| 1. |
- Bark, Rusana, et al.
(författare)
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Sentinel node-assisted neck dissection in advanced oral squamous cell carcinoma - A new protocol for staging and treatment
- 2023
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Ingår i: Cancer Medicine. - : Wiley-Blackwell. - 2045-7634. ; 12:11, s. 12524-12534
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Tidskriftsartikel (refereegranskat)abstract
- Background: Sentinel lymph node biopsy (SLNB) is used to improve the staging of and guide treatment in patients with early-stage T1-T2 N0 oral squamous cell carcinoma (OSCC). The role of sentinel nodes (SNs) and the use of SN-technique in advanced OSCC (T3-T4 and/or N+) remain to be evaluated. This study investigates the nodal drainage and the rate of positive SNs (SNs+) in all stages of OSCC.Materials and Methods: In total, 85 patients with T1-T4 OSCC diagnosed 2019-2021 were included. We used a prolonged interval between peritumoral injection of radionuclide and SPECT-CT to include all SNs.Results: Patients with advanced OSCC presented a higher proportion of contralateral lymphatic drainage and a higher rate of SN+ compared to patients with early-stage disease. T3-T4 and N+ tumors presented a tendency for a higher rate of contralateral lymphatic drainage compared to T1-T2 and N0 tumors (p = 0.1). The prevalence of positive nodes (SNs+) was higher among patients with advanced disease, T3-T4 versus T1-T2 (p = 0.0398).Conclusion: SN-assisted ND enables identification and removal of all SNs + and has the potential for more accurate staging and could possibly give prognostic advantages regarding regional recurrence for all OSCC patients, especially among those with advanced disease. The precise localization of the SNs + also suggests that a more individualized ND approach might be possible in the future even for patients with advanced OSCC.
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| 2. |
- Elliot, Alexandra
(författare)
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Inverted papilloma and sinonasal malignancies in Sweden
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Sinonasal malignancies (SNMs) are rare and in Sweden they account for approximately 0,1% of all malignancies and 5% of all head and neck malignancies. Apart from sinonasal malignant melanoma (SNMM), their incidence has been reported to decrease since 1960 while the survival rates have remained rather stable during the same time-period. Sinonasal inverted papilloma (IP) is a benign tumour with a high risk of local recurrence and a potential to malignify. The true incidence of IP is not yet known. From hospital based studies, its incidence has been estimated to approximately 0.5/100000 person years. Previous studies have reported a malignant transformation of IP in 1–53%. However, it is unknown to what extent IPs are associated with squamous cell carcinoma (SCC) on a population basis. Also, the aetiology and prognostic factors for IP are mainly unknown. However, human papillomavirus (HPV) has previously been suggested as an aetiological factor by some authors. Moreover, p16INK4a (p16) overexpression, is often considered as a surrogate marker for high risk HPV in oropharyngeal carcinomas, but whether there is a correlation between p16 and HPV in IP and/or the prognosis of IP is uncertain. Similarly, a prognostic role of tumour infiltrating lymphocytes (TILs) has been observed in many head and neck tumours. However, their role in IP is sparsely investigated. Prognostic research on cell cycle related proteins such as oncoprotein 18, also called Stathmin, and epidermal growth factor receptor (EGFR) is relatively new regarding IP. In summary, IP is a rare tumour and relevant knowledge regarding factors affecting recurrence, malignant transformation and prognosis is still limited. Aims: The overall aim of this thesis was to investigate possible prognostic factors in IP, more specifically HPV, infiltration of TILs and expression of stathmin and EGFR. The aim was also to present epidemiological data on IP on a population basis and to describe how incidence and survival have changed for SNMs in the Swedish population. Results: In total 3221 patients diagnosed with primary SNMs were identified in the Swedish Cancer Registry (SCR) from 1960-2010. Their incidence decreased during the study-period except for SNMM and adenoid cystic cancer. More than 50 % of the malignancies involved the nasal cavity. The five-year relative survival was highest for adenoid cystic cancer followed by adenocarcinoma. SNMM and undifferentiated carcinoma had the poorest prognosis. In the SCR 814 patients with IP were identified. The incidence of IP increased from 1960 to 2010. Patients with IP had an overrepresentation of SCC when compared with the general population although this proportion was lower than previously reported. 8 Prognostic factors were analysed in tumours from 98 patients diagnosed with IP in Stockholm between 2000-2010. In total, 12.2% of the IPs were HPV positive and p16 overexpression was found in the only high-risk HPV positive tumour. Patients with HPV positive lesions were younger and tended to present with more dysplasia and to relapse less frequently. The tumours also had a higher proportion of EGFR expression compared to HPV negative tumours (91.7% and 52.3%, respectively). Stathmin was expressed by the tumours cells and not at all or weakly in the normal mucosa and more specimens with dysplasia were stathmin-positive than specimens without dysplasia (40.0% as compared to 12.6%). Stathmin positive IPs also tended to have earlier recurrences, although this difference was not statistically significant. No correlation was observed between TILs or EGFR and prognosis. Conclusions: While the overall incidence of SNM showed a slight decrease, the incidence of IP has increased and SCC is less common among patients with IP than previously reported. The results suggest that patients with HPV positive and HPV negative IPs may have different clinical characteristics, possibly indicating two different disease entities. Stathmin is consistently expressed in inverted papilloma but not in the normal mucosa and stathmin positivity seems to be associated with dysplasia and possibly also with recurrence. Stathmin might therefore even more than EGFR be considered a future therapeutic target.
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| 3. |
- Hammarstedt-Nordenvall, Lalle, et al.
(författare)
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Distribution of sentinel nodes from parotid tumors - A feasibility study
- 2023
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Ingår i: Cancer Medicine. - : John Wiley & Sons. - 2045-7634. ; 12:9, s. 19667-19672
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Tidskriftsartikel (refereegranskat)abstract
- Background: Optimum management of the N0 neck is unresolved in parotid salivary gland cancer. Sentinel node biopsy (SNB) can reliably detect microscopic lymph node metastasis and its ' clinical use is increasing for head and neck tumors. The object of this study was to establish whether the technique is applicable to detect distribution of sentinel nodes for parotid tumors.Materials and Methods: Prosepective observational study in 30 patients with benign or low-grade T1-T2N0 malignant tumors in the parotid gland planned for surgical treatment. Distribution of SN was detected with a preoperative ultrasound-guided peritumoral injection with a technetium-99 (Tc-99 m) laballed tracer followed by a SPECT-CT and intraoperative measurement in the neck and parotidal tissue. In patients with cytologically suspected malignant tumor or highly unclerar cytology, SNB was also performed.Results: Sentinel nodes (SNs) were detected in 26/30 cases. Out of these, 7 presented with only one SN, whereas multiple sentinel nodes where detected in 19 cases. No SNs were found in neck level 1. SN was detected in level 5 independent of tumor location within the parotid gland. An intraparotidal distribution of SNs was more frequent in larger tumors.Conclusions: The use of SN-technique in the planning of surgical treatment of parotid tumors seems feasible. It may be of clinical value for patients with parotid cancer to enable a more accurate staging and to detect occult metastasis in the SNs within the parotid as well as in the neck, enabaling the possibility to surgically remove all positive SNs at primary surgery and with reduced surgical morbidity.
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| 4. |
- Jelenkovic, Aline, et al.
(författare)
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Zygosity Differences in Height and Body Mass Index of Twins From Infancy to Old Age : A Study of the CODATwins Project
- 2015
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Ingår i: Twin Research and Human Genetics. - : Cambridge University Press. - 1832-4274 .- 1839-2628. ; 18:5, s. 557-570
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Tidskriftsartikel (refereegranskat)abstract
- A trend toward greater body size in dizygotic (DZ) than in monozygotic (MZ) twins has been suggested by some but not all studies, and this difference may also vary by age. We analyzed zygosity differences in mean values and variances of height and body mass index (BMI) among male and female twins from infancy to old age. Data were derived from an international database of 54 twin cohorts participating in the COllaborative project of Development of Anthropometrical measures in Twins (CODATwins), and included 842,951 height and BMI measurements from twins aged 1 to 102 years. The results showed that DZ twins were consistently taller than MZ twins, with differences of up to 2.0 cm in childhood and adolescence and up to 0.9 cm in adulthood. Similarly, a greater mean BMI of up to 0.3 kg/m(2) in childhood and adolescence and up to 0.2 kg/m(2) in adulthood was observed in DZ twins, although the pattern was less consistent. DZ twins presented up to 1.7% greater height and 1.9% greater BMI than MZ twins; these percentage differences were largest in middle and late childhood and decreased with age in both sexes. The variance of height was similar in MZ and DZ twins at most ages. In contrast, the variance of BMI was significantly higher in DZ than in MZ twins, particularly in childhood. In conclusion, DZ twins were generally taller and had greater BMI than MZ twins, but the differences decreased with age in both sexes.
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| 5. |
- Kolodner, Elliot K, et al.
(författare)
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A cloud environment for data-intensive storage services
- 2011
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Ingår i: IEEE third international conference on Cloud computing technology and science (CloudCom), 2011. - : IEEE conference proceedings. - 9781467300902 ; , s. 357-366
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Konferensbidrag (refereegranskat)abstract
- The emergence of cloud environments has made feasible the delivery of Internet-scale services by addressing a number of challenges such as live migration, fault tolerance and quality of service. However, current approaches do not tackle key issues related to cloud storage, which are of increasing importance given the enormous amount of data being produced in today's rich digital environment (e.g. by smart phones, social networks, sensors, user generated content). In this paper we present the architecture of a scalable and flexible cloud environment addressing the challenge of providing data-intensive storage cloud services through raising the abstraction level of storage, enabling data mobility across providers, allowing computational and content-centric access to storage and deploying new data-oriented mechanisms for QoS and security guarantees. We also demonstrate the added value and effectiveness of the proposed architecture through two real-life application scenarios from the healthcare and media domains.
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| 6. |
- Piersiala, Krzysztof, et al.
(författare)
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Regulatory B cells producing IL-10 are increased in human tumor draining lymph nodes
- 2023
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Ingår i: International Journal of Cancer. - : John Wiley & Sons. - 0020-7136 .- 1097-0215. ; 153:4, s. 854-866
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Tidskriftsartikel (refereegranskat)abstract
- The contribution of different immune cell subsets, especially T cells, in anti-tumor immune response is well established. In contrast to T cells, the anti-tumor contribution of B cells has been scarcely investigated. B-cells are often overlooked, even though they are important players in a fully integrated immune response and constitute a substantial fraction of tumor draining lymph nodes (TDLNs) known also as Sentinel Nodes. In this project, samples including TDLNs, non-TDLNs (nTDLNs) and metastatic lymph nodes from 21 patients with oral squamous cell carcinoma were analyzed by flow cytometry. TDLNs were characterized by a significantly higher proportion of B cells compared with nTDLNs (P = .0127). TDLNs-associated B cells contained high percentages of naive B cells, in contrary to nTDLNs which contained significantly higher percentages of memory B cells. Patients having metastases in TDLNs showed a significantly higher presence of immunosuppressive B regulatory cells compared with metastasis-free patients (P = .0008). Elevated levels of regulatory B cells in TDLNs were associated with the advancement of the disease. B cells in TDLNs were characterized by significantly higher expression of an immunosuppressive cytokine-IL-10 compared with nTDLNs (P = .0077). Our data indicate that B cells in human TDLNs differ from B cells in nTDLNs and exhibit more naive and immunosuppressive phenotypes. We identified a high accumulation of regulatory B cells within TDLNs which may be a potential obstacle in achieving response to novel cancer immunotherapies (ICIs) in head and neck cancer.
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| 7. |
- Silventoinen, Karri, et al.
(författare)
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Education in twins and their parents across birth cohorts over 100 years : an individual-level pooled analysis of 42 twin cohorts
- 2017
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Ingår i: Twin Research and Human Genetics. - Stockholm : Karolinska Institutet, Dept of Medical Epidemiology and Biostatistics. - 1832-4274 .- 1839-2628.
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Tidskriftsartikel (refereegranskat)abstract
- Whether monozygotic (MZ) and dizygotic (DZ) twins differ from each other in a variety of phenotypes is important for genetic twin modeling and for inferences made from twin studies in general. We analyzed whether there were differences in individual, maternal and paternal education between MZ and DZ twins in a large pooled dataset. Information was gathered on individual education for 218,362 adult twins from 27 twin cohorts (53% females; 39% MZ twins), and on maternal and paternal education for 147,315 and 143,056 twins respectively, from 28 twin cohorts (52% females; 38% MZ twins). Together, we had information on individual or parental education from 42 twin cohorts representing 19 countries. The original education classifications were transformed to education years and analyzed using linear regression models. Overall, MZ males had 0.26 (95% CI [0.21, 0.31]) years and MZ females 0.17 (95% CI [0.12, 0.21]) years longer education than DZ twins. The zygosity difference became smaller in more recent birth cohorts for both males and females. Parental education was somewhat longer for fathers of DZ twins in cohorts born in 1990-1999 (0.16 years, 95% CI [0.08, 0.25]) and 2000 or later (0.11 years, 95% CI [0.00, 0.22]), compared with fathers of MZ twins. The results show that the years of both individual and parental education are largely similar in MZ and DZ twins. We suggest that the socio-economic differences between MZ and DZ twins are so small that inferences based upon genetic modeling of twin data are not affected.
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| 8. |
- Silventoinen, Karri, et al.
(författare)
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The CODATwins Project : The Cohort Description of Collaborative Project of Development of Anthropometrical Measures in Twins to Study Macro-Environmental Variation in Genetic and Environmental Effects on Anthropometric Traits
- 2015
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Ingår i: Twin Research and Human Genetics. - : Cambridge University Press. - 1832-4274 .- 1839-2628. ; 18:4
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Tidskriftsartikel (refereegranskat)abstract
- For over 100 years, the genetics of human anthropometric traits has attracted scientific interest. In particular, height and body mass index (BMI, calculated as kg/m2) have been under intensive genetic research. However, it is still largely unknown whether and how heritability estimates vary between human populations. Opportunities to address this question have increased recently because of the establishment of many new twin cohorts and the increasing accumulation of data in established twin cohorts. We started a new research project to analyze systematically (1) the variation of heritability estimates of height, BMI and their trajectories over the life course between birth cohorts, ethnicities and countries, and (2) to study the effects of birth-related factors, education and smoking on these anthropometric traits and whether these effects vary between twin cohorts. We identified 67 twin projects, including both monozygotic (MZ) and dizygotic (DZ) twins, using various sources. We asked for individual level data on height and weight including repeated measurements, birth related traits, background variables, education and smoking. By the end of 2014, 48 projects participated. Together, we have 893,458 height and weight measures (52% females) from 434,723 twin individuals, including 201,192 complete twin pairs (40% monozygotic, 40% same-sex dizygotic and 20% opposite-sex dizygotic) representing 22 countries. This project demonstrates that large-scale international twin studies are feasible and can promote the use of existing data for novel research purposes.
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