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Gudmundsdottir JA, Thorgeirsdottir S, Lundbäck V, Göngrich C, Lingman Framme J, Kindgren E, Rydenman K, Ludviksson BR, Bjarnadottir H, Runarsdottir S, Nilsson S, Zetterström RH, Ekwall O, Lindgren S. Normal neonatal TREC and KREC levels in early onset juvenile idiopathic arthritis. Clin Immunol 2023; 249:109277. [PMID: 36878420 DOI: 10.1016/j.clim.2023.109277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/18/2023] [Accepted: 03/01/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE Dysregulated central tolerance predisposes to autoimmune diseases. Reduced thymic output as well as compromised central B cell tolerance checkpoints have been proposed in the pathogenesis of juvenile idiopathic arthritis (JIA). The aim of this study was to investigate neonatal levels of T-cell receptor excision circles (TRECs) and kappa-deleting element excision circles (KRECs), as markers of T- and B-cell output at birth, in patients with early onset JIA. METHODS TRECs and KRECs were quantitated by multiplex qPCR from dried blood spots (DBS), collected 2-5 days after birth, in 156 children with early onset JIA and in 312 matched controls. RESULTS When analysed from neonatal dried blood spots, the median TREC level was 78 (IQR 55-113) in JIA cases and 88 (IQR 57-117) copies/well in controls. The median KREC level was 51 (IQR 35-69) and 53 (IQR 35-74) copies/well, in JIA cases and controls, respectively. Stratification by sex and age at disease onset did not reveal any difference in the levels of TRECs and KRECs. CONCLUSION T- and B-cell output at birth, as measured by TREC and KREC levels in neonatal dried blood spots, does not differ in children with early onset JIA compared to controls.
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Affiliation(s)
- Judith A Gudmundsdottir
- Children's Medical Center, Landspitali, The National University Hospital, Reykjavik, Iceland
| | - Sigridur Thorgeirsdottir
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Veroniqa Lundbäck
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Christina Göngrich
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Jenny Lingman Framme
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; The Department of Pediatrics, Halland Hospital Halmstad, Halmstad, Region Halland, Sweden
| | - Erik Kindgren
- Division of Pediatrics, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Pediatrics, Skaraborgs Hospital Skövde, Region Västra Götaland, Sweden
| | - Karin Rydenman
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Bjorn Runar Ludviksson
- Department of Immunology, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Helga Bjarnadottir
- Department of Immunology, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Saga Runarsdottir
- Department of Genetics and Molecular Medicine, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Staffan Nilsson
- Department of Mathematical Sciences, Chalmers University of Technology, Gothenburg, Sweden; Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rolf H Zetterström
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Olov Ekwall
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Department of Rheumatology and Inflammation Research, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Susanne Lindgren
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Department of Rheumatology and Inflammation Research, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
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2
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Framme JL, Lundqvist C, Lundell AC, van Schouwenburg PA, Lemarquis AL, Thörn K, Lindgren S, Gudmundsdottir J, Lundberg V, Degerman S, Zetterström RH, Borte S, Hammarström L, Telemo E, Hultdin M, van der Burg M, Fasth A, Oskarsdóttir S, Ekwall O. Long-Term Follow-Up of Newborns with 22q11 Deletion Syndrome and Low TRECs. J Clin Immunol 2022; 42:618-633. [PMID: 35080750 PMCID: PMC9016018 DOI: 10.1007/s10875-021-01201-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 12/12/2021] [Indexed: 01/03/2023]
Abstract
Background Population-based neonatal screening using T-cell receptor excision circles (TRECs) identifies infants with profound T lymphopenia, as seen in cases of severe combined immunodeficiency, and in a subgroup of infants with 22q11 deletion syndrome (22q11DS). Purpose To investigate the long-term prognostic value of low levels of TRECs in newborns with 22q11DS. Methods Subjects with 22q11DS and low TRECs at birth (22q11Low, N=10), matched subjects with 22q11DS and normal TRECs (22q11Normal, N=10), and matched healthy controls (HC, N=10) were identified. At follow-up (median age 16 years), clinical and immunological characterizations, covering lymphocyte subsets, immunoglobulins, TRECs, T-cell receptor repertoires, and relative telomere length (RTL) measurements were performed. Results At follow-up, the 22q11Low group had lower numbers of naïve T-helper cells, naïve T-regulatory cells, naïve cytotoxic T cells, and persistently lower TRECs compared to healthy controls. Receptor repertoires showed skewed V-gene usage for naïve T-helper cells, whereas for naïve cytotoxic T cells, shorter RTL and a trend towards higher clonality were found. Multivariate discriminant analysis revealed a clear distinction between the three groups and a skewing towards Th17 differentiation of T-helper cells, particularly in the 22q11Low individuals. Perturbations of B-cell subsets were found in both the 22q11Low and 22q11Normal group compared to the HC group, with larger proportions of naïve B cells and lower levels of memory B cells, including switched memory B cells. Conclusions This long-term follow-up study shows that 22q11Low individuals have persistent immunologic aberrations and increased risk for immune dysregulation, indicating the necessity of lifelong monitoring. Clinical Implications This study elucidates the natural history of childhood immune function in newborns with 22q11DS and low TRECs, which may facilitate the development of programs for long-term monitoring and therapeutic choices. Supplementary Information The online version contains supplementary material available at 10.1007/s10875-021-01201-5.
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Affiliation(s)
- Jenny Lingman Framme
- Department of Pediatrics, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
- Department of Pediatrics, Halland Hospital Halmstad, Halmstad, Region Halland, Sweden.
| | - Christina Lundqvist
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Anna-Carin Lundell
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Pauline A van Schouwenburg
- Department of Pediatrics, Laboratory for Pediatric Immunology, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Andri L Lemarquis
- Department of Pediatrics, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Karolina Thörn
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Susanne Lindgren
- Department of Pediatrics, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Judith Gudmundsdottir
- Department of Pediatrics, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Children's Medical Center, National University Hospital of Iceland, Reykjavík, Iceland
| | - Vanja Lundberg
- Department of Pediatrics, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Sofie Degerman
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Rolf H Zetterström
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital Solna, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Stephan Borte
- ImmunoDeficiencyCenter Leipzig (IDCL), Municipal Hospital St. Georg Leipzig, Leipzig, Germany
| | - Lennart Hammarström
- Department of Biosciences and Nutrition, Neo, Karolinska Institute, Stockholm, Sweden
| | - Esbjörn Telemo
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Magnus Hultdin
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Mirjam van der Burg
- Department of Pediatrics, Laboratory for Pediatric Immunology, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Anders Fasth
- Department of Pediatrics, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Sólveig Oskarsdóttir
- Department of Pediatrics, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Olov Ekwall
- Department of Pediatrics, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Wilhelmson AS, Lantero Rodriguez M, Johansson I, Svedlund Eriksson E, Stubelius A, Lindgren S, Fagman JB, Fink PJ, Carlsten H, Ekwall O, Tivesten Å. Androgen Receptors in Epithelial Cells Regulate Thymopoiesis and Recent Thymic Emigrants in Male Mice. Front Immunol 2020; 11:1342. [PMID: 32714327 PMCID: PMC7344216 DOI: 10.3389/fimmu.2020.01342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 05/26/2020] [Indexed: 01/14/2023] Open
Abstract
Androgens have profound effects on T cell homeostasis, including regulation of thymic T lymphopoiesis (thymopoiesis) and production of recent thymic emigrants (RTEs), i. e., immature T cells that derive from the thymus and continue their maturation to mature naïve T cells in secondary lymphoid organs. Here we investigated the androgen target cell for effects on thymopoiesis and RTEs in spleen and lymph nodes. Male mice with a general androgen receptor knockout (G-ARKO), T cell-specific (T-ARKO), or epithelial cell-specific (E-ARKO) knockout were examined. G-ARKO mice showed increased thymus weight and increased numbers of thymic T cell progenitors. These effects were not T cell-intrinsic, since T-ARKO mice displayed unaltered thymus weight and thymopoiesis. In line with a role for thymic epithelial cells (TECs), E-ARKO mice showed increased thymus weight and numbers of thymic T cell progenitors. Further, E-ARKO mice had more CD4+ and CD8+ T cells in spleen and an increased frequency of RTEs among T cells in spleen and lymph nodes. Depletion of the androgen receptor in epithelial cells was also associated with a small shift in the relative number of cortical (reduced) and medullary (increased) TECs and increased CCL25 staining in the thymic medulla, similar to previous observations in castrated mice. In conclusion, we demonstrate that the thymic epithelium is a target compartment for androgen-mediated regulation of thymopoiesis and consequently the generation of RTEs.
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Affiliation(s)
- Anna S. Wilhelmson
- Wallenberg Laboratory for Cardiovascular and Metabolic Research, Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Marta Lantero Rodriguez
- Wallenberg Laboratory for Cardiovascular and Metabolic Research, Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Inger Johansson
- Wallenberg Laboratory for Cardiovascular and Metabolic Research, Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Elin Svedlund Eriksson
- Wallenberg Laboratory for Cardiovascular and Metabolic Research, Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Alexandra Stubelius
- Center for Bone and Arthritis Research (CBAR), Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Rheumatology and Inflammation Research, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Susanne Lindgren
- Department of Rheumatology and Inflammation Research, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Johan Bourghardt Fagman
- Wallenberg Laboratory for Cardiovascular and Metabolic Research, Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Pamela J. Fink
- Department of Immunology, University of Washington, Seattle, WA, United States
| | - Hans Carlsten
- Center for Bone and Arthritis Research (CBAR), Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Rheumatology and Inflammation Research, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Olov Ekwall
- Department of Rheumatology and Inflammation Research, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Åsa Tivesten
- Wallenberg Laboratory for Cardiovascular and Metabolic Research, Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
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Gangar V, Curiale MS, Lindberg K, Gambrel-Lenarz S, Adamson E, Barbari W, Brodsky M, Blackwell G, Bryce J, Cook P, Davis B, Deabel J, D’Onorio A, Follmi-Lieder E, Franklin J, Gambrel-Lenarz S, Horne S, James-Davis L, Lindgren S, McIntyre D, Moore J, Moorman M, Puccini M, Pulusani S, Sass A, Saunders L, Schop R, Sigua CA, Sinclair P, Story R, Westmoreland R, Windsor S, Witt JL. Dry Rehydratable Film Method for Enumerating Confirmed Escherichia coli in Poultry, Meats, and Seafood: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/82.1.73] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
A rehydratable dry-film plating method for Escherichia coli, the Petrifilm E. coli/Coliform (EC) Count Plate in foods, has been compared with the AOAC INTERNATIONAL most probable number (MPN) method. Eleven laboratories participated in the collaborative study. Three E. coli levels in 8 samples each of frozen raw ground turkey, frozen raw ground beef, and frozen cooked fish were tested in duplicate. Mean log counts for the Petri film plate procedure were not significantly different from those for the MPN procedure for cooked fish samples inoculated with low or high inocula levels, for samples of raw turkey inoculated at medium level, and for beef inoculated at low, medium, and high levels. Repeatability and reproducibility vari ances of the Petrifilm EC Plate method recorded at 24 h were as good as or better than those of the MPN method. The dry rehydratable film method for enumerating confirmed E. coli in poultry, meats, and seafood has been adopted first action by AOAC INTERNATIONAL.
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Affiliation(s)
- Vidhya Gangar
- Silliker Laboratories Group, Inc., Corporate Research Center, 160 Armory Dr, South Holland, IL 60473
| | - Michael S Curiale
- Silliker Laboratories Group, Inc., Corporate Research Center, 160 Armory Dr, South Holland, IL 60473
| | - Kathryn Lindberg
- 3M Microbiology Products, 3M Center, Building 260-6B-01, St. Paul, MN 55144-1000
| | - Sonya Gambrel-Lenarz
- 3M Microbiology Products, 3M Center, Building 260-6B-01, St. Paul, MN 55144-1000
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Gangar V, Curiale MS, D’Onorio A, Schultz A, Johnson RL, Atrache V, Agin J, Allen M, Armstrong T, Chaney T, Chang P, Chavey C, Clark T, Clover J, Cook P, Copeland F, Courtney T, Davis B, D’Onorio A, Downs D, Fender M, Foster T, Fox W, Hagen H, Hall C, High E, Kalik M, Kallstrom C, Keith M, Kruegel W, Lee J, Lewus C, Light D, Lindgren S, Mills J, Minor J, Murphy M, Muzzy T, Raghubeer E, Robbins R, Salinitro A, Saunders L, Sayer T, Schultz A, Sumpter R, Traux T, Vought K, Witt J, Yonker D. VIDAS® Enzyme-Linked Immunofluorescent Assay for Detection of Listeria in Foods: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/83.4.903] [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: 11/14/2022]
Abstract
Abstract
The VIDAS LIS method and the traditional culture methods for detection of Listeria species in food were evaluated in a multilaboratory comparative study. The 6 foods tested were either naturally contaminated or inoculated with 3 different concentrations of Listeria. Results for each food and each contamination level with the VIDAS LIS method were as good as or better than those obtained with the traditional culture method. Of 1558 samples tested, 935 were positive: 839 by the VIDAS method and 809 by standard culture methods. Overall false negative rates were 10.3 and 13.5% for the VIDAS LIS and culture methods, respectively. The false positive rate for the VIDAS LIS assay was 1.4% based on 9 VIDAS LIS positive assays that did not confirm positive by isolation of Listeria. The agreement between the VIDAS LIS and culture methods for all samples tested was 86%.
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Affiliation(s)
- Vidhya Gangar
- Silliker Laboratories Group, Inc., Corporate Research Center, 160 Armory Dr, South Holland, IL 60473
| | - Michael S Curiale
- Silliker Laboratories Group, Inc., Corporate Research Center, 160 Armory Dr, South Holland, IL 60473
| | - Armando D’Onorio
- Silliker Laboratories Group, Inc., Corporate Research Center, 160 Armory Dr, South Holland, IL 60473
| | - Ann Schultz
- Silliker Laboratories Group, Inc., Corporate Research Center, 160 Armory Dr, South Holland, IL 60473
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6
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Wilhelmson AS, Lantero Rodriguez M, Svedlund Eriksson E, Johansson I, Fogelstrand P, Stubelius A, Lindgren S, Fagman JB, Hansson GK, Carlsten H, Karlsson MCI, Ekwall O, Tivesten Å. Testosterone Protects Against Atherosclerosis in Male Mice by Targeting Thymic Epithelial Cells-Brief Report. Arterioscler Thromb Vasc Biol 2018; 38:1519-1527. [PMID: 29853568 PMCID: PMC6039408 DOI: 10.1161/atvbaha.118.311252] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/16/2018] [Indexed: 02/07/2023]
Abstract
Supplemental Digital Content is available in the text. Objective— Androgen deprivation therapy has been associated with increased cardiovascular risk in men. Experimental studies support that testosterone protects against atherosclerosis, but the target cell remains unclear. T cells are important modulators of atherosclerosis, and deficiency of testosterone or its receptor, the AR (androgen receptor), induces a prominent increase in thymus size. Here, we tested the hypothesis that atherosclerosis induced by testosterone deficiency in male mice is T-cell dependent. Further, given the important role of the thymic epithelium for T-cell homeostasis and development, we hypothesized that depletion of the AR in thymic epithelial cells will result in increased atherosclerosis. Approach and Results— Prepubertal castration of male atherosclerosis-prone apoE−/− mice increased atherosclerotic lesion area. Depletion of T cells using an anti-CD3 antibody abolished castration-induced atherogenesis, demonstrating a role of T cells. Male mice with depletion of the AR specifically in epithelial cells (E-ARKO [epithelial cell-specific AR knockout] mice) showed increased thymus weight, comparable with that of castrated mice. E-ARKO mice on an apoE−/− background displayed significantly increased atherosclerosis and increased infiltration of T cells in the vascular adventitia, supporting a T-cell–driven mechanism. Consistent with a role of the thymus, E-ARKO apoE−/− males subjected to prepubertal thymectomy showed no atherosclerosis phenotype. Conclusions— We show that atherogenesis induced by testosterone/AR deficiency is thymus- and T-cell dependent in male mice and that the thymic epithelial cell is a likely target cell for the antiatherogenic actions of testosterone. These insights may pave the way for new therapeutic strategies for safer endocrine treatment of prostate cancer.
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Affiliation(s)
- Anna S Wilhelmson
- From the Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine (A.S.W., M.L.R., E.S.E., I.J., P.F., J.B.F., A.T.)
| | - Marta Lantero Rodriguez
- From the Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine (A.S.W., M.L.R., E.S.E., I.J., P.F., J.B.F., A.T.)
| | - Elin Svedlund Eriksson
- From the Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine (A.S.W., M.L.R., E.S.E., I.J., P.F., J.B.F., A.T.)
| | - Inger Johansson
- From the Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine (A.S.W., M.L.R., E.S.E., I.J., P.F., J.B.F., A.T.)
| | - Per Fogelstrand
- From the Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine (A.S.W., M.L.R., E.S.E., I.J., P.F., J.B.F., A.T.)
| | - Alexandra Stubelius
- Center for Bone and Arthritis Research, Institute of Medicine (A.S., H.C.).,Department of Rheumatology and Inflammation Research, Institute of Medicine (A.S., S.L., H.C., O.E.)
| | - Susanne Lindgren
- Department of Rheumatology and Inflammation Research, Institute of Medicine (A.S., S.L., H.C., O.E.).,Department of Pediatrics, Institute of Clinical Sciences (S.L., O.E.), University of Gothenburg, Sweden
| | - Johan B Fagman
- From the Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine (A.S.W., M.L.R., E.S.E., I.J., P.F., J.B.F., A.T.)
| | - Göran K Hansson
- Department of Medicine, Center for Molecular Medicine (G.K.H.)
| | - Hans Carlsten
- Center for Bone and Arthritis Research, Institute of Medicine (A.S., H.C.).,Department of Rheumatology and Inflammation Research, Institute of Medicine (A.S., S.L., H.C., O.E.)
| | - Mikael C I Karlsson
- Department of Microbiology, Tumor, and Cell Biology (M.C.I.K.), Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Olov Ekwall
- Department of Rheumatology and Inflammation Research, Institute of Medicine (A.S., S.L., H.C., O.E.).,Department of Pediatrics, Institute of Clinical Sciences (S.L., O.E.), University of Gothenburg, Sweden
| | - Åsa Tivesten
- From the Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine (A.S.W., M.L.R., E.S.E., I.J., P.F., J.B.F., A.T.)
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Hallén K, Jildenstål P, Stenqvist O, Oras J, Ricksten SE, Lindgren S. Isocapnic hyperventilation provides early extubation after head and neck surgery: A prospective randomized trial. Acta Anaesthesiol Scand 2018; 62:1064-1071. [PMID: 29671866 DOI: 10.1111/aas.13133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/21/2018] [Accepted: 03/25/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Isocapnic hyperventilation (IHV) shortens recovery time after inhalation anaesthesia by increasing ventilation while maintaining a normal airway carbon dioxide (CO2 )-level. One way of performing IHV is to infuse CO2 to the inspiratory limb of a breathing circuit during mechanical hyperventilation (HV). In a prospective randomized study, we compared this IHV technique to a standard emergence procedure (control). METHODS Thirty-one adult ASA I-III patients undergoing long-duration (>3 hours) sevoflurane anaesthesia for major head and neck surgery were included and randomized to IHV-treatment (n = 16) or control (n = 15). IHV was performed at minute ventilation 13.6 ± 4.3 L/min and CO2 delivery, dosed according to a nomogram tested in a pilot study. Time to extubation and eye-opening was recorded. Inspired (FICO2 ) and expired (FETCO2 ) CO2 and arterial CO2 levels (PaCO2 ) were monitored. Cognition was tested preoperatively and at 20, 40 and 60 minutes after surgery. RESULTS Time from turning off the vapourizer to extubation was 13.7 ± 2.5 minutes in the IHV group and 27.4 ± 6.5 minutes in controls (P < .001). Two minutes after extubation, PaCO2 was 6.2 ± 0.5 and 6.2 ± 0.6 kPa in the IHV and control group respectively. In 69% (IHV) vs 53% (controls), post-operative cognition returned to pre-operative values within 40 minutes after surgery (NS). Incidences of pain and nausea/vomiting did not differ between groups. CONCLUSIONS In this randomized trial comparing an IHV method with a standard weaning procedure, time to extubation was reduced with 50% in the IHV group. The described IHV method can be used to decrease emergence time from inhalation anaesthesia.
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Affiliation(s)
- K Hallén
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - P Jildenstål
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - O Stenqvist
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - J Oras
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - S-E Ricksten
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - S Lindgren
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Hallén K, Jildenstål P, Stenqvist O, Ricksten SE, Lindgren S. Evaluation of a method for isocapnic hyperventilation: a clinical pilot trial. Acta Anaesthesiol Scand 2018; 62:186-195. [PMID: 29034967 DOI: 10.1111/aas.13008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 09/08/2017] [Accepted: 09/22/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Isocapnic hyperventilation (IHV) is a method that shortens time to extubation after inhalation anaesthesia using hyperventilation (HV) without lowering airway CO2 . In a clinical trial on patients undergoing long-duration sevoflurane anaesthesia for major ear-nose-throat (ENT) surgery, we evaluated the utility of a technique for CO2 delivery (DCO2 ) to the inspiratory limb of a closed breathing circuit, during HV, to achieve isocapnia. METHODS Fifteen adult ASA 1-3 patients were included. After end of surgery, mechanical HV was started by doubling baseline minute ventilation. Simultaneously, CO2 was delivered and dosed using a nomogram developed in a previous experimental study. Time to extubation and eye opening was recorded. Inspired (FICO2 ) and expired (FETCO2 ) CO2 and arterial CO2 levels were monitored during IHV. Cognition was tested pre-operatively and at 20, 40 and 60 min after surgery. RESULTS A DCO2 of 285 ± 45 ml/min provided stable isocapnia during HV (13.5 ± 4.1 l/min). The corresponding FICO2 level was 3.0 ± 0.3%. Time from turning off the vaporizer (1.3 ± 0.1 MACage) to extubation (0.2 ± 0.1 MACage) was 11.3 ± 1.8 min after 342 ± 131 min of anaesthesia. PaCO2 and FETCO2 remained at normal levels during and after IHV. In 85% of the patients, post-operative cognition returned to pre-operative values within 60 min. CONCLUSIONS In this cohort of patients, a DCO2 nomogram for IHV was validated. The patients were safely extubated shortly after discontinuing long-term sevoflurane anaesthesia. Perioperatively, there were no adverse effects on arterial blood gases or post-operative cognition. This technique for IHV can potentially be used to decrease emergence time from inhalation anaesthesia.
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Affiliation(s)
- K. Hallén
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; The Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
| | - P. Jildenstål
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; The Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
| | - O. Stenqvist
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; The Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
| | - S.-E. Ricksten
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; The Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
| | - S. Lindgren
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; The Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
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9
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Arvidsson L, Lindgren S, Martinell L, Lundin S, Rylander C. Target temperature 34 vs. 36°C after out-of-hospital cardiac arrest - a retrospective observational study. Acta Anaesthesiol Scand 2017; 61:1176-1183. [PMID: 28815564 DOI: 10.1111/aas.12957] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/17/2017] [Accepted: 07/20/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Intensive care for comatose survivors of cardiac arrest includes targeted temperature management (TTM) to attenuate cerebral reperfusion injury. A recent multi-center clinical trial did not show any difference in mortality or neurological outcome between TTM targeting 33°C or 36°C after out-of-hospital-cardiac-arrest (OHCA). In our institution, the TTM target was changed accordingly from 34 to 36°C. The aim of this retrospective study was to analyze if this change had affected patient outcome. METHODS Intensive care registry and medical record data from 79 adult patients treated for OHCA with TTM during 2010 (n = 38; 34°C) and 2014 (n = 41; 36°C) were analyzed for mortality and neurological outcome were assessed as cerebral performance category. Student's t-test was used for continuous data and Fischer's exact test for categorical data, and multivariable logistic regression was applied to detect influence from patient factors differing between the groups. RESULTS Witnessed arrest was more common in 2010 (95%) vs. 2014 (76%) (P = 0.03) and coronary angiography was more common in 2014 (95%) vs. 2010 (76%) (P = 0.02). The number of patients awakening later than 72 h after the arrest did not differ. After adjusting for gender, hypertension, and witnessed arrest, neither 1-year mortality (P = 0.77), nor 1-year good neurological outcome (P = 0.85) differed between the groups. CONCLUSION Our results, showing no difference between TTM at 34°C and TTM at 36°C as to mortality or neurological outcome after OHCA, are in line with the previous TTM-trial results, supporting the use of either target temperature in our institution.
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Affiliation(s)
- L. Arvidsson
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - S. Lindgren
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - L. Martinell
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - S. Lundin
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - C. Rylander
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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10
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Reinisch W, Lindgren S. Letter: the importance of dosing and baseline haemoglobin when establishing the relative efficacy of intravenous iron therapies. Aliment Pharmacol Ther 2017; 46:704-705. [PMID: 28880450 DOI: 10.1111/apt.14236] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- W Reinisch
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - S Lindgren
- Department of Medicine, Clinical Sciences, University Hospital MAS, Malmö, Sweden
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11
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12
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Lundberg V, Berglund M, Skogberg G, Lindgren S, Lundqvist C, Gudmundsdottir J, Thörn K, Telemo E, Ekwall O. Thymic exosomes promote the final maturation of thymocytes. Sci Rep 2016; 6:36479. [PMID: 27824109 PMCID: PMC5099897 DOI: 10.1038/srep36479] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 10/10/2016] [Indexed: 01/01/2023] Open
Abstract
Extensive knowledge has been gained the last years concerning mechanisms underlying the selection of single positive thymocytes in the thymic medulla. Less is known regarding other important processes in the thymic medulla such as the regulation of late stage thymocyte maturation. We have previously reported that exosomes are abundant in the thymus with a phenotype that indicates an epithelial cell origin and immunoregulatory properties. In this study we use an in vitro system to investigate the effects of thymic exosomes on the maturation of single positive thymocytes as well as effects on nTreg formation. We show that thymic exosomes promote the maturation of single positive CD4+CD25- cells into mature thymocytes with S1P1+Qa2+ and CCR7+Qa2+ phenotypes. Furthermore, we show that thymic exosomes reduce the formation of CD4+CD25+FoxP3+ thymocytes and that these exosome effects are independent of dendritic cell co-stimulation but require intact exosomal RNA content and surface proteins. An efficient direct uptake of exosomes by both thymocytes and thymic DC's is also demonstrated. In conclusion, this study demonstrates that exosomes may represent a new route of communication within the thymus.
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Affiliation(s)
- Vanja Lundberg
- Dept of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Dept of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Martin Berglund
- Dept of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Gabriel Skogberg
- Dept of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Susanne Lindgren
- Dept of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Dept of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Christina Lundqvist
- Dept of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Judith Gudmundsdottir
- Dept of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Dept of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Karolina Thörn
- Dept of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Esbjörn Telemo
- Dept of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Olov Ekwall
- Dept of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Dept of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
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13
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Gudmundsdottir J, Óskarsdóttir S, Skogberg G, Lindgren S, Lundberg V, Berglund M, Lundell AC, Berggren H, Fasth A, Telemo E, Ekwall O. Early thymectomy leads to premature immunologic ageing: An 18-year follow-up. J Allergy Clin Immunol 2016; 138:1439-1443.e10. [DOI: 10.1016/j.jaci.2016.05.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/27/2016] [Accepted: 05/12/2016] [Indexed: 12/11/2022]
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Hallén K, Stenqvist O, Ricksten SE, Lindgren S. Isocapnic hyperventilation shortens washout time for sevoflurane - an experimental in vivo study. Acta Anaesthesiol Scand 2016; 60:1261-9. [PMID: 27396945 DOI: 10.1111/aas.12761] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/13/2016] [Accepted: 05/25/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Isocapnic hyperventilation (IHV) is a method that fastens weaning from inhalation anaesthesia by increasing airway concentration of carbon dioxide (CO2 ) during hyperventilation (HV). In an animal model, we evaluated a technique of adding CO2 directly to the breathing circuit of a standard anaesthesia apparatus. METHODS Eight anaesthetised pigs weighing 28 ± 2 kg were intubated and mechanically ventilated. From a baseline ventilation of 5 l/min, HV was achieved by doubling minute volume and fresh gas flow. Respiratory rate was increased from 15 to 22/min. The CO2 absorber was disconnected and CO2 was delivered (DCO2 ) to the inspiratory limb of a standard breathing circuit via a mixing box. Time required to decrease end-tidal sevoflurane concentration from 2.7% to 0.2% was defined as washout time. Respiration and haemodynamics were monitored by blood gas analysis, spirometry, electric impedance tomography and pulse contour analysis. RESULTS A DCO2 of 261 ± 19 ml/min was necessary to achieve isocapnia during HV. The corresponding FICO2 -level remained stable at 3.1 ± 0.3%. During IHV, washout of sevoflurane was three times faster, 433 ± 135 s vs. 1387 ± 204 s (P < 0.001). Arterial CO2 tension and end-tidal CO2 , was 5.2 ± 0.4 kPa and 5.6 ± 0.4%, respectively, before IHV and 5.1 ± 0.3 kPa and 5.7 ± 0.3%, respectively, during IHV. CONCLUSIONS In this experimental in vivo model of isocapnic hyperventilation, the washout time of sevoflurane anaesthesia was one-third compared to normal ventilation. The method for isocapnic hyperventilation described can potentially be transferred to a clinical setting with the intention to decrease emergence time from inhalation anaesthesia.
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Affiliation(s)
- K. Hallén
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; The Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
| | - O. Stenqvist
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; The Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
| | - S.-E. Ricksten
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; The Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
| | - S. Lindgren
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; The Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
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15
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Abstract
Single film examinations (iodine and/or barium) were reviewed in 28 patients who had undergone surgery on the cricopharyngeal muscle due to Zenker diverticula (24 patients), cricopharyngeal muscle incoordination (3 patients) and pharyngoesophageal web (one patient). All patients had had a myotomy which included the cricopharyngeal muscle and up to 3 cm of the cervical esophagus. Lateral and anterior deviation of the pharynx and cervical esophagus occurred regularly. A pharyngocutaneous fistula developed in 2 patients which healed within 3 weeks. In 5 patients there was a posterior leak of contrast medium during the first postoperative week which healed within 2 weeks. Six of these seven patients with a fistula or a leak had had either a diverticulum removed or sustained an accidental mucosal perforation. No patient had recurrence of diverticula, although, 9 patients developed a cricopharyngeal muscle impression. Iodine and barium examinations are important for monitoring early and late postoperative changes after cricopharyngeus myotomy.
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16
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Nilsson E, Anderson H, Sargenti K, Lindgren S, Prytz H. Incidence, clinical presentation and mortality of liver cirrhosis in Southern Sweden: a 10-year population-based study. Aliment Pharmacol Ther 2016; 43:1330-9. [PMID: 27091240 DOI: 10.1111/apt.13635] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 01/31/2016] [Accepted: 03/30/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND In Sweden, the most common causes of liver cirrhosis are alcohol overconsumption and hepatitis C. However, recent data on the clinical characteristics of Swedish patients with cirrhosis are scarce. AIMS To determine the incidence, clinical presentation, aetiological spectrum and survival rates of liver cirrhosis in Southern Sweden from 2001 to 2011. METHODS We used population-based medical registries to conduct a cohort study of all patients with liver cirrhosis in the southernmost region of Sweden with a population of 1.17 million. Medical records and histopathology data were reviewed. Patients were classified according to aetiology, and clinical parameters were registered. Patients were followed until death or December 2014. RESULTS A total of 1317 patients with cirrhosis were identified. The crude annual incidence of cirrhosis was estimated at 14.1/100 000. The most common aetiology was alcohol overconsumption with or without additional causes of cirrhosis (58%) followed by HCV alone (13%) and cryptogenic cirrhosis (12%). At diagnosis, ascites occurred in 43%, variceal bleeding in 6% and overt encephalopathy in 4%. The median follow-up was 4.3 years. The total 1-, 5- and 10-year survival rates were 79%, 47% and 27% respectively. Survival rates were better for women than for men. A 10-year cumulative incidence of transplantation was 7.3%. Mortality was worst for alcoholic cirrhosis with concomitant HCV when adjusted for age and gender. CONCLUSIONS Sweden continues to have a low incidence of cirrhosis compared with other European countries. Mortality varies with gender, aetiology and severity at diagnosis. Patients with alcoholic cirrhosis with concomitant HCV infection fare worst.
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Affiliation(s)
- E Nilsson
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Gastroenterology Clinic, Skåne University Hospital, Lund University, Lund, Sweden
| | - H Anderson
- Department of Clinical Sciences, Cancer Epidemiology, Lund University, Lund, Sweden
| | - K Sargenti
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Gastroenterology Clinic, Skåne University Hospital, Lund University, Lund, Sweden
| | - S Lindgren
- Gastroenterology Clinic, Skåne University Hospital, Lund University, Lund, Sweden.,Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - H Prytz
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Gastroenterology Clinic, Skåne University Hospital, Lund University, Lund, Sweden
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17
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Hallén K, Stenqvist O, Ricksten SE, Lindgren S. A simple method for isocapnic hyperventilation evaluated in a lung model. Acta Anaesthesiol Scand 2016; 60:597-606. [PMID: 26688296 DOI: 10.1111/aas.12674] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 11/11/2015] [Accepted: 11/15/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Isocapnic hyperventilation (IHV) has the potential to increase the elimination rate of anaesthetic gases and has been shown to shorten time to wake-up and post-operative recovery time after inhalation anaesthesia. In this bench test, we describe a technique to achieve isocapnia during hyperventilation (HV) by adding carbon dioxide (CO2) directly to the breathing circuit of a standard anaesthesia apparatus with standard monitoring equipment. METHODS Into a mechanical lung model, carbon dioxide was added to simulate a CO2 production (V(CO2)) of 175, 200 and 225 ml/min. Dead space (V(D)) volume could be set at 44, 92 and 134 ml. From baseline ventilation (BLV), HV was achieved by doubling the minute ventilation and fresh gas flow for each level of V(CO2), and dead space. During HV, CO2 was delivered (D(CO2)) by a precision flow meter via a mixing box to the inspiratory limb of the anaesthesia circuit to achieve isocapnia. RESULTS During HV, the alveolar ventilation increased by 113 ± 6%. Tidal volume increased by 20 ± 0.1% during IHV irrespective of V(D) and V(CO2) level. D(CO2) varied between 147 ± 8 and 325 ± 13 ml/min. Low V(CO2) and large V(D) demanded a greater D(CO2) administration to achieve isocapnia. The FICO2 level during IHV varied between 2.3% and 3.3%. CONCLUSION It is possible to maintain isocapnia during HV by delivering carbon dioxide through a standard anaesthesia circuit equipped with modern monitoring capacities. From alveolar ventilation, CO2 production and dead space, the amount of carbon dioxide that is needed to achieve IHV can be estimated.
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Affiliation(s)
- K. Hallén
- Department of Anaesthesiology and Intensive Care medicine; Institution of Clinical Sciences; The Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
| | - O. Stenqvist
- Department of Anaesthesiology and Intensive Care medicine; Institution of Clinical Sciences; The Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
| | - S.-E. Ricksten
- Department of Anaesthesiology and Intensive Care medicine; Institution of Clinical Sciences; The Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
| | - S. Lindgren
- Department of Anaesthesiology and Intensive Care medicine; Institution of Clinical Sciences; The Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
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18
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Hallström H, Lindgren S, Twetman S. Effect of a chlorhexidine-containing brush-on gel on peri-implant mucositis. Int J Dent Hyg 2015; 15:149-153. [DOI: 10.1111/idh.12184] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2015] [Indexed: 12/16/2022]
Affiliation(s)
- H Hallström
- Faculty of Odontology; Department of Periodontology; Malmö University; Malmö Sweden
| | - S Lindgren
- Maxillofacial unit; Halland Hospital; Halmstad Sweden
| | - S Twetman
- Maxillofacial unit; Halland Hospital; Halmstad Sweden
- Faculty of Health and Medical Sciences; Department of Odontology; Section for Cariology, Endodontics, Pediatric Dentistry and Clinical Genetics; University of Copenhagen; Copenhagen Denmark
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19
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Skogberg G, Lundberg V, Lindgren S, Gudmundsdottir J, Sandström K, Kämpe O, Annerén G, Gustafsson J, Sunnegårdh J, van der Post S, Telemo E, Berglund M, Ekwall O. Altered expression of autoimmune regulator in infant down syndrome thymus, a possible contributor to an autoimmune phenotype. J Immunol 2014; 193:2187-95. [PMID: 25038256 PMCID: PMC4135177 DOI: 10.4049/jimmunol.1400742] [Citation(s) in RCA: 35] [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] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 06/18/2014] [Indexed: 12/16/2022]
Abstract
Down syndrome (DS), caused by trisomy of chromosome 21, is associated with immunological dysfunctions such as increased frequency of infections and autoimmune diseases. Patients with DS share clinical features, such as autoimmune manifestations and specific autoantibodies, with patients affected by autoimmune polyendocrine syndrome type 1. Autoimmune polyendocrine syndrome type 1 is caused by mutations in the autoimmune regulator (AIRE) gene, located on chromosome 21, which regulates the expression of tissue-restricted Ags (TRAs) in thymic epithelial cells. We investigated the expression of AIRE and TRAs in DS and control thymic tissue using quantitative PCR. AIRE mRNA levels were elevated in thymic tissue from DS patients, and trends toward increased expression of the AIRE-controlled genes INSULIN and CHRNA1 were found. Immunohistochemical stainings showed altered cell composition and architecture of the thymic medulla in DS individuals with increased frequencies of AIRE-positive medullary epithelial cells and CD11c-positive dendritic cells as well as enlarged Hassall's corpuscles. In addition, we evaluated the proteomic profile of thymic exosomes in DS individuals and controls. DS exosomes carried a broader protein pool and also a larger pool of unique TRAs compared with control exosomes. In conclusion, the increased AIRE gene dose in DS could contribute to an autoimmune phenotype through multiple AIRE-mediated effects on homeostasis and function of thymic epithelial cells that affect thymic selection processes.
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Affiliation(s)
- Gabriel Skogberg
- Department of Rheumatology and Inflammation Research, Institute of Medicine, University of Gothenburg, 405 30 Gothenburg, Sweden;
| | - Vanja Lundberg
- Department of Rheumatology and Inflammation Research, Institute of Medicine, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Susanne Lindgren
- Department of Rheumatology and Inflammation Research, Institute of Medicine, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Judith Gudmundsdottir
- Department of Rheumatology and Inflammation Research, Institute of Medicine, University of Gothenburg, 405 30 Gothenburg, Sweden; Department of Pediatrics at the Institute of Clinical Sciences, University of Gothenburg, 416 86 Gothenburg, Sweden
| | - Kerstin Sandström
- Department of Pediatric Anesthesia and Intensive Care at the Sahlgrenska Academy, University of Gothenburg, 416 86 Gothenburg, Sweden
| | - Olle Kämpe
- Centre of Molecular Medicine, Department of Medicine (Solna), Karolinska Institutet, 171 76 Stockholm, Sweden; Science for Life Laboratory, Uppsala University, 750 03 Uppsala, Sweden
| | - Göran Annerén
- Department of Immunology, Genetics, and Pathology, Science for Life Laboratory, Uppsala University, 751 85 Uppsala, Sweden
| | - Jan Gustafsson
- Department of Women's and Children´s Health, Uppsala University, 751 85 Uppsala, Sweden; and
| | - Jan Sunnegårdh
- Department of Pediatrics at the Institute of Clinical Sciences, University of Gothenburg, 416 86 Gothenburg, Sweden
| | - Sjoerd van der Post
- Proteomics Core Facility at the Sahlgrenska Academy, University of Gothenburg, 413 90 Gothenburg, Sweden
| | - Esbjörn Telemo
- Department of Rheumatology and Inflammation Research, Institute of Medicine, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Martin Berglund
- Department of Rheumatology and Inflammation Research, Institute of Medicine, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Olov Ekwall
- Department of Rheumatology and Inflammation Research, Institute of Medicine, University of Gothenburg, 405 30 Gothenburg, Sweden; Department of Pediatrics at the Institute of Clinical Sciences, University of Gothenburg, 416 86 Gothenburg, Sweden
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20
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Spratt D, Zelefsky M, Fareedy S, Lindgren S, Osborne J. Neuroendocrine Prostate Cancer: FDG-PET and Targeted Molecular Imaging. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.772] [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: 11/25/2022]
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21
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Chan SSM, Luben R, Olsen A, Tjonneland A, Kaaks R, Lindgren S, Grip O, Bergmann MM, Boeing H, Hallmans G, Karling P, Overvad K, Venø SK, van Schaik F, Bueno‐de‐Mesquita B, Oldenburg B, Khaw K, Riboli E, Hart AR. Association between high dietary intake of the n-3 polyunsaturated fatty acid docosahexaenoic acid and reduced risk of Crohn's disease. Aliment Pharmacol Ther 2014; 39:834-42. [PMID: 24611981 PMCID: PMC4114542 DOI: 10.1111/apt.12670] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 11/18/2013] [Accepted: 01/30/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND There are plausible mechanisms for how dietary docosahexaenoic acid (DHA), an n-3 polyunsaturated fatty acid, could prevent Crohn's disease (CD). AIM To conduct a prospective study to investigate the association between increased intake of DHA and risk of CD. METHODS Overall, 229 702 participants were recruited from nine European centres between 1991 and 1998. At recruitment, dietary intakes of DHA and fatty acids were measured using validated food frequency questionnaires. The cohort was monitored through to June 2004 to identify participants who developed incident CD. In a nested case-control analysis, each case was matched with four controls; odds ratios (ORs) were calculated for quintiles of DHA intake, adjusted for total energy intake, smoking, other dietary fatty acids, dietary vitamin D and body mass index. RESULTS Seventy-three participants developed incident CD. All higher quintiles of DHA intake were inversely associated with development of CD; the highest quintile had the greatest effect size (OR = 0.07; 95% CI = 0.02-0.81). The OR trend across quintiles of DHA was 0.54 (95% CI = 0.30-0.99, Ptrend = 0.04). Including BMI in the multivariate analysis, due to its correlation with dietary fat showed similar associations. There were no associations with the other dietary fatty acids studied. CONCLUSION There were inverse associations, with a biological gradient between increasing dietary docosahexaenoic acid intakes and incident Crohn's disease. Further studies in other populations should measure docosahexaenoic acid to determine if the association is consistent and the hypothesis tested in randomised controlled trials of purely docosahexaenoic acid supplementation.
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Affiliation(s)
- S. S. M. Chan
- Department of MedicineNorwich Medical School University of East AngliaNorwichUK,Norfolk & Norwich University Hospitals NHS TrustNorwichUK,Correspondence to:
Dr S. S. M. Chan, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK.
E‐mail:
| | - R. Luben
- Strangeways Research LaboratoryInstitute of Public HealthUniversity of CambridgeCambridgeUK
| | - A. Olsen
- Institute of Cancer EpidemiologyDanish Cancer SocietyCopenhagenDenmark
| | - A. Tjonneland
- Institute of Cancer EpidemiologyDanish Cancer SocietyCopenhagenDenmark
| | - R. Kaaks
- Division of Clinical EpidemiologyDKFZ‐German Cancer Research CentreHeidelbergGermany
| | - S. Lindgren
- Department of Clinical SciencesUniversity HospitalMalmöSweden
| | - O. Grip
- Department of Clinical SciencesUniversity HospitalMalmöSweden
| | - M. M. Bergmann
- Department of EpidemiologyGerman Institute of Human NutritionPotsdamGermany
| | - H. Boeing
- Department of EpidemiologyGerman Institute of Human NutritionPotsdamGermany
| | - G. Hallmans
- Department of Public Health and Clinical MedicineNutritional ResearchUmeå UniversityUmeåSweden
| | - P. Karling
- Department of Public Health and Clinical MedicineGI unitUmeå UniversityUmeåSweden
| | - K. Overvad
- Section for EpidemiologyDepartment of Public HealthAarhus UniversityAarhusDenmark
| | - S. K. Venø
- Department of CardiologyAalborg University HospitalAalborgDenmark
| | - F. van Schaik
- Department of Gastroenterology and HepatologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - B. Bueno‐de‐Mesquita
- Department of Gastroenterology and HepatologyUniversity Medical Center UtrechtUtrechtThe Netherlands,National Institute of Public Health and the Environment (RIVM)BilthovenThe Netherlands,The School of Public HealthImperial College LondonLondonUK
| | - B. Oldenburg
- Department of Gastroenterology and HepatologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - K.‐T. Khaw
- Strangeways Research LaboratoryInstitute of Public HealthUniversity of CambridgeCambridgeUK
| | - E. Riboli
- Division of EpidemiologyImperial College LondonLondonUK
| | - A. R. Hart
- Department of MedicineNorwich Medical School University of East AngliaNorwichUK,Norfolk & Norwich University Hospitals NHS TrustNorwichUK
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Gomollón F, Chowers Y, Danese S, Dignass A, Haagen Nielsen O, Lakatos PL, Lees CW, Lindgren S, Lukas M, Mantzaris GJ, Michetti P, Moum B, Peyrin-Biroulet L, Toruner M, van der Woude J, Weiss G, Stoevelaar H, Reinisch W. Letter: European Medicines Agency recommendations for allergic reactions to intravenous iron-containing medicines. Aliment Pharmacol Ther 2014; 39:743-4. [PMID: 24588280 DOI: 10.1111/apt.12648] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 01/14/2014] [Indexed: 12/08/2022]
Affiliation(s)
- F Gomollón
- CIBEREHD, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain. ,
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Reinisch W, Chowers Y, Danese S, Dignass A, Gomollón F, Nielsen OH, Lakatos PL, Lees CW, Lindgren S, Lukas M, Mantzaris GJ, Michetti P, Moum B, Peyrin-Biroulet L, Toruner M, van der Woude J, Weiss G, Stoevelaar H. The management of iron deficiency in inflammatory bowel disease--an online tool developed by the RAND/UCLA appropriateness method. Aliment Pharmacol Ther 2013; 38:1109-18. [PMID: 24099472 PMCID: PMC3886296 DOI: 10.1111/apt.12493] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 06/24/2013] [Accepted: 08/28/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Iron deficiency is a common and undertreated problem in inflammatory bowel disease (IBD). AIM To develop an online tool to support treatment choice at the patient-specific level. METHODS Using the RAND/UCLA Appropriateness Method (RUAM), a European expert panel assessed the appropriateness of treatment regimens for a variety of clinical scenarios in patients with non-anaemic iron deficiency (NAID) and iron deficiency anaemia (IDA). Treatment options included adjustment of IBD medication only, oral iron supplementation, high-/low-dose intravenous (IV) regimens, IV iron plus erythropoietin-stimulating agent (ESA), and blood transfusion. The panel process consisted of two individual rating rounds (1148 treatment indications; 9-point scale) and three plenary discussion meetings. RESULTS The panel reached agreement on 71% of treatment indications. 'No treatment' was never considered appropriate, and repeat treatment after previous failure was generally discouraged. For 98% of scenarios, at least one treatment was appropriate. Adjustment of IBD medication was deemed appropriate in all patients with active disease. Use of oral iron was mainly considered an option in NAID and mildly anaemic patients without disease activity. IV regimens were often judged appropriate, with high-dose IV iron being the preferred option in 77% of IDA scenarios. Blood transfusion and IV+ESA were indicated in exceptional cases only. CONCLUSIONS The RUAM revealed high agreement amongst experts on the management of iron deficiency in patients with IBD. High-dose IV iron was more often considered appropriate than other options. To facilitate dissemination of the recommendations, panel outcomes were embedded in an online tool, accessible via http://ferroscope.com/.
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Affiliation(s)
- W Reinisch
- Department Internal Medicine III, Medical University of Vienna, Vienna, Austria
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Insulander M, Hökeberg I, Lind G, von Sydow M, Lindgren S, Petersson I, Fischler B. Evaluation of a new vaccination program for infants born to HBsAg-positive mothers in Stockholm County. Vaccine 2013; 31:4284-6. [DOI: 10.1016/j.vaccine.2013.06.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 06/07/2013] [Accepted: 06/19/2013] [Indexed: 12/31/2022]
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25
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Caridha R, Gieng K, Fried U, Lindgren S, Clevestig P, Ehrnst A. Transmitted HIV-1 variants in HIV infected mother-child pairs carrying different subtypes. Retrovirology 2012. [PMCID: PMC3442025 DOI: 10.1186/1742-4690-9-s2-p162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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26
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Bager P, Befrits R, Wikman O, Lindgren S, Moum B, Hjortswang H, Hjollund NH, Dahlerup JF. Fatigue in out-patients with inflammatory bowel disease is common and multifactorial. Aliment Pharmacol Ther 2012; 35:133-41. [PMID: 22059387 DOI: 10.1111/j.1365-2036.2011.04914.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [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: 12/19/2022]
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) often complain of fatigue. AIM To investigate the prevalence and characteristics of fatigue among IBD out-patients in Scandinavia and to provide normative values for fatigue in IBD patients. METHODS A cross-sectional study was conducted on 425 IBD patients from six out-patient centres in Denmark, Norway and Sweden. Fatigue was measured using the Multidimensional Fatigue Inventory. The patients were also screened for anaemia and iron deficiency. Each centre included approximately 5% of their IBD cohort. The patients were enrolled consecutively from the out-patient clinics, regardless of disease activity and whether the visit was scheduled. The fatigue analysis was stratified for age and gender. RESULTS Using the 95th percentile of the score of the general population as a cut-off, approximately 44% of the patients were fatigued. When comparing the IBD patients with disease activity to the IBD patients in remission, all dimensions of fatigue were statistically significant (P < 0.05). Being anaemic or iron deficient was not associated with increased fatigue. Being a male patient with ulcerative colitis treated with corticosteroids was a strong determinant for increased fatigue. The normative ranges for IBD fatigue were calculated. CONCLUSIONS Fatigue in IBD is common regardless of anaemia or iron deficiency. Fatigue in IBD is most marked for patients < 60 years of age. Stratifying for gender and age is necessary when analysing fatigue, as fatigue is expressed differently between groups.
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Affiliation(s)
- P Bager
- Department of Medicine V (Hepatology and Gastroenterology), Aarhus University Hospital, Aarhus, Denmark.
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Abstract
OBJECTIVES This study examined the behavioral health of young children with oral clefts, and effects of satisfaction with facial appearance, cleft team care, number of cleft-related surgeries, and socioeconomic status (SES). SUBJECTS AND METHODS The study included a population-based sample of 104 children aged 2-12 years with isolated oral clefts from the state of Iowa. Behavior was evaluated with the Child Behavior Checklist or the Pediatric Behavior Scale 30, depending on age, compared with normative samples. RESULTS Risks of behavioral problems were not significantly different from normative samples except for higher inattention/hyperactivity risks at age 6-12 years. Low satisfaction with facial appearance was associated with behavioral problems in all domains, except aggression. Team-care effects were not associated with behavioral problems. Number of cleft-related surgeries was associated with increased anxiety/depression and somatic symptom risks. Higher SES was associated with reduced inattention/hyperactivity, aggressive/oppositional behavior, and somatic symptoms. CONCLUSIONS Most children with oral clefts may have similar behavioral health outcomes to unaffected children, except for increased inattention/hyperactivity risks at older ages. However, low satisfaction with facial appearance, increased exposure to surgeries, and lower SES may significantly increase behavioral problems. Also, the findings emphasize the need to study the representation of behavioral health professionals on cleft teams and access to behavioral health care.
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Affiliation(s)
- G L Wehby
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA 52242, USA.
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Navér L, Albert J, Belfrage E, Flamholc L, Gisslén M, Gyllensten K, Josephson F, Karlström O, Lindgren S, Pettersson K, Svedhem V, Sönnerborg A, Westling K, Yilmaz A. Prophylaxis and treatment of HIV-1 infection in pregnancy: Swedish Recommendations 2010. ACTA ACUST UNITED AC 2011; 43:411-23. [DOI: 10.3109/00365548.2011.567392] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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30
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Andersson B, Lundin S, Lindgren S, Stenqvist O, Odenstedt Hergès H. End-expiratory lung volume and ventilation distribution with different continuous positive airway pressure systems in volunteers. Acta Anaesthesiol Scand 2011; 55:157-64. [PMID: 21108619 DOI: 10.1111/j.1399-6576.2010.02337.x] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) has been shown to improve oxygenation and a number of different CPAP systems are available. The aim of this study was to assess lung volume and ventilation distribution using three different CPAP techniques. METHODS A high-flow CPAP system (HF-CPAP), an ejector-driven system (E-CPAP) and CPAP using a Servo 300 ventilator (V-CPAP) were randomly applied at 0, 5 and 10 cmH₂O in 14 volunteers. End-expiratory lung volume (EELV) was measured by N₂ dilution at baseline; changes in EELV and tidal volume distribution were assessed by electric impedance tomography. RESULTS Higher end-expiratory and mean airway pressures were found using the E-CPAP vs. the HF-CPAP and the V-CPAP system (P<0.01). EELV increased markedly from baseline, 0 cmH₂O, with increased CPAP levels: 1110±380, 1620±520 and 1130±350 ml for HF-, E- and V-CPAP, respectively, at 10 cmH₂O. A larger fraction of the increase in EELV occurred for all systems in ventral compared with dorsal regions (P<0.01). In contrast, tidal ventilation was increasingly directed toward dorsal regions with increasing CPAP levels (P<0.01). The increase in EELV as well as the tidal volume redistribution were more pronounced with the E-CPAP system as compared with both the HF-CPAP and the V-CPAP systems (P<0.05) at 10 cmH₂O. CONCLUSION EELV increased more in ventral regions with increasing CPAP levels, independent of systems, leading to a redistribution of tidal ventilation toward dorsal regions. Different CPAP systems resulted in different airway pressure profiles, which may result in different lung volume expansion and tidal volume distribution.
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Affiliation(s)
- B Andersson
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
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Lowhagen K, Lindgren S, Odenstedt H, Stenqvist O, Lundin S. Prolonged moderate pressure recruitment manoeuvre results in lower optimal positive end-expiratory pressure and plateau pressure. Acta Anaesthesiol Scand 2011; 55:175-84. [PMID: 21226859 DOI: 10.1111/j.1399-6576.2010.02366.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND In acute lung injury (ALI)/acute respiratory distress syndrome (ARDS), recruitment manoeuvres (RMs) are used frequently. In pigs with induced ALI, superior effects have been found using a slow moderate-pressure recruitment manoeuvre (SLRM) compared with a vital capacity recruitment manoeuvre (VICM). We hypothesized that the positive recruitment effects of SLRM could also be achieved in ALI/ARDS patients. Our primary research question was whether the same compliance could be obtained using lower RM pressure and subsequent positive end-expiratory pressure (PEEP). Secondly, optimal PEEP levels following the RMs were compared, and the use of volume-dependent compliance (VDC) to identify successful lung recruitment and optimal PEEP was evaluated. PATIENTS AND METHODS We performed a prospective randomised cross-over study where 16 ventilated patients with early ALI/ARDS each were subjected to the two RMs, followed by decremental PEEP titration. Volume-dependent initial, middle and final compliance (C(ini) , C(mid) and C(fin) ) were determined. Electric impedance tomography and end-expiratory lung volume measurements were used to follow lung volume changes. RESULTS The maximum response in compliance, PaO₂/FIO₂, venous admixture and C(ini) /C(fin) after recruitment, during decremental PEEP, was at significantly lower PEEP and plateau pressure after SLRM than VICM. Fewer patients responded in gas exchange after the SLRM, which was not the case for lung mechanics. The response in C(ini) was more pronounced than in conventional compliance. CONCLUSIONS The same compliance increase is achieved with SLRM as with VICM, and lower PEEP can be used, with correspondingly lower plateau pressures. VDC seems promising to identify successful recruitment and optimal PEEP.
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Affiliation(s)
- K Lowhagen
- Department of Anaesthesia and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Lowhagen K, Lindgren S, Odenstedt H, Stenqvist O, Lundin S. A new non-radiological method to assess potential lung recruitability: a pilot study in ALI patients. Acta Anaesthesiol Scand 2011; 55:165-74. [PMID: 21039359 DOI: 10.1111/j.1399-6576.2010.02331.x] [Citation(s) in RCA: 31] [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: 11/27/2022]
Abstract
INTRODUCTION Potentially recruitable lung has been assessed previously in patients with acute lung injury (ALI) by computed tomography. A large variability in lung recruitability was observed between patients. In this study, we assess whether a new non-radiological bedside technique could determine potentially recruitable lung volume (PRLV) in ALI patients. METHODS Sixteen mechanically ventilated patients with early ALI/ARDS were subjected to a recruitment manoeuvre and decremental PEEP titration. Electric impedance tomography, together with measurements of end-expiratory lung volume (EELV) and tracheal pressure, were used to determine PRLV. The method defines fully recruited open lung volume (OLV) as the volume reached at the end of two consecutive vital capacity manoeuvres to 40 cmH₂O. It also uses extrapolation of the baseline alveolar pressure/volume curve up to 40 cmH₂O, the volume reached being the non-recruited lung volume. The difference between the fully recruited and the non-recruited volume was defined as PRLV. RESULTS We observed a considerable heterogeneity among the patients in lung recruitability, PRLV range 11-47%. In a post hoc analysis, dividing the patients into two groups, a high and a low PRLV group, we found at baseline before the recruitment manoeuvre that the high PRLV group had lower compliance and a lower fraction of EELV/OLV. CONCLUSIONS Using non-invasive radiation-free bedside methods, it may be possible to measure PRLV in ALI/ARDS patients. It is possible that this technique could be used to determine the need for recruitment manoeuvres and to select PEEP level on the basis of lung recruitability.
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Affiliation(s)
- K Lowhagen
- Department of Anaesthesia and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Tjonneland A, Overvad K, Bergmann MM, Nagel G, Linseisen J, Hallmans G, Palmqvist R, Sjodin H, Hagglund G, Berglund G, Lindgren S, Grip O, Palli D, Day NE, Khaw KT, Bingham S, Riboli E, Kennedy H, Hart A. Linoleic acid, a dietary n-6 polyunsaturated fatty acid, and the aetiology of ulcerative colitis: a nested case-control study within a European prospective cohort study. Gut 2009; 58:1606-11. [PMID: 19628674 DOI: 10.1136/gut.2008.169078] [Citation(s) in RCA: 245] [Impact Index Per Article: 16.3] [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] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Dietary linoleic acid, an n-6 polyunsaturated fatty acid, is metabolised to arachidonic acid, a component of colonocyte membranes. Metabolites of arachidonic acid have pro-inflammatory properties and are increased in the mucosa of patients with ulcerative colitis. The aim of this investigation was to conduct the first prospective cohort study investigating if a high dietary intake of linoleic acid increases the risk of developing incident ulcerative colitis. DESIGN AND SETTING Dietary data from food frequency questionnaires were available for 203 193 men and women aged 30-74 years, resident in the UK, Sweden, Denmark, Germany or Italy and participating in a prospective cohort study, the European Prospective Investigation into Cancer and Nutrition (EPIC). These participants were followed up for the diagnosis of ulcerative colitis. Each case was matched with four controls and the risk of disease calculated by quartile of intake of linoleic acid adjusted for gender, age, smoking, total energy intake and centre. RESULTS A total of 126 participants developed ulcerative colitis (47% women) after a median follow-up of 4.0 years (range, 1.7-11.3 years). The highest quartile of intake of linoleic acid was associated with an increased risk of ulcerative colitis (odds ratio (OR) = 2.49, 95% confidence interval (CI) = 1.23 to 5.07, p = 0.01) with a significant trend across quartiles (OR = 1.32 per quartile increase, 95% CI = 1.04 to 1.66, p = 0.02 for trend). CONCLUSIONS The data support a role for dietary linoleic acid in the aetiology of ulcerative colitis. An estimated 30% of cases could be attributed to having dietary intakes higher than the lowest quartile of linoleic acid intake.
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Affiliation(s)
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- University of East Anglia, Norwich, NR4 7TJ, UK.
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Sangfelt P, Von Sydow M, Uhnoo I, Weiland O, Lindh G, Fischler B, Lindgren S, Reichard O. Serum ALT Levels as a Surrogate Marker for Serum HBV DNA Levels in HBeAg-negative Pregnant Women. ACTA ACUST UNITED AC 2009; 36:182-5. [PMID: 15119362 DOI: 10.1080/00365540410027111] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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: 10/26/2022]
Abstract
In Stockholm, Sweden, the majority of pregnant women positive for hepatitis B surface antigen (HBsAg) are hepatitis Be antigen (HBeAg) negative. Newborns to HBeAg positive mothers receive vaccination and hepatitis B immunoglobulin (HBIg). Newborns to HBeAg negative mothers receive vaccine and HBIg only if the mothers have elevated ALT levels. The aim of this study was to retrospectively evaluate ALT levels as a surrogate marker for HBV DNA levels in HBeAg negative carrier mothers. Altogether 8947 pregnant women were screened for HBV markers from 1999 to 2001 at the Virology Department, Karolinska Hospital. Among mothers screened 192 tested positive for HBsAg (2.2%). 13 of these samples could not be retrieved. Of the remaining 179 sera, 8 (4%) tested positive for HBeAg and 171 (95.5%) were HBeAg negative. Among the HBeAg negative mothers, 9 had HBV DNA levels > 10(5) copies/ml, and of these 7 had normal ALT levels indicating low sensitivity of an elevated ALT level as a surrogate marker for high HBV DNA level. Furthermore, no correlation was found between ALT and HBV DNA levels. Hence, it is concluded that the use of ALT as a surrogate marker for high viral replication in HBeAg negative mothers could be questioned.
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Affiliation(s)
- Per Sangfelt
- Department of Medical Sciences, Section of Infectious Diseases, Akademiska Hospital, Uppsala, Sweden.
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Grivans C, Lindgren S, Aneman A, Stenqvist O, Lundin S. A Scandinavian survey of drug administration through inhalation, suctioning and recruitment maneuvers in mechanically ventilated patients. Acta Anaesthesiol Scand 2009; 53:710-6. [PMID: 19388888 DOI: 10.1111/j.1399-6576.2009.01957.x] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The aim was to describe current practices for drug administration through inhalation, endotracheal suctioning and lung recruitment maneuvers in mechanically ventilated patients in Scandinavian intensive care units (ICUs). METHODS We invited 161 ICUs to participate in a web-based survey regarding (1) their routine standards and (2) current treatment of ventilated patients during the past 24 h. In order to characterize the patients, the lowest PaO(2) with the corresponding highest FiO(2), and the highest PaO(2) with the corresponding lowest FiO(2) during the 24-h study period were recorded. RESULTS Eighty-seven ICUs answered and reported 186 patients. Positive end-expiratory pressure (PEEP) levels (cmH(2)O) were 5-9 in 65% and >10 in 31% of the patients. Forty percent of the patients had heated humidification and 50% received inhalation of drugs. Endotracheal suctioning was performed >7 times during the study period in 40% of the patients, of which 23% had closed suction systems. Twenty percent of the patients underwent recruitment maneuvers. The most common recruitment maneuver was to increase PEEP and gradually increase the inspiratory pressure. Twenty-six percent of the calculated PaO(2)/FiO(2) ratios varied >13 kPa for the same patient. CONCLUSION Frequent use of drug administration through inhalation and endotracheal suctioning predispose to derecruitment of the lungs, possibly resulting in the large variations in PaO(2)/FiO(2) ratios observed during the 24-h study period. Recruitment maneuvers were performed only in one-fifth of the patients during the day of the survey.
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Affiliation(s)
- C Grivans
- Department of Anaesthesia and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Melander A, Berlin-Wahlén A, Bodin NO, Danielson K, Gustafsson B, Lindgren S, Westerlund D. Bioavailability of D-propoxyphene, acetyl salicylic acid, and phenazone in a combination tablet (Doleron): interindividual variation and influence of food intake. Acta Med Scand 2009; 202:119-24. [PMID: 899874 DOI: 10.1111/j.0954-6820.1977.tb16796.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The influence of food intake on the bioavailability of three analgesic compounds--propoxyphene chloride, acetyl salicylic acid and phenazone--in a combination tablet, Doleron, has been examined in eight healthy volunteers. A single oral dose was given both on an empty stomach and together with a standardized breakfast meal. The plasma concentrations of propoxyphene, its major metabolite norpropoxyphene, salicylic acid and phenazone were determined by mass fragmentography, spectrofluorimetry and gas chromatography. Concomitant food intake had no consistent influence on the bioavailability of any of the components. Hence, doleron may be taken together with meals as well as between meals. Large interindividual variations in propoxyphene and phenazone concentrations were found, indicating that an optimal effect will not always be obtained by standard doses.
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Abstract
Immunofluorescence studies on skin biopsies from 14 patients with primary biliary cirrhosis (PBC) showed granular papillary deposition of IgM in all. In addition, 6 patients had C3 deposition. Control patients with various other liver diseases, idiopathic high plasma levels of igM and extrahepatic cholestasis were only sporadically positive for IgM and not at all for C3. IgM deposition in dermal papillae in PBC does not merely reflect high plasma IgM levels or cholestasis but probably represents an immunochemically abnormal IgM population.
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Hansen BU, Lindgren S, Eriksson S, Henricsson V, Larsson A, Manthorpe R, Warfvinge G. Clinical and immunological features of Sjögren's syndrome in patients with primary biliary cirrhosis with emphasis on focal sialadenitis. Acta Med Scand 2009; 224:611-9. [PMID: 3207072 DOI: 10.1111/j.0954-6820.1988.tb19634.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Serological and pathological findings in 21 patients with primary Sjögren's syndrome (primary SS) were compared with those in 32 patients with primary biliary cirrhosis (PBC). In ELISA, anti-SS-B/La antibodies were detected in sera from 14 (67%) of the patients with primary SS, but only from 12 (38%) of those with PBC. With the Ouchterlony test, anti-SS-A/Ro antibodies were found in sera from 15 (71%) of the primary SS patients, but in no PBC patient. Of those PBC patients investigated prospectively with objective tests, four of 11 (36%) had keratoconjunctivitis sicca, and five of 15 (33%) had pathological sialometry results. In contrast, all PBC patients but one (i.e., 14 of 15 or 93%) showed evidence of focal sialadenitis. In immunochemical study of PBC patients, IgM immunoreactivity was found in the stroma, particularly adjacent to excretory ducts and acini in salivary glands (5 of 5), whereas no such IgM deposits were observed in patients with primary SS (3 of 3), nor in healthy controls (n = 20). We conclude that the frequency of anti-SS-A/Ro and anti-SS-B/La antibodies in serum is lower in PBC patients than in patients with primary SS. The incidence of focal sialadenitis is high in PBC, though only one third of the PBC patients studied here showed clinical evidence of glandular dysfunction. With immunochemical techniques, sialadenitis associated with PBC is distinguishable by its significant IgM reaction from sialadenitis in primary SS.
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Affiliation(s)
- B U Hansen
- Department of Medicine, University of Lund, Malmö General Hospital, Sweden
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Navér L, Bohlin AB, Albert J, Flamholc L, Gisslén M, Gyllensten K, Josephson F, Pehrson P, Sönnerborg A, Westling K, Lindgren S. Prophylaxis and treatment of HIV-1 infection in pregnancy: Swedish Recommendations 2007. ACTA ACUST UNITED AC 2008; 40:451-61. [PMID: 18584531 DOI: 10.1080/00365540801894787] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Prophylaxis and treatment with antiretroviral drugs, a consequent low viral load, and the use of elective Caesarean section, are factors that radically decrease the risk of HIV transmission from mother to child during pregnancy and delivery. The availability of new antiretroviral drugs, updated general treatment guidelines and increasing knowledge of the importance of drug resistance, have necessitated recurrent revisions of the recommendations for 'Prophylaxis and treatment of HIV-1 infection in pregnancy'. For these reasons, The Swedish Reference Group for Antiviral Therapy (RAV) has, at an expert meeting on May 4, 2007, once more updated the treatment recommendations of 1999, 2002 and 2005, which were defined in cooperation with the Swedish Medical Products Agency (Läkemedelsverket). This new text takes the recently updated general HIV treatment recommendations into account. Furthermore, the very low risk of HIV transmission when the mother is treated with combination antiretroviral therapy, has undetectable levels of viraemia and no obstetric risk factors, has been considered in the recommendations concerning the mode of delivery. Finally, the recommendations for monitoring of infants born to HIV-infected mothers have been modified. The recommendations are evidence graded in accordance with the Oxford Centre for Evidence Based Medicine, 2001 (see http://www.cebm.net/levels_of_evidence.asp#levels).
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Affiliation(s)
- Lars Navér
- Department of Paediatrics, Karolinska University Hospital, Stockholm, Sweden.
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Thylin I, Schuisky P, Lindgren S, Gottschal JC. Influence of pH and lactic acid concentration onClostridium tyrobutyricumduring continuous growth in a pH-auxostat. ACTA ACUST UNITED AC 2008. [DOI: 10.1111/j.1365-2672.1995.tb00952.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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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Lindgren S, Odenstedt H, Erlandsson K, Grivans C, Lundin S, Stenqvist O. Bronchoscopic suctioning may cause lung collapse: a lung model and clinical evaluation. Acta Anaesthesiol Scand 2008; 52:209-18. [PMID: 18005383 DOI: 10.1111/j.1399-6576.2007.01499.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To assess lung volume changes during and after bronchoscopic suctioning during volume or pressure-controlled ventilation (VCV or PCV). DESIGN Bench test and patient study. PARTICIPANTS Ventilator-treated acute lung injury (ALI) patients. SETTING University research laboratory and general adult intensive care unit of a university hospital. INTERVENTIONS Bronchoscopic suctioning with a 12 or 16 Fr bronchoscope during VCV or PCV. MEASUREMENTS AND RESULTS Suction flow at vacuum levels of -20 to -80 kPa was measured with a Timeter(trade mark) instrument. In a water-filled lung model, airway pressure, functional residual capacity (FRC) and tidal volume were measured during bronchoscopic suctioning. In 13 ICU patients, a 16 Fr bronchoscope was inserted into the left or the right main bronchus during VCV or PCV and suctioning was performed. Ventilation was monitored with electric impedance tomography (EIT) and FRC with a modified N(2) washout/in technique. Airway pressure was measured via a pressure line in the endotracheal tube. Suction flow through the 16 Fr bronchoscope was 5 l/min at a vacuum level of -20 kPa and 17 l/min at -80 kPa. Derecruitment was pronounced during suctioning and FRC decreased with -479+/-472 ml, P<0.001. CONCLUSIONS Suction flow through the bronchoscope at the vacuum levels commonly used is well above minute ventilation in most ALI patients. The ventilator was unable to deliver enough volume in either VCV or PCV to maintain FRC and tracheal pressure decreased below atmospheric pressure.
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Affiliation(s)
- S Lindgren
- Department of Anaesthesia and Intensive Care, Sahlgrenska University Hospital, SE-413 45, Gothenburg, Sweden.
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Cheng Y, Wu J, Hertervig E, Lindgren S, Duan D, Nilsson A, Duan RD. Identification of aberrant forms of alkaline sphingomyelinase (NPP7) associated with human liver tumorigenesis. Br J Cancer 2007; 97:1441-8. [PMID: 17923876 PMCID: PMC2360232 DOI: 10.1038/sj.bjc.6604013] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Alkaline sphingomyelinase (alk-SMase) is expressed in the intestine and human liver. It may inhibit colonic tumorigenesis, and loss of function mutations have been identified in human colon cancer. The present study investigates its expression in human liver cancer. In HepG2 liver cancer cells, RT–PCR identified three transcripts with 1.4, 1.2 and 0.4 kb, respectively. The 1.4 kb form is the wild-type cDNA with five translated exons, the 1.2 kb product lacks exon 4 and the 0.4 kb form is a combination of exons 1 and 5. Genomic sequence showed that these aberrant transcripts were products of alternative splicing. Transient expression of the 1.2 kb form showed no alk-SMase activity. In HepG2 cells, the alk-SMase activity is low in monolayer condition and increased with cell polarisation. Coexistence of 1.4 and 1.2 kb forms was also identified in one hepatoma biopsy. GenBank search identified a cDNA clone from human liver tumour, which codes a protein containing full length of alk-SMase plus a 73-amino-acid tag at the N terminus. The aberrant form was translated by an alternative starting codon upstream of the wild-type mRNA. Expression study showed that linking the tag markedly reduced the enzyme activity. We also analysed human liver biopsy samples and found relatively low alk-SMase activity in diseases with increased risk of liver tumorigenesis. In conclusion, expression of alk-SMase is changed in hepatic tumorigenesis, resulting in loss or marked reduction of the enzyme function.
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Affiliation(s)
- Y Cheng
- Gastroenterology Lab, Biomedical Centre, B11, Institute of Clinical Sciences, Lund University, Lund S-221 84, Sweden
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Wei G, Bergquist A, Broomé U, Lindgren S, Wallerstedt S, Almer S, Sangfelt P, Danielsson A, Sandberg-Gertzén H, Lööf L, Prytz H, Björnsson E. Acute liver failure in Sweden: etiology and outcome. J Intern Med 2007; 262:393-401. [PMID: 17697161 DOI: 10.1111/j.1365-2796.2007.01818.x] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.7] [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: 12/11/2022]
Abstract
OBJECTIVE To determine the causes and outcome of all patients with acute liver failure (ALF) in Sweden 1994-2003 and study the diagnostic accuracy of King's College Hospital (KCH) criteria and the model for end-stage liver disease (MELD) score with transplant-free deaths as a positive outcome. RESEARCH DESIGN AND METHODS Adult patients in Sweden with international normalized ratio (INR) of >or=1.5 due to severe liver injury with and without encephalopathy at admission between 1994-2003 were included. RESULTS A total of 279 patients were identified. The most common cause of ALF were acetaminophen toxicity in 42% and other drugs in 15%. In 31 cases (11%) no definite etiology could be established. The KCH criteria had a positive-predictive value (PPV) of 67%, negative-predictive value (NPV) of 84% in the acetaminophen group. Positive-predictive value and negative-predictive value of KCH criteria in the nonacetaminophen group were 54% and 63% respectively. MELD score>30 had a positive-predictive value of 21%, negative-predictive value of 94% in the acetaminophen group. The corresponding figures for the nonacetaminophen group were 64% and 76% respectively. CONCLUSIONS Acetaminophen toxicity was the most common cause in unselected patients with ALF in Sweden. KCH criteria had a high NPV in the acetaminophen group, and in combination with MELD score<30 predicts a good prognosis in acetaminophen patients without transplantation.
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Affiliation(s)
- G Wei
- Section of Gastroenterology and Hepatology, Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Ravesloot CH, Seekins T, Cahill T, Lindgren S, Nary DE, White G. Health promotion for people with disabilities: development and evaluation of the Living Well with a Disability program. Health Educ Res 2007; 22:522-31. [PMID: 17032708 DOI: 10.1093/her/cyl114] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
People with disabilities can benefit from health promotion opportunities to reduce the incidence and severity of secondary conditions that further limit their participation in society. This paper describes participatory action research (PAR) methods we used to develop, implement and evaluate the Living Well with a Disability program. Community-based agencies that provide information and referral services to people with disabilities (independent living centers funded under Title VII, Rehabilitation Act) recruited a convenience sample of 246 people with mobility impairments to participate in a randomly assigned, wait-list control health promotion intervention study. Paper-and-pencil outcome measures included the secondary conditions surveillance instrument, unhealthy days and health care utilization. Logistic regression on outcomes controlling for demographic variables and pre-test measures indicated reductions in all three outcome variables. People with mobility impairments who participated in the Living Well with a Disability program reported less limitation from secondary conditions, fewer unhealthy days and less health care utilization. PAR methods are particularly important to design useful interventions for this population.
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Affiliation(s)
- C H Ravesloot
- Rural Institute, University of Montana, Missoula, MT 59812, USA.
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Navér L, Lindgren S, Belfrage E, Gyllensten K, Lidman K, Gisslén M, Ehrnst A, Arneborn M, Bohlin AB. Children born to HIV-1-infected women in Sweden in 1982-2003: trends in epidemiology and vertical transmission. J Acquir Immune Defic Syndr 2006; 42:484-9. [PMID: 16810115 DOI: 10.1097/01.qai.0000224571.30119.3d] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
To describe the HIV-1 epidemic among childbearing women and their children in Sweden, a population-based analysis of data on all known mother-child pairs in Sweden with perinatal exposure to HIV-1 1982-2003 was conducted. The mother-to-child transmission (MTCT) rate in children prospectively followed from birth decreased from 24.7% in 1985-1993 to 5.7% in 1994-1998 and 0.6% in 1999-2003. The use of antiretroviral treatment of the mother during pregnancy and/or prophylactic antiretroviral intervention increased from 2.3% to 91.6% during the same period, and the elective cesarean delivery rate increased from 8.0% to 80.3%. No MTCT of HIV-1 occurred in Sweden after 1999.Fifty-one vertically HIV-1-infected children aged 2.7 to 17.6 years were living in Sweden by 31 December 2003, 71% being treated with antiretroviral agents. No HIV-1-related child death has been reported in Sweden after 1996. The conclusion is that MTCT of HIV-1 can be almost eliminated when appropriate resources are available. A national pregnancy screening program for HIV-1 running since 1987 with a high acceptance rate and the implementation of measures to prevent MTCT since 1994 have resulted in a significant decrease in the number of infected children. Inasmuch as knowledge of the infection status of the mother is crucial for reduction in MTCT of HIV-1, continued antenatal screening is important even in a low-prevalence country such as Sweden.
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Affiliation(s)
- Lars Navér
- Department for Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska University Hospital Huddinge, Sweden.
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Marteau P, Probert CS, Lindgren S, Gassul M, Tan TG, Dignass A, Befrits R, Midhagen G, Rademaker J, Foldager M. Combined oral and enema treatment with Pentasa (mesalazine) is superior to oral therapy alone in patients with extensive mild/moderate active ulcerative colitis: a randomised, double blind, placebo controlled study. Gut 2005; 54:960-5. [PMID: 15951542 PMCID: PMC1774619 DOI: 10.1136/gut.2004.060103] [Citation(s) in RCA: 217] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Oral aminosalicylates are well established in the treatment of active mild/moderate ulcerative colitis (UC) when the disease is extensive (that is, beyond the splenic flexure). The majority of clinical symptoms relate to disease activity in the distal part of the colon and therefore this study was designed to investigate if adding a mesalazine enema to oral mesalazine has additional benefit for patients with extensive mild/moderate active UC. METHODS A randomised double blind study was performed in 127 ambulatory patients. All received 4 g/day (twice daily dosing) oral mesalazine for eight weeks. During the initial four weeks, they additionally received an enema at bedtime containing 1 g of mesalazine or placebo. Disease activity was assessed using the ulcerative colitis disease activity index, with clinical and endoscopic signs at four and eight weeks. RESULTS Remission was obtained in 44% (95% confidence interval (CI) 31%, 58%) of the mesalazine enema group (Me) and in 34% (95% CI 21%, 49%) of the placebo enema group (Pl) at four weeks (p = 0.31) and in 64% (95% CI 50%, 76%) of the Me group versus 43% (95% CI 28%, 58%) of the Pl group at eight weeks (p = 0.03). Improvement was obtained in 89% (95% CI 78%, 96%) of the Me group versus 62% (95% CI 46%, 75%) of the Pl group at four weeks (p = 0.0008) and in 86% (95% CI 75%, 94%) of the Me group versus 68% (95% CI 53%, 81%) of the Pl group at eight weeks (p = 0.026). CONCLUSION In patients with extensive mild/moderate active UC, the combination therapy is superior to oral therapy. It is safe, well accepted, and may be regarded as firstline treatment.
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Affiliation(s)
- P Marteau
- Gastroenterology, Hopital Européen Georges Pompidou, 20 rue Leblanc, 75908 Paris cedex 15, France.
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Clevestig P, Maljkovic I, Casper C, Carlenor E, Lindgren S, Navér L, Bohlin AB, Fenyö EM, Leitner T, Ehrnst A. The X4 phenotype of HIV type 1 evolves from R5 in two children of mothers, carrying X4, and is not linked to transmission. AIDS Res Hum Retroviruses 2005; 21:371-8. [PMID: 15929699 DOI: 10.1089/aid.2005.21.371] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Previously, we found that emergence of the X4 viral phenotype in HIV-1-infected children was related to the presence of X4 in their mothers (C.H. Casper et al., J Infect Dis 2002; 186:914-921). Here, we investigated the origin of the X4 phenotype in the child, analyzing two mother-child pairs (Ma-Ca, Mb-Cb) where the mothers carried X4 and their children developed X4 after an initial presence of R5. We used nested polymerase chain reaction of the env V3 region to generate 203 HIV-1 clones for sequencing (Ma, n = 44; Ca, n = 73; Mb, n = 61; Cb, n = 25) from DNA of peripheral blood mononuclear cell (PBMC) lysates, altogether 167 clones, or from cDNA of plasma RNA, 36 clones. PBMC and plasma isolate sequences from each time point enabled us to assign the probable phenotype to clone sequences in a phylogenetic tree. The transmission and evolution were reconstructed using the maximum likelihood method. In mother-child pair Ma-Ca, one maternal R5 isolate clustered with the child's R5 sequences, at the earliest time when R5 was isolated in the child, confirming this as a likely source of the transmitted R5 phenotype. At age 3, an X4 population was present in the child that had evolved from the child's own R5-associated population, clearly distinct from the maternal X4 sequences. The second mother-child pair (Mb-Cb) displayed a similar pattern. Amino acid substitution patterns corroborated the conclusions from the phylogenetic tree. Thus, in both children, the X4 virus developed from their own R5 population, and was not caused by transmission of X4.
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MESH Headings
- Amino Acid Sequence
- Child
- Child, Preschool
- Evolution, Molecular
- Female
- HIV Envelope Protein gp120/chemistry
- HIV Envelope Protein gp120/genetics
- HIV Infections/transmission
- HIV Infections/virology
- HIV-1/genetics
- HIV-1/metabolism
- Humans
- Infant
- Infant, Newborn
- Infectious Disease Transmission, Vertical
- Leukocytes, Mononuclear/virology
- Molecular Sequence Data
- Peptide Fragments/chemistry
- Peptide Fragments/genetics
- Phenotype
- Phylogeny
- Pregnancy
- Pregnancy Complications, Infectious/virology
- Receptors, CCR5/genetics
- Receptors, CCR5/metabolism
- Receptors, CXCR4/genetics
- Receptors, CXCR4/metabolism
- Sequence Alignment
- Sequence Analysis, DNA
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Affiliation(s)
- P Clevestig
- Microbiology and Tumor Biology Center, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
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Hytönen AM, Löwhagen O, Arvidsson M, Balder B, Björk AL, Lindgren S, Hahn-Zoric M, Hanson LA, Padyukov L. Haplotypes of the interleukin-4 receptor alpha chain gene associate with susceptibility to and severity of atopic asthma. Clin Exp Allergy 2005; 34:1570-5. [PMID: 15479272 DOI: 10.1111/j.1365-2222.2004.02069.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Development of asthma is likely to depend on a complex interaction between environmental and genetic factors. Several groups have suggested the gene of the IL-4 receptor alpha chain (IL4R) as a candidate gene for the development of asthma, although association with single polymorphisms has shown contradicting results. OBJECTIVE We chose to analyse IL4R gene haplotypes and assess their possible relevance in susceptibility to asthma and to certain clinical phenotypes. METHODS IL4R gene haplotypes were analysed, based on the three markers C-3223T, Q551R and I50V, using the expectation-maximization algorithm, in 170 atopic asthma patients and 350 controls, all adult Swedish Caucasians. RESULTS Our data showed significantly higher levels of soluble IL-4R (sIL-4R) in asthma patients compared with controls (P<0.0001). Furthermore, we showed a significant association between the IL4R haplotype containing the alleles T-3223, V50 and R551 (TVR) of the IL4R gene, and susceptibility to atopic asthma, with a frequency of 6.5% in the patients compared with 1% in the controls (P<0.0005). A subgroup of patients with heterozygous or homozygous state for the T-3223, V50 and R551 alleles, also had lower levels of sIL-4R in their circulation compared with patients with homozygous state in the C-3223, I50 and Q551 alleles (P<0.05) and showed less severe asthma according to lung function test (P<0.05). Analysis of single markers showed the T-3223 IL4R allele to associate with lower serum levels of sIL-4 receptor (P<0.0001) and patients carrying the T allele also had more symptoms of active asthma (wheezing, P<0.01; coughing, P<0.05 and breathing difficulties, P<0.01). CONCLUSION Our data suggest that asthmatic patients with low levels of sIL-4 receptor may represent a genetically distinct subgroup of atopic asthma. TVR haplotype analyses confirm the importance of IL4R as a candidate gene for susceptibility to asthma. This finding may have implications for the understanding of the pathogenesis of asthma and possibly for the development of more specific therapies.
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Affiliation(s)
- A-M Hytönen
- Department of Clinical Immunology, Sahlgrenska University Hospital, University of Göteborg, Göteborg, Sweden.
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