| 1. |
- Plate, John, 1993, et al.
(author)
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Expression of inducible nitric oxide synthase, nitrotyrosine, eosinophilic peroxidase, eotaxin-3, and galectin-3 in patients with gastroesophageal reflux disease, eosinophilic esophagitis, and in healthy controls: a semiquantitative image analysis of 3,3′-diaminobenzidine-stained esophageal biopsies
- 2024
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In: DISEASES OF THE ESOPHAGUS. - 1120-8694 .- 1442-2050.
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Journal article (peer-reviewed)abstract
- Eosinophilic esophagitis (EoE) and gastroesophageal reflux disease (GERD) share many histopathological features; therefore, markers for differentiation are of diagnostic interest and may add to the understanding of the underlying mechanisms. The nitrergic system is upregulated in GERD and probably also in EoE. Esophageal biopsies of patients with EoE (n = 20), GERD (n = 20), and healthy volunteers (HVs) (n = 15) were exposed to antibodies against inducible nitric oxide synthase (iNOS), nitrotyrosine, eosinophilic peroxidase, eotaxin-3, and galectin-3. The stained object glasses were randomized, digitized, and blindly analyzed regarding the expression of DAB (3,3 '-diaminobenzidine) by a protocol developed in QuPath software. A statistically significant overexpression of iNOS was observed in patients with any of the two inflammatory diseases compared with that in HVs. Eotaxin-3 could differentiate HVs versus inflammatory states. Gastroesophageal reflux patients displayed the highest levels of nitrotyrosine. Neither iNOS nor nitrotyrosine alone were able to differentiate between the two diseases. For that purpose, eosinophil peroxidase was a better candidate, as the mean levels increased stepwise from HVs via GERD to EoE. iNOS and nitrotyrosine are significantly overexpressed in patients with EoE and GERD compared with healthy controls, but only eosinophil peroxidase could differentiate the two types of esophagitis. The implications of the finding of the highest levels of nitrotyrosine among gastroesophageal reflux patients are discussed.
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| 2. |
- Albinsson, Sofie, 1992, et al.
(author)
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Extracellular distribution of galectin-10 in the esophageal mucosa of patients with eosinophilic esophagitis
- 2023
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In: CLINICAL AND EXPERIMENTAL IMMUNOLOGY. - : Oxford University Press (OUP). - 0009-9104 .- 1365-2249. ; 212:2, s. 147-155
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Journal article (peer-reviewed)abstract
- CD16+ eosinophils and large amounts of extracellular vesicles containing galectin-10, a T-cell suppressive eosinophil protein, were found in the esophageal mucosa of patients with active eosinophilic esophagitis. Both the CD16+ eosinophils and the released galectin-10-containing extracellular vesicles disappeared in successfully treated patients but remained in the mucosa of the non-responders to treatment. Eosinophilic esophagitis is a T-cell-driven allergic condition hallmarked by eosinophil infiltration of the esophagus. Eosinophils exposed to proliferating T cells release galectin-10 and have T-cell suppressive function in vitro. The aims of this study were to evaluate if eosinophils co-localize with T cells and release galectin-10 in the esophagus of patients with eosinophilic esophagitis. Esophageal biopsies from 20 patients with eosinophilic esophagitis were stained for major basic protein, galectin-10, CD4, CD8, CD16, and CD81 and analyzed by immunofluorescence confocal microscopy before and after topical corticosteroid treatment. CD4+ T-cell numbers decreased in the esophageal mucosa of responders to treatment but not in the non-responders. Suppressive (CD16+) eosinophils were present in the esophageal mucosa of patients with active disease and decreased after successful treatment. Unexpectedly, eosinophils and T cells were not in direct contact with each other. Instead, the esophageal eosinophils released large amounts of galectin-10-containing extracellular vesicles and featured cytoplasmic projections that contained galectin-10, both of which disappeared from the esophagus of the responders but remained in the non-responders. To conclude, the presence of CD16+ eosinophils together with the massive release of galectin-10-containing extracellular vesicles in the esophageal mucosa might indicate that eosinophils exert T-cell suppression in eosinophilic esophagitis.
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| 3. |
- Albinsson, Sofie, 1992, et al.
(author)
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Patient-Reported Dysphagia in Adults with Eosinophilic Esophagitis: Translation and Validation of the Swedish Eosinophilic Esophagitis Activity Index
- 2022
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In: Dysphagia. - : Springer Science and Business Media LLC. - 0179-051X .- 1432-0460. ; 37, s. 286-296
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Journal article (peer-reviewed)abstract
- The lack of a Swedish patient-reported outcome instrument for eosinophilic esophagitis (EoE) has limited the assessment of the disease. The aims of the study were to translate and validate the Eosinophilic Esophagitis Activity Index (EEsAI) to Swedish and to assess the symptom severity of patients with EoE compared to a nondysphagia control group. The EEsAI was translated and adapted to a Swedish cultural context (S-EEsAI) based on international guidelines. The S-EEsAI was validated using adult Swedish patients with EoE (n = 97) and an age- and sex-matched nondysphagia control group (n = 97). All participants completed the S-EEsAI, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Oesophageal Module 18 (EORTC QLQ-OES18), and supplementary questions regarding feasibility and demographics. Reliability and validity of the S-EEsAI were evaluated by Cronbach's alpha and Spearman correlation coefficients between the domains of the S-EEsAI and the EORTC QLQ-OES18. A test-retest analysis of 29 patients was evaluated through intraclass correlation coefficients. The S-EEsAI had sufficient reliability with Cronbach's alpha values of 0.83 and 0.85 for the "visual dysphagia question" and the "avoidance, modification and slow eating score" domains, respectively. The test-retest reliability was sufficient, with good to excellent intraclass correlation coefficients (0.60-0.89). The S-EEsAI domains showed moderate correlation to 6/10 EORTC QLQ-OES18 domains, indicating adequate validity. The patient S-EEsAI results differed significantly from those of the nondysphagia controls (p < 0.001). The S-EEsAI appears to be a valid and reliable instrument for monitoring adult patients with EoE in Sweden.
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| 4. |
- Albinsson, Sofie, 1992, et al.
(author)
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Validation of the Swedish Watson Dysphagia Scale for adult patients with eosinophilic esophagitis
- 2022
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In: Diseases of the Esophagus. - : Oxford University Press (OUP). - 1120-8694 .- 1442-2050. ; 35:7
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Journal article (peer-reviewed)abstract
- Background: The Swedish Watson Dysphagia Scale (S-WDS) has been used to assess dysphagia in patients with eosinophilic esophagitis (EoE) but has not been validated for this patient group. The aim of this study was to validate the S-WDS for adult patients with EoE. Methods: Ninety-seven Swedish adult patients with EoE and 97 controls without dysphagia filled out the S-WDS, the Swedish Eosinophilic Esophagitis Activity Index (S-EEsAI) and a set of supplementary questions. The reliability of the S-WDS was evaluated using Cronbach's alpha, Pearson correlation of items and total score, and test-retest analysis (n = 29). Validity was investigated using Spearman correlations of the S-WDS items, S-EEsAI domains and a self-assessment score, and by investigating floor and ceiling effects. Results: The Cronbach's alpha of the S-WDS was 0.77 and all items demonstrated moderate to strong correlation to the S-WDS score (r = 0.40-0.81) indicative of sufficient reliability of the instrument. In addition, the test-retest results reflected excellent reliability with an intraclass correlation coefficient of 0.85 for the S-WDS score. Adequate validity of the instrument was demonstrated, the S-WDS score correlated moderately with the self-assessment score and with 4/6 S-EEsAI domains, and strongly with the remaining two domains. Floor effects were more common for liquids and soft-textured foods and ceiling effects increased with increasing food consistency. The S-WDS scores of the patient group were significantly different from those of the nondysphagia control group (P < 0.001). Conclusion: The S-WDS instrument is an appropriate and valid instrument for assessment of dysphagia in patients with EoE.
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| 5. |
- Bernhardsson, Peter, 1982-
(author)
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I privat och offentligt : Undervisningen i moderna språk i Stockholm 1800–1880
- 2016
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Doctoral thesis (other academic/artistic)abstract
- The aim of this thesis is to characterise the shifting relationship between public and private education in nineteenth-century Sweden. It does so by a study of modern language teaching in Stockholm 1800–1880. Whereas modern languages had long been taught by private language masters, German, French and English were only officially recognised as subjects of public grammar schools in 1807.The study shows that, unlike the impression given by earlier studies, the introduction of public teaching of modern languages did not bring an end to private language instruction. The study further demonstrates that although private language teaching continued to thrive alongside the expanding public language education, the relationship between the two types of education changed over time. Until the 1840s, both private and public education operated as competitors in a local educational market, adjusting their language teaching to local demand and mutual competition. A crucial condition for this competition was the fact that state curriculums still had a relatively limited impact on the actual teaching of public schools.In the later part of the century, the language teaching within public schools became more influenced by the idea of formal education, leading to an increased focus on grammar. Simultaneously, the role of private language instruction evolved into complementing public teaching, primarily by providing the practical proficiency neglected in public schools.While the study questions the importance and effects of central reforms, especially in the earlier decades of the 19th century, it points to other significant factors that influenced the local education market. In particular, the gradual centralisation and systematisation of public schools diminished their ability to cater for local demand. But the growing importance of formal credentials meant that public schools had less need to compete for students. Students were no longer necessarily attracted by the practical usefulness of schooling, creating both the possibility of the specific form of language teaching that developed within public schools, as well as the need of supplementary private instruction.
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| 6. |
- Eeg-Olofsson, Måns, 1967, et al.
(author)
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TTCOV19: timing of tracheotomy in SARS-CoV-2-infected patients: a multicentre, single-blinded, randomized, controlled trial
- 2022
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In: Critical Care. - : Springer Science and Business Media LLC. - 1364-8535. ; 26:1
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Journal article (peer-reviewed)abstract
- Background: Critically ill COVID-19 patients may develop acute respiratory distress syndrome and the need for respiratory support, including mechanical ventilation in the intensive care unit. Previous observational studies have suggested early tracheotomy to be advantageous. The aim of this parallel, multicentre, single-blinded, randomized controlled trial was to evaluate the optimal timing of tracheotomy. Methods: SARS-CoV-2-infected patients within the Region Vastra Gotaland of Sweden who needed intubation and mechanical respiratory support were included and randomly assigned to early tracheotomy (<= 7 days after intubation) or late tracheotomy (>= 10 days after intubation). The primary objective was to compare the total number of mechanical ventilation days between the groups. Results: One hundred fifty patients (mean age 65 years, 79% males) were included. Seventy-two patients were assigned to early tracheotomy, and 78 were assigned to late tracheotomy. One hundred two patients (68%) underwent tracheotomy of whom sixty-one underwent tracheotomy according to the protocol. The overall median number of days in mechanical ventilation was 18 (IQR 9; 28), but no significant difference was found between the two treatment regimens in the intention-to-treat analysis (between-group difference:- 1.5 days (95% CI -5.7 to 2.8); p= 0.5). A significantly reduced number of mechanical ventilation days was found in the early tracheotomy group during the per-protocol analysis (between-group difference: - 8.0 days (95% CI - 13.8 to - 2.27); p= 0.0064). The overall correlation between the timing of tracheotomy and days of mechanical ventilation was significant (Spearman's correlation: 0.39, p < 0.0001). The total death rate during intensive care was 32.7%, but no significant differences were found between the groups regarding survival, complications or adverse events. Conclusions: The potential superiority of early tracheotomy when compared to late tracheotomy in critically ill patients with COVID-19 was not confirmed by the present randomized controlled trial but is a strategy that should be considered in selected cases where the need for MV for more than 14 days cannot be ruled out.
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| 7. |
- Ek, A., et al.
(author)
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Chronic rhinosinusitis in asthma is a negative predictor of quality of life: results from the Swedish GA(2)LEN survey
- 2013
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In: Allergy. - : Wiley. - 0105-4538 .- 1398-9995. ; 68:10, s. 1314-1321
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Journal article (peer-reviewed)abstract
- BackgroundAsthma and chronic rhinosinusitis (CRS) both impair quality of life, but the quality-of-life impact of comorbid asthma and CRS is poorly known. The aim of this study was to evaluate the impact of CRS and other relevant factors on quality of life in asthmatic subjects. MethodsThis Swedish cohort (age 17-76years) consists of 605 well-characterized asthmatics with and without CRS, 110 individuals with CRS only, and 226 controls and is part of the Global Allergy and Asthma European Network (GA(2)LEN) survey. The Mini Asthma Quality of Life Questionnaire (mAQLQ), the Euro Quality of Life (EQ-5D) health questionnaire, spirometry, skin prick test (SPT), exhaled nitric oxide (FeNO), smell test, and peak nasal inspiratory flow were used. ResultsSubjects having both asthma and CRS have lower mAQLQ scores in all domains (P<0.001) and a lower EQ-5D index value and EQ-5D VAS value (P<0.001) compared to those with asthma only. Asthmatics with CRS have significantly lower FEV1%pred and FVC%pred (88.4 [85.1-91.7] and 99.9 [96.7-103.0], respectively) compared with asthma only (91.9 [90.3-93.4] and 104.0 [102.5-105.5], respectively P<0.05). Multiple regression analysis shows that low asthma quality of life is associated with having CRS (P<0.0001), lower lung function (P=0.008), current smoking (P=0.01), BMI>30kg/m(2) (P=0.04), high age (P=0.03), and a negative SPT (P=0.04). ConclusionsComorbid CRS was a significant and independent negative predictor of quality of life in asthmatics. Other negative factors were lower lung function, current smoking, obesity, advanced age, and having nonatopic asthma.
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| 8. |
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| 9. |
- Larsson, Helen, 1982
(author)
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Aspects on the management of patients with eosinophilic esophagitis
- 2015
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Doctoral thesis (other academic/artistic)abstract
- Eosinophilic esophagitis (EoE) is an inflammatory disorder of the esophagus characterized by symptoms of esophageal dysfunction and eosinophilia in the esophageal mucosa. This condition may affect approximately 1% of the general population and is strongly associated with allergy/atopic diatheses. Aims: The overall aim of this thesis was to examine the clinical aspects on the management of patients with EoE. The possibility of a seasonal variation of food bolus impaction in the esophagus, a common complication of EoE patients, was explored. The burden of symptoms and health-related quality of life (HRQL) of patients with EoE at diagnosis, after two months of treatment and at a long-term follow-up point were investigated. The association between the grade of mucosal eosinophilia and the symptoms was studied. Methods & Results: Subjects with bolus impaction (n=314) were included in a retrospective study. A significantly higher incidence of bolus impaction was found in subjects with atopic disorders during the fall (n=90) than during any of the other three seasons (p=0.015). Untreated EoE patients were included in two prospective studies (n=31 and n=47, respectively). Symptoms and HRQL (Watson Dysphagia Scale, EORTC QLQ-OES18, SF-36) were evaluated at diagnosis, after two months of treatment with topical corticosteroids and at least one year after inclusion (median: 23 months after inclusion). The dysphagia-related scores improved after treatment and a partial remission was noted at the long-term follow-up point. The grade of mucosal eosinophilia in untreated patients with dysphagia and esophageal eosinophilia (n=65) was assessed using both hematoxylin-eosin staining and immunohistochemical technique. No correlation was found between the grade of eosinophilia and the symptoms/HRQL using the aforementioned questionnaires, however, a higher grade of eosinophilia was found among patients with concomitant bolus impaction as compared to those without. Conclusions: A seasonal variation was found in the incidence of acute esophageal bolus impaction in patients with atopic disorders. EoE patients had a substantial burden of symptoms, which improved after treatment, and a partial remission was noted more than one year after diagnosis. A high grade of eosinophilia in the proximal part of the esophagus might serve as a marker for an increased risk of bolus impaction.
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| 10. |
- Larsson, Helen, 1982, et al.
(author)
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Dysphagia and health-related of life in patients with eosinophilic esophagitis: a long-term follow-up.
- 2015
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In: European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. - : Springer Science and Business Media LLC. - 1434-4726. ; 272:12, s. 3833-3839
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Journal article (peer-reviewed)abstract
- Eosinophilic esophagitis (EoE) is a chronic immune/antigen-mediated disease, with dysphagia as the main symptom. The aim of this study was to survey symptoms and health-related quality of life in adult patients with EoE at least 1year after diagnosis and a 2-month course of topical corticosteroids. Forty-seven consecutive patients [79% males, mean age 49years (range 18-90years)] were evaluated using three different questionnaires at three different occasions: the Watson Dysphagia Scale (WDS), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Oesophageal Module 18 (EORTC QLQ-OES18) and the Short Form-36 (SF-36). The median time from diagnosis to the long-term follow-up was 23months (range 12-34months). The WDS scores and the EORTC QLQ-OES18 Dysphagia and Eating scale scores were improved after 2months of treatment (p=0.00007, p=0.01, p=0.004, respectively), as were the long-term follow-up scores (p=0.01, p=0.03, p=0.005, respectively), relative to the scores at diagnosis. In addition, the EORTC QLQ-OES18 Choking scores were improved after the steroid course (p=0.003) but not after the long-term follow-up. No significant differences were detected with respect to the SF-36 scores. In summary, EoE seems to be associated with a substantial burden of symptoms that improve significantly after treatment. A partial remission persists more than 1year after diagnosis and the discontinuation of medication. The WDS and the EORTC QLQ-OES18 appear to be sensitive instruments appropriate for surveillance in these patients.
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