| 1. |
- Ramos-Casals, Manuel, et al.
(författare)
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EULAR recommendations for the management of Sjögren's syndrome with topical and systemic therapies.
- 2020
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Ingår i: Annals of the Rheumatic Diseases. - : BMJ. - 0003-4967 .- 1468-2060. ; 79:1, s. 3-18
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Tidskriftsartikel (refereegranskat)abstract
- The therapeutic management of Sjögren syndrome (SjS) has not changed substantially in recent decades: treatment decisions remain challenging in clinical practice, without a specific therapeutic target beyond the relief of symptoms as the most important goal. In view of this scenario, the European League Against Rheumatism (EULAR) promoted and supported an international collaborative study (EULAR SS Task Force) aimed at developing the first EULAR evidence and consensus-based recommendations for the management of patients with SjS with topical and systemic medications. The aim was to develop a rational therapeutic approach to SjS patients useful for healthcare professionals, physicians undergoing specialist training, medical students, the pharmaceutical industry and drug regulatory organisations following the 2014 EULAR standardised operating procedures. The Task Force (TF) included specialists in rheumatology, internal medicine, oral health, ophthalmology, gynaecology, dermatology and epidemiology, statisticians, general practitioners, nurses and patient representatives from 30 countries of the 5 continents. Evidence was collected from studies including primary SjS patients fulfilling the 2002/2016 criteria; when no evidence was available, evidence from studies including associated SjS or patients fulfilling previous sets of criteria was considered and extrapolated. The TF endorsed the presentation of general principles for the management of patients with SjS as three overarching, general consensus-based recommendations and 12 specific recommendations that form a logical sequence, starting with the management of the central triplet of symptoms (dryness, fatigue and pain) followed by the management of systemic disease. The recommendations address the use of topical oral (saliva substitutes) and ocular (artificial tear drops, topical non-steroidal anti-inflammatory drugs, topical corticosteroids, topical CyA, serum tear drops) therapies, oral muscarinic agonists (pilocarpine, cevimeline), hydroxychloroquine, oral glucocorticoids, synthetic immunosuppressive agents (cyclophosphamide, azathioprine, methotrexate, leflunomide and mycophenolate), and biological therapies (rituximab, abatacept and belimumab). For each recommendation, levels of evidence (mostly modest) and TF agreement (mostly very high) are provided. The 2019 EULAR recommendations are based on the evidence collected in the last 16 years in the management of primary 2002 SjS patients and on discussions between a large and broadly international TF. The recommendations synthesise current thinking on SjS treatment in a set of overarching principles and recommendations. We hope that the current recommendations will be broadly applied in clinical practice and/or serve as a template for national societies to develop local recommendations.
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| 2. |
- Acar-Denizli, N., et al.
(författare)
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Systemic phenotype related to primary Sjögren's syndrome in 279 patients carrying isolated anti-La/SSB antibodies
- 2020
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Ingår i: Clinical and Experimental Rheumatology. - : CLINICAL & EXPER RHEUMATOLOGY. - 0392-856X .- 1593-098X. ; 38:4; Suppl. 126, s. S85-S94
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate the systemic phenotype associated with the presence of isolated anti-La/SSB antibodies in a large international registry of patients with primary Sjogren's syndrome (pSS) fulfilling the 2002 classification criteria.Methods: The Big Data Sjogren Project Consortium is an international, multicentre registry created in 2014. Baseline clinical information from leading centres on clinical research in SS of the 5 continents was collected. Combination patterns of anti-Ro/SSA-La/SSB antibodies at the time of diagnosis defined the following four immunological phenotypes: double positive (combined Ro/SSA and La/SSB,) isolated anti-Ro/SSA, isolated anti-La/SSB, and immunonegative.Results: The cohort included 12,084 patients (11,293 females, mean 52.4 years) with recorded ESSDAI scores available. Among them, 279 (2.3%) had isolated anti-La/SSB antibodies. The mean total ESSDAI score at diagnosis of patients with pSS carrying isolated anti-La/SSB was 6.0, and 80.4% of patients had systemic activity (global ESSDAI score >= 1) at diagnosis. The domains with the highest frequency of active patients were the biological (42.8%), glandular (36.8%) and articular (31.2%) domains. Patients with isolated anti-La/ SSB showed a higher frequency of active patients in all ESSDAI domains but two (articular and peripheral nerve) in comparison with immune-negative patients, and even a higher absolute frequency in six clinical ESSDAI domains in comparison with patients with isolated anti-Ro/SSA. In addition, patients with isolated anti-La/SSB showed a higher frequency of active patients in two ESSDAI domains (pulmonary and glandular) with respect to the most active immunological subset (double-positive antibodies). Meanwhile, systemic activity detected in patients with isolated anti-La/SSB was overwhelmingly low. Even in ESSDAI domains where patients with isolated anti-La/SSB had the highest frequencies of systemic activity (lymphadenopathy and muscular), the percentage of patients with moderate or high activity was lower in comparison with the combined Ro/SSA and La/SSB group.Conclusion: Patients carrying isolated La/SSB antibodies represent a very small subset of patients with a systemic SS phenotype characterised by a significant frequency of active patients in most clinical ESSDAI domains but with a relative low frequency of the highest severe organ-specific involvements. Primary SS still remains the best clinical diagnosis for this subset of patients.
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| 3. |
- Asplund, Matthias, et al.
(författare)
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Automatic laser scanning of wheel profiles: condition monitoring to achieve greater capacity for existing infrastructure in an extreme climate
- 2013
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Ingår i: Automatic laser scanning of wheel profiles. - India : Indian Railways, the host of 10th IHHA Conferance. - 9788192651910 ; , s. 445-451
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Konferensbidrag (refereegranskat)abstract
- The Iron Ore Line (Malmbanan) is a 473 km long track section located in northern Sweden and has been in operation since 1903. It is mainly used to transport iron ore and pellets from the mines in Kiruna and Malmberget to Narvik Harbour (Norway) in the northwest and Luleå Harbour (Sweden) in the southeast. The track section on the Swedish side is owned by the Swedish Government and managed by Trafikverket (the Swedish Transport Administration), while the ore wagons are owned and managed by the freight operator (LKAB). Due to the high axle load exerted by the iron ore transports, 30 tonnes, and the high demand for a constant ore/pellets flow, the track and wagons must be monitored and maintained on a regular basis. The condition of the wagon wheel profile is one of the most important aspects in this procedure. For this reason an automatic laser-based wheel profile monitoring system has been installed on this line. This system can automatically measure and monitor the wagon wheel profiles at speeds up to 130 km/h. The system was installed and is being operated in a collaboration project between the freight operator and infrastructure manager. The information generated is collected by the e-maintenance personnel at Luleå Railway Research Center (JVTC). The measurements will be used to diagnose the condition of the wheel and rail, and to optimize their maintenance further. This paper presents a study of the selection and the installation of the equipment. Some results from the measurements are shown. The system’s availability during performance in extreme climate conditions, with severe cold and large quantities of snow, is presented. Then the benefits and perceived challenges of the system are discussed. Some potential improvements in rail and wheel maintenance, to achieve more capacity, are analysed.
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| 4. |
- Asplund, Matthias, et al.
(författare)
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Comparison of TOR lubrication systems on the iron ore line
- 2015
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Konferensbidrag (refereegranskat)abstract
- The Iron Ore Line (IOL) is a 473 km long track section which is located in northern Sweden and northern Norway, and has been in operation since 1903. The northern part is located above the Arctic Circle. The IOL is mainly used to transport iron ore and pellets from the mines in Kiruna and Malmberget to Narvik Harbour (Norway) in the northwest and Luleå Harbour (Sweden) in the southeast. The track section on the Swedish side is owned by the Swedish Government and managed by Trafikverket (the Swedish Transport Administration), while the ore wagons are owned and managed by the freight operator (LKAB).The IOL has seen a considerable increase in the axle load and traffic volume recently. Due to the introduction of new vehicles with a 30-ton axle load, the rails were gradually replaced between 2006 and 2009 with heavier rails, generally with a steel grade of 350LHT. The rail and wheels suffer from rolling contact fatigue (RCF) due to high friction between the rail and wheel. To control the wheel-rail interface, wayside top-of-rail (TOR) lubrication can be used. The reliability of the TOR lubrication equipment and the lubricants in northern conditions has not been investigated, and the long-term maintenance support required for TOR lubrication is unknown to the infrastructure manager. Furthermore, can TOR lubrication reduce the rail and wheel maintenance costs? This project has been conducted through collaboration between the main operator (LKAB) and the infrastructure manager (Trafikverket); the costs have been shared and the results analysed in collaboration. This paper describes the test period of two years, using two different TOR lubrication systems in two different places on the IOL, one situated in the northern loop and one in the southern loop, each with different operational conditions. The paper shows the actual operational conditions for the pilot test locations, the friction value close to the systems, the rail forces during the test period and some results for the noise measurements. Furthermore, the paper includes the improvements of system resulting from the test operation, and ends with recommendations for the continued use of TOR lubrication on the IOL.
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| 5. |
- Asplund, Matthias, et al.
(författare)
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Improved wheel-rail system of Sweden’s iron ore line
- 2017
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Ingår i: Proceedings of the 11th International Heavy Haul Association Conference (IHHA 2017), Cape Town, South Africa, 2–6 September 2017. - 9780911382662 ; , s. 759-766
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- ABSTRACT: The Swedish Iron Ore Line (IOL) is the only heavy haul line in Europe. The northern part of the line is located above the Arctic Circle, a very harsh climate. Because of the introduction of new vehicles with a 30-tonnes axle load, the track were gradually replaced between 2006 and 2009 with heavier rails, mostly with a steel grade of R350LHT. Just after the first replacement of track in 2006, the project presented herein was established with the primary goal of improving the life length of the rail, and monitoring activities started. This project now has a unique database of rail degradation data. So far, the information has been used to improve the performance of the wheel-rail system and thus extend the life length of the rail, as well as to improve our knowledge of heavy haul operations in a cold climate. The paper discusses the project progress in general and gives some examples of improvements that have been successfully implemented, such as new rail profiles and a higher grinding frequency. Finally, it discusses the challenges of future capacity improvements, such as an increase in the axle load, and how these can be addressed.
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| 6. |
- Asplund, Matthias, et al.
(författare)
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Reliability and measurement accuracy of a condition monitoring system in an extreme climate : a case study of automatic laser scanning of wheel profiles
- 2014
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Ingår i: Proceedings of the Institution of mechanical engineers. Part F, journal of rail and rapid transit. - : SAGE Publications. - 0954-4097 .- 2041-3017. ; 228:6, s. 695-704
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Tidskriftsartikel (refereegranskat)abstract
- The Iron Ore Line (Malmbanan) is a 473 km long track section located in northern Sweden and has been in operation since 1903. This track section stretches through two countries, namely Sweden and Norway, and the main part of the track runs on the Swedish side, where the owner is the Swedish Government and the infrastructure manager is Trafikverket (the Swedish Transport Administration). The ore trains are owned and managed by the freight operator and mining company LKAB. Due to the high axle load exerted by transportation of the iron ore, 30 tonnes, and the high demand for a constant flow of ore and pellets, the track and wagons must be monitored and maintained on a regular basis. The condition of the wagon wheel is one of the most important aspects in this connection, and here the wheel profile plays an important role. For this reason an automatic laser-based wheel profile monitoring system (WPMS) has been installed on this line using a system lifecycle approach that is based on the reliability, availability, maintainability and safety (RAMS) approach for railways. The system was prepared and installed and is being operated in a collaborative project between the freight operator and infrastructure manager. The measurements are used to diagnose the condition of the wheels, and to further optimize their maintenance. This paper presents a study of the concepts and ideas of the WPMS, and the selection, installation and validation of the equipment using a system lifecycle approach that is based on RAMS for railways. Results from the profile measurements and validation are shown. The system’s reliability during performance in extreme climate conditions, with severe cold and large quantities of snow, is presented. Then the benefits, perceived challenges and acquired knowledge of the system are discussed, and an improved V-model for the lifecycle approach is presented.
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| 7. |
- Asplund, Matthias, et al.
(författare)
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Slutrapport avseende hjulprofilmätare i Sunderbyn
- 2014
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrunden till projektets genomförande har varit den ökande mängden rälsbyten och mängden trafik med 30 tons axellast på Malmbanan. Spårunderhållet och hjulunderhållet har idag de överlägset högsta underhållskostnaderna av järnvägens olika system. Hjulprofilmätaren sågs som en möjlighet att kunna plocka ut de hjul som närmade sig underhållsgränserna för slitage, och därigenom kunna styra underhållet mer kostnadseffektivt.LKAB och Trafikverket enades därför att sätta upp ett gemensamt projekt där en ny typ av mätutrustning utprovades. För att få stöd med datalagring, bearbetning av data mm anlitades LTU och eMaintenanceLAB. Syftet med projektet har varit att undersöka och verifiera att en utrustning för automatisk hjulprofilmätning kan klara av att registrera och larma vid hjulpassager som avviker från de säkerhetsgränser och underhållsgränser som definieras i projektet med hänsyn till vårt klimat och våra förhållanden på Malmbanan. Den bärande idén i detta projekt har varit att man genom en kontinuerlig mätning av hjulprofiler ska kunna ta ut fordon ur trafik innan den avvikande hjulprofilen ger upphov till ett accelererande hjul- och rälslitage och därigenom sänka underhållskostnaden och öka livslängden på både hjul och räl. Projektet har även lett till en högre säkerhet på spåret då man kan mäta hjul som passerat säkerhetsgränsen för hjulparametrar och plockar bort dem, detta var inte var möjligt tidigare. De slutsatser som kan dras från detta projekt är följande:• Utvecklingsprojekt kan med fördel genomföras gemensamt mellan industri, infrastrukturförvaltare och akademi. • För att säkerställa ett bra resultat är det viktigt att genomföra alla steg i ett projekt från koncept till överlämnande. Som stöd för detta har V-modellen används som representerar livscykeln för systemet enligt EN-50126.• Val av tekniklösning och leverantör har gjorts utifrån tekniknivå, referensanläggningar samt drift- och supportmöjlighet och inte enbart utifrån pris. Ett utvecklingsprojekt likt detta handlar inte primärt om att få en utrustning i drift utan överföring av ”know how” kring vilka möjligheter och begränsningar det finns med denna teknik.• Resursbehovet för test och utvärdering underskattades och gjorde att projektet försenades ett år jämfört med ursprunglig tidplan. • Informationen som genereras från denna utrustning är mycket användbar för alla parter som arbetar med utveckling av underhåll inom järnvägen. • Utmaningen för att tillgodogöra sig nyttan från mätstationen ligger i att kunna förädla och integrera de genererade tillståndsdata till respektive underhållsorganisation.
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| 8. |
- Asplund, Matthias, et al.
(författare)
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The wheel profile measurement system at Sunderbyn, Sweden : final report
- 2014
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The background to the realisation of this project comprises an increasing number of rail replacements and an increasing volume of traffic with a 30-tonne axle load on the Swedish Iron Ore Line (IOL). When comparing the maintenance costs of all the different systems in the Swedish railway network, the maintenance costs for the track and wheels are by far the highest at present. The wheel profile measurement system (WPMS) was considered to provide the possibility of picking out wheels approaching the maintenance limits for wear and thereby of controlling maintenance in a more cost-effective way. Accordingly, LKAB and Trafikverket (the Swedish Transport Administration) reached an agreement concerning the initiation of a joint project in which a new type of measurement equipment would be tested. To obtain assistance with data storage and processing, etc., Luleå University of Technology (LTU) and its eMaintenance Lab were engaged in the project. The objective of the project has been to investigate and verify whether equipment for automatic wheel profile measurement is capable of registering wheel data and sending alerts concerning the passage of wheels which deviate from the safety and maintenance limits defined in the project, with regard to the climate and conditions prevailing along the Swedish IOL. The fundamental idea behind this project has been that, through continuous measurement of wheel profiles, one should be able to take vehicles out of service before any deviating wheel profiles give rise to accelerating wheel and rail wear, and that one should thereby be able to reduce the maintenance costs and increase the operational life of both wheels and rails. An additional result of the project has been increased safety on the track, since it is possible to measure wheels that have exceeded the safety limit for wheel parameters and remove them, which was impossible previously. The following conclusions can be drawn from this project.• There are benefits to be derived from development projects conducted jointly between industry, infrastructure managers and academia. • In order to ensure good results, it is important to perform all the steps in a project, from the concept phase to the handing-over phase. In support of this, the V-model was used, which represents the life cycle of the system according to EN 50126. • The selection of a technical solution and a supplier was made on the basis of the technology level, reference installations, and operation and support possibilities, and not merely based on the price. A development project of this nature is not primarily a question of putting equipment into operation, but of transferring knowhow concerning the possibilities and limitations associated with the technology in question. • The resource requirement for testing and evaluation was underestimated, which resulted in the project being delayed by one year compared with the original timetable. • The information generated by the equipment installed is very useful for all parties working with the development of railway maintenance. • The challenge with regard to utilising the benefits afforded by the measurement station at Sunderby lies in the ability to process the generated condition data for the maintenance organisations concerned and integrate these data in the operations of these organisations.
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| 9. |
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| 10. |
- Brito-Zeron, P., et al.
(författare)
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How immunological profile drives clinical phenotype of primary Sjögren's syndrome at diagnosis : analysis of 10,500 patients (Sjögren Big Data Project)
- 2018
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Ingår i: Clinical and Experimental Rheumatology. - : CLINICAL & EXPER RHEUMATOLOGY. - 0392-856X .- 1593-098X. ; 36:3, s. S102-S112
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate the influence of the main immunological markers on the disease phenotype at diagnosis in a large international cohort of patients with primary Sjogren's syndrome (SjS).Methods: The Big Data Sjogren Project Consortium is an international, multicentre registry created in 2014. As a first step, baseline clinical information from leading centres on clinical research in SjS of the 5 continents was collected. The centres shared a harmonised data architecture and conducted cooperative online efforts in order to refine collected data under the coordination of a big data statistical team. Inclusion criteria were the fulfillment of the 2002 classification criteria. Immunological tests were carried out using standard commercial assays.Results: By January 2018, the participant centres had included 10,500 valid patients from 22 countries. The cohort included 9,806 (93%) women and 694 (7%) men, with a mean age at diagnosis of primary SjS of 53 years, mainly White (78%) and included from European countries (71%). The frequency of positive immunological markers at diagnosis was 79.3% for ANA, 73.2% for anti-Ro, 48.6% for RF, 45.1% for anti-La, 13.4% for low C3 levels, 14.5% for low C4 levels and 7.3% for cryoglobulins. Positive autoantibodies (ANA, Ro, La) correlated with a positive result in salivary gland biopsy, while hypocomplementaemia and especially cryoglobulinaemia correlated with systemic activity (mean ESSDAI score of 17.7 for ctyoglobulins, 11.3 for low C3 and 9.2 for low C4, in comparison with 3.8 for negative markers). The immunological markers with a great number of statistically-significant associations (p<0.001) in the organ-by-organ ESSDAI evaluation were cryoglobulins (9 domains), low C3 (8 domains), anti-La (7 domains) and low C4 (6 domains).Conclusion: We confirm the strong influence of immunological markers on the phenotype of primary SjS at diagnosis in the largest multi-ethnic international cohort ever analysed, with a greater influence for cryoglobulinaemic-related markers in comparison with Ro/La autoantibodies and ANA. Immunological patterns play a central role in the phenotypic expression of the disease already at the time of diagnosis, and may guide physicians to design a specific personalised management during the follow-up of patients with primary SjS.
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