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- Armuand, G. M., et al.
(författare)
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Physicians' self-reported practice behaviour regarding fertility-related discussions in paediatric oncology in Sweden
- 2017
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Ingår i: Psycho-Oncology. - : John Wiley & Sons. - 1057-9249 .- 1099-1611. ; 26:10, s. 1684-1690
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of this study was to investigate practice behaviours of Swedish physicians with regard to discussing the impact of cancer treatment on fertility with paediatric oncology patients and their parents, and to identify factors associated with such discussions.METHODS: A cross-sectional survey study was conducted targeting all physicians in Sweden working in paediatric oncology care settings. Participants responded to a questionnaire measuring practice behaviour, attitudes, barriers, and confidence in knowledge. Multivariable logistic regression was used to determine factors associated with seldom discussing fertility.RESULTS: More than half of the physicians routinely talked with their patients/parents about the treatment's potential impact on fertility (male patients: 62%; female patients: 57%; P = 0.570). Factors associated with less frequently discussing fertility with patients/parents were working at a non-university hospital (male patients: OR 11.49, CI 1.98-66.67; female patients: OR 33.18, CI 4.06-271.07), concerns that the topic would cause worry (male patients: OR 8.23, CI 1.48-45.89; female patients: OR 12.38, CI 1.90-80.70), and perceiving the parents as anxious (male patients: OR 7.18, CI 1.20-42.85; female patients: OR 11.65, CI 1.32-103.17).CONCLUSIONS: Based on our findings, we recommend structured training in how to communicate about fertility issues in stressful situations, which in turn might increase fertility-related discussions in paediatric oncology.
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- Fertleman, C. R., et al.
(författare)
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Paroxysmal extreme pain disorder (previously familial rectal pain syndrome)
- 2007
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Ingår i: Neurology. - : Ovid Technologies (Wolters Kluwer Health). - 0028-3878 .- 1526-632X. ; 69:6, s. 586-595
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe the clinical phenotype of paroxysmal extreme pain disorder (previously called familial rectal pain syndrome), an autosomal dominant condition recently shown to be a sodium channelopathy involving SCN9A. METHODS: An international consortium of clinicians, scientists, and affected families was formed. Clinical details of all accessible families worldwide were collected, including age at onset, features of attacks, problems between attacks, investigational results, treatments tried, and evolution over time. A validated pain questionnaire was completed by 14 affected individuals. RESULTS: Seventy-seven individuals from 15 families were identified. The onset of the disorder is in the neonatal period or infancy and persists throughout life. Autonomic manifestations predominate initially, with skin flushing in all and harlequin color change and tonic attacks in most. Dramatic syncopes with bradycardia and sometimes asystole are common. Later, the disorder is characterized by attacks of excruciating deep burning pain often in the rectal, ocular, or jaw areas, but also diffuse. Attacks are triggered by factors such as defecation, cold wind, eating, and emotion. Carbamazepine is effective in almost all who try it, but the response is often incomplete. CONCLUSIONS: Paroxysmal extreme pain disorder is a highly distinctive sodium channelopathy with incompletely carbamazepine-sensitive bouts of pain and sympathetic nervous system dysfunction. It is most likely to be misdiagnosed as epilepsy and, particularly in infancy, as hyperekplexia and reflex anoxic seizures.
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- Nilsson, J., et al.
(författare)
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'Will I be able to have a baby?' Results from online focus group discussions with childhood cancer survivors in Sweden
- 2014
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Ingår i: Human Reproduction. - : Oxford University Press. - 0268-1161 .- 1460-2350. ; 29:12, s. 2704-2711
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Tidskriftsartikel (refereegranskat)abstract
- STUDY QUESTION: What do adolescent and young adult survivors of childhood cancer think about the risk of being infertile?SUMMARY ANSWER: The potential infertility, as well as the experience of having had cancer, affects well-being, intimate relationships and the desire to have children in the future.WHAT IS KNOWN ALREADY: Many childhood cancer survivors want to have children and worry about possible infertility.STUDY DESIGN, SIZE, DURATION: For this qualitative study with a cross-sectional design, data were collected through 39 online focus group discussions during 2013.PARTICIPANTS/MATERIALS, SETTING, METHODS: Cancer survivors previously treated for selected diagnoses were identified from The Swedish Childhood Cancer Register (16-24 years old at inclusion, ≥5 years after diagnosis) and approached regarding study participation. Online focus group discussions of mixed sex (n = 133) were performed on a chat platform in real time. Texts from the group discussions were analysed using qualitative content analysis.MAIN RESULTS AND THE ROLE OF CHANCE: The analysis resulted in the main category Is it possible to have a baby? including five generic categories: Risk of infertility affects well-being, Dealing with possible infertility, Disclosure of possible infertility is a challenge, Issues related to heredity and Parenthood may be affected. The risk of infertility was described as having a negative impact on well-being and intimate relationships. Furthermore, the participants described hesitation about becoming a parent due to perceived or anticipated physical and psychological consequences of having had cancer.LIMITATIONS, REASONS FOR CAUTION: Given the sensitive topic of the study, the response rate (36%) is considered acceptable. The sample included participants who varied with regard to received fertility-related information, current fertility status and concerns related to the risk of being infertile.WIDER IMPLICATIONS OF THE FINDINGS: The results may be transferred to similar contexts with other groups of patients of childbearing age and a risk of impaired fertility due to disease. The findings imply that achieving parenthood, whether or not with biological children, is an area that needs to be addressed by health care services.STUDY FUNDING/COMPETING INTERESTS: The study was financially supported by The Cancer Research Foundations of Radiumhemmet, The Swedish Childhood Cancer Foundation and the Doctoral School in Health Care Science, Karolinska Institutet. The authors report no conflicts of interest.
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- Bergsten, Johan, 1988, et al.
(författare)
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Performance Enhancement of Microwave GaN HEMTs Without an AlN-Exclusion Layer Using an Optimized AlGaN/GaN Interface Growth Process
- 2016
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Ingår i: IEEE Transactions on Electron Devices. - : Institute of Electrical and Electronics Engineers (IEEE). - 1557-9646 .- 0018-9383. ; 63:1, s. 333-338
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Tidskriftsartikel (refereegranskat)abstract
- The impact of the sharpness of the AlGaN/GaN interface in high-electron mobility transistors (HEMTs) is investigated. Two structures, one with an optimized AlGaN/GaN interface and another with an unoptimized, were grown using hot-wall metal-organic chemical vapor deposition. The structure with optimized sharpness of the interface shows electron mobility of 1760 cm(2)/V . s as compared with 1660 cm(2)/V . s for the nonoptimized interface. Gated Hall measurements indicate that the sharper interface maintains higher mobility when the electrons are close to the interface compared with the nonoptimized structure, indicating less scattering due to alloy disorder and interface roughness. HEMTs were processed and evaluated. The higher mobility manifests as lower parasitic resistance yielding a better dc and high-frequency performance. A small-signal equivalent model is extracted. The results indicate a lower electron penetration into the buffer in the optimized sample. Pulsed-IV measurements imply that the sharper interface provides less dispersive effects at large drain biases. We speculate that the mobility enhancement seen AlGaN/AlN/GaN structures compared with the AlGaN/GaN case is not only related to the larger conduction band offset but also due to a more welldefined interface minimizing scattering due to alloy disorder and interface roughness.
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| 15. |
- Chen, Ding Yuan, et al.
(författare)
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Microwave Performance of 'Buffer-Free' GaN-on-SiC High Electron Mobility Transistors
- 2020
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Ingår i: IEEE Electron Device Letters. - 0741-3106 .- 1558-0563. ; 41:6, s. 828-831
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Tidskriftsartikel (refereegranskat)abstract
- High performance microwave GaN-on-SiC HEMTs are demonstrated on a heterostructure without a conventional thick doped buffer. The HEMT is fabricated on a high-quality 0.25~\boldsymbol {\mu }\text{m} unintentional doped GaN layer grown directly on a transmorphic epitaxially grown AlN nucleation layer. This approach allows the AlN-nucleation layer to act as a back-barrier, limiting short channel effects and removing buffer leakage. The devices with the 'buffer-free' heterostructure show competitive DC and RF characteristics, as benchmarked against the devices made on a commercial Fe-doped epi-wafer. Peak transconductances of 500 mS/mm and a maximum saturated drain current of 1 A/mm are obtained. An extrinsic \text{f}-{\sf T} of 70 GHz and \text{f}-{\sf max} of 130 GHz are achieved for transistors with a gate length of 100 nm. Pulsed-IV measurements reveal a lower current slump and a smaller knee walkout. The dynamic IV performance translates to an output power of 4.1 W/mm, as measured with active load-pull at 3 GHz. These devices suggest that the 'buffer-free' concept may offer an alternative route for high frequency GaN HEMTs with less electron trapping effects.
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- Malmros, Anna, 1977, et al.
(författare)
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Enhanced Mobility in InAlN/AlN/GaN HEMTs Using a GaN Interlayer
- 2019
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Ingår i: IEEE Transactions on Electron Devices. - : IEEE-INST ELECTRICAL ELECTRONICS ENGINEERS INC. - 1557-9646 .- 0018-9383. ; 66:7, s. 2910-2915
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Tidskriftsartikel (refereegranskat)abstract
- © 1963-2012 IEEE. An enhancement of the electron mobility ( \mu ) in InAlN/AlN/GaN heterostructures is demonstrated by the incorporation of a thin GaN interlayer (IL) between the InAlN and AlN. The introduction of a GaN IL increases \mu at room temperature (RT) from 1600 to 1930 cm2/Vs. The effect is further enhanced at cryogenic temperature (5 K), where the GaN IL sample exhibits a \mu of 16000 cm2/Vs, compared to 6900 cm2/Vs without IL. The results indicate the reduction of one or more scattering mechanisms normally present in InAlN/AlN/GaN heterostructures. We propose that the improvement in \mu is either due to the suppression of fluctuations in the quantum well subband energies or to reduced Coulomb scattering, both related to compositional variations in the InAlN. HEMTs fabricated on the GaN IL sample demonstrate larger improvement in dc-and high-frequency performance at 5 K; {f}-{\text {max}} increases by 25 GHz to 153 GHz, compared to an increase of 6 GHz to 133 GHz without IL. The difference in improvement was associated mainly with the drop in the access resistances.
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- Rank, Cecilie U., et al.
(författare)
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Asparaginase-Associated Pancreatitis in Acute Lymphoblastic Leukemia : Results From the NOPHO ALL2008 Treatment of Patients 1-45 Years of Age
- 2020
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Ingår i: Journal of Clinical Oncology. - Alexandria : American Society of Clinical Oncology. - 0732-183X .- 1527-7755. ; 38:2, s. 145-154
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Asparaginase-associated pancreatitis (AAP) is common in patients with acute lymphoblastic leukemia (ALL), but risk differences across age groups both in relation to first-time AAP and after asparaginase re-exposure have not been explored.PATIENTS AND METHODS: We prospectively registered AAP (n = 168) during treatment of 2,448 consecutive ALL patients aged 1.0-45.9 years diagnosed from July 2008 to October 2018 and treated according to the Nordic Society of Pediatric Hematology and Oncology (NOPHO) ALL2008 protocol.RESULTS: Compared with patients aged 1.0-9.9 years, adjusted AAP hazard ratios (HRa) were associated with higher age with almost identical HRa (1.6; 95% CI, 1.1 to 2.3; P = .02) for adolescents (10.0-17.9 years) and adults (18.0-45.9 years). The day 280 cumulative incidences of AAP were 7.0% for children (1.0-9.9 years: 95% CI, 5.4 to 8.6), 10.1% for adolescents (10.0 to 17.9 years: 95% CI, 7.0 to 13.3), and 11.0% for adults (18.0-45.9 years: 95% CI, 7.1 to 14.9; P = .03). Adolescents had increased odds of both acute (odds ratio [OR], 5.2; 95% CI, 2.1 to 13.2; P = .0005) and persisting complications (OR, 6.7; 95% CI, 2.4 to 18.4; P = .0002) compared with children (1.0-9.9 years), whereas adults had increased odds of only persisting complications (OR, 4.1; 95% CI, 1.4 to 11.8; P = .01). Fifteen of 34 asparaginase-rechallenged patients developed a second AAP. Asparaginase was truncated in 17/21 patients with AAP who subsequently developed leukemic relapse, but neither AAP nor the asparaginase truncation was associated with increased risk of relapse.CONCLUSION: Older children and adults had similar AAP risk, whereas morbidity was most pronounced among adolescents. Asparaginase re-exposure should be considered only for patients with an anticipated high risk of leukemic relapse, because multiple studies strongly indicate that reduction of asparaginase treatment intensity increases the risk of relapse.
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- Søgaard Jørgensen, Peter, et al.
(författare)
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Coevolutionary Governance of Antibiotic and Pesticide Resistance
- 2020
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Ingår i: Trends in Ecology & Evolution. - : Elsevier BV. - 0169-5347 .- 1872-8383. ; 35:6, s. 484-494
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Forskningsöversikt (refereegranskat)abstract
- Development of new biocides has dominated human responses to evolution of antibiotic and pesticide resistance. Increasing and uniform biocide use, the spread of resistance genes, and the lack of new classes of compounds indicate the importance of navigating toward more sustainable coevolutionary dynamics between human culture and species that evolve resistance. To inform this challenge, we introduce the concept of coevolutionary governance and propose three priorities for its implementation: (i) new norms and mental models for lowering use, (ii) diversifying practices to reduce directional selection, and (iii) investment in collective action institutions to govern connectivity. We highlight the availability of solutions that facilitate broader sustainable development, which for antibiotic resistance include improved sanitation and hygiene, strong health systems, and decreased meat consumption.
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- Thiagarajan, D, et al.
(författare)
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NATURAL ANTIBODIES AGAINST PHOSPHORYLCHOLINE AND MALONDIALDEHYDE DURING THE FIRST TWO YEARS OF LIFE: IMPLICATIONS FOR RHEUMATIC DISEASE
- 2020
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Ingår i: ANNALS OF THE RHEUMATIC DISEASES. - : BMJ. - 0003-4967 .- 1468-2060. ; 79, s. 1326-1326
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Antibodies against phosphorylcholine (anti-PC) have potentially protective properties in both atherosclerosis and rheumatic disease. IgM anti-PC could play a role in SLE being associated with protection, also in relation to atherosclerotic plaques and vulnerable plaques in SLE1and being a non-responder to biologics in RA.1We reported potential mechanisms by which anti-PC could be protective: 1:anti-inflammatory; 2: inhibits uptake of oxLDL in macrophages, 3: inhibits cell death.14: anti-PC (and anti-MDA) increases clearance of human dead cells which could be of importance not especially in SLE;25: anti-PC increases T regulatory cells in SLE-patients´ T cells from a low level and also in atherosclerosis, with implications for both conditions.3Also antibodies against malondialdehyde (anti-MDA) have interesting propertiesObjectives:It is not known how these antibodies develop early in life and what may cause low levels. The objective is to determine this.Methods:Antibodies were studied by ELISA in healthy pregnant women (n=105; Born into life study) and their newborn children. Women were recruited before conception. Informed consent, questionnaires from parents and plasma sample was collected from children at birth from cord blood, at 1-year and 2 years after birth. Extracted antibodies were compared using a proteomics de novo sequencing approach.Results:Children were born with very low levels of IgM anti-PC, while IgM anti-MDA was present at birth,. Both IgM anti-PC and anti-MDA increased during the first two years of life, but IgM anti-PC in contrast to IgM anti-MDA was still significantly lower than mothers´. IgG anti-PC decreased after 1 year, but reached similar levels as mothers´ after 2 years while IgG anti-MDA reached similar levels as mothers´ already after one year. Proteomics peptide sequencing analysis indicates large peptide sequence variation without specific clone expression during early stage of life compared to the adult stage for which specific peptide sequences dominated.Conclusion:IgM anti-PC levels develop much slower than anti-MDA and are still relatively low at 2 years. We hypothesize that anti-PC is developed by a combination of pre-programming and exposure to the external world, where infectious agents may play a role. For anti-MDA pre-programming is likely to play a major role and at an earlier stage than for anti-PC.References:[1]Frostegard J. Immunity, atherosclerosis and cardiovascular disease.BMC Med. 2013;11:117.[2]Rahman M, Sing S, Golabkesh Z, Fiskesund R, Gustafsson T, Jogestrand T, Frostegard AG, Hafstrom I, Liu A and Frostegard J. IgM antibodies against malondialdehyde and phosphorylcholine are together strong protection markers for atherosclerosis in systemic lupus erythematosus: Regulation and underlying mechanisms.Clin Immunol. 2016;166-167:27-37.[3]Sun J, Lundstrom SL, Zhang B, Zubarev RA, Steuer J, Gillgren P, Rahman M, Ajeganova S, Liu A and Frostegard J. IgM antibodies against phosphorylcholine promote polarization of T regulatory cells from patients with atherosclerotic plaques, systemic lupus erythematosus and healthy donors.Atherosclerosis. 2018;268:36-48.Disclosure of Interests:Divya Thiagarajan: None declared, Susanna Lundström: None declared, Göran Pershagen: None declared, Catharina Almqvist Malmros: None declared, Ellika Andolf: None declared, Anna Hedman: None declared, Oscar Berg: None declared, Nina Oparina: None declared, Johan Frostegård Grant/research support from: Unconditional competitive grant from Amgen, related only to PCSK9, not the topic of this abstract
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