| 1. |
- Elleby, Charlotta, et al.
(författare)
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Long term association of hip fractures by questions of physical health in a cohort of men and women
- 2023
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 18:3 MARCH
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Tidskriftsartikel (refereegranskat)abstract
- We do not know if fracture predicting factors are constant throughout life, if they can be assessed earlier in life, and for how long. The aim was to study the association between questions about health status and mobility and fragility fractures in a cohort during a 35-year follow-up. A cohort of 16,536 men and women in two age groups, 26–45 and 46–65 years old, who answered five questions of their physical health status in postal surveys in 1969–1970. We obtained data on hip fractures from 1970 to the end of 2016. We found most significant results when restricting the follow-up to age 60–85 years, 35 for the younger age group and 20 years for the older. Men of both age groups considered “at risk” according to their answers had a 2.69 (CI 1.85–3.90)– 3.30 (CI 1.51–7.23) increased risk of having a hip fracture during a follow-up. Women in the younger age group had a 2.69 (CI 1.85–3.90) increased risk, but there was no elevated risk for women in the older age group. This study shows that questions/index of physical health status may be associated with hip fractures that occur many years later in life, and that there is a time span when the predictive value of the questions can be used, before other, age-related, factors dominate. Our interpretation of the results is that we are studying the most vulnerable, who have hip fractures relatively early in life, and that hip fractures are so common among older women that the questions in the survey lose their predictive value.
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| 5. |
- Häggmark, Ilian, et al.
(författare)
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Phase-contrast chest radiography
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Respiratory X-ray imaging with phase contrast leads to improved sensitivity, as demonstrated in animal models to date. The translation to humans is limited by currently available technology, leaving the future clinical impact of the technique an open question. Here we demonstrate phase-contrast chest radiography using a proof-of-principle in silico framework. Specifically, we apply our previously developed preprocessing strategy to state-of-the-art realistic virtual human torso phantoms, then generate virtual chest radiographs through wave-propagation simulations. From a blind reader study conducted with clinical radiologists, we predict that phase contrast edge-enhancement has negligible impact for pulmonary nodule detection (6-20 mm). However, edge-enhancement of bronchial walls can visualize small airways (< 2 mm) invisible in conventional radiography. Our results predict that phase-contrast chest radiography could play a future role in diagnosis of small-airway obstruction (e.g., in asthma or chronic obstructive pulmonary disease) thereby motivating the experimental development needed for clinical translation.
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| 6. |
- Häggmark, Ilian, et al.
(författare)
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Phase-contrast virtual chest radiography
- 2023
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Ingår i: Proceedings of the National Academy of Sciences of the United States of America. - : Proceedings of the National Academy of Sciences. - 0027-8424 .- 1091-6490. ; 120:1
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Tidskriftsartikel (refereegranskat)abstract
- Respiratory X-ray imaging enhanced by phase contrast has shown improved airway visualization in animal models. Limitations in current X-ray technology have nevertheless hindered clinical translation, leaving the potential clinical impact an open question. Here, we explore phase-contrast chest radiography in a realistic in silico framework. Specifically, we use preprocessed virtual patients to generate in silico chest radiographs by Fresnel-diffraction simulations of X-ray wave propagation. Following a reader study conducted with clinical radiologists, we predict that phase-contrast edge enhancement will have a negligible impact on improving solitary pulmonary nodule detection (6 to 20 mm). However, edge enhancement of bronchial walls visualizes small airways (<2 mm), which are invisible in conventional radiography. Our results show that phase-contrast chest radiography could play a future role in observing small-airway obstruction (e.g., relevant for asthma or early-stage chronic obstructive pulmonary disease), which cannot be directly visualized using current clinical methods, thereby motivating the experimental development needed for clinical translation. Finally, we discuss quantitative requirements on distances and X-ray source/detector specifications for clinical implementation of phase-contrast chest radiography.
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| 7. |
- Häggmark, Ilian, et al.
(författare)
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Propagation-based phase-contrast CXR: a virtual clinical study
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: Phase-contrast X-ray techniques are known to improve contrast for soft-tissueimaging but has yet to reach the clinical setting due to limitations of available technology. Virtual clinical studies serve as important tools for exploring the potential impact of new imaging technologies. Recent progress in X-ray imaging simulations has enabled virtual studies of propagation-based phase-contrast in clinical imaging. Purpose: To explore if propagation-based phase-contrast chest X-ray providing edge-enhancement of features can improve radiological diagnosis, specifically studying ifdetection sensitivity of pulmonary nodules can be increased. Materials and Methods: A virtual extended cardiac-torso (XCAT) phantom was used to simulate anteroposterior chest X-ray (CXR) images from virtual patients (n = 5) each withthree different settings: 1) Conventional (120 kV tungsten spectrum, patient next to detector), 2) Control (60 keV monochromatic, patient next to detector) and 3) Phase-contrast (60 keV monochromatic, patient 12 m before detector). Simulated images were post-processed using Siemens software for clinical CXR. The images were used to conduct a blind reader study with two radiologists, where 80 image sections (8×8 cm2) containing 0, 1, 2 or 3 pulmonary nodules (n = 20 each) were extracted for each setting (n = 240 sections in total). The sections were presented randomly to the radiologists, who reviewed the sections and potential findings with a degree of malignant suspicion (1-5 scale). The perceived image quality of each section was also reviewed ( 1-5 scale).Result: The radiologists perceived the simulated CXR as realistic enough to be used in a virtual clinical study. P hase-contrast CXR showed the same sensitivity in pulmonary nodule detection as conventional CXR (0.84 and 0.83, respectively). The number of false positives were also similar. The image quality of phase-contrast CXR was perceived worse on average compared to conventional CXR. Conclusion: Virtual clinical studies can be used to explore potential future impact of clinical phase-contrast X-ray imaging. For the task of pulmonary nodule detection, radiologists had similar benefit of propagation-based phase-contrast CXR as conventional CXR. The strong enhancement of airways and pulmonary vasculature did not increase false positives
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| 8. |
- Koyi, Hirsh, et al.
(författare)
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Biopsy testing in an inoperable, non-small cell lung cancer population : a retrospective, real-life study in Sweden
- 2015
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Ingår i: Journal of Thoracic Disease. - 2072-1439 .- 2077-6624. ; 7:12, s. 2226-2233
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Tidskriftsartikel (refereegranskat)abstract
- Background: Correct diagnosis and staging are required for optimal treatment choice in lung cancer patients. This retrospective, patient medical records study investigated the clinical practice of lung cancer biopsy procedures and testing in Sweden. Methods: Consecutive patients with a recorded inoperable, malignant tumour of bronchus and lung were retrospectively identified at geographically widespread pulmonology clinics (NCT01139619). Data, including diagnostic sampling methodology [bronchoscopy, biopsy by pulmonologist and computed tomography (CT)-guided biopsy], were collected for patients diagnosed between 1 June 2009-31 May 2010, and analysed using descriptive statistics. A study-predefined algorithm, including six criteria on tumour localization and size, forced expiratory volume in one second (FEV1), blood saturation and risk of bleeding theoretically categorizing patient suitability for CT-guided biopsy, was used. Results: In total, 132 patients (mean age 68 years, 48% women, 61% adenocarcinoma, 86% current/former smokers, 96% performance status <= 2, mean FEV1 volume >= 2 L) were included. The majority were examined by > 1 diagnostic procedure (29% by CT-guided biopsy). Median overall time from first hospital contact to established diagnosis was 12.0 days (10.0 and 28.0 days for bronchoscopy and CT-guided biopsy, respectively). No major differences in lung function, age, performance status or predefined algorithm criteria were noted for patients examined by CT-guided biopsy versus bronchoscopy or biopsy. Complications were reported for 11 patients, including pneumothorax in six patients. Histopathology was used most frequently to diagnose and subtype (70%), although 66% of patients examined solely by bronchoscopy were diagnosed by cytology. For 26.5% of patients, epidermal growth factor receptor (EGFR) mutation testing was recorded. Conclusions: No limitations regarding patient suitability or methodological complications were noted in this real-life, observational study. The CT-guided biopsy is a relatively safe and well-established method, and may need to be utilized further to fulfil current and future demands for faster diagnosis and high quality tissue as new tumour markers and targeted therapies become available.
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| 9. |
- Mari Svensson, Ann, et al.
(författare)
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Radiologisk och histologisk bild för en ökad förståelse vid covid-19 : [Covid-19 - radiologic and histologic features]
- 2020
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Ingår i: Läkartidningen. - : Läkartidningen. - 0023-7205 .- 1652-7518. ; 117, s. 25-27
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Tidskriftsartikel (refereegranskat)abstract
- We here describe the current knowledge about the radiologic and histologic pulmonary features of covid-19, caused by SARS-CoV-2, and present lung histology from a case with fatal disease. Initial findings on computed tomography (CT) typically include peripheral multifocal bilateral ground-glass opacities, and correspondingly microscopic alveolar edema. This is followed by peripheral consolidations with air bronchogram and perilobular pattern on CT, signs of organizing pneumonia, corresponding to loose (potentially reversible) fibrosis. The posterior parts of the lungs and the lower lobes are typically more markedly affected. In severe disease with acute respiratory distress syndrome, thickened interlobular septa and crazy paving pattern appear on CT, which corresponds to histologic diffuse alveolar damage with, depending on the stage of the disease, features such as edema, hyaline membranes, reactive epithelium, inflammation, and fibrosis.
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| 10. |
- Mari Svensson, Ann, et al.
(författare)
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Radiologisk och histologisk bild för en ökad förståelse vid covid-19
- 2020
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Ingår i: Lakartidningen. - 0023-7205. ; 117
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- We here describe the current knowledge about the radiologic and histologic pulmonary features of covid-19, caused by SARS-CoV-2, and present lung histology from a case with fatal disease. Initial findings on computed tomography (CT) typically include peripheral multifocal bilateral ground-glass opacities, and correspondingly microscopic alveolar edema. This is followed by peripheral consolidations with air bronchogram and perilobular pattern on CT, signs of organizing pneumonia, corresponding to loose (potentially reversible) fibrosis. The posterior parts of the lungs and the lower lobes are typically more markedly affected. In severe disease with acute respiratory distress syndrome, thickened interlobular septa and crazy paving pattern appear on CT, which corresponds to histologic diffuse alveolar damage with, depending on the stage of the disease, features such as edema, hyaline membranes, reactive epithelium, inflammation, and fibrosis.
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| 11. |
- Nybacka, Asa, et al.
(författare)
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Randomized comparison of the influence of dietary management and/or physical exercise on ovarian function and metabolic parameters in overweight women with polycystic ovary syndrome
- 2011
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Ingår i: Fertility and Sterility. - : Elsevier BV. - 0015-0282 .- 1556-5653. ; 96:6, s. 1508-1513
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare the influence of dietary management and/or physical exercise on ovarian function and metabolic variables in women with polycystic ovary syndrome (PCOS). Design: Randomized 4-month trial with three interventions and a long-term follow-up. Setting: Women's health clinical research unit at a university hospital. Patient(s): Fifty-seven overweight/obese women with PCOS. Intervention(s): Dietary management, physical exercise, or both, using programs individually adapted and supervised by a dietician and/or a physical therapist. Main Outcome Measure(s): Ovarian function, endocrinologic, and metabolic status and body composition. Result(s): On average, body mass index was reduced 6% by the dietary management, 3% by the exercise, and 5% by the combined interventions. Lower body fat and lean body mass were significantly decreased in the dietary groups, whereas upper body fat was lowered and lean body mass maintained by exercise alone. The menstrual pattern was significantly improved in 69% and ovulation confirmed in 34% of the patients, with no differences among the groups. The strongest predictor of resumed ovulation was a high serum level of insulin-like growth factor-binding protein 1 after the intervention. Follow-up of one-half of the patients for a median of 2.8 years revealed sustained weight reduction and improvement in menstrual pattern. Conclusion(s): Dietary management and exercise, alone or in combination, are equally effective in improving reproductive function in overweight/obese women with PCOS. The underlying mechanisms appear to involve enhanced insulin sensitivity. Supportive individualized programs for lifestyle change could exert long-term beneficial effects.
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| 13. |
- Nyrén, Sven
(författare)
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The effects of posture, airway pressure and anesthesia on regulation of the regional ventilation and perfusion distribution in healthy humans
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Gas exchange has been observed to vary with posture in adult respiratory distress syndrome (ARDS) patients. In this thesis, the effect of posture on theregional distribution of ventilation (V) and perfusion (Q) in the lungs under normal breathing with and without continuous positive airway pressure (CPAP) and during general anesthesia with mechanical ventilation was studied. Additionally, endogenously produced nitric oxide (NO) may influence the effect of posture on the Q distribution. This was also studied. Since inhalation anesthesia, known to impair pulmonary gas exchange, is sometimes used in ARDS patients we investigated the effect of inhaled sevoflurane on the V and Q regional distribution. All studies were performed on healthy volunteers with Single Photon Emission Tomography (SPECT). Isotope tagged albumin macro aggregates, trapped in the pulmonary capillaries were used to measure regional Q and isotope labeled aerosol or labeled ultrafine carbon particle aerosol to measure regional V. Prone posture, compared to supine, favors a more uniform Q distribution in the anterior to posterior direction both awake and during mechanical ventilation. CPAP, compared to normal breathing, redistributes Q to more dependent parts of the lungs, resulting in a less beneficial V/Q matching. We found indications of a higher release of endothelial NO in dorsal, compared to ventral, parts of the lungs. This may contribute to the more uniform Q distribution seen in prone compared to supine posture. NO from paranasal sinuses contributes to a more homogenous Q distribution in upright position. Inhalation anesthesia with sevoflurane decreases Q distribution heterogeneity but increases V/Q matching heterogeneity. No significant influence on the V distribution was observed in any of the studies. In conclusion, all studied factors in healthy volunteers have an effect on the Q regional distribution but not on V, suggesting that variations in V/Q ratio distribution are a consequence of changes in the intrapulmonary Q distribution.
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| 14. |
- Roos Ljungberg, Karin, et al.
(författare)
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Secretory anti-citrullinated protein antibodies in serum associate with lung involvement in early rheumatoid arthritis
- 2020
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Ingår i: Rheumatology. - : Oxford University Press. - 1462-0324 .- 1462-0332. ; 59:4, s. 852-859
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Tidskriftsartikel (refereegranskat)abstract
- Objective. A 'mucosal connection' in RA presently attracts increasing attention. We recently described the occurrence of secretory antibodies to citrullinated protein (SC-ACPA) in sera from patients with recent-onset RA. The current study was performed to evaluate possible associations between serum levels of secretory ACPA and signs of lung involvement in patients with early, untreated RA. Methods. One hundred and forty-two RA patients were included as part of the 'LUng Investigation in newly diagnosed RA' study. One hundred and six patients were examined with high-resolution CT (HRCT) and 20 patients underwent bronchoscopy, where bronchial biopsies and bronchoalveolar lavage fluid (BALF) samples were obtained. SC-ACPA in serum and BALF were detected by an enzyme-linked immunoassay. Antibody levels were related to smoking history, pulmonary function, HRCT, BALF cell counts and findings in bronchial biopsies. Results. SC-ACPA occurred in 16% of the serum samples and in 35% of the BALF samples. SC-ACPA levels in serum correlated with SC-ACPA levels in BALF (sigma = 0.50, P = 0.027) and were higher among patients with HRCT parenchymal lung abnormalities (P = 0.022) or bronchiectasis (P = 0.042). Also, ever smoking was more frequent among serum SC-ACPA-positive patients (91% vs 67%, P = 0.023), and the SC-ACPA levels correlated with the number of pack-years (sigma=0.20, P = 0.020). Conclusion. In early, untreated RA, serum levels of SC-ACPA reflect lung involvement in terms of local ACPA levels, smoking and lung abnormalities on HRCT. These findings strengthen the link between mucosal ACPA responses and the lungs in RA.
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| 18. |
- Song, Huan, et al.
(författare)
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Increase in the Prevalence of Atrophic Gastritis Among Adults Age 35 to 44 Years Old in Northern Sweden Between 1990 and 2009
- 2015
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Ingår i: Clinical Gastroenterology and Hepatology. - : Elsevier BV. - 1542-3565 .- 1542-7714. ; 13:9, s. 1592-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND & AIMS: Atrophic corpus gastritis (ACG) is believed to be an early precursor of gastric adenocarcinoma. We aimed to investigate trends of ACG in Northern Sweden, from 1990 through 2009, and to identify possible risk factors. METHODS: We randomly selected serum samples collected from 5284 participants in 1990, 1994, 1999, 2004, and 2009, as part of the population-based, cross-sectional Northern Sweden Multinational Monitoring of Trends and Determinants in Cardiovascular Disease study (ages, 35-64 y). Information was collected on sociodemographic, anthropometric, lifestyle, and medical factors using questionnaires. Serum samples were analyzed for levels of pepsinogen I to identify participants with functional ACG; data from participants with ACG were compared with those from frequency-matched individuals without ACG (controls). Blood samples were analyzed for antibodies against Helicobacter pylori and Cag pathogenicity island protein A. Associations were estimated with unconditional logistic regression models. RESULTS: Overall, 305 subjects tested positive for functional ACG, based on their level of pepsinogen I. The prevalence of ACG in participants age 55 to 64 years old decreased from 124 per 1000 to 49 per 1000 individuals between 1990 and 2009. However, the prevalence of ACG increased from 22 per 1000 to 64 per 1000 individuals among participants age 35 to 44 years old during this time period. Cag pathogenicity island protein A seropositivity was associated with risk for ACG (odds ratio, 2.29; 95% confidence interval, 1.69-3.12). Other risk factors included diabetes, low level of education, and high body mass index. The association between body mass index and ACG was confined to individuals age 35 to 44 years old; in this group, overweight and obesity were associated with a 2.8-fold and a 4.7-fold increased risk of ACG, respectively. CONCLUSIONS: Among residents of Northern Sweden, the prevalence of ACG increased from 1990 through 2009, specifically among adults age 35 to 44 years old. The stabilizing seroprevalence of H pylori and the increasing prevalence of overweight and obesity might contribute to this unexpected trend. Studies are needed to determine whether these changes have affected the incidence of gastric cancer.
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