| 1. |
- Andren, Ann, et al.
(författare)
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Effects of treatment with oral appliance on 24-h blood pressure in patients with obstructive sleep apnea and hypertension : a randomized clinical trial
- 2013
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Ingår i: Sleep and Breathing. - : Springer Science and Business Media LLC. - 1520-9512 .- 1522-1709. ; 17:2, s. 705-712
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Tidskriftsartikel (refereegranskat)abstract
- Continuous positive airway pressure treatment has been shown to lower blood pressure (BP) in patients with obstructive sleep apnea (OSA). The aims of the present pilot study were to evaluate the potential effects of oral appliance (OA) therapy on BP, to assess various outcome BP measures, and to inform sample size calculation. Seventy-two patients with OSA and hypertension were randomly assigned to intervention with either an OA with mandibular advancement (active group) or an OA without advancement (control group). Before and after 3 months of treatment, the patients underwent nocturnal somnographic registration and 24-h ambulatory BP monitoring. Among the various BP measures, the largest trend toward effect of OA treatment was seen in 24-h mean systolic BP with a 1.8 mmHg stronger BP reduction in the active group compared with controls. A stronger trend toward effect was seen in a subgroup with baseline ambulatory daytime mean systolic BP > 135/85 mmHg where the mean systolic BP fell, on average, 2.6 mmHg. Additional exclusion of patients with baseline apnea hypopnea index (AHI) a parts per thousand currency sign15 gave a significant reduction in mean systolic BP of 4.4 mmHg (P = 0.044) in the active group compared with controls. In patients with OSA and hypertension, OA treatment had a modest trend toward effect on reducing BP. A stronger trend toward treatment effect was seen after excluding patients with normal baseline ambulatory BP. Additional exclusion of patients with baseline AHI a parts per thousand currency sign15 showed a significant treatment effect. Data to inform sample size for an adequately powered randomized study are provided.
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| 2. |
- Andrén, Cecilia M., et al.
(författare)
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Response of Gammarus pulex and Baetis rhodani to springtime acid episodes in humic brooks
- 2013
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Ingår i: Science of the Total Environment. - : Elsevier BV. - 0048-9697 .- 1879-1026. ; 463, s. 690-699
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Tidskriftsartikel (refereegranskat)abstract
- While chronic acidification of water bodies has been steadily decreasing, episodic acidification continues to affect stream biology by temporarily decreasing pH and mobilizing aluminum. These events are becoming more common as climate change renders more frequent and intense storms and flooding. Throughout Scandinavia, the effects of acidification have been mitigated by liming since the 1980s, but remediation efforts can now be reduced. While transient acidity may reduce fish populations, also other species in streams are affected. In this in-stream study, two macro-invertebrates (Gammarus pulex and Baetis rhodani), both known as salmonid prey organisms, were exposed to snowmelt in six humic brooks with a natural gradient of pH and inorganic monomeric Al (Al-i). We hypothesize that acid toxicity thresholds can be defined using lethal (mortality) and sublethal (changes in body elemental content) metrics. Periodic observations were made of mortality and whole body concentrations of base cations (BC: Ca, Mg, Na and K) and metals (Al, Fe, Zn and Mn). Mortality increased dramatically at pH < 6.0 and Al-i > 15 mu g/L for G. pulex and at pH < 5.7 and Al-i > 20 mu g/L for B. rhodani. No accumulation of Al was found. The invertebrate body Na concentration decreased when pH dropped, suggesting that osmoregulation in both species was affected. In contrast to general BC pattern, Ca concentration in G. pulex and Mg concentration in B. rhodani increased when pH decreased. Although Ali strongly correlates to pH, the Al composition of soil and bedrock also influences Al availability, potentially contributing to toxic Al; episodes. The estimated values calculated in this study can be used to improve water quality criteria and as thresholds to adjust doses of lime compared to old recommendations in ongoing liming programs. Such adjustments may be critical since both Ali and pH levels have to be balanced to mitigate damage to recovering stream ecosystems.
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| 3. |
- Andrén, Cecilia M., 1964-
(författare)
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Toxicity of Inorganic Aluminium in Humic Streams
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aluminium (Al) has been recognised as a main toxic factor alongside pH in acidified water ecosystems. The toxic effect of Al has been attributed to inorganic Al (Ali), though there are few in situ studies in ambient humic waters which are the focus of this thesis.The aim was to estimate Ali toxicity and thus also Ali concentrations in Swedish humic streams. Subsequently it is necessary to analyse Ali correctly, which was studied by modelling and method intercalibrations. The hypothesis was that the effect of Ali could be followed via physiological effects and Al accumulation, as well as by mortality. Toxicity was studied by in stream exposures of brown trout (Salmo trutta L.) and two salmonid prey organisms (Gammarus pulex and Baetis rhodani) during spring flood.The modelling of the Ali fraction was performed using monitoring data covering all of Sweden with satisfactory results. The essential variables for Ali modelling were determined; Al, DOC, pH and F, while Fe, Ca and Mg had less effect. The automated analytical procedure for Ali (with cation exchange followed by complexation with pyrocatechol violet) was modified and validated and showed to be the preferred method for laboratory analyses.To avoid detrimental effects for brown trout Ali should be <20 µg/L and pH >5.0; mortality was high when the Ali was above 50 µg/L. The invertebrates were more sensitive, as mortalities occurred at pH <6.0 and Ali >15 µg/L for G. pulex, and at pH <5.7 and Ali >20 µg/L for B. rhodani. It is prudent to use a wide view and let the most sensitive species set the tolerance limits; a pH above 5.7-6.0 and Ali below 15-20 µg/L allows the stream ecosystems to thrive.Today, as waters are recovering from acidification, the aim of mitigating liming is to carefully adjust dosage to avoid suboptimal water quality. The thresholds found in this thesis can be used to efficiently but carefully decrease liming, as both Ali and pH levels have to be balanced to sustain the recovering aquatic biota.
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| 4. |
- Erlandsson, Ann, 1968-, et al.
(författare)
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High inducible nitric oxide synthase in prostate tumor epithelium is associated with lethal prostate cancer
- 2018
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Ingår i: Scandinavian journal of urology. - : Informa Healthcare. - 2168-1805 .- 2168-1813. ; 52:2, s. 129-133
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of this study was to investigate the role of inducible nitric oxide synthase (iNOS) in lethal prostate cancer (PCa) by studying the iNOS immunoreactivity in tumor tissue from men diagnosed with localized PCa.MATERIALS AND METHODS: This study is nested within a cohort of men diagnosed with incidental PCa undergoing transurethral resection of the prostate (the Swedish Watchful Waiting Cohort). To investigate molecular determinants of lethal PCa, men who died from PCa (n = 132) were selected as cases; controls (n = 168) comprised men with PCa who survived for at least 10 years without dying from PCa during follow-up. The immunoreactivity of iNOS in prostate tumor epithelial cells and in cells of the surrounding stroma was scored as low/negative, moderate or high. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for lethal PCa according to iNOS category.RESULTS: There was no association between iNOS immunoreactivity in stroma and lethal disease. However, when comparing high versus low/negative iNOS immunoreactivity in epithelial cells, the OR for lethal PCa was 3.80 (95% CI 1.45-9.97).CONCLUSION: Patients with localized PCa have variable outcomes, especially those with moderately differentiated tumors. Identifying factors associated with long-term PCa outcomes can elucidate PCa tumor biology and identify new candidate prognostic markers. These findings support the hypothesis that high iNOS in tumor epithelium of the prostate is associated with lethal disease.
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| 5. |
- Erlandsson, Ann, 1968-, et al.
(författare)
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M2 macrophages and regulatory T cells in lethal prostate cancer.
- 2019
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Ingår i: The Prostate. - : John Wiley & Sons. - 0270-4137 .- 1097-0045. ; 79:4, s. 363-369
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Prostate cancer (PCa) is one of the most frequently diagnosed cancers in the world. Emerging evidence suggests that inflammatory cells such as M2 macrophages and regulatory T cells (Tregs ) can contribute to cancer progression by suppressing the anti-tumor immune response. This study investigated the number of CD163-positive M2 macrophages in PCa tissue. It also investigated the correlation and interaction of M2 macrophages and Tregs .METHODS: This nested case-control study included subjects from a cohort of men diagnosed with PCa as an incidental finding during transurethral resection of the prostate. The cases were 225 men who died from PCa, and the controls were 367 men who survived more than 10 years after PCa diagnosis without disease progression. Infiltrating CD163-positive M2 macrophages and FOXP3/CD4-positive Tregs in PCa tissue were identified using immunohistochemistry. The correlation and interaction of M2 macrophages and Tregs were assessed using Spearman's rank-order correlation and a likelihood test, respectively. Logistic regression was used to estimate odds ratios (ORs) for lethal PCa and macrophage counts.RESULTS: The number of M2 macrophages and Tregs showed a significant correlation (P < 0.001) but no interactions. The OR for lethal PCa was 1.93 (95%CI: 1.23-3.03) for men with high numbers of M2 macrophages. Also for cases with uncertain outcome (GS categories 3 + 4 and 4 + 3) high numbers of M2 macrophages does predict a poorer prognosis.CONCLUSIONS: Our data showed that men with high numbers of M2 macrophages in the prostate tumor environment had increased odds of dying of PCa. It is possible that M2 macrophages, together with other suppressor cells such as Tregs , promote an immunosuppressive environment.
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| 6. |
- Rider, Jennifer R., et al.
(författare)
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iNOS expression and lethal prostate cancer in patients with localized disease
- 2017
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Ingår i: Cancer Research. - : American Association for Cancer Research. - 0008-5472 .- 1538-7445. ; :22S
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Tidskriftsartikel (refereegranskat)abstract
- Inducible nitric oxide synthase (iNOS) has demonstrated both tumor-promoting and tumor-inhibiting effects in prostate cancer. However, the relationship between iNOS protein expression and long-term prostate cancer outcomes is unclear. We evaluated iNOS expression in tumor epithelia and stroma in 300 men with localized tumors diagnosed incidentally by transurethral resection of the prostate (TURP) in Sweden. In this extreme case-control design, cases (N=132) died of prostate cancer and controls (N=168) survived at least 8 years following diagnosis without death from prostate cancer or a competing cause. Immunohistochemistry was undertaken with a polyclonal rabbit anti-human NOS2 antibody (Abcam) and the Ventana (Roche) semi-automated staining system. Two observers individually scored the staining according to intensity and number of positive cells from 0-3. The median value across cores in each patient were then categorized as <1, >1-<2, and >2, separately for epithelial and stromal compartments. Odds ratios for lethal prostate cancer were estimated with logistic regression controlling for the matching factors (age, calendar year of diagnosis), as well as tumor stage, Gleason score, and percent tumor. iNOS was expressed by stromal-associated M1 macrophages and fibroblasts, as well as tumor cells. Gleason score was positively associated with both stromal and epithelial iNOS staining. In the stroma, there was no statistically significant association between iNOS expression and lethal prostate cancer after adjustment for clinical covariates. However, the odds of lethal prostate cancer increased with tumor expression of iNOS in the fully adjusted model. Compared to patients with the lowest category of iNOS expression, the odds ratios for lethal prostate cancer were 2.96 (95% CI: 1.26-6.96) for patients in the second category and 3.80 (95% CI: 1.45-9.97) for patients in the top category. These results suggest that iNOS may help to identify patients with aggressive prostate cancer at the time of diagnosis, or may be a therapeutic target. Given previously reported in vitro data suggesting that iNOS promotes proliferation of androgen-independent prostate tumors, future analyses will investigate association between iNOS expression and time to castration-resistant prostate cancer in this patient population.
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| 7. |
- Tegelberg, Åke, et al.
(författare)
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Bed partners' and patients' experiences after treatment of obstructive sleep apnoea with an oral appliance
- 2012
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Ingår i: Swedish Dental Journal. - : Sveriges tandläkarförbund. - 0347-9994. ; 36:1, s. 35-44
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of the study was to evaluate bed-partners' and patients' self-reports of general well-being, physical strength and mental energy after treatment for obstructive sleep apnoea (OSA) with a mandibular advancement oral appliance (OA). Patients (N = 134) referred from medical physicians diagnosed with true OSA, i.e. an apnoea-hypopnoea index of > 10, were treated with an OA for more than one year. The somnographic evaluations were undertaken in a patient's home before the start of, and six months after, treatment. An individually designed monobloc OA was manufactured by a dental technician for nightly use. After one year of treatment, a follow-up questionnaire was sent to patients whose sleep disorder was reduced > 50% from baseline values and to their bed partners. The questionnaire consisted of 15 questions or statements with multi-answer alternatives concerning well-being, physical strength, mental energy, sleep, day and night symptoms, and the Epworth Sleepiness Scale (ESS: eight questions). The questionnaire was answered by 82% (110/134) of the patients and 85 bed partners. Both patients and bed partners reported improvement in general well-being, physical strength and mental energy, between 70-80% for patients and 55-68% for bed partners sharing the same bed-room. Similar results were found for concentration ability, joyfulness and strength of effort in social intercourse, as well as decreased daytime sleepiness, improvement in the feeling of getting enough sleep and reduced nocturia. Conclusions: In all dimensions, the treatment effect had a great influence, not only on patients but on bed partners as well.
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