| 1. |
- Adler, Jan-Olof, et al.
(författare)
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A broad range tagging spectrometer for the MAX-laboratory
- 1997
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Ingår i: Nuclear Instruments & Methods in Physics Research. Section A: Accelerators, Spectrometers, Detectors, and Associated Equipment. - 0167-5087. ; 388:1-2, s. 17-26
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Tidskriftsartikel (refereegranskat)abstract
- A broad range tagging spectrometer together with a new beam transport system for photonuclear experiments at the MAX-laboratory in Lund is described. The spectrometer consists of a quadrupole followed by an Elbek-type dipole and has a large momentum acceptance. It can produce both polarized and unpolarized tagged photons in the energy range 10–80 MeV with an energy resolution of about 300 keV.
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| 2. |
- Andersson, Elin, 1975, et al.
(författare)
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Type-dependent E6/E7 mRNA expression of single and multiple high-risk human papillomavirus infections in cervical neoplasia.
- 2012
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Ingår i: Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology. - : Elsevier BV. - 1873-5967. ; 54:1, s. 61-5
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Tidskriftsartikel (refereegranskat)abstract
- Coinfection with multiple HPV types is common in cervical lesions, but the biological significance of the individual infections is difficult to establish. Expression of oncogenic E6/E7 HPV mRNA is correlated to risk of malignant progression, commercial assays for genotyping E6/E7 mRNA of all HR-HPV are lacking.
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| 3. |
- Andersson, Elin, 1975, et al.
(författare)
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Type-specific HPV E6/E7 mRNA detection by real-time PCR improves identification of cervical neoplasia.
- 2011
-
Ingår i: Journal of clinical microbiology. - 1098-660X. ; 49:11, s. 3794-3799
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Tidskriftsartikel (refereegranskat)abstract
- DNA-based HPV assays show high sensitivity but poor specificity in detecting high-grade cervical lesions. Assays detecting mRNA of oncogenic E6/E7 show higher specificity, but lack either detection of all high-risk HPV genotypes or the capacity to specify the detected genotypes. Therefore, a real-time PCR assay detecting type-specific E6/E7 mRNA was developed and the clinical performance evaluated. 210 cervical LBC (liquid based cytology) samples from 204 women were analysed for HPV DNA and mRNA with the in house real-time PCR as well as PreTect HPV-Proofer. The sensitivity of real-time PCR mRNA-detection to detect histologically confirmed CIN2+ (cervical intraepithelial neoplasia grade 2 or higher) were 0.91, compared to 0.95 for DNA-analysis. The specificity was 0.68 compared to 0.38, and the positive predictive value (PPV) was higher for mRNA (0.67 vs 0.52) without any loss in negative predictive value (NPV). The sensitivity of the real-time PCR mRNA-test was somewhat higher than for PreTect HPV-Proofer (0.83 vs 0.75), when analysing for the same genotypes. The specificity was similar (0.76 vs 0.77). When analysing for mRNA of the eight most common genotypes in cervical cancer (HPV16, 18, 31, 33, 35, 45, 52, 58), the sensitivity to detect CIN2+ lesions was 0.87 and the specificity 0.74, with a PPV of 0.70. In conclusion, real-time PCR for detection of HPV E6/E7 mRNA transcripts can be a sensitive and specific tool in screening and investigation of cervical neoplasia. The composition of HPV-types in mRNA-testing needs to be further investigated to optimize sensitivity and specificity.
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| 4. |
- Antonson, Hans, 1963-, et al.
(författare)
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Transportrelaterad miljökvalitet : rapport från workshop den 10-11 september 2001
- 2001
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Rapport (populärvet., debatt m.m.)abstract
- Under 10–11 september 2001 möttes 31 representanter från departement, myndigheter, forskningsfinansiärer och forskarsamhället på Scandic hotell Hasselbacken i Stockholm för att lyssna till föredragningar om och diskutera kring begreppet transportrelaterad miljökvalitet.Initiativet till workshopen togs av VTI (Statens väg- och transportforskningsinstitut) genom en delansökan i en bred ansökan kallad Tema miljökvalitet ställd till Vägverket, Banverket och KFB.Workshopens syfte var att diskutera begreppet miljökvalitet i relation till transportsektorn och att rekognosera intresset för bildandet av ett nätverk för transportrelaterad miljökvalitet. För att underlätta urvalsarbetet och göra workshopen hanterbar inbjöds ett antal gäster från departement, myndigheter, forskningsfinansiärer och forskarsamhället som alla hade relevanta kunskaper och erfarenheter inom området.
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| 5. |
- Antonson, Hans, et al.
(författare)
-
Uppföljning av miljökonsekvenser av svenska väg- och järnvägsprojekt
- 2002
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Uppföljning av miljökonsekvenser har blivit allt vanligare sedan 1995. Det ständigt pågående utvecklingsarbetet med uppföljning av miljökonsekvenser, vid Vägverket och Banverket, visar många positiva resultat. Bland annat har flera genomgripande uppföljningsprogram tagits fram för några vägobjekt, även om enstaka uppföljningsformuleringar i miljökonsekvensbeskrivningar (MKB) och arbetsplaner/järnvägsplaner fortfarande dominerar.Statens väg- och transportforskningsinstitut (VTI) har studerat ca 70 uppföljningsarbeten, producerade under 1990-talet, huvudsakligen från 1996 och framåt. Materialet har eftersökts vid Vägverkets regionkontor Sydöst, Väst och Mitt samt inom hela Banverket. Det har varit svårt och tidskrävande att få tillgång till relevant material. För att underlätta eftersökningen har dessutom en rad initierade personer vid Vägverkets regionkontor kontaktats.Några av de viktigare slutsatserna är att:det sedan 1995 har blivit vanligare med uppföljningsformuleringar, uppföljning inte självklart omfattar såväl byggskede som tiden efter färdigställande,uppgifter om före-data är ovanliga,de vanligaste uppföljningsparametrarna är vatten, buller, djur och landskapsbild,mätmetoder sällan anges,kompetenskrav sällan anges,fastställda statistiska krav sällan anges,syftet med uppföljningen sällan anges, och attkommunikation med olika aktörsgrupper såsom allmänhet är en ovanlighet.Det material som insamlats, även om det är magert, kommer att kunna användas som en utgångspunkt i såväl upprättande av en handbok för uppföljning i samband med MKB, som vid utvecklandet av ett informationssystem om uppföljning.
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| 6. |
- Bahadoer, Renu R., et al.
(författare)
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Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO) : a randomised, open-label, phase 3 trial
- 2021
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Ingår i: The Lancet Oncology. - : Elsevier. - 1470-2045 .- 1474-5488. ; 22:1, s. 29-42
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Tidskriftsartikel (refereegranskat)abstract
- Background Systemic relapses remain a major problem in locally advanced rectal cancer. Using short-course radiotherapy followed by chemotherapy and delayed surgery, the Rectal cancer And Preoperative Induction therapy followed by Dedicated Operation (RAPIDO) trial aimed to reduce distant metastases without compromising locoregional control. Methods In this multicentre, open-label, randomised, controlled, phase 3 trial, participants were recruited from 54 centres in the Netherlands, Sweden, Spain, Slovenia, Denmark, Norway, and the USA. Patients were eligible if they were aged 18 years or older, with an Eastern Cooperative Oncology Group (ECOG) performance status of 0-1, had a biopsy-proven, newly diagnosed, primary, locally advanced rectal adenocardnoma, which was classified as high risk on pelvic MRI (with at least one of the following criteria: clinical tumour [cT] stage cT4a or cT4b, extramural vascular invasion, clinical nodal [cN] stage cN2, involved mesorectal fascia, or enlarged lateral lymph nodes), were mentally and physically fit for chemotherapy, and could be assessed for staging within S weeks before randomisation. Eligible participants were randomly assigned (1:1), using a management system with a randomly varying block design (each block size randomly chosen to contain two to four allocations), stratified by centre, ECOG performance status, cT stage, and cN stage, to either the experimental or standard of care group. All investigators remained masked for the primary endpoint until a prespecified number of events was reached. Patients allocated to the experimental treatment group received short-course radiotherapy (5 x 5 Gy over a maximum of 8 days) followed by six cycles of CAPDX chemotherapy (capecitabine 1000 mg/m(2) orally twice daily on days 1-14, oxaliplatin 130 mg/m(2) intravenously on day 1, and a chemotherapy-free interval between days 15-21) or nine cycles of FOLFOX4 (oxaliplatin 85 mg/m(2) intravenously on day 1, leucovorin [folinic acid] 200 mg/m 2 intravenously on days 1 and 2, followed by bolus fluorouracil 400 mg/m(2) intravenously and fluorouracil 600 mg/m 2 intravenously for 22 h on days 1 and 2, and a chemotherapy-free interval between days 3-14) followed by total mesorectal excision. Choice of CAPDX or FOLFOX4 was per physician discretion or hospital policy. Patients allocated to the standard of care group received 28 daily fractions of 1.8 Gy up to 50.4 Gy or 25 fractions of 2.0 Gy up to 50.0 Gy (per physician discretion or hospital policy), with concomitant twice-daily oral capecitabine 825 mg/m(2) followed by total mesorectal excision and, if stipulated by hospital policy, adjuvant chemotherapy with eight cycles of CAPDX or 12 cycles of FOLFOX4. The primary endpoint was 3-year disease-related treatment failure, defined as the first occurrence of locoregional failure, distant metastasis, new primary colorectal tumour, or treatment-related death, assessed in the intention-to-treat population. Safety was assessed by intention to treat. This study is registered with the EudraCT, 2010-023957-12, and ClinicalTrials.gov , NCT01558921, and is now complete. Findings Between June 21,2011, and June 2,2016,920 patients were enrolled and randomly assigned to a treatment, of whom 912 were eligible (462 in the experimental group; 450 in the standard of care group). Median follow-up was 4.6 years (IQR 3.5-5.5). At 3 years after randomisation, the cumulative probability of disease-related treatment failure was 23.7% (95% CI 19.8-27.6) in the experimental group versus 30.4% (26.1-34.6) in the standard of care group (hazard ratio 0.75, 95% CI 0.60-0-95; p=0-019). The most common grade 3 or higher adverse event during preoperative therapy in both groups was diarrhoea (81 [18%] of 460 patients in the experimental group and 41 [9%] of 441 in the standard of care group) and neurological toxicity during adjuvant chemotherapy in the standard of care group (16 [9%] of 187 patients). Serious adverse events occurred in 177 (38%) of 460 participants in the experimental group and, in the standard of care group, in 87 (34%) of 254 patients without adjuvant chemotherapy and in 64 (34%) of 187 with adjuvant chemotherapy. Treatment-related deaths occurred in four participants in the experimental group (one cardiac arrest, one pulmonary embolism, two infectious complications) and in four participants in the standard of care group (one pulmonary embolism, one neutropenic sepsis, one aspiration, one suicide due to severe depression). Interpretation The observed decreased probability of disease-related treatment failure in the experimental group is probably indicative of the increased efficacy of preoperative chemotherapy as opposed to adjuvant chemotherapy in this setting. Therefore, the experimental treatment can be considered as a new standard of care in high-risk locally advanced rectal cancer.
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| 7. |
- Beets-Tan, Regina G. H., et al.
(författare)
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Magnetic resonance imaging for the clinical management of rectal cancer patients : recommendations from the 2012 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting
- 2013
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Ingår i: European Radiology. - : Springer Science and Business Media LLC. - 0938-7994 .- 1432-1084. ; 23:9, s. 2522-2531
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Tidskriftsartikel (refereegranskat)abstract
- To develop guidelines describing a standardised approach regarding the acquisition, interpretation and reporting of magnetic resonance imaging (MRI) for clinical staging and restaging of rectal cancer. A consensus meeting of 14 abdominal imaging experts from the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) was conducted following the RAND-UCLA Appropriateness Method. Two independent (non-voting) chairs facilitated the meeting. Two hundred and thirty-six items were scored by participants for appropriateness and classified subsequently as appropriate or inappropriate (defined by a parts per thousand yen 80 % consensus) or uncertain (defined by < 80 % consensus). Items not reaching 80 % consensus were noted. Consensus was reached for 88 % of items: recommendations regarding hardware, patient preparation, imaging sequences, angulation, criteria for MRI assessment and MRI reporting were constructed from these. These expert consensus recommendations can be used as clinical guidelines for primary staging and restaging of rectal cancer using MRI. These guidelines recommend standardised imaging for staging and restaging of rectal cancer. The guidelines were constructed through consensus amongst 14 abdominal imaging experts. Consensus was reached by in 88 % of 236 items discussed.
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| 8. |
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| 9. |
- Björeland, Ulrika, et al.
(författare)
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Impact of neoadjuvant androgen deprivation therapy on magnetic resonance imaging features in prostate cancer before radiotherapy
- 2021
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Ingår i: Physics and Imaging in Radiation Oncology. - : Elsevier. - 2405-6316. ; 17, s. 117-123
-
Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: In locally advanced prostate cancer (PC), androgen deprivation therapy (ADT) in combination with whole prostate radiotherapy (RT) is the standard treatment. ADT affects the prostate as well as the tumour on multiparametric magnetic resonance imaging (MRI) with decreased PC conspicuity and impaired localisation of the prostate lesion. Image texture analysis has been suggested to be of aid in separating tumour from normal tissue. The aim of the study was to investigate the impact of ADT on baseline defined MRI features in prostate cancer with the goal to investigate if it might be of use in radiotherapy planning.Materials and methods: Fifty PC patients were included. Multiparametric MRI was performed before, and three months after ADT. At baseline, a tumour volume was delineated on apparent diffusion coefficient (ADC) maps with suspected tumour content and a reference volume in normal prostatic tissue. These volumes were transferred to MRIs after ADT and were analysed with first-order -and invariant Haralick -features.Results: At baseline, the median value and several of the invariant Haralick features of ADC, showed a significant difference between tumour and reference volumes. After ADT, only ADC median value could significantly differentiate the two volumes.Conclusions: Invariant Haralick -features could not distinguish between baseline MRI defined PC and normal tissue after ADT. First-order median value remained significantly different in tumour and reference volumes after ADT, but the difference was less pronounced than before ADT.
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| 10. |
- Blomqvist, Fredrik Lennart Rune, 1947, et al.
(författare)
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Platelet aggregation in healthy women during normal pregnancy - a longitudinal study.
- 2019
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Ingår i: Platelets. - : Informa UK Limited. - 1369-1635 .- 0953-7104. ; 30:4, s. 438-444
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Tidskriftsartikel (refereegranskat)abstract
- Increased platelet activation is involved in obstetric complications such as preeclampsia and intrauterine growth retardation. It is of interest to study platelet aggregation during pregnancy, since increased aggregation theoretically could be a mechanism associated with placenta-mediated complications, which possibly could be prevented by drugs inhibiting platelet aggregation. There are, however, few robust studies describing platelet aggregation during normal pregnancy. The present longitudinal study was performed in order to study platelet aggregation during normal pregnancy resulting in a healthy child, during the puerperium and in nonpregnant, fertile women. Healthy, nonsmoking, pregnant women (n=104), aged under 39years and with BMI <35, were followed during pregnancy and postpartum. Twenty-seven nonpregnant, non-puerperal, fertile women were studied for comparison. Platelet aggregation was determined with multiple electrode impedance aggregometry and analyzed at inclusion, 4 times during pregnancy and after at least 3 months postpartum. Platelet aggregation postpartum was compared with gestational weeks 8-15 and 37-40, respectively, and with nonpregnant, fertile women. Hemoglobin, leucocyte count, platelet count, prothrombin time, and activated partial thromboplastin time were determined at inclusion in order to verify normal hemostasis. Activation of platelets by arachidonic acid, adenosine diphosphate (ADP), and thrombin receptor activating peptide (trap-6) resulted in less aggregation during pregnancy, compared with postpartum (p<0.03-<0.001). Platelet aggregation following activation by collagen was unchanged. A minor increase in aggregation as pregnancy continued was found related to ADP (p<0.021). Positive correlations were found between platelet counts and platelet aggregation. Postpartum platelet aggregation after activation with arachidonic acid, collagen, and trap-6 was lower than in the non-puerperal fertile state. Other hemostatic analyses were normal. In conclusion, there is a minor decrease in platelet aggregation after activation with arachidonic acid, trap-6, and ADP, measured with multiple electrode impedance aggregometry during normal pregnancy resulting in healthy babies, compared with the postpartum period. The small changes in platelet aggregation may be a consequence of a minor decrease in platelet count and probably lack clinical significance under normal conditions. Interindividual variations at certain time-points are substantial, which limits the usefulness of the multiple electrode impedance aggregometry for determining minor changes in platelet function.
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| 11. |
- Blomqvist, Lennart, 1947, et al.
(författare)
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Acetylsalicylic acid does not prevent first-trimester unexplained recurrent pregnancy loss: A randomized controlled trial
- 2018
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Ingår i: Acta Obstetricia Et Gynecologica Scandinavica. - : Wiley. - 0001-6349. ; 97:11, s. 1365-1372
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Recurrent pregnancy loss occurs in about 1% of fertile couples. Without proper evidence for an effect, different treatments have been used when no etiological factor has been detected. The present trial is the first randomized trial to compare 75 mg acetylsalicylic acid with placebo for women with recurrent pregnancy loss. Material and methods: This randomized, double-blind, placebo-controlled trial was conducted at a single center between 2008 and 2015. Recurrent pregnancy loss was defined as at least 3 consecutive first-trimester miscarriages within the couple. Women < 40 years old with a body mass index < 35 kg/m(2) were eligible if the workup was negative. Randomization was through a third party, who manufactured and delivered the study drugs, and occurred when fetal heartbeat was detected, to either 75 mg acetylsalicylic acid or placebo; 200 women in each group. Group allocation was concealed until all the study participants had a pregnancy outcome registered. All women attended the same control program. Primary outcome was live birth. Statistical analyses were according to intention-to-treat. Results: All 400 women completed the follow up. Live birth rate was 83.0% (n=166) and 85.5% (n=171) for the acetylsalicylic acid and placebo groups, respectively (P=0.58). The difference was -2.5% (95% CI -10.1% to 5.1%). The risk ratio was 0.97 (95% CI 0.89-1.06). Conclusions: Treatment with acetylsalicylic acid did not prevent recurrent miscarriage in women with at least three consecutive miscarriages in the first trimester, of unknown reasons and in the same relationship. The fertility prognosis is very good, the live birth rate being > 80% with or without acetylsalicylic acid.
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| 12. |
- Blomqvist, Lennart, 1947, et al.
(författare)
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Arachidonic acid-induced platelet aggregation and acetylsalicylic acid treatment during pregnancy in women with recurrent miscarriage, a post hoc study
- 2022
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Ingår i: Platelets. - : Informa UK Limited. - 0953-7104 .- 1369-1635. ; 33:2, s. 278-284
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Tidskriftsartikel (refereegranskat)abstract
- In this post hoc study, arachidonic acid (AA)-induced platelet aggregation during pregnancy with and without acetylsalicylic acid (ASA) treatment was studied in 323 women with unexplained recurrent first-trimester miscarriage and in 59 healthy women with normal pregnancies. All women had normal AA-induced platelet aggregation in the non-pregnant state. Women with recurrent miscarriage were treated with 75 mg ASA or placebo daily. AA-induced platelet aggregation was measured with multiple electrode impedance aggregometry and presented in units (U), where 1 U = 10 aggregation units x minutes. There were no significant differences in platelet aggregation between placebo-treated women with recurrent miscarriage and healthy women. The mean differences were -0.7 (95%CI; -7.0; 5.6) U in the non-pregnant state, 3.8 (95%CI; -4.6; 12.2) U during the late first trimester and 1.7 (95%CI; -6.7; 10.3) U and 4.1 (95%CI; -3.9; 12.0) U during the early and late third trimester, respectively. ASA reduced platelet aggregation by median -84.0% (Q1; Q3; -89.8; -76.3), -79.9% (-84.7; -69.2) and -75.7% (-83.5; -49.5), respectively, during pregnancy. The degree of inhibition by ASA decreased during the third trimester (p < .0001). There were two (1.9%) complete non-responders to ASA and 32.1% with a partial response. The rate of subsequent miscarriage was not affected by ASA, which did not seem to influence the rate of early miscarriage if treatment was initiated when a viable pregnancy was detectable by ultrasound.
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| 13. |
- Blomqvist, Lennart, et al.
(författare)
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Gadolinium in Medical Imaging—Usefulness, Toxic Reactions and Possible Countermeasures : A Review
- 2022
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Ingår i: Biomolecules. - : MDPI. - 2218-273X. ; 12:6
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Forskningsöversikt (refereegranskat)abstract
- Gadolinium (Gd) is one of the rare-earth elements. The properties of its trivalent cation (Gd3+) make it suitable to serve as the central ion in chelates administered intravenously to patients as a contrast agent in magnetic resonance imaging. Such Gd-chelates have been used for more than thirty years. During the past decades, knowledge has increased about potential harmful effects of Gd-chelates in patients with severe renal dysfunction. In such patients, there is a risk for a potentially disabling and lethal disease, nephrogenic systemic fibrosis. Restricting the use of Gd-chelates in persons with severely impaired renal function has decreased the occurrence of this toxic effect in the last decade. There has also been an increasing awareness of Gd-retention in the body, even in patients without renal dysfunction. The cumulative number of doses given, and the chemical structure of the chelate given, are factors of importance for retention in tissues. This review describes the chemical properties of Gd and its medically used chelates, as well as its toxicity and potential side effects related to injection of Gd-chelates.
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| 14. |
- Blomqvist, Lennart K., et al.
(författare)
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Gadolinium
- 2022. - 5
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Ingår i: Handbook on the toxicology of metals. - : Elsevier. - 9780128229460 ; , s. 267-274
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Bokkapitel (refereegranskat)abstract
- Gadolinium (Gd) belongs to the rare-earth elements. Depending on the temperature, Gd is either ferromagnetic or paramagnetic. Gadolinium obtained its name from Johan Gadolin, the Finnish chemist who discovered gadolinite, a mineral that contains gadolinium. The specific properties of Gd make it suitable for certain applications in nuclear reactors as well as in medicine being the base for a chelate administered to patients as a contrast agent in magnetic resonance imaging. Such Gd chelates have been used for more than 30 years. During the past decades, there has been increasing knowledge about the potentially harmful effects of Gd chelates in patients with severe renal dysfunction. In such patients, there is a risk for a potentially life-threatening disease, nephrogenic systemic fibrosis. Precautions, restricting the use of Gd chelates in persons with severely impaired renal function have drastically decreased the occurrence of nephrogenic systemic fibrosis in the last decade. There has also been an increasing awareness of the fact that there is Gd deposition in the body even in patients without renal dysfunction and that this deposition is related partly to the cumulative number of doses given but also the chemical structure of the chelate. In this chapter, the physical and chemical properties of Gd and its related chelates, methods for detection, industrial and medical applications, human exposures, toxicity as well as a further description of potential side effects related to injection of Gd chelates are described.
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| 15. |
- Blomqvist, Lennart
(författare)
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Magnetic resonance imaging of rectal tumours
- 1997
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Cross sectional imaging techniques introduced during the last two decades have been increasingly used in the evaluation of patients with pelvic tumours. The extent of tumour - the tumour stage - at the time of diagnosis constitutes a guideline for both the immediate treatment and the follow-up of the patient. Continuous development of imaging modalities, such as magnetic resonance imaging (MRI), has implications which motivates a change of the examination routines. State-of-the-art high resolution MRI was evaluated in patients with rectal tumours considered as resectable by the surgeon. Tumours considered to be primarily not resectable were also evaluated with both computed tomography (CT) and MRI. After surgery, resected rectal specimens were examined using similar MR-techniques. In patients who after surgery presented with a clinical suspicion of local recurrence, dynamic gadolinium contrast-enhanced MRI was evaluated in order to differentiate local tumour recurrence from changes in the pelvis related to the treatment. MRl was also compared to CT and monoclonal antibody (CEA)-scintigraphy for the diagnosis of local recurrence. The results demonstrated that tumour penetration through the rectal wall to the perirectal tissues and the presence of Iymph local Iymph node metastases could be predicted in 75 % of patients with resectable rectal tumours. In patients with unresectable rectal cancer, MRI better predicted involvement of the uterus and the urinary bladder than CT. However, sensitivity of CT and specificity of MRl were both low in terms of diagnosis of organ involvement. After surgery, no parameters were found which helped to distinguish local recurrent tumours from benign changes in contrast-enhanced dynamic MRI. When CT, MRI and CEA-scintigraphy were compared for the diagnosis of locally recurrent rectal tumours, the diagnosis was most effectively established by MRl. It is concluded that local excision of rectal tumours can presently not be performed based on results of MRI. Sensitivity of CT and specificity of MRI is not sufficient to allow for general recommendations in the evaluation unresectable rectal tumours. However, If the cross-sectional investigation begins with CT, MRl will contribute to a more complete evaluation, especially if involvement of the bladder and the internal genitalia cannot be completely ruled out. After surgery, a tumour-free lateral resection margin can be verfied by MRI of rectal specimen if the measured distance is more than one mm. Local tumour recurrence and benign changes in the pelvis related to the treatment of the patient can presently not be differentiated on account of dynamic contrast-enhanced MRI. In the diagnosis of locally recurrent rectal cancer with cross-sectional evaluation, MRl should be considered as the first choice rather than CT or CEA-scintigraphy.
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| 16. |
- Blomqvist, Lennart, 1947, et al.
(författare)
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Preconceptual thyroid peroxidase antibody positivity in women with recurrent pregnancy losses may contribute to an increased risk for another miscarriage.
- 2023
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Ingår i: Clinical endocrinology. - : Wiley. - 0300-0664 .- 1365-2265. ; 98:2, s. 259-269
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Tidskriftsartikel (refereegranskat)abstract
- To investigate preconceptual thyroid peroxidase antibody (TPO-ab) positivity and/or thyroid stimulating hormone (TSH) levels in the upper range of normal as risk factors for recurrent unexplained first-trimester miscarriage.A post-hoc study of a randomized trial, in which acetylsalicylic acid did not affect the risk of a new miscarriage.Women (n=483) with at least three unexplained recurrent first-trimester miscarriages investigated at a Swedish secondary referral center.The levels of TPO-ab and TSH were determined before pregnancy. The occurrence of a new first-trimester miscarriage was analyzed by logistic regression with adjustments when applicable, for age, number of previous miscarriages, obesity and the investigated covariates levels of TPO-ab and TSH.Including all first trimester miscarriages, odds ratio (OR) according to presence of TPO-ab was 1.60 (95% confidence interval [CI]; 0.99-2.57), after adjustment 1.54 (95% CI; 0.94-2.53). Very early (biochemical) pregnancy losses occurred more often in women with than without preconceptual TPO-ab (6.8% vs. 2.0%), OR 3.51 (95% CI; 1.15-10.71), after adjustment 2.91 (95% CI; 0.91-9.29). There was no association between TSH in the upper range of normal and a new miscarriage, adjusted OR 0.76 (95% CI; 0.32-1.83). A prediction model for a new miscarriage included number of previous miscarriages, woman's age and presence of TPO-ab.In women with at least three recurrent unexplained pregnancy losses, the presence of TPO-ab may contribute to an increased risk of a first-trimester miscarriage, possibly more pronounced in very early pregnancy. TSH levels 2.5-4.0 mU/L do not seem to increase the miscarriage risk.
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| 17. |
- Blomqvist, Lennart, 1947
(författare)
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Recurrent unexplained first-trimester miscarriage. Effects of acetylcalicylic acid, platelet aggregation and thyroid disease
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Recurrent unexplained first-trimester miscarriage. Effects of acetylsalicylic acid, platelet aggregation and thyroid disease. Lennart Blomqvist, Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden, 2019. Background/Aims: Recurrent pregnancy loss (RPL) occurs in 1-2% of fertile couples and about 50% of cases are unexplained. Impaired placental circulation, increased platelet aggregation, immunological factors and thyroid autoimmunity have been suggested to be involved. Other placenta-mediated complications have been reduced by inhibition of platelet aggregation with acetylsalicylic acid (ASA). The effect of ASA on RPL has been unclear. These studies aimed at investigating the effect of ASA treatment on RPL and arachidonic acid (AA)-induced platelet aggregation in women with RPL, as well as the effect of thyroid function by analyzing Thyroid Stimulating Hormone (TSH) and thyroid peroxidase antibodies (TPO-ab). Methods: Women (n=640) with at least three unexplained first-trimester miscarriages were screened for inclusion in a single-center, randomized, placebo-controlled trial (the ASA-RCT, Paper I). Four hundred women were given either 75 mg ASA or placebo daily, beginning at gestational week (gw) 6-7, when fetal heartbeat was detected by vaginal ultrasound. Treatment ended at the latest at gw 36. Treatment compliance was determined by analysis of AA-induced platelet aggregation using multiple electrode impedance aggregometry. All women underwent the same follow-up. Primary outcome was live birth rate (LBR). In order to define reference values for the multiple electrode impedance aggregometry (the Multiplate analyzer), a longitudinal study was conducted including 79 healthy, non-smoking pregnant women with normal pregnancies (Paper II). Platelet aggregation induced by AA, adenosine diphosphate (ADP), thrombin receptor activating peptide 6 (TRAP) and collagen (COL) were determined four times during pregnancy and three months postpartum. From the randomized population, 176 and 177 women, respectively, with normal AA-induced platelet aggregation before pregnancy and treated with ASA or placebo, were studied (Paper III). Platelet aggregation was determined before and during pregnancy and results in the randomized groups were compared with one another, as well as with those in the healthy controls from Paper II. From the screened and eligible population, 495 women with complete thyroid test analyses [thyroid stimulating hormone (TSH), free thyroxine (T4) and thyroid peroxidase antibodies TPO-ab] before pregnancy were included. Risk factors for a new miscarriage were studied, in particular associations with TPO-ab and TSH in the upper normal range. Results: In the ASA-RCT, all 400 randomized women completed the follow-up. LBR were 83.0% and 85.5% in the ASA and placebo groups, respectively. The mean difference was -2.5% (95% CI to -10.1% to 5.1%). The risk ratio was 0.97 (95% CI 0.89 to 1.06). In the longitudinal study of platelet aggregation during normal pregnancy, activation of platelets by AA, ADP and TRAP resulted in a minor decrease in platelet aggregation during pregnancy, compared with postpartum. COL-induced platelet aggregation was unchanged. A minor increase in platelet aggregation as pregnancy continued was found related to ADP. There were no significant differences in AA-induced platelet aggregation when placebo-treated women with RPL were compared with healthy women with normal pregnancies. ASA treatment significantly reduced platelet aggregation during pregnancy, compared with before pregnancy. Gradually increased platelet aggregation was seen in the majority of ASA-treated women as pregnancy progressed. There were only two complete non-responders to ASA. Miscarriage occurred more often in women with than without TPO-ab (25.7% vs 17.5%). There was no association between TSH in the upper normal range and a new miscarriage. Potential risk factors for a new miscarriage were age, number of previous miscarriages and presence of TPO-ab. Conclusions: ASA does not prevent a new miscarriage in women with at least three previous first-trimester miscarriages. AA-induced platelet aggregation seems to be similar in women with RPL and in healthy women with normal pregnancies. ASA, 75 mg daily, decreases AA-induced platelet aggregation in most women during pregnancy, but the effect diminishes as pregnancy progresses. TPO-ab, but not TSH in the upper normal range, may be associated with an increased risk of a new miscarriage.
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| 18. |
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| 19. |
- Bratt, Ola, et al.
(författare)
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Satsa på MRT för diagnostik av prostatacancer.
- 2015
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Ingår i: Läkartidningen. - : Läkartidningen Förlag. - 1652-7518 .- 0023-7205. ; 112:Apr 20, s. DFZ3-
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 20. |
- Buschard, Karsten, et al.
(författare)
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Low serum concentration of sulfatide and presence of sulfated lactosylceramid are associated with Type 2 diabetes. The Skaraborg Project
- 2005
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Ingår i: Diabetic Medicine. - : Wiley. - 0742-3071 .- 1464-5491. ; 22:9, s. 1190-8
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: The glycosphingolipid sulfatide (sulfated galactosyl-ceramide) increases exocytosis of beta-cell secretory granules, activates K(ATP)-channels and is thereby able to influence insulin secretion through its presence in the islets. A closely related compound, sulfated lactosylceramide (sulf-lac-cer), is present in the islets during fetal and neonatal life when, as in Type 2 diabetes, insulin is secreted autonomically without the usual first phase response to glucose. The aim was to examine whether serum concentrations of these glycolipids are associated with Type 2 diabetes. METHODS: A case-control study, comprising 286 women and 283 men, was designed using a population-based sample of patients with Type 2 diabetes and a population survey. RESULTS: Low serum concentrations of sulfatide were associated with Type 2 diabetes, independent of traditional risk factors for diabetes in a sex-specific analysis: odds ratio (OR) 2.1 (95% confidence interval 1.1, 3.9) in men, and 2.3 (1.2, 4.3) in women, comparing the lowest and the highest tertiles. Type 2 diabetes was also associated with detectable amounts of sulf-lac-cer in serum: OR 1.7 (0.9, 3.4) in men, and 7.6 (3.8, 15.2) in women. After adjustment for confounding from other diabetes risk factors, these associations remained basically unchanged. The connections between sulfatide and Type 2 diabetes, and sulf-lac-cer and Type 2 diabetes were independent of each other. Insulin resistance (HOMA-IR) was negatively correlated with sulfatide concentration and positively correlated with sulf-lac-cer (both P < 0.0001, independently). CONCLUSIONS: We report a new, robust and highly significant independent association between Type 2 diabetes and serum concentrations of sulfatide in both sexes, and sulf-lac-cer in females. The associations were also independent of other known diabetes risk factors.
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| 21. |
- Dahlman, Ingrid, et al.
(författare)
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A unique role of monocyte chemoattractant protein 1 among chemokines in adipose tissue of obese subjects
- 2005
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Ingår i: Journal of Clinical Endocrinology and Metabolism. - : Endocrine Society. - 0021-972X .- 1945-7197. ; 90:10, s. 5834-5840
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Tidskriftsartikel (refereegranskat)abstract
- Context: Low-grade inflammation in adipose tissue may contribute to insulin resistance in obesity. However, the roles of individual inflammatory mediators in adipose tissue are poorly understood. Objectives: The objective of this study was to determine which inflammation markers are most overexpressed at the gene level in adipose tissue in human obesity and how this relates to corresponding protein secretion. Design: We examined gene expression profiles in 17 lean and 20 obese subjects. The secretory pattern of relevant corresponding proteins was examined in human sc adipose tissue or isolated fat cells in vitro and in vivo in several obese or lean cohorts. Results: In ranking gene expression, defined pathways associated with obesity and immune and defense responses scored high. Among seven markedly overexpressed chemokines, only monocyte chemoattractant protein 1 (MCP1) was released from adipose tissue and isolated fat cells in vitro. In obesity, the secretion and expression of MCP1 in adipose tissue pieces were more than 6- and 2-fold increased, respectively, but there was no change in circulating MCP1 levels. There was no net release of MCP1, but there was a net release of leptin, in vivo from adipose tissue into the circulation. Conclusions: Obesity is associated with the increased expression of several chemokine genes in adipose tissue. However, only MCP1 is secreted into the extracellular space, where it primarily acts as a local factor, because little or no spillover into the circulation occurs. MCP1 influences the function of adipocytes, is a recruitment factor for macrophages, and may be a crucial link among chemokines between adipose tissue inflammation and insulin resistance.
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| 22. |
- Dahlström, Nils, 1969-
(författare)
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Magnetic Resonance Imaging of the Hepatobiliary System Using Hepatocyte-Specific Contrast Media
- 2009
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- There are two Gadolinium-based liver-specific contrast media for Magnetic Resonance Imaging on the market, Gd-BOPTA (MultiHance®, Bracco Imaging, Milan, Italy) and Gd-EOB-DTPA (Primovist®, Bayer Schering Pharma, Berlin, Germany). The aim of this study in two parts was to evaluate the dynamics of biliary, parenchymal and vascular enhancement using these contrast media in healthy subjects. Ten healthy volunteers were examined in a 1.5 T magnetic resonance system using three-dimensional Volumetric Interpolated Breath-Hold (VIBE) sequences for dynamic imaging with both contrast media – at two different occasions – until five hours after injection. The doses given were 0.025 mmol/kg for Gd-EOB-DTPA and 0.1 mmol/kg for Gd-BOPTA. The enhancement over time of the common biliary duct in contrast to the liver parenchyma was analyzed in the first study. This was followed by a study of the image contrasts of the hepatic artery, portal vein and middle hepatic vein versus the liver parenchyma.While Gd-EOB-DTPA gave an earlier and more prolonged enhancement of the biliary duct, Gd-BOPTA achieved higher image contrast for all vessels studied, during the arterial and portal venous phases. There was no significant difference in the maximal enhancement obtained in the liver parenchyma.At the obtained time-points and at the dosage used, the high contrast between the common biliary duct and liver parenchyma had an earlier onset and longer duration for Gd-EOB-DTPA, while Gd-BOPTA achieved higher maximal enhancement of the hepatic artery, portal vein and middle hepatic vein than Gd-EOB-DTPA. Diseases of the liver and biliary system may affect the vasculature, parenchyma, biliary excretion or a combination of these. The clinical context regarding the relative importance of vascular, hepatic parenchymal and biliary processes should determine the choice of contrast media for each patient and examination.
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| 23. |
- D'Souza, Nigel, et al.
(författare)
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Definition of the Rectum An International, Expert-based Delphi Consensus
- 2019
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Ingår i: Annals of Surgery. - : LIPPINCOTT WILLIAMS & WILKINS. - 0003-4932 .- 1528-1140. ; 270:6, s. 955-959
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Tidskriftsartikel (refereegranskat)abstract
- Background: The wide global variation in the definition of the rectum has led to significant inconsistencies in trial recruitment, clinical management, and outcomes. Surgical technique and use of preoperative treatment for a cancer of the rectum and sigmoid colon are radically different and dependent on the local definitions employed by the clinical team. A consensus definition of the rectum is needed to standardise treatment. Methods: The consensus was conducted using the Delphi technique with multidisciplinary colorectal experts from October, 2017 to April, 2018. Results: Eleven different definitions for the rectum were used by participants in the consensus. Magnetic resonance imaging (MRI) was the most frequent modality used to define the rectum (67%), and the preferred modality for 72% of participants. The most agreed consensus landmark (56%) was "the sigmoid take-off,'' an anatomic, image-based definition of the junction of the mesorectum and mesocolon. In the second round, 81% of participants agreed that the sigmoid take-off as seen on computed tomography or MRI achieved consensus, and that it could be implemented in their institution. Also, 87% were satisfied with the sigmoid take-off as the consensus landmark. Conclusion: An international consensus definition for the rectumis the point of the sigmoid take-off as visualized on imaging. The sigmoid take-off can be identified as the mesocolon elongates as the ventral and horizontal course of the sigmoid on axial and sagittal views respectively on cross-sectional imaging. Routine application of this landmark during multidisciplinary team discussion for all patients will enable greater consistency in tumour localisation.
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| 24. |
- Elliot, Anders H., et al.
(författare)
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An audit of performance, interpretation, and influence of pretherapeutic MRI in rectal cancer : a Swedish population-based cohort study
- 2019
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Ingår i: Acta Radiologica. - : SAGE PUBLICATIONS LTD. - 0284-1851 .- 1600-0455. ; 60:8, s. 955-961
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Tidskriftsartikel (refereegranskat)abstract
- Background: The performance of magnetic resonance imaging (MRI) interpretation and communication of findings and its implication on treatment decisions has not fully been explored in rectal cancer.Purpose: To investigate in a region the adherence to MRI protocol standards and the relation between MRI interpretation and selection to preoperative therapy in rectal cancer.Material and Methods: Data on consecutive patients who underwent elective rectal cancer surgery in the region from January to June 2010 were obtained from the National Colorectal Cancer Registry. Pretherapeutic MRI images were re-evaluated. Agreement between the original reports and the re-evaluation was compared using Cohen's kappa coefficient.Results: Among the 94 patients included, 81 (86%) had pretherapeutic MRI in accordance with defined imaging guidelines. In 34% of the original MR reports, data on extramural venous invasion (mrEMVI) and mrT category were not reported. Complete tumor staging was not possible because of missing data in 33 (35%) of the patients. The agreement between the original MR reports and the re-evaluation regarding tumor stage was moderate (kappa = 0.48). For decided treatment compared to recommended preoperative treatment according to the re-evaluation, the agreement was fair (kappa = 0.33).Conclusion: Established MRI protocol standards were not universally applied. Missing data and inadequacies in original MRI reports resulted in moderate agreement between the original report and the re-evaluation indicating a risk of inappropriate treatment selection. The results call for further educational efforts in rectal cancer MRI acquisition and repeated audits of image protocol adherence and interpretation quality.
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| 25. |
- Elliot, Anders H., et al.
(författare)
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Pretreatment MRI in Primary Rectal Cancer as a Predictor for Oncological Outcomes After Surgery for Local Recurrence
- 2021
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Ingår i: Anticancer Research. - : Anticancer Research USA Inc.. - 0250-7005 .- 1791-7530. ; 41:5, s. 2459-2465
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Tidskriftsartikel (refereegranskat)abstract
- Background/Aim: For patients with locally recurrent rectal cancer (LRRC) extensive surgery is often the only curative option and patient selection is crucial. This study aimed to investigate whether magnetic resonance imaging (MRI) characteristics of the primary tumour can predict oncological outcome after surgery for locally recurrent rectal cancer (LRRC). Patients andMethods: All patients undergoing surgery for LRRC with a curative intent at the Karolinska University Hospital 2003-2013 were included. MRI examinations of the primary tumour were re-evaluated.Results: In total, 54 patients were included. A tumour volume decrease of <70% after preoperative radiotherapy or chemoradiotherapy (C)RT for the primary tumour was correlated with a lower proportion of R0 resection of the LRRC (OR=0.07, 95% CI=0.01-0.84). No association between MRI characteristics of the primary tumour and prognosis after LRRC surgery was found.Conclusion: Long-term outcomes after surgery for LRRC were not significantly associated with MRI characteristics of the index tumour. However, factors associated with increased risk of R1 resection of LRRC were identified.
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