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  • 351.
    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.

  • 352.
    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)
  • 353.
    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.

  • 354.
    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.

  • 355.
    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.

  • 356.
    Sperber, Jesper
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Protective Mechanical Ventilation in Inflammatory and Ventilator-Associated Pneumonia Models2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Severe infections, trauma or major surgery can each cause a state of systemic inflammation. These causes for systemic inflammation often coexist and complicate each other. Mechanical ventilation is commonly used during major surgical procedures and when respiratory functions are failing in the intensive care setting. Although necessary, the use of mechanical ventilation can cause injury to the lungs and other organs especially under states of systemic inflammation. Moreover, a course of mechanical ventilator therapy can be complicated by ventilator-associated pneumonia, a factor greatly influencing mortality. The efforts to avoid additional ventilator-induced injury to patients are embodied in the expression ‘protective ventilation’.

    With the use of pig models we have examined the impact of protective ventilation on systemic inflammation, on organ-specific inflammation and on bacterial growth during pneumonia. Additionally, with a 30-hour ventilator-associated pneumonia model we examined the influence of mechanical ventilation and systemic inflammation on bacterial growth. Systemic inflammation was initiated with surgery and enhanced with endotoxin. The bacterium used was Pseudomonas aeruginosa.

    We found that protective ventilation during systemic inflammation attenuated the systemic inflammatory cytokine responses and reduced secondary organ damage. Moreover, the attenuated inflammatory responses were seen on the organ specific level, most clearly as reduced counts of inflammatory cytokines from the liver. Protective ventilation entailed lower bacterial counts in lung tissue after 6 hours of pneumonia. Mechanical ventilation for 24 h, before a bacterial challenge into the lungs, increased bacterial counts in lung tissue after 6 h. The addition of systemic inflammation by endotoxin during 24 h increased the bacterial counts even more. For comparison, these experiments used control groups with clinically common ventilator settings.

    Summarily, these results support the use of protective ventilation as a means to reduce systemic inflammation and organ injury, and to optimize bacterial clearance in states of systemic inflammation and pneumonia.

    List of papers
    1. Lung protective ventilation induces immunotolerance and nitric oxide metabolites in porcine experimental postoperative sepsis
    Open this publication in new window or tab >>Lung protective ventilation induces immunotolerance and nitric oxide metabolites in porcine experimental postoperative sepsis
    Show others...
    2013 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 12, p. e83182-Article in journal (Refereed) Published
    Abstract [en]

    Low tidal volume ventilation is beneficial in patients with severe pulmonary dysfunction and would, in theory, reduce postoperative complications if implemented during routine surgery. The study aimed to investigate whether low tidal volume ventilation and high positive end-expiratory pressure (PEEP) in a large animal model of postoperative sepsis would attenuate the systemic inflammatory response and organ dysfunction. Thirty healthy pigs were randomized to three groups: Group Prot-7h, i.e. protective ventilation for 7 h, was ventilated with a tidal volume of 6 mL x kg-1 for 7 h; group Prot-5h, i.e. protective ventilation for 5 h, was ventilated with a tidal volume of 10 mL x kg-1 for 2 h, after which the group was ventilated with a tidal volume of 6 mL x kg-1; and a control group that was ventilated with a tidal volume of 10 mL x kg-1 for 7 h. In groups Prot-7h and Prot-5h PEEP was 5 cmH2O for 2 h and 10 cmH2O for 5 h. In the control group PEEP was 5 cmH2O for the entire experiment. After surgery for 2 h, postoperative sepsis was simulated with an endotoxin infusion for 5 h. Low tidal volume ventilation combined with higher PEEP led to lower levels of interleukin 6 and 10 in plasma, higher PaO2/FiO2, better preserved functional residual capacity and lower plasma troponin I as compared with animals ventilated with a medium high tidal volume and lower PEEP. The beneficial effects of protective ventilation were seen despite greater reductions in cardiac index and oxygen delivery index. In the immediate postoperative phase low VT ventilation with higher PEEP was associated with reduced ex vivo plasma capacity to produce TNF-α upon endotoxin stimulation and higher nitrite levels in urine. These findings might represent mechanistic explanations for the attenuation of systemic inflammation and inflammatory-induced organ dysfunction.

    National Category
    Basic Medicine
    Identifiers
    urn:nbn:se:uu:diva-213610 (URN)10.1371/journal.pone.0083182 (DOI)000328731800101 ()24349457 (PubMedID)
    Available from: 2013-12-30 Created: 2013-12-30 Last updated: 2018-01-11Bibliographically approved
    2. Evaluating the effects of protective ventilation on organ-specific cytokine production in porcine experimental postoperative sepsis
    Open this publication in new window or tab >>Evaluating the effects of protective ventilation on organ-specific cytokine production in porcine experimental postoperative sepsis
    Show others...
    2015 (English)In: BMC Pulmonary Medicine, ISSN 1471-2466, E-ISSN 1471-2466, Vol. 15, article id 60Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Protective ventilation with lower tidal volume (VT) and higher positive end-expiratory pressure (PEEP) reduces the negative additive effects of mechanical ventilation during systemic inflammatory response syndrome. We hypothesised that protective ventilation during surgery would affect the organ-specific immune response in an experimental animal model of endotoxin-induced sepsis-like syndrome.

    METHODS: 30 pigs were laparotomised for 2 hours (h), after which a continuous endotoxin infusion was started at 0.25 micrograms × kg(-1) × h(-1) for 5 h. Catheters were placed in the carotid artery, hepatic vein, portal vein and jugular bulb. Animals were randomised to two protective ventilation groups (n = 10 each): one group was ventilated with VT 6 mL × kg(-1) during the whole experiment while the other group was ventilated during the surgical phase with VT of 10 mL × kg(-1). In both groups PEEP was 5 cmH2O during surgery and increased to 10 cmH2O at the start of endotoxin infusion. A control group (n = 10) was ventilated with VT of 10 mL × kg(-1) and PEEP 5 cm H20 throughout the experiment. In four sample locations we a) simultaneously compared cytokine levels, b) studied the effect of protective ventilation initiated before and during endotoxemia and c) evaluated protective ventilation on organ-specific cytokine levels.

    RESULTS: TNF-alpha levels were highest in the hepatic vein, IL-6 levels highest in the artery and jugular bulb and IL-10 levels lowest in the artery. Protective ventilation initiated before and during endotoxemia did not differ in organ-specific cytokine levels. Protective ventilation led to lower levels of TNF-alpha in the hepatic vein compared with the control group, whereas no significant differences were seen in the artery, portal vein or jugular bulb.

    CONCLUSIONS: Variation between organs in cytokine output was observed during experimental sepsis. We see no implication from cytokine levels for initiating protective ventilation before endotoxemia. However, during endotoxemia protective ventilation attenuates hepatic inflammatory cytokine output contributing to a reduced total inflammatory burden.

    National Category
    Anesthesiology and Intensive Care
    Identifiers
    urn:nbn:se:uu:diva-253174 (URN)10.1186/s12890-015-0052-9 (DOI)000354840700001 ()25958003 (PubMedID)
    Available from: 2015-05-23 Created: 2015-05-23 Last updated: 2017-12-04Bibliographically approved
    3. Protective Ventilation Reduces Pseudomonas Aeruginosa Growth in a Porcine Pneumonia Model
    Open this publication in new window or tab >>Protective Ventilation Reduces Pseudomonas Aeruginosa Growth in a Porcine Pneumonia Model
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    Anesthesiology and Intensive Care
    Identifiers
    urn:nbn:se:uu:diva-282600 (URN)
    Available from: 2016-04-05 Created: 2016-04-05 Last updated: 2016-05-12
    4. Exposure to Mechanical Ventilation and Endotoxin for 24 Hours Before Infection Influences Pseudomonas Aeruginosa Growth During Experimental Porcine Ventilator-Associated Pneumonia
    Open this publication in new window or tab >>Exposure to Mechanical Ventilation and Endotoxin for 24 Hours Before Infection Influences Pseudomonas Aeruginosa Growth During Experimental Porcine Ventilator-Associated Pneumonia
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    Anesthesiology and Intensive Care
    Identifiers
    urn:nbn:se:uu:diva-282601 (URN)
    Available from: 2016-04-05 Created: 2016-04-05 Last updated: 2016-05-12
  • 357.
    Sperber, Jesper
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Lipcsey, Miklós
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Sjölin, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
    Castegren, Markus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Evaluating the effects of protective ventilation on organ-specific cytokine production in porcine experimental postoperative sepsis2015In: BMC Pulmonary Medicine, ISSN 1471-2466, E-ISSN 1471-2466, Vol. 15, article id 60Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Protective ventilation with lower tidal volume (VT) and higher positive end-expiratory pressure (PEEP) reduces the negative additive effects of mechanical ventilation during systemic inflammatory response syndrome. We hypothesised that protective ventilation during surgery would affect the organ-specific immune response in an experimental animal model of endotoxin-induced sepsis-like syndrome.

    METHODS: 30 pigs were laparotomised for 2 hours (h), after which a continuous endotoxin infusion was started at 0.25 micrograms × kg(-1) × h(-1) for 5 h. Catheters were placed in the carotid artery, hepatic vein, portal vein and jugular bulb. Animals were randomised to two protective ventilation groups (n = 10 each): one group was ventilated with VT 6 mL × kg(-1) during the whole experiment while the other group was ventilated during the surgical phase with VT of 10 mL × kg(-1). In both groups PEEP was 5 cmH2O during surgery and increased to 10 cmH2O at the start of endotoxin infusion. A control group (n = 10) was ventilated with VT of 10 mL × kg(-1) and PEEP 5 cm H20 throughout the experiment. In four sample locations we a) simultaneously compared cytokine levels, b) studied the effect of protective ventilation initiated before and during endotoxemia and c) evaluated protective ventilation on organ-specific cytokine levels.

    RESULTS: TNF-alpha levels were highest in the hepatic vein, IL-6 levels highest in the artery and jugular bulb and IL-10 levels lowest in the artery. Protective ventilation initiated before and during endotoxemia did not differ in organ-specific cytokine levels. Protective ventilation led to lower levels of TNF-alpha in the hepatic vein compared with the control group, whereas no significant differences were seen in the artery, portal vein or jugular bulb.

    CONCLUSIONS: Variation between organs in cytokine output was observed during experimental sepsis. We see no implication from cytokine levels for initiating protective ventilation before endotoxemia. However, during endotoxemia protective ventilation attenuates hepatic inflammatory cytokine output contributing to a reduced total inflammatory burden.

  • 358.
    Sperber, Jesper
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Lipcsey, Miklós
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Sjölin, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
    Castegren, Markus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Lung protective ventilation induces immunotolerance and nitric oxide metabolites in porcine experimental postoperative sepsis2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 12, p. e83182-Article in journal (Refereed)
    Abstract [en]

    Low tidal volume ventilation is beneficial in patients with severe pulmonary dysfunction and would, in theory, reduce postoperative complications if implemented during routine surgery. The study aimed to investigate whether low tidal volume ventilation and high positive end-expiratory pressure (PEEP) in a large animal model of postoperative sepsis would attenuate the systemic inflammatory response and organ dysfunction. Thirty healthy pigs were randomized to three groups: Group Prot-7h, i.e. protective ventilation for 7 h, was ventilated with a tidal volume of 6 mL x kg-1 for 7 h; group Prot-5h, i.e. protective ventilation for 5 h, was ventilated with a tidal volume of 10 mL x kg-1 for 2 h, after which the group was ventilated with a tidal volume of 6 mL x kg-1; and a control group that was ventilated with a tidal volume of 10 mL x kg-1 for 7 h. In groups Prot-7h and Prot-5h PEEP was 5 cmH2O for 2 h and 10 cmH2O for 5 h. In the control group PEEP was 5 cmH2O for the entire experiment. After surgery for 2 h, postoperative sepsis was simulated with an endotoxin infusion for 5 h. Low tidal volume ventilation combined with higher PEEP led to lower levels of interleukin 6 and 10 in plasma, higher PaO2/FiO2, better preserved functional residual capacity and lower plasma troponin I as compared with animals ventilated with a medium high tidal volume and lower PEEP. The beneficial effects of protective ventilation were seen despite greater reductions in cardiac index and oxygen delivery index. In the immediate postoperative phase low VT ventilation with higher PEEP was associated with reduced ex vivo plasma capacity to produce TNF-α upon endotoxin stimulation and higher nitrite levels in urine. These findings might represent mechanistic explanations for the attenuation of systemic inflammation and inflammatory-induced organ dysfunction.

  • 359.
    Sperber, Jesper
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Nyberg, Axel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Lipcsey, Miklós
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Sjölin, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
    Castegren, Markus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Exposure to Mechanical Ventilation and Endotoxin for 24 Hours Before Infection Influences Pseudomonas Aeruginosa Growth During Experimental Porcine Ventilator-Associated PneumoniaManuscript (preprint) (Other academic)
  • 360.
    Sperber, Jesper
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Nyberg, Axel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Lipcsey, Miklós
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Melhus, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology and Infectious Medicine.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Sjölin, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
    Castegren, Markus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Protective Ventilation Reduces Pseudomonas Aeruginosa Growth in a Porcine Pneumonia ModelManuscript (preprint) (Other academic)
  • 361.
    Sperber, Jesper
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Centre for Clinical Research Sörmland, Department of Anesthesiology & Intensive Care Mälarsjukhuset, SE-631 88 Eskilstuna, Sweden.
    Nyberg, Axel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Centre for Clinical Research Sörmland, Department of Anesthesiology & Intensive Care Mälarsjukhuset, SE-631 88 Eskilstuna, Sweden.
    Lipcsey, Miklós
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Hedenstierna laboratory. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Melhus, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Sjölin, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
    Castegren, Markus
    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 Surgical Sciences, Hedenstierna laboratory. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Perioperative Medicine and Intensive Care, Karolinska University Hospital and CLINTEC, Karolinska Institute, Stockholm, Sweden.
    Protective ventilation reduces Pseudomonas aeruginosa growth in lung tissue in a porcine pneumonia model2017In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 5, article id 40Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Mechanical ventilation with positive end expiratory pressure and low tidal volume, i.e. protective ventilation, is recommended in patients with acute respiratory distress syndrome. However, the effect of protective ventilation on bacterial growth during early pneumonia in non-injured lungs is not extensively studied. The main objectives were to compare two different ventilator settings on Pseudomonas aeruginosa growth in lung tissue and the development of lung injury.

    METHODS: A porcine model of severe pneumonia was used. The protective group (n = 10) had an end expiratory pressure of 10 cm H2O and a tidal volume of 6 ml x kg-1. The control group (n = 10) had an end expiratory pressure of 5 cm H2O and a tidal volume of 10 ml x kg-1. 1011 colony forming units of Pseudomonas aeruginosa were inoculated intra-tracheally at baseline, after which the experiment continued for 6 h. Two animals from each group received only saline, and served as sham animals. Lung tissue samples from each animal were used for bacterial cultures and wet-to-dry weight ratio measurements.

    RESULTS: The protective group displayed lower numbers of Pseudomonas aeruginosa (p < 0.05) in the lung tissue, and a lower wet-to-dry ratio (p < 0.01) than the control group. The control group deteriorated in arterial oxygen tension/inspired oxygen fraction, whereas the protective group was unchanged (p < 0.01).

    CONCLUSIONS: In early phase pneumonia, protective ventilation with lower tidal volume and higher end expiratory pressure has the potential to reduce the pulmonary bacterial burden and the development of lung injury.

  • 362.
    Stefansson, M.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Sormland Cty Council, Ctr Clin Res, Kungsgatan 41, SE-63188 Eskilstuna, Sweden.
    Askling, H. H.
    Karolinska Inst, Dept Med, Div Infect Dis, SE-17176 Stockholm, Sweden.
    Rombo, L.
    Malarsjukhuset, Dept Infect Dis, SE-63188 Eskilstuna, Sweden.
    A single booster dose of diphtheria vaccine is effective for travelers regardless of time interval since previous doses2018In: Journal of Travel Medicine, ISSN 1195-1982, E-ISSN 1708-8305, Vol. 25, article id tay041Article in journal (Refereed)
    Abstract [en]

    Our study showed the immune response before and after a booster against diphtheria given within the 20-year interval recommended in Sweden or after a prolonged interval. Of 40 travellers, 10/13 in recommended interval group were immune before booster and 19/27 with a delayed interval. After booster, 13/13 versus 26/27 were protected. One booster was sufficient to achieve immunity regardless of the interval.

  • 363.
    Sterne, Jesper
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Infektionskliniken, Mälarsjukhuset, Eskilstuna, Sweden.
    Rombo, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Infektionskliniken, Mälarsjukhuset, Eskilstuna, Sweden.
    Loperamid ordineras alltför sällan vid turistdiarré: Resultat av enkät till infektionsläkare2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 9-10, p. 466-468Article in journal (Refereed)
  • 364.
    Svensson, Tobias
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Haematology.
    Kättström, Magdalena
    Hammarlund, Ylva
    Roth, Daniel
    Andersson, Per-Ola
    Svensson, Magnus
    Nilsson, Ingmar
    Rombo, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Cherif, Honar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Haematology.
    Kimby, Eva
    Conjugated Pneumococcal Vaccine Triggers a Better Immune Response than Polysaccharide Pneumococcal Vaccine in Patients with Chronic Lymphocytic Leukemia: A Randomized Study by the Swedish CLL group2018In: Vaccine, ISSN 0264-410X, E-ISSN 1873-2518, Vol. 36, no 25, p. 3701-3707Article in journal (Refereed)
    Abstract [en]

    Aim: To determine if patients with untreated chronic lymphocytic leukemia (CLL) benefit from vaccination with a 13-valent conjugated pneumococcal vaccine (PCV13), Prevenar13®, compared with a 23-valent capsular polysaccharide vaccine (PPSV23), Pneumovax®, in terms of immune response.

     

    Background: Patients with CLL have an increased risk for infection and Streptococcus pneumoniae is one of the most common pathogens with high morbidity.  Patients with CLL are known to respond poorly to the traditionally used polysaccharide vaccines. Conjugation of polysaccharide to protein carriers renders a thymus-dependent, memory-inducing and more immunogenic vaccine. In patients with CLL, there is no consensus on a recommendation for pneumococcal vaccination, due to a lack of comparative studies.

     

    Methods: 128 treatment naïve CLL patients from eight hematology clinics in Sweden were randomized to vaccination with PCV13 (n=63) or PPSV23 (n=65) after stratification by IgG levels and CLL clinical stage (Rai). Blood samples for evaluation of immune response were obtained at baseline, at one and at six months after vaccination. Analyses for each of the 12 pneumococcal serotypes common for PCV13 and PPSV23 were performed by opsonophagocytic assay (OPA) and enzyme-linked immunosorbent assay (ELISA).

     

    Results: PCV13 elicited a superior immune response than PPSV23 in 10/12 serotypes one month after vaccination and in 5/12 serotypes six months after vaccination, measured as OPA geometric mean titers (GMTs). Geometric mean concentrations of serotype-specific IgG antibodies elicited by PCV13 as measured by ELISA, were higher than those elicited by PPSV23 in half of the common serotypes, both after one and six months. The proportion of patients with good response (defined as response in 8 of 12 common serotypes according to predefined response criteria) was higher in PCV13 recipients than in PPSV23 recipients after one month (40% vs. 22%, p=0.034) as well as after six months (33% vs. 17%, p=0.041). Never did PPSV23 trigger a better immune response for any of the serotypes, than PCV13, regardless of analysis. For two of the serotypes, OPA GMTs were lower at the six months than at the one-month follow up. Negative predictive factors for vaccination response were hypogammaglobulinemia and long disease duration. Both vaccines were well tolerated.

     

    Conclusions: In patients with previously untreated CLL, the efficacy of PCV13 in terms of immune response is superior to PPSV23 for many serotypes common for the two vaccines. PCV13 should be considered as a part in vaccination programs against Streptococcus pneumoniae for these patients and administered as early as possible during the course of the disease. 

  • 365.
    Säfstrom, Emma
    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 Nursing Sci, Linkoping, Sweden; Nykoping Hosp, Sormland Cty Council, Nykoping, Sweden.
    Jaarsma, Tiny
    Linkoping Univ, Dept Social & Welf Studies, Linkoping, Sweden.
    Stromberg, Anna
    Linkoping Univ, Dept Med & Hlth Sci, Div Nursing Sci, Linkoping, Sweden;Linkoping Univ, Dept Cardiol, Linkoping, Sweden.
    Continuity and utilization of health and community care in elderly patients with heart failure before and after hospitalization2018In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 18, article id 177Article in journal (Refereed)
    Abstract [en]

    Background: The period after hospitalization due to deteriorated heart failure (HF) is characterized as a time of high generalized risk. The transition from hospital to home is often problematic due to insufficient coordination of care, leading to a fragmentation of care rather than a seamless continuum of care. The aim was to describe health and community care utilization prior to and 30 days after hospitalization, and the continuity of care in patients hospitalized due to de novo or deteriorated HF from the patients' perspective and from a medical chart review. Methods: This was a cross-sectional study with consecutive inclusion of patients hospitalized at a county hospital in Sweden due to deteriorated HF during 2014. Data were collected by structured telephone interviews and medical chart review and analyzed with the Spearman's rank correlation coefficient and Chi square. A P value of 0. 05 was considered significant. Results: A total of 121 patients were included in the study, mean age 82.5 (+/- 6.8) and 49% were women. Half of the patients had not visited any health care facility during the month prior to the index hospital admission, and 79% of the patients visited the emergency room (ER) without a referral. Among these elderly patients, a total of 40% received assistance at home prior to hospitalization and 52% after discharge. A total of 86% received written discharge information, one third felt insecure after hospitalization and lacked knowledge of which health care provider to consult with and contact in the event of deterioration or complications. Health care utilization increased significantly after hospitalization. Conclusion: Most patients had not visited any health care facility within 30 days before hospitalization. Health care utilization increased significantly after hospitalization. Flaws in the continuity of care were found; even though most patients received written information at discharge, one third of the patients lacked knowledge about which health care provider to contact in the event of deterioration and felt insecure at home after discharge.

  • 366.
    Söderberg, Anna Karin
    et al.
    Linkoping Univ, Dept Behav Sci & Learning, S-58183 Linkoping, Sweden.
    Elfors, Caroline
    Linkoping Univ, Dept Behav Sci & Learning, S-58183 Linkoping, Sweden.
    Larsson, Mattias Holmqvist
    Linkoping Univ, Dept Behav Sci & Learning, S-58183 Linkoping, Sweden.
    Falkenström, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Dept Behav Sci & Learning, S-58183 Linkoping, Sweden.
    Holmqvist, Rolf
    Linkoping Univ, Dept Behav Sci & Learning, S-58183 Linkoping, Sweden.
    Emotional availability in psychotherapy: The usefulness and validity of the Emotional Availability Scales for analyzing the psychotherapeutic relationship2014In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 24, no 1, p. 91-102Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to assess whether a modified version of the Emotional Availability Scales (EAS), created to assess interaction quality between parents and children, could be applied to psychotherapy sessions and whether emotional availability (EA), as assessed by the modified EAS-T, was associated with client- and therapist-rated working alliance. EAS-T was used to assess 42 sessions from 16 therapies. The therapies came from the LURIPP project, comparing IPT with BRT for depressed clients. The results showed that sessions could be reliably rated with EAS-T. Most rating scales had acceptable variance. The client's perception of task alliance was associated with several of the EA subscales (sensitivity, nonhostility, responsiveness) assessed over therapies, whereas the perception of bond was associated with Structure on EAS.

  • 367.
    Söderlund, Anne
    et al.
    Mälardalens högskola.
    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, Caring Sciences.
    Sterling, Michele
    University of Queensland, Australia.
    Stålnacke, Britt-Marie
    Umeå universitet.
    Exploring patients’ experiences of the whiplash injury-recovery process: A meta-synthesis2018In: Journal of Pain Research, ISSN 1178-7090, E-ISSN 1178-7090, Vol. 11, p. 1263-1271Article, review/survey (Refereed)
    Abstract [en]

    Purpose: The aim of this study was to conduct a meta-synthesis to analyze qualitative research findings and thereby understand patients’ experiences of whiplash-associated disorders (WAD) and the injury-recovery process. Materials and methods: A qualitative meta-synthesis, which is an interpretive integration of existing qualitative findings, was performed. The databases PubMed, PsychINFO, Scopus, and Web of Science were searched. The Critical Assessment Skills Programme was used to assess the quality of the included studies. Results: Four studies were included. The synthesis resulted in several codes, 6 categories, and 3 themes (distancing from normalcy, self-efficacy in controlling the life situation after the injury, and readjustment and acceptance) that described the participants’ pain beliefs, their WAD-related life situation and their future expectations and acceptance. Changes in self-image were difficult to cope with and likely led to perceived stigmatization. Struggling with feelings of loss of control appeared to lead to low confidence and insecurity. Focusing on increasing knowledge and understanding the pain and its consequences were believed to lead to better strategies for handling the situation. Furthermore, recapturing life roles, including returning to work, was challenging, but an optimistic outlook reinforced symptom improvements and contributed to feelings of happiness. Conclusion: The results of the present study provide a comprehensive understanding of patients’ complex, multifaceted experiences of WAD, and the injury-recovery process. The findings can guide us in the development of new ways to evaluate and manage WAD. The results also indicate that a more patient-centered approach is needed to determine the depth and breadth of each patient’s problems.

  • 368.
    Söderström, U
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Samuelsson, U
    Sahlqvist, L
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Åman, J
    Impaired metabolic control and socio-demographic status in immigrant children at onset of Type 1 diabetes2014In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 31, no 11, p. 1418-1423Article in journal (Refereed)
    Abstract [en]

    AIM:

    The aim of the present study was to compare clinical and socio-demographic conditions at the onset of Type 1 diabetes in children born to immigrant families and children born to Swedish families, and to assess whether those conditions had an impact on metabolic status.

    METHODS AND DESIGN:

    This was an observational nationwide population-based matched cohort study on prospectively recorded registry data of all children with diabetes in Sweden and their families during 2000-2010. Out of a total of 13 415 children from the Swedish Childhood Diabetes Registry (SWEDIABKIDS), 879 children born to immigrant parents were collected. To these we added 2627 children with Swedish-born parents, matched for gender, age and year of onset of Type 1 diabetes.

    RESULTS:

    The proportion of low capillary pH (< 7.30) at onset was higher in the immigrant cohort [25.8% vs. 16.4% in the Swedish cohort (P < 0.001)]. HbA1c was also higher [95 mmol/mol (10.8%) vs. 88 mmol/mol (10.2%), respectively (P < 0.001)]. In a logistic regression model with low pH as the dependent variable, we were unable to reveal any significant association to socio-demographic factors, but the odds ratio for HbA1c was 0.983 (95% CI 0.976-0.991) and for plasma glucose was 0.953 (95% CI 0.933-0.973).

    CONCLUSION:

    Children born to immigrant parents have lower capillary pH and higher HbA1c at diabetes onset. Immigrant families harbour lower socio-demographic living conditions, but this fact does not seem to influence the inferior metabolic condition at diabetes onset.

  • 369.
    Söderström, Ulf
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). School of Health and Medical Sciences, Örebro University, Örebro, Sweden; Department of Pediatrics, Mälarsjukhuset Hospital, Eskilstuna, Sweden.
    Samuelsson, Ulf
    Division of Paediatrics, Department of Molecular and Clinical Medicine, Linkoping University, Linköping, Sweden; Department of Pediatrics, The University Hospital in Linköping, Linköping, Sweden.
    Åman, Jan
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    National Swedish study of immigrant children with type 1 diabetes showed impaired metabolic control after three years of treatment2016In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, no 8, p. 935-939Article in journal (Refereed)
    Abstract [en]

    AIM: This study examined the clinical status and socio-demographic conditions of children with type 1 diabetes at baseline and after three years of treatment, comparing those born to immigrant parents and Swedish parents.

    METHODS: This observational nationwide population-based cohort-study used prospectively collected registry data from Swediabkids, the National Quality Registry for Paediatric Diabetes in Sweden from 2000-2010. Of the 13,415 children with type 1 diabetes, there were 879 born to immigrant parents. We selected three children born to Swedish parents from the same registry for each immigrant child matching them by gender, age and year of diabetes onset (n=2627; with 10 control children missing probably due to the matching procedure).

    RESULTS: Immigrant children had a higher median glycated haemoglobin level (HbA1c) than their Swedish peers, but there was no difference in the frequency of hypoglycaemia or keto-acidosis between the two cohorts. A linear regression model with HbA1c as a dependent variable showed that insulin units per kilogram of body weight were the main reason for inferior metabolic control.

    CONCLUSION: Children with type 1 diabetes born to immigrant parents had inferior metabolic control three years after disease onset compared to children with Swedish born parents. Social family support and educational coping programmes are needed to improve treatment outcomes in immigrants with diabetes. This article is protected by copyright. All rights reserved.

  • 370.
    Ternby, Ellen
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Annerén, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medicinsk genetik och genomik.
    Lindgren, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC Obstet, Stockholm, Sweden.
    Ingvoldstad, Charlotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC Obstet, Stockholm, Sweden.
    Why do pregnant women accept or decline prenatal diagnosis for Down syndrome?2016In: Journal of community genetics, ISSN 1868-310X, Vol. 7, no 3, p. 237-242Article in journal (Refereed)
    Abstract [en]

    To investigate if actual knowledge of Down syndrome (DS), influences the decision to accept or decline prenatal diagnosis (PND). Secondary aims were to elucidate reasons for accepting or declining PND and investigate differences between the accepting and declining group in perceived information, knowing someone with DS and thoughts about decision-making. A questionnaire was completed by 76 pregnant women who underwent invasive testing and 65 women who declined tests for chromosomal aberrations in Uppsala, Sweden. Apart from one question no significant differences were found in knowledge of DS between women declining or accepting PND for DS. Both groups had varying and in several respects low levels of knowledge about DS and its consequences. Most common reasons to accept PND were 'to ease my worries' and 'to do all possible tests to make sure the baby is healthy'. Corresponding statements declining PND were 'termination of pregnancy is not an option' and 'because invasive tests increase the risk of miscarriage'. More women declining PND knew someone with DS. Knowledge of DS at these levels is not a major factor when women decide to accept or decline PND for DS. Their choice is mostly based on opinions and moral values.

  • 371.
    Ternby, Ellen
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Ingvoldstad, Charlotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Department of Clinical Science, Intervention and Technology (CLINTEC), Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden.
    Annerén, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medicinsk genetik och genomik.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Midwives and information on prenatal testing with focus on Down syndrome2015In: Prenatal Diagnosis, ISSN 0197-3851, E-ISSN 1097-0223, Vol. 35, no 12, p. 1202-1207Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate midwives' knowledge of prenatal diagnosis especially Down syndrome, information given by midwives to parents, expectant parents' requests for information and how midwives perceive their own competence to give information.

    METHOD: A cross-sectional, prospective study with a questionnaire was completed by 64 out of 70 midwives working in the outpatient antenatal care in Uppsala County, Sweden.

    RESULTS: The midwives had varying and in some areas low levels of knowledge about Down syndrome. Information about Down syndrome was most often given only when asked for or when there was an increased probability of a Down syndrome pregnancy. The most common questions from expectant parents concerned test methods and risk assessments while questions regarding symptoms of Down syndrome and consequences of having a child with Down syndrome were uncommon. The majority (83-89%) had insufficient or no education regarding different prenatal tests. Only 2 midwives (3%) had received education about Down syndrome and 10% felt they had sufficient knowledge to inform about the syndrome. More education about prenatal tests and Down syndrome was desired by 94%.

    CONCLUSION: It is important to ensure that midwives in antenatal care have sufficient knowledge to inform expectant parents about the conditions screened for.

  • 372.
    Ternby, Ellen
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Ingvoldstad, Charlotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Annerén, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medicinsk genetik och genomik.
    Lindgren, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    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.
    Information and knowledge about Down syndrome among women and partners after first trimester combined testing2015In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 94, no 3, p. 329-32Article in journal (Refereed)
    Abstract [en]

    We assessed reasons among women and partners for choosing combined ultrasound-biochemistry testing, information and knowledge about Down syndrome and decisions concerning invasive procedures and termination of pregnancy in a prospective cohort study in Uppsala County. In all 105 pregnant women and 104 partners coming for a combined ultrasound-biochemistry test answered a questionnaire. The most common reason for a combined ultrasound-biochemistry test was "to perform all tests possible to make sure the baby is healthy". Internet and midwives were the most common sources of information. Seventy-two percent had not received information on what it means to live with a child with Down syndrome. Many expectant parents perceived information as insufficient. Both women and partners had varying or low levels of knowledge about medical, cognitive and social consequences of Down syndrome. Twenty-five percent had not decided on an invasive test if indicated and only 42% would consider termination of pregnancy with a Down syndrome diagnosis.

  • 373.
    Thitasan, Anchalee
    et al.
    Mälardalen Univ, Sch Hlth Care & Social Welf, Västerås, Sweden; Boromarajonani Coll Nursing, Sunpasithiprasong, Thailand.
    Aytar, Osman
    Mälardalen Univ, Sch Hlth Care & Social Welf, Eskilstuna, Sweden.
    Annerbäck, Eva-Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Velandia, Marianne
    Mälardalen Univ, Sch Hlth Care & Social Welf, Västerås, Sweden.
    Young people's health and risk behaviours in relation to their sexual orientation: A cross-sectional study of Thailand and Sweden2019In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 21, p. 67-74, article id S1877-5756(18)30291-XArticle in journal (Refereed)
    Abstract [en]

    Objectives: This study examined the associations between sexual orientation of young people and their health and risk behaviours in Thailand and Sweden, and to explore similarities and differences between the countries.

    Study design: A cross-sectional study using data from the Life and Health – Young surveys in Thailand and Sweden. Three different statistical analyses were used to examine the associations of the variables.

    Results: In total, 3869 students aged 16–18 years old were included: 1488 Thai students and 2381 Swedish students. Significantly more Thai (20%) than Swedish (9%) students identified themselves as bisexual, homosexual or unsure (p < .001). Bivariate analysis showed that, in Thailand, self-harm was more often reported by the homosexual, unsure, and bisexual groups than by the heterosexual group (p = .005). In Sweden, early sexual debut was more often reported by the unsure, bisexual, and homosexual groups than by the heterosexual group (p = .033). Multiple logistic regression analysis showed that homosexual and unsure sexual orientations were significantly associated with self-harm (p < .05) among Thai students. Unsure sexual orientation was significantly associated with early sexual debut (p = .04) among Swedish students. Multiple correspondence analysis indicated that sexual orientation was associated with health and risk behaviours, and varied by different subcategories of students’ backgrounds such as country, sexual orientation, family structure and adult support.

    Conclusions: Sexual minority young people reported more risk behaviours and poorer health than their heterosexual counterparts. The findings are useful for policy programmes on sexual and reproductive health and rights of young people.

     

  • 374.
    Treleaven, Julia
    et al.
    Univ Queensland, NHMRC CCRE Spinal Pain Injury & Hlth, Brisbane, Qld, Australia..
    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, Fac Hlth Sci, Physiotherapy, Dept Med & Hlth Sci, Linkoping, Sweden..
    Ludvigsson, Maria Landen
    Linkoping Univ, Fac Hlth Sci, Physiotherapy, Dept Med & Hlth Sci, Linkoping, Sweden.;Cty Council Ostergotland, Rehab Vast, Stockholm, Sweden..
    Kammerlind, Ann-Sofi
    Linkoping Univ, Fac Hlth Sci, Physiotherapy, Dept Med & Hlth Sci, Linkoping, Sweden.;Cty Council Jonkoping, Futurum Acad Healthcare, Jonkoping, Sweden..
    Peolsson, Anneli
    Linkoping Univ, Fac Hlth Sci, Physiotherapy, Dept Med & Hlth Sci, Linkoping, Sweden..
    Balance, dizziness and proprioception in patients with chronic whiplash associated disorders complaining of dizziness: A prospective randomized study comparing three exercise programs2016In: Manual Therapy, ISSN 1356-689X, E-ISSN 1532-2769, Vol. 22, p. 122-130Article in journal (Refereed)
    Abstract [en]

    Background: Dizziness and unsteadiness are common symptoms following a whiplash injury. Objective: To compare the effect of 3 exercise programs on balance, dizziness, proprioception and pain in patients with chronic whiplash complaining of dizziness.

    Design: A sub-analysis of a randomized study.

    Methods: One hundred and forty subjects were randomized to either a physiotherapist-guided neck-specific exercise (NSE), physiotherapist-guided neck-specific exercise, with a behavioural approach (NSEB) or prescription of general physical activity (PPA) group. Pre intervention, 3, 6 and 12 months post baseline they completed the University of California Los Angeles Dizziness Questionnaire (UCLA-DQ), Visual Analogue Scales (VAS) for, dizziness at rest and during activity and physical measures (static and dynamic clinical balance tests and head repositioning accuracy (HRA)).

    Results: There were significant time by group differences with respect to dizziness during activity and UCLA-Q favouring the physiotherapy led neck specific exercise group with a behavioural approach. Within group analysis of changes over time also revealed significant changes in most variables apart from static balance. Conclusion: Between and within group comparisons suggest that physiotherapist led neck exercise groups including a behavioural approach had advantages in improving measures of dizziness compared with the general physical activity group, although many still complained of dizziness and balance impairment. Future studies should consider exercises specifically designed to address balance, dizziness and cervical proprioception in those with persistent whiplash.

  • 375.
    Trouva, Anastasia
    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 Mol Med & Surg, S-10401 Stockholm, Sweden..
    Calissendorff, Jan
    Karolinska Inst, Dept Clin Sci & Educ, Sodersjukhuset, S-10401 Stockholm, Sweden..
    Vanky, Eszter
    St Olavs Hosp, Inst Lab Med Childrens & Womens Hlth, Trondheim, Norway.;St Olavs Hosp, Dept Obstet & Gynecol, Trondheim, Norway..
    Hirschberg, Angelica
    Karolinska Inst, Dept Womens & Childrens Hlth, S-10401 Stockholm, Sweden.;Karolinska Univ Hosp, Dept Obstet & Gynecol, Stockholm, Sweden..
    Thyroid hormone function in pregnant women with polycystic ovary syndrome treated with metformin or placebo2016In: Gynecological Endocrinology, ISSN 0951-3590, E-ISSN 1473-0766, Vol. 32, p. 71-72Article in journal (Other academic)
  • 376.
    Turcotte, Lucie M.
    et al.
    Univ Minnesota, Blood & Marrow Transplant Program, Minneapolis, MN 55455 USA.
    Wang, Tao
    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.
    Hemmer, Michael T.
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA.
    Spellman, Stephen R.
    Natl Marrow Donor Program Be Match, Ctr Int Blood & Marrow Transplant Res, Minneapolis, MN USA.
    Arora, Mukta
    Univ Minnesota, Dept Med, Med Ctr, Div Hematol Oncol & Transplantat, Box 736 UMHC, Minneapolis, MN 55455 USA.
    Couriel, Daniel
    Utah Blood & Marrow Transplant Program, Salt Lake City, UT USA.
    Alousi, Amin
    Univ Texas MD Anderson Canc Ctr, Dept Stem Cell Transplantat, Div Canc Med, Houston, TX 77030 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.
    Ahmed, Ibrahim
    Childrens Mercy Hosp & Clin, Dept Hematol Oncol & Bone Marrow Transplantat, Kansas City, MO USA.
    Beitinjaneh, Amer
    Univ Miami, Miami, FL USA.
    Buchbinder, David
    Childrens Hosp Orange Cty, Div Pediat Hematol, Orange, CA 92668 USA.
    Byrne, Michael
    Vanderbilt Univ, Med Ctr, Nashville, TN USA.
    Callander, Natalie
    Univ Wisconsin Hosp & Clin, Dept Med, Div Hematol Oncol Bone Marrow Transplantat, Madison, WI 53792 USA.
    Chao, Nelson
    Duke Univ, Med Ctr, Dept Med, Div Cell Therapy & Hematol, Durham, NC 27710 USA.
    Choi, Sung Wong
    Univ Michigan, Ann Arbor, MI 48109 USA.
    DeFilipp, Zachariah
    Massachusetts Gen Hosp, Blood & Marrow Transplant Program, Boston, MA 02114 USA.
    Gadalla, Shahinaz M.
    NCI, Div Canc Epidemiol & Genet, NIH, Clin Genet Branch, Rockville, MD USA.
    Gale, Robert Peter
    Imperial Coll London, Dept Med, Div Expt Med, Hematol Res Ctr, London, England.
    Gergis, Usama
    New York Presbyterian Hosp, Weill Cornell Med Ctr, Dept Med Oncol, Hematolg Malignancies & Bone Marrow Transplant, New York, NY USA.
    Hashmi, Shahrukh
    Mayo Clin, Dept Internal Med, Rochester, MN USA;King Faisal Specialist Hosp & Res Ctr, Ctr Oncol, Riyadh, Saudi Arabia.
    Hematti, Peiman
    Univ Wisconsin Hosp & Clin, Dept Med, Div Hematol Oncol Bone Marrow Transplantat, Madison, WI 53792 USA.
    Holmberg, Leona
    Fred Hutchinson Canc Res Ctr, 1124 Columbia St, Seattle, WA 98104 USA.
    Inamoto, Yoshihiro
    Natl Canc Ctr, Div Hematopoiet Stem Cell Transplantat, Tokyo, Japan.
    Kamble, Rammurti T.
    Baylor Coll Med, Ctr Cell & Gene Therapy, Div Hematol & Oncol, Houston, TX 77030 USA.
    Lehmann, Leslie
    Boston Childrens Hosp, Dana Farber Canc Inst, Boston, MA USA.
    MacMillan, Margaret A.
    Univ Minnesota, Dept Med, Med Ctr, Div Hematol Oncol & Transplantat, Box 736 UMHC, Minneapolis, MN 55455 USA.
    McIver, Zachariah
    Wake Forest Baptist Hlth, Winston Salem, NC USA.
    Nishihori, Taiga
    H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL USA.
    Norkin, Maxim
    Univ Florida, Coll Med, Div Hematol Oncol, Gainesville, FL USA.
    O'Brien, Tracey
    Sydney Childrens Hosp, Kids Canc Ctr, Blood & Marrow Transplant Program, Sydney, NSW, Australia.
    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.
    Reshef, Ran
    Columbia Univ, Med Ctr, Blood & Marrow Transplantat Program, New York, NY USA;Columbia Univ, Med Ctr, Columbia Ctr Translat Immunol, New York, NY USA.
    Saad, Ayman
    Univ Alabama Birmingham, Dept Med, Div Hematol Oncol, Birmingham, AL 35294 USA.
    Savani, Bipin N.
    Vanderbilt Univ, Med Ctr, Dept Med, Div Hematol Oncol, Nashville, TN USA.
    Schouten, Harry C.
    Acad Ziekenhuis, Dept Hematol, Maastricht, Netherlands.
    Seo, Sachiko
    Natl Canc Res Ctr East, Dept Hematol & Oncol, Chiba, Japan.
    Solh, Melhem
    Northside Hosp, Blood & Marrow Transplant Grp Georgia, Atlanta, GA USA.
    Verdonck, Leo
    Isala Clin, Dept Hematol Oncol, Zwolle, Netherlands.
    Vij, Ravi
    Washington Univ, Sch Med, Div Hematol & Oncol, St Louis, MO USA.
    Wirk, Baldeep
    Seattle Canc Care Alliance, Div Bone Marrow Transplant, Seattle, WA USA.
    Yared, Jean
    Univ Maryland, Dept Med, Blood & Marrow Transplantat Program, Div Hematol Oncol,Greenebaum Canc Ctr, Baltimore, MD 21201 USA.
    Horowitz, Mary M.
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA.
    Knight, Jennifer M.
    Med Coll Wisconsin, Dept Psychiat, Milwaukee, WI 53226 USA.
    Verneris, Michael R.
    Univ Colorado Denver, Aurora, CO USA.
    Correspondence: Donor body mass index does not predict graft versus host disease following hematopoietic cell transplantation2018In: Bone Marrow Transplantation, ISSN 0268-3369, E-ISSN 1476-5365, Vol. 53, no 7, p. 932-937Article in journal (Other academic)
  • 377.
    Urbano-Ispizua, Alvaro
    et al.
    Univ Barcelona, Hosp Clin, IDIBAPS, Dept Hematol, Barcelona, Spain.;Inst Res Josep Carreras, Barcelona, Spain..
    Pavletic, Steven Z.
    NCI, Expt Transplantat & Immunol Branch, Ctr Canc Res, Bethesda, MD 20892 USA..
    Flowers, Mary E.
    Fred Hutchinson Canc Res Ctr, Div Clin Res, Seattle, WA 98104 USA..
    Klein, John P.
    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..
    Zhang, Mei-Jie
    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..
    Carreras, Jeanette
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA..
    Montoto, Silvia
    Barts Hlth NHS Trust, St Bartholomews Hosp, Dept Haematooncol, London, England..
    Perales, Miguel-Angel
    Mem Sloan Kettering Canc Ctr, Dept Med, Bone Marrow Transplant Serv, New York, NY 10021 USA..
    Aljurf, Mahmoud D.
    King Faisal Specialist Hosp Ctr & Res, Dept Oncol, Riyadh, Saudi Arabia..
    Akpek, Goerguen
    Banner MD Anderson Canc Ctr, Hematol Oncol Sect, Gilbert, AZ USA..
    Bredeson, Christopher N.
    Ottawa Hosp, Blood & Marrow Transplant Program, Ottawa, ON, Canada.;Ottawa Hosp, Res Inst, Ottawa, ON, Canada..
    Costa, Luciano J.
    Univ Alabama Birmingham, Dept Med, Div Hematol Oncol, Birmingham, AL 35294 USA..
    Dandoy, Christopher
    Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH 45229 USA..
    Freytes, Cesar O.
    South Texas Vet Hlth Care Syst, San Antonio, TX USA.;Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA..
    Fung, Henry C.
    Temple Hlth, Fox Chase Canc Ctr, Dept Med Oncol, Philadelphia, PA USA..
    Gale, Robert Peter
    Univ London Imperial Coll Sci Technol & Med, Dept Med, Div Expt Med, Hematol Res Ctr, London, England..
    Gibson, John
    Royal Prince Alfred Hosp, Inst Haematol, Camperdown, NSW 2050, Australia..
    Hamadani, Mehdi
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA..
    Hayashi, Robert J.
    Washington Univ, Sch Med, Dept Pediat, Div Pediat Hematol Oncol, St Louis, MO 63110 USA..
    Inamoto, Yoshihiro
    Fred Hutchinson Canc Res Ctr, Div Clin Res, Seattle, WA 98104 USA..
    Inwards, David J.
    Mayo Clin, Div Hematol, Rochester, MN USA..
    Lazarus, Hillard M.
    Univ Hosp Case Med Ctr, Seidman Canc Ctr, Cleveland, OH USA..
    Maloney, David G.
    Fred Hutchinson Canc Res Ctr, Div Clin Res, Seattle, WA 98104 USA..
    Martino, Rodrigo
    Hosp Santa Creu & Sant Pau, Div Hematol, Barcelona, Spain..
    Munker, Reinhold
    Louisiana State Univ Hlth, Dept Internal Med, Div Hematol Oncol, Shreveport, LA USA..
    Nishihori, Taiga
    Univ S Florida, Coll Med, H Lee Moffitt Canc Ctr & Res Inst, Dept Med Oncol, Tampa, FL 33612 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..
    Rizzieri, David A.
    Duke Univ, Div Hematol Malignancies & Cellular Therapy, Durham, NC USA..
    Reshef, Ran
    Univ Penn, Dept Med, Abramson Canc Ctr, Med Ctr, Philadelphia, PA 19104 USA..
    Saad, Ayman
    Univ Alabama Birmingham, Dept Med, Div Hematol Oncol, Birmingham, AL 35294 USA..
    Savani, Bipin N.
    Vanderbilt Univ, Med Ctr, Dept Med, Div Hematol Oncol, Nashville, TN USA..
    Schouten, Harry C.
    Acad Ziekenhuis, Dept Hematol, Maastricht, Netherlands..
    Smith, Sonali M.
    Univ Chicago, Hematol Oncol Sect, Chicago, IL 60637 USA..
    Socie, Gerard
    Hop St Louis, Dept Hematol, Paris, France..
    Wirk, Baldeep
    SUNY Stony Brook, Med Ctr, Dept Internal Med, Stony Brook, NY 11794 USA..
    Yu, Lolie C.
    Louisiana State Univ, Med Ctr, Childrens Hosp, Div Hematol Oncol,Ctr Canc & Blood Disorders, New Orleans, LA USA..
    Saber, Wael
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA..
    The Impact of Graft-versus-Host Disease on the Relapse Rate in Patients with Lymphoma Depends on the Histological Subtype and the Intensity of the Conditioning Regimen2015In: Biology of blood and marrow transplantation, ISSN 1083-8791, E-ISSN 1523-6536, Vol. 21, no 10, p. 1746-1753Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to analyze the impact of graft-versus-host disease (GVHD) on the relapse rate of different lymphoma subtypes after allogeneic hematopoietic cell transplantation (allo-HCT). Adult patients with a diagnosis of Hodgkin lymphoma, diffuse large B cell lymphoma, follicular lymphoma (FL), peripheral T cell lymphoma, or mantle cell lymphoma (MCL) undergoing HLA-identical sibling or unrelated donor hematopoietic cell transplantation between 1997 and 2009 were included. Two thousand six hundred eleven cases were included. A reduced-intensity conditioning (RIC) regimen was used in 62.8% of the transplantations. In a multivariate analysis of myeloablative cases (n = 970), neither acute (aGVHD) nor chronic GVHD (cGVHD) were significantly associated with a lower incidence of relapse/progression in any lymphoma subtype. In contrast, the analysis of RIC cases (n = 1641) showed that cGVHD was associated with a lower incidence of relapse/progression in FL (risk ratio [RR],.51; P = 3.049) and in MCL (RR,.41; P = .019). Patients with FL or MCL developing both aGVHD and cGVHD had the lowest risk of relapse (RR,.14; P = .007; and RR,.15; P = .0019, respectively). Of interest, the effect of GVHD on decreasing relapse was similar in patients with sensitive disease and chemoresistant disease. Unfortunately, both aGVHD and cGVHD had a deleterious effect on treatment-related mortality and overall survival (OS) in FL cases but did not affect treatment-related mortality, OS or PFS in MCL. This study reinforces the use of RIC allo-HCT as a platform for immunotherapy in FL and MCL patients.

  • 378. Ursing, Johan
    et al.
    Eksborg, Staffan
    Rombo, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Bergqvist, Yngve
    Blessborn, Daniel
    Rodrigues, Amabelia
    Kofoed, Poul-Erik
    Chloroquine Is Grossly Under Dosed in Young Children with Malaria: Implications for Drug Resistance2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 1, p. e86801-Article in journal (Refereed)
    Abstract [en]

    Background: Plasmodium falciparum malaria is treated with 25 mg/kg of chloroquine (CQ) irrespective of age. Theoretically, CQ should be dosed according to body surface area (BSA). The effect of dosing CQ according to BSA has not been determined but doubling the dose per kg doubled the efficacy of CQ in children aged <15 years infected with P. falciparum carrying CQ resistance causing genes typical for Africa. The study aim was to determine the effect of age on CQ concentrations. Methods and Findings: Day 7 whole blood CQ concentrations were determined in 150 and 302 children treated with 25 and 50 mg/kg, respectively, in previously conducted clinical trials. CQ concentrations normalised for the dose taken in mg/kg of CQ decreased with decreasing age (p<0.001). CQ concentrations normalised for dose taken in mg/m(2) were unaffected by age. The median CQ concentration in children aged <2 years taking 50 mg/kg and in children aged 10-14 years taking 25 mg/kg were 825 (95% confidence interval [CI] 662-988) and 758 (95% CI 640-876) nmol/l, respectively (p = 0.67). The median CQ concentration in children aged 10-14 taking 50 mg/kg and children aged 0-2 taking 25 mg/kg were 1521 and 549 nmol/l. Adverse events were not age/concentration dependent. Conclusions: CQ is under-dosed in children and should ideally be dosed according to BSA. Children aged <2 years need approximately double the dose per kg to attain CQ concentrations found in children aged 10-14 years. Clinical trials assessing the efficacy of CQ in Africa are typically performed in children aged <5 years. Thus the efficacy of CQ is typically assessed in children in whom CQ is under dosed. Approximately 3 fold higher drug concentrations can probably be safely given to the youngest children. As CQ resistance is concentration dependent an alternative dosing of CQ may overcome resistance in Africa.

  • 379. Ursing, Johan
    et al.
    Kofoed, Poul-Erik
    Rodrigues, Amabelia
    Blessborn, Daniel
    Thoft-Nielsen, Rikke
    Björkman, Anders
    Rombo, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Similar efficacy and tolerability of double-dose chloroquine and artemether-lumefantrine for treatment of Plasmodium falciparum infection in Guinea-Bissau: a randomized trial2011In: The Journal of infectious diseases, ISSN 1537-6613, Vol. 203, no 1, p. 109-116Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    In 2008, Guinea-Bissau introduced artemether-lumefantrine for treatment of uncomplicated malaria. Previously, 3 times the standard dose of chloroquine, that was probably efficacious against Plasmodium falciparum with the resistance-associated chloroquine-resistance transporter (pfcrt) 76T allele, was routinely used. The present study compared the efficacy and tolerability of a double standard dose of chloroquine with the efficacy and tolerability of artemether-lumefantrine.

    METHODS:

    In a randomized open-label clinical trial, artemether-lumefantrine or chloroquine (50 mg/kg) were given as 6 divided doses over 3 days to children aged 6 months - 15 years who had uncomplicated P. falciparum monoinfection. Drug concentrations were measured on day 7. P. falciparum multidrug resistance gene N86Y and pfcrt K76T alleles were identified.

    RESULTS:

    The polymerase chain reaction-adjusted day 28 and 42 treatment efficacies were 162 (97%) of 168 and 155 (97%) of 161, respectively, for artemether-lumefantrine and 150 (95%) of 158 and 138 (94%) of 148, respectively, for chloroquine. When parasites with resistance-associated pfcrt 76T were treated, the day 28 efficacy of chloroquine was 87%. No severe drug-related adverse events were detected. Symptom resolution was similar with both treatments.

    CONCLUSIONS:

    Both treatments achieved the World Health Organization-recommended efficacy for antimalarials that will be adopted as policy. High-dose chloroquine treatment regimes should be further evaluated with the aim of assessing chloroquine as a potential partner drug to artemisinin derivatives.

    CLINICAL TRIALS REGISTRATION:

    NCT00426439

  • 380.
    Ursing, Johan
    et al.
    Indepth Network, Projecto Saude Bandim, Bissau, Guinea Bissau.;Karolinska Inst, Dept Microbiol Tumor & Cell Biol, Stockholm, Sweden. Danderyd Hosp, Dept Infect Dis, Stockholm, Sweden. Sormland Cty Council, Clin Res Ctr, Eskilstuna, Sweden. Uppsala Univ, Borlange, Sweden. Dalarna Univ Coll, Borlange, Sweden. Kolding Cty Hosp, Dept Paediat, Kolding, Denmark..
    Rombo, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Microbiol Tumor & Cell Biol, Stockholm, Sweden. Danderyd Hosp, Dept Infect Dis, Stockholm, Sweden.
    Bergqvist, Yngve
    Borlange, Sweden. Dalarna Univ Coll, Borlange, Sweden..
    Rodrigues, Amabelia
    Indepth Network, Projecto Saude Bandim, Bissau, Guinea Bissau..
    Kofoed, Poul-Erik
    Indepth Network, Projecto Saude Bandim, Bissau, Guinea Bissau;Kolding Cty Hosp, Dept Paediat, Kolding, Denmark..
    High-Dose Chloroquine for Treatment of Chloroquine-Resistant Plasmodium falciparum Malaria2016In: Journal of Infectious Diseases, ISSN 0022-1899, E-ISSN 1537-6613, Vol. 213, no 8, p. 1315-1321Article in journal (Refereed)
    Abstract [en]

    Background. Due to development of multidrug-resistant Plasmodium falciparum new antimalarial therapies are needed. In Guinea-Bissau, routinely used triple standard-dose chloroquine remained effective for decades despite the existence of "chloroquine-resistant" P. falciparum. This study aimed to determine the in vivo efficacy of higher chloroquine concentrations against P. falciparum with resistance-conferring genotypes. Methods. Standard or double-dose chloroquine was given to 892 children aged < 15 years with uncomplicated malaria during 3 clinical trials (2001-2008) with >= 35 days follow-up. The P. falciparum resistance-conferring genotype (pfcrt 76T) and day 7 chloroquine concentrations were determined. Data were divided into age groups (< 5, 5-9, and 10-14 years) because concentrations increase with age when chloroquine is prescribed according to body weight. Results. Adequate clinical and parasitological responses were 14%, 38%, and 39% after standard-dose and 66%, 84%, and 91% after double-dose chloroquine in children aged < 5, 5-9, and 10-14 years, respectively, and infected with P. falciparum genotypes conferring chloroquine resistance (n = 195, P < .001). In parallel, median chloroquine concentrations were 471, 688, and 809 nmol/L for standard-dose and 1040, 1494, and 1585 nmol/L for double-dose chloroquine. Conclusions. Chloroquine resistance is dose dependent and can be overcome by higher, still well-tolerated doses.

  • 381. Ursing, Johan
    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).
    Rodrigues, Amabelia
    Aaby, Peter
    Kofoed, Poul-Erik
    Malaria Transmission in Bissau, Guinea-Bissau between 1995 and 2012: Malaria Resurgence Did Not Negatively Affect Mortality2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 7, p. e101167-Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: As Plasmodium falciparum prevalence decreases in many parts of Sub-Saharan Africa, so does immunity resulting in larger at risk populations and increased risk of malaria resurgence. In Bissau, malaria prevalence decreased from ?50% to 3% between 1995 and 2003. The epidemiological characteristics of P. falciparum malaria within Bandim health and demographic surveillance site (population similar to 100000) between 1995 and 2012 are described. METHODS AND FINDINGS: The population was determined by census. 3603 children aged <15 years that were enrolled in clinical trials at the Bandim health centre (1995-2012) were considered incident cases. The mean annual malaria incidence per thousand children in 1995-1997, 1999-2003, 2007, 2011, 2012 were as follows; age <5 years 22 -> 29 -> 4 -> 9 -> 3, age 5-9 years 15 -> 28 -> 4 -> 33 -> 12, age 10-14 years 9 -> 15 -> 1 -> 45 -> 19. There were 4 campaigns (2003-2010) to increase use of insecticide treated bed nets (ITN) amongst children <5 years. An efficacious high-dose chloroquine treatment regime was routinely used until artemisinin based combination therapy (ACT) was introduced in 2008. Long lasting insecticide treated bed nets (LLIN) were distributed in 2011. By 2012 there was 1 net per 2 people and 97% usage. All-cause mortality decreased from post-war peaks in 1999 until 2012 in all age groups and was not negatively affected by malaria resurgence. CONCLUSION: The cause of decreasing malaria incidence (1995-2007) was probably multifactorial and coincident with the use of an efficacious high-dose chloroquine treatment regime. Decreasing malaria prevalence created a susceptible group of older children in which malaria resurged, highlighting the need to include all age groups in malaria interventions. ACT did not hinder malaria resurgence. Mass distribution of LLINs probably curtailed malaria epidemics. All-cause mortality was not negatively affected by malaria resurgence.

  • 382.
    Ustun, Celalettin
    et al.
    Rush Univ, Div Hematol Oncol Cell Therapy, Chicago, IL 60612 USA.
    Kim, Soyoung
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA;Med Coll Wisconsin, Inst Hlth & Equ, Div Biostat, Milwaukee, WI 53226 USA.
    Chen, Min
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA.
    Beitinjaneh, Amer M.
    Univ Miami, Dept Hematol, Miami, FL USA.
    Brown, Valerie, I
    Penn State Hershey Childrens Hosp & Coll Med, Div Pediat Oncol Hematol, Dept Pediat, Hershey, PA USA.
    Dahi, Parastoo B.
    Mem Sloan Kettering Canc Ctr, Dept Med, Adult Bone Marrow Transplant Serv, 1275 York Ave, New York, NY 10021 USA.
    Daly, Andrew
    Tom Baker Canc Clin, Calgary, AB, Canada.
    Diaz, Miguel Angel
    Hosp Infantil Univ Nino Jesus, Dept Hematol Oncol, Madrid, Spain.
    Freytes, Cesar O.
    Texas Transplant Inst, San Antonio, TX USA.
    Ganguly, Siddhartha
    Univ Kansas Hlth Syst, Div Hematol Malignancy & Cellular Therapeut, Kansas City, KS USA.
    Hashmi, Shahrukh
    Mayo Clin, Dept Internal Med, Rochester, MN USA;King Faisal Specialist Hosp & Res Ctr, Oncol Ctr, Riyadh, Saudi Arabia.
    Hildebrandt, Gerhard C.
    Univ Kentucky, Markey Canc Ctr, Lexington, KY USA.
    Lazarus, Hillard M.
    Case Western Reserve Univ, Dept Med, Stem Cell Transplant Program, Univ Hosp Cleveland,Div Hematol & Oncol, Cleveland, OH 44106 USA.
    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, Stockholm, Sweden.
    Page, Kristin M.
    Duke Univ, Med Ctr, Div Pediat Blood & Marrow Transplantat, Durham, NC USA.
    Papanicolaou, Genovefa
    Mem Sloan Kettering Canc Ctr, Infect Dis Serv, New York, NY 10021 USA.
    Saad, Ayman
    Ohio State Univ, Div Hematol, Columbus, OH 43210 USA.
    Seo, Sachiko
    Dokkyo Med Univ, Dept Haematol & Oncol, Mibu, Tochigi, Japan.
    William, Basem M.
    Ohio State Univ, Div Hematol, Columbus, OH 43210 USA.
    Wingard, John R.
    Univ Florida, Dept Med, Div Hematol & Oncol, Gainesville, FL USA.
    Wirk, Baldeep
    Seattle Canc Care Alliance, Div Bone Marrow Transplant, Seattle, WA USA.
    Yared, Jean A.
    Univ Maryland, Blood & Marrow Transplantat Program, Div Hematol Oncol, Dept Med,Greenebaum Comprehens Canc Ctr, Baltimore, MD 21201 USA.
    Perales, Miguel-Angel
    Mem Sloan Kettering Canc Ctr, Dept Med, Adult Bone Marrow Transplant Serv, 1275 York Ave, New York, NY 10021 USA.
    Auletta, Jeffery J.
    Nationwide Childrens Hosp, Blood & Marrow Transplant Program, Columbus, OH USA;Nationwide Childrens Hosp, Host Def Program, Div Hematol Oncol & Blood Marrow & Transplant, Columbus, OH USA;Nationwide Childrens Hosp, Div Infect Dis, Columbus, OH USA.
    Komanduri, Krishna, V
    Univ Miami, Dept Hematol, Miami, FL USA.
    Lindemans, Caroline A.
    Univ Utrecht, Univ Med Ctr Utrecht, Pediat Blood & Marrow Transplantat Program, Utrecht, Netherlands;Princess Maxima Ctr Pediat Oncol, Utrecht, Netherlands.
    Riches, Marcie L.
    Univ North Carolina Chapel Hill, Div Hematol Oncol, Chapel Hill, NC USA.
    Increased overall and bacterial infections following myeloablative allogeneic HCT for patients with AML in CR12019In: BLOOD ADVANCES, ISSN 2473-9529, Vol. 3, no 17, p. 2525-2536Article in journal (Refereed)
    Abstract [en]

    Presumably, reduced-intensity/nonmyeloablative conditioning (RIC/NMA) for allogeneic hematopoietic cell transplantation (alloHCT) results in reduced infections compared with myeloablative conditioning (MAC) regimens; however, published evidence is limited. In this Center for International Blood and Marrow Transplant Research study, 1755 patients (aged >= 40 years) with acute myeloid leukemia in first complete remission were evaluated for infections occurring within 100 days after T-cell replete alloHCT. Patients receiving RIC/NMA (n = 777) compared with those receiving MAC (n = 978) were older and underwent transplantation more recently; however, the groups were similar regarding Karnofsky performance score, HCT-comorbidity index, and cytogenetic risk. One or more infections occurred in 1045 (59.5%) patients (MAC, 595 [61%]; RIC/NMA, 450 [58%]; P = .21) by day 100. The median time to initial infection after MAC conditioning occurred earlier (MAC, 15 days [range, <1-99 days]; RIC/NMA, 21 days [range, <1-100 days]; P < .001). Patients receiving MAC were more likely to experience at least 1 bacterial infection by day 100 (MAC, 46% [95% confidence interval (CI), 43-49]; RIC/NMA, 37% [95% CI, 34-41]; P = .0004), whereas at least a single viral infection was more prevalent in the RIC/NMA cohort (MAC, 34% [95% CI, 31-37]; RIC/NMA, 39% [95% CI, 36-42]; P = .046). MAC remained a risk factor for bacterial infections in multivariable analysis (relative risk, 1.44; 95% CI, 1.23-1.67; P < .0001). Moreover, the rate of any infection per patient-days at risk in the first 100 days (infection density) after alloHCT was greater for the MAC cohort (1.21; 95% CI, 1.11-1.32; P < .0001). RIC/NMA was associated with reduced infections, especially bacterial infections, in the first 100 days after alloHCT.

  • 383.
    Uy, G. L.
    et al.
    Washington Univ, Sch Med, Dept Med, St Louis, MO 63110 USA..