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- Ozsahin, Hulya, et al.
(författare)
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Long-term outcome following hematopoietic stem-cell transplantation in Wiskott-Aldrich syndrome: collaborative study of the European Society for Immunodeficiencies and European Group for Blood and Marrow Transplantation.
- 2008
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Ingår i: Blood. - : American Society of Hematology. - 0006-4971 .- 1528-0020. ; 111:1, s. 439-45
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Tidskriftsartikel (refereegranskat)abstract
- Wiskott-Aldrich syndrome (WAS) is a rare X-linked immunodeficiency with microthrombocytopenia, eczema, recurrent infections, autoimmune disorders, and malignancies that are life-threatening in the majority of patients. In this long-term, retrospective, multicenter study, we analyzed events that occurred in 96 WAS patients who received transplants between 1979 and 2001 who survived at least 2 years following hematopoietic stem-cell transplantation (HSCT). Events included chronic graft-versus-host disease (cGVHD), autoimmunity, infections, and sequelae of before or after HSCT complications. Three patients (3%) died 2.1 to 21 years following HSCT. Overall 7-year event-free survival rate was 75%. It was lower in recipients of mismatched related donors, also in relation with an older age at HSCT and disease severity. The most striking finding was the observation of cGVHD-independent autoimmunity in 20% of patients strongly associated with a mixed/split chimerism status (P < .001), suggesting that residual-host lymphocytes can mediate autoimmune disease despite the coexistence of donor lymphocytes. Infectious complications (6%) related to splenectomy were also significant and may warrant a more restrictive approach to performing splenectomy in WAS patients. Overall, this study provides the basis for a prospective, standardized, and more in-depth detailed analysis of chimerism and events in long-term follow-up of WAS patients who receive transplants to design better-adapted therapeutic strategies.
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- Kodra, Yllka, et al.
(författare)
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Recommendations for Improving the Quality of Rare Disease Registries
- 2018
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 15:8
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Forskningsöversikt (refereegranskat)abstract
- Rare diseases (RD) patient registries are powerful instruments that help develop clinical research, facilitate the planning of appropriate clinical trials, improve patient care, and support healthcare management. They constitute a key information system that supports the activities of European Reference Networks (ERNs) on rare diseases. A rapid proliferation of RD registries has occurred during the last years and there is a need to develop guidance for the minimum requirements, recommendations and standards necessary to maintain a high-quality registry. In response to these heterogeneities, in the framework of RD-Connect, a European platform connecting databases, registries, biobanks and clinical bioinformatics for rare disease research, we report on a list of recommendations, developed by a group of experts, including members of patient organizations, to be used as a framework for improving the quality of RD registries. This list includes aspects of governance, Findable, Accessible, Interoperable and Reusable (FAIR) data and information, infrastructure, documentation, training, and quality audit. The list is intended to be used by established as well as new RD registries. Further work includes the development of a toolkit to enable continuous assessment and improvement of their organizational and data quality.
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- Mura, Anna, et al.
(författare)
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Bringing rehabilitation home with an e-health platform to treat stroke patients : study protocol of a randomized clinical trial (RGS@home)
- 2022
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Ingår i: Trials. - : BioMed Central (BMC). - 1745-6215. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThere is a pressing need for scalable healthcare solutions and a shift in the rehabilitation paradigm from hospitals to homes to tackle the increase in stroke incidence while reducing the practical and economic burden for patients, hospitals, and society. Digital health technologies can contribute to addressing this challenge; however, little is known about their effectiveness in at-home settings. In response, we have designed the RGS@home study to investigate the effectiveness, acceptance, and cost of a deep tech solution called the Rehabilitation Gaming System (RGS). RGS is a cloud-based system for delivering AI-enhanced rehabilitation using virtual reality, motion capture, and wearables that can be used in the hospital and at home. The core principles of the brain theory-based RGS intervention are to deliver rehabilitation exercises in the form of embodied, goal-oriented, and task-specific action.MethodsThe RGS@home study is a randomized longitudinal clinical trial designed to assess whether the combination of the RGS intervention with standard care is superior to standard care alone for the functional recovery of stroke patients at the hospital and at home. The study is conducted in collaboration with hospitals in Spain, Sweden, and France and includes inpatients and outpatients at subacute and chronic stages post-stroke. The intervention duration is 3 months with assessment at baseline and after 3, 6, and 12 months. The impact of RGS is evaluated in terms of quality of life measurements, usability, and acceptance using standardized clinical scales, together with health economic analysis. So far, one-third of the patients expected to participate in the study have been recruited (N = 90, mean age 60, days after stroke ≥ 30 days). The trial will end in July 2023.DiscussionWe predict an improvement in the patients’ recovery, high acceptance, and reduced costs due to a soft landing from the clinic to home rehabilitation. In addition, the data provided will allow us to assess whether the prescription of therapy at home can counteract deterioration and improve quality of life while also identifying new standards for online and remote assessment, diagnostics, and intervention across European hospitals.
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| 5. |
- Svensson, Anders, et al.
(författare)
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Bipolar volcanic synchronization of abrupt climate change in Greenland and Antarctic ice cores during the last glacial period
- 2020
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Ingår i: Climate of the Past. - : Copernicus GmbH. - 1814-9324 .- 1814-9332. ; 16:4, s. 1565-1580
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Tidskriftsartikel (refereegranskat)abstract
- The last glacial period is characterized by a number of millennial climate events that have been identified in both Greenland and Antarctic ice cores and that are abrupt in Greenland climate records. The mechanisms governing this climate variability remain a puzzle that requires a precise synchronization of ice cores from the two hemispheres to be resolved. Previously, Greenland and Antarctic ice cores have been synchronized primarily via their common records of gas concentrations or isotopes from the trapped air and via cosmogenic isotopes measured on the ice. In this work, we apply ice core volcanic proxies and annual layer counting to identify large volcanic eruptions that have left a signature in both Greenland and Antarctica. Generally, no tephra is associated with those eruptions in the ice cores, so the source of the eruptions cannot be identified. Instead, we identify and match sequences of volcanic eruptions with bipolar distribution of sulfate, i.e. unique patterns of volcanic events separated by the same number of years at the two poles. Using this approach, we pinpoint 82 large bipolar volcanic eruptions throughout the second half of the last glacial period (12-60ka). This improved ice core synchronization is applied to determine the bipolar phasing of abrupt climate change events at decadal-scale precision. In response to Greenland abrupt climatic transitions, we find a response in the Antarctic water isotope signals (δ18O and deuterium excess) that is both more immediate and more abrupt than that found with previous gas-based interpolar synchronizations, providing additional support for our volcanic framework. On average, the Antarctic bipolar seesaw climate response lags the midpoint of Greenland abrupt δ18O transitions by 122±24 years. The time difference between Antarctic signals in deuterium excess and δ18O, which likewise informs the time needed to propagate the signal as described by the theory of the bipolar seesaw but is less sensitive to synchronization errors, suggests an Antarctic δ18O lag behind Greenland of 152±37 years. These estimates are shorter than the 200 years suggested by earlier gas-based synchronizations. As before, we find variations in the timing and duration between the response at different sites and for different events suggesting an interaction of oceanic and atmospheric teleconnection patterns as well as internal climate variability.
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