| 1. |
- Carlander, Christina, et al.
(författare)
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HPV Types in Cervical Precancer by HIV Status and Birth Region : A Population-Based Register Study
- 2020
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Ingår i: Cancer Epidemiology, Biomarkers and Prevention. - : AMER ASSOC CANCER RESEARCH. - 1055-9965 .- 1538-7755. ; 29:12, s. 2662-2668
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Tidskriftsartikel (refereegranskat)abstract
- Background: Data are lacking regarding which human papillomavirus (HPV) types cause high-grade cervical neoplasia (CIN2+) in people with HIV in Europe. We assessed which HPV types are associated with CIN2+ in women living in Sweden by HIV status.Methods: The Swedish National HIV Registry, the Swedish Population Registry, and the Swedish National Cervical Screening Registry were linked. CIN2+ tissue blocks of 130 women living with HIV (WLWH) and 234 HIV-negative women, matched for country of birth (1:2), were retrieved from bio-banks and HPV genotyped. Adjusted ORs (adjOR), stratified by country of birth, were calculated using conditional logistic regression. Matching was broken for cross-group comparisons.Results: WLWH with CIN2 were less likely to have HPV16 [14% vs. 40%; adjOR 0.1; 95% confidence interval (CI), 0.04-0.56] than HIV-negative women, but among women with CIN3, there was no difference in HPV16 prevalence by HIV status (adjOR 0.9; 95% CI, 0.51-1.70). WLWH were six times more likely to have HPV35 in CIN3 than HIV-negative women (adjOR 6.2; 95% CI, 1.3-30.4). WLWH from sub-Saharan Africa (SSA) had less 9-valent vaccine types, compared with both HIV-negative women born in Sweden (adjOR 0.1; 95% CI, 0.02-0.44) and WLWH born in Sweden (adjOR 0.1; 95% CI, 0.01-0.73), mostly because of decreased HPV16 and increased HPV35.Conclusions: WLWH from SSA were less likely to be covered by the 9-valent vaccine, mostly due to less HPV16 and more HPV35. Impact: This could have implications for HPV vaccines, currently not including HPV35, and for HPV-screening algorithms in women with origin from SSA.
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| 2. |
- Carlander, Christina, et al.
(författare)
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Suppressive antiretroviral therapy associates with effective treatment of high-grade cervical intraepithelial neoplasia
- 2018
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Ingår i: AIDS. - : LIPPINCOTT WILLIAMS & WILKINS. - 0269-9370 .- 1473-5571. ; 32:11, s. 1475-1484
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To assess if women living with HIV (WLWH) have poorer outcome after treatment of cervical intraepithelial neoplasia grade 2, grade 3, adenocarcinoma in situ or cervical cancer (CIN2+) than HIV-negative women (HNW) and to identify predictors of CIN2+ treatment failure and recurrence in WLWH. Design: Population-based cohort study with follow-up between 1983 and 2015. Methods: The Swedish National HIV Registry, the Swedish Population Registry and the Swedish National Cervical Screening Registry were linked to identify all women in Stockholm and Gothenburg counties (Sweden) living with HIV and diagnosed with CIN2+ (n = 179) sometime between 1983 and 2014. For each WLWH, two HNW resident in the same counties and matched for country of birth, diagnosed with CIN2+, were chosen as controls. Treatment failure was defined as the presence of CIN2+ at initial follow-up. Recurrence was defined as the presence of CIN1+ subsequent to an initial normal follow-up. Results: WLWH were three times more likely to have treatment failure (odds ratio (OR) 3.7 [95% confidence interval (CI) 2.0-6.8]) and five times more likely to recur (hazard ratio 5.0 [95% CI 2.1-11.6]) than HNW. Suppressive antiretroviral therapy (ART) at time of treatment of CIN2+ was associated with reduced OR of treatment failure (OR 0.3 [95% CI 0.1-0.8]). Immunosuppression (CD4(+) cell count < 200 cells/mu l) associated strongly with treatment failure (OR compared with CD4 (+) cell count >= 500: 8.5 [95% CI 2.3-30.7]). Conclusion: Suppressive ART is associated with effective treatment of CIN2+. Early HIV diagnosis and ART are essential for successful CIN2+ treatment.
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| 3. |
- Elfgren, Christina
(författare)
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Aspects of Frontal and Medial Temporal Brain Functions : Neuropsychological and functional imaging studies in normals and in frontotemporal dementia
- 1997
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The thesis is based on five investigations. In the first study the nature and the degree of cognitive impairment of patients with frontotemporal dementia (FTD) is explored. The results from neuropsychological assessment are described as three levels of cognitive impairment. These levels of functional disturbance corresponded to increased severity of abnormality of the regional cerebral blood flow measurements (rCBF). In the second study a close coupling between reduced rCBF and specific neuropsychological deficits in FTD is demonstrated. Significant correlations were found between a global impairment score and relative blood flow in frontal areas. The global impairment scale might be useful in detecting and following the progress of frontal deficiencies in FTD patients. The results of the third investigation indicate that for differential diagnosis of FTD versus dementia of Alzheimer type (DAT) the scores on cognitive tests measuring verbal ability, visuospatial ability and verbal episodic memory are of value, especially when evaluated in combination. The fourth study investigates the functional involvement of the frontal lobes during performance of verbal (VFT) and design fluency tasks (DFT), and the influence of different strategies utilised when solving the fluency tasks. The results from measurements of rCBF in normal subjects demonstrate a left-sided frontal activation during the VFT and bilateral flow augmentations during the DFT. Furthermore, the findings suggest that patterns of cortical activity vary according to the chosen cognitive strategy when performing a task. In the fifth investigation the involvement of the medial temporal lobes (MTL) in retrieval of declarative memories (abstract visuospatial designs) is studied by measuring rCBF with positron emission tomography (PET). In the recall of abstract designs a less practised memory state (novel recall) was compared to a well practised (trained recall) memory state. The MTL was more activated during retrieval in the less practised memory state compared to the well practised memory state, indicating a changing role of the MTL during recall in the earlier stages of acquisition of declarative knowledge compared to the well encoded declarative memory state.
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| 4. |
- Elfgren, Christina, et al.
(författare)
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fMRI activity in the medial temporal lobe during famous face processing
- 2006
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Ingår i: NeuroImage. - : Elsevier BV. - 1095-9572 .- 1053-8119. ; 30:2, s. 609-616
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Tidskriftsartikel (refereegranskat)abstract
- The current event-related fMRI study examined the relative involvement of different parts of the medial temporal lobe (MTL), particularly the contribution of hippocampus and perirhinal cortex, in either intentional or incidental recognition of famous faces in contrast to unfamiliar faces. Our intention was to further explore the controversial contribution of MTL in the processing of semantic memory tasks. Subjects viewed a sequence of famous and unfamiliar faces. Two tasks were used encouraging attention to either fame or gender. In the fame task, the subjects were requested to identify the person when seeing his/her face and also to try to generate the name of this person. In the gender task, the subjects were asked to conduct a judgement of a person's gender when seeing his/her face. The visual processing was hence directed to gender and thereby expected to diminish attention to semantic information leading only to a “passive” registration of famous and non-familiar faces. Recognition of famous faces, in both contrasts, produced significant activations in the MTL. First, during the intentional recognition (the person identification task) increased activity was observed in the anterolateral part of left hippocampus, in proximity to amygdala. Second, during the incidental recognition of famous faces (the gender classification task), there was increased activity in the left posterior MTL with focus in the perirhinal cortex. Our results suggest that the hippocampus may be centrally involved in the intentional retrieval of semantic memories while the perirhinal cortex is associated with the incidental recognition of semantic information.
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| 5. |
- Elfgren, Christina, et al.
(författare)
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Subjective experience of memory deficits related to clinical and neuroimaging findings.
- 2003
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Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 16:2, s. 84-92
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate cognitive impairment, psychiatric symptoms and cerebral blood flow (CBF) patterns in middle-aged (35–64 years) and younger old patients (65–74 years) with subjective experience of memory deficits. The study group was heterogeneous with patients fulfilling criteria for dementia, as well as patients with mild cognitive impairment (MCI) and with non-verified cognitive impairment (non-MCI). Seventy per cent of the non-MCI patients reported long-lasting experiences of psychosocial stress tentatively causing the memory problems. The MCI patients were subdivided into two groups: MCI type 1 included patients with isolated memory impairment, while MCI type 2 included patients with memory impairment together with slight verbal and/or visuospatial impairments. CBF measurements comparing the two MCI groups with the non-MCI group were performed. The MCI type 2 showed reduced CBF in the left anterior medial temporal lobe as well as in parts of the posterior cingulate gyrus. The CBF pattern in MCI type 2 concurs with the pathophysiological process of Alzheimer’s disease. The results indicate that it is important to make a subdivision of MCI patients regarding the presence of isolated memory impairments or memory impairments together with other slight cognitive deficits.
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| 6. |
- Elfgren, Christina, et al.
(författare)
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Subjective memory complaints, neuropsychological performance and psychiatric variables in memory clinic attendees: A 3-year follow-up study.
- 2010
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Ingår i: Archives of Gerontology and Geriatrics. - : Elsevier BV. - 1872-6976 .- 0167-4943. ; Apr 7, s. 110-114
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Tidskriftsartikel (refereegranskat)abstract
- The aims were to evaluate the cognitive performance and clinical diagnosis in patients (<75 years) seeking help for subjective memory complaints, to determine the prevalence of certain psychiatric symptoms and to conduct follow-up examinations. At baseline 41% showed normal cognitive performance (subjective memory impairment; SMI), 37% fulfilled criteria for mild cognitive impairment (MCI) and 22% were classified as dementia. There were significant associations between the three groups and experiences of psychosocial stress and feelings of anxiety. The proportion of psychosocial stress was significantly higher in SMI vs. MCI and SMI vs. dementia. Feelings of anxiety were significantly higher in SMI vs. MCI. At the 3-year follow-up, 88% of the SMI patients remained stable SMI and 60% of the MCI patients remained stable. There was a significant reduction of psychosocial stress and moderate reduction of feelings of anxiety among the SMI patients. The findings indicate that the risk of patients with SMI developing dementia is small within a 3-year span. We propose that subjective memory complaints might be influenced by the presence of psychosocial stress and feelings of anxiety disturbing the memory processes and interfering with the patients' evaluation of their memory function.
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| 7. |
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| 8. |
- Gustafson, Lars, et al.
(författare)
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Frontotemporal dementia – Differentiation from Alzheimer's disease
- 2004
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Ingår i: Psychogeriatria Polska. - 1732-2642. ; 1:4, s. 279-292
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Forskningsöversikt (refereegranskat)abstract
- Organic dementia is dominated by primary degenerative disorders such as Alzheimer’s disease (AD) and frontotemporal dementia (FTD). FTD is a distinct clinical syndrome with behavioural, personality, emotional and language disturbances preceding the cognitive decline. This clinical presentation is distinctly different from that of AD which is characterized by early cognitive changes, such as memory impairment, aphasia and apraxia, and a relatively preserved personality and behaviour. The differences between these two conditions reflect the predominant topographic distribution of brain pathology. The differences in clinical profiles and treatment strategies will be highlighted. In both disorders loss of functional ability, development of behavioural disturbances and dependency impose heavy demands on family and other caregivers. This presentation will concentrate on early recognition and diagnosis, using systematic clinical evaluation, neuropsychological testing and different brain imaging methods. This is important for a successful development of therapeutic strategies for both cognitive and behavioural symptoms in FTD and AD.
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| 9. |
- Kvickstrom, Pia, et al.
(författare)
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Selective frontal neurodegeneration of the inferior fronto-occipital fasciculus in progressive supranuclear palsy (PSP) demonstrated by diffusion tensor tractography
- 2011
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Ingår i: BMC Neurology. - : Springer Science and Business Media LLC. - 1471-2377. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Background: The clinical presentation in progressive supranuclear palsy (PSP), an atypical parkinsonian disorder, includes varying degrees of frontal dysexecutive symptoms. Using diffusion tensor imaging (DTI) and tractography (DTT), we investigated whether diffusion changes and atrophy of the inferior fronto-occipital fasciculus (IFO) occurs in PSP and if these changes correlate with disease stage and clinical phenotype. The corticospinal tract (CST), which is often involved in PSP, was investigated for comparison. Methods: DTI of the whole brain was performed with a 3 T MR scanner using a single shot-EPI sequence with diffusion encoding in 48 directions. Scans were obtained in patients with PSP (n = 13) and healthy age-matched controls (n = 12). DTT of the IFO and CST was performed with the PRIDE fibre tracking tool (Philips Medical System). Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were calculated and correlated with disease stage and clinical phenotype. Results: In patients with PSP, significantly decreased FA and increased ADC was found in the frontal part of IFO compared with the medial and occipital parts of IFO, as well as compared to controls. Four of the thirteen patients with PSP showed a marked decrease in the number of tracked voxels in the frontal part of IFO. These findings were most pronounced in patients with severe frontal cognitive symptoms, such as dysexecutive problems, apathy and personality change. There was a strong correlation (r(2) = -0.84; p < 0,001) between disease stage and FA and ADC values in the CST. Conclusions: DTT for identification of neuronal tracts with subsequent measurement of FA and ADC is a useful diagnostic tool for demonstrating patterns of neuronal tract involvement in neurodegenerative disease. In selected tracts, FA and ADC values might act as surrogate markers for disease stage.
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| 10. |
- Landqvist, Maria, et al.
(författare)
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Frontotemporal demens heterogen sjukdomsgrupp.
- 2009
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Ingår i: Läkartidningen. - 0023-7205. ; 106:20, s. 1381-1385
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Tidskriftsartikel (refereegranskat)abstract
- Frontotemporal lobar degeneration (FTLD) or frontotemporal dementia (FTD) is a clinically and neuropathologically heterogeneous group of primary degenerative dementia diseases. The clinical representation consists of progressive psychiatric and/or neurological symtoms such as behavioural changes, language or motor dysfunction. FTD is usually divided into the following subgroups: Behavioural variant FTD (FTD-bv), semantic dementia (SD), progressive non-fluent aphasia (PNFA) and FTD with motor neuron disease (FTD-MND). Progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) show both clinical and neuropathological similarities to FTD, and therefore are often considered being part of the FTD complex. Knowledge about the great diversity in phenotype of FTD facilitates early refererral and diagnosis of patients, which is necessary for adequate support and treatment.
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