| 1. |
- Bai, Lucy, et al.
(författare)
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Clinical assessment of breast symmetry and aesthetic outcome : Can 3D imaging be the gold standard?
- 2023
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Ingår i: Journal of Plastic Surgery and Hand Surgery. - 2000-656X .- 2000-6764. ; 57:1-6, s. 145-152
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Tidskriftsartikel (refereegranskat)abstract
- There is a lack of an accurate standardised objective method to assess aesthetic outcome after breast surgery. In this methodological study, we investigated the intra- and inter-observer reproducibility of breast symmetry and volume assessed using three-dimensional surface imaging (3D-SI), evaluated the reproducibility depending on imaging posture, and proposed a new combined volume-shape-symmetry (VSS) parameter. Images were acquired using the VECTRA XT 3D imaging system, and analysed by two observers using VECTRA Analysis Module. Breast symmetry was measured through the root mean square distance. All women had undergone bilateral risk-reducing mastectomy and immediate breast reconstruction. The reproducibility and correlations of breast symmetry and volume measurements were compared using Bland-Altman's plots and tested with Spearman's rank correlation coefficient. 3D surface images of 58 women were analysed (348 symmetry measurements, 696 volume measurements). The intra-observer reproducibility of breast symmetry measurements was substantial-excellent, the inter-observer reproducibility was substantial, and the inter-posture reproducibility was substantial. For measurements of breast volumes, the intra-observer reproducibility was excellent, the inter-observer reproducibility was moderate-substantial, and the inter-posture reproducibility was substantial-excellent. The intra-observer reproducibility of VSSVSS was excellent while the inter-observer reproducibility was substantial for both observers, independent of posture. There were no statistically strong correlations between breast symmetry and volume differences. The intra-observer reproducibility was found to be substantial-excellent for several 3D-SI measurements independent of imaging posture. However, the inter-observer reproducibility was lower than the intra-observer reproducibility, indicating that 3D-SI in its present form is not a great assessment for symmetry.
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| 2. |
- Bai, Lucy, et al.
(författare)
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Patient-reported outcomes and 3-dimensional surface imaging after risk-reducing mastectomy and immediate breast reconstruction
- 2021
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Ingår i: Plastic and Reconstructive Surgery - Global Open. - 2169-7574. ; 9:5
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Tidskriftsartikel (refereegranskat)abstract
- The cosmetic results after risk-reducing mastectomy (RRM) and immediate breast reconstruction (IBR) are intended to be long-lasting. Long-term follow-up of the cosmetic outcome can be evaluated subjectively by the women themselves through patient-reported outcome measures such as questionnaires, or by using data from three-dimensional surface imaging (3D-SI) to calculate the volume, shape, and symmetry of the reconstructed breasts as a more objective cosmetic evaluation. The study aim was to evaluate the correspondence between patient-reported measures and 3D-SI measurements.Methods: Questionnaires (EORTC QLQ-BRECON23 and BIS) were sent to women on average 13 [7-20] years after RRM and IBR. Items were preselected for comparison with 3D measurements of women imaged using the VECTRA XT 3D-imaging system at the long-term follow-up.Results: Questionnaire responses and 3D images of 58 women, 36 without and 22 with previous breast cancer (where 15 also received radiotherapy) before RRM and IBR, were analyzed. Median age at follow-up was 57 [41-73] years. Patient-reported satisfaction with the cosmetic outcome was positive for both groups. 3D measurements indicated more symmetrical cosmetic results for women without previous breast cancer. No statistically significant associations between patient-reported satisfaction and 3D measurements were found.Conclusions: Satisfaction with the long-term cosmetic outcome after RRM and IBR was, in general, positive when evaluated by the women. 3D-SI could be used as a more objective approach to assess the cosmetic outcome in terms of volume and shape-symmetry; however, it does not directly translate to the patient-reported satisfaction.
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| 3. |
- Gahm, Jessica, et al.
(författare)
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Effectiveness of single vs multiple doses of prophylactic intravenous antibiotics in implant-based breast reconstruction : A randomized clinical trial
- 2022
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Ingår i: JAMA Network Open. - : American Medical Association (AMA). - 2574-3805. ; 5:9
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Tidskriftsartikel (refereegranskat)abstract
- Importance: Multiple-dose antibiotic prophylaxis is widely used to prevent infection after implant-based breast reconstruction despite the lack of high-level evidence regarding its clinical benefit.Objective: To determine whether multiple-dose antibiotic prophylaxis is superior to single-dose antibiotic prophylaxis in preventing surgical site infection (SSI) after implant-based breast reconstruction.Design, Setting, and Participants: This prospective, multicenter, randomized clinical superiority trial was conducted at 7 hospitals (8 departments) in Sweden from April 25, 2013, to October 31, 2018. Eligible participants were women aged 18 years or older who were planned to undergo immediate or delayed implant-based breast reconstruction. Follow-up time was 12 months. Data analysis was performed from May to October 2021.Interventions: Multiple-dose intravenous antibiotic prophylaxis extending over 24 hours following surgery, compared with single-dose intravenous antibiotic. The first-choice drug was cloxacillin (2 g per dose). Clindamycin was used (600 mg per dose) for patients with penicillin allergy.Main Outcomes and Measures: The primary outcome was SSI leading to surgical removal of the implant within 6 months after surgery. Secondary outcomes were the rate of SSIs necessitating readmission and administration of intravenous antibiotics, and clinically suspected SSIs not necessitating readmission but oral antibiotics.Results: A total of 711 women were assessed for eligibility, and 698 were randomized (345 to single-dose and 353 to multiple-dose antibiotics). The median (range) age was 47 (19-78) years for those in the multiple-dose group and 46 (25-76) years for those in the single-dose group. The median (range) body mass index was 23 (18-38) for the single-dose group and 23 (17-37) for the multiple-dose group. Within 6 months of follow-up, 30 patients (4.3%) had their implant removed because of SSI. Readmission for intravenous antibiotics because of SSI occurred in 47 patients (7.0%), and 190 women (27.7%) received oral antibiotics because of clinically suspected SSI. There was no significant difference between the randomization groups for the primary outcome implant removal (odds ratio [OR], 1.26; 95% CI, 0.69-2.65; P = .53), or for the secondary outcomes readmission for intravenous antibiotics (OR, 1.18; 95% CI, 0.65-2.15; P = .58) and prescription of oral antibiotics (OR, 0.72; 95% CI, 0.51-1.02; P = .07). Adverse events associated with antibiotic treatment were more common in the multiple-dose group than in the single-dose group (16.4% [58 patients] vs 10.7% [37 patients]; OR, 1.64; 95% CI, 1.05-2.55; P = .03).Conclusions and Relevance: The findings of this randomized clinical trial suggest that multiple-dose antibiotic prophylaxis is not superior to a single-dose regimen in preventing SSI and implant removal after implant-based breast reconstruction but comes with a higher risk of adverse events associated with antibiotic treatment.Trial Registration: EudraCT 2012-004878-26.
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| 4. |
- Johansson, Unn-Britt, et al.
(författare)
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Mixed methods study on the feasibility of implementing periodic continuous glucose monitoring among individuals with type 2 diabetes mellitus in a primary care setting
- 2024
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Ingår i: Heliyon. - 2405-8440. ; 10:8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Health care professionals (HCPs) play a central role in leveraging technologies to support individuals with diabetes. This mixed-method study was completed to determine the feasibility of implementing periodic continuous glucose monitoring (CGM) in a primary care setting.AIM: This study aimed to evaluate and describe the experiences of using periodic CGM with data visualization tools in patients with type 2 diabetes to foster a person-centered approach in a primary care setting.METHODS: Fifty outpatients aged ≥18 years, diagnosed with type 2 diabetes, and with a disease duration of at least 2 years were included in this study. Data were collected from April 2021 to January 2022. Patients completed a single period of sensor measurements for 28 days and a diabetes questionnaire about feelings and experiences of health care. HbA1c was also measured. A focus group interview was conducted to evaluate and describe the HCPs experiences of using periodic CGM.RESULTS: Patients reported to HCPs that the CGM device was comfortable to wear and noted that LibreView was easy to use when scanning the sensor to obtain and visualize the glucose levels and trends. Data availability of CGM data was >70 %.Clinical observations revealed a mean reduction in HbA1c, mmol/mol from 60.06 [7.65 %] at baseline to 55.42 [7.20 %] after 4 weeks (p < 0.001). Two categories were identified: 1) Fostering dialogue on self-care and 2) Promoting understanding.CONCLUSIONS: The HCPs and participants in this study had a positive experience or viewed the implementation of periodic CGM with data visualization tools as a positive experience and appeared to be feasible for implementation in a primary care setting.
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| 5. |
- Lemonnier, Nathanaël, et al.
(författare)
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A novel whole blood gene expression signature for asthma, dermatitis, and rhinitis multimorbidity in children and adolescents
- 2020
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Ingår i: Allergy. European Journal of Allergy and Clinical Immunology. - : WILEY. - 0105-4538 .- 1398-9995. ; 75:12, s. 3248-3260
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Tidskriftsartikel (refereegranskat)abstract
- Background: Allergic diseases often occur in combination (multimorbidity). Human blood transcriptome studies have not addressed multimorbidity. Large-scale gene expression data were combined to retrieve biomarkers and signaling pathways to disentangle allergic multimorbidity phenotypes.Methods: Integrated transcriptomic analysis was conducted in 1233 participants with a discovery phase using gene expression data (Human Transcriptome Array 2.0) from whole blood of 786 children from three European birth cohorts (MeDALL), and a replication phase using RNA Sequencing data from an independent cohort (EVA-PR, n = 447). Allergic diseases (asthma, atopic dermatitis, rhinitis) were considered as single disease or multimorbidity (at least two diseases), and compared with no disease.Results: Fifty genes were differentially expressed in allergic diseases. Thirty-two were not previously described in allergy. Eight genes were consistently overexpressed in all types of multimorbidity for asthma, dermatitis, and rhinitis (CLC, EMR4P, IL5RA, FRRS1, HRH4, SLC29A1, SIGLEC8, IL1RL1). All genes were replicated the in EVA-PR cohort. RT-qPCR validated the overexpression of selected genes. In MeDALL, 27 genes were differentially expressed in rhinitis alone, but none was significant for asthma or dermatitis alone. The multimorbidity signature was enriched in eosinophil-associated immune response and signal transduction. Protein-protein interaction network analysis identified IL5/JAK/STAT and IL33/ST2/IRAK/TRAF as key signaling pathways in multimorbid diseases. Synergistic effect of multimorbidity on gene expression levels was found.Conclusion: A signature of eight genes identifies multimorbidity for asthma, rhinitis, and dermatitis. Our results have clinical and mechanistic implications, and suggest that multimorbidity should be considered differently than allergic diseases occurring alone.
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| 6. |
- Melén, Erik, et al.
(författare)
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Air pollution and IgE sensitization in 4 European birth cohorts : the MeDALL project
- 2021
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Ingår i: Journal of Allergy and Clinical Immunology. - : Elsevier. - 0091-6749 .- 1097-6825. ; 147:2, s. 713-722
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundWhether long-term exposure air to pollution has effects on allergic sensitization is controversial.ObjectiveOur aim was to investigate associations of air pollution exposure at birth and at the time of later biosampling with IgE sensitization against common food and inhalant allergens, or specific allergen molecules, in children aged up to 16 years.MethodsA total of 6163 children from 4 European birth cohorts participating in the Mechanisms of the Development of ALLergy [MeDALL] consortium were included in this meta-analysis of the following studies: Children, Allergy, Milieu, Stockholm, Epidemiology (BAMSE) (Sweden), Influences of Lifestyle-Related Factors on the Human Immune System and Development of Allergies in Childhood (LISA)/German Infant Study on the Influence of Nutrition Intervention PLUS Environmental and Genetic Influences on Allergy Development (GINIplus) (Germany), and Prevention and Incidence of Asthma and Mite Allergy (PIAMA) (The Netherlands). The following indicators were modeled by land use regression: individual residential outdoor levels of particulate matter with aerodynamic diameters less than 2.5 μm, less than 10 μm, and between 2.5 and 10 μm; PM2.5 absorbance (a measurement of the blackness of PM2.5 filters); and nitrogen oxides levels. Blood samples drawn at ages 4 to 6 (n = 5989), 8 to 10 (n = 6603), and 15 to 16 (n = 5825) years were analyzed for IgE sensitization to allergen extracts by ImmunoCAP. Additionally, IgE against 132 allergen molecules was measured by using the MedALL microarray chip (n = 1021).ResultsAir pollution was not consistently associated with IgE sensitization to any common allergen extract up to age 16 years. However, allergen-specific analyses suggested increased risks of sensitization to birch (odds ratio [OR] = 1.12 [95% CI = 1.01-1.25] per 10-μg/m3 increase in NO2 exposure). In a subpopulation with microarray data, IgE to the major timothy grass allergen Phleum pratense 1 (Phl p 1) and the cat allergen Felis domesticus 1 (Fel d 1) greater than 3.5 Immuno Solid-phase Allergen Chip standardized units for detection of IgE antibodies were related to PM2.5 exposure at birth (OR = 3.33 [95% CI = 1.40-7.94] and OR = 4.98 [95% CI = 1.59-15.60], respectively, per 5-μg/m3 increase in exposure).ConclusionAir pollution exposure does not seem to increase the overall risk of allergic sensitization; however, sensitization to birch as well as grass pollen Phl p 1 and cat Fel d 1 allergen molecules may be related to specific pollutants.
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