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Onjukka E, Karlsson K, Lindberg K. In Regard to Milano et al. Int J Radiat Oncol Biol Phys 2024; 118:1144. [PMID: 38401969 DOI: 10.1016/j.ijrobp.2023.08.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/29/2023] [Indexed: 02/26/2024]
Affiliation(s)
- Eva Onjukka
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Kristin Karlsson
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Karin Lindberg
- Department of Head, Neck, Lung and Skin Tumors, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
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Lindberg S, Grozman V, Karlsson K, Onjukka E, Lindbäck E, Jirf KA, Lax I, Wersäll P, Persson GF, Josipovic M, Khalil AA, Møller DS, Hoffmann L, Knap MM, Nyman J, Drugge N, Bergström P, Olofsson J, Rogg LV, Hagen RK, Frøland AS, Ramberg C, Kristiansen C, Jeppesen SS, Nielsen TB, Lödén B, Rosenbrand HO, Engelholm S, Haraldsson A, Billiet C, Lewensohn R, Lindberg K. Expanded HILUS Trial: A Pooled Analysis of Risk Factors for Toxicity From Stereotactic Body Radiation Therapy of Central and Ultracentral Lung Tumors. Int J Radiat Oncol Biol Phys 2023; 117:1222-1231. [PMID: 37423292 DOI: 10.1016/j.ijrobp.2023.06.246] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE Stereotactic body radiation therapy for tumors near the central airways implies high-grade toxic effects, as concluded from the HILUS trial. However, the small sample size and relatively few events limited the statistical power of the study. We therefore pooled data from the prospective HILUS trial with retrospective data from patients in the Nordic countries treated outside the prospective study to evaluate toxicity and risk factors for high-grade toxic effects. METHODS AND MATERIALS All patients were treated with 56 Gy in 8 fractions. Tumors within 2 cm of the trachea, the mainstem bronchi, the intermediate bronchus, or the lobar bronchi were included. The primary endpoint was toxicity, and the secondary endpoints were local control and overall survival. Clinical and dosimetric risk factors were analyzed for treatment-related fatal toxicity in univariable and multivariable Cox regression analyses. RESULTS Of 230 patients evaluated, grade 5 toxicity developed in 30 patients (13%), of whom 20 patients had fatal bronchopulmonary bleeding. The multivariable analysis revealed tumor compression of the tracheobronchial tree and maximum dose to the mainstem or intermediate bronchus as significant risk factors for grade 5 bleeding and grade 5 toxicity. The 3-year local control and overall survival rates were 84% (95% CI, 80%-90%) and 40% (95% CI, 34%-47%), respectively. CONCLUSIONS Tumor compression of the tracheobronchial tree and high maximum dose to the mainstem or intermediate bronchus increase the risk of fatal toxicity after stereotactic body radiation therapy in 8 fractions for central lung tumors. Similar dose constraints should be applied to the intermediate bronchus as to the mainstem bronchi.
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Affiliation(s)
- Sara Lindberg
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Theme Cancer, Department of Head, Neck, Lung and Skin Tumors, Karolinska University Hospital, Stockholm, Sweden.
| | - Vitali Grozman
- Section of Thoracic Radiology, Department of Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Kristin Karlsson
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Section of Radiotherapy Physics and Engineering, Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Onjukka
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Section of Radiotherapy Physics and Engineering, Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Elias Lindbäck
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Section of Radiotherapy Physics and Engineering, Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Karam Al Jirf
- Theme Cancer, Department of Head, Neck, Lung and Skin Tumors, Karolinska University Hospital, Stockholm, Sweden
| | - Ingmar Lax
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Theme Cancer, Department of Head, Neck, Lung and Skin Tumors, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Wersäll
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Section of Radiotherapy, Department of Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Gitte Fredberg Persson
- Section of Radiotherapy, Department of Oncology, Rigshospitalet, Copenhagen, Denmark; Department of Oncology, Herlev-Gentofte Hospital, Herlev, Denmark; Department of Clinical Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mirjana Josipovic
- Section of Radiotherapy, Department of Oncology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Azza Ahmed Khalil
- Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Ditte Sloth Møller
- Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Lone Hoffmann
- Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Marianne Marquard Knap
- Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
| | - Jan Nyman
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ninni Drugge
- Department of Therapeutic Radiation Physics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per Bergström
- Department of Oncology, Northern Sweden University Hospital, Umeå, Sweden
| | - Jörgen Olofsson
- Department of Oncology, Northern Sweden University Hospital, Umeå, Sweden
| | | | | | | | - Christina Ramberg
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
| | - Charlotte Kristiansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Stefan Starup Jeppesen
- Department of Oncology, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Tine Bjørn Nielsen
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - Britta Lödén
- Oncology Department, Central Hospital in Karlstad, Karlstad, Sweden
| | | | - Silke Engelholm
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - André Haraldsson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Charlotte Billiet
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk, University of Antwerp, Antwerp, Belgium
| | - Rolf Lewensohn
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Theme Cancer, Department of Head, Neck, Lung and Skin Tumors, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Lindberg
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Theme Cancer, Department of Head, Neck, Lung and Skin Tumors, Karolinska University Hospital, Stockholm, Sweden
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Backlund E, Grozman V, Egyhazi Brage S, Lewensohn R, Lindberg K, Helgadottir H. Radiotherapy with or without immunotherapy in metastatic melanoma: efficacy and tolerability. Acta Oncol 2023; 62:1921-1930. [PMID: 37966921 DOI: 10.1080/0284186x.2023.2280766] [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: 09/01/2023] [Accepted: 11/03/2023] [Indexed: 11/17/2023]
Abstract
INTRODUCTION Radiotherapy (RT) is primarily considered as a palliative treatment in patients with metastatic melanoma. However, observations suggest that when RT is combined with immune checkpoint inhibitors (ICI), it can induce an immune response leading to an anti-tumoral effect also distant from the irradiated area - a phenomenon called 'abscopal effect'. The frequency and circumstances of abscopal effect among metastatic melanoma patients remains uncertain and further research is necessary. MATERIAL AND METHOD This retrospective study included all metastatic melanoma patients who received non-stereotactic RT in Stockholm, Sweden in 2015-2020. Patients were grouped depending on if RT was given at start of ICI (RT + ICI(start)), at ICI progression (RT + ICI(salvage)) or without ICI (RT(only)). Response rates in irradiated (RR(irradiated)) and overall response rates in non-irradiated (ORR(non-irradiated)) metastases were evaluated together with survival and toxicity in each cohort. RESULTS In the RT + ICI(start) (n = 47), RT + ICI(salvage) (n = 41) and RT(only) (n = 55) cohorts, RR(irradiated) was 70.7%, 67.5% and 43.1% (p = 0.018) while the ORR(non-irradiated) was 36.1%, 14.8% and 0.0% (p = 0.003), and the median overall survival was 18.2, 15.0 and 7.2 months, respectively (p = 0.014). Local response to RT was in all cohorts associated with longer survival (p < 0.001). The frequency of grade ≥3 immune-related adverse events was 17.0% and 19.5% in the RT + ICI(start) and RT + ICI(salvage) cohorts. No increased frequency of RT-related adverse events was seen in the RT + ICI cohorts, compared to the RT(only) cohort. CONCLUSION This retrospective study showed that melanoma patients receiving RT in combination with ICI had a superior antitumoral response in both irradiated and non-irradiated lesions as compared to patients receiving only RT. Additionally, a subgroup of patients receiving RT when progressing on ICI experienced tumor regression also in non-irradiated areas.
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Affiliation(s)
- Ellen Backlund
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Vitali Grozman
- Department of Diagnostic Radiology, Karolinska University Hospital, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm
| | | | - Rolf Lewensohn
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Karin Lindberg
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Hildur Helgadottir
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
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Lindberg K. Balancing tumour control probability and toxicity in SBRT of ultra-central lung tumours - One step forward. Lung Cancer 2023; 184:107343. [PMID: 37625912 DOI: 10.1016/j.lungcan.2023.107343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023]
Affiliation(s)
- Karin Lindberg
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Centre of Pulmonary Oncology, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden.
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Lagergren Lindberg M, Hedman C, Lindberg K, Valentin J, Stenke L. Mental health and psychosocial consequences linked to radiation emergencies-increasingly recognised concerns. J Radiol Prot 2022; 42:031001. [PMID: 35767945 DOI: 10.1088/1361-6498/ac7d19] [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] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
A major radiological or nuclear emergency may, apart from causing a substantial loss of life and physical damage, also put a substantial strain on affected societies with social, economic and political consequences. Although such emergencies are relatively uncommon, it is now being increasingly recognised that their subsequent psychosocial impact can be widespread and long lasting. Mental health effects, such as depression, anxiety and post-traumatic stress disorder, are highly represented in a population affected by a radiation disaster. In order to reach the majority of the people affected by radiation accidents, we need to be aware of how to distribute relevant and accurate information related to both short- and long-term medical effects. Effective risk communication is associated with improved compliance with any given recommendations. It is important to protect the public from physical radiation damage, but it is also essential to take into account the social and mental health effects that radiation disasters may induce. This article provides a brief review of recent reporting on the psychological consequences after a major radiation emergency.
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Affiliation(s)
- Marita Lagergren Lindberg
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Palliative Care Unit, Byle Gård, Förenade Care, Stockholm, Sweden
| | - Christel Hedman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- R & D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden
- Division of Palliative Care, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Karin Lindberg
- Department of Pathology and Oncology, Karolinska Institutet, Stockholm, Sweden
- Pulmonary Oncology Centre, Section of Head, Neck, Lung and Skin Cancers, Karolinska University Hospital, Stockholm, Sweden
| | - Jack Valentin
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Leif Stenke
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
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Backlund E, Yang M, Grozman V, Masucci G, Falkenius J, Eriksson H, Jovanovic B, Hammarlund K, Isacsson U, Radu C, Abel E, Karlsson K, Palanco Zamora R, Wersäll P, Edbäck U, Wickström S, Darai Ramqvist E, Egyhazi Brage S, Kiessling R, Viktorsson K, Franzén B, Lewensohn R, Olofsson Bagge R, Ullenhag GJ, Ny L, Lindberg K, Helgadottir H. Precision radiation of immune checkpoint therapy resistant melanoma metastases (PROMMEL study): study protocol for a phase II open-label multicenter trial. Acta Oncol 2022; 61:869-873. [PMID: 35638255 DOI: 10.1080/0284186x.2022.2079959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Ellen Backlund
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Muyi Yang
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Vitali Grozman
- Department of Diagnostic Radiology, Karolinska University Hospital, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Giuseppe Masucci
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Johan Falkenius
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Eriksson
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Braslav Jovanovic
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | | | - Ulf Isacsson
- Medical Radiation Physics, Uppsala University Hospital, Uppsala, Sweden
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Calin Radu
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Edvard Abel
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristin Karlsson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Ricardo Palanco Zamora
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Wersäll
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Ulrika Edbäck
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Stina Wickström
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Eva Darai Ramqvist
- Department of Clinical Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Rolf Kiessling
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | | | - Bo Franzén
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Rolf Lewensohn
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Roger Olofsson Bagge
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gustav J. Ullenhag
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
- Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Lars Ny
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Karin Lindberg
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Hildur Helgadottir
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
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Stenke L, Hedman C, Lagergren Lindberg M, Lindberg K, Valentin J. The acute radiation syndrome-need for updated medical guidelines. J Radiol Prot 2022; 42:014004. [PMID: 35021163 DOI: 10.1088/1361-6498/ac4ac6] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/12/2022] [Indexed: 06/14/2023]
Abstract
The major immediate and severe medical consequences in man following exposure to high doses of ionising radiation can be summarised within the concept of the acute radiation syndrome (ARS). In a dose-dependent fashion, a multitude of organ systems can be affected by such irradiation, presenting considerable medical challenges to treating physicians. Accidents or malevolent events leading to ARS can provoke devastating effects, but they occur at a low frequency and in a highly varying manner and magnitude. Thus, it is difficult to make precise medical predictions and planning, or to draw conclusive evidence from occurred events. Therefore, knowledge from on-going continuous developments within related medical areas needs to be acknowledged and incorporated into the ARS setting, enabling the creation of evidence-based guidelines. In 2011 the World Health Organization published a first global consensus on the medical management of ARS among patients subjected to nontherapeutic radiation. During the recent decade the understanding of and capability to counteract organ damage related to radiation and other agents have improved considerably. Furthermore, legal and logistic hurdles in the process of formally approving appropriate medical countermeasures have been reduced. We believe the time is now ripe for developing an update of internationally consented medical guidelines on ARS.
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Affiliation(s)
- Leif Stenke
- Department of Hematology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Christel Hedman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- R & D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden
| | | | - Karin Lindberg
- Department of Pathology and Oncology, Karolinska Institutet, Stockholm, Sweden
| | - Jack Valentin
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Lindberg K, Onjukka E. Medical consequences of radiation exposure of the bronchi-what can we learn from high-dose precision radiation therapy? J Radiol Prot 2021; 41:S355-S370. [PMID: 34547741 DOI: 10.1088/1361-6498/ac28ef] [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] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/21/2021] [Indexed: 06/13/2023]
Abstract
The bronchial tolerance to high doses of radiation is not fully understood. However, in the event of a radiological accident with unintended exposure of the central airways to high doses of radiation it would be important to be able to anticipate the clinical consequences given the magnitude of the absorbed dose to different parts of the bronchial tree. Stereotactic body radiation therapy (SBRT) is a radiation treatment technique involving a few large fractions of photon external-beam radiation delivered to a well-defined target in the body. Despite generally favourable results, with high local tumour control and low-toxicity profile, its utility for tumours located close to central thoracic structures has been questioned, considering reports of severe toxic symptoms such as haemoptysis (bleedings from the airways), bronchial necrosis, bronchial stenosis, fistulas and pneumonitis. In conjunction with patient- and tumour-related risk factors, recent studies have analysed the absorbed radiation dose to different thoracic structures of normal tissue to better understand their tolerance to these high doses per fraction. Although the specific mechanisms behind the toxicity are still partly unknown, dose to the proximal bronchial tree has been shown to correlate with high-grade radiation side effects. Still, there is no clear consensus on the tolerance dose of the different bronchial structures. Recent data indicate that a too high dose to a main bronchus may result in more severe clinical side effects as compared to a smaller sized bronchus. This review analyses the current knowledge on the clinical consequences of bronchial exposure to high dose hypofractionated radiation delivered with the SBRT technique, and the tolerance doses of the bronchi. It presents the current literature regarding types of high-grade clinical side effects, data on dose response and comments on other risk factors for high-grade toxic effects.
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Affiliation(s)
- Karin Lindberg
- Section of Head, Neck, Lung and Skin tumours, Department of Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Eva Onjukka
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Section of Radiotherapy Physics and Engineering, Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
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Lindberg K, Lax I, Karlsson K, Lewensohn R. In Response to Rosenberg et al. "The Nordic-HILUS Trial: Ultracentral Lung SABR and a Narrow Therapeutic Window". J Thorac Oncol 2021; 16:e81-e82. [PMID: 34561040 DOI: 10.1016/j.jtho.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Karin Lindberg
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Section of Head, Neck, Lung, and Skin Tumours, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden.
| | - Ingmar Lax
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Section of Radiotherapy Physics and Engineering, Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Kristin Karlsson
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Section of Radiotherapy Physics and Engineering, Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Rolf Lewensohn
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Section of Head, Neck, Lung, and Skin Tumours, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
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Karlsson K, Lax I, Lindbäck E, Grozman V, Lindberg K, Wersäll P, Poludniowski G. Estimation of delivered dose to lung tumours considering setup uncertainties and breathing motion in a cohort of patients treated with stereotactic body radiation therapy. Phys Med 2021; 88:53-64. [PMID: 34175747 DOI: 10.1016/j.ejmp.2021.06.015] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Dose-response relationships for local control of lung tumours treated with stereotactic body radiotherapy (SBRT) have proved ambiguous, however, these have been based on the prescribed or planned dose. Delivered dose to the target may be a better predictor for local control. In this study, the probability of the delivered minimum dose to the clinical target volume (CTV) in relation to the prescribed dose was estimated for a cohort of patients, considering geometrical uncertainties. MATERIALS AND METHODS Delivered doses were retrospectively simulated for 50 patients treated with SBRT for lung tumours, comparing two image-guidance techniques: pre-treatment verification computed tomography (IG1) and online cone-beam computed tomography (IG2). The prescribed dose was typically to the 67% isodose line of the treatment plan. Simulations used in-house software that shifted the static planned dose according to a breathing motion and sampled setup/matching errors. Each treatment was repeatedly simulated, generating a multiplicity of dose-volume histograms (DVH). From these, tumour-specific and population-averaged statistics were derived. RESULTS For IG1, the probability that the minimum CTV dose (D98%) exceeded 100% of the prescribed dose was 90%. With IG2, this probability increased to 99%. CONCLUSIONS Doses below the prescribed dose were delivered to a considerably larger part of the population prior to the introduction of online soft-tissue image-guidance. However, there is no clear evidence that this impacts local control, when compared to previous published data.
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Affiliation(s)
- Kristin Karlsson
- Section of Radiotherapy Physics and Engineering, Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.
| | - Ingmar Lax
- Section of Radiotherapy Physics and Engineering, Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.
| | - Elias Lindbäck
- Section of Radiotherapy Physics and Engineering, Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.
| | - Vitali Grozman
- Section of Thoracic Radiology, Department of Radiology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
| | - Karin Lindberg
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Section of Head, Neck, Lung and Skin Tumours, Department of Cancer, Karolinska University Hospital, Stockholm, Sweden.
| | - Peter Wersäll
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Section of Radiotherapy, Department of Cancer, Karolinska University Hospital, Stockholm, Sweden.
| | - Gavin Poludniowski
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden.
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Salak B, Lindberg K, Kienast F, Hunziker M. Hybrid choice model dataset of a representative Swiss online panel survey on peoples' preferences related to mixed renewable energy scenarios in landscapes and the effect of landscape-technology fit. Data Brief 2021; 36:107025. [PMID: 34026963 PMCID: PMC8131564 DOI: 10.1016/j.dib.2021.107025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 11/24/2022] Open
Abstract
We present stated preference data based on a national representative Swiss online panel survey related to preference of mixed renewable energy infrastructure in landscapes. Data were collected between November 2018 and March 2019 via an online questionnaire and yielded 1026 responses. The online questionnaire consisted of two main parts - (1) questions covering meanings related to landscapes, nature and renewable energy infrastructure and questions regarding the "fit" of landscape/renewable energy infrastructure (REI) combinations and (2) a stated choice experiment. While in the first part of the questionnaire we asked respondents about their personal connection to certain landscapes, to nature and to specific REI, we also asked them to evaluate the fitting of seven different Swiss landscapes (near natural alpine areas, northern alps, touristic alpine areas, agricultural plateau, urban plateau, Jura ridges, urban alpine valley) with five different REI (wind, PV ground/agricultural, PV ground/other, PV roof, power lines) combinations. In the second part of the questionnaire, the stated choice experiment confronted respondents with 15 consecutive choice tasks, with each task involving a choice between two "energy system transformation" options and an opt-out option (none). Each choice option (beside the opt-out option) included four unlabeled attributes (landscape, wind energy infrastructure, photovoltaic energy infrastructure, high voltage overhead power line infrastructure) with varying levels. Due to data cleaning procedures (item nonresponse) the number of responses used within hybrid choice modeling and analysis was n = 844 (12,660 choice observations). An analysis of the hybrid choice model and further insights are presented in the article "How landscape-technology fit affects public evaluations of renewable energy infrastructure scenarios. A hybrid choice model."
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Affiliation(s)
- B. Salak
- Swiss Federal Institute for Forest, Snow and Landscape Research WSL, Social Sciences in Landscape Research Group, Research Unit Economics and Social Sciences, Zürcherstrasse 111, 8903 Birmensdorf, Switzerland
| | - K. Lindberg
- Oregon State University-Cascades, Department of Forest Ecosystems and Society, 1500 SW Chandler Avenue, Bend, OR 97702, United States
| | - F. Kienast
- Swiss Federal Institute for Forest, Snow and Landscape Research WSL, Land Change Science Research Group, Research Unit Land-use Systems, Zürcherstrasse 111, 8903 Birmensdorf, Switzerland
| | - M. Hunziker
- Swiss Federal Institute for Forest, Snow and Landscape Research WSL, Social Sciences in Landscape Research Group, Research Unit Economics and Social Sciences, Zürcherstrasse 111, 8903 Birmensdorf, Switzerland
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Hallqvist A, Koyi H, de Petris L, Lindberg K, Farooqi S, Helland Å, Wikström A, Johansson M, Planck M, Lindberg L, Yksnøy Ø, Grønberg B, Helbekkmo N, Nyman J. 63MO Safety analysis of durvalumab following stereotactic body radiotherapy (SBRT) in early-stage non-small cell lung cancer (NSCLC) patients: A first report of a randomized phase II trial (ASTEROID). J Thorac Oncol 2021. [DOI: 10.1016/s1556-0864(21)01905-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Grozman V, Onjukka E, Wersäll P, Lax I, Tsakonas G, Nyren S, Lewensohn R, Lindberg K. Extending hypofractionated stereotactic body radiotherapy to tumours larger than 70cc - effects and side effects. Acta Oncol 2021; 60:305-311. [PMID: 33448899 DOI: 10.1080/0284186x.2020.1866776] [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] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE Stereotactic body radiotherapy (SBRT) for tumours ≥5 cm is poorly studied and its utility and feasibility is uncertain. We here report the Karolinska experience of SBRT in this setting. MATERIAL AND METHODS All patients had a gross tumour volume (GTV) ≥70 cc, a prescribed physical dose of at least 40 Gy and received treatment between 1995-2012. RESULTS We included 164 patients with 175 tumours located in the thorax (n = 86), the liver (n = 27) and the abdomen (n = 62) and treated with a median prescribed dose (BEDα/β 10Gy) of 80 Gy (71.4-113). One- and 2- year local control rates were 82% and 61%. In multivariate analyses, minimum dose to the GTV and histological subtype were associated with local control. Renal cell carcinoma (RCC) histology showed the most favourable local control - 94% at 2 years for all histologies. Thirty-seven patients experienced grade 3-5 toxicity most likely related to SBRT. Seven of the ten patients with grade 5 toxicity, had a centrally located tumour in the thorax. CONCLUSION SBRT of tumours >5 cm in diameter may be an option for peripherally located lung and abdominal tumours. Histological origin and tumour location should be considered before treatment.
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Affiliation(s)
- Vitali Grozman
- Section of Thoracic Radiology, Department of Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Eva Onjukka
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Section of Radiotherapy Physics and Engineering, Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Wersäll
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Section of Radiotherapy, Department of Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Ingmar Lax
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Section of Radiotherapy Physics and Engineering, Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Georgios Tsakonas
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Section of Head, Neck, Lung and Skin tumours, Department of Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Sven Nyren
- Section of Thoracic Radiology, Department of Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Rolf Lewensohn
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Section of Head, Neck, Lung and Skin tumours, Department of Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Lindberg
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Section of Head, Neck, Lung and Skin tumours, Department of Cancer, Karolinska University Hospital, Stockholm, Sweden
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Guckenberger M, Belka C, Bezjak A, Bradley J, Daly ME, DeRuysscher D, Dziadziuszko R, Faivre-Finn C, Flentje M, Gore E, Higgins KA, Iyengar P, Kavanagh BD, Kumar S, Le Pechoux C, Lievens Y, Lindberg K, McDonald F, Ramella S, Rengan R, Ricardi U, Rimner A, Rodrigues GB, Schild SE, Senan S, Simone CB, Slotman BJ, Stuschke M, Videtic G, Widder J, Yom SS, Palma D. Practice recommendations for lung cancer radiotherapy during the COVID-19 pandemic: An ESTRO-ASTRO consensus statement. Radiother Oncol 2020; 146:223-229. [PMID: 32342863 PMCID: PMC7252074 DOI: 10.1016/j.radonc.2020.04.001] [Citation(s) in RCA: 133] [Impact Index Per Article: 33.3] [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: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 01/08/2023]
Abstract
Background The COVID-19 pandemic has caused radiotherapy resource pressures and led to increased risks for lung cancer patients and healthcare staff. An international group of experts in lung cancer radiotherapy established this practice recommendation pertaining to whether and how to adapt radiotherapy for lung cancer in the COVID-19 pandemic. Methods For this ESTRO & ASTRO endorsed project, 32 experts in lung cancer radiotherapy contributed to a modified Delphi consensus process. We assessed potential adaptations of radiotherapy in two pandemic scenarios. The first, an early pandemic scenario of risk mitigation, is characterized by an altered risk–benefit ratio of radiotherapy for lung cancer patients due to their increased susceptibility for severe COVID-19 infection, and minimization of patient travelling and exposure of radiotherapy staff. The second, a later pandemic scenario, is characterized by reduced radiotherapy resources requiring patient triage. Six common lung cancer cases were assessed for both scenarios: peripherally located stage I NSCLC, locally advanced NSCLC, postoperative radiotherapy after resection of pN2 NSCLC, thoracic radiotherapy and prophylactic cranial irradiation for limited stage SCLC and palliative thoracic radiotherapy for stage IV NSCLC. Results In a risk-mitigation pandemic scenario, efforts should be made not to compromise the prognosis of lung cancer patients by departing from guideline-recommended radiotherapy practice. In that same scenario, postponement or interruption of radiotherapy treatment of COVID-19 positive patients is generally recommended to avoid exposure of cancer patients and staff to an increased risk of COVID-19 infection. In a severe pandemic scenario characterized by reduced resources, if patients must be triaged, important factors for triage include potential for cure, relative benefit of radiation, life expectancy, and performance status. Case-specific consensus recommendations regarding multimodality treatment strategies and fractionation of radiotherapy are provided. Conclusion This joint ESTRO-ASTRO practice recommendation established pragmatic and balanced consensus recommendations in common clinical scenarios of radiotherapy for lung cancer in order to address the challenges of the COVID-19 pandemic.
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Affiliation(s)
- Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland.
| | - Claus Belka
- Department of Radiation Oncology, LMU Klinikum, LMU Munich, Germany
| | - Andrea Bezjak
- Department of Radiation Oncology, Princess Margaret Cancer Center, University of Toronto, Canada
| | - Jeffrey Bradley
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, USA
| | - Megan E Daly
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, USA
| | - Dirk DeRuysscher
- Department of Radiation Oncology (Maastro Clinic), Maastricht University Medical Center(+), GROW Research Institute, The Netherlands
| | - Rafal Dziadziuszko
- Dept. of Oncology and Radiotherapy, Medical University of Gdansk, Poland
| | - Corinne Faivre-Finn
- Division of Cancer Sciences, University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - Michael Flentje
- Department of Radiation Oncology, University Hospital Würzburg, JMU Würzburg, Germany
| | - Elizabeth Gore
- Department of Radiation Oncology, Medical College of Wisconsin and Zablocki VAMC, Milwaukee, USA
| | - Kristin A Higgins
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, USA
| | - Puneeth Iyengar
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, USA
| | - Brian D Kavanagh
- Department of Radiation Oncology, University of Colorado, Aurora, USA
| | - Sameera Kumar
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, USA
| | - Cecile Le Pechoux
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Belgium
| | - Karin Lindberg
- Department of Head, Neck, Lung and Skin Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | | | - Sara Ramella
- Radiation Oncology, Campus Bio-Medico University of Rome, Italy
| | - Ramesh Rengan
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, USA
| | | | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | | | | | - Suresh Senan
- Department of Radiation Oncology, Amsterdam UMC, The Netherlands
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center and Memorial Sloan Kettering Cancer Center, USA
| | - Ben J Slotman
- Department of Radiation Oncology, Amsterdam UMC, The Netherlands
| | - Martin Stuschke
- Department of Radiotherapy, University Duisburg-Essen, Germany
| | - Greg Videtic
- Department of Radiation Oncology, Cleveland Clinic Lerner College of Medicine of Case Western University, USA
| | - Joachim Widder
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Sue S Yom
- Department of Radiation Oncology, University of California San Francisco, USA
| | - David Palma
- Division of Radiation Oncology, Western University, London, Canada
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Lindberg K, Grozman V, Lindberg S, Onjukka E, Lax I, Lewensohn R, Wersäll P. Radiation-induced brachial plexus toxicity after SBRT of apically located lung lesions. Acta Oncol 2019; 58:1178-1186. [PMID: 31066326 DOI: 10.1080/0284186x.2019.1601255] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose: To evaluate the rate and dose response of brachial plexus toxicity post stereotactic body radiation therapy (SBRT) of apically situated lung lesions. Material/methods: We retrospectively identified all patients with apically located tumors, defined by the epicenter of the tumor being located superiorly to the aortic arch, and treated with SBRT between 2008 and 2013. Patients with a shorter follow-up than 6 months were excluded. Primary aim was to evaluate radiation-induced brachial plexopathy (RIBP). Dose to the plexus was assessed by a retrospective delineation of the brachial plexus on the CT used for treatment planning. Then, Dmax, D0.1cc, D1cc and D3.0cc of the brachial plexus were collected from the dose-volume histograms (DVH) and recalculated to the biologically effective dose (BED) using α/β = 3 Gy. A normal tissue complication probability (NTCP) model, based on four different dose-volume parameters (BED3,max, BED3,0.1cc, BED3,1.0cc, BED3,3.0cc) was fitted to the data. Results: Fifty-two patients with 56 apically located tumors were identified. Median prescription dose per fraction was 15 Gy (range 6-17) and median number of fractions was 3 (3-10). With a median follow-up of 30 months (6.1-72) seven patients experienced maximum grade 2 (scored 3 times) or 3 (scored 4 times) RIBP after a median of 8.7 months (range 4.0-31). Three patients had combined symptoms with pain, sensory and motor affection and four patients had isolated pain. Median BED3,max for the patients experiencing RIBP was 381 Gy (range 30-524) versus BED3,max of 34 Gy (range 0.10-483) for the patients without RIBP. The NTCP models showed a very high predictive ability (area under the receiver operating characteristic curve (AUC) 0.80-0.88). Conclusion: SBRT of apically located lung lesions may cause severe neurological symptoms; for a three-fraction treatment, we suggest that the maximum dose to the plexus should be kept ≤30 Gy (130 Gy BED3).
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Affiliation(s)
- Karin Lindberg
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Section of Head, Neck, Lung and Skin tumors, Department of Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Vitali Grozman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Section of Thoracic Radiology, Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Sara Lindberg
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Onjukka
- Section of Radiotherapy Physics and Engineering, Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Ingmar Lax
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Section of Radiotherapy Physics and Engineering, Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Rolf Lewensohn
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Section of Head, Neck, Lung and Skin tumors, Department of Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Wersäll
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Section of Radiotherapy, Department of Cancer, Karolinska University Hospital, Stockholm, Sweden
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Stenke L, Lindberg K, Lagergren Lindberg M, Lewensohn R, Valentin J, Powles R, Dainiak N. COORDINATION OF MANAGEMENT OF THE ACUTE RADIATION SYNDROME. Radiat Prot Dosimetry 2018; 182:80-84. [PMID: 30418654 DOI: 10.1093/rpd/ncy144] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Indexed: 06/09/2023]
Abstract
The acute radiation syndrome (ARS) constitutes the most challenging, immediate medical consequence of exposure to high doses of ionizing radiation in an emergency situation. This report highlights some of the currently available medical guidelines and recommendations on the clinical management of ARS, comments recent trends regarding the approval of targeted pharmaceuticals for ARS, and suggests further initiatives for international collaboration aiming at continuously updating the medical knowledge base of this syndrome.
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Affiliation(s)
- L Stenke
- Swedish Radiation Emergency Medicine Centre, Karolinska Institutet and Natinal Board of Health and Welfare, Stockholm, Sweden
- Division of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - K Lindberg
- Swedish Radiation Emergency Medicine Centre, Karolinska Institutet and Natinal Board of Health and Welfare, Stockholm, Sweden
- Division of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - M Lagergren Lindberg
- Swedish Radiation Emergency Medicine Centre, Karolinska Institutet and Natinal Board of Health and Welfare, Stockholm, Sweden
| | - R Lewensohn
- Swedish Radiation Emergency Medicine Centre, Karolinska Institutet and Natinal Board of Health and Welfare, Stockholm, Sweden
- Division of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - J Valentin
- Swedish Radiation Emergency Medicine Centre, Karolinska Institutet and Natinal Board of Health and Welfare, Stockholm, Sweden
| | - R Powles
- European Blood and Marrow Group (EBMT) Nuclear Accident Committee, Cancer Centre London, Parkside, UK
| | - N Dainiak
- Radiation Emergency Assistance Center/Training Site, Oak Ridge, TN, USA
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Lindberg K, Miller J, Weigel S. B - 56Impact of Visual Dimensions on Matrix Reasoning Performance. Arch Clin Neuropsychol 2018. [DOI: 10.1093/arclin/acy061.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Rosén S, Johansson K, Lindberg K, Dahlbäck B. Multicenter Evaluation of a Kit for Activated Protein C Resistance on Various Coagulation Instruments Using Plasmas from Healthy Individuals. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1648849] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryRecently a new hemostatic disorder has been described which appears to be an important risk factor for familial thromboembolism. The disorder is characterized by a poor anticoagulant response to activated Protein C (APC) and has been shown to be due to lack of an APC cofactor activity which is a property of factor V.A kit for determining the response of plasma samples towards addition of APC in an APTT-based assay - COATEST APC Resistance -has been evaluated on 35 coagulation instruments in a multicenter study involving 32 laboratories. A lyophilized normal plasma and identical plasma aliquots from 20 individuals, one of whom had a borderline resistance to APC, were analysed in each laboratory and the sensitivity of each plasma to APC was determined as the ratio between the clotting times obtained in the presence and absence of APC (APC ratio).The plasma from the individual with a borderline resistance to APC activity was correctly classified as the lowest responder in each laboratory, with an APC ratio in the range 1.6-2.4. In comparison, plasmas from individuals with a pronounced response to APC activity resulted in APC ratios above 3.4 in most cases. Interestingly, although the actual APT time for a plasma from a given individual showed a more than 10 s difference due to the type of instrumentation used, the variation in the APC ratio was limited. A similar discrimination was also obtained from evaluation of the actual prolongation of the clotting time in the presence of APC.The intra-laboratory coefficient of variation for the clotting times were on average 2.0% and 3.9% in the absence and presence of APC, respectively, indicating that the precision for the prolonged clotting times obtained in the presence of APC is sufficient to allow a safe assignment of the APC response. The APC ratio for the lyophilized normal plasma was 2.7 ± 0.2 (2 S.D.) illustrating a narrow distribution between instruments which shows the feasibility of including such plasma for assay validation. Altogether, the results indicate that all the coagulation instruments included in the study can be used for detection of individuals with resistance to APC activity through determination of the APC ratio or the prolongation time.
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Affiliation(s)
- S Rosén
- Chromogenix AB, Mölndal, Sweden and Department of Clinical Chemistry and Department of Coagulation Disorders, University of Lund, Malmö General Hospital, Malmö, Sweden
| | - K Johansson
- Chromogenix AB, Mölndal, Sweden and Department of Clinical Chemistry and Department of Coagulation Disorders, University of Lund, Malmö General Hospital, Malmö, Sweden
| | - K Lindberg
- Chromogenix AB, Mölndal, Sweden and Department of Clinical Chemistry and Department of Coagulation Disorders, University of Lund, Malmö General Hospital, Malmö, Sweden
| | - B Dahlbäck
- Chromogenix AB, Mölndal, Sweden and Department of Clinical Chemistry and Department of Coagulation Disorders, University of Lund, Malmö General Hospital, Malmö, Sweden
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Peker Y, Balcan B, Yucel-Lindberg T, Lindberg K, Thunström E. Determinants of nonsleepy vs sleepy phenotypes of obstructive sleep apnea in a revascularized coronary artery disease cohort. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.751] [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: 10/18/2022]
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Deist T, Jochems A, Oberije C, Reymen B, Vandecasteele K, Lievens Y, Wanders R, Lindberg K, De Ruysscher D, Van Elmpt W, Vinod S, Dekker A, Lambin P. OC-0139: Expert knowledge vs. data-driven algorithms: Bayesian prediction models for post-radiotherapy dyspnea. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31388-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Deist T, Jochems A, Oberije C, Reymen B, Vandecasteele K, Lievens Y, Wanders R, Lindberg K, De Ruysscher D, van Elmpt W, Vinod S, Faivre-Finn C, Dekker A, Lambin P. Expert knowledge and data-driven Bayesian Networks to predict post-RT dyspnea and 2-year survival. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)30060-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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22
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Lindberg K, Kristensen M. Construct validity and responsiveness of functional measures used in lower limb amputees following an outpatient prosthetic rehabilitation program. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lindberg K, Grozman V, Lindberg S, Lax I, Lewensohn R, Wersäll P. PO-0665: Radiation induced brachial plexus toxicity after SBRT of apically located lung lesions. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40657-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lindberg K, Nyman J, Riesenfeld Källskog V, Hoyer M, Lund JÅ, Lax I, Wersäll P, Karlsson K, Friesland S, Lewensohn R. Long-term results of a prospective phase II trial of medically inoperable stage I NSCLC treated with SBRT - the Nordic experience. Acta Oncol 2015; 54:1096-104. [PMID: 25813471 DOI: 10.3109/0284186x.2015.1020966] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Presentation of long term results of a phase II multicenter Nordic trial of medically inoperable stage I non-small cell lung cancer (NSCLC) treated with stereotactic body radiotherapy (SBRT). MATERIAL AND METHODS We report the extended outcome, focusing on long-term effects, of a prospective cohort of 57 evaluable patients with peripherally located T1N0M0 (72%) and T2N0M0 (28%) NSCLC, treated with SBRT 15 Gy × 3, prescribed to the 67% isodose line encompassing the PTV. The patients were inoperable due to chronic obstructive pulmonary disease (65%), cardiovascular disease (25%) or other illnesses (3%) or refused surgery (7%). Median Karnofsky score pre-treatment was 80% (70-100%). Late effects were defined as occurring > 36 months. RESULTS Thirty-eight patients (67%) were relapse free during their entire follow-up. Local control rate at four and five years were 79% (CI 95% 64-95%) and local relapses occurred at 10-76 months post-treatment. Seven local failures were noted, four occurring ≤ 36 months (all T2a-tumors; two isolated and two in combination with out-of-field relapses) and three occurring > 36 months (T1b-tumors n = 3). Thirteen patients had out-of-field failure only as first presentation of recurrence. Overall survival rate and lung cancer-specific survival rate at five years were 30% and 74%, respectively. Toxicity throughout the entire observation period was acceptable without any grade 5 toxicities. Seventeen grade 3-4 toxicities were noted, three presenting > 36 months (rib fracture, dyspnea and ventricle tachycardia). Median follow-up was 41.5 months (3.4-113.0) for the entire cohort and 59.3 months (36.4-113.0) for the 34 patients (60%) with a follow-up of > 36 months. CONCLUSION Throughout the observation period local control was excellent and toxicity limited with no increase in late presenting local relapses or late treatment-related morbidity. This further supports SBRT as an efficient local treatment modality even in a medically impaired patient cohort.
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Affiliation(s)
- Karin Lindberg
- a Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
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Lindberg K, Nordic SBRT study group, Nordic SBRT study group, Nordic SBRT study group, Nordic SBRT-study group, Nordic SBRT-study group, Nordic SBRT-study group, Nordic SBRT-study group. OC-0256: Long-term result of a prospective phase II trial of medically inoperable stage I NSCLC treated with SBRT. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30361-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Andersson T, Gothman B, Lindberg K. Mucinous Cystic Dissecting Intramural Degeneration of the Popliteal Artery. Acta Radiol 2013. [DOI: 10.1177/028418515905200605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Thunstrom E, Glantz H, Fu M, Yucel-Lindberg T, Petzold M, Lindberg K, Peker Y. Obstructive sleep apnea is associated with increased inflammatory activity in non-obese patients with coronary artery disease; a cross sectional study. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lai CF, Lin SL, Chiang WC, Chen YM, Kuo ML, Tsai TJ, Hwang HS, Choi YA, Park KC, Yang KJ, Choi HS, Kim SH, Lee SJ, Chang YK, Kim SY, Yang CW, Xiujuan Z, Yoshimura R, Matsuyama M, Chargui J, Touraine JL, Yoshimura N, Zulkarnaev AB, Vasilenko IA, Artemov DV, Vatazin AV, Park SK, Kang KP, Lee S, Kim W, Schneider R, Betz B, Moller-Ehrlich K, Wanner C, Sauvant C, Yang KJ, Park KC, Choi HS, Kim SH, Choi YA, Chang YK, Park CW, Kim SY, Lee SJ, Yang CW, Hwang HS, Sohotnik R, Nativ O, Abbasi A, Awad H, Frajewicki V, Armaly Z, Heyman SN, Nativ O, Abassi Z, Chen PY, Chen BL, Yang CC, Chiang CK, Liu SH, Abozahra AE, Abd-Elkhabir AA, Shokeir A, Hussein A, Awadalla A, Barakat N, Abdelaziz A, Yamaguchi J, Tanaka T, Eto N, Nangaku M, Quiros Y, Lopez-Hernandez FJ, Perez de Obanos MP, Ruiz J, Lopez-Novoa JM, Shin HS, Kim MJ, Choi YJ, Ryu ES, Choi HS, Kang DH, Jankauskas SS, Pevzner IB, Zorova LD, Babenko VA, Morosanova MA, Plotnikov EY, Zorov DB, Huang CY, Huang TM, Wu VC, Young GH, Plotnikov EY, Pevzner IB, Zorova LD, Chupyrkina AA, Zorov SD, Zorov DB, Grande JP, Hartono SP, Knudsen BE, Mederle K, Castrop H, Hocherl K, Iwakura T, Fujikura T, Ohashi N, Yasuda H, Fujigaki Y, Matsui I, Hamano T, Inoue K, Obi Y, Nakano C, Kusunoki Y, Tsubakihara Y, Rakugi H, Isaka Y, Shimomura A, Wallentin Guron C, Nguy L, Lundgren J, Grimberg E, Kashioulis P, Guron G, Guron G, DiBona GF, Nguy L, Grimberg E, Lundgren J, Nedergaard Mikkelsen M, Marcussen N, Saeed A, Edvardsson K, Lindberg K, Larsson T, Ito K, Nakashima H, Watanabe M, Abe Y, Ogahara S, Saito T, Albertoni G, Borges F, Schor N, Beresneva ON, Parastayeva MM, Kucher AG, Ivanova GT, Shved N, Rybakova MG, Kayukov IG, Smirnov AV, Chen JF, Ni HF, Pan MM, Liu H, Xu M, Zhang MH, Liu BC, Kim Y, Choi BS, Kim YS, Han JS, Reis LA, Christo JS, Simoes MDJ, Schor N, Mulay SR, Santhosh Kumar VR, Kulkarni OP, Darisipudi M, Lech M, Anders HJ, Zorov DB, Plotnikov EY, Silachev DN, Jankauskas SS, Pevzner IB, Zorova LD, Zorov SD, Morosanova MA, Sola A, Jung M, Ventayol M, Mastora C, Buenestado S, Hotter G, Rong S, Shushakova N, Wensvoort G, Haller H, Gueler F, Pan MM, Zhang MH, Ni HF, Chen JF, Xu M, Liu BC, Morais C, Vesey DA, Johnson DW, Gobe GC, Godo M, Kaucsar T, Revesz C, Hamar P, Cheng Q, Wen J, Ma Q, Zhao J, Castellano G, Stasi A, Di Palma AM, Gigante M, Netti GS, Curci C, Intini A, Divella C, Prattichizzo C, Fiaccadori E, Pertosa G, Grandaliano G, Gesualdo L, Wei QW, Jing QQ, Ying NJ, Dong QZ, Yong G, Choi YJ, Kim MJ, Shin HS, Ryu ES, Choi HS, Kang DH, Pevzner IB, Pulkova NV, Plotnikov EY, Zorova LD, Silachev DN, Morosanova MA, Sukhikh GT, Zorov DB, Kim S, Lee J, Nam NJ, Na KY, Han JS, Ma SK, Joo SY, Kim CS, Choi JS, Bae EH, Lee J, Kim SW, Cernaro V, Medici MA, Donato V, Trimboli D, Lorenzano G, Santoro D, Montalto G, Buemi M, Longo V, Segreto HRC, Almeida W, Schor N, Ramos MF, Gomes L, Razvickas C, Schor N, Gueler F, Rong S, Gutberlet M, Meier M, Mengel M, Wacker D, Haller H, Hueper K, Uzum A, Ersoy R, Cakalagaoglu F, Karaman M, Kolatan E, Sahin O, Yilmaz O, Cirit M, Inal S, Koc E, Okyay GU, Pasaoglu O, Gonul I, Oyar E, Pasaoglu H, Guz G, Sabbatini M, Rossano R, Andreucci M, Pisani A, Riccio E, Choi DE, Jeong JY, Kim SS, Chang YK, Na KR, Lee KW, Shin YT, Silva AF, Teixeira VC, Schor N, Meszaros K, Koleganova-Gut N, Schaefer F, Ritz E, Walacides D, Ruskamp N, Rong S, Hueper K, Meier M, Haller H, Schiffer M, Gueler F, Marom O, Haick H, Nakhoul F, Chen JF, Liu H, Ni HF, Lv LL, Zhang MH, Tang RN, Zhang JD, Ma KL, Chen PS, Liu BC, Wu VC, Young GH, Chen YM, Ko WJ, Misiara GP, Coimbra TM, Silva GEB, Costa RS, Francescato HDC, Neto MM, Dantas M, Lindberg K, Olauson H, Amin R, Ponnusamy A, Goetz R, Mohammadi M, Canfield A, Kublickiene K, Larsson T, Rodriguez J, Reyes EP, Cortes PP, Fernandez R, Yoon HE, Koh ES, Chung S, Shin SJ, Pazzano D, Montalto G, Cernaro V, Lupica R, Torre F, Costantino G, Buemi M, Prieto M, Gonzalez-Buitrago JM, Lopez-Hernandez F, Lopez-Novoa JM, Morales AI, Vicente-Vicente L, Ferreira L, Christo JS, Reis LA, Simoes MJ, Passos CD, Schor NS, Shimizu MHM, Canale D, de Braganca AC, Andrade L, Luchi WM, Seguro AC, Canale D, de Braganca AC, Goncalves J, Shimizu MHM, Volpini RA, Andrade L, Seguro AC, Garrido P, Fernandes J, Ribeiro S, Vala H, Parada B, Alves R, Belo L, Costa E, Santos-Silva A, Reis F. AKI - experimental models. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Persson J, Lindberg K, Gustafsson TP, Eriksson P, Paulsson-Berne G, Lundman P. Low plasma adiponectin concentration is associated with myocardial infarction in young individuals. J Intern Med 2010; 268:194-205. [PMID: 20528971 DOI: 10.1111/j.1365-2796.2010.02247.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The importance of adiponectin in coronary heart disease remains to be elucidated. Therefore, the associations between plasma adiponectin levels and i) myocardial infarction and ii) genetic variation within the adiponectin gene were investigated. METHODS The study included young survivors (age <60 years) of a first myocardial infarction and gender- and age-matched controls (244 pairs). Adiponectin concentrations were analysed by radioimmunoassay. Two polymorphisms, rs266729 and rs1501299, of the adiponectin gene ADIPOQ were genotyped. RESULTS Adiponectin levels were inversely associated with myocardial infarction [odds ratio (OR) 9.3, 95% confidence interval (CI) 4.7-18.2, for the lowest quartile compared to the highest quartile]. This persisted after adjustment for history of hypertension, HDL cholesterol, smoking and body mass index (BMI) (OR 3.1, 95% CI 1.3-7.6). The rs266729 polymorphism was associated with adiponectin levels. Plasma adiponectin concentrations were lower in individuals with the rare G/G genotype [median 4.3 mg/L, [corrected] interquartile range (IQR) 2.8-6.2] compared to the C/G (median 5.8 mg/L), [corrected] IQR 3.9-8.0; P = 0.035) and C/C genotypes (median 5.5 mg/L, [corrected] IQR 4.0-7.5; P = 0.083). CONCLUSION Low plasma adiponectin concentrations are associated with myocardial infarction in individuals below the age of 60, and this remains significant after adjustment for history of hypertension, HDL cholesterol, smoking and BMI. In addition, adiponectin levels differ according to rs266729 genotype.
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Affiliation(s)
- J Persson
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden.
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Karlsson M, Lindberg K, Karlén P, Ost A, Thörn M, Winqvist O, Eberhardson M. Evidence for immunosurveillance in intestinal premalignant lesions. Scand J Immunol 2010; 71:362-8. [PMID: 20500687 DOI: 10.1111/j.1365-3083.2010.02377.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The immunosurveillance theory argues that the immune system recognizes tumour-specific antigens expressed by transformed cells, which results in the destruction of cancer precursors before they become clinically manifest. As a model for the development of cancer, we set out to study premalignant lesions and immune responses in sentinel lymph nodes from patients with long-standing ulcerative colitis and progression of mucosal dysplasia. Mesenteric lymph nodes draining dysplastic and normal intestinal segments were identified by sentinel node technique during surgery in 13 patients with ulcerative colitis who were subjected to colectomy because of intestinal dysplasia. T cells were extracted from the lymph nodes and analysed by flow cytometry, and lymphocyte proliferation assays were set up in the presence of extracts from dysplastic and normal intestinal mucosa. Increase in CD4/CD8 ratio was observed in sentinel lymph nodes draining dysplastic epithelium compared to normal mucosa. The increase in CD4(+) T cells in relation to CD8(+) T cells correlated with the degree of dysplasia reflected by a significant increase in the ratio against low-grade dysplasia compared to indefinite dysplastic lesions. The T-cell response was specific to antigens from dysplastic epithelial lining as seen in proliferation assays. The observation suggests an important surveillance role for the immune system against premalignant intestinal lesions in patients with long-standing ulcerative colitis.
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Affiliation(s)
- M Karlsson
- Department of Clinical Science and Education, Sodersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Lindberg K, Nyquist O, Edhag O. The significance of ST and T changes for the development of coronary events in patients with acute coronary chest pain, treated in a coronary care unit without verified acute myocardial infarction. Acta Med Scand 2009; 217:559-65. [PMID: 4025010 DOI: 10.1111/j.0954-6820.1985.tb03263.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The one-year prognosis for patients with a confirmed diagnosis of acute myocardial infarction (AMI) was compared with that of non-AMI patients treated in the coronary care unit (CCU). The one-year incidence of coronary events (CE) after discharge from CCU was 37% in the 51 AMI patients and 20% in the 81 non-AMI patients. The one-year mortality rates were 27 and 4%, respectively. Among the non-AMI patients, well known risk factors such as hypertension, previous AMI, congestive heart failure, smoking, diabetes and hyperlipaemia were not more common in those who developed a CE. ST segment depression and T wave inversion, each of at least 0.1 mV, in three or more ECG leads were selective criteria for a high-risk group with respect to CE. Preventive measures should be considered in this group of patients without verified AMI.
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Bashkanov M, Bargholtz C, Berłowski M, Bogoslawsky D, Calén H, Clement H, Demiroers L, Doroshkevich E, Duniec D, Ekström C, Fransson K, Geren L, Gustafsson L, Höistad B, Ivanov G, Jacewicz M, Jiganov E, Johansson T, Khakimova O, Keleta S, Koch I, Kren F, Kullander S, Kupść A, Lindberg K, Marciniewski P, Meier R, Morosov B, Pauly C, Pettersson H, Petukhov Y, Povtorejko A, Pricking A, Ruber RJMY, Schönning K, Scobel W, Shwartz B, Skorodko T, Sopov V, Stepaniak J, Tegner PE, Thörngren-Engblom P, Tikhomirov V, Turowiecki A, Wagner GJ, Wolke M, Zabierowski J, Zartova I, Złomanczuk J. Double-pionic fusion of nuclear systems and the "ABC" effect: approaching a puzzle by exclusive and kinematically complete measurements. Phys Rev Lett 2009; 102:052301. [PMID: 19257507 DOI: 10.1103/physrevlett.102.052301] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Revised: 10/10/2008] [Indexed: 05/27/2023]
Abstract
The ABC effect-a puzzling low-mass enhancement in the pipi invariant mass spectrum, first observed by Abashian, Booth, and Crowe-is well known from inclusive measurements of two-pion production in nuclear fusion reactions. Here we report on the first exclusive and kinematically complete measurements of the most basic double-pionic fusion reaction pn-->dpi;{0}pi;{0} at beam energies of 1.03 and 1.35 GeV. The measurements, which have been carried out at CELSIUS-WASA, reveal the ABC effect to be a (pipi)_{I=L=0} channel phenomenon associated with both a resonancelike energy dependence in the integral cross section and the formation of a DeltaDelta system in the intermediate state. A corresponding simple s-channel resonance ansatz provides a surprisingly good description of the data.
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Affiliation(s)
- M Bashkanov
- Physikalisches Institut der Universität Tübingen, D-72076 Tübingen, Germany
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Granath A, Rynnel-Dagöö B, Backheden M, Lindberg K. Tube associated otorrhea in children with recurrent acute otitis media; results of a prospective randomized study on bacteriology and topical treatment with or without systemic antibiotics. Int J Pediatr Otorhinolaryngol 2008; 72:1225-33. [PMID: 18565598 DOI: 10.1016/j.ijporl.2008.04.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Revised: 04/28/2008] [Accepted: 04/30/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To establish if otorrhea associated to tympanostomy tubes in infants suffering from recurrent acute otitis media is similar to acute otitis media, and if topical treatment alone is sufficient or if addition of systemic antibiotics is required. METHODS Children under 3 years of age with tympanostomy tubes due to recurrent acute otitis media were recruited to the study. The study design was open label randomized and prospective. Fifty patients were allocated to either of two treatment groups and were monitored for 6 months. Group I received only topical treatment (commercially available ear drops and saline solution) in case of otorrhea. Group II was treated with topical treatment together with systemic antibiotics. All episodes of acute otorrhea were registered. Main outcome measure was duration of otorrhea in days. Bacterial samples from the ear discharge were taken. RESULTS Forty-one episodes were treated according to protocol. The bacteriological testing mainly showed bacteria typical of acute otitis media. A majority of episodes were cured within 7 days in both groups, and statistical analysis showed no significant difference between the treatment groups in duration of otorrhea. In Group I systemic antibiotics were added in one-third (7/21) of the episodes due to signs of affected general condition such as high fever and severe earache. CONCLUSIONS The otorrhea episodes in the study were similar to acute otitis media based on the bacteriological results. Topical treatment alone might be used as first treatment of choice. Although systemic antibiotics were added in several cases in the topical treatment group, the findings of the study do not support use of systemic antibiotics for tube associated otorrhea in RAOM children in general.
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Affiliation(s)
- Anna Granath
- Karolinska Institutet, Department of Clinical Science, Intervention and Technology and Ear-, Nose-, Throat- and Cochlear Department at Karolinska University Hospital Huddinge, Stockholm, Sweden.
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Hartman J, Lindberg K, Inzunza J, Wan J, Ström A, Gustafsson J. Estrogen receptor β represses breast tumor growth and angiogenesis in vivo. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.10101] [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: 11/20/2022] Open
Abstract
10101 Background: Estrogens are well known stimulators of breast cancer cell growth in vitro as well as in vivo. Two different estrogen receptors exist, namely estrogen receptor (ER) α and β. ERα mediates the proliferative effect of estrogen in breast cancer cells and we have earlier shown that ERβ inhibits cell-cycle progression in vitro. Estrogens are well known stimulators of in vivo breast cancer cell growth as well as angiogenesis, and the effect is mediated through ERα. The function of ERβ in this context is not well understood. Methods: We have used ERα-positive T47D breast cancer cells stably transfected with a Tet/Off regulated ERβ expression vector system. The ERβ-inducible tumor cells are studied in vitro as well as in vivo. Results: By transplanting ERβ-inducible breast cancer cells into SCID-mice, we show that ERβ inhibits tumor growth and reduces the volume of established tumors. Furthermore, we show by immunohistochemistry, that the number of blood microvessels in the tumor periphery is decreased by ERβ expression, counteracting the well-known pro-angiogenic effect of ERα. By Western blot analysis on tumor extracts, we show that the concentration of the important pro-angiogenic growth factors VEGF and bFGF, normally expressed by breast tumor cells, is decreased in the ERβ-expressing tumors compared to the normal tumors. To exclude that the observed anti-angiogenic effect is just a result of reduced tumor growth, we incubated Tet/Off regulated ERβ expressing cells in vitro, during non-hypoxic conditions. We found that the expression of ERβ leads to decreased expression of VEGF and PDGFβ at the mRNA and protein-levels. In transient transfection assays, we found estrogen-ERα mediated up regulation of VEGF, PDGFβ and bFGF-promoter activities in T47D cells, and these activities were all suppressed following co-transfection with an ERβ-expression vector. Conclusions: We conclude that ERβ inhibits growth factor expression at transcriptional level in breast cancer cells; taken together, our data indicates that ERβ inhibits growth and angiogenesis of tumors formed by T47D breast cancer cells. This makes ERβ an interesting therapeutic target in breast cancer and perhaps treatment with the newly designed ERβ-selective ligands might work as a new anti-proliferative and anti-angiogenic therapy. No significant financial relationships to disclose.
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Affiliation(s)
- J. Hartman
- Karolinska Institutet, Stockholm, Sweden
| | | | - J. Inzunza
- Karolinska Institutet, Stockholm, Sweden
| | - J. Wan
- Karolinska Institutet, Stockholm, Sweden
| | - A. Ström
- Karolinska Institutet, Stockholm, Sweden
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Lindberg K, Rønn SG, Tornehave D, Richter H, Hansen JA, Rømer J, Jackerott M, Billestrup N. Regulation of pancreatic beta-cell mass and proliferation by SOCS-3. J Mol Endocrinol 2005; 35:231-43. [PMID: 16216905 DOI: 10.1677/jme.1.01840] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Growth hormone and prolactin are important growth factors for pancreatic beta-cells. The effects exerted by these hormones on proliferation and on insulin synthesis and secretion in beta-cells are largely mediated through the Janus kinase (JAK)/signal transducer and activator of transcription (STAT) signaling pathway. Suppressors of cytokine signaling (SOCS) proteins are specific inhibitors of the JAK/STAT pathway acting through a negative-feedback loop. To investigate in vivo effects of SOCS-3 in growth hormone (GH)/prolactin signaling in beta-cells we generated transgenic mice with beta-cell-specific overexpression of SOCS-3. The relative beta-cell proliferation and volume in the mice were measured by morphometry. Beta-cell volume of transgenic female mice was reduced by over 30% compared with beta-cell volume in wild-type female mice. Stimulation of transgenic islets in vitro with GH showed a reduced tyrosine phosphorylation of STAT-5 when compared with wild-type islets. Transduction of primary islet cultures with adenoviruses expressing various SOCS proteins followed by stimulation with GH or glucagon-like peptide-1 (GLP-1) revealed that SOCS-3 inhibited GH- but not GLP-1-mediated islet cell proliferation, indicating that the decreased beta-cell volume observed in female transgenic mice could be caused by an inhibition of GH-induced beta-cell proliferation by SOCS-3. In spite of the reduced beta-cell volume the transgenic female mice exhibited enhanced glucose tolerance compared with wild-type littermates following an oral glucose-tolerance test. Together these data suggest that SOCS-3 modulates cytokine signaling in pancreatic beta-cells and therefore potentially could be a candidate target for development of new treatment strategies for diabetes.
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Affiliation(s)
- K Lindberg
- Department of Signal Transduction, Novo Nordisk A/S, Bagsvaerd, Denmark
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Lindberg K, Gustafson R, Samuelson A, Rynnel-Dagöö B. Impact of IgG replacement therapy and antibiotic treatment on the colonization of non-encapsulated Haemophilus influenzae in the nasopharynx in patients with hypogammaglobulinaemia. Scand J Infect Dis 2002; 33:904-8. [PMID: 11868763 DOI: 10.1080/00365540110076769] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Non-typable Haemophilus influenzae (NTHI) and Streptococcus pneumoniae are regarded as the main pathogens in patients with humoral immunodeficiency. These patients have been given IgG replacement therapy since the 1950s. However, a number of individuals still suffer from recurrent episodes of respiratory tract infections. Nasopharyngeal cultures were obtained on a regular basis over a 3-6-month period from 11 patients with common variable immunodeficiency disease in 1989 and 1998. The proportion of cultures positive for NTHI decreased from 56% in 1989-90 to 16% in 1998-99 (p < 0.003). After 9 y of IgG therapy, 7 of the 11 patients were free from NTHI in the nasopharynx. Specific NTHI strains were analysed by pulsed-field gel electrophoresis and compared, with regard to genetic relatedness, on an intra-individual basis. In 1 patient the same NTHI strain was found in both 1989 and 1999. The apparent absence of NTHI from the nasopharynx in most of the patients was assumed to be due to subcutaneous IgG treatment, as well as adequate antibiotic treatment.
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Affiliation(s)
- K Lindberg
- Department of Otorhinolaryngology, Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden
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Lindén D, Lindberg K, Oscarsson J, Claesson C, Asp L, Li L, Gustafsson M, Borén J, Olofsson SO. Influence of peroxisome proliferator-activated receptor alpha agonists on the intracellular turnover and secretion of apolipoprotein (Apo) B-100 and ApoB-48. J Biol Chem 2002; 277:23044-53. [PMID: 11925428 DOI: 10.1074/jbc.m110416200] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The peroxisome proliferator-activated receptor (PPAR) alpha agonist WY 14,643 increased the secretion of apolipoprotein (apo) B-100, but not that of apoB-48, and decreased triglyceride biosynthesis and secretion from primary rat hepatocytes. These effects resulted in decreased secretion of apoB-100-very low density lipoprotein (VLDL) and an increased secretion of apoB-100 on low density lipoproteins/intermediate density lipoproteins. ApoB-48-VLDL was also replaced by more dense particles. The proteasomal inhibitor lactacystin did not influence the recovery of apoB-100 or apoB-48 in primary rat hepatocytes, indicating that co-translational (proteasomal) degradation is of less importance in these cells. Treatment with WY 14,643 made the recovery of apoB-100 sensitive to lactacystin, most likely reflecting the decreased biosynthesis of triglycerides. The PPAR alpha agonist induced a significant increase in the accumulation of pulse-labeled apoB-100 even after a short pulse (2-5 min). There was also an increase in apoB-100 nascent polypeptides, indicating that the co-translational degradation of apoB-100 was inhibited. However, a minor influence on an early posttranslation degradation cannot be excluded. This decreased co-translational degradation of apoB-100 explained the increased secretion of the protein. The levels of apoB-48 remained unchanged during these pulse-chase experiments, and albumin production was not affected, indicating a specific effect of PPAR alpha agonists on the co-translational degradation of apoB-100. These findings explain the difference in the rate of secretion of the two apoB proteins seen after PPAR alpha activation. PPAR alpha agonists increased the expression and biosynthesis of liver fatty acid-binding protein (LFABP). Increased expression of LFABP by transfection of McA-RH7777 cells increased the secretion of apoB-100, decreased triglyceride biosynthesis and secretion, and increased PPAR alpha mRNA levels. These findings suggest that PPAR alpha and LFABP could interact to amplify the effect of endogenous PPAR alpha agonists on the assembly of VLDL.
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Affiliation(s)
- Daniel Lindén
- Department of Physiology, Göteborg University, SE 405 30 Göteborg, Sweden
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Karlsen AE, Rønn SG, Lindberg K, Johannesen J, Galsgaard ED, Pociot F, Nielsen JH, Mandrup-Poulsen T, Nerup J, Billestrup N. Suppressor of cytokine signaling 3 (SOCS-3) protects beta -cells against interleukin-1beta - and interferon-gamma -mediated toxicity. Proc Natl Acad Sci U S A 2001; 98:12191-6. [PMID: 11593036 PMCID: PMC59790 DOI: 10.1073/pnas.211445998] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Suppressor of cytokine signaling 3 (SOCS-3) is a negative feedback regulator of IFN-gamma signaling, shown up-regulated in mouse bone marrow cells by the proinflammatory cytokines interleukin-1beta (IL-1beta), tumor necrosis factor-alpha (TNF-alpha), and IFN-gamma. IL-1beta and IFN-gamma alone, or potentiated by TNF-alpha, are cytotoxic to the insulin producing pancreatic beta-cells and beta-cell lines in vitro and suggested to contribute to the specific beta-cell destruction in Type-1 diabetes mellitus (T1DM). Using a doxycycline-inducible SOCS-3 expression system in the rat beta-cell line INS-1, we demonstrate that the toxic effect of both IL-1beta or IFN-gamma at concentrations that reduced the viability by 50% over 3 days, was fully preventable when SOCS-3 expression was turned on in the cells. At cytokine concentrations or combinations more toxic to the cells, SOCS-3 overexpression yielded a partial protection. Whereas SOCS-3-mediated inhibition of IFN-gamma signaling is described in other cell systems, SOCS-3 mediated inhibition of IL-1beta signaling has not previously been described. In addition we show that SOCS-3 prevention of IL-1beta-induced toxicity is accompanied by inhibited transcription of the inducible nitric oxide synthase (iNOS) by 80%, resulting in 60% decreased formation of the toxic nitric oxide (NO). Analysis of isolated native rat islets exposed to IL-1beta revealed a naturally occurring but delayed up-regulated SOCS-3 transcription. Influencing SOCS-3 expression thus represents an approach for affecting cytokine-induced signal transduction at a proximal step in the signal cascade, potentially useful in future therapies aimed at reducing the destructive potential of beta-cell cytotoxic cytokines in T1DM, as well as other cytokine-dependent diseases.
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Affiliation(s)
- A E Karlsen
- Steno Diabetes Center, Niels Steensensvej 2, 2820 Gentofte, Denmark.
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Lindberg K, Badylak SF. Porcine small intestinal submucosa (SIS): a bioscaffold supporting in vitro primary human epidermal cell differentiation and synthesis of basement membrane proteins. Burns 2001; 27:254-66. [PMID: 11311519 DOI: 10.1016/s0305-4179(00)00113-3] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The growth pattern of human epidermal cells, fibroblasts or Swiss mouse 3T3/J2 fibroblasts cultured upon the extracellular matrix (ECM) derived from small intestinal submucosa (SIS) was evaluated. The cell/SIS composites were grown submerged, then maintained in air/liquid interface for 2, 7, 10 or 14 days. The presence of differentiation-related keratins 10, 14 and 16, FN, laminin, collagen type VII and collagen type IV was determined by immunohistochemical methods in SIS alone and in the SIS/cell composite. Only FN could be detected in SIS alone. SIS supported the formation of an epithelial structure with suprabasal expression of K16 and regional suprabasal expression of K10. The epidermal cells were K14 positive and tended to 'invade' the SIS to various degrees. Following the growth of epidermal cells and fibroblasts on the SIS substratum, immunolabeling of FN, laminin, collagen type VII and collagen type IV was observed in a cell-associated pattern. The fibroblasts commonly invaded the SIS, when co-cultivated with epidermal cells on the opposite side of the SIS. The ability of SIS to support epidermal cell/fibroblast attachment, migration and/or proliferation and differentiation with deposition of basement membrane (BM) components indicates that the composite model may be useful for studying cell-matrix interactions and for investigation as a dermal substitute.
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Affiliation(s)
- K Lindberg
- Department of Biomedical Engineering, 1296 A.A. Potter Building, Room 204, Purdue University, West Lafayette, IN 47907-1296, USA.
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Olofsson SO, Asp L, Stillemark P, Lindberg K, Claesson C, Rutberg M, Marchesan D, Borén J. Intracellular lipidation of ApoB. Atherosclerosis 2000. [DOI: 10.1016/s0021-9150(00)81079-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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41
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Lindberg K, Hammarström L, Samuelson A, Rynnel-Dagöö B. Children with recurrent episodes of acute otitis media: the effect of local administration of immunoglobulin G on acute otitis media, colonization and turnover of non-encapsulated Haemophilus influenzae in the nasopharynx. Clin Otolaryngol Allied Sci 2000; 25:161-8. [PMID: 10816223 DOI: 10.1046/j.1365-2273.2000.00344.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In most children with recurrent episodes of acute otitis media (AOM), tube treatment is successful, but there are those who nevertheless suffer from middle ear infections. The aim of the present study was to ascertain whether local administration of immunoglobulin could reduce the number of episodes of otorrhoea in otitis-prone infants <2 years old who were treated with tubes, or whether it could affect the nasopharyngeal colonization and turnover of bacterial pathogens in the nasopharynx. IgG or placebo were also administered intranasally daily for 6 months to 50 infants, randomized in a double-blind study. An arbitrarily primed polymerase chain reaction (AP-PCR) was used to characterize the different isolates of NTHI (non-encapsulated, non-typable Haemophilus influenzae). Three infants in the IgG group and six infants in the control group suffered from > or =3 episodes of acute otitis media. No effect on the nasopharyngeal colonization or the turnover of non-encapsulated H. influenzae in the nasopharynx could be detected in either group.
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Affiliation(s)
- K Lindberg
- Department of Otorhinolaryngology, Karolinska Institute, Huddinge Hospital, Sweden
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42
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Lidén G, Melin B, Lidblom A, Lindberg K, Norén JO. Personal sampling in parallel with open-face filter cassettes and IOM samplers for inhalable dust--implications for occupational exposure limits. Appl Occup Environ Hyg 2000; 15:263-76. [PMID: 10701289 DOI: 10.1080/104732200301584] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Parallel personal sampling was carried out with the open-face filter cassette and the IOM sampler for inhalable dust for nine types of organic dust. Parallel samples numbering 749 were obtained from 152 plants. Extremely large values and outliers were disregarded, and the remaining data for each type of dust were divided into subsets according to type of product or work task, and analyzed with the aid of linear regression. The coefficient of regression for each subset ranged between 0.2 and 0.7. Hypothetical occupational exposure limits (OELs) for inhalable dust were calculated based on the linear relation obtained between the dust concentrations measured with the open-face filter cassette and the IOM sampler. The fraction of person days with time-weighted average (TWA) concentrations exceeding the calculated hypothetical OELs for inhalable dust was obtained from the distribution of measured TWA inhalable dust concentrations. Based on the results of this study and the difference in sampling efficiency for large particles between the two samplers, it was concluded that the numerical value of the OEL for inhalable dust may be set at approximately twice the numerical value of the corresponding limit value for "total dust." Additional consideration of recently discovered health effects, and technical and economical factors may result in other numerical values of future OELs for inhalable dust.
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Affiliation(s)
- G Lidén
- National Institute for Working Life, Solna, Sweden
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Hansen JA, Lindberg K, Hilton DJ, Nielsen JH, Billestrup N. Mechanism of inhibition of growth hormone receptor signaling by suppressor of cytokine signaling proteins. Mol Endocrinol 1999; 13:1832-43. [PMID: 10551777 DOI: 10.1210/mend.13.11.0368] [Citation(s) in RCA: 136] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In this study we have investigated the role of suppressor of cytokine signaling (SOCS) proteins in GH receptor-mediated signaling. GH-induced transcription was inhibited by SOCS-1 and SOCS-3, while SOCS-2 and cytokine inducible SH2-containing protein (CIS) had no effect By using chimeric SOCS proteins it was found that the ability of SOCS proteins to inhibit GH-mediated transcription was located in the amino-terminal 40-80 amino acids. In SOCS-3, 46 amino acids C-terminal to the SH2 domain were required for the inhibitory activity, while a truncated SOCS-1 having only 2 amino acids C-terminal to the SH2 domain was able to inhibit GH-mediated transcription. Both SOCS-1 and SOCS-3 were able to inhibit GH-induced STAT5 (signal transducer and activator of transcription) activation. SOCS-1 inhibited the tyrosine kinase activity of Janus kinase 2 (JAK2) directly, while SOCS-3 only inhibited JAK2 when stimulated by the GH receptor. All four SOCS proteins were able to bind to a tyrosine-phosphorylated glutathione-S-transferase-GH receptor fusion protein, and SOCS-3 required the same 46 C-terminal amino acids for GH receptor binding as it did for inhibition of GH-mediated transcription and STAT5 activation. These data suggest that SOCS-1 and -3 can suppress GH-induced transcriptional activity, presumably by inhibiting the kinase activity of JAK2 either directly in the case of SOCS-1 or via binding to the tyrosine-phosphorylated GH receptor in the case of SOCS-3.
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Affiliation(s)
- J A Hansen
- Hagedorn Research Institute, Gentofte, Denmark
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Agren K, Lindberg K, Samulesson A, Blomberg S, Forsgren J, Rynnel-Dagöö B. What is wrong in chronic adenoiditis/tonsillitis immunological factor. Int J Pediatr Otorhinolaryngol 1999; 49 Suppl 1:S137-9. [PMID: 10577792 DOI: 10.1016/s0165-5876(99)00148-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The local immune response in adenoid and tonsil tissue can be visualized and the complexity of the cytokine network and effector molecule expression has not been illustrated in several different tonsillar entities. Many factors still remain to be learned in order to help us to understand the interactions between microorganisms and host in peripheral lymphatic tissue.
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Affiliation(s)
- K Agren
- Department of Clinical Sciences, Huddinge Hospital, Sweden
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Abstract
The first family with hyperferritinaemia-cataract syndrome in Scandinavia is described. We discuss the etiology and point at this diagnosis as a differential diagnosis in case of hereditary cataract.
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Affiliation(s)
- K Lindberg
- Department of Ophthalmology, University Hospital of Oslo, Norway
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46
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47
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Haas-wilson D, Lindberg K. Regulation and the optimal size and type of abortion provider. Appl Econ 1999; 31:409-415. [PMID: 12295468 DOI: 10.1080/000368499324110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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48
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McClure FD, Lee JK, Lindberg K, Johnson R, Horwitz W, Condon R, Anderson SM, Nelson TC, Philllips JG, Hay ward S, Newell R, Mowrey D, Britton P. Statistics Committee. J AOAC Int 1999. [DOI: 10.1093/jaoac/82.2.558a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Foster D McClure
- Canadian Food Inspection Agency, Food Safety Laboratory, 3155 Willingdon Green, Burnaby, BC V5G 4P2, Canada
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Rustaeus S, Lindberg K, Stillemark P, Claesson C, Asp L, Larsson T, Borén J, Olofsson SO. Assembly of very low density lipoprotein: a two-step process of apolipoprotein B core lipidation. J Nutr 1999; 129:463S-466S. [PMID: 10064310 DOI: 10.1093/jn/129.2.463s] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The liver plays a primary role in lipid metabolism. Important functions include the synthesis and incorporation of hydrophobic lipids, triacylglycerols and cholesteryl esters into the core of water-miscible particles called lipoproteins and the secretion of these particles into the circulation for transport to distant tissues. In this article, we present a brief overview of one aspect of the assembly process of very low density lipoproteins, namely, possible mechanisms for combining core lipids with apolipoprotein B. This is a complex process in which apolipoprotein B interacts with core lipids to form very low density lipoproteins by a two-step process that can be dissociated biochemically.
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Affiliation(s)
- S Rustaeus
- Department of Medical Biochemistry, Göteborg University, Sweden
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Abstract
Four techniques for dissociation of skin biopsies were compared to identify the method of choice for optimal expansion of isolated keratinocytes. Equivalent biopsies were obtained from 4 healthy human subjects and each divided into four parts. One part was minced and placed in a trypsinizing flask containing 0.05% trypsin and 0.01% ethylenediaminetetraacetic acid (EDTA). Released cells were harvested hourly. With the other parts, the epidermis was separated from the dermis after treatment with 0.5 mg/nml thermolysin, 2.5 mg/ml Dispase, or 0.17% trypsin and the epidermal portions were minced and incubated for 1 h in trypsin:EDTA. The cells were cocultivated with irradiated 3T3 fibroblasts to study the keratinocytes proliferative capacity. Freshly isolated cells were immunostained with anti-vimentin antibodies or grown in fibroblast-supportive conditions to detect the presence of human dermal fibroblasts. The mean number of cells dissociated per cm2 biopsy was higher after trypsin:EDTA digestion of a dermis-containing biopsy using a trypsinizing flask (4.0x 10(6) cells/cm2) compared to a biopsy where dermis-epidermis had been separated by thermolysin (2.8x 10(6) cells/cm2), Dispase (2.3x 10(6) cells/cm2) or trypsin (1.1 x 10(6) cells/cm2). Between 0.5% and 4% of the cells dissociated from a dermis-containing biopsy were human fibroblasts. This comprised more than twice the number of fibroblasts obtained by using epidermal/dermal split techniques. The proliferative capacity in primary and secondary culture was higher in cells isolated by trypsin:EDTA incubation in the trypsinizing flask or after epidermal-dermal separation using thermolysin, suggesting that Dispase or trypsin may have a more detrimental effect on the isolated keratinocytes. Our results show that dissociating the cells by trypsin:EDTA incubation in a trypsinizing flask or after epidermal-dermal separation using thermolysin, are preferable methods for isolating keratinocytes from human skin.
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Affiliation(s)
- S Hybbinette
- Department of Plastic Surgery, Uppsala University Hospital, Sweden
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