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Bertonnier‐Brouty L, Andersson J, Kaprio T, Hagström J, Bsharat S, Asplund O, Hatem G, Haglund C, Seppänen H, Prasad RB, Artner I. E2F transcription factors promote tumorigenicity in pancreatic ductal adenocarcinoma. Cancer Med 2024; 13:e7187. [PMID: 38686617 PMCID: PMC11058697 DOI: 10.1002/cam4.7187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 03/14/2024] [Accepted: 04/02/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal cancers with limited treatment options, illustrating an urgent need to identify new drugable targets in PDACs. OBJECTIVE Using the similarities between tumor development and normal embryonic development, which is accompanied by rapid cell expansion, we aimed to identify and characterize embryonic signaling pathways that were reinitiated during tumor formation and expansion. METHODS AND RESULTS Here, we report that the transcription factors E2F1 and E2F8 are potential key regulators in PDAC. E2F1 and E2F8 RNA expression is mainly localized in proliferating cells in the developing pancreas and in malignant ductal cells in PDAC. Silencing of E2F1 and E2F8 in PANC-1 pancreatic tumor cells inhibited cell proliferation and impaired cell spreading and migration. Moreover, loss of E2F1 also affected cell viability and apoptosis with E2F expression in PDAC tissues correlating with expression of apoptosis and mitosis pathway genes, suggesting that E2F factors promote cell cycle regulation and tumorigenesis in PDAC cells. CONCLUSION Our findings illustrate that E2F1 and E2F8 transcription factors are expressed in pancreatic progenitor and PDAC cells, where they contribute to tumor cell expansion by regulation of cell proliferation, viability, and cell migration making these genes attractive therapeutic targets and potential prognostic markers for pancreatic cancer.
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Affiliation(s)
- Ludivine Bertonnier‐Brouty
- Lund Stem Cell CenterLund UniversityLundSweden
- Lund University Diabetes Center, Lund UniversityMalmöSweden
| | | | - Tuomas Kaprio
- Department of SurgeryHelsinki University HospitalHelsinkiFinland
- Translational Cancer Medicine Research Program, Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- iCAN, Digital Cancer Precision MedicineUniversity of Helsinki and HUS Helsinki University HospitalHelsinkiFinland
| | - Jaana Hagström
- Department of SurgeryHelsinki University HospitalHelsinkiFinland
- Translational Cancer Medicine Research Program, Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- iCAN, Digital Cancer Precision MedicineUniversity of Helsinki and HUS Helsinki University HospitalHelsinkiFinland
- Department of Oral Pathology and RadiologyUniversity of TurkuTurkuFinland
| | - Sara Bsharat
- Lund Stem Cell CenterLund UniversityLundSweden
- Lund University Diabetes Center, Lund UniversityMalmöSweden
| | - Olof Asplund
- Lund University Diabetes Center, Lund UniversityMalmöSweden
| | - Gad Hatem
- Lund University Diabetes Center, Lund UniversityMalmöSweden
| | - Caj Haglund
- Department of SurgeryHelsinki University HospitalHelsinkiFinland
- Translational Cancer Medicine Research Program, Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- iCAN, Digital Cancer Precision MedicineUniversity of Helsinki and HUS Helsinki University HospitalHelsinkiFinland
| | - Hanna Seppänen
- Department of SurgeryHelsinki University HospitalHelsinkiFinland
- Translational Cancer Medicine Research Program, Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- iCAN, Digital Cancer Precision MedicineUniversity of Helsinki and HUS Helsinki University HospitalHelsinkiFinland
| | | | - Isabella Artner
- Lund Stem Cell CenterLund UniversityLundSweden
- Lund University Diabetes Center, Lund UniversityMalmöSweden
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Böhm F, Mogensen B, Engstrøm T, Stankovic G, Srdanovic I, Lønborg J, Zwackman S, Hamid M, Kellerth T, Lauermann J, Kajander OA, Andersson J, Linder R, Angerås O, Renlund H, Ērglis A, Menon M, Schultz C, Laine M, Held C, Rück A, Östlund O, James S. FFR-Guided Complete or Culprit-Only PCI in Patients with Myocardial Infarction. N Engl J Med 2024; 390:1481-1492. [PMID: 38587995 DOI: 10.1056/nejmoa2314149] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
BACKGROUND The benefit of fractional flow reserve (FFR)-guided complete revascularization in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease remains unclear. METHODS In this multinational, registry-based, randomized trial, we assigned patients with STEMI or very-high-risk non-STEMI (NSTEMI) and multivessel disease who were undergoing primary percutaneous coronary intervention (PCI) of the culprit lesion to receive either FFR-guided complete revascularization of nonculprit lesions or no further revascularization. The primary outcome was a composite of death from any cause, myocardial infarction, or unplanned revascularization. The two key secondary outcomes were a composite of death from any cause or myocardial infarction and unplanned revascularization. RESULTS A total of 1542 patients underwent randomization, with 764 assigned to receive FFR-guided complete revascularization and 778 assigned to receive culprit-lesion-only PCI. At a median follow-up of 4.8 years (interquartile range, 4.3 to 5.2), a primary-outcome event had occurred in 145 patients (19.0%) in the complete-revascularization group and in 159 patients (20.4%) in the culprit-lesion-only group (hazard ratio, 0.93; 95% confidence interval [CI], 0.74 to 1.17; P = 0.53). With respect to the secondary outcomes, no apparent between-group differences were observed in the composite of death from any cause or myocardial infarction (hazard ratio, 1.12; 95% CI, 0.87 to 1.44) or unplanned revascularization (hazard ratio, 0.76; 95% CI, 0.56 to 1.04). There were no apparent between-group differences in safety outcomes. CONCLUSIONS Among patients with STEMI or very-high-risk NSTEMI and multivessel coronary artery disease, FFR-guided complete revascularization was not shown to result in a lower risk of a composite of death from any cause, myocardial infarction, or unplanned revascularization than culprit-lesion-only PCI at 4.8 years. (Funded by the Swedish Research Council and others; FULL REVASC ClinicalTrials.gov number, NCT02862119.).
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Affiliation(s)
- Felix Böhm
- From the Department of Cardiology, Karolinska Institute and Danderyd Hospital, Danderyd (F.B., B.M., R.L.), the Department of Cardiology, Karolinska Institute and Karolinska University Hospital, Stockholm (A.R.), the Department of Cardiology, Linköping University Hospital, Linköping (S.Z.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Central Hospital, Karlstad (T.K.), the Department of Cardiology, Ryhov Hospital, Jönköping (J. Lauermann), the Department of Cardiology, Umeå University Hospital, Umeå (J.A.), the Department of Cardiology, Sahlgrenska University Hospital, and the Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg (O.A.), and the Department of Medical Sciences, Cardiology (H.R., C.H., O.Ö., S.J.), and Uppsala Clinical Research Center (C.H., S.J.), Uppsala University, Uppsala - all in Sweden; the Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen (T.E., J. Lønborg); the University Clinical Center of Serbia and the Faculty of Medicine, University of Belgrade, Belgrade (G.S.), and the Faculty of Medicine, University of Novi Sad, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica (I.S.) - all in Serbia; the Heart Hospital, Tampere University Hospital, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), and the Heart and Lung Center, Helsinki University Central Hospital, Helsinki (M.L.) - all in Finland; the Latvian Center of Cardiology, Pauls Stradins Clinical University Hospital, University of Latvia, Riga (A..); the Cardiology Department, Waikato Hospital, Hamilton, New Zealand (M.M.); and the Medical School, University of Western Australia, and the Department of Cardiology, Royal Perth Hospital - both in Perth, WA (C.S.)
| | - Brynjölfur Mogensen
- From the Department of Cardiology, Karolinska Institute and Danderyd Hospital, Danderyd (F.B., B.M., R.L.), the Department of Cardiology, Karolinska Institute and Karolinska University Hospital, Stockholm (A.R.), the Department of Cardiology, Linköping University Hospital, Linköping (S.Z.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Central Hospital, Karlstad (T.K.), the Department of Cardiology, Ryhov Hospital, Jönköping (J. Lauermann), the Department of Cardiology, Umeå University Hospital, Umeå (J.A.), the Department of Cardiology, Sahlgrenska University Hospital, and the Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg (O.A.), and the Department of Medical Sciences, Cardiology (H.R., C.H., O.Ö., S.J.), and Uppsala Clinical Research Center (C.H., S.J.), Uppsala University, Uppsala - all in Sweden; the Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen (T.E., J. Lønborg); the University Clinical Center of Serbia and the Faculty of Medicine, University of Belgrade, Belgrade (G.S.), and the Faculty of Medicine, University of Novi Sad, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica (I.S.) - all in Serbia; the Heart Hospital, Tampere University Hospital, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), and the Heart and Lung Center, Helsinki University Central Hospital, Helsinki (M.L.) - all in Finland; the Latvian Center of Cardiology, Pauls Stradins Clinical University Hospital, University of Latvia, Riga (A..); the Cardiology Department, Waikato Hospital, Hamilton, New Zealand (M.M.); and the Medical School, University of Western Australia, and the Department of Cardiology, Royal Perth Hospital - both in Perth, WA (C.S.)
| | - Thomas Engstrøm
- From the Department of Cardiology, Karolinska Institute and Danderyd Hospital, Danderyd (F.B., B.M., R.L.), the Department of Cardiology, Karolinska Institute and Karolinska University Hospital, Stockholm (A.R.), the Department of Cardiology, Linköping University Hospital, Linköping (S.Z.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Central Hospital, Karlstad (T.K.), the Department of Cardiology, Ryhov Hospital, Jönköping (J. Lauermann), the Department of Cardiology, Umeå University Hospital, Umeå (J.A.), the Department of Cardiology, Sahlgrenska University Hospital, and the Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg (O.A.), and the Department of Medical Sciences, Cardiology (H.R., C.H., O.Ö., S.J.), and Uppsala Clinical Research Center (C.H., S.J.), Uppsala University, Uppsala - all in Sweden; the Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen (T.E., J. Lønborg); the University Clinical Center of Serbia and the Faculty of Medicine, University of Belgrade, Belgrade (G.S.), and the Faculty of Medicine, University of Novi Sad, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica (I.S.) - all in Serbia; the Heart Hospital, Tampere University Hospital, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), and the Heart and Lung Center, Helsinki University Central Hospital, Helsinki (M.L.) - all in Finland; the Latvian Center of Cardiology, Pauls Stradins Clinical University Hospital, University of Latvia, Riga (A..); the Cardiology Department, Waikato Hospital, Hamilton, New Zealand (M.M.); and the Medical School, University of Western Australia, and the Department of Cardiology, Royal Perth Hospital - both in Perth, WA (C.S.)
| | - Goran Stankovic
- From the Department of Cardiology, Karolinska Institute and Danderyd Hospital, Danderyd (F.B., B.M., R.L.), the Department of Cardiology, Karolinska Institute and Karolinska University Hospital, Stockholm (A.R.), the Department of Cardiology, Linköping University Hospital, Linköping (S.Z.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Central Hospital, Karlstad (T.K.), the Department of Cardiology, Ryhov Hospital, Jönköping (J. Lauermann), the Department of Cardiology, Umeå University Hospital, Umeå (J.A.), the Department of Cardiology, Sahlgrenska University Hospital, and the Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg (O.A.), and the Department of Medical Sciences, Cardiology (H.R., C.H., O.Ö., S.J.), and Uppsala Clinical Research Center (C.H., S.J.), Uppsala University, Uppsala - all in Sweden; the Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen (T.E., J. Lønborg); the University Clinical Center of Serbia and the Faculty of Medicine, University of Belgrade, Belgrade (G.S.), and the Faculty of Medicine, University of Novi Sad, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica (I.S.) - all in Serbia; the Heart Hospital, Tampere University Hospital, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), and the Heart and Lung Center, Helsinki University Central Hospital, Helsinki (M.L.) - all in Finland; the Latvian Center of Cardiology, Pauls Stradins Clinical University Hospital, University of Latvia, Riga (A..); the Cardiology Department, Waikato Hospital, Hamilton, New Zealand (M.M.); and the Medical School, University of Western Australia, and the Department of Cardiology, Royal Perth Hospital - both in Perth, WA (C.S.)
| | - Ilija Srdanovic
- From the Department of Cardiology, Karolinska Institute and Danderyd Hospital, Danderyd (F.B., B.M., R.L.), the Department of Cardiology, Karolinska Institute and Karolinska University Hospital, Stockholm (A.R.), the Department of Cardiology, Linköping University Hospital, Linköping (S.Z.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Central Hospital, Karlstad (T.K.), the Department of Cardiology, Ryhov Hospital, Jönköping (J. Lauermann), the Department of Cardiology, Umeå University Hospital, Umeå (J.A.), the Department of Cardiology, Sahlgrenska University Hospital, and the Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg (O.A.), and the Department of Medical Sciences, Cardiology (H.R., C.H., O.Ö., S.J.), and Uppsala Clinical Research Center (C.H., S.J.), Uppsala University, Uppsala - all in Sweden; the Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen (T.E., J. Lønborg); the University Clinical Center of Serbia and the Faculty of Medicine, University of Belgrade, Belgrade (G.S.), and the Faculty of Medicine, University of Novi Sad, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica (I.S.) - all in Serbia; the Heart Hospital, Tampere University Hospital, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), and the Heart and Lung Center, Helsinki University Central Hospital, Helsinki (M.L.) - all in Finland; the Latvian Center of Cardiology, Pauls Stradins Clinical University Hospital, University of Latvia, Riga (A..); the Cardiology Department, Waikato Hospital, Hamilton, New Zealand (M.M.); and the Medical School, University of Western Australia, and the Department of Cardiology, Royal Perth Hospital - both in Perth, WA (C.S.)
| | - Jacob Lønborg
- From the Department of Cardiology, Karolinska Institute and Danderyd Hospital, Danderyd (F.B., B.M., R.L.), the Department of Cardiology, Karolinska Institute and Karolinska University Hospital, Stockholm (A.R.), the Department of Cardiology, Linköping University Hospital, Linköping (S.Z.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Central Hospital, Karlstad (T.K.), the Department of Cardiology, Ryhov Hospital, Jönköping (J. Lauermann), the Department of Cardiology, Umeå University Hospital, Umeå (J.A.), the Department of Cardiology, Sahlgrenska University Hospital, and the Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg (O.A.), and the Department of Medical Sciences, Cardiology (H.R., C.H., O.Ö., S.J.), and Uppsala Clinical Research Center (C.H., S.J.), Uppsala University, Uppsala - all in Sweden; the Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen (T.E., J. Lønborg); the University Clinical Center of Serbia and the Faculty of Medicine, University of Belgrade, Belgrade (G.S.), and the Faculty of Medicine, University of Novi Sad, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica (I.S.) - all in Serbia; the Heart Hospital, Tampere University Hospital, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), and the Heart and Lung Center, Helsinki University Central Hospital, Helsinki (M.L.) - all in Finland; the Latvian Center of Cardiology, Pauls Stradins Clinical University Hospital, University of Latvia, Riga (A..); the Cardiology Department, Waikato Hospital, Hamilton, New Zealand (M.M.); and the Medical School, University of Western Australia, and the Department of Cardiology, Royal Perth Hospital - both in Perth, WA (C.S.)
| | - Sammy Zwackman
- From the Department of Cardiology, Karolinska Institute and Danderyd Hospital, Danderyd (F.B., B.M., R.L.), the Department of Cardiology, Karolinska Institute and Karolinska University Hospital, Stockholm (A.R.), the Department of Cardiology, Linköping University Hospital, Linköping (S.Z.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Central Hospital, Karlstad (T.K.), the Department of Cardiology, Ryhov Hospital, Jönköping (J. Lauermann), the Department of Cardiology, Umeå University Hospital, Umeå (J.A.), the Department of Cardiology, Sahlgrenska University Hospital, and the Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg (O.A.), and the Department of Medical Sciences, Cardiology (H.R., C.H., O.Ö., S.J.), and Uppsala Clinical Research Center (C.H., S.J.), Uppsala University, Uppsala - all in Sweden; the Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen (T.E., J. Lønborg); the University Clinical Center of Serbia and the Faculty of Medicine, University of Belgrade, Belgrade (G.S.), and the Faculty of Medicine, University of Novi Sad, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica (I.S.) - all in Serbia; the Heart Hospital, Tampere University Hospital, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), and the Heart and Lung Center, Helsinki University Central Hospital, Helsinki (M.L.) - all in Finland; the Latvian Center of Cardiology, Pauls Stradins Clinical University Hospital, University of Latvia, Riga (A..); the Cardiology Department, Waikato Hospital, Hamilton, New Zealand (M.M.); and the Medical School, University of Western Australia, and the Department of Cardiology, Royal Perth Hospital - both in Perth, WA (C.S.)
| | - Mehmet Hamid
- From the Department of Cardiology, Karolinska Institute and Danderyd Hospital, Danderyd (F.B., B.M., R.L.), the Department of Cardiology, Karolinska Institute and Karolinska University Hospital, Stockholm (A.R.), the Department of Cardiology, Linköping University Hospital, Linköping (S.Z.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Central Hospital, Karlstad (T.K.), the Department of Cardiology, Ryhov Hospital, Jönköping (J. Lauermann), the Department of Cardiology, Umeå University Hospital, Umeå (J.A.), the Department of Cardiology, Sahlgrenska University Hospital, and the Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg (O.A.), and the Department of Medical Sciences, Cardiology (H.R., C.H., O.Ö., S.J.), and Uppsala Clinical Research Center (C.H., S.J.), Uppsala University, Uppsala - all in Sweden; the Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen (T.E., J. Lønborg); the University Clinical Center of Serbia and the Faculty of Medicine, University of Belgrade, Belgrade (G.S.), and the Faculty of Medicine, University of Novi Sad, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica (I.S.) - all in Serbia; the Heart Hospital, Tampere University Hospital, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), and the Heart and Lung Center, Helsinki University Central Hospital, Helsinki (M.L.) - all in Finland; the Latvian Center of Cardiology, Pauls Stradins Clinical University Hospital, University of Latvia, Riga (A..); the Cardiology Department, Waikato Hospital, Hamilton, New Zealand (M.M.); and the Medical School, University of Western Australia, and the Department of Cardiology, Royal Perth Hospital - both in Perth, WA (C.S.)
| | - Thomas Kellerth
- From the Department of Cardiology, Karolinska Institute and Danderyd Hospital, Danderyd (F.B., B.M., R.L.), the Department of Cardiology, Karolinska Institute and Karolinska University Hospital, Stockholm (A.R.), the Department of Cardiology, Linköping University Hospital, Linköping (S.Z.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Central Hospital, Karlstad (T.K.), the Department of Cardiology, Ryhov Hospital, Jönköping (J. Lauermann), the Department of Cardiology, Umeå University Hospital, Umeå (J.A.), the Department of Cardiology, Sahlgrenska University Hospital, and the Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg (O.A.), and the Department of Medical Sciences, Cardiology (H.R., C.H., O.Ö., S.J.), and Uppsala Clinical Research Center (C.H., S.J.), Uppsala University, Uppsala - all in Sweden; the Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen (T.E., J. Lønborg); the University Clinical Center of Serbia and the Faculty of Medicine, University of Belgrade, Belgrade (G.S.), and the Faculty of Medicine, University of Novi Sad, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica (I.S.) - all in Serbia; the Heart Hospital, Tampere University Hospital, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), and the Heart and Lung Center, Helsinki University Central Hospital, Helsinki (M.L.) - all in Finland; the Latvian Center of Cardiology, Pauls Stradins Clinical University Hospital, University of Latvia, Riga (A..); the Cardiology Department, Waikato Hospital, Hamilton, New Zealand (M.M.); and the Medical School, University of Western Australia, and the Department of Cardiology, Royal Perth Hospital - both in Perth, WA (C.S.)
| | - Jörg Lauermann
- From the Department of Cardiology, Karolinska Institute and Danderyd Hospital, Danderyd (F.B., B.M., R.L.), the Department of Cardiology, Karolinska Institute and Karolinska University Hospital, Stockholm (A.R.), the Department of Cardiology, Linköping University Hospital, Linköping (S.Z.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Central Hospital, Karlstad (T.K.), the Department of Cardiology, Ryhov Hospital, Jönköping (J. Lauermann), the Department of Cardiology, Umeå University Hospital, Umeå (J.A.), the Department of Cardiology, Sahlgrenska University Hospital, and the Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg (O.A.), and the Department of Medical Sciences, Cardiology (H.R., C.H., O.Ö., S.J.), and Uppsala Clinical Research Center (C.H., S.J.), Uppsala University, Uppsala - all in Sweden; the Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen (T.E., J. Lønborg); the University Clinical Center of Serbia and the Faculty of Medicine, University of Belgrade, Belgrade (G.S.), and the Faculty of Medicine, University of Novi Sad, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica (I.S.) - all in Serbia; the Heart Hospital, Tampere University Hospital, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), and the Heart and Lung Center, Helsinki University Central Hospital, Helsinki (M.L.) - all in Finland; the Latvian Center of Cardiology, Pauls Stradins Clinical University Hospital, University of Latvia, Riga (A..); the Cardiology Department, Waikato Hospital, Hamilton, New Zealand (M.M.); and the Medical School, University of Western Australia, and the Department of Cardiology, Royal Perth Hospital - both in Perth, WA (C.S.)
| | - Olli A Kajander
- From the Department of Cardiology, Karolinska Institute and Danderyd Hospital, Danderyd (F.B., B.M., R.L.), the Department of Cardiology, Karolinska Institute and Karolinska University Hospital, Stockholm (A.R.), the Department of Cardiology, Linköping University Hospital, Linköping (S.Z.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Central Hospital, Karlstad (T.K.), the Department of Cardiology, Ryhov Hospital, Jönköping (J. Lauermann), the Department of Cardiology, Umeå University Hospital, Umeå (J.A.), the Department of Cardiology, Sahlgrenska University Hospital, and the Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg (O.A.), and the Department of Medical Sciences, Cardiology (H.R., C.H., O.Ö., S.J.), and Uppsala Clinical Research Center (C.H., S.J.), Uppsala University, Uppsala - all in Sweden; the Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen (T.E., J. Lønborg); the University Clinical Center of Serbia and the Faculty of Medicine, University of Belgrade, Belgrade (G.S.), and the Faculty of Medicine, University of Novi Sad, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica (I.S.) - all in Serbia; the Heart Hospital, Tampere University Hospital, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), and the Heart and Lung Center, Helsinki University Central Hospital, Helsinki (M.L.) - all in Finland; the Latvian Center of Cardiology, Pauls Stradins Clinical University Hospital, University of Latvia, Riga (A..); the Cardiology Department, Waikato Hospital, Hamilton, New Zealand (M.M.); and the Medical School, University of Western Australia, and the Department of Cardiology, Royal Perth Hospital - both in Perth, WA (C.S.)
| | - Jonas Andersson
- From the Department of Cardiology, Karolinska Institute and Danderyd Hospital, Danderyd (F.B., B.M., R.L.), the Department of Cardiology, Karolinska Institute and Karolinska University Hospital, Stockholm (A.R.), the Department of Cardiology, Linköping University Hospital, Linköping (S.Z.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Central Hospital, Karlstad (T.K.), the Department of Cardiology, Ryhov Hospital, Jönköping (J. Lauermann), the Department of Cardiology, Umeå University Hospital, Umeå (J.A.), the Department of Cardiology, Sahlgrenska University Hospital, and the Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg (O.A.), and the Department of Medical Sciences, Cardiology (H.R., C.H., O.Ö., S.J.), and Uppsala Clinical Research Center (C.H., S.J.), Uppsala University, Uppsala - all in Sweden; the Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen (T.E., J. Lønborg); the University Clinical Center of Serbia and the Faculty of Medicine, University of Belgrade, Belgrade (G.S.), and the Faculty of Medicine, University of Novi Sad, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica (I.S.) - all in Serbia; the Heart Hospital, Tampere University Hospital, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), and the Heart and Lung Center, Helsinki University Central Hospital, Helsinki (M.L.) - all in Finland; the Latvian Center of Cardiology, Pauls Stradins Clinical University Hospital, University of Latvia, Riga (A..); the Cardiology Department, Waikato Hospital, Hamilton, New Zealand (M.M.); and the Medical School, University of Western Australia, and the Department of Cardiology, Royal Perth Hospital - both in Perth, WA (C.S.)
| | - Rikard Linder
- From the Department of Cardiology, Karolinska Institute and Danderyd Hospital, Danderyd (F.B., B.M., R.L.), the Department of Cardiology, Karolinska Institute and Karolinska University Hospital, Stockholm (A.R.), the Department of Cardiology, Linköping University Hospital, Linköping (S.Z.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Central Hospital, Karlstad (T.K.), the Department of Cardiology, Ryhov Hospital, Jönköping (J. Lauermann), the Department of Cardiology, Umeå University Hospital, Umeå (J.A.), the Department of Cardiology, Sahlgrenska University Hospital, and the Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg (O.A.), and the Department of Medical Sciences, Cardiology (H.R., C.H., O.Ö., S.J.), and Uppsala Clinical Research Center (C.H., S.J.), Uppsala University, Uppsala - all in Sweden; the Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen (T.E., J. Lønborg); the University Clinical Center of Serbia and the Faculty of Medicine, University of Belgrade, Belgrade (G.S.), and the Faculty of Medicine, University of Novi Sad, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica (I.S.) - all in Serbia; the Heart Hospital, Tampere University Hospital, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), and the Heart and Lung Center, Helsinki University Central Hospital, Helsinki (M.L.) - all in Finland; the Latvian Center of Cardiology, Pauls Stradins Clinical University Hospital, University of Latvia, Riga (A..); the Cardiology Department, Waikato Hospital, Hamilton, New Zealand (M.M.); and the Medical School, University of Western Australia, and the Department of Cardiology, Royal Perth Hospital - both in Perth, WA (C.S.)
| | - Oskar Angerås
- From the Department of Cardiology, Karolinska Institute and Danderyd Hospital, Danderyd (F.B., B.M., R.L.), the Department of Cardiology, Karolinska Institute and Karolinska University Hospital, Stockholm (A.R.), the Department of Cardiology, Linköping University Hospital, Linköping (S.Z.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Central Hospital, Karlstad (T.K.), the Department of Cardiology, Ryhov Hospital, Jönköping (J. Lauermann), the Department of Cardiology, Umeå University Hospital, Umeå (J.A.), the Department of Cardiology, Sahlgrenska University Hospital, and the Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg (O.A.), and the Department of Medical Sciences, Cardiology (H.R., C.H., O.Ö., S.J.), and Uppsala Clinical Research Center (C.H., S.J.), Uppsala University, Uppsala - all in Sweden; the Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen (T.E., J. Lønborg); the University Clinical Center of Serbia and the Faculty of Medicine, University of Belgrade, Belgrade (G.S.), and the Faculty of Medicine, University of Novi Sad, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica (I.S.) - all in Serbia; the Heart Hospital, Tampere University Hospital, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), and the Heart and Lung Center, Helsinki University Central Hospital, Helsinki (M.L.) - all in Finland; the Latvian Center of Cardiology, Pauls Stradins Clinical University Hospital, University of Latvia, Riga (A..); the Cardiology Department, Waikato Hospital, Hamilton, New Zealand (M.M.); and the Medical School, University of Western Australia, and the Department of Cardiology, Royal Perth Hospital - both in Perth, WA (C.S.)
| | - Henrik Renlund
- From the Department of Cardiology, Karolinska Institute and Danderyd Hospital, Danderyd (F.B., B.M., R.L.), the Department of Cardiology, Karolinska Institute and Karolinska University Hospital, Stockholm (A.R.), the Department of Cardiology, Linköping University Hospital, Linköping (S.Z.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Central Hospital, Karlstad (T.K.), the Department of Cardiology, Ryhov Hospital, Jönköping (J. Lauermann), the Department of Cardiology, Umeå University Hospital, Umeå (J.A.), the Department of Cardiology, Sahlgrenska University Hospital, and the Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg (O.A.), and the Department of Medical Sciences, Cardiology (H.R., C.H., O.Ö., S.J.), and Uppsala Clinical Research Center (C.H., S.J.), Uppsala University, Uppsala - all in Sweden; the Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen (T.E., J. Lønborg); the University Clinical Center of Serbia and the Faculty of Medicine, University of Belgrade, Belgrade (G.S.), and the Faculty of Medicine, University of Novi Sad, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica (I.S.) - all in Serbia; the Heart Hospital, Tampere University Hospital, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), and the Heart and Lung Center, Helsinki University Central Hospital, Helsinki (M.L.) - all in Finland; the Latvian Center of Cardiology, Pauls Stradins Clinical University Hospital, University of Latvia, Riga (A..); the Cardiology Department, Waikato Hospital, Hamilton, New Zealand (M.M.); and the Medical School, University of Western Australia, and the Department of Cardiology, Royal Perth Hospital - both in Perth, WA (C.S.)
| | - Andrejs Ērglis
- From the Department of Cardiology, Karolinska Institute and Danderyd Hospital, Danderyd (F.B., B.M., R.L.), the Department of Cardiology, Karolinska Institute and Karolinska University Hospital, Stockholm (A.R.), the Department of Cardiology, Linköping University Hospital, Linköping (S.Z.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Central Hospital, Karlstad (T.K.), the Department of Cardiology, Ryhov Hospital, Jönköping (J. Lauermann), the Department of Cardiology, Umeå University Hospital, Umeå (J.A.), the Department of Cardiology, Sahlgrenska University Hospital, and the Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg (O.A.), and the Department of Medical Sciences, Cardiology (H.R., C.H., O.Ö., S.J.), and Uppsala Clinical Research Center (C.H., S.J.), Uppsala University, Uppsala - all in Sweden; the Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen (T.E., J. Lønborg); the University Clinical Center of Serbia and the Faculty of Medicine, University of Belgrade, Belgrade (G.S.), and the Faculty of Medicine, University of Novi Sad, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica (I.S.) - all in Serbia; the Heart Hospital, Tampere University Hospital, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), and the Heart and Lung Center, Helsinki University Central Hospital, Helsinki (M.L.) - all in Finland; the Latvian Center of Cardiology, Pauls Stradins Clinical University Hospital, University of Latvia, Riga (A..); the Cardiology Department, Waikato Hospital, Hamilton, New Zealand (M.M.); and the Medical School, University of Western Australia, and the Department of Cardiology, Royal Perth Hospital - both in Perth, WA (C.S.)
| | - Madhav Menon
- From the Department of Cardiology, Karolinska Institute and Danderyd Hospital, Danderyd (F.B., B.M., R.L.), the Department of Cardiology, Karolinska Institute and Karolinska University Hospital, Stockholm (A.R.), the Department of Cardiology, Linköping University Hospital, Linköping (S.Z.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Central Hospital, Karlstad (T.K.), the Department of Cardiology, Ryhov Hospital, Jönköping (J. Lauermann), the Department of Cardiology, Umeå University Hospital, Umeå (J.A.), the Department of Cardiology, Sahlgrenska University Hospital, and the Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg (O.A.), and the Department of Medical Sciences, Cardiology (H.R., C.H., O.Ö., S.J.), and Uppsala Clinical Research Center (C.H., S.J.), Uppsala University, Uppsala - all in Sweden; the Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen (T.E., J. Lønborg); the University Clinical Center of Serbia and the Faculty of Medicine, University of Belgrade, Belgrade (G.S.), and the Faculty of Medicine, University of Novi Sad, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica (I.S.) - all in Serbia; the Heart Hospital, Tampere University Hospital, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), and the Heart and Lung Center, Helsinki University Central Hospital, Helsinki (M.L.) - all in Finland; the Latvian Center of Cardiology, Pauls Stradins Clinical University Hospital, University of Latvia, Riga (A..); the Cardiology Department, Waikato Hospital, Hamilton, New Zealand (M.M.); and the Medical School, University of Western Australia, and the Department of Cardiology, Royal Perth Hospital - both in Perth, WA (C.S.)
| | - Carl Schultz
- From the Department of Cardiology, Karolinska Institute and Danderyd Hospital, Danderyd (F.B., B.M., R.L.), the Department of Cardiology, Karolinska Institute and Karolinska University Hospital, Stockholm (A.R.), the Department of Cardiology, Linköping University Hospital, Linköping (S.Z.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Central Hospital, Karlstad (T.K.), the Department of Cardiology, Ryhov Hospital, Jönköping (J. Lauermann), the Department of Cardiology, Umeå University Hospital, Umeå (J.A.), the Department of Cardiology, Sahlgrenska University Hospital, and the Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg (O.A.), and the Department of Medical Sciences, Cardiology (H.R., C.H., O.Ö., S.J.), and Uppsala Clinical Research Center (C.H., S.J.), Uppsala University, Uppsala - all in Sweden; the Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen (T.E., J. Lønborg); the University Clinical Center of Serbia and the Faculty of Medicine, University of Belgrade, Belgrade (G.S.), and the Faculty of Medicine, University of Novi Sad, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica (I.S.) - all in Serbia; the Heart Hospital, Tampere University Hospital, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), and the Heart and Lung Center, Helsinki University Central Hospital, Helsinki (M.L.) - all in Finland; the Latvian Center of Cardiology, Pauls Stradins Clinical University Hospital, University of Latvia, Riga (A..); the Cardiology Department, Waikato Hospital, Hamilton, New Zealand (M.M.); and the Medical School, University of Western Australia, and the Department of Cardiology, Royal Perth Hospital - both in Perth, WA (C.S.)
| | - Mika Laine
- From the Department of Cardiology, Karolinska Institute and Danderyd Hospital, Danderyd (F.B., B.M., R.L.), the Department of Cardiology, Karolinska Institute and Karolinska University Hospital, Stockholm (A.R.), the Department of Cardiology, Linköping University Hospital, Linköping (S.Z.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Central Hospital, Karlstad (T.K.), the Department of Cardiology, Ryhov Hospital, Jönköping (J. Lauermann), the Department of Cardiology, Umeå University Hospital, Umeå (J.A.), the Department of Cardiology, Sahlgrenska University Hospital, and the Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg (O.A.), and the Department of Medical Sciences, Cardiology (H.R., C.H., O.Ö., S.J.), and Uppsala Clinical Research Center (C.H., S.J.), Uppsala University, Uppsala - all in Sweden; the Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen (T.E., J. Lønborg); the University Clinical Center of Serbia and the Faculty of Medicine, University of Belgrade, Belgrade (G.S.), and the Faculty of Medicine, University of Novi Sad, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica (I.S.) - all in Serbia; the Heart Hospital, Tampere University Hospital, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), and the Heart and Lung Center, Helsinki University Central Hospital, Helsinki (M.L.) - all in Finland; the Latvian Center of Cardiology, Pauls Stradins Clinical University Hospital, University of Latvia, Riga (A..); the Cardiology Department, Waikato Hospital, Hamilton, New Zealand (M.M.); and the Medical School, University of Western Australia, and the Department of Cardiology, Royal Perth Hospital - both in Perth, WA (C.S.)
| | - Claes Held
- From the Department of Cardiology, Karolinska Institute and Danderyd Hospital, Danderyd (F.B., B.M., R.L.), the Department of Cardiology, Karolinska Institute and Karolinska University Hospital, Stockholm (A.R.), the Department of Cardiology, Linköping University Hospital, Linköping (S.Z.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Central Hospital, Karlstad (T.K.), the Department of Cardiology, Ryhov Hospital, Jönköping (J. Lauermann), the Department of Cardiology, Umeå University Hospital, Umeå (J.A.), the Department of Cardiology, Sahlgrenska University Hospital, and the Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg (O.A.), and the Department of Medical Sciences, Cardiology (H.R., C.H., O.Ö., S.J.), and Uppsala Clinical Research Center (C.H., S.J.), Uppsala University, Uppsala - all in Sweden; the Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen (T.E., J. Lønborg); the University Clinical Center of Serbia and the Faculty of Medicine, University of Belgrade, Belgrade (G.S.), and the Faculty of Medicine, University of Novi Sad, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica (I.S.) - all in Serbia; the Heart Hospital, Tampere University Hospital, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), and the Heart and Lung Center, Helsinki University Central Hospital, Helsinki (M.L.) - all in Finland; the Latvian Center of Cardiology, Pauls Stradins Clinical University Hospital, University of Latvia, Riga (A..); the Cardiology Department, Waikato Hospital, Hamilton, New Zealand (M.M.); and the Medical School, University of Western Australia, and the Department of Cardiology, Royal Perth Hospital - both in Perth, WA (C.S.)
| | - Andreas Rück
- From the Department of Cardiology, Karolinska Institute and Danderyd Hospital, Danderyd (F.B., B.M., R.L.), the Department of Cardiology, Karolinska Institute and Karolinska University Hospital, Stockholm (A.R.), the Department of Cardiology, Linköping University Hospital, Linköping (S.Z.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Central Hospital, Karlstad (T.K.), the Department of Cardiology, Ryhov Hospital, Jönköping (J. Lauermann), the Department of Cardiology, Umeå University Hospital, Umeå (J.A.), the Department of Cardiology, Sahlgrenska University Hospital, and the Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg (O.A.), and the Department of Medical Sciences, Cardiology (H.R., C.H., O.Ö., S.J.), and Uppsala Clinical Research Center (C.H., S.J.), Uppsala University, Uppsala - all in Sweden; the Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen (T.E., J. Lønborg); the University Clinical Center of Serbia and the Faculty of Medicine, University of Belgrade, Belgrade (G.S.), and the Faculty of Medicine, University of Novi Sad, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica (I.S.) - all in Serbia; the Heart Hospital, Tampere University Hospital, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), and the Heart and Lung Center, Helsinki University Central Hospital, Helsinki (M.L.) - all in Finland; the Latvian Center of Cardiology, Pauls Stradins Clinical University Hospital, University of Latvia, Riga (A..); the Cardiology Department, Waikato Hospital, Hamilton, New Zealand (M.M.); and the Medical School, University of Western Australia, and the Department of Cardiology, Royal Perth Hospital - both in Perth, WA (C.S.)
| | - Ollie Östlund
- From the Department of Cardiology, Karolinska Institute and Danderyd Hospital, Danderyd (F.B., B.M., R.L.), the Department of Cardiology, Karolinska Institute and Karolinska University Hospital, Stockholm (A.R.), the Department of Cardiology, Linköping University Hospital, Linköping (S.Z.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Central Hospital, Karlstad (T.K.), the Department of Cardiology, Ryhov Hospital, Jönköping (J. Lauermann), the Department of Cardiology, Umeå University Hospital, Umeå (J.A.), the Department of Cardiology, Sahlgrenska University Hospital, and the Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg (O.A.), and the Department of Medical Sciences, Cardiology (H.R., C.H., O.Ö., S.J.), and Uppsala Clinical Research Center (C.H., S.J.), Uppsala University, Uppsala - all in Sweden; the Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen (T.E., J. Lønborg); the University Clinical Center of Serbia and the Faculty of Medicine, University of Belgrade, Belgrade (G.S.), and the Faculty of Medicine, University of Novi Sad, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica (I.S.) - all in Serbia; the Heart Hospital, Tampere University Hospital, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), and the Heart and Lung Center, Helsinki University Central Hospital, Helsinki (M.L.) - all in Finland; the Latvian Center of Cardiology, Pauls Stradins Clinical University Hospital, University of Latvia, Riga (A..); the Cardiology Department, Waikato Hospital, Hamilton, New Zealand (M.M.); and the Medical School, University of Western Australia, and the Department of Cardiology, Royal Perth Hospital - both in Perth, WA (C.S.)
| | - Stefan James
- From the Department of Cardiology, Karolinska Institute and Danderyd Hospital, Danderyd (F.B., B.M., R.L.), the Department of Cardiology, Karolinska Institute and Karolinska University Hospital, Stockholm (A.R.), the Department of Cardiology, Linköping University Hospital, Linköping (S.Z.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Central Hospital, Karlstad (T.K.), the Department of Cardiology, Ryhov Hospital, Jönköping (J. Lauermann), the Department of Cardiology, Umeå University Hospital, Umeå (J.A.), the Department of Cardiology, Sahlgrenska University Hospital, and the Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg (O.A.), and the Department of Medical Sciences, Cardiology (H.R., C.H., O.Ö., S.J.), and Uppsala Clinical Research Center (C.H., S.J.), Uppsala University, Uppsala - all in Sweden; the Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen (T.E., J. Lønborg); the University Clinical Center of Serbia and the Faculty of Medicine, University of Belgrade, Belgrade (G.S.), and the Faculty of Medicine, University of Novi Sad, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica (I.S.) - all in Serbia; the Heart Hospital, Tampere University Hospital, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), and the Heart and Lung Center, Helsinki University Central Hospital, Helsinki (M.L.) - all in Finland; the Latvian Center of Cardiology, Pauls Stradins Clinical University Hospital, University of Latvia, Riga (A..); the Cardiology Department, Waikato Hospital, Hamilton, New Zealand (M.M.); and the Medical School, University of Western Australia, and the Department of Cardiology, Royal Perth Hospital - both in Perth, WA (C.S.)
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Omerovic E, James S, Råmundal T, Fröbert O, Linder R, Danielewicz M, Hamid M, Pagonis C, Henareh L, Wagner H, Stewart J, Jensen J, Lindros P, Robertsson L, Wikström H, Ulvenstam A, Bhiladval P, Tödt T, Ioanes D, Kellerth T, Zagozdzon L, Götberg M, Andersson J, Angerås O, Östlund O, Held C, Koul S, Erlinge D. Bivalirudin versus heparin in ST and non-ST-segment elevation myocardial infarction-Outcomes at two years. Cardiovasc Revasc Med 2024:S1553-8389(24)00113-1. [PMID: 38575449 DOI: 10.1016/j.carrev.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 01/12/2024] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND The registry-based randomized VALIDATE-SWEDEHEART trial (NCT02311231) compared bivalirudin vs. heparin in patients undergoing percutaneous coronary intervention (PCI) for myocardial infarction (MI). It showed no difference in the composite primary endpoint of death, MI, or major bleeding at 180 days. Here, we report outcomes at two years. METHODS Analysis of primary and secondary endpoints at two years of follow-up was prespecified in the study protocol. We report the study results for the extended follow-up time here. RESULTS In total, 6006 patients were enrolled, 3005 with ST-segment elevation MI (STEMI) and 3001 with Non-STEMI (NSTEMI), representing 70 % of all eligible patients with these diagnoses during the study. The primary endpoint occurred in 14.0 % (421 of 3004) in the bivalirudin group compared with 14.3 % (429 of 3002) in the heparin group (hazard ratio [HR] 0.97; 95 % confidence interval [CI], 0.85-1.11; P = 0.70) at one year and in 16.7 % (503 of 3004) compared with 17.1 % (514 of 3002), (HR 0.97; 95 % CI, 0.96-1.10; P = 0.66) at two years. The results were consistent in patients with STEMI and NSTEMI and across major subgroups. CONCLUSIONS Until the two-year follow-up, there were no differences in endpoints between patients with MI undergoing PCI and allocated to bivalirudin compared with those allocated to heparin. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02311231.
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Affiliation(s)
- Elmir Omerovic
- Dept of Cardiology, Sahlgrenska University, Gothenburg, Sweden.
| | - Stefan James
- Dept of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Truls Råmundal
- Dept of Cardiology, Sahlgrenska University, Gothenburg, Sweden
| | - Ole Fröbert
- Dept of Cardiology, Örebro University, Faculty of Health, Sweden
| | - Rikard Linder
- Dept of Cardiology, Danderyd, Karolinska University, Stockholm, Sweden
| | | | - Mehmet Hamid
- Dept of Cardiology, Mälarsjukhuset, Eskilstuna, Sweden
| | - Christos Pagonis
- Dept of Cardiology, Linköping University Hospital, Linköping, Sweden
| | - Loghman Henareh
- Dept of Cardiology, Karolinska Hospital, Karolinska University, Stockholm, Sweden
| | - Henrik Wagner
- Dept of Cardiology, Helsingborg Lasarett, Helsingborg, Sweden
| | - Jason Stewart
- Dept of Cardiology, Skaraborgs Hospital, Skövde, Sweden
| | - Jens Jensen
- Dept of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Unit of Cariology, Capio St Görans Sjukhus, Stockholm
| | | | | | - Helena Wikström
- Dept of Cardiology, Kristianstad Hospital, Kristianstad, Sweden
| | | | - Pallonji Bhiladval
- Dept of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Tim Tödt
- Dept of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Dan Ioanes
- Dept of Cardiology, Sahlgrenska University, Gothenburg, Sweden
| | - Thomas Kellerth
- Dept of Cardiology, Örebro University, Faculty of Health, Sweden
| | - Leszek Zagozdzon
- Dept of Cardiology, Örebro University, Faculty of Health, Sweden
| | - Matthias Götberg
- Dept of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | | | - Oskar Angerås
- Dept of Cardiology, Sahlgrenska University, Gothenburg, Sweden
| | - Ollie Östlund
- Dept of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Claes Held
- Dept of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Sasha Koul
- Dept of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - David Erlinge
- Dept of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
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4
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Arnold N, Blaum C, Goßling A, Brunner FJ, Bay B, Ferrario MM, Brambilla P, Cesana G, Leoni V, Palmieri L, Donfrancesco C, Padró T, Andersson J, Jousilahti P, Ojeda F, Zeller T, Linneberg A, Söderberg S, Iacoviello L, Gianfagna F, Sans S, Veronesi G, Thorand B, Peters A, Tunstall-Pedoe H, Kee F, Salomaa V, Schnabel RB, Kuulasmaa K, Blankenberg S, Koenig W, Waldeyer C. C-reactive protein modifies lipoprotein(a)-related risk for coronary heart disease: the BiomarCaRE project. Eur Heart J 2024:ehad867. [PMID: 38240386 DOI: 10.1093/eurheartj/ehad867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 11/20/2023] [Accepted: 12/06/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND AND AIMS Recent investigations have suggested an interdependence of lipoprotein(a) [Lp(a)]-related risk for cardiovascular disease with background inflammatory burden. The aim the present analysis was to investigate whether high-sensitive C-reactive protein (hsCRP) modulates the association between Lp(a) and coronary heart disease (CHD) in the general population. METHODS Data from 71 678 participants from 8 European prospective population-based cohort studies were used (65 661 without/6017 with established CHD at baseline; median follow-up 9.8/13.8 years, respectively). Fine and Gray competing risk-adjusted models were calculated according to accompanying hsCRP concentration (<2 and ≥2 mg/L). RESULTS Among CHD-free individuals, increased Lp(a) levels were associated with incident CHD irrespective of hsCRP concentration: fully adjusted sub-distribution hazard ratios [sHRs (95% confidence interval)] for the highest vs. lowest fifth of Lp(a) distribution were 1.45 (1.23-1.72) and 1.48 (1.23-1.78) for a hsCRP group of <2 and ≥2 mg/L, respectively, with no interaction found between these two biomarkers on CHD risk (Pinteraction = 0.82). In those with established CHD, similar associations were seen only among individuals with hsCRP ≥ 2 mg/L [1.34 (1.03-1.76)], whereas among participants with a hsCRP concentration <2 mg/L, there was no clear association between Lp(a) and future CHD events [1.29 (0.98-1.71)] (highest vs. lowest fifth, fully adjusted models; Pinteraction = 0.024). CONCLUSIONS While among CHD-free individuals Lp(a) was significantly associated with incident CHD regardless of hsCRP, in participants with CHD at baseline, Lp(a) was related to recurrent CHD events only in those with residual inflammatory risk. These findings might guide adequate selection of high-risk patients for forthcoming Lp(a)-targeting compounds.
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Affiliation(s)
- Natalie Arnold
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christopher Blaum
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alina Goßling
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian J Brunner
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Bay
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marco M Ferrario
- Research Center in Epidemiology and Preventive Medicine-EPIMED, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Paolo Brambilla
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Giancarlo Cesana
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Valerio Leoni
- Laboratory of Clinical Pathology, Hospital Pio XI of Desio, ASST Brianza, School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità-ISS, Rome, Italy
| | - Chiara Donfrancesco
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità-ISS, Rome, Italy
| | - Teresa Padró
- Cardiovascular-Program ICCC, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Jonas Andersson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Skellefteå, Sweden
| | - Pekka Jousilahti
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Francisco Ojeda
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tanja Zeller
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- University Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Allan Linneberg
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Licia Iacoviello
- Research Center in Epidemiology and Preventive Medicine-EPIMED, Department of Medicine and Surgery, University of Insubria, Varese, Italy
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | - Francesco Gianfagna
- Research Center in Epidemiology and Preventive Medicine-EPIMED, Department of Medicine and Surgery, University of Insubria, Varese, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Susana Sans
- Catalan Department of Health, Barcelona, Spain
| | - Giovanni Veronesi
- Research Center in Epidemiology and Preventive Medicine-EPIMED, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology-IBE, Ludwig-Maximilians University of Munich, Munich, Germany
- German Center for Cardiovascular Disease Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
| | - Hugh Tunstall-Pedoe
- Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, Dundee, Scotland
| | - Frank Kee
- Centre for Public Health, Queens University of Belfast, Belfast, Northern Ireland, UK
| | - Veikko Salomaa
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Renate B Schnabel
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kari Kuulasmaa
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Koenig
- German Center for Cardiovascular Disease Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
- German Heart Center, Munich, Technical University of Munich, Lazarettstr. 36, Munich 80636, Germany
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - Christoph Waldeyer
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Johansson C, Örtendahl L, Lind MM, Andersson J, Johansson L, Brunström M. Diabetes, prediabetes, and atrial fibrillation-A population-based cohort study based on national and regional registers. J Intern Med 2023; 294:605-615. [PMID: 37387643 DOI: 10.1111/joim.13688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
BACKGROUND Previous studies have shown an increased risk for atrial fibrillation and atrial flutter (AF) in people with type 2 diabetes and prediabetes. It is unclear whether this increase in AF risk is independent of other risk factors for AF. OBJECTIVE To investigate the association between diabetes and different prediabetic states, as independent risk factors for the onset of AF. METHODS We performed a population-based cohort study in Northern Sweden, including data on fasting plasma glucose, oral glucose tolerance test, major cardiovascular risk factors, medical history, and lifestyle factors. Participants were divided into six groups depending on glycemic status and followed through national registers for AF diagnosis. Cox proportional hazard model was used to assess the association between glycemic status and AF, using normoglycemia as reference. RESULTS The cohort consisted of 88,889 participants who underwent a total of 139,661 health examinations. In the model adjusted for age and sex, there was a significant association between glycemic status and development of AF in all groups except the impaired glucose tolerance group, with the strongest association for the group with known diabetes (p-value <0.001). In a model adjusted for sex, age, systolic blood pressure, body mass index, antihypertensive drugs, cholesterol, alcohol, smoking, education level, marital status, and physical activity, there was no significant association between glycemic status and AF. CONCLUSIONS/INTERPRETATION The association between glycemic status and AF disappears upon adjustment for potential confounders. Diabetes and prediabetes do not appear to be independent risk factors for AF.
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Affiliation(s)
- Cecilia Johansson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lina Örtendahl
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Marcus M Lind
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Jonas Andersson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lars Johansson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Mattias Brunström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Näsmark T, Andersson J. The influence of dual-energy computed tomography image noise in proton therapy treatment planning. Phys Imaging Radiat Oncol 2023; 28:100493. [PMID: 37789872 PMCID: PMC10544042 DOI: 10.1016/j.phro.2023.100493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 09/04/2023] [Accepted: 09/18/2023] [Indexed: 10/05/2023] Open
Abstract
Background and purpose In proton therapy, a 3.5% margin is often used to account for proton range uncertainties, of which computed tomography (CT) image noise is assumed to contribute 0.5%. This work evaluates the noise-sensitivity of three dual-energy computed tomography (DECT)-based methods for mapping proton stopping power relative to water (SPR): Näsmark & Andersson (N&A), Landry-Saito (L-S), and the commercial application DirectSPR. Methods and materials DECT image data of a CIRS-062M phantom was acquired with CT scanners from two different vendors. Acquisitions were repeated 30 times to account for intra- and inter-scan variations. SPR maps were generated with the three DECT-based methods and range simulated in a commercial treatment planning system. Results Noise in input data was amplified in L-S SPR maps, kept level with DirectSPR, while N&A compressed noise overall but displayed sensitivity to the choice of input data, potentially leading to increased noise levels. In our simulations, only N&A improved upon the assumed 0.5% noise contribution to range uncertainty on one scanner. On the other scanner, uncertainties exceeded 0.5% for all three methods. Mitigation of this issue was demonstrated by using a method employing virtual mono-energetic images as input. Increasing imaging radiation dose, as expected, alleviates the problem, while applying noise reduction only helped to a lesser extent. Conclusions While range uncertainty due to noise is small compared to other contributions, it becomes more important as we move towards smaller treatment margins and the noise-sensitivity of SPR mapping methods should be carefully estimated and considered before clinical implementation.
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Affiliation(s)
- Torbjörn Näsmark
- Department of Radiation Sciences, Radiation Physics, Umeå University, SE-901 85 UMEÅ, Sweden
| | - Jonas Andersson
- Department of Radiation Sciences, Radiation Physics, Umeå University, SE-901 85 UMEÅ, Sweden
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7
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Nair M, Andersson J, Nygren JM, Lundgren LE. Barriers and Enablers for Implementation of an Artificial Intelligence-Based Decision Support Tool to Reduce the Risk of Readmission of Patients With Heart Failure: Stakeholder Interviews. JMIR Form Res 2023; 7:e47335. [PMID: 37610799 PMCID: PMC10483295 DOI: 10.2196/47335] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 03/16/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Artificial intelligence (AI) applications in health care are expected to provide value for health care organizations, professionals, and patients. However, the implementation of such systems should be carefully planned and organized in order to ensure quality, safety, and acceptance. The gathered view of different stakeholders is a great source of information to understand the barriers and enablers for implementation in a specific context. OBJECTIVE This study aimed to understand the context and stakeholder perspectives related to the future implementation of a clinical decision support system for predicting readmissions of patients with heart failure. The study was part of a larger project involving model development, interface design, and implementation planning of the system. METHODS Interviews were held with 12 stakeholders from the regional and municipal health care organizations to gather their views on the potential effects implementation of such a decision support system could have as well as barriers and enablers for implementation. Data were analyzed based on the categories defined in the nonadoption, abandonment, scale-up, spread, sustainability (NASSS) framework. RESULTS Stakeholders had in general a positive attitude and curiosity toward AI-based decision support systems, and mentioned several barriers and enablers based on the experiences of previous implementations of information technology systems. Central aspects to consider for the proposed clinical decision support system were design aspects, access to information throughout the care process, and integration into the clinical workflow. The implementation of such a system could lead to a number of effects related to both clinical outcomes as well as resource allocation, which are all important to address in the planning of implementation. Stakeholders saw, however, value in several aspects of implementing such system, emphasizing the increased quality of life for those patients who can avoid being hospitalized. CONCLUSIONS Several ideas were put forward on how the proposed AI system would potentially affect and provide value for patients, professionals, and the organization, and implementation aspects were important parts of that. A successful system can help clinicians to prioritize the need for different types of treatments but also be used for planning purposes within the hospital. However, the system needs not only technological and clinical precision but also a carefully planned implementation process. Such a process should take into consideration the aspects related to all the categories in the NASSS framework. This study further highlighted the importance to study stakeholder needs early in the process of development, design, and implementation of decision support systems, as the data revealed new information on the potential use of the system and the placement of the application in the care process.
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Affiliation(s)
- Monika Nair
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | | | - Jens M Nygren
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Lina E Lundgren
- School of Business, Innovation and Sustainability, Halmstad University, Halmstad, Sweden
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8
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Chadalavada S, Reinikainen J, Andersson J, Di Castelnuovo A, Iacoviello L, Jousilahti P, Kårhus LL, Linneberg A, Söderberg S, Tunstall-Pedoe H, Lekadir K, Aung N, Jensen MT, Kuulasmaa K, Niiranen TJ, Petersen SE. Diabetes and heart failure associations in women and men: Results from the MORGAM consortium. Front Cardiovasc Med 2023; 10:1136764. [PMID: 37180793 PMCID: PMC10167048 DOI: 10.3389/fcvm.2023.1136764] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/20/2023] [Indexed: 05/16/2023] Open
Abstract
Background Diabetes and its cardiovascular complications are a growing concern worldwide. Recently, some studies have demonstrated that relative risk of heart failure (HF) is higher in women with type 1 diabetes (T1DM) than in men. This study aims to validate these findings in cohorts representing five countries across Europe. Methods This study includes 88,559 (51.8% women) participants, 3,281 (46.3% women) of whom had diabetes at baseline. Survival analysis was performed with the outcomes of interest being death and HF with a follow-up time of 12 years. Sub-group analysis according to sex and type of diabetes was also performed for the HF outcome. Results 6,460 deaths were recorded, of which 567 were amongst those with diabetes. Additionally, HF was diagnosed in 2,772 individuals (446 with diabetes). A multivariable Cox proportional hazard analysis showed that there was an increased risk of death and HF (hazard ratio (HR) of 1.73 [1.58-1.89] and 2.12 [1.91-2.36], respectively) when comparing those with diabetes and those without. The HR for HF was 6.72 [2.75-16.41] for women with T1DM vs. 5.80 [2.72-12.37] for men with T1DM, but the interaction term for sex differences was insignificant (p for interaction 0.45). There was no significant difference in the relative risk of HF between men and women when both types of diabetes were combined (HR 2.22 [1.93-2.54] vs. 1.99 [1.67-2.38] respectively, p for interaction 0.80). Conclusion Diabetes is associated with increased risks of death and heart failure, and there was no difference in relative risk according to sex.
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Affiliation(s)
- Sucharitha Chadalavada
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
| | - Jaakko Reinikainen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Jonas Andersson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Skellefteå, Sweden
| | | | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
- Research Center in Epidemiology and Preventive Medicine-EPIMED, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Pekka Jousilahti
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Line Lund Kårhus
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Allan Linneberg
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Hugh Tunstall-Pedoe
- Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, Dundee, United Kingdom
| | - Karim Lekadir
- Artificial Intelligence in Medicine Lab (BCN-AIM), Departament de Matemàtiques and Informàtica, Universitat de Barcelona, Barcelona, Spain
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
| | - Magnus T Jensen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom
- Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, Herlev, Denmark
| | - Kari Kuulasmaa
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Teemu J Niiranen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- Department of Internal Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
- Health Data Research UK, London, United Kingdom
- National Institute for Health and Care Research, London, United Kingdom
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Santos J, Foley S, Andersson J, Figueiredo JP, Hoeschen C, Damilakis J, Frija G, Alves F, Riklund K, Rainford L, Nestle U, McNulty J, Bacher K, Hierath M, Paulo G. Education and training in radiation protection in Europe: results from the EURAMED Rocc-n-Roll project survey. Insights Imaging 2023; 14:55. [PMID: 37005914 PMCID: PMC10067777 DOI: 10.1186/s13244-023-01398-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 02/24/2023] [Indexed: 04/04/2023] Open
Abstract
PURPOSE To analyse the existing radiation protection (RP) education and training (E&T) capabilities in the European Union and identify associated needs, problems and challenges. METHOD An online survey was disseminated via the EURAMED Rocc-n-Roll consortium network and prominent medical societies in the field of radiological research. The survey sections analyse the RP E&T during undergraduate, residency/internship and continuous professional development; RP E&T problems and legal implementation. Differences were analysed by European geographic regions, profession, years of professional experience and main area of practice/research. RESULTS The majority of the 550 respondents indicated that RP topics are part of undergraduate curricula in all courses for their profession and country (55%); however, hands-on practical training is not included according to 30% of the respondents. The lack of E&T, practical aspects in current E&T, and mandatory continuing E&T were considered the major problems. The legal requirement that obtained higher implementation score was the inclusion of the practical aspects of medical radiological procedures on education (86%), and lower score was obtained for the inclusion of RP E&T on medical and dental school curriculums (61%). CONCLUSIONS A heterogeneity in RP E&T during undergraduate, residency/internship and continuous professional development is evident across Europe. Differences were noted per area of practice/research, profession, and European geographic region. A large variation in RP E&T problem rating was also obtained.
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Affiliation(s)
- Joana Santos
- Instituto Politécnico de Coimbra, ESTESC - Coimbra Health School, Medical Imaging and Radiotherapy, Rua 5 de Outubro, S. Martinho Do Bispo, 3046-854, Coimbra, Portugal.
| | - Shane Foley
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland
| | - Jonas Andersson
- Department of Radiation Sciences, Radiation Physics, Umeå University, Umeå, Sweden
| | - João Paulo Figueiredo
- Instituto Politécnico de Coimbra, ESTESC - Coimbra Health School, Medical Imaging and Radiotherapy, Rua 5 de Outubro, S. Martinho Do Bispo, 3046-854, Coimbra, Portugal
| | - Christoph Hoeschen
- Institute of Medical Technology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - John Damilakis
- School of Medicine, University of Crete, Iráklion, Crete, Greece
| | | | - Francisco Alves
- Instituto Politécnico de Coimbra, ESTESC - Coimbra Health School, Medical Imaging and Radiotherapy, Rua 5 de Outubro, S. Martinho Do Bispo, 3046-854, Coimbra, Portugal
| | - Katrine Riklund
- Department of Radiation Sciences, Diagnostic Radiology and Umeå Centre for Functional Brain Imaging, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Louise Rainford
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland
| | - Ursula Nestle
- Department of Radiation Oncology, Kliniken Maria Hilf, Mönchengladbach, Germany
- Department of Radiation Oncology, University Hospital Freiburg, Freiburg, Germany
| | - Jonathan McNulty
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland
| | - Klaus Bacher
- Division of Medical Physics, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Monika Hierath
- European Institute for Biomedical Imaging Research (EIBIR), Vienna, Austria
| | - Graciano Paulo
- Instituto Politécnico de Coimbra, ESTESC - Coimbra Health School, Medical Imaging and Radiotherapy, Rua 5 de Outubro, S. Martinho Do Bispo, 3046-854, Coimbra, Portugal
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Jarva E, Oikarinen A, Andersson J, Tomietto M, Kääriäinen M, Mikkonen K. Healthcare professionals' digital health competence and its core factors; development and psychometric testing of two instruments. Int J Med Inform 2023; 171:104995. [PMID: 36689840 DOI: 10.1016/j.ijmedinf.2023.104995] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/03/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND Healthcare professionals' digital health competence is an important phenomenon to study as healthcare practices are changing globally. Recent research aimed to define this complex phenomenon and identify the current state of healthcare professionals' competence in digitalisation but did not include an overarching outlook when measuring digital health competence of healthcare professionals. OBJECTIVES The purpose of this study was to develop and psychometrically validate two self-assessed instruments measuring digital health competence and factors associating with it. METHODS The study followed three phases of instrument development and validation: 1) conceptualisation and item pool generation; 2) content validity testing and pilot study; and 3) construct validity and reliability testing. The conceptual background of the instruments was based on individual interviews conducted with healthcare professionals (n = 20) and previous systematic reviews. A total of 17 experts assessed the instrument's content validity. Face validity was evaluated by a group of healthcare professionals (n = 20). Data collection from 817 professionals took place in spring-summer 2022 in nine organisations. Construct validity was confirmed with exploratory factor analysis. Cronbach's alpha was used to assess the internal consistency of the instruments. RESULTS The instrument development and validation process resulted in two instruments: DigiHealthCom and DigiComInf. DigiHealthCom included 42 items in 5 factors related to digital health competence, and DigiComInf included 15 items in 3 factors related to educational and organisational factors associated with digital health competence. The DigiHealthCom instrument explained 68.9 % of the total variance and the factors' Cronbach alpha values varied between 0.91 and 0.97. The DigiComInf instrument explained 59.6 % of the total variance and the factors' Cronbach alpha values varied between 0.76 and 0.88. CONCLUSIONS The two instruments gave valid and reliable results in psychometric testing. The instruments could be used to evaluate healthcare professionals' digital health competence and associated factors.
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Affiliation(s)
- E Jarva
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland.
| | - A Oikarinen
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Wellbeing Services County of North Ostrobothnia, Oulu, Finland.
| | - J Andersson
- Academy of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - M Tomietto
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland; Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK.
| | - M Kääriäinen
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Wellbeing Services County of North Ostrobothnia, Oulu, Finland
| | - K Mikkonen
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Wellbeing Services County of North Ostrobothnia, Oulu, Finland.
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Söderström E, Andersson J, Söderberg S, van Guelpen B, Nilsson TK, Hultdin J. CTH G1208T and MTHFR A1298C polymorphisms are associated with a higher risk of a first myocardial infarction with fatal outcome among women. Drug Metab Pers Ther 2023; 38:57-63. [PMID: 36279151 DOI: 10.1515/dmpt-2022-0119] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 09/10/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Cystathionine-gamma-lyase (CSE) in the transsulfuration pathway generates hydrogen sulfide (H2S), suggested regulating cardiovascular function. The G1208T polymorphism in the CTH gene, rs1021737, has, in addition to MTHFR, been found to increase homocysteine, related to myocardial infarction (MI) risk. This study aimed, for the first time, to investigate the associations of the polymorphisms CTH G1208T, MTHFR C677T, and A1298C with the prospective risk of developing a fatal or non-fatal first MI. METHODS This case-referent study included 545 cases later developing a first-ever MI and 1,054 referents from the Northern Sweden Health and Disease Study. Fatal MI was defined as death within 28 days after MI symptoms. RESULTS Women, but not men, had a positive association between fatal MI and the CTH G1208T, odds ratio [95% confidence interval] 3.14 [1.16-8.54] for heterozygotes, and the dominant model 3.22 [1.22-8.51], and for the MTHFR A1298C heterozygotes 3.24 [1.26-8.34] and the dominant model 2.63 [1.06-6.50]. The MTHFR C677T polymorphism was not related to MI. CONCLUSIONS This study indicates that the minor alleles of CTH G1208T and MTHFR A1298C polymorphisms are associated with a higher risk for a fatal MI among women but not for non-fatal MI. No association was found in men.
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Affiliation(s)
- Elisabet Söderström
- Department of Medical Biosciences, Clinical Chemistry, Norrbotten County Council, Sunderby Hospital, Umeå University, Umeå, Sweden
| | - Jonas Andersson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Skellefteå, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Bethany van Guelpen
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Torbjörn K Nilsson
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
| | - Johan Hultdin
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
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Nasmark MT, Andersson J. MAPPING PROTON STOPPING POWER WITH DUAL ENERGY GENERATED VIRTUAL MONOENERGETIC IMAGES. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)02262-1] [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: 12/15/2022] Open
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Fortuin-de Smidt MC, Sewe MO, Lassale C, Weiderpass E, Andersson J, Huerta JM, Ekelund U, Aleksandrova K, Tong TY, Dahm CC, Tjønneland A, Kyrø C, Steindorf K, Schulze MB, Katzke V, Sacerdote C, Agnoli C, Masala G, Tumino R, Panico S, Boer JM, Onland-Moret NC, Wendel-Vos GW, van der Schouw YT, Borch KB, Agudo A, Petrova D, Chirlaque MD, Conchi MI, Amiano P, Melander O, Heath AK, Aune D, Forouhi NG, Langenberg C, Brage S, Riboli E, Wareham NJ, Danesh J, Butterworth AS, Wennberg P. Physical activity attenuates but does not eliminate coronary heart disease risk amongst adults with risk factors: EPIC-CVD case-cohort study. Eur J Prev Cardiol 2022; 29:1618-1629. [PMID: 35403197 DOI: 10.1093/eurjpc/zwac055] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 02/02/2023]
Abstract
AIMS This study aimed to evaluate the association between physical activity and the incidence of coronary heart disease (CHD) in individuals with and without CHD risk factors. METHODS AND RESULTS EPIC-CVD is a case-cohort study of 29 333 participants that included 13 582 incident CHD cases and a randomly selected sub-cohort nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Self-reported physical activity was summarized using the Cambridge physical activity index (inactive, moderately inactive, moderately active, and active). Participants were categorized into sub-groups based on the presence or the absence of the following risk factors: obesity (body mass index ≥30 kg/m2), hypercholesterolaemia (total cholesterol ≥6.2 mmol/L), history of diabetes, hypertension (self-reported or ≥140/90 mmHg), and current smoking. Prentice-weighted Cox regression was used to assess the association between physical activity and incident CHD events (non-fatal and fatal).Compared to inactive participants without the respective CHD risk factor (referent), excess CHD risk was highest in physically inactive and lowest in moderately active participants with CHD risk factors. Corresponding excess CHD risk estimates amongst those with obesity were 47% [95% confidence interval (CI) 32-64%] and 21% (95%CI 2-44%), with hypercholesterolaemia were 80% (95%CI 55-108%) and 48% (95%CI 22-81%), with hypertension were 80% (95%CI 65-96%) and 49% (95%CI 28-74%), with diabetes were 142% (95%CI 63-260%), and 100% (95%CI 32-204%), and amongst smokers were 152% (95%CI 122-186%) and 109% (95%CI 74-150%). CONCLUSIONS In people with CHD risk factors, moderate physical activity, equivalent to 40 mins of walking per day, attenuates but does not completely offset CHD risk.
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Affiliation(s)
- Melony C Fortuin-de Smidt
- Department of Public Health and Clinical Medicine, Umeå University, Universitetstorget 4, 901 87, Umeå, Sweden
| | - Maquins Odhiambo Sewe
- Department of Public Health and Clinical Medicine, Umeå University, Universitetstorget 4, 901 87, Umeå, Sweden
| | - Camille Lassale
- Cardiovascular epidemiology and genetics, Hospital del Mar Research Institute (IMIM), Carrer del Dr. Aiguader, 88, 08003, Barcelona, Spain
- CIBER of Pathophysiology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, C. de Melchor Fernández Almagro, 3, 28029 Madrid, Spain
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon, France
| | - Jonas Andersson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Lasarettsvägen 29, 931 41, Skellefteå, Sweden
| | - José María Huerta
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, 30120 El Palmar, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, C. de Melchor Fernández Almagro, 3, 28029 Madrid, Spain
| | - Ulf Ekelund
- Department of Sports Medicine, Norwegian School of Sport Science, Sognsveien 220, 0863 Oslo, Norway
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Lovisenberggata 8, 0456, Oslo, Norway
| | - Krasimira Aleksandrova
- Department Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany
- Faculty of Human and Health Sciences, University of Bremen, Grazer Straße 2, 28359, Bremen, Germany
| | - Tammy Yn Tong
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, United Kingdom
| | - Christina C Dahm
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus, Denmark
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen, Denmark
| | - Cecilie Kyrø
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
- Institute for Nutritional Science, University of Potsdam, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
| | - Verena Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital, Via Santena 7, 10126, Turin, Italy
| | - Claudia Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy
| | - Giovanna Masala
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo II Vecchio 2, 50139, Florence, Italy
| | - Rosario Tumino
- Hyblean Association for Epidemiological Research, AIRE-ONLUS, Via Giuseppe di Vittoria 49, 97100, Ragusa, Italy
| | - Salvatore Panico
- Dipartimento di medicina clinica e chirurgia, Federico II University, Corso Umberto I 40, 80138, Naples, Italy
| | - Jolanda Ma Boer
- National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - N Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Gc Wanda Wendel-Vos
- National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Kristin Benjaminsen Borch
- Department of Community Medicine, UiT, The Arctic University of Norway, Hansine Hansens veg 18, 9019, Tromsø, Norway
| | - Antonio Agudo
- Unit of Nutrition and Cancer, Catalan Institute of Oncology - ICO, L'Hospitalet de Llobregat, Avinguda de la Granvia de l'Hospitalet, 199-203, 08908, Barcelona, Spain
- Nutrition and Cancer Group; Epidemiology, Public Health, Cancer Prevention and Palliative Care Program; Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Avinguda de la Granvia de l'Hospitalet, 199, 08908, Barcelona, Spain
| | - Dafina Petrova
- Escuela Andaluza de Salud Pública (EASP), Cta. del Observatorio 4,18011 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Av. De Madrid 15, 18012 Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), C/ Montforte de Lemos 3-5, 28029 Madrid, Spain
| | - María Dolores Chirlaque
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, 30120 El Palmar, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, C. de Melchor Fernández Almagro, 3, 28029 Madrid, Spain
| | - Moreno Iribas Conchi
- Navarra Public Health Institute, IdiSNA, C. de Irunlarrea, 3, 31008, Pamplona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), C. de Irunlarrea, 3, 31008 Pamplona, Spain
| | - Pilar Amiano
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, C. de Melchor Fernández Almagro, 3, 28029 Madrid, Spain
- Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, 20013 San Sebastian, Spain
- Biodonostia Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, Paseo Dr Bergiristain, s/n, 20014, San Sebastián, Spain
| | - Olle Melander
- Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, Malmö, Sweden
- Department of Emergency and Internal Medicine, Skåne University Hospital, Carl-Bertil Laurells gata 9, 214 28, Malmö, Sweden
| | - Alicia K Heath
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, United Kingdom
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, United Kingdom
- Department of Nutrition, Bjørknes University College, Lovisenberggata 13, 0456, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Trondheimsveien 235, 0586, Oslo, Norway
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 6, 171 77, Stockholm, Sweden
| | - Nita G Forouhi
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge CB2 0SL, United Kingdom
| | - Claudia Langenberg
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge CB2 0SL, United Kingdom
- Computational Medicine, Berlin Institute of Health, Charité-University Medicine Berlin, Anna-Louisa-Karsch-Straße 2, 10178, Berlin, Germany
| | - Soren Brage
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge CB2 0SL, United Kingdom
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, United Kingdom
| | - Nicholas J Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge CB2 0SL, United Kingdom
| | - John Danesh
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, 2 Worts's Causeway, Cambridge CB1 8RN, United Kingdom
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, 2 Worts's Causeway, Cambridge CB1 8RN, United Kingdom
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Hills Road, Cambridge CB2 0QQ, United Kingdom
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Saffron Walden CB10 1SA, United Kingdom
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton, CB10 1SA, United Kingdom
| | - Adam S Butterworth
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, 2 Worts's Causeway, Cambridge CB1 8RN, United Kingdom
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, 2 Worts's Causeway, Cambridge CB1 8RN, United Kingdom
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Hills Road, Cambridge CB2 0QQ, United Kingdom
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Saffron Walden CB10 1SA, United Kingdom
| | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Umeå University, Universitetstorget 4, 901 87, Umeå, Sweden
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Rainford L, Santos J, Alves F, Figueiredo JP, Hoeschen C, Damilakis J, Frija G, Andersson J, McNulty J, Foley S, Bacher K, Nestle U, Hierath M, Paulo G. Education and training in radiation protection in Europe: an analysis from the EURAMED rocc-n-roll project. Insights Imaging 2022; 13:142. [PMID: 36057698 PMCID: PMC9440860 DOI: 10.1186/s13244-022-01271-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 07/09/2022] [Indexed: 11/17/2022] Open
Abstract
Background A Strengths, weaknesses, opportunities and threats analysis was performed to understand the status quo of education and training in radiation protection (RP) and to develop a coordinated European approach to RP training needs based on stakeholder consensus and existing activities in the field. Fourteen team members represented six European professional societies, one European voluntary organisation, two international healthcare organisations and five professions, namely: Medical Physicists; Nuclear Medicine Physicians; Radiologists; Radiation Oncologists and Radiographers. Four subgroups analysed the “Strengths”, “Weaknesses”, “Opportunities” and “Threats” related to E&T in RP developed under previous European Union (EU) programmes and on the Guidelines on Radiation Protection Education and Training of Medical Professionals in the EU.
Results Consensus agreement identified four themes for strengths and opportunities, namely: (1) existing structures and training recommendations; (2) RP training needs assessment and education & training (E&T) model(s) development; (3) E&T dissemination, harmonisation, and accreditation; (4) financial supports. Weaknesses and Threats analysis identified two themes: (1) awareness and prioritisation at a national/global level and (2) awareness and prioritisation by healthcare professional groups and researchers. Conclusions A lack of effective implementation of RP principles in daily practice was identified. EuRnR strategic planning needs to consider processes at European, national and local levels. Success is dependent upon efficient governance structures and expert leadership. Financial support is required to allow the stakeholder professional agencies to have sufficient resources to achieve a pan European radiation protection training network which is sustainable and accredited across multiple national domains.
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Affiliation(s)
- Louise Rainford
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Room A201, UCD Health Science Centre, Belfield Campus, Dublin 4, Ireland.
| | - Joana Santos
- Instituto Politécnico de Coimbra, ESTESC - Coimbra Health School, Medical Imaging and Radiotherapy, Coimbra, Portugal
| | - Francisco Alves
- Instituto Politécnico de Coimbra, ESTESC - Coimbra Health School, Medical Imaging and Radiotherapy, Coimbra, Portugal
| | - João Paulo Figueiredo
- Instituto Politécnico de Coimbra, ESTESC - Coimbra Health School, Medical Imaging and Radiotherapy, Coimbra, Portugal
| | - Christoph Hoeschen
- Institute of Medical Technology, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
| | | | | | - Jonas Andersson
- Department of Radiation Sciences, Radiation Physics, Umeå, Sweden
| | - Jonathan McNulty
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Room A201, UCD Health Science Centre, Belfield Campus, Dublin 4, Ireland
| | - Shane Foley
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Room A201, UCD Health Science Centre, Belfield Campus, Dublin 4, Ireland
| | - Klaus Bacher
- Division of Medical Physics, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Ursula Nestle
- Department of Radiation Oncology, Kliniken Maria Hilf, Moenchengladbach, Germany.,Department of Radiation Oncology, University Hospital Freiburg, Freiburg im Breisgau, Germany
| | - Monika Hierath
- European Institute for Biomedical Imaging Research (EIBIR), Vienna, Austria
| | - Graciano Paulo
- Instituto Politécnico de Coimbra, ESTESC - Coimbra Health School, Medical Imaging and Radiotherapy, Coimbra, Portugal
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Omerovic E, Erlinge D, Koul S, Frobert O, Andersson J, Ponten J, Björklund F, Kastberg R, Petzold M, Ljungman C, Bolin K, Redfors B. Rationale and design of switch Swedeheart: A registry-based, stepped-wedge, cluster-randomized, open-label multicenter trial to compare prasugrel and ticagrelor for treatment of patients with acute coronary syndrome. Am Heart J 2022; 251:70-77. [PMID: 35644221 DOI: 10.1016/j.ahj.2022.05.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/22/2022] [Accepted: 05/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND European treatment guidelines recommend prasugrel over ticagrelor for treating patients with non-ST-elevation acute coronary syndrome (ACS), prompting several Swedish administrative regions to transition from ticagrelor to prasugrel as the preferred treatment for patients with ACS. We aim to systematically evaluate this transition to determine the relative efficacy of prasugrel versus ticagrelor in a real-world cohort of patients with ACS. STUDY DESIGN AND OBJECTIVES The SWITCH SWEDEHEART trial is a prospective, multicenter, open-label, cross-sectional, stepped-wedge cluster-randomized clinical trial, in which administrative regions in Sweden will constitute the clusters. At the start of the study, all clusters will use ticagrelor as the P2Y12 inhibitor drug of choice for ACS. The order in which the clusters will implement the transition from ticagrelor to prasugrel will be randomly assigned. Every 9 months, 1 cluster will switch from ticagrelor to prasugrel as the P2Y12 inhibitor of choice for patients with ACS. The primary endpoint is the composite 1-year rate of the death, stroke, or myocardial infarction. CONCLUSIONS The SWITCH SWEDEHEART study will provide an extensive randomized comparison between ticagrelor and prasugrel. Novel therapies are frequently costly and supported by evidence from few or small studies, and systematic evaluation after the introduction is rare. This study will establish an important standard for introducing and evaluating the effects of health care changes within our societies.
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Affiliation(s)
- Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Sasha Koul
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Ole Frobert
- Department of Cardiology, Faculty of Health, Örebro University Hospital, Örebro, Sweden; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Jonas Andersson
- Department of Cardiology, Umeå University Hospital, Umeå, Sweden
| | - Johan Ponten
- Department of Cardiology, Hallands hospital Halmstad, Halmstad, Sweden
| | | | - Robert Kastberg
- Department of Cardiology, Östersund Hospital, Östersund, Sweden
| | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Sweden
| | - Charlotta Ljungman
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristian Bolin
- Department of Economics, Centre for Health Economics, University of Gothenburg, Gothenburg, Sweden
| | - Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Koulentianos D, Carravetta V, Couto RC, Andersson J, Hult Roos A, Squibb RJ, Wallner M, Eland JHD, Simon M, Ågren H, Feifel R. Formation and relaxation of K −2 and K −2V double-core-hole states in n-butane. J Chem Phys 2022; 157:044306. [DOI: 10.1063/1.5135388] [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: 11/14/2022] Open
Abstract
Using a magnetic bottle multi-electron time-of-flight spectrometer in combination with synchrotron radiation, double-core-hole pre-edge and continuum states involving the K-shell of the carbon atoms in n-butane ( n-C4H10) have been identified, where the ejected core electron(s) and the emitted Auger electrons from the decay of such states have been detected in coincidence. An assignment of the main observed spectral features is based on the results of multi-configurational self-consistent field (MCSCF) calculations for the excitation energies and static exchange (STEX) calculations for energies and intensities. MCSCF results have been analyzed in terms of static and dynamic electron relaxation as well as electron correlation contributions to double-core-hole state ionization potentials. The analysis of applicability of the STEX method, which implements the one-particle picture toward the complete basis set limit, is motivated by the fact that it scales well toward large species. We find that combining the MCSCF and STEX techniques is a viable approach to analyze double-core-hole spectra.
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Affiliation(s)
- D. Koulentianos
- Department of Physics, University of Gothenburg, Origovägen 6B, SE-412 96 Gothenburg, Sweden
- Laboratoire de Chimie Physique-Matière et Rayonnement, CNRS, Sorbonne Université, Cedex 05, F-75005 Paris, France
| | - V. Carravetta
- Institute of Chemical Physical Processes - CNR, via Moruzzi 1, 56124 Pisa, Italy
| | - R. C. Couto
- Department of Chemistry-Ångström, Uppsala University, Box 538, SE-751 21 Uppsala, Sweden
| | - J. Andersson
- Department of Physics, University of Gothenburg, Origovägen 6B, SE-412 96 Gothenburg, Sweden
| | - A. Hult Roos
- Department of Physics, University of Gothenburg, Origovägen 6B, SE-412 96 Gothenburg, Sweden
| | - R. J. Squibb
- Department of Physics, University of Gothenburg, Origovägen 6B, SE-412 96 Gothenburg, Sweden
| | - M. Wallner
- Department of Physics, University of Gothenburg, Origovägen 6B, SE-412 96 Gothenburg, Sweden
| | - J. H. D. Eland
- Physical and Theoretical Chemistry Laboratory, Department of Chemistry, Oxford University, South Parks Road, Oxford OX1 3QZ, United Kingdom
| | - M. Simon
- Laboratoire de Chimie Physique-Matière et Rayonnement, CNRS, Sorbonne Université, Cedex 05, F-75005 Paris, France
| | - H. Ågren
- Department of Physics and Astronomy, Uppsala University, Box 516, SE-751 20 Uppsala, Sweden
- College of Chemistry and Chemical Engineering, Henan University, Kaifeng, Henan 475004, People’s Republic of China
| | - R. Feifel
- Department of Physics, University of Gothenburg, Origovägen 6B, SE-412 96 Gothenburg, Sweden
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Olsson E, Ayari T, Ideböhn V, Wallner M, Squibb RJ, Andersson J, Roos AH, Stranges S, Dyke JM, Eland JHD, Hochlaf M, Feifel R. An experimental and theoretical characterization of the electronic structure of doubly ionised disulfur. Sci Rep 2022; 12:12236. [PMID: 35851404 PMCID: PMC9293938 DOI: 10.1038/s41598-022-16327-8] [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: 06/05/2022] [Accepted: 07/08/2022] [Indexed: 12/05/2022] Open
Abstract
Using time-of-flight multiple electron and ion coincidence techniques in combination with a helium gas discharge lamp and synchrotron radiation, the double ionisation spectrum of disulfur (S\documentclass[12pt]{minimal}
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\begin{document}$$_2$$\end{document}2) and the subsequent fragmentation dynamics of its dication are investigated. The S\documentclass[12pt]{minimal}
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\begin{document}$$_2$$\end{document}2 sample was produced by heating mercury sulfide (HgS), whose vapour at a suitably chosen temperature consists primarily of two constituents: S\documentclass[12pt]{minimal}
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\begin{document}$$_2$$\end{document}2 and atomic Hg. A multi-particle-coincidence technique is thus particularly useful for retrieving spectra of S\documentclass[12pt]{minimal}
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\begin{document}$$_2$$\end{document}2 from ionisation of the mixed vapour. The results obtained are compared with detailed calculations of the electronic structure and potential energy curves of S\documentclass[12pt]{minimal}
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\begin{document}$$_2^{2+}$$\end{document}22+ which are also presented. These computations are carried out using configuration interaction methodology. The experimental results are interpreted with and strongly supported by the computational results.
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Affiliation(s)
- Emelie Olsson
- Department of Physics, University of Gothenburg, Origovägen 6B, 412 58, Gothenburg, Sweden
| | - Tarek Ayari
- Université Gustave Eiffel, COSYS/IMSE, 5 Bd Descartes, 77454, Champs sur Marne, France
| | - Veronica Ideböhn
- Department of Physics, University of Gothenburg, Origovägen 6B, 412 58, Gothenburg, Sweden
| | - Måns Wallner
- Department of Physics, University of Gothenburg, Origovägen 6B, 412 58, Gothenburg, Sweden
| | - Richard J Squibb
- Department of Physics, University of Gothenburg, Origovägen 6B, 412 58, Gothenburg, Sweden
| | - Jonas Andersson
- Department of Physics, University of Gothenburg, Origovägen 6B, 412 58, Gothenburg, Sweden
| | - Andreas Hult Roos
- Department of Physics, University of Gothenburg, Origovägen 6B, 412 58, Gothenburg, Sweden.,ELI Beamlines, Institute of Physics AS CR, v.v.i., Na Slovance 2, 182 21, Prague 8, Czech Republic
| | - Stefano Stranges
- IOM-CNR Tasc, SS-14, Km 163.5 Area Science Park Basovizza, 34149, Trieste, Italy.,Dipartimento di Chimica e Tecnologie del Farmaco, Universitá Sapienza, 00185, Rome, Italy
| | - John M Dyke
- School of Chemistry, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
| | - John H D Eland
- Department of Chemistry, Physical and Theoretical Chemistry Laboratory, Oxford University, South Parks Road, Oxford, OX1 3QZ, UK
| | - Majdi Hochlaf
- Université Gustave Eiffel, COSYS/IMSE, 5 Bd Descartes, 77454, Champs sur Marne, France.
| | - Raimund Feifel
- Department of Physics, University of Gothenburg, Origovägen 6B, 412 58, Gothenburg, Sweden.
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18
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Fabricius V, Habibovic A, Rizgary D, Andersson J, Wärnestål P. Interactions Between Heavy Trucks and Vulnerable Road Users—A Systematic Review to Inform the Interactive Capabilities of Highly Automated Trucks. Front Robot AI 2022; 9:818019. [PMID: 35316985 PMCID: PMC8934416 DOI: 10.3389/frobt.2022.818019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/03/2022] [Indexed: 11/13/2022] Open
Abstract
This study investigates interactive behaviors and communication cues of heavy goods vehicles (HGVs) and vulnerable road users (VRUs) such as pedestrians and cyclists as a means of informing the interactive capabilities of highly automated HGVs. Following a general framing of road traffic interaction, we conducted a systematic literature review of empirical HGV-VRU studies found through the databases Scopus, ScienceDirect and TRID. We extracted reports of interactive road user behaviors and communication cues from 19 eligible studies and categorized these into two groups: 1) the associated communication channel/mechanism (e.g., nonverbal behavior), and 2) the type of communication cue (implicit/explicit). We found the following interactive behaviors and communication cues: 1) vehicle-centric (e.g., HGV as a larger vehicle, adapting trajectory, position relative to the VRU, timing of acceleration to pass the VRU, displaying information via human-machine interface), 2) driver-centric (e.g., professional driver, present inside/outside the cabin, eye-gaze behavior), and 3) VRU-centric (e.g., racer cyclist, adapting trajectory, position relative to the HGV, proximity to other VRUs, eye-gaze behavior). These cues are predominantly based on road user trajectories and movements (i.e., kinesics/proxemics nonverbal behavior) forming implicit communication, which indicates that this is the primary mechanism for HGV-VRU interactions. However, there are also reports of more explicit cues such as cyclists waving to say thanks, the use of turning indicators, or new types of external human-machine interfaces (eHMI). Compared to corresponding scenarios with light vehicles, HGV-VRU interaction patterns are to a high extent formed by the HGV’s size, shape and weight. For example, this can cause VRUs to feel less safe, drivers to seek to avoid unnecessary decelerations and accelerations, or lead to strategic behaviors due to larger blind-spots. Based on these findings, it is likely that road user trajectories and kinematic behaviors will form the basis for communication also for highly automated HGV-VRU interaction. However, it might also be beneficial to use additional eHMI to compensate for the loss of more social driver-centric cues or to signal other types of information. While controlled experiments can be used to gather such initial insights, deeper understanding of highly automated HGV-VRU interactions will also require naturalistic studies.
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Affiliation(s)
- Victor Fabricius
- RISE Research Institutes of Sweden, Gothenburg, Sweden
- Halmstad University, Halmstad, Sweden
- *Correspondence: Victor Fabricius,
| | | | - Daban Rizgary
- RISE Research Institutes of Sweden, Gothenburg, Sweden
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19
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James S, Koul S, Andersson J, Angerås O, Bhiladvala P, Calais F, Danielewicz M, Fröbert O, Grimfjärd P, Götberg M, Henareh L, Ioanes D, Jensen J, Linder R, Lindroos P, Omerovic E, Panayi G, Råmunddal T, Sarno G, Ulvenstam A, Völtz S, Wagner H, Wikström H, Östlund O, Erlinge D. Bivalirudin Versus Heparin Monotherapy in ST-Segment-Elevation Myocardial Infarction. Circ Cardiovasc Interv 2021; 14:e008969. [PMID: 34903034 DOI: 10.1161/circinterventions.120.008969] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 11/16/2022]
Abstract
BACKGROUND Bivalirudin was not superior to unfractionated heparin in patients with myocardial infarction (MI) treated with percutaneous coronary intervention and no planned use of GPI (glycoprotein IIb/IIIa inhibitors) in contemporary clinical practice of radial access and potent P2Y12-inhibitors in the VALIDATE-SWEDEHEART randomized clinical trial (Bivalirudin Versus Heparin in STEMI and NSTEMI Patients on Modern Antiplatelet Therapy-Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies Registry). METHODS In this prespecified separately powered subgroup analysis, we included patients with ST-segment-elevation MI undergoing primary percutaneous coronary intervention with the primary composite end point of all-cause death, MI, or major bleeding event within 180 days. RESULTS Among the 6006 patients enrolled in the trial, 3005 patients with ST-segment-elevation MI were randomized to receive bivalirudin or heparin. The mean age was 66.8 years. According to protocol recommendations, 87% were treated with potent oral P2Y12-inhibitors before start of angiography and radial access was used in 90%. GPI was used in 51 (3.4%) and 74 (4.9%) of patients randomized to receive bivalirudin and heparin, respectively. The primary end point occurred in 12.5% (187 of 1501) and 13.0% (196 of 1504; hazard ratio [HR], 0.95 [95% CI, 0.78-1.17], P=0.64) with consistent results in all major subgroups. All-cause death occurred in 3.9% versus 3.9% (HR, 1.00 [0.70-1.45], P=0.98), MI in 1.7% versus 2.2% (HR, 0.76 [0.45-1.28], P=0.30), major bleeding in 8.3% versus 8.0% (HR, 1.04 [0.81-1.33], P=0.78), and definite stent thrombosis in 0.5% versus 1.3% (HR, 0.42 [0.18-0.96], P=0.04). CONCLUSIONS In patients with ST-segment-elevation MI undergoing primary percutaneous coronary intervention with radial access and receiving current recommended treatments with potent P2Y12-inhibitors rate of the composite of all-cause death, MI, or major bleeding was not lower in those randomized to receive bivalirudin as compared with heparin. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02311231.
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Affiliation(s)
- Stefan James
- Department of Medical Sciences (S.J., G.S.), Uppsala University, Sweden
| | - Sasha Koul
- Department of Cardiology, Clinical Sciences, Lund University, Sweden (S.K., P.B., M.G., D.E.)
| | | | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (O.A., D.I., E.O., T.R., S.V.)
| | - Pallonji Bhiladvala
- Department of Cardiology, Clinical Sciences, Lund University, Sweden (S.K., P.B., M.G., D.E.)
| | - Fredrik Calais
- Department of Cardiology, Faculty of Health, Örebro University, Sweden (F.C., O.F.)
| | | | - Ole Fröbert
- Department of Cardiology, Faculty of Health, Örebro University, Sweden (F.C., O.F.)
| | - Per Grimfjärd
- Department of Internal Medicine, Västmanlands Sjukhus, Västerås, Sweden (P.G.)
| | - Matthias Götberg
- Department of Cardiology, Clinical Sciences, Lund University, Sweden (S.K., P.B., M.G., D.E.)
| | - Loghman Henareh
- Department of Cardiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (L.H.)
| | - Dan Ioanes
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (O.A., D.I., E.O., T.R., S.V.)
| | - Jens Jensen
- Department of Cardiology, Capio St Görans Hospital AB, Stockholm, Sweden (J.J., P.L.)
| | - Rikard Linder
- Department of Cardiology, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden (R.L.)
| | - Pontus Lindroos
- Department of Cardiology, Capio St Görans Hospital AB, Stockholm, Sweden (J.J., P.L.)
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (O.A., D.I., E.O., T.R., S.V.)
| | - Georgios Panayi
- Department of Cardiology, Linköping University, Sweden (G.P.)
| | - Truls Råmunddal
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (O.A., D.I., E.O., T.R., S.V.)
| | - Giovanna Sarno
- Department of Medical Sciences (S.J., G.S.), Uppsala University, Sweden
| | | | - Sebastian Völtz
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (O.A., D.I., E.O., T.R., S.V.)
| | - Henrik Wagner
- Department of Cardiology, Helsingborg Lasarett, Sweden (H. Wagner)
| | - Helena Wikström
- Department of Cardiology, Kristianstad Hospital, Sweden (H. Wikström)
| | - Ollie Östlund
- Uppsala Clinical Research Center (O.Ö.), Uppsala University, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Sweden (S.K., P.B., M.G., D.E.)
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20
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Mickelsson M, Söderström E, Stefansson K, Andersson J, Söderberg S, Hultdin J. Smoking tobacco is associated with renal hyperfiltration. Scand J Clin Lab Invest 2021; 81:622-628. [PMID: 34669529 DOI: 10.1080/00365513.2021.1989713] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 06/14/2021] [Revised: 09/13/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
Tobacco consumption is a renal risk factor, but the effects on the estimated glomerular filtration rate (eGFR) remain unclear. We aimed to evaluate the possible impact of using tobacco products (smoking and snus) on eGFR based on creatinine or cystatin C. We used a first cohort with 949 participants and a second cohort with 995 participants; none had pre-existing renal disease. All subjects donated a blood sample and completed a questionnaire, including questions about tobacco use. To assess the effect on eGFR, hierarchical multiple linear regression models were used. Active smoking associated independently with a higher eGFRcreatinine in all subjects (p < 0.001; β = 0.11). Further analyses stratified for sex, showed similar findings for men (p < 0.001; β = 0.14) and for women (p = 0.026; β = 0.10). eGFRcystatin C was significantly associated with active smoking in all subjects (p = 0.040; β = -0.05), but no association was seen after stratification for sex. Snus did not associate with eGFR. In conclusion, smoking associated significantly with a higher eGFRcreatinine. The mechanism may be renal hyperfiltration of smaller molecules such as creatinine. This is probably caused by substances from smoked tobacco other than nicotine, as no effect was seen for snus.
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Affiliation(s)
- Malin Mickelsson
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
| | - Elisabet Söderström
- Department of Medical Biosciences, Clinical Chemistry, Norrbotten County Council, Sunderby Hospital, Umeå University, Umeå, Sweden
| | - Kristina Stefansson
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
| | - Jonas Andersson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Umeå, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden
| | - Johan Hultdin
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
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21
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Abstract
Linked to: V. Stadnytskyi et al. J Intern Med 2021; https://doi.org/10.1111/joim.13326
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Affiliation(s)
- J Andersson
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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22
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Brunström M, Andersson J, Eliasson M, Fu M, Hansson PO, Söderberg S. [SCORE2 - an updated model for cardiovascular risk prediction]. Lakartidningen 2021; 118:21164. [PMID: 34590704] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Cardiovascular disease is the most important cause of death and life-years lost in Sweden today. Cardiovascular risk prediction is a cornerstone in primary prevention; the use of antihypertensive and lipid-lowering therapy is guided by absolute cardiovascular risk. The Systematic COronary Risk Evaluation (SCORE) model has been the most widely applied model in Sweden for almost two decades. Recently, an updated model called SCORE2 was published. The new risk prediction model is based on contemporary data, predicts the risk of incident cardiovascular disease in addition to cardiovascular mortality, and accounts for competing risks, thus overcoming some major limitations with SCORE. Sweden is classified as a moderate-risk country according to the new model; here we report the risk chart for moderate-risk countries translated into Swedish.
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Affiliation(s)
- Mattias Brunström
- med dr, ST-läkare, Hjärtcentrum, Norrlands universitetssjukhus, Umeå
| | | | - Mats Eliasson
- professor, överläkare, medicinkliniken, Sunderby sjukhus, Luleå
| | - Michael Fu
- professor, överläkare, VO medicin, geriatrik och akutmottagning Östra, Sahlgrenska universitetssjukhuset, Göteborg
| | | | - Stefan Söderberg
- professor, överläkare, Hjärtcentrum, Norrlands universitetssjukhus, Umeå
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23
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Söderström E, Blind R, Wennberg P, Andersson J, Söderberg S, Nilsson T, Hultdin J. Increased risk of a first-ever myocardial infarction for women with mild impairment of renal glomerular function. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.638] [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: 10/20/2022]
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24
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Vano E, Frija G, Loose R, Paulo G, Efstathopoulos E, Granata C, Andersson J. Dosimetric quantities and effective dose in medical imaging: a summary for medical doctors. Insights Imaging 2021; 12:99. [PMID: 34255191 PMCID: PMC8276901 DOI: 10.1186/s13244-021-01041-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/15/2021] [Accepted: 06/15/2021] [Indexed: 12/21/2022] Open
Abstract
This review presents basic information on the dosimetric quantities used in medical imaging for reporting patient doses and establishing diagnostic reference levels. The proper use of the radiation protection quantity "effective dose" to compare doses delivered by different radiological procedures and different imaging modalities with its uncertainties and limitations, is summarised. The estimates of population doses required by the European Directive on Basic Safety Standards is commented on. Referrers and radiologists should be familiar with the dose quantities to inform patients about radiation risks and benefits. The application of effective dose on the cumulative doses from recurrent imaging procedures is also discussed. Patient summary: Basic information on the measurement units (dosimetric quantities) used in medical imaging for reporting radiation doses should be understandable to patients. The Working Group on "Dosimetry for imaging in clinical practice" recommended that a brief explanation on the used dosimetric quantities and units included in the examination imaging report, should be available for patients. The use of the quantity "effective dose" to compare doses to which patients are exposed to from different radiological procedures and its uncertainties and limitations, should also be explained in plain language. This is also relevant for the dialog on to the cumulative doses from recurrent imaging procedures. The paper summarises these concepts, including the need to estimate the population doses required by the European Directive on Basic Safety Standards. Referrers and radiologists should be familiar with the dose quantities to inform patients about radiation risks and benefits.
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Affiliation(s)
- Eliseo Vano
- Radiology Department, Complutense University, 28040, Madrid, Spain.
| | - Guy Frija
- Université de Paris, 12 Rue de l'École de Médecine, 75006, Paris, France
| | - Reinhard Loose
- Institute of Medical Physics, Hospital Nuremberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany
| | - Graciano Paulo
- ESTESC-Coimbra Health School, Medical Imaging and Radiotherapy Department, Instituto Politécnico de Coimbra, Rua 5 de Outubro, S. Martinho Do Bispo, 3046-854, Coimbra, Portugal
| | - Efstathios Efstathopoulos
- 2Nd Department of Radiology, Medical Physics Unit, National and Kapodistrian University of Athens, Attikon University Hospital, 12462, Athens, Greece
| | - Claudio Granata
- Department of Paediatric Radiology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Jonas Andersson
- Department of Radiation Sciences, Umea University, Umeå, Sweden
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25
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Söderström E, Blind R, Wennberg P, Andersson J, Söderberg S, Nilsson TK, Hultdin J. Mild impairment of renal function (shrunken pore syndrome) is associated with increased risk of a future first-ever myocardial infarction in women. Scand J Clin Lab Invest 2021; 81:438-445. [PMID: 34237228 DOI: 10.1080/00365513.2021.1941235] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Impaired renal function is associated both with the development of cardiovascular disease and its prognosis. A new syndrome called 'Shrunken Pore Syndrome' has been suggested, as the estimated glomerular filtration rate for cystatin C (eGFRcystatin C) is affected earlier due to differences in molecular size compared to eGFRcreatinine. The aim was to investigate if a lower eGFRcystatin C/eGFRcreatinine ratio in a prospective setting increases the risk of later developing a first-ever myocardial infarction (MI) independently of other cardiovascular risk factors. We used a nested case-referent study design within the Northern Sweden Health and Disease Study, and 545 subjects (29.0% women) were identified who prospectively developed a first-ever MI, and their 1054 matched referents. For women, but not for men, one standard deviation (SD) increase of ln z-scores of eGFRcystatin C/eGFRcreatinine ratio was associated with a lower risk of a future MI: odds ratio [95% confidence interval] 0.58 [0.34-0.99], adjusted for apolipoprotein B/A1 ratio, CRP, homocysteine, systolic blood pressure, body mass index, and diabetes. Furthermore, a high eGFRcreatinine associated independently with an increased risk of future MI in men only: OR 1.25 [1.05-1.48]. Thus, for women, a lower eGFRcystatin C/eGFRcreatinine ratio is associated with a higher risk of having a future first-ever MI, and it may be a valuable, easily implemented biomarker for risk of cardiovascular disease.
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Affiliation(s)
- Elisabet Söderström
- Department of Medical Biosciences, Clinical Chemistry, Norrbotten County Council, Sunderby Hospital, Umeå University, Umeå, Sweden
| | - Ravna Blind
- Department of Medical Biosciences, Clinical Chemistry, Norrbotten County Council, Sunderby Hospital, Umeå University, Umeå, Sweden
| | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Jonas Andersson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Umeå, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Torbjörn K Nilsson
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
| | - Johan Hultdin
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
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Näsmark T, Andersson J. Proton stopping power prediction based on dual-energy CT-generated virtual monoenergetic images. Med Phys 2021; 48:5232-5243. [PMID: 34213768 DOI: 10.1002/mp.15066] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 11/11/2022] Open
Abstract
PURPOSE The purpose of this work was to assess a proof of concept for a novel method for predicting proton stopping power ratios (SPRs) based on a pair of dual-energy CT generated virtual monoenergetic (VM) images. MATERIALS AND METHODS A rapid kV-switching dual-energy CT scanner was used to acquire Gemstone Spectral Imaging (GSI) and 120 kV conventional single-energy CT (SECT) image data of the CIRS 062M phantom. The proposed method was applied to every possible pairing of VM images between 40 and 140 keV to find the optimal energy pairs for SPR prediction in lung tissue, soft tissue, and bone. The predicted SPRs were compared against SPRs predicted from the SECT data using the conventional SECT-based method. The impact of different scan and reconstruction parameters was also investigated. RESULTS The SPR residual root mean square errors (RMSE) yielded by the optimal pairs were 7.2% for lung tissue, 0.4% for soft tissue, and 0.8% for bone. While no direct comparison could be made to other DECT-based methods for SPR prediction, as these methods could not be directly implemented on a fast kV-switching system, the SPR RMSEs for soft tissue and bone in Table 4 are comparable to RMSEs reported in the literature. For the conventional SECT-based method, the SPR RMSEs were 5.9% for lung tissue, 0.9% for soft tissue, and 5.1% for bone. CONCLUSIONS The proposed method is a valid alternative to, and has the potential to improve upon, the conventional SECT-based method for predicting SPRs. The formalism used in the method is applied directly, with no approximations made on our part, and requires neither prior knowledge of the spectra nor calibration with a phantom. This work presents a way of optimizing the proposed method for a specific scanner by determining the optimal energy pairs to use as input and demonstrates the method's robustness to different levels of ASiR-V, reconstruction kernels, and dose levels.
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Affiliation(s)
- Torbjörn Näsmark
- Department of Radiation Sciences, Radiation Physics, Umeå University, Umeå, Sweden
| | - Jonas Andersson
- Department of Radiation Sciences, Radiation Physics, Umeå University, Umeå, Sweden
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Hageman S, Pennells L, Ojeda F, Kaptoge S, Kuulasmaa K, de Vries T, Xu Z, Kee F, Chung R, Wood A, McEvoy JW, Veronesi G, Bolton T, Achenbach S, Aleksandrova K, Amiano P, Sebastian DS, Amouyel P, Andersson J, Bakker SJL, Da Providencia Costa RB, Beulens JWJ, Blaha M, Bobak M, Boer JMA, Bonet C, Bonnet F, Boutron-Ruault MC, Braaten T, Brenner H, Brunner F, Brunner EJ, Brunström M, Buring J, Butterworth AS, Capkova N, Cesana G, Chrysohoou C, Colorado-Yohar S, Cook NR, Cooper C, Dahm CC, Davidson K, Dennison E, Di Castelnuovo A, Donfrancesco C, Dörr M, Doryńska A, Eliasson M, Engström G, Ferrari P, Ferrario M, Ford I, Fu M, Gansevoort RT, Giampaoli S, Gillum RF, Gómez de la Cámara A, Grassi G, Hansson PO, Huculeci R, Hveem K, Iacoviello L, Ikram MK, Jørgensen T, Joseph B, Jousilahti P, Wouter Jukema J, Kaaks R, Katzke V, Kavousi M, Kiechl S, Klotsche J, König W, Kronmal RA, Kubinova R, Kucharska-Newton A, Läll K, Lehmann N, Leistner D, Linneberg A, Pablos DL, Lorenz T, Lu W, Luksiene D, Lyngbakken M, Magnussen C, Malyutina S, Ibañez AM, Masala G, Mathiesen EB, Matsushita K, Meade TW, Melander O, Meyer HE, Moons KGM, Moreno-Iribas C, Muller D, Münzel T, Nikitin Y, Nordestgaard BG, Omland T, Onland C, Overvad K, Packard C, Pająk A, Palmieri L, Panagiotakos D, Panico S, Perez-Cornago A, Peters A, Pietilä A, Pikhart ,H, Psaty BM, Quarti-Trevano F, Garcia JRQ, Riboli E, Ridker PM, Rodriguez B, Rodriguez-Barranco M, Rosengren A, Roussel R, Sacerdote C, Sans S, Sattar N, Schiborn C, Schmidt B, Schöttker B, Schulze M, Schwartz JE, Selmer RM, Shea S, Shipley MJ, Sieri S, Söderberg S, Sofat R, Tamosiunas A, Thorand B, Tillmann T, Tjønneland A, Tong TYN, Trichopoulou A, Tumino R, Tunstall-Pedoe H, Tybjaerg-Hansen A, Tzoulaki J, van der Heijden A, van der Schouw YT, Verschuren WMM, Völzke H, Waldeyer C, Wareham NJ, Weiderpass E, Weidinger F, Wild P, Willeit J, Willeit P, Wilsgaard T, Woodward M, Zeller T, Zhang D, Zhou B, Dendale P, Ference BA, Halle M, Timmis A, Vardas P, Danesh J, Graham I, Salomaa V, Visseren F, De Bacquer D, Blankenberg S, Dorresteijn J, Di Angelantonio E. SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe. Eur Heart J 2021; 42:2439-2454. [PMID: 34120177 PMCID: PMC8248998 DOI: 10.1093/eurheartj/ehab309] [Citation(s) in RCA: 379] [Impact Index Per Article: 126.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/08/2021] [Accepted: 05/05/2021] [Indexed: 12/14/2022] Open
Abstract
AIMS The aim of this study was to develop, validate, and illustrate an updated prediction model (SCORE2) to estimate 10-year fatal and non-fatal cardiovascular disease (CVD) risk in individuals without previous CVD or diabetes aged 40-69 years in Europe. METHODS AND RESULTS We derived risk prediction models using individual-participant data from 45 cohorts in 13 countries (677 684 individuals, 30 121 CVD events). We used sex-specific and competing risk-adjusted models, including age, smoking status, systolic blood pressure, and total- and HDL-cholesterol. We defined four risk regions in Europe according to country-specific CVD mortality, recalibrating models to each region using expected incidences and risk factor distributions. Region-specific incidence was estimated using CVD mortality and incidence data on 10 776 466 individuals. For external validation, we analysed data from 25 additional cohorts in 15 European countries (1 133 181 individuals, 43 492 CVD events). After applying the derived risk prediction models to external validation cohorts, C-indices ranged from 0.67 (0.65-0.68) to 0.81 (0.76-0.86). Predicted CVD risk varied several-fold across European regions. For example, the estimated 10-year CVD risk for a 50-year-old smoker, with a systolic blood pressure of 140 mmHg, total cholesterol of 5.5 mmol/L, and HDL-cholesterol of 1.3 mmol/L, ranged from 5.9% for men in low-risk countries to 14.0% for men in very high-risk countries, and from 4.2% for women in low-risk countries to 13.7% for women in very high-risk countries. CONCLUSION SCORE2-a new algorithm derived, calibrated, and validated to predict 10-year risk of first-onset CVD in European populations-enhances the identification of individuals at higher risk of developing CVD across Europe.
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Andersson J, Bednarek DR, Bolch W, Boltz T, Bosmans H, Gislason-Lee AJ, Granberg C, Hellstrom M, Kanal K, McDonagh E, Paden R, Pavlicek W, Khodadadegan Y, Torresin A, Trianni A, Zamora D. Estimation of patient skin dose in fluoroscopy: summary of a joint report by AAPM TG357 and EFOMP. Med Phys 2021; 48:e671-e696. [PMID: 33930183 DOI: 10.1002/mp.14910] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 04/04/2021] [Accepted: 04/23/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Physicians use fixed C-arm fluoroscopy equipment with many interventional radiological and cardiological procedures. The associated effective dose to a patient is generally considered low risk, as the benefit-risk ratio is almost certainly highly favorable. However, X-ray-induced skin injuries may occur due to high absorbed patient skin doses from complex fluoroscopically guided interventions (FGI). Suitable action levels for patient-specific follow-up could improve the clinical practice. There is a need for a refined metric regarding follow-up of X-ray-induced patient injuries and the knowledge gap regarding skin dose-related patient information from fluoroscopy devices must be filled. The most useful metric to indicate a risk of erythema, epilation or greater skin injury that also includes actionable information is the peak skin dose, that is, the largest dose to a region of skin. MATERIALS AND METHODS The report is based on a comprehensive review of best practices and methods to estimate peak skin dose found in the scientific literature and situates the importance of the Digital Imaging and Communication in Medicine (DICOM) standard detailing pertinent information contained in the Radiation Dose Structured Report (RDSR) and DICOM image headers for FGI devices. Furthermore, the expertise of the task group members and consultants have been used to bridge and discuss different methods and associated available DICOM information for peak skin dose estimation. RESULTS The report contributes an extensive summary and discussion of the current state of the art in estimating peak skin dose with FGI procedures with regard to methodology and DICOM information. Improvements in skin dose estimation efforts with more refined DICOM information are suggested and discussed. CONCLUSIONS The endeavor of skin dose estimation is greatly aided by the continuing efforts of the scientific medical physics community, the numerous technology enhancements, the dose-controlling features provided by the FGI device manufacturers, and the emergence and greater availability of the DICOM RDSR. Refined and new dosimetry systems continue to evolve and form the infrastructure for further improvements in accuracy. Dose-related content and information systems capable of handling big data are emerging for patient dose monitoring and quality assurance tools for large-scale multihospital enterprises.
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Affiliation(s)
- Jonas Andersson
- Department of Radiation Sciences, Radiation Physics, Umeå University, SE-901 85, Umeå, Sweden
| | - Daniel R Bednarek
- State University of New York, 875 Ellicott St, Buffalo, NY, 14203-1070, USA
| | - Wesley Bolch
- University of Florida, 1275 Center Drive, Gainesville, FL, 32611-6131, USA
| | - Thomas Boltz
- Orange Factor Imaging Physicists, 4035 E Captain Dreyfus Ave, Phoenix, AZ, 85032, USA
| | - Hilde Bosmans
- University of Leuven, Herestraat 49, Leuven, B-3000, Belgium
| | | | - Christoffer Granberg
- Department of Radiation Sciences, Radiation Physics, Umeå University, SE-901 85, Umeå, Sweden
| | - Max Hellstrom
- Department of Radiation Sciences, Radiation Physics, Umeå University, SE-901 85, Umeå, Sweden
| | - Kalpana Kanal
- University of Washington Medical Center, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Ed McDonagh
- Joint Department of Physics, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Robert Paden
- Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | | | - Yasaman Khodadadegan
- Progressive Insurance, Customer Relation Management, 6300 Wilson Mills Rd., Mayfield Village, OH, 44143, USA
| | - Alberto Torresin
- Niguarda Ca'Granda Hospital, Via Leon Battista Alberti 5, Milano, 20149, Italy
| | - Annalisa Trianni
- Udine University Hospital, Piazzale S. Maria Della Misericordia, n. 15, 33100, Udine, Italy
| | - David Zamora
- University of Washington Medical Center, 6852 31st Ave NE, Seattle, WA, 98115-7245, USA
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Perez-Cornago A, Crowe FL, Appleby PN, Bradbury KE, Wood AM, Jakobsen MU, Johnson L, Sacerdote C, Steur M, Weiderpass E, Würtz AML, Kühn T, Katzke V, Trichopoulou A, Karakatsani A, La Vecchia C, Masala G, Tumino R, Panico S, Sluijs I, Skeie G, Imaz L, Petrova D, Quirós JR, Yohar SMC, Jakszyn P, Melander O, Sonestedt E, Andersson J, Wennberg M, Aune D, Riboli E, Schulze MB, di Angelantonio E, Wareham NJ, Danesh J, Forouhi NG, Butterworth AS, Key TJ. Plant foods, dietary fibre and risk of ischaemic heart disease in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Int J Epidemiol 2021; 50:212-222. [PMID: 33245137 PMCID: PMC7938513 DOI: 10.1093/ije/dyaa155] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Accepted: 07/27/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Epidemiological evidence indicates that diets rich in plant foods are associated with a lower risk of ischaemic heart disease (IHD), but there is sparse information on fruit and vegetable subtypes and sources of dietary fibre. This study examined the associations of major plant foods, their subtypes and dietary fibre with risk of IHD in the European Prospective Investigation into Cancer and Nutrition (EPIC). METHODS We conducted a prospective analysis of 490 311 men and women without a history of myocardial infarction or stroke at recruitment (12.6 years of follow-up, n cases = 8504), in 10 European countries. Dietary intake was assessed using validated questionnaires, calibrated with 24-h recalls. Multivariable Cox regressions were used to estimate hazard ratios (HR) of IHD. RESULTS There was a lower risk of IHD with a higher intake of fruit and vegetables combined [HR per 200 g/day higher intake 0.94, 95% confidence interval (CI): 0.90-0.99, P-trend = 0.009], and with total fruits (per 100 g/day 0.97, 0.95-1.00, P-trend = 0.021). There was no evidence for a reduced risk for fruit subtypes, except for bananas. Risk was lower with higher intakes of nuts and seeds (per 10 g/day 0.90, 0.82-0.98, P-trend = 0.020), total fibre (per 10 g/day 0.91, 0.85-0.98, P-trend = 0.015), fruit and vegetable fibre (per 4 g/day 0.95, 0.91-0.99, P-trend = 0.022) and fruit fibre (per 2 g/day 0.97, 0.95-1.00, P-trend = 0.045). No associations were observed between vegetables, vegetables subtypes, legumes, cereals and IHD risk. CONCLUSIONS In this large prospective study, we found some small inverse associations between plant foods and IHD risk, with fruit and vegetables combined being the most strongly inversely associated with risk. Whether these small associations are causal remains unclear.
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Affiliation(s)
- Aurora Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Francesca L Crowe
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Paul N Appleby
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kathryn E Bradbury
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Angela M Wood
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge and Cambridge University Hospitals, Cambridge, UK
- Medical Research Council Biostatistics Unit, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- The Alan Turing Institute, London, UK
| | - Marianne Uhre Jakobsen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Division for Diet, Disease Prevention and Toxicology, National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Laura Johnson
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, UK
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy
| | - Marinka Steur
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | | | - Tilman Kühn
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Verena Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Anna Karakatsani
- Hellenic Health Foundation, Athens, Greece
- 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, “ATTIKON” University Hospital, Haidari, Greece
| | - Carlo La Vecchia
- Hellenic Health Foundation, Athens, Greece
- Department of Clinical Sciences and Community Health Università degli Studi di Milano, Milan, Italy
| | - Giovanna Masala
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, “M.P.Arezzo” Hospital, ASP Ragusa, Italy
| | - Salvatore Panico
- Dipartimento Di Medicina Clinica E Chirurgia Federico Ii University, Naples, Italy
| | - Ivonne Sluijs
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Guri Skeie
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
- The Nutrition Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Liher Imaz
- Public Health Division of Gipuzkoa, Health Department of Basque Country, Spain
| | - Dafina Petrova
- Andalusian School of Public Health (EASP), Granada, Spain
- Instituto de Investigaciœn Biosanitaria de Granada (ibs.GRANADA), Universidad de Granada, Granada, Spain
- CIBER de Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain
| | | | - Sandra Milena Colorado Yohar
- CIBER de Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- Research Group on Demography and Health, National Faculty of Public Health, University of Antioquia, MedellÚn, Colombia
| | - Paula Jakszyn
- Nutrition and Cancer Unit, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Barcelona, Spain
- Facultad de Ciencias de la salud, Universidad Ramon LLul, Barcelona, Spain
| | - Olle Melander
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
- Department of Emergency and Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Emily Sonestedt
- Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Jonas Andersson
- Department of Public Health and Clinical Medicine, Research Unit Skellefteå, Umeå University, Umeå, Sweden
| | - Maria Wennberg
- Department of Public Health and Clinical Medicine, Section of Sustainable Health/Nutritional Research, Umeå University, Umeå, Sweden
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Nutrition, Bjørknes University College, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Institute of Nutritional Sciences, University of Potsdam, Nuthetal, Germany
| | - Emanuele di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge and Cambridge University Hospitals, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
| | - Nicholas J Wareham
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
| | - John Danesh
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge and Cambridge University Hospitals, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton, UK
| | - Nita G Forouhi
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Adam S Butterworth
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge and Cambridge University Hospitals, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
| | - Timothy J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Abstract
AIM The primary objective was to describe the incidence, symptoms, clinical signs, and time of onset of neonatal pneumothorax in Örebro County during 2011-2017. Secondary objectives were to describe risk factors, diagnostic procedures, treatments, and mortality and to compare preterm with term/post-term neonates. MATERIALS AND METHODS This retrospective population-based descriptive study included all neonates born in Örebro County during 2011-2017 and admitted to the neonatal intensive care unit at Örebro University Hospital at age <28 days with an x-ray verified diagnosis of "Pneumothorax originating in the perinatal period" in their medical record. RESULTS Seventy-five neonates matched the inclusion criteria. The incidence of neonatal pneumothorax in Örebro County during the study period was 3.1 (95% CI: 2.5-3.8) per 1000 live births. All neonates were <48 h at debut of respiratory symptoms and the most common symptom was tachypnea. Twelve (16%) received invasive treatment. The mortality rate was 2 (3%), none due to pneumothorax. CONCLUSION The incidence of 3.1 per 1000 live births was relatively high, but the frequency of invasive treatment and mortality was low, indicating a high proportion of mild pneumothoraces. The lack of patients aged >48 h indicates that most neonatal pneumothoraces now occur very early in life.
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Affiliation(s)
| | - A Magnuson
- Clinical Epidemiology and Biostatistics Department, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - A Ohlin
- Department of Pediatrics, Örebro University Hospital, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Olsen MH, Møller M, Romano S, Andersson J, Mlodzinski E, Raines NH, Sherak R, Jeppesen AN. Association Between ICU-Acquired Hypernatremia and In-Hospital Mortality: Data From the Medical Information Mart for Intensive Care III and the Electronic ICU Collaborative Research Database. Crit Care Explor 2020; 2:e0304. [PMID: 33354677 PMCID: PMC7746205 DOI: 10.1097/cce.0000000000000304] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives Describe the relationship between ICU-acquired hypernatremia and in-hospital mortality and investigate the optimal hypernatremia correction rate. Design Setting Participants and Measurements Observational study including two individual ICU cohorts. We used the Medical Information Mart for Intensive Care III v. 1.4 database consists of all ICU patients admitted to the Beth Israel Deaconess Medical Center in Boston from 2001 to 2012 (n = 46,476). The electronic ICU v. 2.0 database consists of all ICU patients admitted to 208 distinct hospitals across the United States from 2014 to 2015 (n = 200,859). We included all adult patients admitted to an ICU with two consecutive sodium samples within normal range (135-145 mmol/L) and without two consecutive hyponatremic samples (< 135 mmol/L) during the ICU stay. Results Of 23,445 patients identified in Medical Information Mart for Intensive Care III, 9% (n = 2,172) developed hypernatremia during their ICU stay. In electronic ICU, 88,160 patients were identified and 7% (n = 5,790) developed hypernatremia. In both cohorts, patients with hypernatremia had a higher mortality (Medical Information Mart for Intensive Care III: 20% vs 42%; p < 0.01 and electronic ICU: 6% vs 22%; p < 0.01), with hypernatremia increasing the risk of in-hospital mortality (Medical Information Mart for Intensive Care III: odds ratio, 1.15; 95% CI, 1.13-1.17 and electronic ICU: odds ratio, 1.11; 95% CI, 1.10-1.12) and over time using a Cox regression. Rapid sodium correction rate (> 0.5 mmol/L/hr) was associated with an increased in-hospital mortality in both cohorts (Medical Information Mart for Intensive Care III: odds ratio, 1.08; 95% CI, 1.03-1.13 and electronic ICU: odds ratio, 1.10; 95% CI, 1.06-1.13). In the electronic ICU cohort, rapid correction rates were associated with a significant difference in in-hospital mortality, but there was no statistically significant association in the Medical Information Mart for Intensive Care III cohort. Conclusions ICU-acquired hypernatremia is associated with increased in-hospital mortality. Furthermore, a rapid sodium correction rates may be harmful. This suggests it is important to both prevent ICU-acquired hypernatremia and to avoid rapid correction rates if a patient becomes hypernatremic.
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Affiliation(s)
- Markus Harboe Olsen
- Department of Neuroanaesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marcus Møller
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stefano Romano
- Department of Electronic, Information and Biomedical Engineering, Politecnico di Milano, Milano, Italy
| | | | - Eric Mlodzinski
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Nathan H Raines
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA
| | - Raphael Sherak
- Albert Einstein College of Medicine, Bronx, NY.,Yale Department of Emergency Medicine, New Haven, CT
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Andersson J, Nordgren L, Cheng I, Nilsson U, Kurland L. Long emergency department length of stay: A concept analysis. Int Emerg Nurs 2020; 53:100930. [PMID: 33035877 DOI: 10.1016/j.ienj.2020.100930] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 08/31/2020] [Accepted: 09/10/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Emergency Department (ED) Length of stay (LOS) has been associated with poor patient outcomes, which has led to the implementation of time targets designed to keep EDLOS below a specific limit. The cut-offs defining long EDLOS varies across settings and seem to be arbitrarily chosen. This study aimed to clarify the meaning of long EDLOS. METHODS A concept analysis using the Walker and Avant approach was conducted. It included a literature search aiming to identify all uses of the concept, resulting in a set of defining attributes and a way of measuring the concept empirically. RESULTS Long EDLOS was primarily used as proxy for other phenomena, e.g. boarding or crowding. The definitions had cut-offs ranging between 4 and 48 h. The attributes defining long EDLOS was waiting, a crowded ED environment and an inefficient organization. DISCUSSION Time targets are probably more suitable when directed towards and tailored for specific sub-groups of the ED population.
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Affiliation(s)
- Jonas Andersson
- School of Medical Sciences, Örebro University, Örebro, Sweden; Centre for Clinical Research Sörmland/Uppsala University, Mälarsjukhuset, Eskilstuna, Sweden.
| | - Lena Nordgren
- Centre for Clinical Research Sörmland/Uppsala University, Mälarsjukhuset, Eskilstuna, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Ivy Cheng
- School of Medical Sciences, Örebro University, Örebro, Sweden; University of Toronto, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Ulrica Nilsson
- Division of Nursing, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm, Sweden
| | - Lisa Kurland
- School of Medical Sciences, Örebro University, Örebro, Sweden
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Johansson C, Lind MM, Eriksson M, Wennberg M, Andersson J, Johansson L. Alcohol consumption and risk of incident atrial fibrillation: A population-based cohort study. Eur J Intern Med 2020; 76:50-57. [PMID: 32147331 DOI: 10.1016/j.ejim.2020.02.022] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/01/2020] [Accepted: 02/18/2020] [Indexed: 02/06/2023]
Abstract
AIMS Atrial fibrillation (AF) is a common tachyarrhythmia. High alcohol consumption is associated with increased AF risk. It remains unclear whether lower levels of alcohol consumption are also associated with AF risk, and whether the association differs between men and women. In this study, we investigated the association between low to moderate levels of alcohol consumption and AF risk in men and women. METHODS We performed a population-based cohort study of 109,230 health examination participants in northern Sweden. Data regarding alcohol intake were obtained using a questionnaire administered at the health examination. Incident AF cases were identified from the Swedish National Patient Registry. RESULTS AF was diagnosed in 5,230 individuals during a total follow-up of 1,484,547 person-years. Among men, AF risk increased over quartiles of weekly alcohol consumption (P for trend 0.001). Men with alcohol consumption in the highest quartile (≥4.83 standard drinks [each drink containing 12 gs of ethanol] per week; SDW) had a HR of 1.21 (95% CI 1.09-1.34) for AF compared to men in the lowest quartile (<0.90 SDW). In men, problem drinking was also associated with an increased AF risk (HR: 1.24; 95% CI: 1.10-1.39). Among women, AF risk was not significantly associated with alcohol consumption (P for trend 0.09 for decreasing risk of AF over quartiles of weekly alcohol consumption) or problem drinking (HR: 1.00; 95% CI 0.70-1.42). CONCLUSION Self-reported alcohol consumption and problem drinking were associated with an increased risk of AF among men, but not in women.
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Affiliation(s)
- Cecilia Johansson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, 931 86 Skellefteå, Sweden.
| | - Marcus M Lind
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, 931 86 Skellefteå, Sweden
| | | | - Maria Wennberg
- Department of Public Health and Clinical Medicine, Section of Sustainable Health and Nutritional Research, Umeå University, Sweden
| | - Jonas Andersson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, 931 86 Skellefteå, Sweden
| | - Lars Johansson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, 931 86 Skellefteå, Sweden
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Andersson J, Fall T, Delicano R, Wennberg P, Jansson JH. GDF-15 is associated with sudden cardiac death due to incident myocardial infarction. Resuscitation 2020; 152:165-169. [PMID: 32422242 DOI: 10.1016/j.resuscitation.2020.05.001] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/09/2020] [Accepted: 05/01/2020] [Indexed: 11/27/2022]
Abstract
AIMS Preventing sudden cardiac death (SCD) due to acute myocardial infarction (MI) in previously healthy patients is challenging. Proteomic analysis may lead to an understanding of biological mechanisms and provide predictive biomarkers. METHODS In this prospective, nested case-control study from northern Sweden, 87 candidate cardiovascular protein biomarkers were studied in 244 individuals who later died within 24 h from an incident MI and 244 referents without MI and individually matched for age, sex and date of health examination and alive at the date of event in the index person. Association analysis was conducted using conditional logistic regression. Bonferroni correction was applied to avoid false positive findings. RESULTS Ten proteins were associated with future SCD due to acute MI in the non-adjusted analysis. The strongest association were found for growth differentiation factor 15 (GDF-15) with an odds ratio (OR) of 1.79 (95% confidence interval [CI] 1.41, 2.25) per standard deviation increase in protein, and urokinase-type plasminogen activator receptor with an OR of 1.66 (95% CI 1.34, 2.06). In models adjusted for lipid levels, body mass index, education, smoking, hypertension and C-reactive protein, only association with GDF-15 remained (OR 1.47 (95% 1.11, 1.95)). CONCLUSION Elevated levels of GDF-15 are associated with increased risk of SCD within 24 h of incident MI. Further research may enable the use of GDF-15 together with other clinical and biological markers to guide primary preventive interventions for individuals at high risk for SCD.
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Affiliation(s)
- Jonas Andersson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Sweden.
| | - Tove Fall
- Uppsala University and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Rachel Delicano
- Uppsala University and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Sweden
| | - Jan-Håkan Jansson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Sweden
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35
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Wallner M, Eland JHD, Squibb RJ, Andersson J, Roos AH, Singh R, Talaee O, Koulentianos D, Piancastelli MN, Simon M, Feifel R. Coulomb explosion of CD 3I induced by single photon deep inner-shell ionisation. Sci Rep 2020; 10:1246. [PMID: 31988321 PMCID: PMC6985119 DOI: 10.1038/s41598-020-58251-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/13/2020] [Indexed: 12/05/2022] Open
Abstract
L-shell ionisation and subsequent Coulomb explosion of fully deuterated methyl iodide, CD3I, irradiated with hard X-rays has been examined by a time-of-flight multi-ion coincidence technique. The core vacancies relax efficiently by Auger cascades, leading to charge states up to 16+. The dynamics of the Coulomb explosion process are investigated by calculating the ions’ flight times numerically based on a geometric model of the experimental apparatus, for comparison with the experimental data. A parametric model of the explosion, previously introduced for multi-photon induced Coulomb explosion, is applied in numerical simulations, giving good agreement with the experimental results for medium charge states. Deviations for higher charges suggest the need to include nuclear motion in a putatively more complete model. Detection efficiency corrections from the simulations are used to determine the true distributions of molecular charge states produced by initial L1, L2 and L3 ionisation.
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Affiliation(s)
- M Wallner
- Department of Physics, University of Gothenburg, Origovägen 6B, 412 58, Gothenburg, Sweden
| | - J H D Eland
- Department of Physics, University of Gothenburg, Origovägen 6B, 412 58, Gothenburg, Sweden.,Department of Chemistry, Physical and Theoretical Chemistry Laboratory, Oxford University, South Parks Road, Oxford, OX1 3QZ, United Kingdom
| | - R J Squibb
- Department of Physics, University of Gothenburg, Origovägen 6B, 412 58, Gothenburg, Sweden
| | - J Andersson
- Department of Physics, University of Gothenburg, Origovägen 6B, 412 58, Gothenburg, Sweden
| | - A Hult Roos
- Department of Physics, University of Gothenburg, Origovägen 6B, 412 58, Gothenburg, Sweden
| | - R Singh
- Department of Physics, University of Gothenburg, Origovägen 6B, 412 58, Gothenburg, Sweden
| | - O Talaee
- Department of Physics, University of Gothenburg, Origovägen 6B, 412 58, Gothenburg, Sweden.,Nano and Molecular Systems Research Unit, University of Oulu, P.O. Box 3000, FI-90014, Oulu, Finland
| | - D Koulentianos
- Department of Physics, University of Gothenburg, Origovägen 6B, 412 58, Gothenburg, Sweden.,Sorbonne Université, CNRS, Laboratoire de Chimie Physique-Matière et Rayonnement, F-75005, Paris, Cedex 05, France
| | - M N Piancastelli
- Sorbonne Université, CNRS, Laboratoire de Chimie Physique-Matière et Rayonnement, F-75005, Paris, Cedex 05, France.,Department of Physics and Astronomy, Uppsala University, Box 516, SE-751 20, Uppsala, Sweden
| | - M Simon
- Sorbonne Université, CNRS, Laboratoire de Chimie Physique-Matière et Rayonnement, F-75005, Paris, Cedex 05, France.,Synchrotron SOLEIL, L'Orme des Merisiers, Saint-Aubin, BP 48, F-91192, Gif-sur-Yvette, Cedex, France
| | - R Feifel
- Department of Physics, University of Gothenburg, Origovägen 6B, 412 58, Gothenburg, Sweden.
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Otten J, Andersson J, Ståhl J, Stomby A, Saleh A, Waling M, Ryberg M, Hauksson J, Svensson M, Johansson B, Olsson T. Exercise Training Adds Cardiometabolic Benefits of a Paleolithic Diet in Type 2 Diabetes Mellitus. J Am Heart Assoc 2020; 8:e010634. [PMID: 30652528 PMCID: PMC6497343 DOI: 10.1161/jaha.118.010634] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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] [Indexed: 12/12/2022]
Abstract
Background The accumulation of myocardial triglycerides and remodeling of the left ventricle are common features in type 2 diabetes mellitus and represent potential risk factors for the development of diastolic and systolic dysfunction. A few studies have investigated the separate effects of diet and exercise training on cardiac function, but none have investigated myocardial changes in response to a combined diet and exercise intervention. This 12‐week randomized study assessed the effects of a Paleolithic diet, with and without additional supervised exercise training, on cardiac fat, structure, and function. Methods and Results Twenty‐two overweight and obese subjects with type 2 diabetes mellitus were randomized to either a Paleolithic diet and standard‐care exercise recommendations (PD) or to a Paleolithic diet plus supervised exercise training 3 hours per week (PD‐EX). This study includes secondary end points related to cardiac structure and function, ie, myocardial triglycerides levels, cardiac morphology, and strain were measured using cardiovascular magnetic resonance, including proton spectroscopy, at baseline and after 12 weeks. Both groups showed major favorable metabolic changes. The PD‐EX group showed significant decreases in myocardial triglycerides levels (−45%, P=0.038) and left ventricle mass to end‐diastolic volume ratio (−13%, P=0.008) while the left ventricle end‐diastolic volume and stroke volume increased significantly (+14%, P=0.004 and +17%, P=0.008, respectively). These variables were unchanged in the PD group. Conclusions Exercise training plus a Paleolithic diet reduced myocardial triglycerides levels and improved left ventricle remodeling in overweight/obese subjects with type 2 diabetes mellitus. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01513798.
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Affiliation(s)
- Julia Otten
- 1 Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
| | - Jonas Andersson
- 1 Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
| | - Jens Ståhl
- 1 Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
| | - Andreas Stomby
- 1 Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
| | - Ahmed Saleh
- 1 Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
| | - Maria Waling
- 2 Department of Food and Nutrition Umeå University Umeå Sweden
| | - Mats Ryberg
- 1 Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
| | - Jon Hauksson
- 4 Department of Radiation Sciences Umeå University Umeå Sweden.,5 Department of Radiography and Biomedical Science Faculty of Medicine University of Iceland Reykjavik Iceland
| | - Michael Svensson
- 3 Sports Medicine Unit Department of Community Medicine and Rehabilitation Umeå University Umeå Sweden
| | - Bengt Johansson
- 1 Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
| | - Tommy Olsson
- 1 Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
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Andersson J, Zagorodskikh S, Roos AH, Talaee O, Squibb RJ, Koulentianos D, Wallner M, Zhaunerchyk V, Singh R, Eland JHD, Rost JM, Feifel R. Parametrization of energy sharing distributions in direct double photoionization of He. Sci Rep 2019; 9:17883. [PMID: 31784628 PMCID: PMC6884530 DOI: 10.1038/s41598-019-53545-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 03/26/2019] [Accepted: 10/31/2019] [Indexed: 11/18/2022] Open
Abstract
We present experimental results on the characteristic sharing of available excess energy, ranging from 11–221 eV, between two electrons in single-photon direct double ionization of He. An effective parametrization of the sharing distributions is presented along with an empirical model that describes the complete shape of the distribution based on a single experimentally determinable parameter. The measured total energy sharing distributions are separated into two distributions representing the shake-off and knock-out parts by simulating the sharing distribution curves expected from a pure wave collapse after a sudden removal of the primary electron. In this way, empirical knock-out distributions are extracted and both the shake-off and knock-out distributions are parametrized. These results suggest a simple method that can be applied to other atomic and molecular systems to experimentally study important aspects of the direct double ionization process.
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Affiliation(s)
- J Andersson
- Department of Physics, University of Gothenburg, Origovägen 6B, 412 96, Gothenburg, Sweden
| | - S Zagorodskikh
- Department of Physics, University of Gothenburg, Origovägen 6B, 412 96, Gothenburg, Sweden.,Department of Physics and Astronomy, Uppsala University, Box 516, SE-751 20, Uppsala, Sweden
| | - A Hult Roos
- Department of Physics, University of Gothenburg, Origovägen 6B, 412 96, Gothenburg, Sweden
| | - O Talaee
- Department of Physics, University of Gothenburg, Origovägen 6B, 412 96, Gothenburg, Sweden.,Nano and Molecular Systems Research Unit, University of Oulu, P.O. Box 3000, FI-90014 University of Oulu, Oulu, Finland
| | - R J Squibb
- Department of Physics, University of Gothenburg, Origovägen 6B, 412 96, Gothenburg, Sweden
| | - D Koulentianos
- Department of Physics, University of Gothenburg, Origovägen 6B, 412 96, Gothenburg, Sweden.,Sorbonne Université, CNRS, Laboratoire de Chimie Physique-Matière et Rayonnement, F-75005, Paris, Cedex 05, France
| | - M Wallner
- Department of Physics, University of Gothenburg, Origovägen 6B, 412 96, Gothenburg, Sweden
| | - V Zhaunerchyk
- Department of Physics, University of Gothenburg, Origovägen 6B, 412 96, Gothenburg, Sweden
| | - R Singh
- Department of Particle Physics and Astrophysics, Weizmann Institute of Science, Rehovot, 7610001, Israel
| | - J H D Eland
- Department of Physics, University of Gothenburg, Origovägen 6B, 412 96, Gothenburg, Sweden.,Department of Chemistry, Physical and Theoretical Chemistry Laboratory, Oxford University, South Parks Road, Oxford, OX1 3QZ, United Kingdom
| | - J M Rost
- Max-Planck-Institut für Physik komplexer Systeme, Nöthnitzer Str. 38, D-01187, Dresden, Germany
| | - R Feifel
- Department of Physics, University of Gothenburg, Origovägen 6B, 412 96, Gothenburg, Sweden.
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Key TJ, Appleby PN, Bradbury KE, Sweeting M, Wood A, Johansson I, Kühn T, Steur M, Weiderpass E, Wennberg M, Lund Würtz AM, Agudo A, Andersson J, Arriola L, Boeing H, Boer JM, Bonnet F, Boutron-Ruault MC, Cross AJ, Ericson U, Fagherazzi G, Ferrari P, Gunter M, Huerta JM, Katzke V, Khaw KT, Krogh V, La Vecchia C, Matullo G, Moreno-Iribas C, Naska A, Nilsson LM, Olsen A, Overvad K, Palli D, Panico S, Molina-Portillo E, Quirós JR, Skeie G, Sluijs I, Sonestedt E, Stepien M, Tjønneland A, Trichopoulou A, Tumino R, Tzoulaki I, van der Schouw YT, Verschuren WM, di Angelantonio E, Langenberg C, Forouhi N, Wareham N, Butterworth A, Riboli E, Danesh J. Consumption of Meat, Fish, Dairy Products, and Eggs and Risk of Ischemic Heart Disease. Circulation 2019; 139:2835-2845. [PMID: 31006335 PMCID: PMC6629175 DOI: 10.1161/circulationaha.118.038813] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/23/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND There is uncertainty about the relevance of animal foods to the pathogenesis of ischemic heart disease (IHD). We examined meat, fish, dairy products, and eggs and risk for IHD in the pan-European EPIC cohort (European Prospective Investigation Into Cancer and Nutrition). METHODS In this prospective study of 409 885 men and women in 9 European countries, diet was assessed with validated questionnaires and calibrated with 24-hour recalls. Lipids and blood pressure were measured in a subsample. During a mean of 12.6 years of follow-up, 7198 participants had a myocardial infarction or died of IHD. The relationships of animal foods with risk were examined with Cox regression with adjustment for other animal foods and relevant covariates. RESULTS The hazard ratio (HR) for IHD was 1.19 (95% CI, 1.06-1.33) for a 100-g/d increment in intake of red and processed meat, and this remained significant after exclusion of the first 4 years of follow-up (HR, 1.25 [95% CI, 1.09-1.42]). Risk was inversely associated with intakes of yogurt (HR, 0.93 [95% CI, 0.89-0.98] per 100-g/d increment), cheese (HR, 0.92 [95% CI, 0.86-0.98] per 30-g/d increment), and eggs (HR, 0.93 [95% CI, 0.88-0.99] per 20-g/d increment); the associations with yogurt and eggs were attenuated and nonsignificant after exclusion of the first 4 years of follow-up. Risk was not significantly associated with intakes of poultry, fish, or milk. In analyses modeling dietary substitutions, replacement of 100 kcal/d from red and processed meat with 100 kcal/d from fatty fish, yogurt, cheese, or eggs was associated with ≈20% lower risk of IHD. Consumption of red and processed meat was positively associated with serum non-high-density lipoprotein cholesterol concentration and systolic blood pressure, and consumption of cheese was inversely associated with serum non-high-density lipoprotein cholesterol. CONCLUSIONS Risk for IHD was positively associated with consumption of red and processed meat and inversely associated with consumption of yogurt, cheese, and eggs, although the associations with yogurt and eggs may be influenced by reverse causation bias. It is not clear whether the associations with red and processed meat and cheese reflect causality, but they were consistent with the associations of these foods with plasma non-high-density lipoprotein cholesterol and for red and processed meat with systolic blood pressure, which could mediate such effects.
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Affiliation(s)
- Timothy J. Key
- Nuffield Department of Population Health, University of Oxford, United Kingdom (T.J.K., P.N.A., K.E.B.)
| | - Paul N. Appleby
- Nuffield Department of Population Health, University of Oxford, United Kingdom (T.J.K., P.N.A., K.E.B.)
| | - Kathryn E. Bradbury
- Nuffield Department of Population Health, University of Oxford, United Kingdom (T.J.K., P.N.A., K.E.B.)
- National Institute for Health Innovation, School of Population Health, University of Auckland, New Zealand (K.E.B.)
| | - Michael Sweeting
- Medical Research Council/British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom (M. Sweeting, A.W., E.d.A., A.B., J.D.)
| | - Angela Wood
- Medical Research Council/British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom (M. Sweeting, A.W., E.d.A., A.B., J.D.)
| | | | - Tilman Kühn
- German Cancer Research Center, Division of Cancer Epidemiology, Heidelberg (T.K., V. Katzke)
| | - Marinka Steur
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, United Kingdom (M. Steur, C.L., N.F., N.W.)
| | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, Universitetet i Tromsø, Arctic University of Norway, Tromsø (E.W., G.S.)
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo (E.W.)
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (E.W.)
- Genetic Epidemiology Group, Folkhälsan Research Center, and Faculty of Medicine, University of Helsinki, Finland (E.W.)
| | - Maria Wennberg
- Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Sweden (M.W.)
| | - Anne Mette Lund Würtz
- Section for Epidemiology, Department of Public Health, Aarhus University, Denmark (A.M.L.W., K.O.)
| | - Antonio Agudo
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology–Institut d'Investigació Biomédica de Bellvitge, Barcelona, Spain (A.A.)
| | - Jonas Andersson
- Department of Public Health and Clinical Medicine, Research Unit Skellefteå, Umeå University, Sweden (J.A.)
| | - Larraitz Arriola
- Public Health Division of Gipuzkoa, Instituto BIO–Donostia, Basque Government, San Sebastian, Spain (L.A.)
- CIBER (Biomedical Research Networking Centres) de Epidemiología y Salud Pública, Madrid, Spain (L.A., J.M.H.)
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition (DIfE), Potsdam-Rehbrücke (H.B.)
| | - Jolanda M.A. Boer
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (J.M.A.B.)
| | - Fabrice Bonnet
- CESP, INSERM (Centre de recherche en Epidémiologie et Santé des Populations, Institut national de la santé et de la recherche médicale) U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif Cedex, France (F.B., M.-C.B.-R., G.F.)
- Gustave Roussy, Villejuif Cedex, Paris, France (F.B., M.-C.B.-R., G.F.)
- Department of Endocrinology, Rennes University Hospital (CHU), France (F.B.)
- Rennes 1 University, France (F.B.)
| | - Marie-Christine Boutron-Ruault
- CESP, INSERM (Centre de recherche en Epidémiologie et Santé des Populations, Institut national de la santé et de la recherche médicale) U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif Cedex, France (F.B., M.-C.B.-R., G.F.)
- Gustave Roussy, Villejuif Cedex, Paris, France (F.B., M.-C.B.-R., G.F.)
| | - Amanda J. Cross
- School of Public Health, Imperial College, London, United Kingdom (A.J.C., E.R.)
| | - Ulrika Ericson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden (U.E., E.S.)
| | - Guy Fagherazzi
- CESP, INSERM (Centre de recherche en Epidémiologie et Santé des Populations, Institut national de la santé et de la recherche médicale) U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif Cedex, France (F.B., M.-C.B.-R., G.F.)
- Gustave Roussy, Villejuif Cedex, Paris, France (F.B., M.-C.B.-R., G.F.)
| | - Pietro Ferrari
- International Agency for Research on Cancer, World Health Organization, Lyon, France (P.F., M.G., M. Stepien)
| | - Marc Gunter
- International Agency for Research on Cancer, World Health Organization, Lyon, France (P.F., M.G., M. Stepien)
| | - José María Huerta
- Department of Epidemiology, Murcia Regional Health Council, IMIB (Instituto Murciano de Investigación Biosanitaria)-Arrixaca, Spain (J.M.H.)
| | - Verena Katzke
- German Cancer Research Center, Division of Cancer Epidemiology, Heidelberg (T.K., V. Katzke)
| | - Kay-Tee Khaw
- Clinical Gerontology, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, United Kingdom (K.-T.K.)
| | - Vittorio Krogh
- Epidemiology and Prevention Unit, Fondazione IRCCS (Institute for Research, Hospitalization and Health Care) Istituto Nazionale dei Tumori, Milan, Italy (V. Krogh)
| | - Carlo La Vecchia
- Hellenic Health Foundation, Athens, Greece (C.L.V., A. Trichopoulou)
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy (C.L.V.)
| | - Giuseppe Matullo
- Italian Institute for Genomic Medicine, Turin (G.M.)
- Department of Medical Sciences, University of Turin, Italy (G.M.)
| | - Conchi Moreno-Iribas
- Instituto de Salud Pública de Navarra, IdiSNA–Navarre Institute for Health Research, Pamplona, Spain (C.M.-I.)
| | - Androniki Naska
- World Health Organization Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece (A.N., A. Trichopoulou)
| | | | - Anja Olsen
- Danish Cancer Society Research Center, Copenhagen, Denmark (A.O., A.Tjønneland)
| | - Kim Overvad
- Section for Epidemiology, Department of Public Health, Aarhus University, Denmark (A.M.L.W., K.O.)
| | - Domenico Palli
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network–ISPRO, Florence, Italy (D.P.)
| | - Salvatore Panico
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy (S.P.)
| | - Elena Molina-Portillo
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria, Universidad de Granada, Spain (E.M.-P.)
| | - J. Ramón Quirós
- Public Health Directorate of Asturias, Oviedo, Spain (J.R.Q.)
| | - Guri Skeie
- Department of Community Medicine, Faculty of Health Sciences, Universitetet i Tromsø, Arctic University of Norway, Tromsø (E.W., G.S.)
| | - Ivonne Sluijs
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands (I.S., Y.T.v.d.S., W.M.M.V.)
| | - Emily Sonestedt
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden (U.E., E.S.)
| | - Magdalena Stepien
- International Agency for Research on Cancer, World Health Organization, Lyon, France (P.F., M.G., M. Stepien)
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark (A.O., A.Tjønneland)
| | - Antonia Trichopoulou
- Hellenic Health Foundation, Athens, Greece (C.L.V., A. Trichopoulou)
- World Health Organization Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece (A.N., A. Trichopoulou)
| | - Rosario Tumino
- Cancer Registry and Histopathology Unit, “Civic-M.p.Arezzo” Hospital, ASP (Azienda Sanitaria Provinciale) Ragusa, Italy (R.T.)
| | - Ioanna Tzoulaki
- Department of Epidemiology and Biostatistics (I.T.), School of Public Health, Imperial College London, United Kingdom
- Medical Research Council-Public Health England Centre for Environment (I.T.), School of Public Health, Imperial College London, United Kingdom
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Greece (I.T.)
| | - Yvonne T. van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands (I.S., Y.T.v.d.S., W.M.M.V.)
| | - W.M. Monique Verschuren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands (I.S., Y.T.v.d.S., W.M.M.V.)
| | - Emanuele di Angelantonio
- Medical Research Council/British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom (M. Sweeting, A.W., E.d.A., A.B., J.D.)
| | - Claudia Langenberg
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, United Kingdom (M. Steur, C.L., N.F., N.W.)
| | - Nita Forouhi
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, United Kingdom (M. Steur, C.L., N.F., N.W.)
| | - Nick Wareham
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, United Kingdom (M. Steur, C.L., N.F., N.W.)
| | - Adam Butterworth
- Medical Research Council/British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom (M. Sweeting, A.W., E.d.A., A.B., J.D.)
| | - Elio Riboli
- School of Public Health, Imperial College, London, United Kingdom (A.J.C., E.R.)
| | - John Danesh
- Medical Research Council/British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom (M. Sweeting, A.W., E.d.A., A.B., J.D.)
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Motiani P, Teuho J, Saari T, Virtanen KA, Honkala SM, Middelbeek RJ, Goodyear LJ, Eskola O, Andersson J, Löyttyniemi E, Hannukainen JC, Nuutila P. Exercise training alters lipoprotein particles independent of brown adipose tissue metabolic activity. Obes Sci Pract 2019; 5:258-272. [PMID: 31275600 PMCID: PMC6587322 DOI: 10.1002/osp4.330] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 08/17/2018] [Revised: 01/15/2019] [Accepted: 01/17/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction New strategies for weight loss and weight maintenance in humans are needed. Human brown adipose tissue (BAT) can stimulate energy expenditure and may be a potential therapeutic target for obesity and type 2 diabetes. However, whether exercise training is an efficient stimulus to activate and recruit BAT remains to be explored. This study aimed to evaluate whether regular exercise training affects cold‐stimulated BAT metabolism and, if so, whether this was associated with changes in plasma metabolites. Methods Healthy sedentary men (n = 11; aged 31 [SD 7] years; body mass index 23 [0.9] kg m−2; VO2 max 39 [7.6] mL min−1 kg−1) participated in a 6‐week exercise training intervention. Fasting BAT and neck muscle glucose uptake (GU) were measured using quantitative [18F]fluorodeoxyglucose positron emission tomography–magnetic resonance imaging three times: (1) before training at room temperature and (2) before and (3) after the training period during cold stimulation. Cervico‐thoracic BAT mass was measured using MRI signal fat fraction maps. Plasma metabolites were analysed using nuclear magnetic resonance spectroscopy. Results Cold exposure increased supraclavicular BAT GU by threefold (p < 0.001), energy expenditure by 59% (p < 0.001) and plasma fatty acids (p < 0.01). Exercise training had no effect on cold‐induced GU in BAT or neck muscles. Training increased aerobic capacity (p = 0.01) and decreased visceral fat (p = 0.02) and cervico‐thoracic BAT mass (p = 0.003). Additionally, training decreased very low‐density lipoprotein particle size (p = 0.04), triglycerides within chylomicrons (p = 0.04) and small high‐density lipoprotein (p = 0.04). Conclusions Although exercise training plays an important role for metabolic health, its beneficial effects on whole body metabolism through physiological adaptations seem to be independent of BAT activation in young, sedentary men.
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Affiliation(s)
- P Motiani
- Turku PET Centre University of Turku Turku Finland
| | - J Teuho
- Turku PET Centre University of Turku Turku Finland.,Department of Medical Physics Turku University Hospital Turku Finland
| | - T Saari
- Turku PET Centre University of Turku Turku Finland
| | - K A Virtanen
- Turku PET Centre University of Turku Turku Finland.,Institute of Public Health and Clinical Nutrition University of Eastern Finland (UEF) Kuopio Finland
| | - S M Honkala
- Turku PET Centre University of Turku Turku Finland
| | - R J Middelbeek
- Section on Integrative Physiology and Metabolism Joslin Diabetes Center, Harvard Medical School Boston MA USA.,Division of Endocrinology Diabetes and Metabolism, Beth Israel Deaconess Medical Center Boston MA USA
| | - L J Goodyear
- Section on Integrative Physiology and Metabolism Joslin Diabetes Center, Harvard Medical School Boston MA USA
| | - O Eskola
- Turku PET Centre University of Turku Turku Finland
| | - J Andersson
- Section of Radiology, Department of Surgical Sciences Uppsala University Uppsala Sweden
| | - E Löyttyniemi
- Department of Biostatistics University of Turku Turku Finland
| | | | - P Nuutila
- Turku PET Centre University of Turku Turku Finland.,Department of Endocrinology, Turku PET Centre Turku University Hospital Turku Finland
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Andersson J, Skansén-Saphir U, Sparrelid E, Andersson U. Intravenous immune globulin affects cytokine production in T lymphocytes and monocytesjmacrophages. Clin Exp Immunol 2019. [DOI: 10.1111/cei.1996.104.s1.10] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Habibovic A, Andersson J, Malmsten Lundgren V, Klingegård M, Englund C, Larsson S. External Vehicle Interfaces for Communication with Other Road Users? Lecture Notes in Mobility 2019. [DOI: 10.1007/978-3-319-94896-6_9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Hult Roos A, Eland JHD, Andersson J, Wallner M, Squibb RJ, Feifel R. Relative extent of triple Auger decay in CO and CO2. Phys Chem Chem Phys 2019; 21:9889-9894. [DOI: 10.1039/c9cp01415b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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
Systematic measurements on single and triple Auger decay in CO and CO2 after the creation of a C 1s or a O 1s core vacancy show that the percentage of triple Auger decay is on the order of 10−2 of the single Auger decay in these molecules.
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Affiliation(s)
- A. Hult Roos
- Department of Physics
- University of Gothenburg
- 412 96 Gothenburg
- Sweden
| | - J. H. D. Eland
- Department of Physics
- University of Gothenburg
- 412 96 Gothenburg
- Sweden
- Department of Chemistry
| | - J. Andersson
- Department of Physics
- University of Gothenburg
- 412 96 Gothenburg
- Sweden
| | - M. Wallner
- Department of Physics
- University of Gothenburg
- 412 96 Gothenburg
- Sweden
| | - R. J. Squibb
- Department of Physics
- University of Gothenburg
- 412 96 Gothenburg
- Sweden
| | - R. Feifel
- Department of Physics
- University of Gothenburg
- 412 96 Gothenburg
- Sweden
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Roos AH, Eland JHD, Andersson J, Squibb RJ, Feifel R. Dissociations of water ions after valence and inner-valence ionization. J Chem Phys 2018; 149:204307. [DOI: 10.1063/1.5055593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- A. Hult Roos
- Department of Physics, University of Gothenburg, Origovägen 6B, 412 96 Gothenburg, Sweden
| | - J. H. D. Eland
- Department of Physics, University of Gothenburg, Origovägen 6B, 412 96 Gothenburg, Sweden
- Department of Chemistry, Physical and Theoretical Chemistry Laboratory, Oxford University, South Parks Road, Oxford OX1 3QZ, United Kingdom
| | - J. Andersson
- Department of Physics, University of Gothenburg, Origovägen 6B, 412 96 Gothenburg, Sweden
| | - R. J. Squibb
- Department of Physics, University of Gothenburg, Origovägen 6B, 412 96 Gothenburg, Sweden
| | - R. Feifel
- Department of Physics, University of Gothenburg, Origovägen 6B, 412 96 Gothenburg, Sweden
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Bekele A, Gebreselassie N, Ashenafi S, Kassa E, Aseffa G, Amogne W, Getachew M, Aseffa A, Worku A, Raqib R, Agerberth B, Hammar U, Bergman P, Aderaye G, Andersson J, Brighenti S. Daily adjunctive therapy with vitamin D 3 and phenylbutyrate supports clinical recovery from pulmonary tuberculosis: a randomized controlled trial in Ethiopia. J Intern Med 2018; 284:292-306. [PMID: 29696707 PMCID: PMC6202271 DOI: 10.1111/joim.12767] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [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: 12/21/2022]
Abstract
OBJECTIVE Immunotherapy using vitamin D (vitD3 ) and phenylbutyrate (PBA) may support standard drug regimens used to treat infectious diseases. We investigated if vitD3 + PBA enhanced clinical recovery from pulmonary tuberculosis (TB). METHODS A randomized controlled trial was conducted in Addis Ababa, Ethiopia. Patients with smear-positive or smear-negative TB received daily oral supplementation with 5000 IU vitD3 and 2 × 500 mg PBA or placebo for 16 weeks, together with 6-month chemotherapy. Primary end-point: reduction of a clinical composite TB score at week 8 compared with baseline using modified intention-to-treat (mITT, n = 348) and per-protocol (n = 296) analyses. Secondary end-points: primary and modified TB scores (week 0, 4, 8, 16, 24), sputum conversion, radiological findings and plasma 25(OH)D3 concentrations. RESULTS Most subjects had low baseline plasma 25(OH)D3 levels that increased gradually in the vitD3 + PBA group compared with placebo (P < 0.0001) from week 0 to 16 (mean 34.7 vs. 127.4 nmol L-1 ). In the adjusted mITT analysis, the primary TB score was significantly reduced in the intervention group at week 8 (-0.52, 95% CI -0.93, -0.10; P = 0.015) while the modified TB score was reduced at week 8 (-0.58, 95% CI -1.02, -0.14; P = 0.01) and 16 (-0.34, 95% CI -0.64, -0.03; P = 0.03). VitD3 + PBA had no effect on longitudinal sputum-smear conversion (P = 0.98). Clinical adverse events were more common in the placebo group (24.3%) compared with the vitD3 + PBA group (12.6%). CONCLUSION Daily supplementation with vitD3 + PBA may ameliorate clinical TB symptoms and disease-specific complications, while the intervention had no effect on bacterial clearance in sputum.
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Affiliation(s)
- A Bekele
- Department of Internal Medicine, Faculty of Medicine, Black Lion University Hospital, Addis Ababa University, Addis Ababa, Ethiopia
| | - N Gebreselassie
- Center for Infectious Medicine (CIM), F59, Department of Medicine, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden.,Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - S Ashenafi
- Center for Infectious Medicine (CIM), F59, Department of Medicine, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - E Kassa
- Department of Internal Medicine, Faculty of Medicine, Black Lion University Hospital, Addis Ababa University, Addis Ababa, Ethiopia
| | - G Aseffa
- Department of Radiology, Faculty of Medicine, Black Lion University Hospital, Addis Ababa University, Addis Ababa, Ethiopia
| | - W Amogne
- Department of Internal Medicine, Faculty of Medicine, Black Lion University Hospital, Addis Ababa University, Addis Ababa, Ethiopia
| | - M Getachew
- Department of Internal Medicine, Faculty of Medicine, Black Lion University Hospital, Addis Ababa University, Addis Ababa, Ethiopia
| | - A Aseffa
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - A Worku
- Department of Public Health, Faculty of Medicine, Black Lion University Hospital, Addis Ababa University, Addis Ababa, Ethiopia
| | - R Raqib
- Infectious Diseases Division (IDD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - B Agerberth
- Clinical Microbiology, Department of Laboratory Medicine (Labmed), Karolinska Institutet, Stockholm, Sweden
| | - U Hammar
- Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden
| | - P Bergman
- Clinical Microbiology, Department of Laboratory Medicine (Labmed), Karolinska Institutet, Stockholm, Sweden
| | - G Aderaye
- Department of Internal Medicine, Faculty of Medicine, Black Lion University Hospital, Addis Ababa University, Addis Ababa, Ethiopia
| | - J Andersson
- Center for Infectious Medicine (CIM), F59, Department of Medicine, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden.,Division of Infectious Diseases, Department of Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - S Brighenti
- Center for Infectious Medicine (CIM), F59, Department of Medicine, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden
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Habibovic A, Lundgren VM, Andersson J, Klingegård M, Lagström T, Sirkka A, Fagerlönn J, Edgren C, Fredriksson R, Krupenia S, Saluäär D, Larsson P. Communicating Intent of Automated Vehicles to Pedestrians. Front Psychol 2018; 9:1336. [PMID: 30131737 PMCID: PMC6090516 DOI: 10.3389/fpsyg.2018.01336] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [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: 05/31/2017] [Accepted: 07/12/2018] [Indexed: 11/25/2022] Open
Abstract
While traffic signals, signs, and road markings provide explicit guidelines for those operating in and around the roadways, some decisions, such as determinations of “who will go first,” are made by implicit negotiations between road users. In such situations, pedestrians are today often dependent on cues in drivers’ behavior such as eye contact, postures, and gestures. With the introduction of more automated functions and the transfer of control from the driver to the vehicle, pedestrians cannot rely on such non-verbal cues anymore. To study how the interaction between pedestrians and automated vehicles (AVs) might look like in the future, and how this might be affected if AVs were to communicate their intent to pedestrians, we designed an external vehicle interface called automated vehicle interaction principle (AVIP) that communicates vehicles’ mode and intent to pedestrians. The interaction was explored in two experiments using a Wizard of Oz approach to simulate automated driving. The first experiment was carried out at a zebra crossing and involved nine pedestrians. While it focused mainly on assessing the usability of the interface, it also revealed initial indications related to pedestrians’ emotions and perceived safety when encountering an AV with/without the interface. The second experiment was carried out in a parking lot and involved 24 pedestrians, which enabled a more detailed assessment of pedestrians’ perceived safety when encountering an AV, both with and without the interface. For comparison purposes, these pedestrians also encountered a conventional vehicle. After a short training course, the interface was deemed easy for the pedestrians to interpret. The pedestrians stated that they felt significantly less safe when they encountered the AV without the interface, compared to the conventional vehicle and the AV with the interface. This suggests that the interface could contribute to a positive experience and improved perceived safety in pedestrian encounters with AVs – something that might be important for general acceptance of AVs. As such, this topic should be further investigated in future studies involving a larger sample and more dynamic conditions.
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Affiliation(s)
| | | | | | | | | | - Anna Sirkka
- RISE Research Institutes of Sweden, Gothenburg, Sweden
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de las Heras Gala H, Torresin A, Dasu A, Rampado O, Delis H, Giron IH, Theodorakou C, Andersson J, Holroyd J, Edyvean S, Delpon G, Caprile P, Peterlin P, Trianni A, Wg E. [OA176] The CBCT protocol of EFOMP-ESTRO-IAEA is alive: Update by eurados and din. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.06.248] [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: 10/28/2022] Open
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49
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Bujila R, Kull L, Danielsson M, Andersson J. Applying three different methods of measuring CTDI free air to the extended CTDI formalism for wide-beam scanners (IEC 60601-2-44): A comparative study. J Appl Clin Med Phys 2018; 19:281-289. [PMID: 29900670 PMCID: PMC6036408 DOI: 10.1002/acm2.12363] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/06/2018] [Accepted: 05/01/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose The weighted CT dose index (CTDIw) has been extended for a nominal total collimation width (nT) greater than 40 mm and relies on measurements of CTDIfreeair. The purpose of this work was to compare three methods of measuring CTDIfreeair and subsequent calculations of CTDIw to investigate their clinical appropriateness. Methods The CTDIfreeair, for multiple nTs up to 160 mm, was calculated from (1) high‐resolution air kerma profiles from a step‐and‐shoot translation of a liquid ionization chamber (LIC) (considered to be a dosimetric reference), (2) pencil ionization chamber (PIC) measurements at multiple contiguous positions, and (3) air kerma profiles obtained through the continuous translation of a solid‐state detector. The resulting CTDIfreeair was used to calculate the CTDIw, per the extended formalism, and compared. Results The LIC indicated that a 40 mm nT should not be excluded from the extension of the CTDIw formalism. The solid‐state detector differed by as much as 8% compared to the LIC. The PIC was the most straightforward method and gave equivalent results to the LIC. Conclusions The CTDIw calculated with the latest CTDI formalism will differ most for 160 mm nTs (e.g., whole‐organ perfusion or coronary CT angiography) compared to the previous CTDI formalism. Inaccuracies in the measurement of CTDIfreeair will subsequently manifest themselves as erroneous calculations of the CTDIw, for nTs greater than 40 mm, with the latest CTDI formalism. The PIC was found to be the most clinically feasible method and was validated against the LIC.
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Affiliation(s)
- Robert Bujila
- Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Physics, Royal Institute of Technology, Stockholm, Sweden
| | - Love Kull
- Department of Radiation Physics, Sunderby Hospital, Luleå, Sweden
| | - Mats Danielsson
- Department of Physics, Royal Institute of Technology, Stockholm, Sweden
| | - Jonas Andersson
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
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Lindholm D, James S, Andersson J, Braun OÖ, Heller S, Henriksson P, Lauermann J, Öhagen P, Varenhorst C. Caffeine and incidence of dyspnea in patients treated with ticagrelor. Am Heart J 2018; 200:141-143. [PMID: 29898843 DOI: 10.1016/j.ahj.2018.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/14/2018] [Indexed: 01/08/2023]
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