1BJ, UK
| | - F Taddia
- Oskar Klein Centre, Department of Astronomy, Stockholm University, Albanova University Center, SE 106 91 Stockholm, Sweden
| | - R Walters
- Cahill Center for Astrophysics, California Institute of Technology, Pasadena, CA 91125, USA
| | - D Wilson
- Department of Physics and Astronomy, University of California, Irvine, CA 92697, USA
| | - L Yan
- Cahill Center for Astrophysics, California Institute of Technology, Pasadena, CA 91125, USA
| | - O Yaron
- Department of Particle Physics and Astrophysics, Weizmann Institute of Science, Rehovot 7610001, Israel
| |
Collapse
|
34
|
Johansson J, Lindahl M, Gyllencreutz E, Hahn RG. Symptomatic absorption of isotonic saline during transcervical endometrial resection. Acta Anaesthesiol Scand 2017; 61:121-124. [PMID: 27918101 DOI: 10.1111/aas.12834] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 11/01/2016] [Indexed: 12/01/2022]
Affiliation(s)
- J Johansson
- Department of Anesthesiology and Intensive Care, Östersund Hospital, Östersund, Sweden
- Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care, Unit of Research, Education and Development - Östersund, Umeå University, Umeå, Sweden
| | - M Lindahl
- Department of Anesthesiology and Intensive Care, Östersund Hospital, Östersund, Sweden
| | - E Gyllencreutz
- Department of Obstetrics and Gynecology, Östersund Hospital, Östersund, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - R G Hahn
- Research Unit, Södertälje Hospital, Södertälje, Sweden
| |
Collapse
|
35
|
Klevebro F, Lindblad M, Johansson J, Lundell L, Nilsson M. Outcome of neoadjuvant therapies for cancer of the oesophagus or gastro-oesophageal junction based on a national data registry. Br J Surg 2016; 103:1864-1873. [PMID: 27689845 DOI: 10.1002/bjs.10304] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/24/2016] [Accepted: 07/25/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Randomized trials have shown that neoadjuvant treatment improves survival in the curative treatment of oesophageal and gastro-oesophageal junction cancer. Results from population-based observational studies are, however, sparse and ambiguous. METHODS This prospective population-based cohort study included all patients who had oesophagectomy for cancer in Sweden, excluding clinical T1 N0, recorded in the National Register for Oesophageal and Gastric Cancer, 2006-2014. Patients were stratified into three groups: surgery alone, neoadjuvant chemotherapy and neoadjuvant chemoradiotherapy. RESULTS Neoadjuvant treatment was given to 521 patients (51·1 per cent) and 499 (48·9 per cent) received surgery alone. Neoadjuvant chemotherapy increased the risk of postoperative surgical complications compared with surgery alone (adjusted odds ratio 2·01, 95 per cent c.i. 1·24 to 3·25; P = 0·005). Postoperative mortality was significantly increased after neoadjuvant chemoradiotherapy compared with surgery alone (odds ratio 2·37, 1·06 to 5·29; P = 0·035). Survival improved in patients with squamous cell carcinoma after neoadjuvant chemotherapy, whereas after neoadjuvant chemoradiotherapy survival was significantly improved only in the subgroup with the highest performance status and without known co-morbidity. In adenocarcinoma there was a trend towards improved overall survival after neoadjuvant chemotherapy, but neoadjuvant chemoradiotherapy did not offer a survival benefit. Stratified analysis including only patients with adenocarcinoma in the highest performance category without known co-morbidity showed a strong trend towards improved survival after neoadjuvant chemotherapy compared with surgery alone (adjusted hazard ratio 0·47, 0·21 to 1·04; P = 0·061). CONCLUSION For patients with squamous cell carcinoma of the oesophagus or gastro-oesophageal junction, neoadjuvant treatments seemed to increase long-term survival, but also the risk of postoperative morbidity and mortality, compared with surgery alone. Neither neoadjuvant treatment option seemed to improve survival significantly among patients with adenocarcinoma, compared with surgery alone.
Collapse
Affiliation(s)
- F Klevebro
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institute, and Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - M Lindblad
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institute, and Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - J Johansson
- Department of Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - L Lundell
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institute, and Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - M Nilsson
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institute, and Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
36
|
Stenke L, von Schreeb J, Simonsson M, Johansson J, Postgård P, Sigurdsson S, Ljungquist Å, Lagergren Lindberg M. Lessons Learnt from the Fukushima Accident-A Swedish Medical Preparedness Perspective. Radiat Prot Dosimetry 2016; 171:134-138. [PMID: 27574328 DOI: 10.1093/rpd/ncw201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The triple disaster in March 2011 tragically and severely affected the Japanese society, in spite of its well-developed infrastructure and good access to resources. A multitude of Japanese and international reports have since described the chain of events and actions taken in connection with the earthquake, the tsunami and the power plant failure in Fukushima. In order to further evaluate Japanese experiences of the disaster, and to bring home 'lessons-learnt' of relevance for continued emergency preparedness planning, a group from the National Board of Health and Welfare and other Swedish agencies performed an observer visit to Japan in 2012. A report from the group was recently published. Its main conclusions, and implications focusing on a strengthened national medical preparedness for radionuclear events in Sweden (and possibly elsewhere), are presented here.
Collapse
Affiliation(s)
- L Stenke
- Swedish National Board of Health and Welfare, SE-106 30 Stockholm, Sweden Karolinska Institute, Depts of Oncology/Pathology and Public Health Sciences, SE-17177 Stockholm, Sweden
| | - J von Schreeb
- Swedish National Board of Health and Welfare, SE-106 30 Stockholm, Sweden Karolinska Institute, Depts of Oncology/Pathology and Public Health Sciences, SE-17177 Stockholm, Sweden
| | - M Simonsson
- Swedish National Board of Health and Welfare, SE-106 30 Stockholm, Sweden
| | - J Johansson
- Swedish Radiation Safety Authority, SE-17116 Stockholm, Sweden
| | - P Postgård
- Swedish Civil Contingencies Agency, SE-15181, Karlstad, Sweden
| | - S Sigurdsson
- Swedish National Board of Health and Welfare, SE-106 30 Stockholm, Sweden
| | - Å Ljungquist
- Swedish National Board of Health and Welfare, SE-106 30 Stockholm, Sweden
| | - M Lagergren Lindberg
- Swedish National Board of Health and Welfare, SE-106 30 Stockholm, Sweden Karolinska Institute, Depts of Oncology/Pathology and Public Health Sciences, SE-17177 Stockholm, Sweden
| |
Collapse
|
37
|
Wong N, Kulikowski E, Wasiak S, Gilham D, Calosing C, Laura T, Halliday C, Johansson J, Sweeney M. Apabetalone (RVX-208) decreases atherogenic, thrombotic and inflammatory mediators in vitro and in plasma of patients with cardiovascular disease (CVD). Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2016.07.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
38
|
Messager M, de Steur W, Boelens P, Jensen L, Mariette C, Reynolds J, Osorio J, Pera M, Johansson J, Kołodziejczyk P, Roviello F, De Manzoni G, Mönig S, Allum W. Description and analysis of clinical pathways for oesophago-gastric adenocarcinoma, in 10 European countries (the EURECCA upper gastro intestinal group – European Registration of Cancer Care). Eur J Surg Oncol 2016; 42:1432-47. [DOI: 10.1016/j.ejso.2016.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 01/02/2016] [Indexed: 01/27/2023] Open
|
39
|
Nilsson S, Berglund I, Erikson U, Johansson J, Walldius G. Optimization of ecg gating in quantitative femoral angiography. Acta Radiol 2016; 44:489-93. [PMID: 14510754 DOI: 10.1080/j.1600-0455.2003.00101.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/20/2022]
Abstract
Purpose: To determine which phase of the heart cycle would yield the highest reproducibility in measuring atherosclerosis-related variables such as arterial lumen volume and edge roughness. Material and Methods: 35 patients with hypercholesterolemia underwent select‐ ive femoral angiography, repeated four times at 10-min intervals. The angiographies were performed with ECG-gated exposures. In angiographies 1 and 2 the delay from R-wave maximum to each exposure was 0.1 s, in angiographies 3 and 4 the delay was 0.1, 0.3, 0.5 or 0.7 s or the exposures were performed 1/s without ECG gating. Arterial lumen volume and edge roughness were measured in a 20-cm segment of the superficial femoral artery using a computer-based densitometric method. Measurement reproducibility was determined by comparing angiographies 1–2 and angiographies 3–4. Results: When measuring arterial lumen volume and edge roughness of a 20-cm segment of the femoral artery, reproducibility was not dependent on ECG gating. In measuring single arterial diameters and cross-sectional areas, the reproducibility was better when exposures were made 0.1 s after the R-wave maximum than when using other settings of the ECG gating device or without ECG gating. Conclusion: The influence of pulsatile flow upon quantitative measurement in femoral angiograms seems to be the smallest possible in early systole, as can be demonstrated when measuring single diameters and cross-sectional areas. In variables based on integration over longer segments, measurement reproducibility seems to be independent of phase.
Collapse
Affiliation(s)
- S Nilsson
- Department of Oncology, Radiology and Clinical Immunology, University Hospital, SE-751 85 Uppsala, Sweden.
| | | | | | | | | |
Collapse
|
40
|
Bergstrand L, Erikson U, Holme I, Johansson J, Olsson AG, Mølgaard J, Nilsson S, Stenport G, Walldius G. Reproducibility of Quantitative Arteriographic Assessment of Atherosclerosis in the Femoral Artery. Acta Radiol 2016. [DOI: 10.1177/028418519303400616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
Results from computer-analysed angiograms in the Probucol Quantitative Regression Swedish Trial (PQRST) were analysed to determine the reproducibility of the method and any drift in the analysing system. The precision index (P(μ)) for 2 angiography series, made at 10 min intervals, of the femoral artery in 276 patients was 10.5 for lumen volume and 21.9 for roughness (edge irregularity). No difference in reproducibility was found between patients with and without symptoms of peripheral atherosclerosis or when looking at the reproducibility over years. A drift of 0.67% per year in the radiographic equipment (but not in the analysis system) was found, confirmed by use of phantoms. Computer-based analysis of femoral atherosclerosis is a reliable method for follow-up trials, giving high reproducibility even if the trial spans over several years and involves different centres. The use of phantoms is essential for checking the method over time.
Collapse
|
41
|
Nilsson S, Berglund I, Christoffersson A, Erikson U, Högman N, Johansson J, Lörelius LE, Roberts RG, Walldius G. Arterial Segmental Vasoconstriction in Hypercholesterolaemic Patients. Acta Radiol 2016. [DOI: 10.1177/028418519003100403] [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
Regular, wave-like constriction in medium-sized arteries, arterial segmental vasoconstriction (ASV), has been observed at arteriography and described by many authors. We found ASV in arteriograms of the superficial femoral artery in 13 of 107 hypercholesterolaemic patients, enrolled in the Probucol Quantitative Regression Swedish Trial (PQRST). The arteriograms were digitized and studied with a quantitative computer-assisted technique. The frequency of ASV was higher than has been reported earlier in clinical materials, possibly because of an increased vasoreactivity in hypercholesterolaemia, as recently observed experimentally. The ASV patients were, on average, younger, had lower blood pressure and less atherosclerosis, than the non-ASV patients. ASV was not found in any of the 19 patients in the material who either had symptoms of peripheral vascular disease or arteriographically verified arterial occlusions. No significant correlations with smoking habits or serum cholesterol levels were found. A computer-based index of ASV and measurement of ASV wavelength are discussed.
Collapse
|
42
|
Abstract
Purpose: To study the occurrence of allergy-like reactions at angiography, repeated several times, and, secondly, to evaluate the effect of prophylactic treatment in individuals who had earlier experienced such reactions. Material and Methods: One hundred and fifty-seven patients with hypercholesterolaemia, participating in the Probucol Quantitative Regression Swedish Trial (PQRST), underwent aortofemoral angiography with ioxaglate (Hexabrix) repeated annually for 3 years. Allergic reactions to the contrast medium were recorded. At the following angiographies, all patients who had earlier experienced such reactions were treated prophylactically with steroids and antihistamine. Results: Allergic reactions were observed in 35 patients. Twelve reacted only year 0, 3 only year 1, 5 only year 2 and 6 only year 3. Eight patients had at least one reaction also when treated prophylactically. It was significantly ( p<0.05) more common to react at year 0 but not at year 1 than to react at year 1 but not at year 0. At years 1, 2 and 3 the frequency of reactions was significantly greater in the group given prophylactic treatment than in the group without any earlier reaction at all: 8/20 versus 3/137, 4/23 versus 6/134, and 6/29 versus 6/128, respectively. Conclusion: Some individuals had an increased risk of an allergy-like reaction to the contrast agent. Prophylactic treatment reduced the risk of renewed reactions, but not to the same level as for those without earlier reaction. Nevertheless, individuals who have had earlier reactions can be investigated in the future, with prophylactic treatment.
Collapse
Affiliation(s)
- S. Nilsson
- Department of Diagnostic Radiology, University Hospital, Uppsala, Sweden
| | - L. Bergstrand
- Department of Diagnostic Radiology, University Hospital, Uppsala, Sweden
| | - U. Erikson
- Department of Diagnostic Radiology, University Hospital, Uppsala, Sweden
| | - J. Johansson
- Department of Diagnostic Radiology, King Gustav V Research Institute, Karolinska Hospital, Stockholm, Sweden
| | - Smedby Ö.
- Department of Diagnostic Radiology, University Hospital, Uppsala, Sweden
| | - G. Walldius
- Department of Diagnostic Radiology, King Gustav V Research Institute, Karolinska Hospital, Stockholm, Sweden
| |
Collapse
|
43
|
Abstract
Atherosclerosis is reflected in the arteriogram as narrowing of the arterial lumen and irregularity of the arterial wall. We have quantified these changes in digitized femoral arteriograms from 107 hypercholesterolaemic patients and defined 10 different measures concerning arterial diameter, cross-sectional area, stenosis and edge irregularity. We examined the precision of these measures and the correlations between them. Lumen volume and mean diameter for defined arterial segments had the highest precision and may be useful for follow-up studies. The linear correlation between the mean diameter and the square root of the lumen volume was > 0.99, so these two measures seem to be equivalent for all practical purposes. The measured variables could be separated into 2 groups: the measures concerning arterial diameter and lumen volume and those concerning edge irregularity and localized stenosis. The measures within each group showed strong positive mutual correlations, while the correlations between measures from different groups were negative and small. It was concluded that if the results of one measure from each group, suitably those of lumen volume and edge roughness, are known, the other described measures will add no further information about the atherosclerotic process.
Collapse
|
44
|
Ankarcrona M, Winblad B, Monteiro C, Fearns C, Powers ET, Johansson J, Westermark GT, Presto J, Ericzon BG, Kelly JW. Current and future treatment of amyloid diseases. J Intern Med 2016; 280:177-202. [PMID: 27165517 PMCID: PMC4956553 DOI: 10.1111/joim.12506] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
There are more than 30 human proteins whose aggregation appears to cause degenerative maladies referred to as amyloid diseases or amyloidoses. These disorders are named after the characteristic cross-β-sheet amyloid fibrils that accumulate systemically or are localized to specific organs. In most cases, current treatment is limited to symptomatic approaches and thus disease-modifying therapies are needed. Alzheimer's disease is a neurodegenerative disorder with extracellular amyloid β-peptide (Aβ) fibrils and intracellular tau neurofibrillary tangles as pathological hallmarks. Numerous clinical trials have been conducted with passive and active immunotherapy, and small molecules to inhibit Aβ formation and aggregation or to enhance Aβ clearance; so far such clinical trials have been unsuccessful. Novel strategies are therefore required and here we will discuss the possibility of utilizing the chaperone BRICHOS to prevent Aβ aggregation and toxicity. Type 2 diabetes mellitus is symptomatically treated with insulin. However, the underlying pathology is linked to the aggregation and progressive accumulation of islet amyloid polypeptide as fibrils and oligomers, which are cytotoxic. Several compounds have been shown to inhibit islet amyloid aggregation and cytotoxicity in vitro. Future animal studies and clinical trials have to be conducted to determine their efficacy in vivo. The transthyretin (TTR) amyloidoses are a group of systemic degenerative diseases compromising multiple organ systems, caused by TTR aggregation. Liver transplantation decreases the generation of misfolded TTR and improves the quality of life for a subgroup of this patient population. Compounds that stabilize the natively folded, nonamyloidogenic, tetrameric conformation of TTR have been developed and the drug tafamidis is available as a promising treatment.
Collapse
Affiliation(s)
- M Ankarcrona
- Department of Neurobiology Care Sciences and Society, Division of Neurogeriatrics, Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden
| | - B Winblad
- Department of Neurobiology Care Sciences and Society, Division of Neurogeriatrics, Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden
| | - C Monteiro
- Department of Chemistry, The Skaggs Institute for Chemical Biology, La Jolla, CA, USA.,Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - C Fearns
- Department of Chemistry, The Skaggs Institute for Chemical Biology, La Jolla, CA, USA.,Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - E T Powers
- Department of Chemistry, The Skaggs Institute for Chemical Biology, La Jolla, CA, USA
| | - J Johansson
- Department of Neurobiology Care Sciences and Society, Division of Neurogeriatrics, Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden
| | - G T Westermark
- Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
| | - J Presto
- Department of Neurobiology Care Sciences and Society, Division of Neurogeriatrics, Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden
| | - B-G Ericzon
- Division of Transplantation Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - J W Kelly
- Department of Chemistry, The Skaggs Institute for Chemical Biology, La Jolla, CA, USA.,Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA
| |
Collapse
|
45
|
Affiliation(s)
- J Johansson
- Department of Neurobiology, Care Sciences and Society (NVS), Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden
| | - L Olson
- Department of Neuroscience, Retzius Laboratory, Karolinska Institutet, Stockholm, Sweden
| | - J Andersson
- Department of Medicine, Center for Infectious Medicine (CIM), Karolinska Institutet, Stockholm, Sweden
| | - G Johansson
- Department of Neurobiology, Care Sciences and Society (NVS), Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden
| | - B Winblad
- Department of Neurobiology, Care Sciences and Society (NVS), Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden
| |
Collapse
|
46
|
Abstract
There are around 30 human diseases associated with protein misfolding and amyloid formation, each one caused by a certain protein or peptide. Many of these diseases are lethal and together they pose an enormous burden to society. The prion protein has attracted particular interest as being shown to be the pathogenic agent in transmissible diseases such as kuru, Creutzfeldt-Jakob disease and bovine spongiform encephalopathy. Whether similar transmission could occur also in other amyloidoses such as Alzheimer's disease, Parkinson's disease and serum amyloid A amyloidosis is a matter of intense research and debate. Furthermore, it has been suggested that novel biomaterials such as artificial spider silk are potentially amyloidogenic. Here, we provide a brief introduction to amyloid, prions and other proteins involved in amyloid disease and review recent evidence for their potential transmission. We discuss the similarities and differences between amyloid and silk, as well as the potential hazards associated with protein-based biomaterials.
Collapse
Affiliation(s)
- L O Tjernberg
- Department of Neurobiology Care Sciences and Society, Division of Neurogeriatrics, Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden
| | - A Rising
- Department of Neurobiology Care Sciences and Society, Division of Neurogeriatrics, Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden.,Department of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - J Johansson
- Department of Neurobiology Care Sciences and Society, Division of Neurogeriatrics, Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden.,Department of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - K Jaudzems
- Latvian Institute of Organic Synthesis, Riga, Latvia
| | - P Westermark
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
47
|
Niiranen TJ, Lindroos A, Johansson J, Puukka P, Kantola I. Nighttime Blood Pressure Measured with a Timer-Equipped Home Device - An Alternative to Nighttime Ambulatory Monitoring. J Am Soc Hypertens 2016; 10 Suppl 1:e2. [PMID: 27677131 DOI: 10.1016/j.jash.2016.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- T J Niiranen
- Framingham Heart Study, Framingham, MA; National Institute for Health and Welfare, Turku, Finland
| | - A Lindroos
- National Institute for Health and Welfare, Turku, Finland
| | - J Johansson
- National Institute for Health and Welfare, Turku, Finland
| | - P Puukka
- National Institute for Health and Welfare, Turku, Finland
| | - I Kantola
- Turku University Hospital, Turku, Finland
| |
Collapse
|
48
|
Vercellone S, Caldrer S, Johansson J, Buffelli M, Melotti P, Sorio C. 22 Testing flow cytometry to detect CFTR expression recovery after drug treatment in epithelial cell lines. J Cyst Fibros 2016. [DOI: 10.1016/s1569-1993(16)30262-4] [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: 10/21/2022]
|
49
|
Johansson J, Sjöberg F. Response to the article by Jämsä. Leukocyte receptor expression as a biomarker for severe sepsis. Acta Anaesthesiol Scand 2016; 60:407-8. [PMID: 26482839 DOI: 10.1111/aas.12647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
50
|
Domigan LJ, Andersson M, Alberti KA, Chesler M, Xu Q, Johansson J, Rising A, Kaplan DL. Carbonic anhydrase generates a pH gradient in Bombyx mori silk glands. Insect Biochem Mol Biol 2015; 65:100-6. [PMID: 26365738 PMCID: PMC4628561 DOI: 10.1016/j.ibmb.2015.09.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 09/02/2015] [Accepted: 09/03/2015] [Indexed: 05/08/2023]
Abstract
Silk is a protein of interest to both biological and industrial sciences. The silkworm, Bombyx mori, forms this protein into strong threads starting from soluble silk proteins using a number of biochemical and physical cues to allow the transition from liquid to fibrous silk. A pH gradient has been measured along the gland, but the methodology employed was not able to precisely determine the pH at specific regions of interest in the silk gland. Furthermore, the physiological mechanisms responsible for the generation of this pH gradient are unknown. In this study, concentric ion selective microelectrodes were used to determine the luminal pH of B. mori silk glands. A gradient from pH 8.2 to 7.2 was measured in the posterior silk gland, with a pH 7 throughout the middle silk gland, and a gradient from pH 6.8 to 6.2 in the beginning of the anterior silk gland where silk processing into fibers occurs. The small diameter of the most anterior region of the anterior silk gland prevented microelectrode access in this region. Using a histochemical method, the presence of active carbonic anhydrase was identified in the funnel and anterior silk gland of fifth instar larvae. The observed pH gradient collapsed upon addition of the carbonic anhydrase inhibitor methazolamide, confirming an essential role for this enzyme in pH regulation in the B. mori silk gland. Plastic embedding of whole silk glands allowed clear visualization of the morphology, including the identification of four distinct epithelial cell types in the gland and allowed correlations between silk gland morphology and silk stages of assembly related to the pH gradient. B. mori silk glands have four different epithelial cell types, one of which produces carbonic anhydrase. Carbonic anhydrase is necessary for the mechanism that generates an intraluminal pH gradient, which likely regulates the assembly of silk proteins and then the formation of fibers from soluble silk proteins. These new insights into native silk formation may lead to a more efficient production of artificial or regenerated silkworm silk fibers.
Collapse
Affiliation(s)
- L J Domigan
- Department of Biomedical Engineering, Tufts University, Medford, MA, USA; School of Biological Sciences, The University of Auckland, Auckland, New Zealand
| | - M Andersson
- Department of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - K A Alberti
- Department of Biomedical Engineering, Tufts University, Medford, MA, USA
| | - M Chesler
- Department of Neurosurgery, Physiology and Neuroscience, New York University School of Medicine, New York, NY, USA
| | - Q Xu
- Department of Biomedical Engineering, Tufts University, Medford, MA, USA
| | - J Johansson
- Department of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, Uppsala, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden; Institute of Mathematics and Natural Sciences, Tallinn University, Tallinn, Estonia
| | - A Rising
- Department of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, Uppsala, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden.
| | - D L Kaplan
- Department of Biomedical Engineering, Tufts University, Medford, MA, USA.
| |
Collapse
|