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  • 301. Papp, K.
    et al.
    Poulin, Y.
    Barber, K.
    Lynde, C.
    Prinz, J. C.
    Berg, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Dermatology and Venereology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Kerrouche, N.
    Rives, V. P.
    Cost-effectiveness evaluation of clobetasol propionate shampoo (CPS) maintenance in patients with moderate scalp psoriasis: A Pan-European analysis2012In: Journal of the European Academy of Dermatology and Venereology, ISSN 0926-9959, E-ISSN 1468-3083, Vol. 26, no 11, p. 1407-1414Article in journal (Refereed)
    Abstract [en]

    Background Scalp psoriasis is a difficult to treat and usually chronic manifestation of psoriasis. The CalePso study showed that CPS (Clobex ® Shampoo) in maintenance therapy of scalp psoriasis (twice weekly) significantly increases the probability of keeping patient under remission during 6 months, compared with vehicle (40.3% relapses vs. 11.6% relapses, ITT). Objective The objective of the study was to assess the cost-effectiveness of a maintenance therapy with CPS vs. its vehicle in nine European countries. Methods A 24-week decision tree model was developed with 4-weekly time steps. The considered population has moderate scalp psoriasis successfully treated with a daily application of CPS up to 4 weeks. Data were taken from the CalePso study and from national experts' recommendations for alternative treatment choices, with their probabilities of success taken from literature to develop country-specific models. Health benefits are measured in disease-free days (DFD). The economic analysis includes drug and physician costs. A probabilistic sensitivity analysis (PrSA) assesses the uncertainty of the model. Results Depending on the country, the mean total number of DFDs per patient is 21-42% higher with CPS compared with vehicle, and the mean total cost is 11-31% lower. The mean costs per DFD are 30-46% lower with CPS compared with the vehicle. The PrSA showed in 1000 simulations that CPS is more effective vs. vehicle in 100% of the cases and less expensive than its vehicle in 80-99% of the cases. Conclusion This model suggests that CPS is cost-effective in maintaining the success achieved in moderate scalp psoriasis patients.

  • 302.
    Pathak, Ashish
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Mårtensson, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Gawariker, Sudhir
    Department of Medicine, R D Gardi Medical College, Surasa, Ujjain, India.
    Mandliya, Jagdish
    Department of Pediatrics, R D Gardi Medical College, Surasa, Ujjain, India.
    Sharma, Ashish
    Department of Medicine, R D Gardi Medical College, Surasa, Ujjain, India.
    Diwan, Vishal
    Department of Public Health Sciences (Global Health/IHCAR), Karolinska Institutet, Stockholm, Sweden.
    Ursing, Johan
    Malaria Research, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Characterization of drug resistance associated genetic polymorphisms among Plasmodium falciparum field isolates in Ujjain, Madhya Pradesh, India.2014In: Malaria Journal, ISSN 1475-2875, E-ISSN 1475-2875, Vol. 13, p. 182-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Since 2011, artesunate + sulphadoxine-pyrimethamine (ASP), instead of chloroquine, has been recommended for treatment of uncomplicated malaria in India. In Ujjain, central India, with an annual parasite index <0.1, the prevalence of drug-resistant Plasmodium falciparum is unknown. In other parts of India chloroquine and sulphadoxine-pyrimethamine-resistant P. falciparum is prevalent. The aim of this study was to determine the prevalence of anti-malarial drug resistance-associated genetic polymorphisms in P. falciparum collected in Ujjain in 2009 and 2010, prior to the introduction of ASP.

    METHODS: Blood samples from 87 patients with P. falciparum mono-infection verified by microscopy were collected on filter-paper at all nine major pathology laboratories in Ujjain city. Codons Pfcrt 72-76, pfmdr1 1034-1246, pfdhfr 16-185, pfdhps 436-632 and pfnhe1 ms4760 haplotypes were identified by sequencing. Pfcrt K76T and pfmdr1 N86Y were identified by restriction fragment length polymorphism, and pfmdr1 gene copy number by real-time PCR.

    RESULTS: Sulphadoxine-pyrimethamine resistance-associated pfdhfr 108 N and 59R alleles were found in 75/78 (96%) and 70/78 (90%) samples, respectively, and pfdhps 437G was found in 7/77 (9%) samples. Double mutant pfdhfr 59R + 108 N were found in 62/76 (82%) samples. Triple mutant pfdhfr 59R + 108 N and pfdhps 437G were found in 6/76 (8%) samples. Chloroquine-resistance-associated pfcrt 76 T was found in 82/87 (94%). The pfcrt 72-76 haplotypes found were: 80/84 (95%) SVMNT, 3/84 (4%) CVMNK and 1/84 (1%) CVMNT. Pfmdr1 N86 and 86Y were identified in 70/83 (84%) and 13/83 (16%) samples, respectively. Pfmdr1 S1034 + N1042 + D1246 were identified together in 70/72 (97%) of successfully sequenced samples. One pfmdr1 gene copy was found in 74/75 (99%) successfully amplified samples.

    CONCLUSION: This is the first characterization of key anti-malarial drug resistance-associated genetic markers among P. falciparum collected in Ujjain, Madhya Pradesh, India. The results indicate that the efficacy of standard dose chloroquine at the time of the study was likely to be poor, whereas ASP was likely to be efficacious, supporting the changed drug treatment policy. However, P. falciparum with reduced susceptibility to sulphadoxine-pyrimethamine is highly prevalent, highlighting the need for continuous surveillance of ASP efficacy in the study area.

  • 303.
    Peolsson, Anneli
    et al.
    Linkoping Univ, Dept Med & Hlth Sci, Physiotherapy, Linkoping, Sweden;Linkoping Univ, Ctr Med Image Sci & Visualizat CMIV, Linkoping, Sweden.
    Karlsson, Anette
    Linkoping Univ, Ctr Med Image Sci & Visualizat CMIV, Linkoping, Sweden;Linkoping Univ, Dept Biomed Engn, Linkoping, Sweden.
    Ghafouri, Bijar
    Linkoping Univ, Pain & Rehabil Ctr, Linkoping, Sweden;Linkoping Univ, Dept Med & Hlth Sci, Rehabil Med, Linkoping, Sweden.
    Ebbers, Tino
    Linkoping Univ, Ctr Med Image Sci & Visualizat CMIV, Linkoping, Sweden;Linkoping Univ, Div Cardiovasc Med, Dept Med & Hlth Sci, Linkoping, Sweden.
    Engstrom, Maria
    Linkoping Univ, Ctr Med Image Sci & Visualizat CMIV, Linkoping, Sweden;Linkoping Univ, Dept Med & Hlth Sci, Radiol Sci, Linkoping, Sweden.
    Jonsson, Margaretha
    Linkoping Univ, Dept Med & Hlth Sci, Physiotherapy, Linkoping, Sweden;Herrgardets Vardcentral, Vasteras, Region Vastmanl, Sweden.
    Wahlen, Karin
    Linkoping Univ, Pain & Rehabil Ctr, Linkoping, Sweden;Linkoping Univ, Dept Med & Hlth Sci, Rehabil Med, Linkoping, Sweden.
    Romu, Thobias
    Linkoping Univ, Ctr Med Image Sci & Visualizat CMIV, Linkoping, Sweden;Linkoping Univ, Dept Biomed Engn, Linkoping, Sweden.
    Borga, Magnus
    Linkoping Univ, Ctr Med Image Sci & Visualizat CMIV, Linkoping, Sweden;Linkoping Univ, Dept Biomed Engn, Linkoping, Sweden.
    Kristjansson, Eythor
    Univ Iceland, Landspitali Univ Hosp, Reykjavik, Iceland.
    Bahat, Hilla Sarig
    Univ Haifa, Dept Phys Therapy, Haifa, Israel.
    German, Dmitry
    Univ Haifa, Dept Phys Therapy, Haifa, Israel.
    Zsigmond, Peter
    Linkoping Univ, Dept Neurosurg & Clin & Expt Med, Linkoping, Sweden.
    Peterson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Dept Med & Hlth Sci, Physiotherapy, Linkoping, Sweden.
    Pathophysiology behind prolonged whiplash associated disorders: study protocol for an experimental study2019In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 20, article id 51Article in journal (Refereed)
    Abstract [en]

    BackgroundThere is insufficient knowledge of pathophysiological parameters to understand the mechanism behind prolonged whiplash associated disorders (WAD), and it is not known whether or not changes can be restored by rehabilitation. The aims of the projects are to investigate imaging and molecular biomarkers, cervical kinaesthesia, postural sway and the association with pain, disability and other outcomes in individuals with longstanding WAD, before and after a neck-specific exercise intervention. Another aim is to compare individuals with WAD with healthy controls.MethodsParticipants are a sub-group (n=30) of individuals recruited from an ongoing randomized controlled study (RCT). Measurements in this experimental prospective study will be carried out at baseline (before intervention) and at a three month follow-up (end of physiotherapy intervention), and will include muscle structure and inflammation using magnetic resonance imaging (MRI), brain structure and function related to pain using functional MRI (fMRI), muscle function using ultrasonography, biomarkers using samples of blood and saliva, cervical kinaesthesia using the butterfly test and static balance test using an iPhone app. Association with other measures (self-reported and clinical measures) obtained in the RCT (e.g. background data, pain, disability, satisfaction with care, work ability, quality of life) may be investigated. Healthy volunteers matched for age and gender will be recruited as controls (n=30).DiscussionThe study results may contribute to the development of improved diagnostics and improved rehabilitation methods for WAD.Trial registrationClinicaltrial.gov Protocol ID: NCT03664934, initial release 09/11/2018.

  • 304.
    Peolsson, Anneli
    et al.
    Linköping University, Physiotherapy, Department of Medical and Health Sciences.
    Landén Ludvigsson, Maria
    Linköping University, Physiotherapy, Department of Medical and Health Sciences; Linköping University, ehab Väst, County Council of Östergötland, Department of Rehabilitation and Department of Medical and Health Sciences .
    Peterson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linköping University, Physiotherapy, Department of Medical and Health Sciences.
    Neck-specific exercises with internet-based support compared to neck-specific exercises at a physiotherapy clinic for chronic whiplash-associated disorders: study protocol of a randomized controlled multicentre trial.2017In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 18, article id 524Article in journal (Refereed)
    Abstract [en]

    Background:Globally, neck pain is the fourth most common condition associated with longer periods of living withdisability. Annually, approximately 0.3% of the population of Western countries undergo whiplash trauma, and half ofthose individuals will develop chronic problems with highcosts for the individual and society. Evidence for chronicwhiplash-associated disorders (WAD) treatment is scarce, though neck-specific training at a physiotherapy clinic twice aweek for 12 weeks has demonstrated good results. More efficient, flexible rehabilitation with reduced waiting times andlower costs is needed, ideally replacing lengthy on-site treatment series by healthcare providers. Internet-based care hasbeen shown to be a viable alternative for a variety of diseases and interventions, but studies are lacking on Internet-basedinterventions for individuals with chronic neck problems. The aim of the trial described here is to compare the effects ofan Internet-based neck-specific exerciseprogrammetothesameexercisesperformed at a physiotherapy clinic in regardsto self-reported and clinical measures, as well as cost-effectiveness.

    Methods:This prospective, randomized controlled trial will involve 140 participants. Measurements will be made atbaseline, 3 months (end of treatment), and 15 months (12 months after end of intervention) and will include ratings ofpain, disability, satisfaction with care, work ability, quality of life, and cost-effectiveness.

    Discussion:The study results may contribute to the development of a more effective rehabilitation, flexible and equalcare, shorter waiting times, increased availability, and lower costs for healthcare and society.

    Trial registration:ClinicalTrials.gov Protocol ID: NCT03022812, initial release 12/20/2016.

  • 305. Peolsson, Anneli
    et al.
    Ludvigsson, Maria Landen
    Overmeer, Thomas
    Dedering, Asa
    Bernfort, Lars
    Johansson, Gun
    Kammerlind, Ann-Sofi
    Peterson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Effects of neck-specific exercise with or without a behavioural approach in addition to prescribed physical activity for individuals with chronic whiplash-associated disorders: a prospective randomised study2013In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 14, p. 311-Article in journal (Refereed)
    Abstract [en]

    Background: Up to 50% of chronic whiplash associated disorders (WAD) patients experience considerable pain and disability and remain on sick-leave. No evidence supports the use of physiotherapy treatment of chronic WAD, although exercise is recommended. Previous randomised controlled studies did not evaluate the value of adding a behavioural therapy intervention to neck-specific exercises, nor did they compare these treatments to prescription of general physical activity. Few exercise studies focus on patients with chronic WAD, and few have looked at patients' ability to return to work and the cost-effectiveness of treatments. Thus, there is a great need to develop successful evidence-based rehabilitation models. The study aim is to investigate whether neck-specific exercise with or without a behavioural approach (facilitated by a single caregiver per patient) improves functioning compared to prescription of general physical activity for individuals with chronic WAD. Methods/Design: The study is a prospective, randomised, controlled, multi-centre study with a 2-year follow-up that includes 216 patients with chronic WAD (>6 months and <3 years). The patients (aged 18 to 63) must be classified as WAD grade 2 or 3. Eligibility will be determined with a questionnaire, telephone interview and clinical examination. The participants will be randomised into one of three treatments: (A) neck-specific exercise followed by prescription of physical activity; (B) neck-specific exercise with a behavioural approach followed by prescription of physical activity; or (C) prescription of physical activity alone without neck-specific exercises. Treatments will be performed for 3 months. We will examine physical and psychological function, pain intensity, health care consumption, the ability to resume work and economic health benefits. An independent, blinded investigator will perform the measurements at baseline and 3, 6, 12 and 24 months after inclusion. The main study outcome will be improvement in neck-specific disability as measured with the Neck Disability Index. All treatments will be recorded in treatment diaries and medical records. Discussion: The study findings will help improve the treatment of patients with chronic WAD.

  • 306. Peolsson, Anneli
    et al.
    Ludvigsson, Maria Landen
    Wibault, Johanna
    Dedering, Asa
    Peterson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Function in Patients With Cervical Radiculopathy or Chronic Whiplash-Associated Disorders Compared With Healthy Volunteers2014In: Journal of Manipulative and Physiological Therapeutics, ISSN 0161-4754, E-ISSN 1532-6586, Vol. 37, no 4, p. 211-218Article in journal (Refereed)
    Abstract [en]

    Objective: The purposes of this study were to examine whether any differences in function and health exist between patients with cervical radiculopathy (CR) due to disk disease scheduled for surgery and patients with chronic whiplash-associated disorders (WADs) and to compare measures of patients' physical function with those obtained from healthy volunteers. Methods: This is a cross-sectional study of patients with CR (n = 198) and patients with chronic WAD (n = 215). Patient data were compared with raw data previously obtained from healthy people. Physical measures included cervical active range of motion, neck muscle endurance, and hand grip strength. Self-rated measures included pain intensity (visual analog scale), neck disability (Neck Disability Index), self-efficacy (Self-Efficacy Scale), and health-related quality of life (EuroQol 5-dimensional self-classifier). Results: Patient groups exhibited significantly lower performance than the healthy group in all physical measures (P < .0005) except for neck muscle endurance in flexion for women (P > .09). There was a general trend toward worse results in the CR group than the WAD group, with significant differences in neck active range of motion, left hand strength for women, pain intensity, Neck Disability Index, EuroQol 5-dimensional self-classifier, and Self-Efficacy Scale (P < .0001). Conclusions: Patients had worse values than healthy individuals in almost all physical measures. There was a trend toward worse results for CR than WAD patients.

  • 307.
    Peolsson, Anneli
    et al.
    Linkoping Univ, Div Physiotherapy, Dept Med & Hlth Sci, SE-58183 Linkoping, Sweden..
    Ludvigsson, Maria Landén
    Linkoping Univ, Div Physiotherapy, Dept Med & Hlth Sci, SE-58183 Linkoping, Sweden.;Cty Council Ostergotland, Rehab Vast, Motala, Sweden..
    Tigerfors, Ann-Marie
    Previa Occupat Hlth Care AB, Gavle, Sweden..
    Peterson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Div Physiotherapy, Dept Med & Hlth Sci, SE-58183 Linkoping, Sweden..
    Effects of Neck-Specific Exercises Compared to Waiting List for Individuals With Chronic Whiplash-Associated Disorders: A Prospective, Randomized Controlled Study2016In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 97, no 2, p. 189-195Article in journal (Refereed)
    Abstract [en]

    Objective: To determine whether 3 months of neck-specific exercises (NSEs) could benefit individuals with chronic whiplash-associated disorder (WAD) who were on a waiting list (WL) for treatment. Design: A prospective, randomized controlled study. Setting: Primary health care. Participants: Individuals (N=41; 31 women, 10 men; mean age +/- SD, 38 +/- 11.2y) with chronic (6-36mo) WAD, grades 2 and 3, were analyzed. Interventions: Patients were randomly assigned to NSEs or no treatment for 3 months. Main Outcome Measures: Neck-specific disability (Neck Disability Index [NDI]), neck pain (visual analog scale), general pain-related disability (Pain Disability Index [PDI]), self-perceived performance ability (Self-Efficacy Scale [SES]), and health-related quality of life (EuroQol 5 dimensions [EQ-5D]) were measured. Results: NSEs significantly improved the NDI, SES, and EQ-5D compared with WL (P<.01). There was significant improvement (P<.0001) over time in all outcomes for NSEs, and apart from the PDI, significant worsening (P=.002-.0002) over time for the untreated group. Conclusions: NSEs were more beneficial than no intervention while on a WL for individuals with chronic WAD.

  • 308.
    Peolsson, Anneli
    et al.
    Linkoping Univ, Dept Med & Hlth Sci, Physiotherapy, Linkoping, Sweden.
    Peterson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Dept Med & Hlth Sci, Physiotherapy, Linkoping, Sweden.
    Hermansen, Anna
    Linkoping Univ, Dept Med & Hlth Sci, Physiotherapy, Linkoping, Sweden.
    Ludvigsson, Maria Landen
    Linkoping Univ, Dept Med & Hlth Sci, Physiotherapy, Linkoping, Sweden;Reg Council Ostergotland, Rehab Vast, Dept Rehabil, Linkoping, Sweden;Reg Council Ostergotland, Rehab Vast, Dept Med & Hlth Sci, Linkoping, Sweden.
    Dedering, Åsa
    Univ Hosp, Allied Hlth Profess Funct Occupat Therapy & Physi, Stockholm, Sweden;Karolinska Inst, Div Physiotherapy, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.
    Löfgren, Hakan
    Ryhov Hosp, Neuroorthoped Ctr, Jonkoping, Sweden.
    Physiotherapy after anterior cervical spine surgery for cervical disc disease: study protocol of a prospective randomised study to compare internet-based neck-specific exercise with prescribed physical activity2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 2, article id e027387Article in journal (Refereed)
    Abstract [en]

    Introduction Patients suffering from remaining disability after anterior cervical decompression and fusion (ACDF) surgery for cervical disc disease may be prescribed physical activity (PPA) or neck-specific exercises (NSEs). Currently, we lack data for the success of either approach. There is also a knowledge gap concerning the use of internet-based care for cervical disc disease. The scarcity of these data, and the high proportion of patients with various degrees of incapacity following ACDF, warrant increased efforts to investigate and improve cost-effective rehabilitation. The objective is to compare the effectiveness of a structured, internet-based NSE programme, versus PPA following ACDF surgery. Methods and analysis This is a prospective, randomised, multicentre study that includes 140 patients with remaining disability (>= 30% on the Neck Disability Index, NDI) following ACDF for radiculopathy due to cervical disc disease. Patient recruitment occurs following attendance at routine clinical appointments, scheduled at 3 months postsurgery. Patients are then randomised to one of two groups (70 patients/group) for a 3-month treatment programme/period of either internet-based NSE or PPA. Questionnaires on background data, pain and discomfort, physical and mental capacity, satisfaction with care, and health and workplace factors are completed, along with physical measures of neck-related function conducted by independent test leaders blinded to randomisation. Measures are collected at inclusion, after the 3-month treatments (end of treatment) and at a 2-year follow-up. Radiography will be completed at the 2-year follow-up. Preoperative data will be collected from the Swedish Spine Registry. Data on healthcare consumption, drug use and sick leave will be requested from the relevant national registers. Ethical considerations This study was approved by the Regional Ethical Review Board in Linkoping Ref. 2016/283-31 and 2017/91-32. The scientists are independent with no commercial ties. Patients are recruited after providing written informed consent. Patient data are presented at group level such that no connection to any individual can be made. All data are anonymised when reported, and subject to the Swedish Official Secrets Health Acts. The test leaders are independent and blinded for randomisation. Exercises, both general and neck-specific, have been used extensively in clinical practice and we anticipate no harm from their implementation other than a risk of muscle soreness. Both randomisation groups will receive care that is expected to relieve pain, although the group receiving NSE is expected to demonstrate a greater and more cost-effective improvement versu s the PPA group. Any significant harm or unintended effects in each group will be collected by the test leaders. All questionnaires and test materials are coded by the research group, with code lists stored in locked, fireproof file cabinets, housed at the university in a room with controlled (card-based) access. Only individuals in receipt of a unique website address posted by the researchers can access the programme; patients can neither communicate with each other nor with caregivers via the programme. Study participation might lead to improved rehabilitation versus non-participation, and might therefore be of benefit. The results of this study should also contribute to more effective and flexible rehabilitation, shorter waiting times, lower costs and the possibility to implement our findings on a wider level. Dissemination If effective, the protocols used in this study can be implemented in existing healthcare structures. The results of the study will be presented in scientific journals and popular science magazines of relevance to health. The findings will also be presented at local, regional, national and international conferences and meetings, as well as in the education of university students and at public lectures. Information about the results will be communicated to the general population in cooperation with patient organisations and the media.

  • 309.
    Peolsson, Anneli
    et al.
    Linkoping Univ, Div Physiotherapy, Dept Med & Hlth Sci, S-58183 Linkoping, Sweden..
    Peterson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Div Physiotherapy, Dept Med & Hlth Sci, S-58183 Linkoping, Sweden.
    Trygg, Johan
    Umea Univ, Computat Life Sci Cluster CLiC, Dept Chem, S-90187 Umea, Sweden..
    Nilsson, David
    Umea Univ, Computat Life Sci Cluster CLiC, Dept Chem, S-90187 Umea, Sweden..
    Multivariate analysis of ultrasound-recorded dorsal strain sequences: Investigation of dynamic neck extensions in women with chronic whiplash associated disorders2016In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 6, article id 30415Article in journal (Refereed)
    Abstract [en]

    Whiplash Associated Disorders (WAD) refers to the multifaceted and chronic burden that is common after a whiplash injury. Tools to assist in the diagnosis of WAD and an increased understanding of neck muscle behaviour are needed. We examined the multilayer dorsal neck muscle behaviour in nine women with chronic WAD versus healthy controls during the entire sequence of a dynamic low-loaded neck extension exercise, which was recorded using real-time ultrasound movies with high frame rates. Principal component analysis and orthogonal partial least squares were used to analyse mechanical muscle strain (deformation in elongation and shortening). The WAD group showed more shortening during the neck extension phase in the trapezius muscle and during both the neck extension and the return to neutral phase in the multifidus muscle. For the first time, a novel non-invasive method is presented that is capable of detecting altered dorsal muscle strain in women with WAD during an entire exercise sequence. This method may be a breakthrough for the future diagnosis and treatment of WAD.

  • 310. Petersen, Eskild
    et al.
    Rombo, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Tools for travellers' diarrhoea: bring back the vaccine?2014In: Travel Medicine and Infectious Disease, ISSN 1477-8939, E-ISSN 1873-0442, Vol. 12, no 4, p. 305-306Article in journal (Refereed)
  • 311.
    Peterson, Gunnel
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Dedering, Asa
    Andersson, Erika
    Nilsson, David
    Trygg, Johan
    Peolsson, Michael
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Peolsson, Anneli
    Altered ventral neck muscle deformation for individuals with whiplash associated disorder compared to healthy controls: A case-control ultrasound study2015In: Manual Therapy, ISSN 1356-689X, E-ISSN 1532-2769, Vol. 20, no 2, p. 319-327Article in journal (Refereed)
    Abstract [en]

    Previous studies have shown altered neck muscle function in individuals with chronic whiplash associated disorder (WAD). However, we lack real-time investigations with non-invasive methods that can distinguish between the different ventral neck muscle layers. This study investigated deformations and deformation rates in the sternocleidomastoid (SCM), longus capitis (Lcap), and longus colli (Lco) muscles with real-time ultrasonography. Twenty-six individuals with WAD were compared with 26 controls, matched for age and sex. Ultrasound imaging of the SCM, Lcap, and Lco were recorded during 10 repetitive arm elevations. The first and tenth arm elevations were post-process analyzed with speckle tracking. There were few significant differences in the deformations or deformation rates in the SCM, Lcap, and Lco between the WAD and control group. In controls, deformations and deformation rates showed linear positive relationships between SCM/Lcap, SCM/Lco, and Lcap/Lco which increased from the first arm elevation (R(2) = 0.14-0.70); to the tenth arm elevation (R(2) = 0.51-0.71). The WAD group showed similar or weaker linear relationship (R(2) < 0.19) during the tenth compared to the first (R(2) < 0.44) arm elevation except for deformations in Lcap/Lco (R(2) = 0.13-0.57). This result indicated that deformations and deformation rates in one muscle were correlated by similar deformations and deformation rates in other neck muscles in the control group, but this interplay between muscles was not found in the WAD group.

  • 312.
    Peterson, Gunnel E.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala Univ, Ctr Clin Res Sormland, Eskilstuna, Sweden.;Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, Fac Hlth Sci, Linkoping, Sweden..
    Ludvigsson, Maria H. Landen
    Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, Fac Hlth Sci, Linkoping, Sweden.;Cty Council Ostergotland, Rehab Vast, Ostergotland, Sweden..
    O'Leary, Shaun P.
    Univ Queensland, NHMRC CCRE Spinal Pain Injury & Hlth, Brisbane, Qld, Australia.;Queensland Hlth, Physiotherapy Dept, Royal Brisbane & Womens Hosp, Brisbane, Qld, Australia..
    Dedering, Asa M.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Physiotherapy, S-10401 Stockholm, Sweden.;Karolinska Univ Hosp, Dept Phys Therapy, Stockholm, Sweden..
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala Univ, Ctr Clin Res Sormland, Eskilstuna, Sweden.;Uppsala Univ, Publ Hlth & Caring Sci, Family Med & Prevent Med Sect, Uppsala, Sweden..
    Jonsson, Margaretha I. N.
    Cty Council Vastmanland, Prima Rehab, Herrgardet Hlth Care Ctr, Vastmanland, Sweden..
    Peolsson, Anneli L. C.
    Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, Fac Hlth Sci, Linkoping, Sweden.;Univ Queensland, NHMRC CCRE Spinal Pain Injury & Hlth, Brisbane, Qld, Australia..
    THE EFFECT OF 3 DIFFERENT EXERCISE APPROACHES ON NECK MUSCLE ENDURANCE, KINESIOPHOBIA, EXERCISE COMPLIANCE, AND PATIENT SATISFACTION IN CHRONIC WHIPLASH2015In: Journal of Manipulative and Physiological Therapeutics, ISSN 0161-4754, E-ISSN 1532-6586, Vol. 38, no 7, p. 465-476Article in journal (Refereed)
    Abstract [en]

    Objective: The purpose of this study was to compare the effects of 3 different exercise approaches on neck muscle endurance (NME), kinesiophobia, exercise compliance, and patient satisfaction in patients with chronic whiplash. Methods: This prospective randomized clinical trial included 216 individuals with chronic whiplash. Participants were randomized to 1 of 3 exercise interventions: neck-specific exercise (NSE), NSE combined with a behavioral approach (NSEB), or prescribed physical activity (PPA). Measures of ventral and dorsal NME (endurance time in seconds), perceived pain after NME testing, kinesiophobia, exercise compliance, and patient satisfaction were recorded at baseline and at the 3- and 6-month follow-ups. Results: Compared with individuals in the prescribed physical activity group, participants in the NSE and NSEB groups exhibited greater gains in dorsal NME (P = .003), greater reductions in pain after NME testing (P = .03), and more satisfaction with treatment (P < .001). Kinesiophobia and exercise compliance did not significantly differ between groups (P > .07). Conclusion: Among patients with chronic whiplash, a neck-specific exercise intervention (with or without a behavioral approach) appears to improve NME. Participants were more satisfied with intervention including neck-specific exercises than with the prescription of general exercise.

  • 313.
    Peterson, Gunnel
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, SE-58183 Linkoping, Sweden.
    Nilsson, David
    Umea Univ, Dept Chem, Computat Life Sci Cluster CLiC, S-90187 Umea, Sweden.
    Peterson, Simon
    Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, SE-58183 Linkoping, Sweden.
    Dedering, Åsa
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Physiotherapy, Stockholm, Sweden.; Karolinska Univ Hosp, Dept Phys Therapy, Solna, Sweden.
    Trygg, Johan
    Umea Univ, Dept Chem, Computat Life Sci Cluster CLiC, S-90187 Umea, Sweden.
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Peolsson, Anneli
    Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, SE-58183 Linkoping, Sweden.
    Changes in dorsal neck muscle function in individuals with chronic whiplash-associated disorders: a real-time ultrasound case-control study2016In: Ultrasound in Medicine and Biology, ISSN 0301-5629, E-ISSN 1879-291X, Vol. 42, no 5, p. 1090-1102Article in journal (Refereed)
    Abstract [en]

    Impaired neck muscle function leads to disability in individuals with chronic whiplash-associated disorder (WAD), but diagnostic tools are lacking. In this study, deformations and deformation rates were investigated in five dorsal neck muscles during 10 arm elevations by ultrasonography with speckle tracking analyses. Forty individuals with chronic WAD (28 women and 12 men, mean age = 37 y) and 40 healthy controls matched for age and sex were included. The WAD group had higher deformation rates in the multifidus muscle during the first (p < 0.04) and 10th (only women, p < 0.01) arm elevations compared with the control group. Linear relationships between the neck muscles for deformation rate (controls: R-2 = 0.24-0.82, WAD: R-2 = 0.05-0.74) and deformation of the deepest muscles (controls: R-2 = 0.61-0.32, WAD: R-2 = 0.15-0.01) were stronger for women in the control group versus women with WAD, indicating there is altered interplay between dorsal neck muscles in chronic WAD.

  • 314.
    Peterson, Gunnel
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Fac Hlth Sci, Dept Med & Hlth Sci, Div Physiotherapy, Linkoping, Sweden..
    Nilsson, David
    Umea Univ, Computat Life Sci Cluster CLiC, Dept Chem, S-90187 Umea, Sweden..
    Trygg, Johan
    Umea Univ, Computat Life Sci Cluster CLiC, Dept Chem, S-90187 Umea, Sweden..
    Falla, Deborah
    Univ Gottingen, Inst Neurorehabil Syst, Bernstein Focus Neurotechnol BFNT Gottingen, Bernstein Ctr Computat Neurosci,Univ Med Ctr Gott, D-37073 Gottingen, Germany.;Univ Hosp Gottingen, Pain Clin, Ctr Anesthesiol Emergency & Intens Care Med, Gottingen, Germany..
    Dedering, Asa
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Physiotherapy, S-10401 Stockholm, Sweden.;Karolinska Univ Hosp, Dept Phys Therapy, Solna, Sweden..
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Peolsson, Anneli
    Linkoping Univ, Fac Hlth Sci, Dept Med & Hlth Sci, Div Physiotherapy, Linkoping, Sweden..
    Novel insights into the interplay between ventral neck muscles in individuals with whiplash-associated disorders2015In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 5, article id 15289Article in journal (Refereed)
    Abstract [en]

    Chronic whiplash-associated disorder (WAD) is common after whiplash injury, with considerable personal, social, and economic burden. Despite decades of research, factors responsible for continuing pain and disability are largely unknown, and diagnostic tools are lacking. Here, we report a novel model of mechanical ventral neck muscle function recorded from non-invasive, real-time, ultrasound measurements. We calculated the deformation area and deformation rate in 23 individuals with persistent WAD and compared them to 23 sex-and age-matched controls. Multivariate statistics were used to analyse interactions between ventral neck muscles, revealing different interplay between muscles in individuals with WAD and healthy controls. Although the cause and effect relation cannot be established from this data, for the first time, we reveal a novel method capable of detecting different neck muscle interplay in people with WAD. This non-invasive method stands to make a major breakthrough in the assessment and diagnosis of people following a whiplash trauma.

  • 315.
    Peterson, Gunnel
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linköping Univ, Dept Med & Hlth Sci, Linköping, Sweden.
    Nilsson, David
    Umea Univ, Dept Chem, Computat Life Sci Cluster CLiC, Umea, Sweden.
    Trygg, Johan
    Umea Univ, Dept Chem, Computat Life Sci Cluster CLiC, Umea, Sweden.
    Peolsson, Anneli
    Linköping Univ, Dept Med & Hlth Sci, Linköping, Sweden.
    Neck-specific exercise improves impaired interactions between ventral neck muscles in chronic whiplash: A randomized controlled ultrasound study2018In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 8, article id 9649Article in journal (Refereed)
    Abstract [en]

    Chronic pain and disability is common in whiplash-associated disorders (WAD), leading to personal suffering, sick leave, and social cost. The cervical spine is heavily dependent on muscular support and whiplash injury can cause damage to the neck muscles, but diagnostic tools to measure neck muscle impairment and evaluate exercise interventions are lacking. Therefore, the present study investigated ventral neck muscle interactions in 26 individuals with chronic WAD randomized to neck-specific exercise (NSE) or remaining on a waiting list (WL) in 3 months. We performed real-time, non-invasive ultrasound measurements with speckle tracking analysis and calculated the deformation area and deformation rate in three ventral neck muscles. Multivariate statistics were used to analyse interactions between the muscles. After 3 months of NSE, significant improvements were observed in neck muscle interactions and pain intensity in the NSE group compared to the WL group. Thus, this study demonstrates that non-invasive ultrasound can be a diagnostic tool for muscle impairment and used to evaluate exercise interventions in WAD and stands to make a breakthrough for better management in chronic WAD.

  • 316. Picelli, Simone
    et al.
    Zajac, Pawel
    Zhou, Xiao-Lei
    Edler, David
    Lenander, Claes
    Dalén, Johan
    Hjern, Fredrik
    Lundqvist, Nils
    Lindforss, Ulrik
    Påhlman, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery.
    Smedh, Kennet
    Törnqvist, Anders
    Holm, Jörn
    Janson, Martin
    Andersson, Magnus
    Ekelund, Susanne
    Olsson, Louise
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Lundeberg, Joakim
    Lindblom, Annika
    Common variants in human CRC genes as low-risk alleles2010In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 46, no 6, p. 1041-1048Article in journal (Refereed)
    Abstract [en]

    The genetic susceptibility to colorectal cancer (CRC) has been estimated to be around 35% and yet high-penetrance germline mutations found so far explain less than 5% of all cases. Much of the remaining variations could be due to the co-inheritance of multiple low penetrant variants. The identification of all the susceptibility alleles could have public health relevance in the near future. To test the hypothesis that what are considered polymorphisms in human CRC genes could constitute low-risk alleles, we selected eight common SNPs for a pilot association study in 1785 cases and 1722 controls. One SNP, rs3219489:G>C (MUTYH Q324H) seemed to confer an increased risk of rectal cancer in homozygous status (OR=1.52; CI=1.06-2.17). When the analysis was restricted to our 'super-controls', healthy individuals with no family history for cancer, also rs1799977:A>G (MLH1 I219V) was associated with an increased risk in both colon and rectum patients with an odds ratio of 1.28 (CI=1.02-1.60) and 1.34 (CI=1.05-1.72), respectively (under the dominant model); while 2 SNPs, rs1800932:A>G (MSH6 P92P) and rs459552:T>A (APC D1822V) seemed to confer a protective effect. The latter, in particular showed an odds ratio of 0.76 (CI=0.60-0.97) among colon patients and 0.73 (CI=0.56-0.95) among rectal patients. In conclusion, our study suggests that common variants in human CRC genes could constitute low-risk alleles.

  • 317.
    Pikwer, Andreas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Mälarsjukhuset.
    Castegren, Markus
    Karolinska Univ Hosp, Perioperat Med & Intens Care PMI, Stockholm, Sweden.;Karolinska Inst, Clintec, Stockholm, Sweden..
    Namdar, Sijal
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Mälarsjukhuset.
    Blennow, Kaj
    Univ Gothenburg, Sahlgrenska Acad, Inst Neurosci & Physiol, Dept Psychiat & Neurochem, Molndal, Sweden.;Sahlgrens Univ Hosp, Clin Neurochem Lab, Molndal, Sweden..
    Zetterberg, Henrik
    Univ Gothenburg, Sahlgrenska Acad, Inst Neurosci & Physiol, Dept Psychiat & Neurochem, Molndal, Sweden.;Sahlgrens Univ Hosp, Clin Neurochem Lab, Molndal, Sweden.;UCL, Inst Neurol, Dept Mol Neurosci, Queen Sq, London, England..
    Mattsson, Niklas
    Lund Univ, Clin Memory Res Unit, Fac Med, Lund, Sweden.;Skane Univ Hosp, Dept Neurol, Lund, Sweden..
    Effects of surgery and propofol-remifentanil total intravenous anesthesia on cerebrospinal fluid biomarkers of inflammation, Alzheimer's disease, and neuronal injury in humans: a cohort study2017In: Journal of Neuroinflammation, ISSN 1742-2094, E-ISSN 1742-2094, Vol. 14, article id 193Article in journal (Refereed)
    Abstract [en]

    Background: Surgery and anesthesia have been linked to postoperative cognitive disturbance and increased risk of Alzheimer's disease. It is not clear by which mechanisms this increased risk for cognitive disease is mediated. Further, amyloid beta production has been suggested to depend on the sleep-wake cycle and neuronal activity. The aim of the present study was to examine if cerebrospinal fluid (CSF) concentrations of a number of biomarkers for Alzheimer's disease-related processes, including amyloid beta, neuronal injury, and inflammation, changed over time during intravenous anesthesia in surgical patients. Methods: We included patients scheduled for hysterectomy via laparotomy during general anesthesia with intravenous propofol and remifentanil. CSF samples were obtained before, during, and after surgery (5 h after induction) and tested for 27 biomarkers. Changes over time were tested with linear mixed effects models. Results: A total of 22 patients, all females, were included. The mean age was 50 years (+/- 9 SD). The mean duration of the anesthesia was 145 min (+/- 40 SD). Interleukin (IL)-6, IL-8, monocyte chemoattractant protein 1, and vascular endothelial growth factor A increased over time. IL-15 and IL-7 decreased slightly over time. Macrophage inflammatory protein 1 beta and placental growth factor also changed significantly. There were no significant effects on amyloid beta (A beta) or tau biomarkers. Conclusions: Surgery and general anesthesia with intravenous propofol and remifentanil induce, during and in the short term after the procedure, a neuroinflammatory response which is dominated by monocyte attractants, without biomarker signs of the effects on Alzheimer's disease pathology or neuronal injury.

  • 318.
    Pikwer, M.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Orellana, C.
    Kallberg, H.
    Pikwer, A.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Turesson, C.
    Klareskog, L.
    Alfredsson, L.
    Saevarsdottir, S.
    Bengtsson, C.
    Parity and severity of ACPA-positive/-negative rheumatoid arthritis. Results from the Swedish EIRA study2014In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 43, no S127, p. 11-11Article in journal (Other academic)
  • 319.
    Pikwer, M.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Turesson, C.
    Orellana, C.
    Kallgren, H.
    Pikwer, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Klareskog, L.
    Alfredsson, L.
    Saevarsdottir, S.
    Bengtsson, C.
    Parity and Severity of Acpa-Positive and Acpa-Negative Rheumatoid Arthritis. Results from the Swedish EIRA Study and the Swedish Rheumatology Quality Register2014In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 73, no S2, p. 391-391Article in journal (Other academic)
  • 320.
    Pikwer, Mitra
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Malarsjukhuset Hosp, Rheumatol Unit, Eskilstuna, Sweden.;Karolinska Inst, Inst Environm Med, S-10401 Stockholm, Sweden.; Lund Univ, Dept Clin Sci, Rheumatol, Malmo, Sweden..
    Orellana, Cecilia
    Karolinska Inst, Inst Environm Med, S-10401 Stockholm, Sweden..
    Kallberg, Henrik
    Karolinska Inst, Inst Environm Med, S-10401 Stockholm, Sweden..
    Pikwer, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Turesson, Carl
    Lund Univ, Dept Clin Sci, Rheumatol, Malmo, Sweden..
    Klareskog, Lars
    Karolinska Inst, Rheumatol Unit, Dept Med, Stockholm, Sweden.;Karolinska Univ Hosp Solna, Stockholm, Sweden..
    Alfredsson, Lars
    Karolinska Inst, Inst Environm Med, S-10401 Stockholm, Sweden.;Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden..
    Saevarsdottir, Saedis
    Karolinska Inst, Inst Environm Med, S-10401 Stockholm, Sweden.;Karolinska Inst, Rheumatol Unit, Dept Med, Stockholm, Sweden.;Karolinska Univ Hosp Solna, Stockholm, Sweden..
    Bengtsson, Camilla
    Karolinska Inst, Inst Environm Med, S-10401 Stockholm, Sweden..
    Parity influences the severity of ACPA-negative early rheumatoid arthritis: a cohort study based on the Swedish EIRA material2015In: Arthritis Research & Therapy, ISSN 1478-6354, E-ISSN 1478-6362, Vol. 17, article id 358Article in journal (Refereed)
    Abstract [en]

    Background: In women with rheumatoid arthritis (RA) it has been observed that during pregnancy a majority of patients experience amelioration, but after delivery a relapse of the disease is common. However, there are few studies, with diverging results, addressing the effect of parity on the severity of RA over time. Our aim was to explore the impact of parity, with stratification for anti-citrullinated protein antibody (ACPA) status as well as for onset during reproductive age or not. Methods: Female RA cases aged 18-70 years were recruited for the Epidemiological Investigation of Rheumatoid Arthritis (EIRA). Information on disease severity (the health assessment questionnaire (HAQ) and the disease activity score 28 (DAS28)) was retrieved from the Swedish Rheumatology Quality Register at inclusion and 3, 6, 12 and 24 months after diagnosis. Mixed models were used to compare mean DAS28 and HAQ scores over time in parous and nulliparous women. Mean differences at individual follow-up visits were compared using analysis of covariance. The odds of having DAS28 or HAQ above the median in parous verus nulliparous women were estimated in logistic regression models. Results: A total of 1237 female cases (mean age 51 years, 65 % ACPA-positive) were included. ACPA-negative parous women, aged 18-44 years, had on average 1.17 units higher DAS28 (p < 0.001) and 0.43 units higher HAQ score (p < 0.001) compared to nulliparous women during the follow-up time, adjusted for age. In this subgroup, the average DAS28 and HAQ scores were significantly higher in parous women at all follow-up time points. Younger parous ACPA-negative women were significantly more likely to have DAS28 and HAQ values above the median compared to nulliparous women at all follow-up visits. No association between parity and severity of ACPA-positive disease was observed. Conclusions: Parity was a predictor of a more severe RA among ACPA-negative younger women, which might indicate that immunomodulatory changes during and after pregnancy affect RA severity, in particular for the ACPA-negative RA phenotype.

  • 321. Pinnock, Hilary
    et al.
    Thomas, Mike
    Tsiligianni, Ioanna
    Lisspers, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Østrem, Anders
    Ställberg, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Yusuf, Osman
    Ryan, Dermot
    Buffels, Johan
    Cals, Jochen W L
    Chavannes, Niels H
    Henrichsen, Svein Høegh
    Langhammer, Arnulf
    Latysheva, Elena
    Lionis, Christos
    Litt, John
    van der Molen, Thys
    Zwar, Nick
    Williams, Sian
    The International Primary Care Respiratory Group (IPCRG) Research Needs Statement 20102010In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 19, no Suppl 1, p. S1-S20Article in journal (Refereed)
    Abstract [en]

    AIM: Respiratory diseases are a public health issue throughout the world, with high prevalence and morbidity. This Research Needs Statement from the International Primary Care Respiratory Group (IPCRG) aims to highlight unanswered questions on the management of respiratory diseases that are of importance to practising primary care clinicians. METHODS: An informal but inclusive consultation process was instigated in 2009. Draft statements in asthma, rhinitis, COPD, tobacco dependence, and respiratory infections were circulated widely to IPCRG members, other recognised experts, and representatives from a range of economic and healthcare backgrounds. An iterative process was used to generate, prioritise and refine research questions in each section. RESULTS: Two overarching themes emerged. Firstly, there is a real need for research to be undertaken within primary care, which recruits patients representative of primary care populations, evaluates interventions realistically delivered within primary care, and draws conclusions that will be meaningful to professionals working within primary care. Secondly, international and national guidelines exist, but there is little evidence on the best strategies for implementing recommendations. Disease-specific research questions focus on effective and cost-effective ways to prevent disease, confirm the diagnosis, assess control, manage treatment, and empower selfmanagement. Practical questions about how to deliver this comprehensive agenda in diverse primary care settings are highlighted. CONCLUSIONS: We hope that this Research Needs Statement will be used by clinicians and patients campaigning for answers to relevant questions, by researchers seeking funding to provide answers to these questions, and by funding bodies to enable them to prioritise research agendas.

  • 322.
    Prokopishyn, Nicole L.
    et al.
    Univ Calgary, Dept Pathol & Lab Med, Calgary, AB, Canada.
    Logan, Brent R.
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA;Med Coll Wisconsin, Inst Hlth & Soc, Div Biostat, Milwaukee, WI 53226 USA.
    Kiefer, Deidre M.
    Natl Marrow Donor Program Be Match, Ctr Int Blood & Marrow Transplant Res, Minneapolis, MN USA.
    Sees, Jennifer A.
    Natl Marrow Donor Program Be Match, Ctr Int Blood & Marrow Transplant Res, Minneapolis, MN USA.
    Chitphakdithai, Pintip
    Natl Marrow Donor Program Be Match, Ctr Int Blood & Marrow Transplant Res, Minneapolis, MN USA.
    Ahmed, Ibrahim A.
    Childrens Mercy Hosp & Clin, Dept Hematol Oncol & Bone Marrow Transplantat, Kansas City, MO USA.
    Anderlini, Paolo N.
    Univ Texas MD Anderson Canc Ctr, Dept Stem Cell Transplantat & Cellular Therapy, Houston, TX 77030 USA.
    Beitinjaneh, Amer M.
    Univ Miami, Dept Hematol, Miami, FL USA.
    Bredeson, Christopher
    Ottawa Hosp, Blood & Marrow Transplant Program, Ottawa, ON, Canada;Ottawa Hosp Res Inst, Ottawa, ON, Canada.
    Cerny, Jan
    Univ Massachusetts, Med Ctr, Dept Med, Div Hematol Oncol, Worcester, MA USA.
    Chhabra, Saurabh
    Med Coll Wisconsin, Dept Med, Div Hematol Oncol, Milwaukee, WI 53226 USA.
    Daly, Andrew
    Tom Baker Canc Clin, Calgary, AB, Canada.
    Angel Diaz, Miguel
    Hosp Infantil Univ Nino Jesus, Dept Hematol Oncol, Madrid, Spain.
    Farhadfar, Nosha
    Univ Florida, Coll Med, Div Hematol Oncol, Gainesville, FL USA.
    Frangoul, Haydar A.
    TriStar Centennial, Childrens Hosp, Div Pediat Hematol & Oncol, Nashville, TN USA;Sarah Cannon Res Inst, Nashville, TN USA.
    Ganguly, Siddhartha
    Univ Kansas Hlth Syst, Div Hematol Malignancy & Cellular Therapeut, Kansas City, KS USA.
    Gastineau, Dennis A.
    Mayo Clin Rochester, Div Hematol, Rochester, MN USA.
    Gergis, Usama
    Weill Cornell Med Coll, New York Presbyterian Hosp, Dept Med Oncol, Hematolg Malignancies & Bone Marrow Transplant, New York, NY USA.
    Hale, Gregory A.
    Johns Hopkins All Childrens Hosp, Dept Hematol Oncol, St Petersburg, FL USA.
    Hematti, Peiman
    Univ Wisconsin Hosp & Clin, Dept Med, Div Hematol Oncol Bone Marrow Transplantat, Madison, WI 53792 USA.
    Kamble, Rammurti T.
    Baylor Coll Med, Ctr Cell & Gene Therapy, Div Hematol & Oncol, Houston, TX 77030 USA.
    Kasow, Kimberly A.
    Univ N Carolina, Div Hematol Oncol, Dept Pediat, Chapel Hill, NC 27515 USA.
    Lazarus, Hillard M.
    Univ Hosp Cleveland, Med Ctr, Seidman Canc Ctr, Cleveland, OH 44106 USA.
    Liesveld, Jane L.
    Univ Rochester, Med Ctr, Strong Mem Hosp, Rochester, NY 14642 USA.
    Murthy, Hemant S.
    Univ Florida, Coll Med, Div Hematol Oncol, Gainesville, FL USA.
    Norkin, Maxim
    Univ Florida, Coll Med, Div Hematol Oncol, Gainesville, FL USA.
    Olsson, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Lab Med, Div Therapeut Immunol, Stockholm, Sweden.
    Papari, Mona
    ITxM Clin Serv Cord Blood Lab, Rosemont, IL USA.
    Savani, Bipin N.
    Vanderbilt Univ, Med Ctr, Dept Med, Div Hematol Oncol, Nashville, TN USA.
    Szer, Jeffrey
    Peter MacCalluma Canc Ctr, Clin Haematol, Melbourne, Vic, Australia;Royal Melbourne Hosp, Parkville, Vic, Australia.
    Waller, Edmund K.
    Emory Univ Hosp, Dept Hematol & Meidcal Oncol, 1364 Clifton Rd NE, Atlanta, GA 30322 USA.
    Wirk, Baldeep
    Seattle Canc Care Alliance, Div Bone Marrow Transplant, Seattle, WA USA.
    Yared, Jean A.
    Univ Maryland, Greenebaum Canc Ctr, Blood & Marrow Transplantat Program, Div Hematol Oncol,Dept Med, Baltimore, MD 21201 USA.
    Pulsipher, Michael A.
    USC Keck Sch Med, Childrens Hosp Los Angeles, Div Hematol Oncol & Blood & Marrow Transplantat, Los Angeles, CA USA.
    Shah, Nirali N.
    NCI, Pediat Oncol Branch, Ctr Canc Res, NIH, Bethesda, MD 20892 USA.
    Switzer, Galen E.
    Univ Pittsburgh, Dept Med, Pittsburgh, PA USA.
    O'Donnell, Paul V.
    Harvard Med Sch, Massachusetts Gen Hosp, Dept Hematol Oncol, Boston, MA 02115 USA.
    Confer, Dennis L.
    Natl Marrow Donor Program Be Match, Ctr Int Blood & Marrow Transplant Res, Minneapolis, MN USA;Natl Marrow Donor Program Be Match, Minneapolis, MN USA.
    Shaw, Bronwen E.
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA.
    The Concentration of Total Nucleated Cells in Harvested Bone Marrow for Transplantation Has Decreased over Time2019In: Biology of blood and marrow transplantation, ISSN 1083-8791, E-ISSN 1523-6536, Vol. 25, no 7, p. 1325-1330Article in journal (Refereed)
    Abstract [en]

    Bone marrow (BM) is an essential source of hematopoietic stem cell grafts for many allogeneic hematopoietic cell transplant (HCT) recipients, including adult patients (for specific diseases and transplantation strategies) and the majority of pediatric recipient. However, since the advent of granulocyte colony-stimulating factor-mobilized peripheral blood stem cell (PBSC) grafts, there has been a significant decrease in the use of BM in HCT, thought to be due mainly to the increased logistical challenges in harvesting BM compared with PBSCs, as well as generally no significant survival advantage of BM over PBSCs. The decreased frequency of collection has the potential to impact the quality of BM harvests. In this study, we examined >15,000 BM donations collected at National Marrow Donor Program centers between 1994 and 2016 and found a significant decline in the quality of BM products, as defined by the concentration of total nucleated cells (TNCs). The mean TNC concentration in BM donations dropped from 21.8 x 10(6) cells/mL in the earliest era (1994 to 1996) to 18.7 x 10(6) cells/mL in the most recent era (2012 to 2016) (means ratio,.83; P < .001). This decline in BM quality was seen despite the selection of more donors perceived to be optimal (eg, younger and male). Multivariate regression analysis showed that higher volume centers (performing >30 collections per era) had better-quality harvests with higher concentrations of TNCs collected. In conclusion, we have identified a significant decrease in the quality of BM collections over time, and lower-volume collection centers had poorer-quality harvests. In this analysis, we could not elucidate the direct cause for this finding, suggesting the need for further studies to investigate the key factors responsible and to explore the impact on transplant recipients. (C) 2019 American Society for Blood and Marrow Transplantation.

  • 323.
    Protudjer, Jennifer L. P.
    et al.
    Stockholm Cty Council, Ctr Occupat & Environm Med, S-11365 Stockholm, Sweden;Karolinska Inst, Inst Environm Med, S-17111 Stockholm, Sweden.
    Olen, Ola
    Karolinska Inst, Dept Med Solna, Clin Epidemiol Unit, S-17176 Stockholm, Sweden;South Gen Hosp, Sachs Children & Youth Hosp, S-11883 Stockholm, Sweden;Karolinska Inst, Dept Clin Sci & Educ, Sodersjukhuset, S-11883 Stockholm, Sweden.
    Vetander, Mirja
    Karolinska Inst, Inst Environm Med, S-17111 Stockholm, Sweden;South Gen Hosp, Sachs Children & Youth Hosp, S-11883 Stockholm, Sweden.
    Kull, Inger
    Karolinska Inst, Inst Environm Med, S-17111 Stockholm, Sweden;South Gen Hosp, Sachs Children & Youth Hosp, S-11883 Stockholm, Sweden;Karolinska Inst, Dept Clin Sci & Educ, Sodersjukhuset, S-11883 Stockholm, Sweden.
    Melen, Erik
    Karolinska Inst, Inst Environm Med, S-17111 Stockholm, Sweden;South Gen Hosp, Sachs Children & Youth Hosp, S-11883 Stockholm, Sweden.
    van Hage, Marianne
    Karolinska Inst, Immunol & Allergy Unit, Dept Med Solna, S-17176 Stockholm, Sweden;Karolinska Univ Hosp, S-17176 Stockholm, Sweden.
    Wickman, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Inst Environm Med, S-17111 Stockholm, Sweden.
    Bergström, Anna
    Stockholm Cty Council, Ctr Occupat & Environm Med, S-11365 Stockholm, Sweden;Karolinska Inst, Inst Environm Med, S-17111 Stockholm, Sweden.
    Milk-Related Symptoms and Immunoglobulin E Reactivity in Swedish Children from Early Life to Adolescence2018In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 10, no 5, article id 651Article in journal (Refereed)
    Abstract [en]

    Cow's milk often causes symptoms in infants. Whereas, some continue to experience symptoms through childhood, others become tolerant. Yet, the ages at which persistence and tolerance occur are less clear. Thus, we examined the age of onset and persistence of milk-related symptoms from early life to adolescence, and Immunoglobulin E (IgE) milk reactivity, focusing on gender differences in a large, population-based birth cohort. Overall, 20.0% (537/2985) of children, with a comparable gender distribution, had early life milk-related symptoms. At 16y, approximately 2% (62/2985) children had persistent symptoms and high milk IgE levels (e.g., median at 4 years: 1.5 kU(A)/L) that were beginning in early life. In contrast, 94% had transient symptoms and low median IgE levels (early life: 0.63 kU(A)/L, 8y: 0.72 kU(A)/L; 16 years: 1.1 kU(A)/L). Also, at 16 years, approximately 6% of females and 3% of males without any previously reported symptoms reported adolescent-onset of symptoms (p < 0.001). Such symptoms were almost exclusively gastrointestinal symptoms and were not associated with detectable IgE. In conclusion, early life milk-related symptoms are common, although most cases are transient by 16 years. Twice as many females vs. males report adolescent-onset symptoms, and particularly gastrointestinal symptoms. Children with persistent symptoms have both a higher prevalence and higher milk IgE levels, as compared to other phenotypes.

  • 324.
    Qayed, Muna
    et al.
    Emory Univ, Sch Med, Aflac Canc & Blood Disorders Ctr, 2015 Uppergate Dr NE, Atlanta, GA, USA.
    Wang, Tao
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI, USA; Med Coll Wisconsin, Inst Hlth & Soc, Div Biostat, Milwaukee, WI , USA.
    Hemmer, Michael T.
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI, USA.
    Spellman, Stephen
    Natl Marrow Donor Program Be Match, Ctr Int Blood & Marrow Transplant Res, Minneapolis, MN, USA.
    Arora, Mukta
    Univ Minnesota, Med Ctr, Dept Med, Div Hematol Oncol & Transplantat, Minneapolis, MN, USA.
    Couriel, Daniel
    Utah Blood & Marrow Transplant Program, Div Hematol & Hematol Malignancies, Dept Internal Med, Salt Lake City, UT USA.
    Alousi, Amin
    Univ Texas MD Anderson Canc Ctr, Div Canc Med, Dept Stem Cell Transplantat, Houston, TX, USA.
    Pidala, Joseph
    H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL USA.
    Abdel-Azim, Hisham
    Univ Southern Calif, Keck Sch Med, Childrens Hosp Los Angeles, Div Hematol Oncol & Blood & Marrow Transplantat, Los Angeles, CA, USA.
    Aljurf, Mahmoud
    King Faisal Specialist Hosp & Res Ctr, Dept Oncol, Riyadh, Saudi Arabia.
    Ayas, Mouhab
    King Faisal Specialist Hosp & Res Ctr, Dept Pediat Hematol Oncol, Riyadh, Saudi Arabia.
    Bitan, Menachem
    Tel Aviv Sourasky Med Ctr, Dept Pediat Hematol Oncol, Tel Aviv, Israel.
    Cairo, Mitchell
    New York Med Coll, Dept Pediat, Div Pediat Hematol Oncol & Stem Cell Transplantat, Valhalla, NY, USA.
    Choi, Sung Won
    Univ Michigan, Dept Pediat & Communicable Dis, Ann Arbor, MI, USA.
    Dandoy, Christopher
    Cincinnati Childrens Hosp Med Ctr, Dept Pediat, Div Bone Marrow Transplantat & Immune Deficiency, Cincinnati, OH, USA.
    Delgado, David
    Indiana Univ Hosp, Dept Pediat, Indianapolis, IN, USA.
    Gale, Robert Peter
    Imperial Coll London, Dept Med, Div Expt Med, Hematol Res Ctr, London, England.
    Hale, Gregory
    Johns Hopkins All Childrens Hosp, Dept Hematol Oncol, St Petersburg, FL, USA.
    Frangoul, Haydar
    TriStar Centennial, Childrens Hosp, Pediat Hematol Oncol, Nashville, TN USA; Sarah Cannon Res Inst, Nashville, TN, USA.
    Kamble, Rammurti T.
    Baylor Coll Med, Ctr Cell & Gene Therapy, Div Hematol & Oncol, Houston, TX, USA.
    Kharfan-Dabaja, Mohamed
    H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL USA.
    Lehman, Leslie
    Dana Farber Canc Inst, Dept Pediat Hematol Oncol, Boston, MA, USA.
    Levine, John
    Icahn Sch Med Mt Sinai, Tisch Canc Inst, New York, NY, USA.
    MacMillan, Margaret
    Univ Minnesota, Med Ctr, Dept Med, Div Hematol Oncol & Transplantat, Minneapolis, MN, USA.
    Marks, David I.
    Univ Hosp Bristol NHS Trust, Adult Bone Marrow Transplant, Bristol, Avon, England.
    Nishihori, Taiga
    H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL USA.
    Olsson, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Lab Med, Div Therapeut Immunol, Stockholm, Sweden.
    Hematti, Peiman
    Univ Wisconsin Hosp & Clin, Dept Med, Div Hematol Oncol Bone Marrow Transplantat, Madison, WI, USA.
    Ringden, Olov
    Karolinska Inst, Dept Lab Med, Div Therapeut Immunol, Stockholm, Sweden.
    Saad, Ayman
    Univ Alabama Birmingham, Dept Med, Div Hematol Oncol, Birmingham, AL, USA.
    Satwani, Prakash
    Columbia Univ, Med Ctr, Dept Pediat, Div Pediat Hematol Oncol & Stem Cell Transplantat, New York, NY, USA.
    Savani, Bipin N.
    Vanderbilt Univ, Med Ctr, Dept Med, Div Hematol Oncol, Nashville, TN, USA.
    Schultz, Kirk R.
    Univ British Columbia, British Columbias Childrens Hosp, Dept Pediat Hematol Oncol & Bone Marrow Transplan, Vancouver, BC, Canada.
    Seo, Sachiko
    East Hosp, Natl Canc Res Ctr, Kashiwa, Chiba, Japan.
    Shenoy, Shalini
    Washington Univ, Dept Pediat Hematol Oncol, St Louis, MO, USA.
    Waller, Edmund K.
    Emory Univ, Winship Canc Inst, Dept Hematol & Med Oncol, Atlanta, GA, USA.
    Yu, Lolie
    Louisiana State Univ, Hlth Sci Ctr, Ctr Canc & Blood Disorders, Div Hematol Oncol, New Orleans, LA, USA.
    Horowitz, Mary M.
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI, USA.
    Horan, John
    Emory Univ, Sch Med, Aflac Canc & Blood Disorders Ctr, Atlanta, GA, USA.
    Influence of Age on Acute and Chronic GVHD in Children Undergoing HLA-Identical Sibling Bone Marrow Transplantation for Acute Leukemia: Implications for Prophylaxis2018In: Biology of blood and marrow transplantation, ISSN 1083-8791, E-ISSN 1523-6536, Vol. 24, no 3, p. 521-528Article in journal (Refereed)
    Abstract [en]

    Relapse remains the major cause of mortality after hematopoietic cell transplantation (HCT) for pediatric acute leukemia. Previous research has suggested that reducing the intensity of calcineurin inhibitor-based graft-versus-host disease (GVHD) prophylaxis may be an effective strategy for abrogating the risk of relapse in pediatric patients undergoing matched sibling donor (MSD) HCT. We reasoned that the benefits of this strategy could be maximized by selectively applying it to those patients least likely to develop GVHD. We conducted a study of risk factors for GVHD, to risk-stratify patients based on age. Patients age <18 years with leukemia who received myeloablative, T cell-replete MSD bone marrow transplantation and calcineurin inhibitor-based GVHD prophylaxis between 2000 and 2013 and were entered into the Center for International Blood and Marrow Transplant Research registry were included. The cumulative incidence of grade II-IV acute GVHD (aGVHD) was 19%, that of grade II-IV aGVHD 7%, and that of chronic GVHD (cGVHD) was 16%. Compared with age 13 to 18 years, age 2 to 12 years was associated with a lower risk of grade II-IV aGVHD (hazard ratio [HR], .42; 95% confidence interval [CI], .26 to .70; P = .0008), grade II-IV aGVHD (HR, .24; 95% CI, .10 to .56; P = .001), and cGVHD (HR, .32; 95% CI, .19 to .54; P < .001). Compared with 2000-2004, the risk of grade II-IV aGVHD was lower in children undergoing transplantation in 2005-2008 (HR, .36; 95% CI, .20 to .65; P = .0007) and in 2009-2013 (HR, .24; 95% CI. .11 to .53; P = .0004). Similarly, the risk of grade III-IV aGVHD was lower in children undergoing transplantation in 2005-2008 (HR, .23; 95% CI, .08 to .65; P = .0056) and 2009-2013 (HR, .16; 95% CI, .04 to .67; P = .0126) compared with those doing so in 2000-2004. We conclude that aGVHD rates have decreased significantly over time, and that children age 2 to 12 years are at very low risk for aGVHD and cGVHD. These results should be validated in an independent analysis, because these patients with high-risk malignancies may be good candidates for trials of reduced GVHD prophylaxis.

  • 325.
    Radivoyevitch, Tomas
    et al.
    Cleveland Clin Fdn, Dept Quantitat Hlth Sci, 9500 Euclid Ave, Cleveland, OH 44195 USA;Cleveland Clin Fdn, Dept Hematol & Oncol Res, 9500 Euclid Ave, Cleveland, OH 44195 USA.
    Dean, Robert M.
    Cleveland Clin, Blood & Marrow Transplant Program, Cleveland, OH 44106 USA;Royal Melbourne Hosp City Campus, Melbourne, Vic, Australia.
    Shaw, Bronwen E.
    Med Coll Wisconsin, CIBMTR, Milwaukee, WI 53226 USA.
    Brazauskas, Ruta
    Med Coll Wisconsin, CIBMTR, Milwaukee, WI 53226 USA;Med Coll Wisconsin, Div Biostat, Milwaukee, WI 53226 USA.
    Tecca, Heather R.
    Med Coll Wisconsin, CIBMTR, Milwaukee, WI 53226 USA.
    Molenaar, Remco J.
    Cleveland Clin Fdn, Dept Quantitat Hlth Sci, 9500 Euclid Ave, Cleveland, OH 44195 USA;Cleveland Clin Fdn, Dept Hematol & Oncol Res, 9500 Euclid Ave, Cleveland, OH 44195 USA;Acad Med Ctr, Dept Med Oncol, Amsterdam, Netherlands.
    Battiwalla, Minoo
    NHLBI, Hematol Branch, Bethesda, MD 20892 USA.
    Savani, Bipin N.
    Vanderbilt Univ, Med Ctr, Dept Med, Nashville, TN USA.
    Flowers, Mary E. D.
    Fred Hutchinson Canc Res Ctr, Div Clin Res, 1124 Columbia St, Seattle, WA 98104 USA.
    Cooke, Kenneth R.
    Johns Hopkins, Sidney Kimmel Comprehens Canc Ctr, Pediat Blood & Marrow Transplantat Program, Baltimore, MD USA.
    Hamilton, Betty K.
    Cleveland Clin, Blood & Marrow Transplant Program, Cleveland, OH 44106 USA;Royal Melbourne Hosp City Campus, Melbourne, Vic, Australia.
    Kalaycio, Matt
    Cleveland Clin, Blood & Marrow Transplant Program, Cleveland, OH 44106 USA;Royal Melbourne Hosp City Campus, Melbourne, Vic, Australia.
    Maciejewski, Jaroslaw P.
    Cleveland Clin, Blood & Marrow Transplant Program, Cleveland, OH 44106 USA;Royal Melbourne Hosp City Campus, Melbourne, Vic, Australia.
    Ahmed, Ibrahim
    Childrens Mercy Hosp & Clin, Dept Hematol Oncol & Bone Marrow Transplantat, Kansas City, MO USA.
    Akpek, Gorgun
    Rush Univ, Med Ctr, Stem Cell Transplantat & Cell Therapy, Chicago, IL 60612 USA.
    Bajel, Ashish
    Buchbinder, David
    Childrens Hosp Orange Cty, Div Pediat Hematol, Orange, CA 92668 USA.
    Cahn, Jean-Yves
    CHU Grenoble Alpes, Dept Hematol, Grenoble, France.
    D'Souza, Anita
    Med Coll Wisconsin, CIBMTR, Milwaukee, WI 53226 USA.
    Daly, Andrew
    Tom Baker Canc Clin, Calgary, AB, Canada.
    DeFilipp, Zachariah
    Massachusetts Gen Hosp, Blood & Marrow Transplant Program, Boston, MA 02114 USA.
    Ganguly, Siddhartha
    Univ Kansas, Med Ctr, Blood & Marrow Transplantat, Kansas City, KS 66103 USA.
    Hamadani, Mehdi
    Med Coll Wisconsin, CIBMTR, Milwaukee, WI 53226 USA.
    Hayashi, Robert J.
    Washington Univ, Dept Pediat, Sch Med St Louis, St Louis, MO 63130 USA.
    Hematti, Peiman
    Univ Wisconsin Hosp & Clin, Dept Med, Madison, WI 53792 USA.
    Inamoto, Yoshihiro
    Natl Canc Ctr, Div Hematopoiet Stem Cell Transplantat, Tokyo, Japan.
    Khera, Nandita
    Mayo Clin, Dept Hematol Oncol, Phoenix, AZ USA.
    Kindwall-Keller, Tamila
    Univ Virginia Hlth Syst, Div Hematol Oncol, Charlottesville, VA USA.
    Landau, Heather
    Mem Sloan Kettering Canc Ctr, Div Hematol, Bone Marrow Transplant Serv, 1275 York Ave, New York, NY 10021 USA.
    Lazarus, Hillard
    Case Western Reserve Univ, Seidman Canc Ctr, Cleveland, OH 44106 USA.
    Majhail, Navneet S.
    Cleveland Clin, Blood & Marrow Transplant Program, Cleveland, OH 44106 USA;Royal Melbourne Hosp City Campus, Melbourne, Vic, Australia.
    Marks, David I.
    Univ Hosp Bristol NHS Trust, Adult Bone Marrow Transplant, Bristol, Avon, England.
    Olsson, Richard F.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Lab Med, Stockholm, Sweden.
    Seo, Sachiko
    Natl Canc Res Ctr East, Dept Hematol & Oncol, Chiba, Japan.
    Steinberg, Amir
    Mt Sinai Hosp, Dept Hematol Oncol, New York, NY 10029 USA.
    William, Basem M.
    Ohio State Med Ctr, Columbus, OH USA.
    Wirk, Baldeep
    Seattle Canc Care Alliance, Div Bone Marrow Transplant, Seattle, WA USA.
    Yared, Jean A.
    Univ Maryland, Dept Med, Baltimore, MD 21201 USA.
    Aljurf, Mahmoud
    King Faisal Specialist Hosp & Res Ctr, Dept Oncol, Riyadh, Saudi Arabia.
    Abidi, Muneer H.
    Wayne State Univ, Karmanos Canc Inst, Dept Oncol, Detroit, MI USA.
    Allewelt, Heather
    Duke Univ, Med Ctr, Durham, NC USA.
    Beitinjaneh, Amer
    Univ Miami, Miami, FL USA.
    Cook, Rachel
    Oregon Hlth & Sci Univ, Portland, OR 97201 USA.
    Cornell, Robert F.
    Vanderbilt Univ, Med Ctr, Dept Med, Nashville, TN USA.
    Fay, Joseph W.
    Baylor Univ, Med Ctr, Dallas, TX USA.
    Hale, Gregory
    Johns Hopkins All Childrens Hosp, Dept Hematol Oncol, St Petersburg, FL USA.
    Chakrabarty, Jennifer Holter
    Univ Oklahoma, Dept Hematol Oncol, Oklahoma City, OK USA.
    Jodele, Sonata
    Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH 45229 USA.
    Kasow, Kimberly A.
    Univ N Carolina, Chapel Hill, NC 27515 USA.
    Mahindra, Anuj
    Scripps Blood & Marrow Transplant Program, La Jolla, CA USA.
    Malone, Adriana K.
    Icahn Sch Med Mt Sinai, Tisch Canc Inst, New York, NY 10029 USA.
    Popat, Uday
    Univ Texas MD Anderson Canc Ctr, Houston, TX 77030 USA.
    Rizzo, J. Douglas
    Natl Canc Res Ctr East, Dept Hematol & Oncol, Chiba, Japan.
    Schouten, Harry C.
    Acad Ziekenhuis, Dept Hematol, Maastricht, Netherlands.
    Warwick, Anne B.
    Uniformed Serv Univ Hlth Sci, Dept Pediat, Bethesda, MD 20814 USA.
    Wood, William A.
    Univ N Carolina, Chapel Hill, NC 27515 USA.
    Sekeres, Mikkael A.
    Cleveland Clin, Blood & Marrow Transplant Program, Cleveland, OH 44106 USA;Royal Melbourne Hosp City Campus, Melbourne, Vic, Australia.
    Litzow, Mark R.
    Mayo Clin, Dept Med, Rochester, MN USA.
    Gale, Robert P.
    Imperial Coll London, Dept Med, London, England.
    Hashmi, Shahrukh K.
    King Faisal Specialist Hosp & Res Ctr, Dept Oncol, Riyadh, Saudi Arabia.
    Risk of acute myeloid leukemia and myelodysplastic syndrome after autotransplants for lymphomas and plasma cell myeloma2018In: Leukemia research: a Forum for Studies on Leukemia and Normal Hemopoiesis, ISSN 0145-2126, E-ISSN 1873-5835, Vol. 74, p. 130-136Article in journal (Refereed)
    Abstract [en]

    Background: Exposures to DNA-damaging drugs and ionizing radiations increase risks of acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS).

    Methods: 9028 recipients of hematopoietic cell autotransplants (1995-2010) for Hodgkin lymphoma (HL; n=916), non-Hodgkin lymphoma (NHL; n=3546) and plasma cell myeloma (PCM; n=4566), reported to the CIBMTR, were analyzed for risk of subsequent AML or MDS.

    Results: 335 MDS/ AML cases were diagnosed posttransplant (3.7%). Variables associated with an increased risk for AML or MDS in multivariate analyses were: (1) conditioning with total body radiation versus chemotherapy alone for HL (HR=4.0; 95% confidence interval [1.4, 11.6]) and NHL (HR=2.5 [1.1, 2.5]); (2) >= 3 versus 1 line of chemotherapy for NHL (HR=1.9 [1.3, 2.8]); and (3) subjects with NHL transplanted in 2005-2010 versus 1995-1999 (HR=2.1 [1.5, 3.1]). Using Surveillance, Epidemiology and End Results (SEER) data, we found risks for AML/ MDS in HL, NHL and PCM to be 5-10 times the background rate. In contrast, relative risks were 10-50 for AML and approximately 100 for MDS in the autotransplant cohort.

    Conclusions: There are substantial risks of AML and MDS after autotransplants for HL, NHL and PCM.

  • 326. Rahnama, Leila
    et al.
    Peterson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Department of Medical and Health Sciences, Physiotherapy, Linköping University, Linköping, Sweden.
    Kazemnejad, Anoshirvan
    Trygg, Johan
    Peolsson, Anneli
    Alterations in the Mechanical Response of Deep Dorsal Neck Muscles in Individuals Experiencing Whiplash-Associated Disorders Compared to Healthy Controls: An Ultrasound Study2018In: American Journal of Physical Medicine & Rehabilitation, ISSN 0894-9115, E-ISSN 1537-7385, Vol. 97, no 2, p. 75-82Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to investigate and compare the mechanical responses of dorsal neck muscles in individuals with whiplash-associated disorders (WAD) versus healthy individuals.

    DESIGN: This study included 36 individuals with WAD (26 women and 10 men) and 36 healthy controls (26 women and 10 men). Ultrasound imaging with speckle tracking was used to measure deformation and deformation rate in five dorsal neck muscles during a neck extension task.

    RESULTS: Compared with controls, individuals with WAD showed higher deformations of the semispinalis cervicis (P = 0.02) and multifidus (P = 0.002) muscles and higher deformation rates (P = 0.03 and 0.0001, respectively). Among individuals with WAD, multifidus deformation and deformation rate were significantly associated with pain, disability, and fatigue (r = 0.31-0.46, P = 0.0001-0.01).

    CONCLUSIONS: These findings indicate that the mechanical responses of the deep dorsal neck muscles differ between individuals with WAD and healthy controls, possibly reflecting that these muscles use altered strategies while performing a neck extension task. This finding provides new insight into neck muscles pathology in patients with chronic WAD and may help improve rehabilitation programs.

  • 327.
    Rashidi, Armin
    et al.
    Univ Minnesota, Dept Hematol Oncol & Transplantat, Minneapolis, MN USA.
    Hamadani, Mehdi
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA.
    Zhang, Mei-Jie
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA;Med Coll Wisconsin, Div Biostat, Inst Hlth & Soc, Milwaukee, WI 53226 USA.
    Wang, Hai-Lin
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA.
    Abdel-Azim, Hisham
    Univ Southern Calif, Div Hematol Oncol & Blood & Marrow Transplantat, Childrens Hosp Los Angeles, Keck Sch Med, Los Angeles, CA USA.
    Aljurf, Mahmoud
    King Faisal Specialist Hosp Ctr & Res, Dept Oncol, Riyadh, Saudi Arabia.
    Assal, Amer
    Columbia Univ, Med Ctr, NYPH, New York, NY USA.
    Bajel, Ashish
    Royal Melbourne Hosp, City Campus, Parkville, Vic, Australia.
    Bashey, Asad
    Northside Hosp, Blood & Marrow Transplant Program, Atlanta, GA USA.
    Battiwalla, Minoo
    Sarah Cannon BMT Program, Hematol Branch, Nashville, TN USA.
    Beitinjaneh, Amer M.
    Univ Miami, Miami, FL USA.
    Bejanyan, Nelli
    H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplant & Cellular Immunot, Minneapolis, MN USA.
    Bhatt, Vijaya Raj
    Univ Nebraska, Med Ctr, Fred & Pamela Buffett Canc Ctr, Omaha, NE 68182 USA.
    Bolanos-Meade, Javier
    Sidney Kimmel Comprehens Canc Ctr Johns Hopkins, Baltimore, MD USA.
    Byrne, Michael
    Vanderbilt Univ, Med Ctr, 221 Kirkland Hall, Nashville, TN 37235 USA.
    Cahn, Jean-Yves
    CHU Grenoble Alpes, Dept Hematol, Grenoble, France.
    Cairo, Mitchell
    New York Med Coll, Dept Pediat, Div Pediat Hematol Oncol & Stem Cell Transplantat, Valhalla, NY 10595 USA.
    Ciurea, Stefan
    MD Anderson Canc Ctr, Houston, TX USA.
    Copelan, Edward
    Atrium Hlth, Carolinas HealthCare Syst, Levine Canc Inst, Charlotte, NC USA.
    Cutler, Corey
    Dana Farber Canc Inst, Boston, MA 02115 USA.
    Daly, Andrew
    Tom Baker Canc Clin, Calgary, AB, Canada.
    Diaz, Miguel-Angel
    Hosp Infantil Univ Nino Jesus, Dept Hematol Oncol, Madrid, Spain.
    Farhadfar, Nosha
    Univ Florida, Coll Med, Div Hematol Oncol, Gainesville, FL USA.
    Gale, Robert P.
    Imperial Coll London, Hematol Res Ctr, Dept Med, Div Expt Med, London, England.
    Ganguly, Siddhartha
    Univ Kansas, Westwood, KS USA.
    Grunwald, Michael R.
    Atrium Hlth, Carolinas HealthCare Syst, Levine Canc Inst, Charlotte, NC USA.
    Hahn, Theresa
    Roswell Pk Canc Inst, Dept Med, Buffalo, NY 14263 USA.
    Hashmi, Shahrukh
    King Faisal Specialist Hosp Ctr & Res, Dept Oncol, Riyadh, Saudi Arabia;Mayo Clin, Dept Internal Med, Rochester, MN USA.
    Hildebrandt, Gerhard C.
    Univ Kentucky, Markey Canc Ctr, Lexington, KY USA.
    Holland, H. Kent
    Northside Hosp, Blood & Marrow Transplant Program, Atlanta, GA USA.
    Hossain, Nasheed
    Loyola Univ, Chicago Stritch Sch Med, Maywood, IL 60153 USA.
    Kanakry, Christopher G.
    NCI, Expt Transplantat & Immunol Branch, Ctr Canc Res, NIH, Bethesda, MD 20892 USA.
    Kharfan-Dabaja, Mohamed A.
    Mayo Clin, Div Hematol Oncol, Blood & Marrow Transplantat Program, Jacksonville, FL 32224 USA.
    Khera, Nandita
    Mayo Clin, Dept Hematol Oncol, Phoenix, AZ USA.
    Koc, Yener
    Med Pk Hosp, Antalya, Turkey.
    Lazarus, Hillard M.
    Case Western Reserve Univ, Cleveland, OH 44106 USA.
    Lee, Jong-Wook
    Catholic Univ Korea, Seoul St Marys Hosp, Div Hematol, Seoul, South Korea.
    Maertens, Johan
    Univ Hosp Gasthuisberg, Leuven, Belgium.
    Martino, Rodrigo
    Hosp Santa Creu i St Pau, Div Clin Hematol, Barcelona, Spain.
    McGuirk, Joseph
    Univ Kansas, Westwood, KS USA.
    Munker, Reinhold
    Louisiana State Univ Hlth Shreveport, Dept Internal Med, Sect Hematol Oncol, Shreveport, LA USA.
    Murthy, Hemant S.
    Univ Florida, Coll Med, Div Hematol Oncol, Gainesville, FL USA.
    Nakamura, Ryotaro
    City Hope Natl Med Ctr, Dept Hematol & Hematopoiet Cell Transplantat, Duarte, CA USA.
    Nathan, Sunita
    Rush Univ, Med Ctr, Chicago, IL 60612 USA.
    Nishihori, Taiga
    H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL USA;Res Inst, Tampa, FL USA.
    Palmisiano, Neil
    Thomas Jefferson Univ Hosp, Philadelphia, PA 19107 USA.
    Patel, Sagar
    Cleveland Clin Fdn, Blood & Marrow Transplant Program, 9500 Euclid Ave, Cleveland, OH 44195 USA.
    Pidala, Joseph
    Res Inst, Tampa, FL USA;H Lee Moffitt Canc Ctr & Res Inst, Tampa, FL USA.
    Olin, Rebecca
    Univ Calif San Francisco, Med Ctr, San Francisco, CA 94143 USA.
    Olsson, Richard F.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Lab Med, Stockholm, Sweden.
    Oran, Betul
    Univ Texas MD Anderson Canc Ctr, Div Canc Med, Dept Stem Cell Transplantat, Houston, TX 77030 USA.
    Ringden, Olov
    Karolinska Inst, Clintec, Translat Cell Therapy Res, Stockholm, Sweden.
    Rizzieri, David
    Duke Univ, Div Hematol Malignancies & Cellular Therapy, Durham, NC USA.
    Rowe, Jacob
    Shaare Zedek Med Ctr, Dept Hematol, Jerusalem, Israel.
    Savoie, Mary Lynn
    Tom Baker Canc Clin, Calgary, AB, Canada.
    Schultz, Kirk R.
    Univ British Columbia, British Columbia Childrens Hosp, Dept Pediat Hematol Oncol & Bone Marrow Transplan, Vancouver, BC, Canada.
    Seo, Sachiko
    Dokkyo Med Univ, Dept Hematol & Oncol, Mibu, Tochigi, Japan.
    Shaffer, Brian C.
    Mem Sloan Kettering Canc Ctr, 1275 York Ave, New York, NY 10021 USA.
    Singh, Anurag
    Univ Kansas, Westwood, KS USA.
    Solh, Melhem
    Northside Hosp, Blood & Marrow Transplant Program, Atlanta, GA USA.
    Stockerl-Goldstein, Keith
    Barnes Jewish Hosp, St Louis, MO 63110 USA.
    Verdonck, Leo F.
    Isala Clin, Dept Hematol Oncol, Zwolle, Netherlands.
    Wagner, John
    Thomas Jefferson Univ Hosp, Philadelphia, PA 19107 USA.
    Waller, Edmund K.
    Emory Univ, Dept Hematol & Med Oncol, Winship Canc Inst, Atlanta, GA 30322 USA.
    De Lima, Marcos
    Univ Hosp, Case Med Ctr, Dept Med, Seidman Canc Ctr, Cleveland, OH USA.
    Sandmaier, Brenda M.
    Univ Washington, Div Med Oncol, Seattle, WA 98195 USA;Fred Hutchinson Canc Res Ctr, Div Clin Res, 1124 Columbia St, Seattle, WA 98104 USA.
    Litzow, Mark
    Mayo Clin, Div Hematol, Rochester, MN USA;Mayo Clin, Transplant Ctr, Rochester, MN USA.
    Weisdorf, Dan
    Univ Minnesota, Med Ctr, Dept Med, Div Hematol Oncol & Transplantat, Minneapolis, MN 55455 USA.
    Romee, Rizwan
    Dana Farber Canc Inst, Boston, MA 02115 USA.
    Saber, Wael
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA.
    Outcomes of haploidentical vs matched sibling transplantation for acute myeloid leukemia in first complete remission2019In: BLOOD ADVANCES, ISSN 2473-9529, Vol. 3, no 12, p. 1826-1836Article in journal (Refereed)
    Abstract [en]

    HLA-haploidentical hematopoietic cell transplantation (Haplo-HCT) using posttransplantation cyclophosphamide (PT-Cy) has improved donor availability. However, a matched sibling donor (MSD) is still considered the optimal donor. Using the Center for International Blood and Marrow Transplant Research database, we compared outcomes after Haplo-HCT vs MSD in patients with acute myeloid leukemia (AML) in first complete remission (CR1). Data from 1205 adult CR1 AML patients (2008-2015) were analyzed. A total of 336 patients underwent PT-Cy-based Haplo-HCT and 869 underwent MSD using calcineurin inhibitor-based graft-versus-host disease (GVHD) prophylaxis. The Haplo-HCT group included more reduced-intensity conditioning (65% vs 30%) and bone marrow grafts (62% vs 7%), consistent with current practice. In multivariable analysis, Haplo-HCT and MSD groups were not different with regard to overall survival (P = .15), leukemia-free survival (P = .50), nonrelapse mortality (P = .16), relapse (P = .90), or grade II-IV acute GVHD (P = .98). However, the Haplo-HCT group had a significantly lower rate of chronic GVHD (hazard ratio, 0.38; 95% confidence interval, 0.30-0.48; P < .001). Results of subgroup analyses by conditioning intensity and graft source suggested that the reduced incidence of chronic GVHD in Haplo-HCT is not limited to a specific graft source or conditioning intensity. Center effect and minimal residual disease-donor type interaction were not predictors of outcome. Our results indicate a lower rate of chronic GVHD after PT-Cy-based Haplo-HCT vs MSD using calcineurin inhibitor-based GVHD prophylaxis, but similar other outcomes, in patients with AML in CR1. Haplo-HCT is a viable alternative to MSD in these patients.

  • 328. Rosdahl, Anja
    et al.
    Herzog, Christian
    Frösner, Gert
    Norén, Torbjörn
    Rombo, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Askling, Helena H
    An extra priming dose of hepatitis A vaccine to adult patients with rheumatoid arthritis and drug induced immunosuppression: A prospective, open-label, multi-center study2018In: Travel Medicine and Infectious Disease, ISSN 1477-8939, E-ISSN 1873-0442, Vol. 21, p. 43-50Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Previous studies have indicated that a pre-travel single dose of hepatitis A vaccine is not sufficient as protection against hepatitis A in immunocompromised travelers. We evaluated if an extra dose of hepatitis A vaccine given shortly prior to traveling ensures seroconversion.

    METHOD:

    Patients with rheumatoid arthritis (n = 69, median age = 55 years) treated with Tumor Necrosis Factor inhibitor(TNFi) and/or Methotrexate (MTX) were immunized with two doses of hepatitis A vaccine, either as double dose or four weeks apart, followed by a booster dose at six months. Furthermore, 48 healthy individuals, median age = 60 years were immunized with two doses, six months apart. Anti-hepatitis A antibodies were measured at 0, 1, 2, 6, 7 and 12 months.

    RESULTS:

    Two months after the initial vaccination, 84% of the RA patients had protective antibodies, compared to 85% of the healthy individuals. There was no significant difference between the two vaccine schedules. At twelve months, 99% of RA patients and 100% of healthy individuals had seroprotective antibodies.

    CONCLUSION:

    An extra priming dos of hepatitis A vaccine prior to traveling offered an acceptable protection in individuals treated with TNFi and/or MTX. This constitutes an attractive pre-travel solution to this vulnerable group of patients.

  • 329. Rosdahl, Anja
    et al.
    Herzog, Christian
    Frösner, Gert
    Norén, Torbjörn
    Rombo, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Askling, Helena H
    Corrigendum to " An extra priming dose of hepatitis A vaccine to adult patients with rheumatoid arthritis and drug induced immunosuppression - A prospective, open-label, multi-center study" [Trav. Med. Infect. Dis. 21, January-February 2018, 43-50].2019In: Travel Medicine and Infectious Disease, ISSN 1477-8939, E-ISSN 1873-0442, Vol. 27, p. 115-115Article in journal (Refereed)
  • 330. Rumke, Hans C.
    et al.
    Richardus, Jan Hendrik
    Rombo, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Pauksens, Karlis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
    Plassmann, Georg
    Durand, Christelle
    Devaster, Jeanne-Marie
    Dewe, Walthere
    Oostvogels, Lidia
    Selection of an adjuvant for seasonal influenza vaccine in elderly people: modelling immunogenicity from a randomized trial2013In: BMC Infectious Diseases, ISSN 1471-2334, E-ISSN 1471-2334, Vol. 13, p. 348-Article in journal (Refereed)
    Abstract [en]

    Background: Improved influenza vaccines are needed to reduce influenza-associated complications in older adults. The aim of this study was to identify the optimal formulation of adjuvanted seasonal influenza vaccine for use in elderly people. Methods: This observer-blind, randomized study assessed the optimal formulation of adjuvanted seasonal influenza vaccine based on immunogenicity and safety in participants aged >= 65 years. Participants were randomized (similar to 200 per group) to receive one dose of non-adjuvanted vaccine or one of eight formulations of vaccine formulated with a squalene and tocopherol oil-in-water emulsion-based Adjuvant System (AS03(C), AS03(B) or AS03(A), with 2.97, 5.93 and 11.86 mg tocopherol, respectively) together with the immunostimulant monophosphoryl lipid A (MPL, doses of 0, 25 or 50 mg). Hemagglutination-inhibition (HI) antibody responses and T-cell responses were assessed on Day 0 and 21 days post-vaccination. The ratio of HI-based geometric mean titers in adjuvanted versus non-adjuvanted vaccine groups were calculated and the lower limit of the 90% confidence interval was transformed into a desirability index (a value between 0 and 1) in an experimental domain for each vaccine strain, and plotted in relation to the AS03 and MPL dose combination in the formulation. This model was used to assess the optimal formulation based on HI antibody titers. Reactogenicity and safety were also assessed. The immunogenicity and safety analyses were used to evaluate the optimal formulation of adjuvanted vaccine. Results: In the HI antibody-based model, an AS03 dose-response was evident; responses against the A/H1N1 and A/H3N2 strains were higher for all adjuvanted formulations versus non-adjuvanted vaccine, and for the AS03(A)-MPL25, AS03(B)-MPL25 and AS03(B)-MPL50 formulations against the B strain. Modelling using more stringent criteria (post hoc) showed a clear dose-range effect for the AS03 component against all strains, whereas MPL showed a limited effect. Higher T-cell responses for adjuvanted versus non-adjuvanted vaccine were observed for all except two formulations (AS03(C) and AS03(B)-MPL25). Reactogenicity increased with increasing AS03 dosage, and with MPL. No safety concerns were raised. Conclusions: Five formulations containing AS03(A) or AS03(B) were identified as potential candidates to improve immune responses to influenza vaccination; AS03(B) without MPL showed the best balance between improved immunogenicity and acceptable reactogenicity.

  • 331.
    Rydell, Andreas
    et al.
    Karolinska Inst, Stockholm, Sweden.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Lisspers, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Ställberg, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Nowak, Christoph
    Karolinska Inst, Stockholm, Sweden.
    Carlsson, Axel
    Karolinska Inst, Stockholm, Sweden.
    Feldreich, Tobias
    Dalarna Univ, Falun, Sweden.
    Iggman, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology.
    Ärnlöv, Johan
    Karolinska Inst, Stockholm, Sweden.
    Endothelial dysfunction is associated with impaired lung function in two independent community cohorts2018In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52Article in journal (Other academic)
  • 332. Rüger, Gabriela
    et al.
    Gabutti, Giovanni
    Rümke, Hans
    Rombo, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Bernaola, Enrique
    Diez-Domingo, Javier
    Martinon-Torres, Federico
    Høgh, Birthe
    Konstantopoulos, Antreas
    Fiquet, Anne
    Thomas, Stéphane
    Eymin, Cécile
    Baudin, Martine
    Safety of a 2-dose regimen of a combined measles, mumps, rubella and varicella live vaccine manufactured with recombinant human albumin2012In: The Pediatric Infectious Disease Journal, ISSN 0891-3668, E-ISSN 1532-0987, Vol. 31, no 11, p. 1166-1172Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    ProQuad, a vaccine containing antigens from M-M-RVAXPRO (measles, mumps and rubella vaccine) and VARIVAX (varicella vaccine), is indicated for simultaneous vaccination against measles, mumps, rubella and varicella (MMRV) in individuals from 12 months of age. To eliminate blood-derived products of human origin from the manufacturing process of the MMRV vaccine, recombinant human albumin was selected as a replacement for human serum albumin.

    METHODS:

    This open-label, multicenter clinical trial (clinicaltrials.gov identifier NCT00560755) was designed to describe the safety profile of a 2-dose schedule of the MMRV vaccine at a 1-month interval in healthy children aged 12-22 months.

    RESULTS:

    In total, 3388 children received at least 1 dose of the MMRV vaccine. Overall, 3376 (99.65%) children were included in the post-dose 1 safety analysis and 3342 (98.64%) in the post-dose 2 safety analysis. After doses 1 and 2, the frequencies of children experiencing solicited injection-site reactions (post-dose 1: erythema 14.31%; swelling 5.57% and pain 10.31%; post-dose 2: erythema 30.46%; swelling 13.23% and pain 11.49%), rashes of interest (post-dose 1: 11.4%; post-dose 2: 2.78%), vaccine-related nonserious systemic adverse events (post-dose 1: 34.86%; post-dose 2: 13.4%) and temperature ≥39.4 °C (post-dose 1: 25.24%; post-dose 2: 12.06%) were consistent with those observed in previous studies of the MMRV vaccine manufactured with human serum albumin. Neither serious allergic-type adverse events nor anaphylactic reactions were reported.

    CONCLUSION:

    The results confirm the good safety profiles of MMRV and of measles, mumps and rubella vaccines manufactured with recombinant human albumin.

  • 333.
    Sadr-Azodi, Omid
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Inst Environm Med, Epidemiol Unit, S-17177 Stockholm, Sweden..
    Gudbjornsdottir, Soffia
    Registerctr VGR, Natl Diabet Register, Gothenburg, Sweden.;Univ Gothenburg, Sahlgrenska Univ Hosp, Dept Med, Gothenburg, Sweden..
    Ljung, Rickard
    Karolinska Inst, Inst Environm Med, Epidemiol Unit, S-17177 Stockholm, Sweden..
    Pattern of increasing HbA(1c) levels in patients with diabetes mellitus before clinical detection of pancreatic cancer - a population-based nationwide case-control study2015In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 54, no 7, p. 986-992Article in journal (Refereed)
    Abstract [en]

    Background. Diabetes mellitus is a risk factor for pancreatic cancer. Impaired insulin resistance might precede the clinical detection of this cancer by several years. Methods. This was a nested case-control population-based study assessing the pattern of glycated hemoglobin (HbA(1c)) change before clinical detection of pancreatic cancer in a population of individuals with diabetes mellitus. All patients registered in the Swedish National Diabetes Register with a prescription of an anti-diabetic drug between 2005 and 2011 were identified. For each case of pancreatic cancer, 10 controls were randomly selected, matched for age, sex, and factors related to diabetes mellitus. Multivariable conditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between HbA(1c) and pancreatic cancer. Results. In total, 391 cases and 3910 matched controls were identified. The risk of pancreatic cancer was increased more than two-fold in individuals with the highest HbA(1c) quartile compared with the lowest (OR 1.96, 95% CI 1.40-2.75). The risk of pancreatic cancer remained elevated when comparing the highest HbA(1c) quartile measured within five years from the clinical detection of pancreatic cancer to the lowest HbA(1c) quartile (p-value for trend < 0.05). No association was found between HbA(1c) and pancreatic cancer if HbA(1c) was measured > 5 years before the clinical detection of pancreatic cancer. Conclusions. The pattern of increasing HbA(1c) in patients with diabetes mellitus preceded the clinical detection of pancreatic cancer by up to five years. These findings indicate that there is a lead time of several years during which the development of pancreatic cancer might be detectable through screening in patients with diabetes mellitus.

  • 334.
    Sadr-Azodi, Omid
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Med Solna, Clin Epidemiol Unit, T2 Karolinska Univ Hosp, Stockholm, Sweden.; Eskilstuna Cty Hosp, Dept Surg, Eskilstuna, Sweden..
    Konings, Peter
    Karolinska Inst, Dept Mol Med & Surg, Upper Gastrointestinal Res, Stockholm, Sweden..
    Brusselaers, Nele
    Karolinska Inst, Dept Mol Med & Surg, Upper Gastrointestinal Res, Stockholm, Sweden..
    Menopausal hormone therapy and pancreatic cancer risk in women: a population-based matched cohort study2017In: United European Gastroenterology journal, ISSN 2050-6406, E-ISSN 2050-6414, Vol. 5, no 8, p. 1123-1128Article in journal (Refereed)
    Abstract [en]

    Background The role of menopausal hormone therapy (MHT) in the development of pancreatic cancer is inconclusive owing to small studies and lack of proper study design. Methods This population-based matched cohort study included all Swedish women who used systemic MHT between 1 July 2005 and 31 December 2012. For each user of MHT, three never-users of MHT were randomly selected, matched for childbirth, history of thromboembolic events, and previous hysterectomy, as well as for year of birth, diabetes, obesity, and smoking- or alcohol-related disorders. Multivariable conditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between MHT use and pancreatic cancer. The effect of MHT duration on pancreatic cancer development was calculated using multivariable Poisson regression. Results There were 290,186 ever-users of MHT and 870,165 matched never-users. During the follow-up, 311 (0.0011%) ever-users of MHT and 1220 (0.0014) never-users developed pancreatic cancer. In a multivariable adjusted model, ever-users had a 23% reduced risk (OR 0.77; 95% CI: 0.68-0.87) of pancreatic cancer. This risk decreased by 35% (incidence rate ratio (IRR) 0.65; 95% CI: 0.33-1.27) in women who used MHT 1-2 years and by 60% (IRR 0.40; 95% CI: 0.18-0.88) in women who used MHT3 years compared to women with <1 year of MHT use. The type of MHT did not change the results. Conclusion Systemic MHT use might reduce the risk of pancreatic cancer.

  • 335.
    Sadr-Azodi, Omid
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Med Solna, Clin Epidemiol Unit, Stockholm, Sweden;Eskilstuna Cty Hosp, Dept Surg, Eskilstuna, Sweden.
    Oskarsson, Viktor
    Karolinska Inst, Inst Environm Med, Unit Nutr Epidemiol, Stockholm, Sweden.
    Discacciati, Andrea
    Karolinska Inst, Inst Environm Med, Unit Biostat, Stockholm, Sweden.
    Askling, Johan
    Karolinska Inst, Dept Med Solna, Clin Epidemiol Unit, Stockholm, Sweden.
    Videhult, Per
    Vasteras Cty Hosp, Dept Surg, Vasteras, Sweden.
    Ekbom, Anders
    Karolinska Inst, Dept Med Solna, Clin Epidemiol Unit, Stockholm, Sweden.
    Pancreatic Cancer Following Acute Pancreatitis: A Population-based Matched Cohort Study2018In: American Journal of Gastroenterology, ISSN 0002-9270, E-ISSN 1572-0241, Vol. 113, no 11, p. 1711-1719Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Acute pancreatitis is linked to pancreatic cancer, but the direction of this association is not fully elaborated.

    METHODS: This was a population-based cohort study including all Swedish residents diagnosed with a first-time episode of acute pancreatitis between 1997 and 2013 and corresponding matched pancreatitis-free individuals from the general population. Hazard ratios for the association between acute pancreatitis and pancreatic cancer were estimated using multivariable Cox regression models.

    RESULTS: Overall, 49,749 individuals with acute pancreatitis and 138,750 matched individuals without acute pancreatitis were followed up for 1,192,134 person-years (median 5.3 years). A total of 769 individuals developed pancreatic cancer, of whom 536 (69.7%) had a history of acute pancreatitis. The risk of pancreatic cancer was substantially increased during the first few years after a diagnosis of acute pancreatitis but declined gradually over time, reaching a level comparable to the pancreatitis-free population after >10 years of follow-up. In those with non-gallstone-related acute pancreatitis, the risk of pancreatic cancer declined to a level comparable to the pancreatitis-free population only when follow-up time was censored for a second episode of acute pancreatitis or a diagnosis of chronic pancreatitis. Increasing number of recurrent episodes of acute pancreatitis was associated with increased risk of pancreatic cancer.

    CONCLUSION: These findings imply a delay in the diagnosis of pre-existing pancreatic cancer, if clinically presented as acute pancreatitis. Any association between non-gallstone-related acute pancreatitis and pancreatic cancer in the long-term (>10 years) could be mediated through recurrent acute pancreatitis or chronic pancreatitis.

  • 336.
    Samreth, D.
    et al.
    Kyomed, Montpellier, France.
    Arnavielhe, S.
    Kyomed, Montpellier, France.
    Ingenrieth, F.
    Selbstregulierung Informationswirtschaft eV, Berlin, Germany.
    Bedbrook, A.
    MACVIA France, Fondat Partenariale FMC VIA LR, Montpellier, France.
    Onorato, G. L.
    MACVIA France, Fondat Partenariale FMC VIA LR, Montpellier, France.
    Murray, R.
    MedScript Ltd, Dundalk, Co Louth, Ireland.
    Almeida, R.
    Medina, Lda, Porto, Portugal;Univ Porto, Ctr Hlth Technol & Serv Res CINTESIS, Fac Med, Porto, Portugal.
    Mizani, M. A.
    Univ Edinburgh, Asthma UK Ctr Appl Res, Ctr Med Informat, Usher Inst Populat Hlth Sci & Informat, Edinburgh, Midlothian, Scotland.
    Fonseca, J.
    Medina, Lda, Porto, Portugal;Univ Porto, Ctr Hlth Technol & Serv Res CINTESIS, Fac Med, Porto, Portugal.
    Costa, E.
    Univ Porto, UCIBIO, REQUINTE, Fac Pharm, Porto, Portugal;Univ Porto, Competence Ctr Active & Hlth Ageing, Porto, Portugal.
    Malva, J.
    Univ Coimbra, IBILI, Fac Med, Ageing Coimbra EIP AHA Reference Site, Coimbra, Portugal.
    Morais-Almeida, M.
    CUF Descobertas Hosp, Allergy Ctr, Lisbon, Portugal.
    Pereira, A. M.
    Univ Porto, Allergy Unit, CUF Porto Hosp & Inst, Ctr Res Hlth Technol & informat Syst CINTESIS, Porto, Portugal.
    Todo-Bom, A.
    Univ Coimbra, Imunoalergol Ctr Hosp, Coimbra, Portugal;Univ Coimbra, Fac Med, Coimbra, Portugal.
    Menditto, E.
    Univ Naples Federico II, CIRFF, Naples, Italy.
    Stellato, C.
    Univ Salerno, Scuola Med Salernitana, Dept Med Surg & Dent, Salerno, Italy.
    Ventura, M. T.
    Univ Bari, Med Sch, Unit Geriatr Immunoallergol, Bari, Italy.
    Larenas-Linnemann, D.
    Hosp Med Sur, Ctr Excellence Asthma & Allergy, Mexico City, DF, Mexico.
    Fuentes-Perez, J-M
    Huerta-Villalobos, Y. R.
    Cruz, A. A.
    Univ Fed Bahia, ProAR Nucl Excelencia Asma, Salvador, BA, Brazil;Univ Fed Bahia, WHO GARD Planning Grp, Salvador, BA, Brazil.
    Stelmach, R.
    Univ Sao Paulo, Pulmonary Div, Heart Inst InCor, Hosp Clin Fac Med, Sao Paulo, Brazil.
    Da Silva, J.
    Fed Univ Santa Catarina UFSC, Dept Internal Med, Florianopolis, SC, Brazil;Fed Univ Santa Catarina UFSC, Allergy Clin, Prof Polydoro Ernani Sao Thiago Univ Hosp, Florianopolis, SC, Brazil.
    Emuzyte, R.
    Vilnius Univ, Clin Childrens Dis, Fac Med, Vilnius, Lithuania.
    Kvedariene, V.
    Vilnius Univ, Fac Med, Vilnius, Lithuania.
    Valiulis, A.
    Furopean Acad Paediat, FAP UEMS SP, Brussels, Belgium;Vilnius Univ, Inst Hlth Sci, Dept Publ Hlth, Inst Clin Med, Vilnius, Lithuania;Vilnius Univ, Clin Childrens Dis, Inst Clin Med, Vilnius, Lithuania.
    Annesi-Maesano, I.
    Sorbonne Univ Paris, Epidemiol Allerg & Resp Dis, Dept Inst Pierre Louis Epidemiol & Publ Hlth, Med Sch St Antoine,INSERM, Paris, France.
    Bosse, I.
    Allergist, La Rochelle, France.
    Demoly, P.
    Montpellier Univ Hosp, Dept Resp Dis, Montpellier, France.
    Devillier, P.
    Univ Paris Saclay, UPRES EA220, Pole Malad Voies Resp, Hop Foch, Suresnes, France.
    Fontaine, J. F.
    Allergist, Reims, France.
    Kuna, P.
    Med Univ Lodz, Div Internal Med Asthma & Allergy, Barlicki Univ Hosp, Lodz, Poland.
    Samolinski, B.
    Med Univ Warsaw, Samolinski Dept Prevent Envinronm Hazards, Warsaw, Poland.
    Klimek, L.
    Ctr Rhinol & Allergol, Wiesbaden, Germany.
    Mosges, R.
    CRI Clin Res Int Ltd, Hamburg, Germany;Univ Cologne, Inst Med Stat & Computat Biol, Med Fac, Cologne, Germany.
    Pfaar, O.
    Heidelberg Univ, Dept Otorhinolaryngol Head & Neck Surg, Univ Med Mannheim, Med Fac Mannheim, Heidelberg, Germany;Ctr Rhinol & Allergol, Wiesbaden, Germany.
    Shamai, S.
    CRI Clin Res Int Ltd, Hamburg, Germany;Univ Cologne, Inst Med Stat & Computat Biol, Med Fac, Cologne, Germany.
    Bewick, M.
    iQ4U Consultants Ltd, London, England.
    Ryan, D.
    Univ Edinburgh, Usher Inst Populat Hlth Sci & Informat, Honorary Clin Res Fellow, Allergy & Resp Res Grp,Med Sch, Edinburgh, Midlothian, Scotland;Woodbrook Med Ctr, Loughborough, Leics, England.
    Sheikh, A.
    Univ Edinburgh, Asthma UK Ctr Appl Res, Ctr Med Informat, Usher Inst Populat Hlth Sci & Informat, Edinburgh, Midlothian, Scotland.
    Anto, J. M.
    CIBER Epidemiol Salud Publ CIBERESP, Barcelona, Spain;ISGlobAL, Ctr Res Environm Epidemiol CREAL, Barcelona, Spain;UPF, Barcelona, Spain;Hosp Mar Res Inst, IMIM, Barcelona, Spain.
    Cardona, V.
    Hosp Valle De Hebron, S Med Interna, Barcelona, Spain.
    Mullol, J.
    Univ Barcelona, Rhinol Unit, Barcelona, Spain.
    Valero, A.
    Univ Barcelona, Smell Clin, ENT Dept,Hosp Clin, Clin & Expt Resp Immunoallergy,IDIBAPS CIBERES, Barcelona, Spain.
    Chavannes, N. H.
    Univ Barcelona, Pneumol & Allergy Dept CIBERES, Clin & Expt Resp Immunoallergy, IDIBAPS, Barcelona, Spain.
    Fokkens, W. J.
    Leiden Univ Med Ctr, Dept Publ Hlth & Primary Care, Leiden, Netherlands.
    Reitsma, S.
    Leiden Univ Med Ctr, Dept Publ Hlth & Primary Care, Leiden, Netherlands.
    Roller-Wirnsberger, R. E.
    Acad Med Ctr, Dept Otorhinolaryngol, Amsterdam, Netherlands.
    Tomazic, P. V.
    Med Univ Graz, Dept Internal Med, Graz, Austria.
    Haahtela, T.
    Med Univ Graz, Dept ENT, Graz, Austria.
    Toppila-Salmi, S.
    Med Univ Graz, Dept ENT, Graz, Austria.
    Valovirta, E.
    Helsinki Univ Hosp, Skin & Allergy Hosp, Helsinki, Finland.
    Makris, M.
    Univ Turku, Terveystalo Allergy clin, Dept Lung Dis & Clin Immunol, Turku, Finland;Univ Manchester, Div Infect, Immun Resp Med 1, Manchester, Lancs, England.
    Papadopoulos, N. G.
    Univ Turku, Terveystalo Allergy clin, Dept Lung Dis & Clin Immunol, Turku, Finland;Univ Manchester, Div Infect, Immun Resp Med 1, Manchester, Lancs, England.
    Prokopakis, E. P.
    Univ Athens, Allergy Dept, Pediat Clin 2, Athens, Greece.
    Psarros, F.
    Allergy Dept Athens Naval Hosp, Athens, Greece;Univ Crete, Sch Med, Dept Otorhinolaryngol, Iraklion, Greece.
    Gemicioglu, B.
    Istanbul Univ, Cerrahpasa Fac Med, Dept Pulm Dis, Istanbul, Turkey.
    Yorgancioglu, A.
    Celal Bayar Univ, Dept Pulm Dis, Fac Med, Manisa, Turkey;Celal Bayar Univ, GARD Execut Comm, Manisa, Turkey.
    Bindslev-Jensen, C.
    Celal Bayar Univ, Dept Pulm Dis, Fac Med, Manisa, Turkey;Odense Univ Hosp, Dept Dermatol, Odense, Denmark;Odense Univ Hosp, Allergy Ctr, ORCA, Odense, Denmark.
    Eller, E.
    Odense Univ Hosp, Dept Dermatol, Odense, Denmark;Odense Univ Hosp, Allergy Ctr, ORCA, Odense, Denmark.
    Kull, I.
    Karolinska Inst, Dept Clin Sci & Educ Sodersjukhuset, Stockholm, Sweden.
    Wickman, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Bachert, C.
    Univ Amsterdam, Acad Med Ctr, Amsterdam, Netherlands.
    Hellings, P. W.
    Euforea, Brussels, Belgium.
    Pugin, B.
    Bosnic-Anticevich, S.
    Sydney Local Hlth Dist, Glebe, NSW, Australia.
    O'Hehir, R. E.
    Monash Univ, Dept Allergy Immunol & Resp Med, Alfred Hosp, Melbourne, Vic, Australia;Monash Univ, Cent Clin Sch, Melbourne, Vic, Australia.
    Kolek, V.
    Sova, M.
    Wehner, K.
    Tech Univ, Fachbereich Biol, Darmstadt, Germany.
    De Vries, G.
    Peercode BV, Geldermalsen, Netherlands.
    van Eerd, M.
    Peercode BV, Geldermalsen, Netherlands.
    Laune, D.
    Selbstregulierung Informationswirtschaft eV, Berlin, Germany.
    Wittmann, J.
    Bousquet, J.
    Euforea, Brussels, Belgium;INSERM, VIMA, Ageing & chron Dis Epidemiol & publ Hlth approach, U 1168, Villejuif, France;Univ Versailles St Quentin En Yvelines, UMR S 1168, Montigny La Bretonneux, France.
    Poncelet, P.
    LIRMM, Montpellier, France.
    Geolocation with respect to persona privacy for the Allergy Diary app - a MASK study2018In: World Allergy Organization Journal, ISSN 1731-3317, E-ISSN 1939-4551, Vol. 11, article id 15Article in journal (Refereed)
    Abstract [en]

    Background: Collecting data on the localization of users is a key issue for the MASK (Mobile Airways Sentinel network: the Allergy Diary) App. Data anonymization is a method of sanitization for privacy. The European Commission's Article 29 Working Party stated that geolocation information is personal data. To assess geolocation using the MASK method and to compare two anonymization methods in the MASK database to find an optimal privacy method. Methods: Geolocation was studied for all people who used the Allergy Diary App from December 2015 to November 2017 and who reported medical outcomes. Two different anonymization methods have been evaluated: Noise addition (randomization) and k-anonymity (generalization). Results: Ninety-three thousand one hundred and sixteen days of VAS were collected from 8535 users and 54,500 (58. 5%) were geolocalized, corresponding to 5428 users. Noise addition was found to be less accurate than k-anonymity using MASK data to protect the users' life privacy. Discussion: k-anonymity is an acceptable method for the anonymization of MASK data and results can be used for other databases.

  • 337.
    Satwani, P.
    et al.
    Columbia Univ, Dept Pediat, Med Ctr, Div Pediat Hematol Oncol & Stem Cell Transplantat, New York, NY 10027 USA..
    Ahn, K. W.
    Med Coll Wisconsin, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA.;Med Coll Wisconsin, Inst Hlth & Soc, Div Biostat, Milwaukee, WI 53226 USA..
    Carreras, J.
    Med Coll Wisconsin, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA..
    Abdel-Azim, H.
    Univ So Calif, Keck Sch Med, Childrens Hosp Los Angeles, Div Hematol Oncol & Blood & Marrow Transplantat, Los Angeles, CA 90033 USA..
    Cairo, M. S.
    New York Med Coll, Pediat Hematol Oncol & Stem Cell Transplantat, New York, NY USA..
    Cashen, A.
    Washington Univ, Sch Med, Div Oncol, St Louis, MO USA..
    Chen, A. I.
    Oregon Hlth & Sci Univ, Portland, OR 97201 USA..
    Cohen, J. B.
    Emory Univ, Sch Med, Winship Canc Inst, Dept Hematol & Med Oncol, Atlanta, GA USA..
    Costa, L. J.
    Univ Alabama Birmingham, Dept Med, Div Hematol Oncol, Birmingham, AL 35294 USA..
    Dandoy, C.
    Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH 45229 USA..
    Fenske, T. S.
    Med Coll Wisconsin, Div Hematol & Oncol, Milwaukee, WI 53226 USA..
    Freytes, C. O.
    South Texas Vet Hlth Care Syst, San Antonio, TX USA.;Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA..
    Ganguly, S.
    Univ Kansas, Med Ctr, Div Hematol & Oncol, Blood & Marrow Transplantat, Kansas City, KS 66103 USA..
    Gale, R. P.
    Univ London Imperial Coll Sci Technol & Med, Dept Med, Div Expt Med, Hematol Res Ctr, London, England..
    Ghosh, N.
    Carolinas Healthcare Syst, Levine Canc Inst, Dept Hematol Oncol & Blood Disorders, Charlotte, NC USA..
    Hertzberg, M. S.
    Prince Wales Hosp, Dept Haematol, Randwick, NSW 2031, Australia..
    Hayashi, R. J.
    Washington Univ, Dept Pediat, Sch Med St Louis, Div Pediat Hematol Oncol, St Louis, MO 63130 USA..
    Kamble, R. T.
    Baylor Coll Med, Ctr Cell & Gene Therapy, Div Hematol & Oncol, Houston, TX 77030 USA..
    Kanate, A. S.
    W Virginia Univ, Osborn Hematopoiet Malignancy & Transplantat Prog, Morgantown, WV 26506 USA..
    Keating, A.
    Kharfan-Dabaja, M. A.
    Univ S Florida, Coll Med, H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL 33612 USA..
    Lazarus, H. M.
    Univ Hosp Case Med Ctr, Seidman Canc Ctr, Cleveland, OH USA..
    Marks, D. I.
    Univ Hosp Bristol NHS Trust, Pediat Bone Marrow Transplant, Bristol, Avon, England..
    Nishihori, T.
    Univ S Florida, Coll Med, H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL 33612 USA..
    Olsson, R. F.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Lab Med, Div Therapeut Immunol, Stockholm, Sweden..
    Prestidge, T. D.
    Starship Childrens Hosp, Blood & Canc Ctr, Auckland, New Zealand..
    Rolon, J. M.
    FUNDALEU, Bone Marrow Transplante Unit, Buenos Aires, DF, Argentina..
    Savani, B. N.
    Vanderbilt Univ, Med Ctr, Dept Med, Div Hematol Oncol, Nashville, TN 37235 USA..
    Vose, J. M.
    Nebraska Med Ctr, Dept Internal Med, Omaha, NE USA..
    Wood, W. A.
    Univ N Carolina, Dept Med, Div Hematol Oncol, Chapel Hill, NC USA..
    Inwards, D. J.
    Mayo Clin, Div Hematol, Rochester, MN USA..
    Bachanova, V.
    Univ Minnesota, Med Ctr, Bone & Marrow Transplant Program, Minneapolis, MN 55455 USA..
    Smith, S. M.
    Univ Chicago, Sect Hematol Oncol, Chicago, IL 60637 USA..
    Maloney, D. G.
    Fred Hutchinson Canc Res Ctr, Seattle, WA 98104 USA..
    Sureda, A.
    Hosp Duran & Reynals, Inst Catala Oncol, Serv Hematol, Barcelona, Spain..
    Hamadani, M.
    Med Coll Wisconsin, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA..
    A prognostic model predicting autologous transplantation outcomes in children, adolescents and young adults with Hodgkin lymphoma2015In: Bone Marrow Transplantation, ISSN 0268-3369, E-ISSN 1476-5365, Vol. 50, no 11, p. 1416-1423Article in journal (Refereed)
    Abstract [en]

    Autologous hematopoietic cell transplantation (AutoHCT) is a potentially curative treatment modality for relapsed/ refractory Hodgkin lymphoma (HL). However, no large studies have evaluated pretransplant factors predictive of outcomes of AutoHCT in children, adolescents and young adults (CAYA, age < 30 years). In a retrospective study, we analyzed 606 CAYA patients (median age 23 years) with relapsed/refractory HL who underwent AutoHCT between 1995 and 2010. The probabilities of PFS at 1, 5 and 10 years were 66% (95% confidence interval (CI): 62-70), 52% (95% CI: 48-57) and 47% (95% CI: 42-51), respectively. Multivariate analysis for PFS demonstrated that at the time of AutoHCT patients with Karnofsky/Lansky score >= 90, no extranodal involvement and chemosensitive disease had significantly improved PFS. Patients with time from diagnosis to first relapse of < 1 year had a significantly inferior PFS. A prognostic model for PFS was developed that stratified patients into low-, intermediate-and high-risk groups, predicting for 5-year PFS probabilities of 72% (95% CI: 64-80), 53% (95% CI: 47-59) and 23% (95% CI: 9-36), respectively. This large study identifies a group of CAYA patients with relapsed/refractory HL who are at high risk of progression after AutoHCT. Such patients should be targeted for novel therapeutic and/or maintenance approaches post-AutoHCT.

  • 338.
    Schell, Carl Otto
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy, Stockholm, Sweden.
    Beane, Abigail
    Mahidol Oxford Trop Res Unit, Bangkok, Thailand.
    Kayambankadzanja, Raphael Kazidule
    Univ Malawi, Coll Med, Blantyre, Malawi.
    Khalid, Karima
    Muhimbili Univ Hlth & Allied Sci, Dept Anaesthesia & Crit Care, Dar Es Salaam, Tanzania.
    Haniffa, Rashan
    Network Improving Crit Care Syst & Training, Colombo, Sri Lanka;UCL, Div Med, Bloomsbury Inst Intens Care Med, London, England.
    Baker, Tim
    Karolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy, Stockholm, Sweden;Univ Malawi, Coll Med, Blantyre, Malawi.
    Global Critical Care: Add Essentials to the Roadmap2019In: Annals of Global Health, E-ISSN 2214-9996, Vol. 85, no 1, article id 97Article in journal (Other academic)
  • 339.
    Schell, Carl Otto
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Castegren, Markus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Lugazia, Edwin
    Blixt, Jonas
    Mulungu, Moses
    Konrad, David
    Baker, Tim
    Severely deranged vital signs as triggers for acute treatment modifications on an intensive care unit in a low-income country2015In: BMC Research Notes, ISSN 1756-0500, E-ISSN 1756-0500, Vol. 8, article id 313Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Critical care saves lives of the young with reversible disease. Little is known about critical care services in low-income countries. In a setting with a shortage of doctors the actions of the nurse bedside are likely to have a major impact on the outcome of critically ill patients with rapidly changing physiology. Identification of severely deranged vital signs and subsequent treatment modifications are the basis of modern routines in critical care, for example goal directed therapy and rapid response teams. This study assesses how often severely deranged vital signs trigger an acute treatment modification on an Intensive Care Unit (ICU) in Tanzania.

    METHODS: A medical records based, observational study. Vital signs (conscious level, respiratory rate, oxygen saturation, heart rate and systolic blood pressure) were collected as repeated point prevalences three times per day in a 1-month period for all adult patients on the ICU. Severely deranged vital signs were identified and treatment modifications within 1 h were noted.

    RESULTS: Of 615 vital signs studied, 126 (18%) were severely deranged. An acute treatment modification was in total indicated in 53 situations and was carried out three times (6%) (2/32 for hypotension, 0/8 for tachypnoea, 1/6 for tachycardia, 0/4 for unconsciousness and 0/3 for hypoxia).

    CONCLUSIONS: This study suggests that severely deranged vital signs are common and infrequently lead to acute treatment modifications on an ICU in a low-income country. There may be potential to improve outcome if nurses are guided to administer acute treatment modifications by using a vital sign directed approach. A prospective study of a vital sign directed therapy protocol is underway.

  • 340.
    Schell, Carl Otto
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy, Stockholm, Sweden.
    Warnberg, Martin Gerdin
    Karolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy, Stockholm, Sweden.
    Hvarfner, Anna
    Uppsala Univ, Fac Med, Uppsala, Sweden.
    Hoog, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Baker, Ulrika
    Karolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy, Stockholm, Sweden;Coll Med, Blantyre, Malawi.
    Castegren, Markus
    Karolinska Univ Hosp, Perioperat Med & Intens Care PMI, Stockholm, Sweden.
    Baker, Tim
    Karolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy, Stockholm, Sweden;Coll Med, Blantyre, Malawi;Karolinska Univ Hosp, Perioperat Med & Intens Care PMI, Stockholm, Sweden.
    The global need for essential emergency and critical care2018In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 22, article id 284Article in journal (Other academic)
    Abstract [en]

    Critical illness results in millions of deaths each year. Care for those with critical illness is often neglected due to a lack of prioritisation, co-ordination, and coverage of timely identification and basic life-saving treatments. To improve care, we propose a new focus on essential emergency and critical care (EECC)care that all critically ill patients should receive in all hospitals in the world. Essential emergency and critical care should be part of universal health coverage, is appropriate for all countries in the world, and is intended for patients irrespective of age, gender, underlying diagnosis, medical specialty, or location in the hospital. Essential emergency and critical care is pragmatic and low-cost and has the potential to improve care and substantially reduce preventable mortality.

  • 341.
    Schriber, Jeffrey R.
    et al.
    Virginia G Piper Canc Ctr, Canc Transplant Inst, Scottsdale, AZ USA.;Arizona Oncol, Scottsdale, AZ USA..
    Hari, Parameswaran N.
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, 9200 West Wisconsin Ave, Milwaukee, WI 53226 USA..
    Ahn, Kwang Woo
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, 9200 West Wisconsin Ave, Milwaukee, WI 53226 USA.;Med Coll Wisconsin, Dept Biostat, Inst Hlth & Soc, 9200 West Wisconsin Ave, Milwaukee, WI 53226 USA..
    Fei, Mingwei
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, 9200 West Wisconsin Ave, Milwaukee, WI 53226 USA..
    Costa, Luciano J.
    Univ Alabama Birmingham, Dept Med, Div Hematol Oncol, Birmingham, AL 35294 USA..
    Kharfan-Dabaja, Mohamad A.
    H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL USA..
    Angel-Diaz, Miguel
    Hosp Infantil Univ Nino Jesus, Dept Hematol Oncol, Madrid, Spain..
    Gale, Robert P.
    Imperial Coll London, Dept Med, Div Expt Med, Hematol Res Ctr, London, England..
    Ganguly, Siddharatha
    Univ Kansas, Med Ctr, Div Hematol & Oncol, Blood & Marrow Transplantat, Kansas City, KS 66103 USA..
    Girnius, Saulius K.
    Univ Cincinnati, Div Hematol Oncol, Cincinnati, OH USA..
    Hashmi, Shahrukh
    Mayo Clin, Dept Internal Med, Rochester, MN USA..
    Pawarode, Attaphol
    Univ Michigan, Sch Med, Dept Internal Med, Blood & Marrow Transplantat Program,Div Hematol O, Ann Arbor, MI USA..
    Vesole, David H.
    Hackensack Univ, Med Ctr, John Theurer Canc Ctr, Hackensack, NJ USA..
    Wiernik, Peter H.
    Our Lady Mercy Med Ctr, Div Hematol Oncol, Bronx, NY USA..
    Wirk, Baldeep M.
    Seattle Canc Care Alliance, Div Bone Marrow Transplant, Seattle, WA USA..
    Marks, David I.
    Univ Hosp Bristol Natl Hlth Serv Trust, Adult Bone Marrow Transplant, Bristol, Avon, England..
    Nishihori, Taiga
    H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL USA..
    Olsson, Richard F.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Lab Med, Div Therapeut Immunol, Stockholm, Sweden..
    Usmani, Saad Z.
    Carolinas HealthCare Syst, Levine Canc Inst, Dept Hematol & Med Oncol, Charlotte, NC USA..
    Mark, Tomer M.
    Weill Cornell Med Coll, Dept Med, New York, NY USA..
    Nieto, Yago L.
    Univ Texas MD Anderson Canc Ctr, Dept Stem Cell Transplantat & Cellular Therapy, Houston, TX 77030 USA..
    D'Souza, Anita
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, 9200 West Wisconsin Ave, Milwaukee, WI 53226 USA..
    Hispanics Have the Lowest Stem Cell Transplant Utilization Rate for Autologous Hematopoietic Cell Transplantation for Multiple Myeloma in the United States: A CIBMTR Report2017In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 123, no 16, p. 3141-3149Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Race/ethnicity remains an important barrier in clinical care. The authors investigated differences in the receipt of autologous hematopoietic cell transplantation (AHCT) among patients with multiple myeloma (MM) and outcomes based on race/ethnicity in the United States. METHODS: The Center for International Blood and Marrow Transplant Research database was used to identify 28,450 patients who underwent AHCT for MM from 2008 through 2014. By using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results 18 registries, the incidence of MM was calculated, and a stem cell transplantation utilization rate (STUR) was derived. Post-AHCT outcomes were analyzed among patients ages 18 to 75 years who underwent melphalan-conditioned peripheral cell grafts (N = 24,102). RESULTS: The STUR increased across all groups from 2008 to 2014. The increase was substantially lower among Hispanics (range, 8.6%-16.9%) and non-Hispanic blacks (range, 12.2%-20.5%) compared with non-Hispanic whites (range, 22.6%-37.8%). There were 18,046 non-Hispanic whites, 4123 non-Hispanic blacks, and 1933 Hispanic patients. The Hispanic group was younger (P <.001). Fewer patients older than 60 years underwent transplantation among Hispanics (39%) and nonHispanic blacks (42%) compared with non-Hispanic whites (56%). A Karnofsky score <90% and a hematopoietic cell transplantation comorbidity index score >3 were more common in non-Hispanic blacks compared with Hispanic and non-Hispanic whites (P <.001). More Hispanics (57%) versus non-Hispanic blacks (54%) and non-Hispanic whites (52%; P <.001) had stage III disease. More Hispanics (48%) versus non-Hispanic blacks (45%) and non-Hispanic whites (44%) had a very good partial response or better before transplantation (P =.005). Race/ethnicity did not impact post-AHCT outcomes. CONCLUSIONS: Although the STUR increased, it remained low and was significantly lower among Hispanics followed by non-Hispanic blacks compared with non-Hispanic whites. Race/ethnicity did not impact transplantation outcomes. Efforts to increase the rates of transplantation for eligible patients who have MM, with an emphasis on groups that underuse transplantation, are warranted. (C) 2017 American Cancer Society.

  • 342.
    Schwarz, Tino F.
    et al.
    Standort Juliusspital, Klinikum Wurzburg Mitte, Lab Med & Vaccinat, Wurzburg, Germany.
    Volpe, Stephanie
    GSK, Clin R&D, Wavre, Belgium.
    Catteau, Gregory
    GSK, R&D, Clin Evidence Generat, Biostat & Stat Programming, Wavre, Belgium.
    Chlibek, Roman
    Univ Def, Fac Mil Hlth Sci, Dept Epidemiol, Hradec Kralove, Czech Republic.
    David, Marie Pierre
    GSK, R&D, Clin Evidence Generat, Biostat & Stat Programming, Rixensart, Belgium.
    Richardus, Jan Hendrik
    Municipal Publ Hlth Serv Rotterdam Rijnmond, Dept Infect Dis Control, Rotterdam, Netherlands.
    Lal, Himal
    Pfizer Inc, Clin R&D, Collegeville, PA USA.
    Oostvogels, Lidia
    GSK, Clin R&D, Wavre, Belgium.
    Pauksens, Karlis
    Uppsala Univ Hosp, Infect Dis Sect, Med Sci, Uppsala, Sweden.
    Ravault, Stephanie
    GSK, Clin Lab Sci, Rixensart, Belgium.
    Rombo, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Sonder, Gerard
    Publ Hlth Serv Amsterdam, Dept Infect Dis, Amsterdam, Netherlands.
    Smetana, Jan
    Univ Def, Fac Mil Hlth Sci, Dept Epidemiol, Hradec Kralove, Czech Republic.
    Heineman, Thomas
    Genocea Biosci, Clin Dev, Cambridge, MA USA.
    Bastidas, Adriana
    GSK, Clin R&D, Wavre, Belgium.
    Persistence of immune response to an adjuvanted varicella-zoster virus subunit vaccine for up to year nine in older adults2018In: Human Vaccines & Immunotherapeutics, ISSN 2164-5515, E-ISSN 2164-554X, Vol. 14, no 6, p. 1370-1377Article in journal (Refereed)
    Abstract [en]

    Background: In adults aged 60years, two doses of the herpes zoster subunit vaccine (HZ/su; 50 mu g varicella-zoster virus glycoprotein E [gE] and AS01(B) Adjuvant System) elicited humoral and cell-mediated immune responses persisting for at least six years. We assessed immunogenicity nine years post-initial vaccination.Methods: This open extension study (NCT02735915) followed 70 participants who received two HZ/su doses in the initial trial (NCT00434577). Blood samples to assess the cellular (intracellular cytokine staining) and humoral (ELISA) immunity were taken at year nine post-initial vaccination.Results: Participants' mean age at dose 1 was 72.3years. The fold increases over pre-vaccination in the mean frequency of gE-specific CD4+ T-cells expressing 2 activation markers plateaued from year four post-dose 1 until year nine. Anti-gE antibody geometric mean concentrations plateaued and remained above pre-vaccination levels from year four onwards. Immunogenicity at year nine was similar across age strata (60-69, 70years) and confirmed statistical prediction model results using data for up to year six. Further modeling using all data up to year nine predicted immune responses would remain above the pre-vaccination level up to year 15.Conclusion: In adults aged 60years, HZ/su-induced immunogenicity remained above pre-vaccination levels for at least nine years post-initial vaccination.Summary: After vaccination with HZ/su, both cell mediated and humoral immunity remained above pre-vaccination levels up to year 9 regardless of age group. Immune responses are predicted to remain above baseline up to 15years post initial vaccination.

  • 343.
    Shaw, Bronwen E.
    et al.
    Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA..
    Logan, Brent R.
    Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA.;CIBMTR, Natl Marrow Donor Program Be Match, Minneapolis, MN USA..
    Kiefer, Deidre M.
    CIBMTR, Natl Marrow Donor Program Be Match, Minneapolis, MN USA..
    Chitphakdithai, Pintip
    CIBMTR, Natl Marrow Donor Program Be Match, Minneapolis, MN USA..
    Pedersen, Tanya L.
    Allina Hlth, Minneapolis, MN USA..
    Abdel-Azim, Hisham
    Univ So Calif, Keck Sch Med, Childrens Hosp Los Angeles, Div Hematol Oncol & Blood & Marrow Transplantat, Los Angeles, CA 90033 USA..
    Abidi, Muneer H.
    Wayne State Univ, Karmanos Canc Inst, Dept Oncol, Div BMT, Detroit, MI USA..
    Akpek, Gorgun
    Banner MD Anderson Canc Ctr, Stem Cell Transplantat & Cellular Therapy Program, Gilbert, AZ USA..
    Diaz, Miguel A.
    Hosp Infantil Univ Nino Jesus, Dept Hematol Oncol, Madrid, Spain..
    Artz, Andrew S.
    Dandoy, Christopher
    Univ Chicago, Hematol Oncol Sect, Chicago, IL 60637 USA.;Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH 45229 USA..
    Gajewski, James L.
    Oregon Hlth & Sci Univ, Portland, OR 97201 USA..
    Hematti, Peiman
    Univ Wisconsin Hosp & Clin, Div Hematol Oncol Bone Marrow Transplantat, Madison, WI 53792 USA..
    Kamble, Rammurti T.
    Baylor Coll Med, Ctr Cell & Gene Therapy, Div Hematol & Oncol, Houston, TX 77030 USA..
    Kasow, Kimberley A.
    Univ N Carolina, Dept Pediat, Div Hematol Oncol, Chapel Hill, NC USA..
    Lazarus, Hillard M.
    Univ Hosp Case Med Ctr, Seidman Canc Ctr, Cleveland, OH USA..
    Liesveld, Jane L.
    Univ Rochester, Med Ctr, Dept Med, Rochester, NY 14642 USA..
    Majhail, Navneet S.
    Cleveland Clin, Taussig Canc Inst, Blood & Marrow Transplant Program, Cleveland, OH 44106 USA..
    O'Donne, Paul V.
    Fred Hutchinson Canc Res Ctr, Seattle, WA 98104 USA..
    Olsson, Richard F.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Lab Med, Div Therapeut Immunol, Stockholm, Sweden..
    Savani, Bipin N.
    Vanderbilt Univ, Med Ctr, Dept Med, Div Hematol Oncol, Nashville, TN USA..
    Schears, Raquel M.
    Mayo Clin, Rochester, MN USA..
    Stroncek, David F.
    NIH, Dept Transfus Med, Clin Ctr, Bethesda, MD 20892 USA..
    Switzer, Galen E.
    Univ Pittsburgh, Pittsburgh, PA USA..
    Williams, Eric P.
    BeTheMatch Natl Marrow Donor Program, Minneapolis, MN USA..
    Wingard, John R.
    Univ Florida, Dept Med, Div Hematol & Oncol, Gainesville, FL USA..
    Wirk, Baldeep M.
    Seattle Canc Care Alliance, Div Bone Marrow Transplant, Seattle, WA USA..
    Confer, Dennis L.
    BeTheMatch Natl Marrow Donor Program, Minneapolis, MN USA..
    Pulsipher, Michael A.
    Univ So Calif, Keck Sch Med, Childrens Hosp Los Angeles, Div Hematol Oncol & Blood & Marrow Transplantat, Los Angeles, CA 90033 USA..
    Analysis of the Effect of Race, Socioeconomic Status, and Center Size on Unrelated National Marrow Donor Program Donor Outcomes: Donor Toxicities Are More Common at Low-Volume Bone Marrow Collection Centers2015In: Biology of blood and marrow transplantation, ISSN 1083-8791, E-ISSN 1523-6536, Vol. 21, no 10, p. 1830-1838Article in journal (Refereed)
    Abstract [en]

    Previous studies have shown that risks of collection-related pain and symptoms are associated with sex, body mass index, and age in unrelated donors undergoing collection at National Marrow Donor Program centers. We hypothesized that other important factors (race, socioeconomic status [SES], and number of procedures at the collection center) might affect symptoms in donors. We assessed outcomes in 2726 bone marrow (BM) and 6768 peripheral blood stem cell (PBSC) donors collected between 2004 and 2009. Pain/symptoms are reported as maximum levels over mobilization and collection (PBSC) or within 2 days of collection (BM) and at 1 week after collection. For PBSC donors, race and center volumes were not associated with differences in pain/symptoms at any time. PBSC donors with high SES levels reported higher maximum symptom levels 1 week after donation (P = .017). For BM donors, black males reported significantly higher levels of pain (OR, 1.90; CI, 1.14 to 3.19; P = .015). No differences were noted by SES group. BM donors from low-volume centers reported more toxicity (OR, 2.09; CI, 1.26 to 3.46; P = .006). In conclusion, race and SES have a minimal effect on donation-associated symptoms. However, donors from centers performing <= 1 BM collection every 2 months have more symptoms after BM donation. Approaches should be developed by registries and low-volume centers to address this issue.

  • 344. Silfverdal, Sven Arne
    et al.
    Flodmark, Carl-Erik
    Rombo, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Tansey, Susan P.
    Sidhu, Mohinder
    Trammel, James
    Emini, Emilio A.
    Gruber, William C.
    Scott, Daniel A.
    Gurtman, Alejandra
    13-Valent pneumococcal conjugate vaccine (PCV13) in children partially immunized with 7-valent pneumococcal conjugate vaccine (PCV7): A phase 3, open-label trial2013In: Vaccine, ISSN 0264-410X, E-ISSN 1873-2518, Vol. 31, no 9, p. 1284-1292Article in journal (Refereed)
    Abstract [en]

    Background: As 13-valent pneumococcal conjugate vaccine (PCV13) is introduced, children who began vaccination with 7-valent pneumococcal conjugate vaccine (PCV7) may complete their vaccination with PCV13. This open-label phase 3 study evaluated immunogenicity and safety of PCV13 in Swedish infants and toddlers previously given 1 or 2 doses of PCV7 during infancy. Methods: Healthy infants previously given PCV7 at ages 3 months (group 1; n = 118) or 3 and 5 months (group 2; n = 116) received PCV13 at ages 5 (group 1) and 12 months (both groups). IgG responses were assessed 1 month after each PCV13 dose and before the 12-month dose. Local reactions and systemic events were collected for 7 days postvaccination. Other adverse events were also collected. Results: Post-5-month dose, IgG geometric mean concentrations (GMCs) in group 1 were 1.56-4.70 mu g/ml for most PCV7 serotypes except 6B (0.40 mu g/ml) and 23F (0.57 mu g/ml) and 0.72-1.88 mu g/ml for most of the 6 additional serotypes, except 6A (0.28 mu g/ml). Post-12-month dose, IgG GMCs for the PCV7 serotypes were 2.93-9.63 mu g/ml (group 1) and 3.33-9.30 mu g/ml (group 2); and for the 6 additional serotypes, 1.85-14.65 mu g/ml (group 1) and 1.34-13.16 mu g/ml (group 2). GMCs increased by >4-fold in both groups from pre- to post-12-month dose. Proportions of subjects in group 1 with pneumococcal serotype-specific IgG concentrations >= 0.35 mu g/ml (WHO-designated postprimary reference antibody level) post-5-month dose were 92.2-99.1% for most PCV7 serotypes except 6B (53.0%) and 23F (62.6%) and 80.9-100.0% for most of the 6 additional serotypes except 6A (36.8%). Local reactions and fever were mostly mild or moderate. Conclusions: PCV13 was immunogenic and safe in infants and toddlers previously partially immunized with PCV7. Even a single dose in an infant or toddler induces an immune response to the 6 additional serotypes.

  • 345.
    Siroux, V.
    et al.
    Univ Grenoble Alpes, IAB, CNRS, INSERM, Grenoble, France.
    Ballardini, N.
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden;Soder Sjukhuset, Sachs Children & Youth Hosp, Stockholm, Sweden;Kings Coll London, St Johns Inst Dermatol, London, England.
    Soler, M.
    Univ Grenoble Alpes, IAB, CNRS, INSERM, Grenoble, France.
    Lupinek, C.
    Med Univ Vienna, Dept Pathophysiol & Allergy Res, Div Immunopathol, Ctr Pathophysiol Infectiol & Immunol, Vienna, Austria.
    Boudier, A.
    Univ Grenoble Alpes, IAB, CNRS, INSERM, Grenoble, France.
    Pin, I.
    Univ Grenoble Alpes, IAB, CNRS, INSERM, Grenoble, France;CHU Grenoble Alpes, Dept Pediat, Grenoble, France.
    Just, J.
    Children Hosp Armand Trousseau, Allergol Dept, Paris, France;UPMC, INSERM, UMR S 1136, Paris, France.
    Nadif, R.
    INSERM, U1168, VIMA Aging & Chron Dis Epidemiol & Publ Hlth Appr, Villejuif, France;Univ Versailles St Quentin En Yvelines, UMR S 1168, Montigny Le Bretonneux, France.
    Anto, J. M.
    Ctr Res Environm Epidemiol CREAL, ISGLoBAL, Barcelona, Spain.
    Melen, E.
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden;Soder Sjukhuset, Sachs Children & Youth Hosp, Stockholm, Sweden.
    Valenta, R.
    Med Univ Vienna, Dept Pathophysiol & Allergy Res, Div Immunopathol, Ctr Pathophysiol Infectiol & Immunol, Vienna, Austria;NRC Inst Immunol FMBA Russia, Moscow, Russia.
    Wickman, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Inst Environm Med, Stockholm, Sweden;Soder Sjukhuset, Sachs Children & Youth Hosp, Stockholm, Sweden.
    Bousquet, J.
    INSERM, U1168, VIMA Aging & Chron Dis Epidemiol & Publ Hlth Appr, Villejuif, France;Univ Versailles St Quentin En Yvelines, UMR S 1168, Montigny Le Bretonneux, France.
    The asthma-rhinitis multimorbidity is associated with IgE polysensitization in adolescents and adults2018In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 73, no 7, p. 1447-1458Article in journal (Refereed)
    Abstract [en]

    Background

    Children with multimorbid asthma and rhinitis show IgE polysensitization to several allergen sources. This association remains poorly studied in adolescents and adults using defined allergen molecules. We investigated IgE sensitization patterns towards a broad panel of aeroallergen components in adults and adolescents with a focus on individuals with asthma and rhinitis multimorbidity.

    Methods

    IgE reactivity to 64 micro-arrayed aeroallergen molecules was determined with the MeDALL-chip in samples from the French EGEA study (n = 840, age = 40.7 17.1) and the Swedish population-based birth cohort BAMSE (n = 786, age = 16 0.26). The age- and sex-adjusted associations between the number of IgE-reactive allergen molecules (0.3 ISU) and the asthma-rhinitis phenotypes were assessed using a negative binomial model.

    Results

    Groups representing 4 phenotypes were identified: no asthma-no rhinitis (A-R-; 30% in EGEA and 54% in BAMSE), asthma alone (A+R-; 11% and 8%), rhinitis alone (A-R+; 15% and 24%) and asthma-rhinitis (A+R+; 44% and 14%). The numbers of IgE-reactive aeroallergen molecules significantly differed between phenotypes (median in A-R-, A+R-, A-R+ and A+R+: 0, 1, 2 and 7 in EGEA and 0, 0, 3 and 5 in BAMSE). As compared to A-R- subjects, the adjusted ratio of the mean number of IgE-reactive molecules was higher in A+R+ than in A+R- or A-R+ (10.0, 5.4 and 5.0 in EGEA and 7.2, 0.7 and 4.8 in BAMSE). ConclusionThe A+R+ phenotype combined the sensitization pattern of both the A-R+ and A+R- phenotypes. This multimorbid polysensitized phenotype seems to be generalizable to various ages and allergenic environments and may be associated with specific mechanisms.

  • 346.
    Skorup, Paul
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
    Maudsdotter, Lisa
    Lipcsey, Miklós
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Castegren, Markus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Jonsson, Ann-Beth
    Sjölin, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
    Beneficial Antimicrobial Effect of the Addition of an Aminoglycoside to a β-Lactam Antibiotic in an E. coli Porcine Intensive Care Severe Sepsis Model.2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 2, p. e90441-Article in journal (Refereed)
    Abstract [en]

    This study aimed to determine whether the addition of an aminoglycoside to a ß-lactam antibiotic increases the antimicrobial effect during the early phase of Gram-negative severe sepsis/septic shock. A porcine model was selected that considered each animal's individual blood bactericidal capacity. Escherichia coli, susceptible to both antibiotics, was given to healthy pigs intravenously during 3 h. At 2 h, the animals were randomized to a 20-min infusion with either cefuroxime alone (n = 9), a combination of cefuroxime+tobramycin (n = 9), or saline (control, n = 9). Blood samples were collected hourly for cultures and quantitative polymerase chain reaction (PCR). Bacterial growth in the organs after 6 h was chosen as the primary endpoint. A blood sample was obtained at baseline before start of bacterial infusion for ex vivo investigation of the blood bactericidal capacity. At 1 h after the administration of the antibiotics, a second blood sample was taken for ex vivo investigation of the antibiotic-induced blood killing activity. All animals developed severe sepsis/septic shock. Blood cultures and PCR rapidly became negative after completed bacterial infusion. Antibiotic-induced blood killing activity was significantly greater in the combination group than in the cefuroxime group (p<0.001). Growth of bacteria in the spleen was reduced in the two antibiotic groups compared with the controls (p<0.01); no difference was noted between the two antibiotic groups. Bacterial growth in the liver was significantly less in the combination group than in the cefuroxime group (p<0.05). High blood bactericidal capacity at baseline was associated with decreased growth in the blood and spleen (p<0.05). The addition of tobramycin to cefuroxime results in increased antibiotic-induced blood killing activity and less bacteria in the liver than cefuroxime alone. Individual blood bactericidal capacity may have a significant effect on antimicrobial outcome.

  • 347.
    Skålén, Charlotta
    et al.
    Sormland Cty Council, Patient Advisory Comm, Nykoping, Sweden.
    Nordgren, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Annerbäck, Eva-Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Patient complaints about healthcare in a Swedish county: Characteristics and satisfaction after handling2016In: Nursing Open, ISSN 2054-1058, Vol. 3, no 4, p. 203-211Article in journal (Refereed)
  • 348.
    Sohlberg, Sara
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Mulic-Lutvica, Ajlana
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Olovsson, Matts
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Weis, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Wikström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Wikström, Anna-Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    MRI estimated placental perfusion in fetal growth assessment2015In: Ultrasound in Obstetrics and Gynecology, ISSN 0960-7692, E-ISSN 1469-0705, Vol. 46, no 6, p. 700-705Article in journal (Refereed)
    Abstract [en]

    Objective

    This study aimed to evaluate placental perfusion fraction estimated by magnetic resonance imaging (MRI) in vivo as a marker of placental function.

    Methods

    The study population included 35 pregnant women, of whom 13 had preeclampsia, examined at gestational weeks 22 to 40. Each woman underwent, within a 24 hour period: a MRI diffusion-weighted sequence (from which we calculated the placental perfusion fraction); venous blood sampling; and an ultrasound examination including estimation of fetal weight, amniotic fluid index and Doppler velocity measurements. We compared the perfusion fraction in pregnancies with and without fetal growth restriction and estimated correlations between the perfusion fraction and ultrasound estimates and plasma markers with linear regression. The associations between the placental perfusion fraction and ultrasound estimates were modified by the presence of preeclampsia (p < 0.05) and therefore we included an interaction term between preeclampsia and the covariates in the models.

    Results

    The median placental perfusion fraction in pregnancies with and without fetal growth restriction was 21% and 32%, respectively (p = 0.005). The correlations between the placental perfusion fraction and ultrasound estimates and plasma markers were highly significant (p-values 0.002 to 0.0001). The highest coefficient of determination (R2= 0.56) for placental perfusion fraction was found for a model including pulsatility index in ductus venosus, plasma level of sFlt1, estimated fetal weight and presence of preeclampsia.

    Conclusion

    The placental perfusion fraction has potential to contribute to the clinical assessment in cases of placental insufficiency.

  • 349.
    Sohlberg, Sara
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Wikström, Anna-Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Olovsson, Matts
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Lindgren, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Mulic-Lutvica, Ajlana
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Weis, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Wikström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    In vivo(31)P-MR spectroscopy in normal pregnancy, early and late preeclampsia: A study of placental metabolism2014In: Placenta, ISSN 0143-4004, E-ISSN 1532-3102, Vol. 35, no 5, p. 318-323Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Preeclampsia affects about 3% of pregnancies and the placenta is believed to play a major role in its pathophysiology. Lately, the role of the placenta has been hypothesised to be more pronounced in preeclampsia of early (<34 weeks) rather than late (≥34 weeks) onset. (31)P Magnetic Resonance Spectroscopy (MRS) enables non-invasive, in vivo studies of placental metabolism. Our aim was to study placental energy and membrane metabolism in women with normal pregnancies and those with early and late onset preeclampsia.

    METHODS: The study population included fourteen women with preeclampsia (five with early onset and nine with late onset preeclampsia) and sixteen women with normal pregnancy (seven with early and nine with late pregnancy). All women underwent a (31)P-MRS examination of the placenta.

    RESULTS: The phosphodiester (PDE) spectral intensity fraction of the total (31)P signal and the phosphodiester/phosphomonoester (PDE/PME) spectral intensity ratio was higher in early onset preeclampsia than in early normal pregnancy (p = 0.03 and p = 0.02). In normal pregnancy the PDE spectral intensity fraction and the PDE/PME spectral intensity ratio increased with increasing gestational age (p = 0.006 and p = 0.001).

    DISCUSSION: Since PDE and PME are related to cell membrane degradation and formation, respectively, our findings indicate increased cell degradation and maybe also decreased cell proliferation in early onset preeclampsia compared to early normal pregnancy, and with increasing gestational age in normal pregnancy.

    CONCLUSIONS: Our findings could be explained by increased apoptosis due to ischaemia in early onset preeclampsia and also increased apoptosis with increasing gestational age in normal pregnancy.

  • 350.
    Sonesson, Sofi
    et al.
    Linkoping Univ, Div Physiotherapy, S-58183 Linkoping, Sweden.
    Kvist, Joanna
    Linkoping Univ, Div Physiotherapy, S-58183 Linkoping, Sweden.
    Ardern, Clare
    Linkoping Univ, Div Physiotherapy, S-58183 Linkoping, Sweden.; La Trobe Univ, Sch Allied Hlth, Fac Hlth Sci, Melbourne, Vic, Australia.; Aspetar Orthopaed & Sports Med Hosp, Doha, Qatar.
    Österberg, Annika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Div Physiotherapy, S-58183 Linkoping, Sweden.
    Silbernagel, Karin Grävare
    Univ Delaware, Dept Phys Therapy, Newark, DE USA.
    Psychological factors are important to return to pre-injury sport activity after anterior cruciate ligament reconstruction: expect and motivate to satisfy.2017In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 25, no 5, p. 1375-1384Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To describe individuals' expectations, motivation, and satisfaction before, during, and after rehabilitation for ACL reconstruction and to explore how these factors were associated with return to pre-injury sport activity at 1-year follow-up.

    METHODS: Sixty-five individuals (34 males), median age 22 (15-45) years, scheduled for ACL reconstruction participated. Participants completed the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) and questions about expectations, satisfaction, and motivation pre-operatively and at 16 and 52 weeks after surgery.

    RESULTS: Prior to surgery, 86 % of participants stated that their goal was to return to their pre-injury sport activity. Those who had returned to their pre-injury sport activity at 52 weeks were more motivated during rehabilitation to return to their pre-injury activity level, more satisfied with their activity level and knee function at 52 weeks, and scored significantly higher on the IKDC-SKF [median 92.0 (range 66.7-100.0)] at 52 weeks, compared to those who had not returned [median 77.6 (range 50.6-97.7)].

    CONCLUSION: Prior to ACL reconstruction, most participants expected to return to their pre-injury activity level. Higher motivation during rehabilitation was associated with returning to the pre-injury sport activity. The participants who had returned to their pre-injury sport activity were more satisfied with their activity level and knee function 1 year after the ACL reconstruction. Facilitating motivation might be important to support individuals in achieving their participation goals after ACL reconstruction.

    LEVEL OF EVIDENCE: Prospective cohort study, Level II.

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