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  • 1.
    Alexandre, Luana
    et al.
    Univ Porto, Fac Med, Porto, Portugal..
    Pereira, Ana Margarida
    Univ Porto, Fac Med, Dept Community Med Informat & Hlth Decis Sci MEDCI, Porto, Portugal.;CUF Porto Hosp, Allergy Unit, Porto, Portugal.;Institute, Porto, Portugal..
    Amaral, Rita
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research. Univ Porto, Fac Med, CINTESISRISE MEDCIDS, Porto, Portugal.;Polytech Inst Porto, Sch Hlth, Dept Cardiovasc & Resp Sci, Porto, Portugal..
    Alves-Correia, Magna
    CUF Porto Hosp, Allergy Unit, Porto, Portugal.;Institute, Porto, Portugal..
    Almeida, Rute
    Univ Porto, Fac Med, CINTESISRISE MEDCIDS, Porto, Portugal..
    Fonseca, Joao Almeida
    CUF Porto Hosp, Allergy Unit, Porto, Portugal.;Institute, Porto, Portugal.;Univ Porto, Fac Med, CINTESISRISE MEDCIDS, Porto, Portugal.;MEDIDA Med Educ Invest Desenvolvimento & Avaliacao, Porto, Portugal..
    Jacome, Cristina
    Univ Porto, Fac Med, CINTESISRISE MEDCIDS, Porto, Portugal.;Univ Porto, Fac Med, Ctr Hlth Technol & Serv Res, Dept Community Med Informat & Hlth Decis Sci, Rua Placido da Costa, P-4200450 Porto, Portugal..
    Patients' Satisfaction with Remote Asthma Medical Follow-Up Before and During the COVID-19 Pandemic2023In: Telemedicine journal and e-health, ISSN 1530-5627, E-ISSN 1556-3669, Vol. 29, no 9, p. 1383-1389Article in journal (Refereed)
    Abstract [en]

    Background: The COVID-19 pandemic forced the change of health care services, favoring the use of remote consultations.

    Objective: To assess the differences in asthma medical follow-up before and during the COVID-19 pandemic and to evaluate patients' satisfaction regarding remote consultations.

    Methods: A cross-sectional, observational, web-based study, including 335 Portuguese patients with self-reported physician-diagnosed asthma, was conducted. The survey was available between February and May 2021 and included questions about patients' sociodemographic and clinical characteristics and follow-up (consultations' type and satisfaction in 2019 and 2020). Satisfaction was assessed using 10 statements on different aspects of patient experience (Likert scale 1-5), with a total score between 10 and 50.

    Results: The 335 patients included had a median [P25-P75] age of 27 [21-43] years and 75% had uncontrolled asthma. Overall, fewer participants had consultations during the pandemic compared to 2019 (161 vs. 185; p < 0.001). Most patients had >= 1 face-to-face consultation both in 2020 and 2019 (131 vs. 184; p < 0.001). In 2020, there was an increase in the proportion of participants reporting >= 1 remote (telephonic plus video) consultation (40% vs. 3%; p < 0.001). This increase was mainly attributed to the use of telephonic consultation (38% vs. video 3%, p < 0.001). Patients' satisfaction was similar in 2020 and 2019 for face-to-face consultations (44 [38-47] and 44 [39-48], p = 0.136). In 2020, satisfaction with remote consultations was slightly lower than with face-to-face (43 [37-46] vs. 44 [38-47], p < 0.001).

    Conclusions: Even though patients were slightly more satisfied with face-to-face consultations, remote consultations can be an alternative in follow-up services for patients with asthma in the near future.

  • 2.
    Alving, Kjell
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Longitudinal Changes in Biomarker Levels: An Important Part of Asthma Follow-Up2024In: Journal of Allergy and Clinical Immunology: In Practice, ISSN 2213-2198, E-ISSN 2213-2201, Vol. 12, no 7, p. 1773-1774Article in journal (Other academic)
  • 3.
    Alving, Kjell
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation, Metabolism and Child Health Research.
    Diamant, Zuzana
    Lund Univ, Dept Resp Med & Allergol, Lund, Sweden.;Charles Univ Prague, Fac Med 1, Dept Resp Med, Prague, Czech Republic.;Thomayer Hosp, Prague, Czech Republic..
    Lucas, Sarah
    Resp Effectiveness Grp, Ely, Cambs, England..
    Magnussen, Helgo
    German Ctr Lung Res, Airway Res Ctr North, Lung Clin Grosshansdorf, Pulm Res Inst, Grosshansdorf, Germany..
    Pavord, Ian D.
    Univ Oxford, Resp Med Unit, Oxford, England.;Univ Oxford, Oxford Resp NIHR Biomed Res Ctr, Nuffield Dept Med, Oxford, England..
    Piacentini, Giorgio
    Univ Verona, Dept Surg Dent Paediat & Gynaecol, Paediat Sect, Verona, Italy..
    Price, David
    Univ Aberdeen, Inst Appl Hlth Sci, Ctr Acad Primary Care, Aberdeen, Scotland.;Observat & Pragmat Res Inst, Singapore, Singapore..
    Roche, Nicolas
    Univ Paris 05, Hop Cochin, Serv Pneumol, Paris, France..
    Sastre, Joaquin
    Fdn Jimenez Diaz, Allergy Div, Madrid, Spain..
    Thomas, Mike
    Univ Southampton, Primary Care & Populat Sci, Southampton, Hants, England..
    Usmani, Omar
    Imperial Coll London, Natl Heart & Lung Inst, Airway Dis Sect, London, England.;Royal Brompton Hosp, London, England..
    Bjermer, Leif
    Lund Univ, Dept Resp Med & Allergol, Lund, Sweden..
    Point-of-care biomarkers in asthma management: Time to move forward2020In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 75, no 4, p. 995-997Article in journal (Other academic)
  • 4.
    Alving, Kjell
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Teague, W. Gerald
    Univ Virginia, Child Hlth Res Ctr, Sch Med, Dept Pediat, Charlottesville, VA USA..
    Further Fine-Tuning of the Interpretation of FeNO Measurement in Asthma2024In: Journal of Allergy and Clinical Immunology: In Practice, ISSN 2213-2198, E-ISSN 2213-2201, Vol. 12, no 1, p. 118-119Article in journal (Other academic)
  • 5.
    Alving, Kjell
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Teague, William G.
    Univ Virginia, Child Hlth Res Ctr, Dept Pediat, Sch Med, Charlottesville, VA USA..
    Inflammatory Markers to Inform Treatment of Asthma With Biologicals: FeNO Versus Blood Eosinophils2023In: Journal of Allergy and Clinical Immunology: In Practice, ISSN 2213-2198, E-ISSN 2213-2201, Vol. 11, no 4, p. 1221-1223Article in journal (Other academic)
  • 6.
    Amaral, Rita
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation, Metabolism and Child Health Research. Univ Porto, CINTESIS Ctr Hlth Technol & Serv Res, Fac Med, Edificio Nascente,Piso 2, P-4200450 Porto, Portugal; Polytech Inst Porto, Porto Hlth Sch, Dept Cardiovasc & Resp Sci, Porto, Portugal; Univ Porto, MEDCIDS Dept Community Med Informat & Hlth Sci, Fac Med, Porto, Portugal.
    Jacinto, Tiago
    Univ Porto, CINTESIS Ctr Hlth Technol & Serv Res, Fac Med, Edificio Nascente, Piso 2, P-4200450 Porto, Portugal; Polytech Inst Porto, Porto Hlth Sch, Dept Cardiovasc & Resp Sci, Porto, Portugal.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Price, David
    Observat & Pragmat Res Inst, Singapore, Singapore; Univ Aberdeen, Div Appl Hlth Sci, Ctr Acad Primary Care, Aberdeen, Scotland.
    Fonseca, Joao A.
    Univ Porto, CINTESIS Ctr Hlth Technol & Serv Res, Fac Med, Edificio Nascente, Piso 2, P-4200450 Porto, Portugal; Univ Porto, MEDCIDS Dept Community Med Informat & Hlth Sci, Fac Med, Porto, Portugal.
    Alving, Kjell
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation, Metabolism and Child Health Research.
    The influence of individual characteristics and non-respiratory diseases on blood eosinophil count2021In: Clinical and Translational Allergy, E-ISSN 2045-7022, Vol. 11, no 4, article id e12036Article in journal (Refereed)
    Abstract [en]

    Background

    Blood eosinophil (B-Eos) count is an emerging biomarker in the management of respiratory disease but determinants of B-Eos count besides respiratory disease are poorly described. Therefore, we aimed to evaluate the influence of non-respiratory diseases on B-Eos count, in comparison to the effect on two other biomarkers: fraction of exhaled nitric oxide (FeNO) and C-reactive protein (CRP), and to identify individual characteristics associated with B-Eos count in healthy controls.

    Methods

    Children/adolescents (<18 years) and adults with complete B-Eos data from the US National Health and Nutritional Examination Surveys 2005–2016 were included, and they were divided into having respiratory diseases (n = 3333 and n = 7,894, respectively) or not having respiratory disease (n = 8944 and n = 15,010, respectively). After excluding any respiratory disease, the association between B-Eos count, FeNO or CRP, and non-respiratory diseases was analyzed in multivariate models and multicollinearity was tested. After excluding also non-respiratory diseases independently associated with B-Eos count (giving healthy controls; 8944 children/adolescents and 5667 adults), the independent association between individual characteristics and B-Eos count was analyzed.

    Results

    In adults, metabolic syndrome, heart disease or stroke was independently associated with higher B-Eos count (12%, 13%, and 15%, respectively), whereas no associations were found with FeNO or CRP. In healthy controls, male sex or being obese was associated with higher B-Eos counts, both in children/adolescents (15% and 3% higher, respectively) and adults (14% and 19% higher, respectively) (p < 0.01 all). A significant influence of race/ethnicity was also noted, and current smokers had 17% higher B-Eos count than never smokers (p < 0.001).

    Conclusions

    Non-respiratory diseases influence B-Eos count but not FeNO or CRP. Male sex, obesity, certain races/ethnicities, and current smoking are individual characteristics or exposures that are associated with higher B-Eos counts. All these factors should be considered when using B-Eos count in the management of respiratory disease.

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  • 7.
    Amaral, Rita
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation, Metabolism and Child Health Research. Univ Porto, Fac Med, Ctr Hlth Technol & Serv Res CINTESIS, P-4200319 Porto, Portugal.;Univ Porto, Dept Community Med Informat & Hlth Decis Sci MEDC, Fac Med, P-4200319 Porto, Portugal.;Polytech Inst Porto, Porto Hlth Sch, Dept Cardiovasc & Resp Sci, P-4200072 Porto, Portugal.;Uppsala Univ, Dept Womens & Childrens Hlth, Paediat Res, SE-75105 Uppsala, Sweden..
    Jacome, Cristina
    Univ Porto, Fac Med, Ctr Hlth Technol & Serv Res CINTESIS, P-4200319 Porto, Portugal.;Univ Porto, Dept Community Med Informat & Hlth Decis Sci MEDC, Fac Med, P-4200319 Porto, Portugal..
    Almeida, Rute
    Univ Porto, Fac Med, Ctr Hlth Technol & Serv Res CINTESIS, P-4200319 Porto, Portugal.;Univ Porto, Dept Community Med Informat & Hlth Decis Sci MEDC, Fac Med, P-4200319 Porto, Portugal..
    Pereira, Ana Margarida
    Univ Porto, Fac Med, Ctr Hlth Technol & Serv Res CINTESIS, P-4200319 Porto, Portugal.;Univ Porto, Dept Community Med Informat & Hlth Decis Sci MEDC, Fac Med, P-4200319 Porto, Portugal.;CUF Porto Hosp & Inst, Allergy Unit, P-4100180 Porto, Portugal..
    Alves-Correia, Magna
    CUF Porto Hosp & Inst, Allergy Unit, P-4100180 Porto, Portugal..
    Mendes, Sandra
    Univ Porto, Fac Med, Ctr Hlth Technol & Serv Res CINTESIS, P-4200319 Porto, Portugal..
    Rodrigues, Jose Carlos Cidrais
    Hosp Pedro Hispano, Serv Pediat, Unidade Local Saude Matosinhos, P-4464513 Matosinhos, Portugal..
    Carvalho, Joana
    Hosp Pedro Hispano, Serv Pediat, Unidade Local Saude Matosinhos, P-4464513 Matosinhos, Portugal..
    Araujo, Luis
    CUF Porto Hosp & Inst, Allergy Unit, P-4100180 Porto, Portugal..
    Costa, Alberto
    Hosp Senhora Oliveira, Serv Pediat, P-4835044 Guimaraes, Portugal..
    Silva, Armandina
    Hosp Senhora Oliveira, Serv Pediat, P-4835044 Guimaraes, Portugal..
    Teixeira, Maria Fernanda
    Ctr Hosp Univ Porto, Ctr Materno Infantil Norte, Serv Pediat, P-4099001 Porto, Portugal..
    Ferreira-Magalhaes, Manuel
    Univ Porto, Dept Community Med Informat & Hlth Decis Sci MEDC, Fac Med, P-4200319 Porto, Portugal.;Ctr Hosp Univ Porto, Ctr Materno Infantil Norte, Serv Pediat, P-4099001 Porto, Portugal..
    Alves, Rodrigo Rodrigues
    Hosp Div Espirito Santo, Serv Imunoalergol, P-9500370 Ponta Delgada, Portugal..
    Moreira, Ana Sofia
    Hosp Divino Espirito Santo, Unidade Imunoalergol, P-9500370 Ponta Delgada, Portugal..
    Fernandes, Ricardo M.
    Ctr Hosp Lisboa Norte, Hosp Santa Maria, Dept Pediat, P-1649035 Lisbon, Portugal..
    Ferreira, Rosario
    Ctr Hosp Lisboa Norte, Hosp Santa Maria, Dept Pediat, P-1649035 Lisbon, Portugal..
    Pinto, Paula Leiria
    Ctr Hosp Univ Lisboa Cent, Hosp Dona Estefania, Serv Imunoalergol, P-1150199 Lisbon, Portugal..
    Neuparth, Nuno
    Ctr Hosp Univ Lisboa Cent, Hosp Dona Estefania, Serv Imunoalergol, P-1150199 Lisbon, Portugal.;Nova Med Sch, CHRC CEDOC, Pathophysiol, P-1150190 Lisbon, Portugal..
    Bordalo, Diana
    Ctr Hosp Medio Ave, Unidade Hosp Famalicao, Serv Pediat, P-4780371 Vila Nova De Famalicao, Portugal..
    Bom, Ana Todo
    Ctr Hosp & Univ Coimbra, Serv Imunoalergol, P-3000075 Coimbra, Portugal..
    Calix, Maria Jose
    Hosp Sao Teotonio, Ctr Hosp Tondela Viseu, Serv Pediat, P-3504509 Viseu, Portugal..
    Ferreira, Tania
    ACeS Baixo Mondego, Unidade Saude Familiar Progresso & Saude, P-3060716 Tocha, Portugal..
    Gomes, Joana
    Ctr Hosp Vila Nova Gaia Espinho, Unidade 1, Serv Imunoalergol, P-4434502 Vila Nova De Gaia, Portugal..
    Vidal, Carmen
    Complejo Hosp Univ Santiago, Serv Alergia, Santiago De Compostela 15706, Spain..
    Mendes, Ana
    Ctr Hosp Lisboa Norte, Hosp Santa Maria, Dept Pediat, P-1649035 Lisbon, Portugal..
    Vasconcelos, Maria Joao
    Ctr Hosp Univ Sao Joao, Serv Imunoalergol, P-4200319 Porto, Portugal..
    Silva, Pedro Morais
    Grp HPA Saude, Imunoalergol, P-8500322 Portimao, Portugal..
    Ferraz, Jose
    Hosp Privado Alfena, Imunoalergol, P-4445243 Trofa Saude, Alfena, Portugal..
    Morete, Ana
    Hosp Infante D Pedro, Ctr Hosp Baixo Vouga, Serv Imunoalergol, P-3814501 Aveiro, Portugal..
    Pinto, Claudia Sofia
    Hosp Sao Pedro Vila Real, Ctr Hosp Tras Os Montes E Alto Douro, Serv Pneumol, P-5000508 Vila Real, Portugal..
    Santos, Natacha
    Ctr Hosp Univ Algarve, Serv Imunoalergol, P-8000386 Portimao, Portugal..
    Loureiro, Claudia Chaves
    Hosp Univ Coimbra, Serv Pneumol, P-3000076 Coimbra, Portugal..
    Arrobas, Ana
    Ctr Hosp & Univ Coimbra, Serv Pneumol, P-3000075 Coimbra, Portugal..
    Marques, Maria Luis
    Ctr Hosp Univ Porto, Serv Imunoalergol, P-4099001 Porto, Portugal..
    Lozoya, Carlos
    Hosp Amato Lusitano, Unidade Local Saude Castelo Branco, Serv Imunoalergol, P-6000085 Castelo Branco, Portugal..
    Lopes, Cristina
    Hosp Pedro Hispano, Serv Pediat, Unidade Local Saude Matosinhos, P-4464513 Matosinhos, Portugal.;Univ Porto, Fac Med, Imunol Basica & Clin, P-4200319 Porto, Portugal..
    Cardia, Francisca
    ACES Dao Lafoes, Unidade Saude Familiar Terras Azurara, P-3530113 Mangualde, Portugal..
    Loureiro, Carla Chaves
    Ctr Hosp & Univ Coimbra, Dept Pediat, Serv Pediat Ambulatoria, P-3000075 Coimbra, Portugal..
    Camara, Raquel
    Hosp Nossa Senhora Rosario, Ctr Hosp Barreiro Montijo, Serv Pneumol, P-2834003 Barreiro, Portugal..
    Vieira, Ines
    ACES Pinhal Litoral, UCSP Dr Arnaldo Sampaio, P-2419014 Leiria, Portugal..
    da Silva, Sofia
    USF Cuidarte, Unidade Local Saude Alto Minho, P-4925083 Portuzelo, Portugal..
    Silva, Eurico
    ACeS Baixo Vouga, Unidade Saude Familiar Joao Semana, P-3880225 Ovar, Portugal..
    Rodrigues, Natalina
    ACES Baixo Mondego, Unidade Saude Familiar Mondego, P-3045059 Coimbra, Portugal..
    Fonseca, Joao A.
    Univ Porto, Fac Med, Ctr Hlth Technol & Serv Res CINTESIS, P-4200319 Porto, Portugal.;Univ Porto, Dept Community Med Informat & Hlth Decis Sci MEDC, Fac Med, P-4200319 Porto, Portugal.;CUF Porto Hosp & Inst, Allergy Unit, P-4100180 Porto, Portugal..
    Profiling Persistent Asthma Phenotypes in Adolescents: A Longitudinal Diagnostic Evaluation from the INSPIRERS Studies2021In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, no 3, article id 1015Article in journal (Refereed)
    Abstract [en]

    We aimed to identify persistent asthma phenotypes among adolescents and to evaluate longitudinally asthma-related outcomes across phenotypes. Adolescents (13-17 years) from the prospective, observational, and multicenter INSPIRERS studies, conducted in Portugal and Spain, were included (n = 162). Latent class analysis was applied to demographic, environmental, and clinical variables, collected at a baseline medical visit. Longitudinal differences in clinical variables were assessed at a 4-month follow-up telephone contact (n = 128). Three classes/phenotypes of persistent asthma were identified. Adolescents in class 1 (n = 87) were highly symptomatic at baseline and presented the highest number of unscheduled healthcare visits per month and exacerbations per month, both at baseline and follow-up. Class 2 (n = 32) was characterized by female predominance, more frequent obesity, and uncontrolled upper/lower airways symptoms at baseline. At follow-up, there was a significant increase in the proportion of controlled lower airway symptoms (p < 0.001). Class 3 (n = 43) included mostly males with controlled lower airways symptoms; at follow-up, while keeping symptom control, there was a significant increase in exacerbations/month (p = 0.015). We have identified distinct phenotypes of persistent asthma in adolescents with different patterns in longitudinal asthma-related outcomes, supporting the importance of profiling asthma phenotypes in predicting disease outcomes that might inform targeted interventions and reduce future risk.

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  • 8.
    Andersson, Björn
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Markasz, Laszlo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research.
    Mobini-Far, Hamid
    Uppsala Univ Hosp, Dept Pathol, Uppsala, Sweden..
    Engstrand Lilja, Helene
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Vascular adhesion protein-1 expression is reduced in the intestines of infants with necrotizing enterocolitis: an observational research study2022In: BMC Pediatrics, E-ISSN 1471-2431, Vol. 22, article id 640Article in journal (Refereed)
    Abstract [en]

    Background: Necrotizing enterocolitis (NEC) is an inflammatory bowel disease in preterm neonates with high morbidity and mortality. The only treatment available is supportive with broad-spectrum antibiotics and gastrointestinal rest. Better understanding of the pathogenesis is crucial for the development of new therapies. Vascular adhesion protein-1 (VAP-1), expressed in human blood vessels and lymphatic, plays a crucial role in the pathogenesis of inflammatory diseases in adults. The aim of the study was to investigate the VAP-1 expression in the intestines of infants affected by NEC.

    Methods: Intestinal tissues from 42 preterm infants with NEC were examined with immunohistochemical staining using antibodies against VAP-1 and semi-automated digital image analysis was performed to determine tissue protein expression of VAP-1 in blood vessels located in the submucosa. Intestinal tissue from 26 neonates that underwent laparotomy and ileostomy due to other intestinal surgical conditions served as controls. Clinical data and protein expression were compared between the NEC-group and Controls.

    Results: Mean gestational age was lower in NEC infants compared to controls, 26.6 +/- 3.0 gestational weeks versus 36.5 +/- 4.0 (p < 0.001) but without any significant difference in median postnatal age at surgery; for NEC 8 (5-27) days and for controls 3 (1-36) days (p = 0.6). Low VAP-1 correlated with increased risk for developing NEC in the logistic regression (p < 0.001). Multiple linear regression showed that both gestational age and NEC were independent predictors of VAP-1 expression.

    Conclusion: VAP-1 may play a role in the pathogenesis of NEC. Diminished expression of VAP-1 independent of maturation could indicate arrested vascular development in infants suffering from NEC. Further studies are needed to elucidate the role of VAP-1 in NEC.

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    FULLTEXT01
  • 9.
    Andorf, Sandra
    et al.
    Stanford Univ, Sch Med, Sean N Parker Ctr Allergy & Asthma Res, 300 Pasteur Dr,Grant Bldg, Stanford, CA 94305 USA..
    Bunning, Bryan
    Stanford Univ, Sch Med, Sean N Parker Ctr Allergy & Asthma Res, 300 Pasteur Dr,Grant Bldg, Stanford, CA 94305 USA..
    Tupa, Dana
    Stanford Univ, Sch Med, Sean N Parker Ctr Allergy & Asthma Res, 300 Pasteur Dr,Grant Bldg, Stanford, CA 94305 USA..
    Cao, Shu
    Stanford Univ, Sch Med, Sean N Parker Ctr Allergy & Asthma Res, 300 Pasteur Dr,Grant Bldg, Stanford, CA 94305 USA..
    Long, Andrew J.
    Stanford Univ, Sch Med, Sean N Parker Ctr Allergy & Asthma Res, 300 Pasteur Dr,Grant Bldg, Stanford, CA 94305 USA..
    Borres, Magnus P
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation, Metabolism and Child Health Research. Thermo Fisher Sci, Uppsala, Sweden.
    Galli, Stephen J.
    Stanford Univ, Sch Med, Sean N Parker Ctr Allergy & Asthma Res, 300 Pasteur Dr,Grant Bldg, Stanford, CA 94305 USA.;Stanford Univ, Dept Pathol, Stanford, CA USA.;Stanford Univ, Dept Microbiol & Immunol, Stanford, CA USA..
    Chinthrajah, Rebecca S.
    Stanford Univ, Sch Med, Sean N Parker Ctr Allergy & Asthma Res, 300 Pasteur Dr,Grant Bldg, Stanford, CA 94305 USA..
    Nadeau, Kari C.
    Stanford Univ, Sch Med, Sean N Parker Ctr Allergy & Asthma Res, 300 Pasteur Dr,Grant Bldg, Stanford, CA 94305 USA..
    Trends in egg specific immunoglobulin levels during natural tolerance and oral immunotherapy2020In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 75, no 6, p. 1454-1456Article in journal (Other academic)
  • 10.
    Aranda, Carolina Sanchez
    et al.
    Univ Fed Sao Paulo, Dept Pediat, Sao Paulo, SP, Brazil..
    Cocco, Renata R.
    Univ Fed Sao Paulo, Dept Pediat, Sao Paulo, SP, Brazil..
    Pierotti, Felipe F.
    Univ Fed Sao Paulo, Dept Pediat, Sao Paulo, SP, Brazil..
    Sarinho, Emanuel
    Univ Fed Pernambuco, Dept Pediat, Recife, PE, Brazil..
    Sano, Flavio
    Hosp Nipo Brasileiro, Dept Pediat, Sao Paulo, SP, Brazil..
    Porto, Arnaldo
    Univ Passo Fundo, Dept Pediat, Passo Fundo, RS, Brazil..
    Rosario, Nelson
    Univ Fed Parana, Dept Pediat, Curitiba, Parana, Brazil..
    Chong Neto, Herberto J.
    Univ Fed Parana, Dept Pediat, Curitiba, Parana, Brazil..
    Goudouris, Ekaterini
    Univ Fed Rio de Janeiro, Dept Pediat, Rio De Janeiro, RJ, Brazil..
    Moraes, Lillian S.
    Univ Fed Mato Grosso, Dept Pediat, Cuiaba, MT, Brazil..
    Wandalsen, Neusa F.
    Fac Med ABC, Dept Pediat, Sao Paulo, SP, Brazil..
    Mallozi, Marcia C.
    Univ Fed Sao Paulo, Dept Pediat, Sao Paulo, SP, Brazil..
    Pastorino, Antonio C.
    Univ Sao Paulo, Dept Pediat, Sao Paulo, SP, Brazil..
    Franco, Jackeline M.
    Univ Fed Sergipe, Dept Pediat, Aracaju, SE, Brazil..
    Chavarria, Maria L.
    Univ Fed Goias, Dept Pediat, Goiania, Go, Brazil..
    Borres, Magnus P
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation, Metabolism and Child Health Research.
    Sole, Dirceu
    Univ Fed Sao Paulo, Dept Pediat, Sao Paulo, SP, Brazil..
    Allergic sensitization pattern of patients in Brazil2021In: Jornal de Pediatria, ISSN 0021-7557, E-ISSN 1678-4782, Vol. 97, no 4, p. 387-395Article in journal (Refereed)
    Abstract [en]

    Objective: Allergic sensitization is one of the key components for the development of allergies. Polysensitization seems to be related to the persistence and severity of allergic diseases. Furthermore, allergic sensitization has a predictive role in the development of allergies. The aim of this study was to characterize the pattern of sensitization of atopic patients treated at different pediatric allergy referral centers in Brazil.

    Methods: A nation-wide transversal multicenter study collected data on patients attended in Brazil. Peripheral blood samples were collected to determine the serum levels of allergen-specific IgE. If allergen-specific IgE was higher than 0.1 kUA/L, the following specific components were quantified.

    Results: A total of 470 individuals were enrolled in the study. Mite sensitization was the most frequent kind in all participants. A high frequency of sensitization to furry animals and grasses featured in the respiratory allergies. Regarding components, there was a predominance of sensitization to Der p 1 and Der p 2. It has been verified that having a food allergy, atopic dermatitis, or multimorbidity are risk factors for the development of more severe allergic disease.

    Conclusion: Studies on the pattern of allergic sensitization to a specific population offer tools for the more effectual prevention, diagnosis, and treatment of allergic diseases. Sensitization to dust mites house was the most prevalent in the evaluated sample. High rates of sensitization to furry animals also stand out. Patients with food allergy, atopic dermatitis, or multimorbidity appear to be at greater risk for developing more severe allergic diseases.

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  • 11.
    Arat, Arzu
    et al.
    Karolinska Inst, Dept Med, Solna, Sweden.;Stockholm Univ, Dept Publ Hlth Sci, Stockholm, Sweden..
    Norredam, Marie
    Univ Copenhagen, Danish Res Ctr Migrat Ethn & Hlth, Dept Publ Hlth, Copenhagen, Denmark..
    Baum, Ulrike
    Natl Inst Hlth & Welf, Dept Publ Hlth Solut, Helsinki, Finland..
    Jonsson, Stefan Hrafn
    Univ Iceland, Fac Sociol Anthropol & Folklorist, Reykjavik, Iceland..
    Gunlaugsson, Geir
    Univ Iceland, Fac Sociol Anthropol & Folklorist, Reykjavik, Iceland..
    Wallby, Thomas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation, Metabolism and Child Health Research.
    Hjern, Anders
    Karolinska Inst, Dept Med, Solna, Sweden.;Sachsska Childrens Hosp, Stockholm, Sweden.;Stockholm Univ, Karolinska Inst, Ctr Hlth Equ Studies, Stockholm, Sweden..
    Organisation of preventive child health services: Key to socio-economic equity in vaccine uptake?2020In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 48, no 5, p. 491-494Article in journal (Refereed)
    Abstract [en]

    Background:Measles has made a comeback in Western Europe, with more cases being reported each year. One factor behind this development is low vaccination coverage in socially disadvantaged segments of the population in many countries. This study investigates whether socioeconomic patterns of uptake of the measles, mumps and rubella (MMR) vaccine in the Nordic countries differ by national organisation of preventive health services for children.Methods: MMR vaccine uptake before the age of two years was analysed in register data from Denmark, Finland, Iceland and Sweden, linked to family indicators of socio-economic status (SES) from national registers.Results: Denmark, a country where child vaccinations are administered by general practitioners, presented the lowest overall coverage of MMR at 83%. It also had the greatest difference between subpopulations of low and high SES at 14 percentage points. Finland, Iceland and Sweden, countries where preschool children are vaccinated in 'well-baby' clinics, had a higher overall coverage at 91-94%, with a more equal distribution between SES groups at 1-4 percentage points.Conclusions: This study suggests that the organisation of preventive health care in special units, 'well-baby' clinics, facilitates vaccine uptake among children with low SES in a Nordic welfare context.

  • 12.
    Arnstad, Ellen Dalen
    et al.
    Levanger Hosp, Nord Trondelag Hosp Trust, Dept Pediat, Pb 333, N-7601 Levanger, Norway.;NTNU Norwegian Univ Sci & Technol, Dept Clin & Mol Med, Trondheim, Norway..
    Glerup, Mia
    Aarhus Univ Hosp, Dept Pediat, Aarhus, Denmark..
    Rypdal, Veronika
    Univ Hosp North Norway, Dept Pediat, Tromso, Norway.;UIT Arctic Univ Norway, Dept Clin Med, Tromso, Norway..
    Peltoniemi, Suvi
    Univ Helsinki, Pediat Res Ctr, Helsinki Univ Hosp, New Childrens Hosp, Helsinki, Finland..
    Fasth, Anders
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Pediat, Gothenburg, Sweden..
    Nielsen, Susan
    Copenhagen Univ Hosp, Rigshosp, Dept Pediat, Copenhagen, Denmark..
    Zak, Marek
    Copenhagen Univ Hosp, Rigshosp, Dept Pediat, Copenhagen, Denmark..
    Aalto, Kristiina
    Univ Helsinki, Pediat Res Ctr, Helsinki Univ Hosp, New Childrens Hosp, Helsinki, Finland..
    Berntson, Lillemor
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Nordal, Ellen
    Univ Hosp North Norway, Dept Pediat, Tromso, Norway.;UIT Arctic Univ Norway, Dept Clin Med, Tromso, Norway..
    Herlin, Troels
    Aarhus Univ Hosp, Dept Pediat, Aarhus, Denmark..
    Romundstad, Pal Richard
    NTNU Norwegian Univ Sci & Technol, Dept Publ Hlth & Nursing, Trondheim, Norway..
    Rygg, Marite
    NTNU Norwegian Univ Sci & Technol, Dept Clin & Mol Med, Trondheim, Norway.;St Olavs Hosp, Dept Pediat, Trondheim, Norway..
    Fatigue in young adults with juvenile idiopathic arthritis 18 years after disease onset: data from the prospective Nordic JIA cohort2021In: Pediatric Rheumatology, E-ISSN 1546-0096, Vol. 19, no 1, article id 33Article in journal (Refereed)
    Abstract [en]

    Background To study fatigue in young adults with juvenile idiopathic arthritis (JIA) 18 years after disease onset, and to compare with controls. Methods Consecutive children with onset of JIA between 1997 and 2000, from geographically defined areas of Norway, Sweden, Denmark and Finland were followed for 18 years in a close to population-based prospective cohort study. Clinical features, demographic and patient-reported data were collected. Inclusion criteria in the present study were a baseline visit 6 months after disease onset, followed by an 18-year follow-up with available self-reported fatigue score (Fatigue Severity Scale (FSS), 1-7). Severe fatigue was defined as FSS >= 4. For comparison, Norwegian age and sex matched controls were used. Results Among 377 young adults with JIA, 26% reported severe fatigue, compared to 12% among controls. We found higher burden of fatigue among participants with sleep problems, pain, poor health, reduced participation in school/work, physical disability, active disease, or use of disease-modifying anti-rheumatic drugs (DMARDs)/biologics/systemic steroids. In contrast, participants without these challenges, had fatigue scores similar to controls. Active disease assessed at all three time points (baseline, 8-year and 18-year follow-up) was associated with higher mean fatigue score and higher percentage of severe fatigue compared to disease courses characterized by periods of inactive disease. Predictors of fatigue at the 18-year follow-up were female sex and diagnostic delay of >= 6 months at baseline, and also pain, self-reported poor health, active disease, and previous/ongoing use of DMARDs/biologics at 8 years. Conclusions Fatigue is a prominent symptom in young adults with JIA, with higher fatigue burden among participants with poor sleep, pain, self-reported health problems, active disease, or use of DMARDs/biologics. Participants without these challenges have results similar to controls. Patient- and physician-reported variables at baseline and during disease course predicted fatigue at 18-year follow-up.

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  • 13.
    Asif, Sana
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Frithiof, Robert
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Lipcsey, Miklós
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Hedenstierna laboratory.
    Kristensen, Bjarne
    Alving, Kjell
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation, Metabolism and Child Health Research.
    Hultström, Michael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology, Integrative Physiology.
    Weak anti-SARS-CoV-2 antibody response is associated with mortality in a Swedish cohort of COVID-19 patients in critical care2020In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 24, no 1, article id 639Article in journal (Refereed)
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  • 14.
    Backlund, Malin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Venge, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
    Berntson, Lillemor
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    A cross-sectional cohort study of the activity and turnover of neutrophil granulocytes in juvenile idiopathic arthritis2021In: Pediatric Rheumatology, E-ISSN 1546-0096, Vol. 19, no 1, article id 102Article in journal (Refereed)
    Abstract [en]

    Background: The inflammatory process in juvenile idiopathic arthritis (JIA) involves both the innate and the adaptive immune system. The turnover and activity of neutrophil granulocytes may be reflected by proteins secreted from primary or secondary granules and from the cytoplasm of sequestered cells. Our primary aim was to compare the levels of the secondary neutrophil granule protein human neutrophil lipocalin (HNL), in JIA patients and controls, and to explore a possible priming of neutrophils through parallel analyses in plasma and serum. A secondary aim was to relate the levels of HNL to two other well-studied leukocyte proteins, S100A8/A9 and myeloperoxidase (MPO), as well as to clinical aspects of JIA.

    Methods: The concentrations of the three biomarkers in serum, two of them also in plasma, were measured using enzyme-linked immunosorbent assay in 37 children with JIA without medical treatment, in high disease activity based on juvenile arthritis disease activity score 27 (JADAS27), 32 children on medical treatment, mainly in lower disease activity, and 16 healthy children. We assessed for differences between two groups using the Mann-Whitney U test, and used the Kruskal-Wallis test for multiple group comparisons. Spearman rank correlation, linear and multiple regression analyses were used for evaluation of associations between biomarker concentrations and clinical scores.

    Results: The concentrations of HNL and MPO in serum were significantly increased in children with JIA (p<0.001, p=0.002) compared with healthy children, but we found no difference in the plasma levels of HNL and MPO between children with JIA and controls. The serum concentrations of MPO and HNL were unaffected by medical treatment, but S100A8/A9 was reduced by medical treatment and correlated with JADAS27 in both univariate (r=0.58, p<0.001) and multivariate (r=0.59, p<0.001) analyses.

    Conclusions: Neutrophil granulocytes in children with JIA are primed to release primary and secondary granule proteins, without relation to medical treatment, whereas signs of increased turnover and sequestration of neutrophil granulocytes are reduced by treatment. Levels of neutrophil-originating proteins in serum most likely reflect underlying disease activities of JIA.

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  • 15.
    Badi, Yusef Eamon
    et al.
    Imperial Coll London, Natl Heart & Lung Inst, Dovehouse St, London SW3 6LY, England.;NIHR Imperial Biomed Res Ctr, London, England.;Imperial Coll London, Data Sci Inst, London, England..
    Pavel, Ana B.
    Icahn Sch Med Mt Sinai, Dept Dermatol, Lab Inflammatory Skin Dis, New York, NY 10029 USA.;Univ Mississippi, Dept Biomed Engn, Oxford, MS USA..
    Pavlidis, Stelios
    Imperial Coll London, Data Sci Inst, London, England.;Janssen Res & Dev Ltd, High Wycombe, Bucks, England..
    Riley, John H.
    GSK Resp Therapeut Area Unit, Stevenage, Herts, England..
    Bates, Stewart
    GSK Resp Therapeut Area Unit, Stevenage, Herts, England..
    Kermani, Nazanin Zounemat
    Imperial Coll London, Data Sci Inst, London, England..
    Knowles, Richard
    Knowles Consulting, Stevenage, Herts, England..
    Kolmert, Johan
    Karolinska Inst, Inst Environm Med, Ctr Allergy Res, Stockholm, Sweden.;Karolinska Inst, Dept Med Biochem & Biophys, Div Physiol Chem 2, Stockholm, Sweden..
    Wheelock, Craig E.
    Karolinska Inst, Dept Med Biochem & Biophys, Div Physiol Chem 2, Stockholm, Sweden..
    Worsley, Sally
    GSK Value Evidence & Outcomes, Brentford, England..
    Uddin, Mohib
    AstraZeneca, Resp Global Med Dev, Gothenburg, Sweden..
    Alving, Kjell
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research. Uppsala Univ, Dept Womens & Childrens Hlth Paediat Res, Uppsala, Sweden..
    Bakke, Per S.
    Univ Bergen, Dept Clin Sci, Bergen, Norway..
    Behndig, Annelie
    Umeå Univ, Dept Publ Hlth & Clin Med, Div Med Resp Med, Umeå, Sweden..
    Caruso, Massimo
    Univ Catania, Dept Biomed & Biotechnol Sci, Catania, Italy..
    Chanez, Pascal
    Aix Marseille Univ, AP HM, Clin Bronches Allergies & Sommeil, Marseille, France..
    Fleming, Louise J.
    Imperial Coll London, Natl Heart & Lung Inst, Dovehouse St, London SW3 6LY, England.;NIHR Imperial Biomed Res Ctr, London, England..
    Fowler, Stephen J.
    Univ Manchester, Fac Biol Med & Hlth, Sch Biol Sci, Div Infect Immun & Resp Med, Manchester, Lancs, England.;Manchester Univ Hosp NHS Fdn Trust, Manchester Acad Hlth Sci Ctr, Manchester, Lancs, England.;Manchester Univ Hosp NHS Fdn Trust, NIHR Biomed Res Ctr, Manchester, Lancs, England..
    Frey, Urs
    Univ Basel, Univ Childrens Hosp Basel, Basel, Switzerland..
    Howarth, Peter
    Univ Southampton, Clin & Expt Sci & Human Dev Hlth, Fac Med, Southampton, Hants, England.;Univ Hosp Southampton NHS Fdn Trust, NIHR Southampton Biomed Res Ctr, Southampton, Hants, England.;St Marys Hosp, David Hide Asthma & Allergy Res Ctr, Newport, Wight, England..
    Horvath, Ildiko
    Semmelweis Univ, Dept Publ Hlth, Budapest, Hungary..
    Krug, Norbert
    Fraunhofer ITEM, Hannover, Germany..
    Maitland-van der Zee, Anke H.
    Univ Amsterdam, Dept Resp Med, Amsterdam UMC, Amsterdam, Netherlands..
    Montuschi, Paolo
    Univ Cattolica Sacro Cuore, Agostino Gemelli Univ Hosp Fdn, Pharmacol, Rome, Italy..
    Roberts, Graham
    Univ Southampton, Clin & Expt Sci & Human Dev Hlth, Fac Med, Southampton, Hants, England.;Univ Hosp Southampton NHS Fdn Trust, NIHR Southampton Biomed Res Ctr, Southampton, Hants, England.;St Marys Hosp, David Hide Asthma & Allergy Res Ctr, Newport, Wight, England..
    Sanak, Marek
    Jagiellonian Univ Med Coll, Dept Internal Med, Krakow, Poland..
    Shaw, Dominick E.
    Univ Nottingham, NIHR Biomed Res Ctr, Nottingham, England..
    Singer, Florian
    Univ Bern, Dept Paediat, Div Resp Med, Inselspital, Bern, Switzerland..
    Sterk, Peter J.
    Univ Amsterdam, Dept Resp Med, Amsterdam UMC, Amsterdam, Netherlands..
    Djukanovic, Ratko
    Univ Southampton, Clin & Expt Sci & Human Dev Hlth, Fac Med, Southampton, Hants, England.;Univ Hosp Southampton NHS Fdn Trust, NIHR Southampton Biomed Res Ctr, Southampton, Hants, England.;St Marys Hosp, David Hide Asthma & Allergy Res Ctr, Newport, Wight, England..
    Dahlen, Sven-Eric
    Karolinska Inst, Inst Environm Med, Ctr Allergy Res, Stockholm, Sweden..
    Guo, Yi-Ke
    Imperial Coll London, Data Sci Inst, London, England..
    Chung, Kian Fan
    Imperial Coll London, Natl Heart & Lung Inst, Dovehouse St, London SW3 6LY, England.;NIHR Imperial Biomed Res Ctr, London, England..
    Guttman-Yassky, Emma
    Icahn Sch Med Mt Sinai, Dept Dermatol, Lab Inflammatory Skin Dis, New York, NY 10029 USA..
    Adcock, Ian M.
    Imperial Coll London, Natl Heart & Lung Inst, Dovehouse St, London SW3 6LY, England.;NIHR Imperial Biomed Res Ctr, London, England..
    Mapping atopic dermatitis and anti-IL-22 response signatures to type 2-low severe neutrophilic asthma2022In: Journal of Allergy and Clinical Immunology, ISSN 0091-6749, E-ISSN 1097-6825, Vol. 149, no 1, p. 89-101Article in journal (Refereed)
    Abstract [en]

    Background: Transcriptomic changes in patients who respond clinically to biological therapies may identify responses in other tissues or diseases. Objective: We sought to determine whether a disease signature identified in atopic dermatitis (AD) is seen in adults with severe asthma and whether a transcriptomic signature for patients with AD who respond clinically to anti-IL-22 (fezakinumab [FZ]) is enriched in severe asthma. Methods: An AD disease signature was obtained from analysis of differentially expressed genes between AD lesional and nonlesional skin biopsies. Differentially expressed genes from lesional skin from therapeutic superresponders before and after 12 weeks of FZ treatment defined the FZ-response signature. Gene set variation analysis was used to produce enrichment scores of AD and FZ-response signatures in the Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes asthma cohort. Results: The AD disease signature (112 upregulated genes) encompassing inflammatory, T-cell, T(H)2, and T(H)17/T(H)22 pathways was enriched in the blood and sputum of patients with asthma with increasing severity. Patients with asthma with sputum neutrophilia and mixed granulocyte phenotypes were the most enriched (P < .05). The FZ-response signature (296 downregulated genes) was enriched in asthmatic blood (P < .05) and particularly in neutrophilic and mixed granulocytic sputum (P < .05). These data were confirmed in sputum of the Airway Disease Endotyping for Personalized Therapeutics cohort. IL-22 mRNA across tissues did not correlate with FZ-response enrichment scores, but this response signature correlated with T(H)22/IL-22 pathways. Conclusions: The FZ-response signature in AD identifies severe neutrophilic asthmatic patients as potential responders to FZ therapy. This approach will help identify patients for future asthma clinical trials of drugs used successfully in other chronic diseases.

  • 16.
    Bager, Jessica
    et al.
    Karolinska Inst, Dept Womens & Childrens Hlth, SE-17177 Stockholm, Sweden..
    Tedner, Sandra G.
    Karolinska Inst, Dept Womens & Childrens Hlth, SE-17177 Stockholm, Sweden.;Karolinska Univ Hosp, Astrid Lindgren Childrens Hosp, Pediat Allergy & Pulmonol Unit, Stockholm, Sweden..
    Andersson, Niklas
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden..
    Ballardini, Natalia
    Sachs Children & Youth Hosp, Stockholm, Sweden.;Karolinska Inst, Dept Clin Sci & Educ Sodersjukhuset, Stockholm, Sweden.;Dept Dermatol & Sexual Hlth, Stockholm, Sweden..
    Borres, Magnus P
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research. Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden.;Thermo Fisher Sci, Uppsala, Sweden..
    Konradsen, Jon R.
    Karolinska Inst, Dept Womens & Childrens Hlth, SE-17177 Stockholm, Sweden.;Karolinska Univ Hosp, Astrid Lindgren Childrens Hosp, Pediat Allergy & Pulmonol Unit, Stockholm, Sweden..
    Nilsson, Caroline
    Sachs Children & Youth Hosp, Stockholm, Sweden.;Karolinska Inst, Dept Clin Sci & Educ Sodersjukhuset, Stockholm, Sweden..
    Westman, Marit
    Karolinska Inst, Div Immunol & Allergy, Dept Med Solna, Stockholm, Sweden.;Karolinska Univ Hosp, Stockholm, Sweden.;Asthma & Allergy Clin St Goran, Stockholm, Sweden..
    Kull, Inger
    Sachs Children & Youth Hosp, Stockholm, Sweden.;Karolinska Inst, Dept Clin Sci & Educ Sodersjukhuset, Stockholm, Sweden..
    Bergstrom, Anna
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden.;Ctr Occupat & Environm Med, Stockholm, Sweden..
    van Hage, Marianne
    Karolinska Inst, Div Immunol & Allergy, Dept Med Solna, Stockholm, Sweden.;Karolinska Univ Hosp, Stockholm, Sweden..
    Melen, Erik
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden.;Sachs Children & Youth Hosp, Stockholm, Sweden.;Karolinska Inst, Dept Clin Sci & Educ Sodersjukhuset, Stockholm, Sweden..
    Asarnoj, Anna
    Karolinska Inst, Dept Womens & Childrens Hlth, SE-17177 Stockholm, Sweden.;Karolinska Univ Hosp, Astrid Lindgren Childrens Hosp, Pediat Allergy & Pulmonol Unit, Stockholm, Sweden..
    Prevalence and early-life risk factors for tree nut sensitization and allergy in young adults2021In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 51, no 11, p. 1429-1437Article in journal (Refereed)
    Abstract [en]

    Background Tree nut allergy may cause anaphylaxis. There are limited population-based studies on prevalence and early-life risk factors. Methods We evaluated the prevalence of reported symptoms and allergic sensitization to tree nuts at age 24 years in the BAMSE population-based cohort study and assessed early-life factors associated with the development of tree nut allergy. We estimated tree nut allergy prevalence, by analysing questionnaire data on tree nut ingestion and symptoms at age 12, 16 and 24 years, and IgE sensitization at age 24 years to hazelnut, walnut, pecan, cashew, pistachio, Brazil nut, almond extracts and allergen molecules Cor a 1, 9, 14 (hazelnut), Jug r 1 (walnut) and Ana o 3 (cashew). We evaluated eczema, asthma, food allergies, inherited risk of allergy and gender as potential early-life risk factors. Results Data were available for 2215/4089 (54%) BAMSE study participants, for estimation of the prevalence of tree nut sensitization (21.2%), tree nut allergy symptoms (9.8%) and combined sensitization and symptoms (7.9%, 2.1% for storage protein sensitization and symptoms, 4.3% for any sensitization and non-mild symptoms). Sixty-three per cent of sensitized individuals (295/470) were asymptomatic, but only 76/470 (16%) storage protein sensitized individuals. Egg allergy (ORadj 8.50 95% CI 2.15-33.6), eczema (ORadj 2.53 95% CI 1.21-5.32) and asthma (ORadj 5.59 95% CI 2.35-13.3)) at pre-school age were associated with future development of tree nut symptoms and storage protein sensitization. At age 24 years, tree nut allergy was associated with current eczema and with markers of current asthma severity. Sensitization to storage proteins was more strongly associated with symptoms than sensitization to whole extract for all tree nuts evaluated. Conclusions In this Swedish cohort, we found tree nut whole extract sensitization is common but usually asymptomatic. Storage protein sensitization is a more reliable indicator of tree nut symptoms. Tree nut allergy is associated with early onset, persistent and severe atopic disease.

  • 17.
    Ballardini, Natalia
    et al.
    Karolinska Inst, Dept Clin Sci & Educ Sodersjukhuset, SE-11883 Stockholm, Sweden.;Karolinska Inst, Inst Environm Med, Stockholm, Sweden.;Sachs Children & Youth Hosp, Sodersjukhuset, Stockholm, Sweden..
    Bergstrom, Anna
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden.;Ctr Occupat & Environm Med, Stockholm, Sweden..
    Kull, Inger
    Karolinska Inst, Dept Clin Sci & Educ Sodersjukhuset, SE-11883 Stockholm, Sweden.;Sachs Children & Youth Hosp, Sodersjukhuset, Stockholm, Sweden..
    Almqvist, Catarina
    Karolinska Univ Hosp, Astrid Lindgren Childrens Hosp, Pediat Allergy & Pulmonol Unit, Stockholm, Sweden.;Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Andersson, Niklas
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden..
    Asarnoj, Anna
    Karolinska Univ Hosp, Astrid Lindgren Childrens Hosp, Pediat Allergy & Pulmonol Unit, Stockholm, Sweden.;Karolinska Inst, Dept Med Solna, Div Immunol & Allergy, Stockholm, Sweden.;Karolinska Univ Hosp, Stockholm, Sweden.;Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Borres, Magnus P
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation, Metabolism and Child Health Research. Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden.;Thermo Fisher Sci, Uppsala, Sweden..
    Georgellis, Antonis
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden.;Ctr Occupat & Environm Med, Stockholm, Sweden..
    Pershagen, Goran
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden.;Ctr Occupat & Environm Med, Stockholm, Sweden..
    Westman, Marit
    Karolinska Inst, Dept Med Solna, Div Immunol & Allergy, Stockholm, Sweden.;Karolinska Univ Hosp, Stockholm, Sweden..
    van Hage, Marianne
    Karolinska Inst, Dept Med Solna, Div Immunol & Allergy, Stockholm, Sweden.;Karolinska Univ Hosp, Stockholm, Sweden..
    Melen, Erik
    Karolinska Inst, Dept Clin Sci & Educ Sodersjukhuset, SE-11883 Stockholm, Sweden.;Karolinska Inst, Inst Environm Med, Stockholm, Sweden.;Sachs Children & Youth Hosp, Sodersjukhuset, Stockholm, Sweden..
    Resolved allergen-specific IgE sensitization among females and early poly-sensitization among males impact IgE sensitization up to age 24 years2021In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 51, no 6, p. 849-852Article in journal (Other academic)
  • 18.
    Bergsten, Amadeus
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Larsson, Jens
    Skane Univ Hosp, Urotherapy Unit, Sect Pediat Surg, Lund, Sweden..
    Borgstrom, Malin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Center for Clinical Research Dalarna.
    Karanikas, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Nevéus, Tryggve
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Predictors of response and adherence to enuresis alarm therapy: a confirmatory study2024In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 113, no 3, p. 573-579Article in journal (Refereed)
    Abstract [en]

    Aim:

    To look for predictors to response and adherence to the enuresis alarm while exploring the possibility of families managing therapy independently.Methods: We used a body-worn alarm linked to a smartphone app. Subjects with enuresis were recruited both via paediatric nurses and independently as families bought the alarm and downloaded the app on their own.

    Results:

    We recruited 385 nurse-supported and 1125 independent subjects. Many (79.9%) dropped out before 8 weeks, but among adherent subjects 48.2% had a full or partial response. Age was a predictor of non-response (p = 0.019). Daytime incontinence did not influence response. If enuresis frequency did not decrease during the first 4 weeks of therapy the chance of response was very small (p < 0.001). Adherence was higher among subjects supported by a nurse (p < 0.001), but for adherent subjects the outcome was similar regardless of nurse support (p = 0.554).

    Conclusions:

    Daytime incontinence is no contraindication to enuresis alarm therapy. Treatment can be managed independently by the families, but adherence is enhanced by nurse support. Alarm treatment should be reassessed after 4 weeks. Enuresis alarm treatment guidelines need to be updated.

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  • 19.
    Berntson, Lillemor
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    A pilot study of possible anti-inflammatory effects of the specific carbohydrate diet in children with juvenile idiopathic arthritis2021In: Pediatric Rheumatology, E-ISSN 1546-0096, Vol. 19, no 1, article id 88Article in journal (Refereed)
    Abstract [en]

    Background

    To explore possible anti-inflammatory effects of the specific carbohydrate diet in children with juvenile idiopathic arthritis. This diet has shown anti-inflammatory effect in children with inflammatory bowel disease.

    Methods

    Twenty-two patients with juvenile idiopathic arthritis (age 6.3–17.3 years), with ≤2 inflamed joints and an erythrocyte sedimentation rate < 30 mm/h, were included in this explorative study. Fifteen children completing four weeks on the diet were evaluated. A dietician introduced parents and children to the diet, and two follow-ups were performed during the intervention. Conventional laboratory tests and multiplex analyses of 92 inflammatory proteins were used. Short-chain fatty acids in faecal samples were examined.

    Results

    The diet significantly decreased morning stiffness (p = 0.003) and pain (p = 0.048). Physical function, assessed through the child health assessment questionnaire, improved (p = 0.022). Arthritis improved in five of the seven children with arthritis; in those seven, multiplex analyses showed a significant decrease in nine inflammatory proteins, including TNF-alpha (p = 0.028), after four weeks. Faecal butyrate, analysed in all 15 participants, increased significantly (p = 0.020).

    Conclusion

    The specific carbohydrate diet may have significant positive effects on arthritis in children with juvenile idiopathic arthritis, but further studies are needed.

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  • 20.
    Berntson, Lillemor
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Elfving, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Gabrielsson Samuelsson, Alice
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Öman, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Mobarrez, Fariborz
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
    Blood brain barrier permeability and astrocyte-derived extracellular vesicles in children with juvenile idiopathic arthritis: a cross-sectional study2024In: Pediatric Rheumatology, E-ISSN 1546-0096, Vol. 22, no 1, article id 47Article in journal (Refereed)
    Abstract [en]

    Background: Juvenile idiopathic arthritis (JIA) is the most prevalent rheumatic disease in children, and the inflammatory process is widely studied, primarily characterized by its impact on joint health. Emerging evidence suggests that JIA may also affect the central nervous system (CNS). This study investigates the potential CNS involvement in JIA by analyzing the presence of astrocyte-derived extracellular vesicles (EVs) and the S100B protein in plasma, both of which are indicative of astrocyte activity and blood-brain barrier (BBB) integrity.

    Methods: EDTA plasma from 90 children diagnosed with JIA and 10 healthy controls, matched by age and gender, was analyzed for extracellular vesicles by flow cytometric measurement. Astrocyte-derived EVs were identified using flow cytometry with markers for aquaporin 4 (AQP-4) and glial fibrillary acidic protein (GFAP). Levels of the S100B protein were measured using a commercial ELISA. Disease activity was assessed using the Juvenile Arthritis Disease Activity Score (JADAS27, 0-57), and pain levels were measured using a visual analogue scale (VAS, 0-10 cm).

    Results: Our analyses revealed a significantly higher concentration of astrocyte-derived EVs in the plasma of children with JIA compared with healthy controls. Furthermore, children with JADAS27 scores of 1 or higher exhibited notably higher levels of these EVs. The S100B protein was detectable exclusively in the JIA group.

    Conclusion: The elevated levels of astrocyte-derived EVs and the presence of S100B in children with JIA provide evidence of BBB disruption and CNS involvement, particularly in those with higher disease activity. These findings underscore the importance of considering CNS health in the comprehensive management of JIA. Further research is required to elucidate the mechanisms behind CNS engagement in JIA and to develop treatments that address both joint and CNS manifestations of the disease.

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  • 21.
    Berntson, Lillemor
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Liminga, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatric oncological and neurological research.
    Severe Raynaud's phenomenon from ethosuximide raised concern over possible onset of systemic vasculitis: a case report2022In: Pediatric Rheumatology, E-ISSN 1546-0096, Vol. 20, article id 120Article in journal (Refereed)
    Abstract [en]

    Background: Ethosuximide and other anti-epileptic drugs have been reported to cause idiosyncratic reactions such as lupus-like syndromes, with elevated antinuclear antibody (ANA) levels. Herein, we present a case of a girl who developed a very severe Raynaud's phenomenon reaction and anti-Scl-70 antibodies related to treatment with ethosuximide, due to juvenile absence epilepsy (JAE).

    Case presentation: A 12-year-old girl was diagnosed with JAE and treatment with ethosuximide was initiated. Two and a half months later her fingers, digits II-V bilaterally, began to ache and were discolored, alternatingly white, blue, or normal-colored. Two weeks later, her fingers were bluish-black, aching severely, almost continuously. The family sought medical advice. Ethosuximide was halted and due to the severe symptoms, treatment with both prednisolone and intravenous iloprost was commenced. Laboratory tests revealed high ANA levels with anti-Scl-70 pattern and confirmed anti-Scl-70 antibodies. After a few weeks, she started to improve and the symptoms slowly decreased over five months. Anti-Scl-70 was still detectable four months after onset of symptoms, though she was much improved. After eleven months, repeated ANA analyses were completely negative.

    Conclusion: Although extremely rare, it is important to recognize that severe Raynaud's phenomenon, threatening peripheral digital circulation, may occur as an idiosyncratic reaction to ethosuximide, raising concern over possible onset of vasculitis.

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  • 22.
    Berntson, Lillemor
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Palm, Jakob
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Gastroenterology/Hepatology.
    Axling, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Zarelius, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Gastroenterology/Hepatology.
    Hellström, Per M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Gastroenterology/Hepatology.
    Webb, Dominic-Luc
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Gastroenterology/Hepatology.
    Haptoglobin in Juvenile Idiopathic Arthritis2022In: Pediatric Rheumatology, E-ISSN 1546-0096, Vol. 20, no 1, article id 117Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Haptoglobin (Hp), a liver derived acute phase inflammatory protein (APP), has scarcely been studied in juvenile idiopathic arthritis (JIA). Hp can occur in blood as two isoforms (Hp1 and Hp2) in precursor and mature forms. Routine clinical chemistry immunoturbidimetry does not discern these forms. It is unknown how different forms relate to disease activity in JIA. Our aims were to determine allele frequency and plasma concentrations of different Hp forms at higher versus lower JIA disease activity and compare to other APPs.

    METHODS: Plasma from JIA (n = 77) and healthy (n = 42) children were analyzed for apparent Hp allelic frequency and densitometric concentrations of alpha forms by Western blot (WB). Polymerase chain reaction (PCR) (buffy coat) was performed in a subset to estimate conformity with genetics. At higher versus lower juvenile arthritis disease activity score (JADAS27) (which includes erythrocyte sedimentation rate (ESR)), total mature Hp concentration from WB was compared and correlated against immunoturbidimetry and total protein, albumin, serum amyloid A (SAA) and C-reactive protein (CRP).

    RESULTS: At 300-fold dilution needed to study mature forms in Western blot, precursors were undetectable. Hp2 contributed most signal in most samples. Hp allele frequency was similar in JIA and controls. Both mature forms, taken separately or by sum, declined following treatment, but remained above concentrations of healthy controls, even in a remission subset that achieved JADAS27 < 1. Densitometry correlated with immunoturbidimetry. Hp concentrations correlated with JADAS27, albumin (negatively), CRP and SAA with immunoturbidimetric method correlating strongest to JADAS27 (Spearman R ~ 0.6, p < 0.0001).

    CONCLUSION: Hp allele frequency in JIA is similar to the general population, indicating that children with JIA should have the same possibility as in healthy children to produce preHp2 (zonulin), thought to increase intestinal permeability. Circulating Hp concentrations largely parallel other APPs and ESR; none of these measures correlate very strongly to JADAS27 score but Hp can be measured from capillary sampling which is impossible with ESR.

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    Berntson_etal_Hap_PROJ2022
  • 23.
    Berntson, Lillemor
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Öman, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Engstrand, Lars
    Dicksved, Johan
    A Pilot Study Investigating Faecal Microbiota After Two Dietary Interventions in Children with Juvenile Idiopathic Arthritis2022In: Current Microbiology, ISSN 0343-8651, E-ISSN 1432-0991, Vol. 79, no 7, article id 215Article in journal (Refereed)
    Abstract [en]

    There is evidence for an impact of the gut microbiota on the immune system, which has consequences for inflammatory diseases. Exclusive enteral nutrition (EEN) and the specific carbohydrate diet (SCD) have been demonstrated as effective anti-inflammatory treatments for children with Crohn’s disease. We have previously shown an anti-inflammatory effect from these nutritional treatments in children with juvenile idiopathic arthritis (JIA). The aim of this study was to investigate if improved clinical symptoms after EEN or SCD treatment in children with JIA could be linked to changes in faecal microbiota. We included sixteen patients with JIA (age 7–17 years), six for treatment with EEN and ten with SCD. EEN was given for 3–5 weeks and SCD for 4–5 weeks, with clinical and laboratory status assessed before and after treatment. Faecal samples were analysed for microbiota diversity and composition using 16S rRNA gene sequencing. Analyses of the faecal microbiota showed an effect on the overall composition with both interventions; the most striking result was a decreased relative abundance of the genus Faecalibacterium from EEN and of Bifidobacterium from SCD. The α-diversity decreased significantly from SCD (P = 0.04), but not from EEN (P = 0.22). Despite the study cohorts being small, both EEN and SCD were shown to impact the faecal microbiota. Future larger studies with a focus on metagenomics or metabolomics could possibly reveal a link and clarify the clinical effects of those nutritional regimens.

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  • 24.
    Blomquist, Axel
    et al.
    Lund Univ, Skane Univ Hosp, Dept Clin Sci Lund, Sect Infect Med, BMC B14, S-22184 Lund, Sweden..
    Inghammar, Malin
    Lund Univ, Skane Univ Hosp, Dept Clin Sci Lund, Sect Infect Med, BMC B14, S-22184 Lund, Sweden..
    Al Shakirchi, Mahasin
    Karolinska Univ Hosp Huddinge, Stockholm Cyst Fibrosis Ctr, Karolinska Inst, Dept Clin Sci Intervent & Technol,Div Paediat, Stockholm, Sweden..
    Ericson, Petrea
    Sahlgrens Univ Hosp, Dept Resp Med, S-41345 Gothenburg, Sweden..
    Krantz, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Svedberg, Marcus
    Univ Gothenburg, Sahlgrenska Acad, Dept Paediat, Inst Clin Sci, Gothenburg, Sweden..
    Lindblad, Anders
    Univ Gothenburg, Sahlgrenska Acad, Dept Paediat, Inst Clin Sci, Gothenburg, Sweden..
    Påhlman, Lisa, I
    Lund Univ, Skane Univ Hosp, Dept Clin Sci Lund, Sect Infect Med, BMC B14, S-22184 Lund, Sweden.;Lund Univ, Wallenberg Ctr Mol Med, Lund, Sweden..
    Persistent Aspergillus fumigatus infection in cystic fibrosis: impact on lung function and role of treatment of asymptomatic colonization-a registry-based case-control study2022In: BMC Pulmonary Medicine, E-ISSN 1471-2466, Vol. 22, no 1, article id 263Article in journal (Refereed)
    Abstract [en]

    Background Aspergillus fumigatus is the most common filamentous fungus isolated from the airways of people with cystic fibrosis (CF). The aim of this study was to investigate how chronic A. fumigatus colonization affects lung function in people with CF, to identify risk factors for colonization, and to evaluate antifungal treatment of asymptomatic Aspergillus colonization. Methods Data from 2014-2018 was collected from the Swedish CF registry and medical records. Baseline data before the start of A. fumigatus colonization was compared with the two succeeding years to evaluate how colonization and treatment affected lung function and other clinical aspects. Results A total of 437 patients were included, of which 64 (14.6%) became colonized with A. fumigatus during the study period. Inhaled antibiotics was associated with A. fumigatus colonization (adjusted OR 3.1, 95% CI 1.6-5.9, p < 0.05). Fungal colonization was not associated with a more rapid lung function decline or increased use of IV-antibiotics compared to the non-colonized group, but patients with A. fumigatus had more hospital days, a higher increase of total IgE, and higher eosinophil counts. In the Aspergillus group, 42 patients were considered to be asymptomatic. Of these, 19 patients received antifungal treatment. Over the follow up period, the treated group had a more pronounced decrease in percent predicted Forced Expiratory Volume in one second (ppFEV1) compared to untreated patients (- 8.7 vs - 1.4 percentage points, p < 0.05). Conclusion Inhaled antibiotics was associated with A. fumigatus colonization, but no association was found between persistent A. fumigatus and subsequent lung function decline. No obvious benefits of treating asymptomatic A. fumigatus colonization were demonstrated.

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  • 25.
    Blöndal, Viiu
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Sundbom, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Borres, Magnus P
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Hallgren, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Tsolakis, Nikolaos
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Alving, Kjell
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology, Integrative Physiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Asthma in combination with rhinitis and eczema is associated with a higher degree of type-2 inflammation and symptom burden than asthma alone2021In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 76, no 12, p. 3827-3829Article in journal (Refereed)
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    fulltext
  • 26.
    Blöndal, Viiu
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Department of Medical Sciences, Lung Allergy and Sleep Research, Uppsala University Hospital, Uppsala, Sweden. .
    Sundbom, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Borres, Magnus P
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation, Metabolism and Child Health Research. Thermo Fischer Sci, Uppsala, Sweden.
    Högman, Marieann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Alving, Kjell
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation, Metabolism and Child Health Research.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Study of atopic multimorbidity in subjects with rhinitis using multiplex allergen component analysis2020In: Clinical and Translational Allergy, E-ISSN 2045-7022, Vol. 10, no 1, article id 6Article in journal (Refereed)
    Abstract [en]

    Background Rhinitis is a common problem within the population. Many subjects with rhinitis also have atopic multimorbidity, such as asthma and eczema. The purpose of this investigation was to compare subjects with only rhinitis to those that have rhinitis, asthma and/or eczema in relation to immunoglobulin E (IgE) sensitization, inflammatory markers, family history, lung function and body mass index (BMI). Methods A total of 216 adult subjects with rhinitis from the European Community Respiratory Health Survey II were investigated with multiplex component allergen analysis (103 allergen components), total IgE, C-reactive protein, eosinophilic cationic protein, fractional exhaled nitric oxide and spirometry. Rhinitis, eczema, asthma and parental allergy were questionnaire-assessed. Results Of the 216 participants with rhinitis, 89 also had asthma and/or eczema. Participants with rhinitis that also had asthma or eczema were more likely to be IgE-sensitized (3.44, odds ratio, OR: 95% CI 1.62-7.30, adjusted for sex, age, mother's allergy, total IgE and forced expiratory volume (FEV1)). The number of IgE-positive components was independently associated with atopic multimorbidity (1.11, OR: 95% Cl 1.01-1.21) adjusted for sex, age, mother's allergy, total IgE and FEV1. When analysing different types of sensitization, the strongest association with atopic multimorbidity was found in participants that were IgE-sensitized both to perennial and seasonal allergens (4.50, OR: 95% CI 1.61-12.5). Maternal allergy (2.75, OR: 95% CI 1.15-4.46), high total IgE (2.38, OR: 95% CI 1.21-4.67) and lower FEV1 (0.73, OR: 95% CI 0.58-0.93) were also independently associated with atopic multimorbidity, while no association was found with any of the other inflammatory markers. Conclusion IgE polysensitization, to perennial and seasonal allergens, and levels of total IgE seem to be the main determinants of atopic multimorbidity in subjects with rhinitis. This indicates that disease-modifying treatment that targets IgE sensitization may be of value when decreasing the risk of developing atopic multimorbidity.

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  • 27.
    Blöndal, Viiu
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Sundbom, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Zhou, Xingwu
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Movérare, Robert
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Thermo Fischer Sci, Uppsala, Sweden..
    Borres, Magnus P
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research. Thermo Fischer Sci, Uppsala, Sweden..
    Högman, Marieann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Alving, Kjell
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Allergic sensitisation and type-2 inflammation is associated with new-onset and persistent allergic disease2023In: Clinical and Translational Allergy, E-ISSN 2045-7022, Vol. 13, no 4, article id e12240Article in journal (Refereed)
    Abstract [en]

    Background: Allergic disease is common. The aim of this study was to look at the change in asthma and rhinitis over time and to characterise factors contributing to remission and persistence of disease.

    Methods: This cohort study included 255 individuals with or without asthma and or rhinitis that participated in a population survey and a follow-up 10 years later. The participants were tested for allergic sensitisation, total IgE, multiplex allergen component analysis and type-2 inflammatory markers: exhaled nitric oxide (FENO), eosinophil cationic protein (ECP) and eosinophil-derived neurotoxin (EDN).

    Results: Of the 132 healthy individuals, 112 remained healthy, 16 developed rhinitis, 4 asthma and rhinitis over the 10 years. Out of 82 subjects with rhinitis, 26 went into remission, 53 remained unchanged and 3 developed asthma in addition to rhinitis. None of the 41 participants with asthma and rhinitis went into remission. Subjects with persistent rhinitis and asthma had higher levels of total IgE (odds ratio [OR] 95% confidence interval [CI]: 6.16 [3.05-12.5]) at baseline and after 10 years, and FENO and ECP at baseline (OR per log unit increase, 95% CI 5.21 [1.20-22.7] and 6.32 [1.52-26.4], respectively), compared with those that remained healthy. Subjects with persistent rhinitis were more likely to be sensitised to grass pollen and had higher total IgE levels than those that went into remission. Individuals with persistent asthma were more likely to be sensitised to tree pollen and furry animals than those with only persistent rhinitis (OR 95% CI: 3.50 [1.29-9.49] and 6.73 [2.00-22.6], respectively).

    Conclusion: IgE sensitisation and total IgE levels are associated with the persistence of rhinitis and asthma. Participants with persistent allergic disease had higher levels of allergen sensitisation and type 2 inflammation markers at baseline than those who remained healthy.

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  • 28.
    Borgstrom, Malin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Ctr Clin Res Dalarn79a, Nissers Vag 3, SE-182 Falun, Sweden..
    Bergsten, Amadeus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Cederblad, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Skogman, Barbro Hedin
    Ctr Clin Res Dalarna, Nissers Vag 3, SE-79182 Falun, Sweden.;Örebro Univ, Fak Gatan 1, SE-70281 Örebro, Sweden.;Uppsala Univ, Ctr Clin Res Dalarna, Nissers Vag 3, SE-79182 Falun, Sweden..
    Nevéus, Tryggve
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Fecal disimpaction in children with enuresis and constipation does not make them dry at night2022In: Journal of Pediatric Urology, ISSN 1477-5131, E-ISSN 1873-4898, Vol. 18, no 4Article in journal (Refereed)
    Abstract [en]

    Background: Constipation, daytime incontinence and nocturnal enuresis often overlap. Treatment of constipation has been shown to be an important aspect of therapy for children with daytime incontinence. However, the value of fecal disimpaction, as a part of constipation therapy, in children with enuresis has not been evaluated.

    Aim: Our aim was to evaluate the antienuretic effect of fecal disimpaction in children with enuresis and concomitant constipation.

    Methods: The bladder and bowel function was assessed non-invasively in children aged six to ten years who sought help for enuresis for the first time. If they were constipated according to the Rome IV criteria or had a rectal diameter exceeding 30 mm, as assessed by ultrasound, they were given standard evacuation with mini-enemas and macrogol therapy for at least two weeks. Enuresis frequency was documented 14 nights preceding and following therapy.

    Results: In total, 66 children (20 girls, 46 boys) were evaluated, 23 (35%) of whom were constipated. There were no differences in age, sex or baseline bladder function between the two groups. The enuresis frequency per two weeks was 9.8 +/- 4.1 nights before and 9.3 +/- 5.1 nights after constipation therapy (p = 0.43).

    Discussion: This study found that fecal disimpaction in children with enuresis who are also constipated did not alleviate nocturnal enuresis. Bowel problems may still need to be addressed but the child should not be given the false hope that this approach alone will make them dry at night. It might be that evidenced based therapies, such as the enuresis alarm and desmopressin, could be less efficient in children with enuresis and constipation unless their bowel disturbance is first properly addressed.

    Conclusions: Fecal disimpaction in children with enuresis and concomitant constipation will, by itself, not make the children dry at night. [GRAPHICS] .

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  • 29.
    Borgström, Malin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Center for Clinical Research Dalarna.
    Bergsten, Amadeus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Tunebjer, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Hedin Skogman, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Center for Clinical Research Dalarna. Örebro Univ, Inst Med & Hlth Sci, Örebro, Sweden..
    Nevéus, Tryggve
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Daytime urotherapy in nocturnal enuresis: a randomised, controlled trial2022In: Archives of Disease in Childhood, ISSN 0003-9888, E-ISSN 1468-2044, Vol. 107, no 6, p. 570-574Article in journal (Refereed)
    Abstract [en]

    Objective

    According to international guidelines, children with enuresis are recommended urotherapy, or basic bladder advice, before treatment with evidence-based alternatives such as the enuresis alarm is given. The efficacy of this strategy has, however, not been supported by controlled studies. We wanted to test if basic bladder advice is useful in enuresis.

    Design

    Randomised, controlled trial.

    Setting

    Paediatric outpatient ward, regional hospital.

    Patients

    Treatment-naive enuretic children aged >= 6 years, no daytime incontinence.

    Interventions

    Three groups, each during 8 weeks: (A) basic bladder advice--that is, voiding and drinking according to a strict schedule and instructions regarding toilet posture, (B) enuresis alarm therapy and (C) no treatment (control group). Main outcome measures Reduction in enuresis frequency during week 7-8 compared with baseline.

    Results

    The median number of wet nights out of 14 before and at the end of treatment were in group A (n=20) 12.5 and 11.5 (p=0.44), in group B (n=22) 11.0 and 3.5 (p<0.001) and in group C (n=18) 12.5 and 12.0 (p=0.55). The difference in reduction of enuresis frequency between the groups was highly significant (p=0.002), but no difference was found between basic bladder advice and controls.

    Conclusions

    Urotherapy, or basic bladder advice, is ineffective as a first-line treatment of nocturnal enuresis. Enuretic children who are old enough to be bothered by their condition should be offered treatment with the alarm or desmopressin.

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  • 30.
    Borres, Magnus P.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Sato, Sakura
    Department of Allergy, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.
    Ebisawa, Motohiro
    Department of Allergy, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.
    Recent advances in diagnosing and managing nut allergies with focus on hazelnuts, walnuts, and cashew nuts2022In: World Allergy Organization Journal, E-ISSN 1939-4551, Vol. 15, no 4, article id 100641Article in journal (Refereed)
    Abstract [en]

    Tree nuts are a powerful and common source of food allergens that induce IgE-mediated allergic reactions. Health authorities endorse the intake of tree nuts because they are regarded as nutritious. Allergic reactions to nuts can lead to severe and occasionally lethal reactions. Allergies to tree nuts are observed worldwide and are found in up to 4.9% of people in unspecific populations. Over the last 2 decades, the rates of allergic reactions and anaphylaxis have increased in different countries. Most proteins implicated in tree nut allergic reactions are members of the lipid transfer protein, 2S albumin, vicilin, legumin, and oleosin protein families. Bet v 1 homologs and profilins are involved in pollen-related tree nut allergies. Systematic literature reviews and meta-analyses on the diagnostic accuracy of specific immunoglobulin E (sIgE) for commercially available nut components have recently been published. IgE testing of the storage proteins Cor a 14, Cor a 9, Jug r 1, and Ana o 3 increases diagnostic specificity in assessing hazelnut, walnut, and cashew allergies in children, respectively. The resolution of tree nut allergies has been reported; however, only a few studies are available in this regard. Complete avoidance of nuts is the safest approach for nutallergic subjects. However, this is difficult to achieve and can result in a severely restricted diet. Patients can eat nuts that they know are safe at home, but should avoid them when eating out because of the risk of cross-contamination. Nuts have become part of a modern healthy diet, and this enhanced consumption is reflected in an increased prevalence of nut allergies.

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  • 31.
    Brix, Ninna
    et al.
    Aalborg Univ Hosp, Dept Pediat & Adolescent Med, Aalborg, Denmark..
    Glerup, Mia
    Aarhus Univ Hosp, Dept Pediat & Adolescent Med, Aarhus, Denmark..
    Foell, Dirk
    Univ Munster, Dept Pediat Rheumatol & Immunol, Munster, Germany..
    Kessel, Christoph
    Univ Munster, Dept Pediat Rheumatol & Immunol, Munster, Germany..
    Wittkowski, Helmut
    Univ Munster, Dept Pediat Rheumatol & Immunol, Munster, Germany..
    Berntson, Lillemor
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Fasth, Anders
    Univ Gothenburg, Inst Clin Sci, Sahlgrenska Acad, Dept Pediat, Gothenburg, Sweden..
    Nielsen, Susan
    Copenhagen Univ Hosp, Dept Hematol, Rigshosp, Copenhagen, Denmark..
    Nordal, Ellen
    Univ Hosp North Norway, Dept Pediat, Tromso, Norway.;Arctic Univ Norway, UiT, Dept Clin Med, Tromso, Norway..
    Rygg, Marite
    NTNU Norwegian Univ Sci & Technol, Dept Clin & Mol Med, Trondheim, Norway.;St Olavs Hosp, Dept Pediat, Trondheim, Norway..
    Hasle, Henrik
    Aarhus Univ Hosp, Dept Pediat & Adolescent Med, Aarhus, Denmark..
    Herlin, Troels
    Aarhus Univ Hosp, Dept Pediat & Adolescent Med, Aarhus, Denmark..
    Inflammatory Biomarkers Can Differentiate Acute Lymphoblastic Leukemia with Arthropathy from Juvenile Idiopathic Arthritis Better Than Standard Blood Tests2023In: The Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 258, article id 113406Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate the predictive value of biomarkers of inflammation like phagocyte-related S100 proteins and a panel of inflammatory cytokines in order to differentiate the child with acute lymphoblastic leukemia (ALL) from juvenile idiopathic arthritis (JIA).

    Study design: In this cross-sectional study, we measured S100A9, S100A12, and 14 cytokines in serum from children with ALL (n = 150, including 27 with arthropathy) and JIA (n = 236). We constructed predictive models computing areas under the curve (AUC) as well as predicted probabilities in order to differentiate ALL from JIA. Logistic regression was used for predictions of ALL risk, considering the markers as the respective exposures. We performed internal validation using repeated 10-fold cross-validation and recalibration, adjusted for age.

    Results: In ALL, the levels of S100A9, S100A12, interleukin (IL)-1 beta, IL-4, IL-13, IL-17, matrix metalloproteinase-3, and myeloperoxidase were low compared with JIA (P < .001). IL-13 had an AUC of 100% (95% CI 100%-100%) due to no overlap between the serum levels in the 2 groups. Further, IL-4 and S100A9 had high predictive performance with AUCs of 99% (95% CI 97%-100%) and 98% (95% CI 94%-99%), respectively, exceeding both hemoglobin, platelets, C-reactive protein, and erythrocyte sedimentation rate.

    Conclusions: The biomarkers S100A9, IL-4, and IL-13 might be valuable markers to differentiate ALL from JIA.

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  • 32.
    Brix, Ninna
    et al.
    Aarhus Univ Hosp, Dept Pediat & Adolescent Med, Aarhus, Denmark.;Aalborg Univ Hosp, Dept Pediat & Adolescent Med, Aalborg, Denmark.
    Glerup, Mia
    Aarhus Univ Hosp Skejby, Dept Pediat & Adolescent Med, Aarhus, Denmark.
    Thiel, Steffen
    Aarhus Univ, Dept Biomed, Aarhus, Denmark.
    Mistegaard, Clara Elbaek
    Aarhus Univ, Dept Biomed, Aarhus, Denmark.;Aarhus Univ Hosp Skejby, Dept Rheumatol, Aarhus, Denmark.
    Skals, Regitze Gyldenholm
    Aalborg Univ Hosp, Dept Clin Biostat, Aalborg, Denmark.
    Berntson, Lillemor
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Fasth, Anders
    Univ Gothenburg, Inst Clin Sci, Dept Pediat, Gothenburg, Sweden.
    Nielsen, Susan Mary
    Copenhagen Univ Hosp, Dept Pediat, Copenhagen, Denmark.
    Nordal, Ellen
    Univ Hosp North Norway, Dept Pediat, Tromso, Norway.;UiT Arctic Univ Norway, Dept Clin Med, Tromso, Norway.
    Rygg, Marite
    NTNU Norwegian Univ Sci & Technol, Dept Clin & Mol Med, Trondheim, Norway.;St Olavs Hosp, Dept Pediat, Trondheim, Norway.
    Hasle, Henrik
    Aarhus Univ Hosp, Dept Pediat & Adolescent Med, Aarhus, Denmark.
    Albertsen, Birgitte Klug
    Aarhus Univ Hosp, Dept Pediat & Adolescent Med, Aarhus, Denmark.
    Herlin, Troels
    Aarhus Univ Hosp, Dept Pediat & Adolescent Med, Aarhus, Denmark.
    M-ficolin: a valuable biomarker to identify leukaemia from juvenile idiopathic arthritis2022In: Archives of Disease in Childhood, ISSN 0003-9888, E-ISSN 1468-2044, Vol. 107, no 4, p. 371-376Article in journal (Refereed)
    Abstract [en]

    Objective: Distinction on clinical grounds between acute lymphoblastic leukaemia presenting with arthropathy (ALL arthropathy) and juvenile idiopathic arthritis (JIA) is difficult, as the clinical and paraclinical signs of leukaemia may be vague. The primary aim was to examine the use of lectin complement pathway proteins as markers to differentiate ALL arthropathy from JIA. The secondary aims were to compare the protein levels at baseline and follow-up in a paired number of children with ALL and to examine the correlation with haematology counts, erythrocyte sedimentation reaction (ESR), C-reactive protein (CRP), blasts, relapse and death.

    Study design: In this observational study, we measured M-ficolin, CL-K1 and MASP-3 in serum from children with ALL (n=151) and JIA (n=238) by time-resolved immunofluorometric assays. Logistic regression was used for predictions of ALL risk, considering the markers as the respective exposures. We performed internal validation using repeated '10-fold cross-validation' with 100 repetitions computing the area under the curve (AUC) as well as positive and negative predictive values in order to evaluate the predictive performance.

    Results: The level of M-ficolin was higher in JIA than ALL total and the ALL arthropathy subgroup. The M-ficolin level normalised after remission of ALL. M-ficolin could differentiate ALL from JIA with an AUC of 94% and positive predictive value (PPV) of 95%, exceeding CRP and haemoglobin. In a dichotomised predictive model with optimal cut-offs for M-ficolin, platelets and haemoglobin, AUC was 99% and PPV 98% in detecting ALL from JIA.

    Conclusion: M-ficolin is a valuable marker to differentiate the child with ALL from JIA.

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  • 33.
    Cachim, Afonso
    et al.
    Univ Porto, Fac Med, Porto, Portugal..
    Pereira, Ana Margarida
    Univ Porto, Fac Med, Ctr Hlth Technol & Serv Res CINTESIS, Porto, Portugal.;Univ Porto, Fac Med, Dept Community Med Informat & Hlth Decis Sci MEDC, Porto, Portugal.;Inst & Hosp CUF Porto, Allergy Unit, Porto, Portugal..
    Almeida, Rute
    Univ Porto, Fac Med, Ctr Hlth Technol & Serv Res CINTESIS, Porto, Portugal.;Univ Porto, Fac Med, Dept Community Med Informat & Hlth Decis Sci MEDC, Porto, Portugal..
    Amaral, Rita
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research. Univ Porto, Fac Med, Ctr Hlth Technol & Serv Res CINTESIS, Porto, Portugal; Univ Porto, Fac Med, Dept Community Med Informat & Hlth Decis Sci MEDC, Porto, Portugal; Polytech Inst Porto, Porto Hlth Sch, Dept Cardiovasc & Resp Sci, Porto, Portugal.
    Alves-Correia, Magna
    Univ Porto, Fac Med, Ctr Hlth Technol & Serv Res CINTESIS, Porto, Portugal.;Inst & Hosp CUF Porto, Allergy Unit, Porto, Portugal..
    Vieira-Marques, Pedro
    Univ Porto, Fac Med, Ctr Hlth Technol & Serv Res CINTESIS, Porto, Portugal..
    Chaves-Loureiro, Claudia
    Ctr Hosp & Univ Coimbra, Hosp Univ Coimbra, Pulmonol Dept, Coimbra, Portugal.;Clin Acad Ctr Coimbra, Coimbra, Portugal..
    Ribeiro, Carmelita
    Ctr Hosp & Univ Coimbra, Serv Imunoalergol, Coimbra, Portugal..
    Cardia, Francisca
    Agrupamento Ctr Saude Dao Lafoes, Unidade Saude Familiar USF Terras Azurara, Mangualde, Portugal..
    Gomes, Joana
    Ctr Hosp Vila Nova de Gaia Espinho, Serv Imunoalergol, Unidade 1, Vila Nova de Gaia, Portugal..
    Vidal, Carmen
    Complejo Hosp Univ Santiago, Serv Alergia, Santiago De Compostela, Spain..
    Silva, Eurico
    USF Joao Semana, Agrupamento Ctr Saude ACES Baixo Vouga, Ovar, Portugal..
    Rocha, Sara
    USF Arte Nova, ACES Baixo Vouga, Oliveirinha, Portugal..
    Rocha, Diana
    USF Sa de Miranda, ACES Cavado II Geres Cabreira, Vila Verde, Portugal..
    Marques, Maria Luis
    Hosp Senhora Oliveira, Serv Imunoalergol, Guimaraes, Portugal..
    Pascoa, Rosalia
    Univ Porto, Fac Med, Ctr Hlth Technol & Serv Res CINTESIS, Porto, Portugal.;Univ Porto, Fac Med, Dept Community Med Informat & Hlth Decis Sci MEDC, Porto, Portugal.;USF Abel Salazar, ACES Gaia, Vila Nova de Gaia, Portugal..
    Morais, Daniela
    USF Corgo, ACES Douro I Marao & Douro Norte, Vila Real, Portugal..
    Cruz, Ana Margarida
    USF Bom Porto, ACES Grande Porto V Porto Ocidental, Porto, Portugal..
    Santalha, Marta
    Hosp Senhora Oliveira, Serv Pediat, Guimaraes, Portugal..
    Simoes, Jose Augusto
    Univ Porto, Fac Med, Ctr Hlth Technol & Serv Res CINTESIS, Porto, Portugal.;USF Caminhos do Certoma, ACES Baixo Mondego, Pampilhosa, Portugal.;Univ Beira Interior, Dept Med Sci, Covilha, Portugal..
    da Silva, Sofia
    USF Cuidarte, Unidade Local Saude Alto Minho, Portuzelo, Portugal..
    Silva, Diana
    Univ Porto, Fac Med, Porto, Portugal.;Ctr Hosp Univ Sao Joao, Serv Imunoalergol, Porto, Portugal..
    Gerardo, Rita
    Ctr Hosp Univ Lisboa Cent, Hosp Santa Marta, Serv Pneumol, Lisbon, Portugal..
    Todo Bom, Filipa
    Hosp Beatriz Angelo, Serv Pneumol, Loures, Portugal..
    Morete, Ana
    Inst & Hosp CUF Porto, Allergy Unit, Porto, Portugal.;Ctr Hosp Baixo Vouga, Hosp Infante D Pedro, Serv Imunoalergol, Aveiro, Portugal..
    Vieira, Ines
    ACES Pinhal Litoral, Unidade Cuidados Saude Personalizados Arnaldo Sam, Leiria, Portugal..
    Vieira, Pedro
    USF Mondego, ACES Baixo Mondego, Coimbra, Portugal..
    Monteiro, Rosario
    Univ Porto, Fac Med, Ctr Hlth Technol & Serv Res CINTESIS, Porto, Portugal.;USF Homem Do Leme, ACES Porto Ocidental, Porto, Portugal..
    Rosario Raimundo, Maria
    USF Marques, ACES Pinhal Litoral, Pombal, Portugal..
    Monteiro, Luis
    Univ Porto, Fac Med, Ctr Hlth Technol & Serv Res CINTESIS, Porto, Portugal.;USF Esgueira, ACES Baixo Vouga, Esgueira, Portugal..
    Neves, Ângela
    USF Araceti, ACES Baixo Mondego, Arazede, Portugal..
    Santos, Carlos
    USF Santo Antonio, ACES Cavado Barcelos Esposende 3, Barcelos, Portugal..
    Penas, Ana Margarida
    USF Baltar, ACES Tamega Vale Sousa Sul 2, Baltar, Portugal..
    Regadas, Rita
    USF Aquilino Ribeiro, ACES Douro Douro Sul 2, Moimenta da Beira, Portugal..
    Varanda Marques, José
    USF Viseu Cidade, ACES Dao Lafoes, Viseu, Portugal..
    Rosendo, Inês
    Univ Porto, Fac Med, Ctr Hlth Technol & Serv Res CINTESIS, Porto, Portugal.;USF Coimbra Ctr, ACES Baixo Mondego, Coimbra, Portugal..
    Abreu Aguiar, Margarida
    USF Valongo, ACES Grande Porto Maia Valongo 3, Valongo, Portugal..
    Fernandes, Sara
    UCSP Sao Joao da Pesqueira, ACES Douro Sul, Sao Joao da Pesqueira, Portugal..
    Seica Cardoso, Carlos
    Univ Porto, Fac Med, Ctr Hlth Technol & Serv Res CINTESIS, Porto, Portugal.;USF Condeixa, ACES Baixo Mondego, Condeixa A Nova, Portugal..
    Pimenta, Filipa
    UCSP Figueira Da Foz Sul, ACES Baixo Mondego, Lavos, Portugal..
    Meireles, Patricia
    USF Almedina, ACES Douro 2, Lamego, Portugal..
    Goncalves, Mariana
    USF Antonina, ACES Ave Famalicao, Requiao, Portugal..
    Almeida Fonseca, João
    Univ Porto, Fac Med, Ctr Hlth Technol & Serv Res CINTESIS, Porto, Portugal.;Univ Porto, Fac Med, Dept Community Med Informat & Hlth Decis Sci MEDC, Porto, Portugal.;MEDIDA Med Educ Invest Desenvolvimento & Avaliaca, Porto, Portugal..
    Jácome, Cristina
    Univ Porto, Fac Med, Ctr Hlth Technol & Serv Res CINTESIS, Porto, Portugal.;Univ Porto, Fac Med, Dept Community Med Informat & Hlth Decis Sci MEDC, Porto, Portugal..
    Measuring adherence to inhaled control medication in patients with asthma: Comparison among an asthma app, patient self-report and physician assessment2023In: Clinical and Translational Allergy, E-ISSN 2045-7022, Vol. 13, no 2, article id e12210Article in journal (Refereed)
    Abstract [en]

    Background

    Previous studies have demonstrated the feasibility of using an asthma app to support medication management and adherence but failed to compare with other measures currently used in clinical practice. However, in a clinical setting, any additional adherence measurement must be evaluated in the context of both the patient and physician perspectives so that it can also help improve the process of shared decision making. Thus, we aimed to compare different measures of adherence to asthma control inhalers in clinical practice, namely through an app, patient self-report and physician assessment.

    Methods

    This study is a secondary analysis of three prospective multicentre observational studies with patients (≥13 years old) with persistent asthma recruited from 61 primary and secondary care centres in Portugal. Patients were invited to use the InspirerMundi app and register their inhaled medication. Adherence was measured by the app as the number of doses taken divided by the number of doses scheduled each day and two time points were considered for analysis: 1-week and 1-month. At baseline, patients and physicians independently assessed adherence to asthma control inhalers during the previous week using a Visual Analogue Scale (VAS 0–100).

    Results

    A total of 193 patients (72% female; median [P25–P75] age 28 [19–41] years old) were included in the analysis. Adherence measured by the app was lower (1 week: 31 [0–71]%; 1 month: 18 [0–48]%) than patient self-report (80 [60–95]) and physician assessment (82 [51–94]) (p < 0.001). A negligible non-significant correlation was found between the app and subjective measurements (ρ 0.118–0.156, p > 0.05). There was a moderate correlation between patient self-report and physician assessment (ρ = 0.596, p < 0.001).

    Conclusions

    Adherence measured by the app was lower than that reported by the patient or the physician. This was expected as objective measurements are commonly lower than subjective evaluations, which tend to overestimate adherence. Nevertheless, the low adherence measured by the app may also be influenced by the use of the app itself and this needs to be considered in future studies.

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  • 34.
    Cadamuro, Janne
    et al.
    Paracelsus Med Univ, Dept Lab Med, Salzburg, Austria..
    Bergsten, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Mörwald, Katharina
    Paracelsus Med Univ, Dept Pediat, Univ Hosp, Pediat Gastroenterol Hepatol & Nutr, Salzburg, Austria.;Paracelsus Med Univ, Univ Hosp, Obes Res Unit, Salzburg, Austria..
    Forslund, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Dahlbom, Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Bergquist, Jonas
    Uppsala University, Disciplinary Domain of Science and Technology, Chemistry, Department of Chemistry - BMC, Analytical Chemistry.
    Ciba, Iris
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Brunner, Susanne M.
    Paracelsus Med Univ, Dept Pediat, Univ Hosp, Salzburg, Austria..
    Jabbour, Jeanne
    Paracelsus Med Univ, Dept Pediat, Univ Hosp, Pediat Gastroenterol Hepatol & Nutr, Salzburg, Austria..
    Weghuber, Daniel
    Paracelsus Med Univ, Dept Pediat, Univ Hosp, Pediat Gastroenterol Hepatol & Nutr, Salzburg, Austria.;Paracelsus Med Univ, Univ Hosp, Obes Res Unit, Salzburg, Austria..
    Deviating glucose results in an international dual-center study. A root cause investigation2022In: Biochemia Medica, ISSN 1330-0962, E-ISSN 1846-7482, Vol. 32, no 1, article id 011001Article in journal (Refereed)
    Abstract [en]

    During a dual-center study on obese and normal weight children and adolescents, focusing on glucose metabolism, we observed a marked difference in glucose results (N = 16,840) between the two sites, Salzburg, Austria and Uppsala, Sweden (P < 0.001). After excluding differences in patient characteristics between the two populations as cause of this finding, we investigated other preanalytic influences. Finally, only the tubes used for blood collection at the two sites were left to evaluate. While the Vacuette FC-Mix tube (Greiner Bio-One, Kremsmunster, Austria) was used in Uppsala, in Salzburg blood collections were performed with a lithium heparin tube (LH-Monovette, Sarstedt, Germany). To prove our hypothesis, we collected two blood samples in either of these tubes from 51 children (Salzburg N = 27, Uppsala N = 24) and compared the measured glucose results. Indeed, we found the suspected bias and calculated a correction formula, which significantly diminished the differences of glucose results between the two sites (P = 0.023). Our finding is in line with those of other studies and although this issue should be widely known, we feel that it is widely neglected, especially when comparing glucose concentrations across Europe, using large databases without any information on preanalytic sample handling.

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  • 35. Cederblad, Lars
    et al.
    Eklund, Gustav
    Vedal, Amund
    Hill, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Caballero-Corbalán, José
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Transplantation and regenerative medicine.
    Hellman, Jarl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Abrahamsson, Niclas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Wahlström-Johnsson, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Carlsson, Per-Ola
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Transplantation and regenerative medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology.
    Espes, Daniel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Transplantation and regenerative medicine. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Classification of Hypoglycemic Events in Type 1 Diabetes Using Machine Learning Algorithms2023In: Diabetes Therapy, ISSN 1869-6953, E-ISSN 1869-6961, Vol. 14, no 6, p. 953-965Article in journal (Refereed)
    Abstract [en]

    Introduction

    To improve the utilization of continuous- and flash glucose monitoring (CGM/FGM) data we have tested the hypothesis that a machine learning (ML) model can be trained to identify the most likely root causes for hypoglycemic events.

    Methods

    CGM/FGM data were collected from 449 patients with type 1 diabetes. Of the 42,120 identified hypoglycemic events, 5041 were randomly selected for classification by two clinicians. Three causes of hypoglycemia were deemed possible to interpret and later validate by insulin and carbohydrate recordings: (1) overestimated bolus (27%), (2) overcorrection of hyperglycemia (29%) and (3) excessive basal insulin presure (44%). The dataset was split into a training (n = 4026 events, 304 patients) and an internal validation dataset (n = 1015 events, 145 patients). A number of ML model architectures were applied and evaluated. A separate dataset was generated from 22 patients (13 ‘known’ and 9 ‘unknown’) with insulin and carbohydrate recordings. Hypoglycemic events from this dataset were also interpreted by five clinicians independently.

    Results

    Of the evaluated ML models, a purpose-built convolutional neural network (HypoCNN) performed best. Masking the time series, adding time features and using class weights improved the performance of this model, resulting in an average area under the curve (AUC) of 0.921 in the original train/test split. In the dataset validated by insulin and carbohydrate recordings (n = 435 events), i.e. ‘ground truth,’ our HypoCNN model achieved an AUC of 0.917.

    Conclusions

    The findings support the notion that ML models can be trained to interpret CGM/FGM data. Our HypoCNN model provides a robust and accurate method to identify root causes of hypoglycemic events.

  • 36.
    Cedströmer, Anna-Lena
    et al.
    Univ Gothenburg, Sahlgrenska Acad, Inst Odontol, Dept Behav & Community Dent, Gothenburg, Sweden..
    Andlin-Sobocki, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery. Folktandvarden Eastman Inst, Dept Orthodont, Stockholm, Stockholms Lan, Sweden..
    Abbu, Nadjwan
    Folktandvarden Eastman Inst, Dept Orthodont, Stockholm, Stockholms Lan, Sweden..
    Hedenberg-Magnusson, Britt
    Karolinska Inst, Dept Dent Med, Sect Orofacial Pain & Jaw Funct, Huddinge, Sweden.;Folktandvarden Eastman Inst, Dept Orofacial Pain & Jaw Funct, Stockholm, Stockholms Lan, Sweden..
    Dahlström, Lars
    Univ Gothenburg, Sahlgrenska Acad, Inst Odontol, Dept Behav & Community Dent, Gothenburg, Sweden..
    Berntson, Lillemor
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation, Metabolism and Child Health Research.
    Condylar alterations and facial growth in children with juvenile idiopathic arthritis2020In: Journal of Orofacial Orthopedics, ISSN 1434-5293, E-ISSN 1615-6714, Vol. 81, no 3, p. 163-171Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of this retrospective study was to evaluate facial growth in children with juvenile idiopathic arthritis (JIA) by means of lateral head cephalometric radiographs and relate the findings to temporomandibular joint (TMJ) condylar changes on panoramic radiographs.

    Methods: Radiographic and medical records were evaluated in 65 children with JIA. Cephalometric and panoramic analyses were performed for the impact of condylar changes on facial growth. We compared children with condylar alterations, minor or major, with those without condylar alterations.

    Results: Based on panoramic radiographs, no condylar alterations were seen in 27 of the 65 children and condylar alterations were seen in 38 children (i.e., 23 had minor and 15 major condylar alterations). The cephalometric analyses of the children with condylar changes showed significant growth disturbances with a more retrognathic mandible (SNB; p = 0.03), retruded chin position (SNPog; p = 0.02), larger mandibular angulation (ML/NSL; p = 0.009) and maxillary angulation (NL/NSL; p = 0.03) compared with children without condylar alterations. Children with minor condylar alterations had a significantly more retruded chin position (SNPog) than those with no condylar changes (p = 0.04).

    Conclusions: Condylar changes in the TMJ, judged on panoramic radiography, in children with JIA, have impact on craniofacial growth. Even minor alterations seem to have an impact.

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  • 37.
    Ciba, Iris
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research. Uppsala Univ, Childrens Hosp, Uppsala, Sweden..
    Dahlbom, Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research. Uppsala Univ, Childrens Hosp, Uppsala, Sweden..
    Manell, Hannes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology. Uppsala Univ, Childrens Hosp, Uppsala, Sweden..
    Mörwald, Katharina
    Paracelsus Med Univ, Dept Pediat, Salzburg, Austria.;Paracelsus Med Univ, Obes Res Unit, Salzburg, Austria..
    Roomp, Kirsten
    Univ Luxembourg, Luxembourg Ctr Syst Biomed, Belvaux, Luxembourg..
    Weghuber, Daniel
    Paracelsus Med Univ, Dept Pediat, Salzburg, Austria.;Paracelsus Med Univ, Obes Res Unit, Salzburg, Austria..
    Bergsten, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research. Uppsala Univ, Childrens Hosp, Uppsala, Sweden..
    Forslund, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research. Uppsala Univ, Childrens Hosp, Uppsala, Sweden..
    Studies in children with obesity in two European treatment centres show a high