| 1. |
- Dunberger, Gail, et al.
(author)
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Lower limb lymphedema in gynecological cancer survivors-effect on daily life functioning.
- 2013
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In: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. - : Springer Science and Business Media LLC. - 1433-7339 .- 0941-4355. ; 21:11, s. 3063-70
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Journal article (peer-reviewed)abstract
- Lower limb lymphedema (LLL) is a common condition after pelvic cancer treatment but few studies have evaluated its effect on the quality of life and its consequences on daily life activities among gynecological cancer survivors.
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| 2. |
- Lindquist, Helene, et al.
(author)
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Self-Care Among Female Cancer Survivors With Secondary Lymphedema: A Qualitative Study
- 2015
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In: Rehabilitation Oncology. - : Ovid Technologies (Wolters Kluwer Health). - 2168-3808. ; 33:1, s. 51-57
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Journal article (peer-reviewed)abstract
- Objectives: To describe experiences about management of self-care in female cancer survivors with lymphedema. Methodological approach: Descriptive qualitative. We used individual open interviews 1.5-2 hours per individual about self-care related to secondary lymphedema. Eight female cancer survivors with secondary lymphedema participated. The interviews were audio recorded and transcribed verbatim. The content was analysed with a phenomenographical approach. Findings: Eight major themes emerged in the study: acceptance, recovery, physical activity, manageability, obstacles, social self-care, manual self-treatment, and ergonomics. The major themes were classified in subcategories. Conclusion: The study indicates that self-care involves physical, psychological, and social aspects, which mean that all perspectives should be included to help patients adhere to self-care. We need to understand that acceptance of having lymphedema can empower the patients to actually deal with self-care. Interpretation: We need to help the patients to talk about the obstacles with self-care. We could motivate them to see the good things about themselves when the self-care gives results and talk open minded with them about their frustration and guilt about not doing enough. A dialogue with others in the same situation, support from family and friends, and good advice from health care can empower the women, increase their self-esteem and make them feel good, and thus actually do the self-care.
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| 3. |
- Lindquist, Helene
(author)
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Self performed treatment in female cancer survivors with secondary lymphedema
- 2015
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Doctoral thesis (other academic/artistic)abstract
- Background and aim: Many female cancer survivors who suffer from the consequences of secondary lymphedema experience physical, physiological and social limitations. Many studies have been made of some elements of self-care in the management of lymphedema but there are few if any studies of all of the potential elements that self-care might consist of. Therefore the overall aim of this study was to identify and then explore as many of the different elements of self-care as possible that are applicable in dealing with secondary lymphedema in female cancer survivors. Methods: In study I, a cohort of women (n=786) treated with radiotherapy after gynecological cancer treatment answered a study-specific questionnaire. In study II women (n=8) were interviewed about self-care. Study III was a cross-sectional study (n=83) and the women answered a study-specific questionnaire. The same women were included in study IV, a clinical controlled intervention (n=88). The women answered a lymphedema study-specific questionnaire and a questionnaire on daily function. The women were also measured for the outcome limb volume, joint movement and BMI. Results: In study I, overall quality of life was significantly lower among women with LLL, with a RR 1.4, 95 % CI 1.2-1.7. The women reported that LLL had a negative impact on several daily activities. In study II self-care as practiced by these women consisted of elements that were physical, physiological and social. The emerging themes were: Acceptance, Recovery, Physical activity, Manageability, Obstacles, Social self-care, Manual self-treatment and Ergonomics. In study III, women with low well-being (OR= 4.5, CI 1.7-11.7) not accepting their body (OR= 3.9, CI 1.0-15.3) and ethnicities other than Swedish (OR= 5.3, CI 1.1-25.6) were observed to engage less in self-care of their lymphedema. Not accepting lymphedema was a risk to think that self-care did not help (OR= 5.9, CI 1.6-22.4). Sleep quality and self-care were correlated (r = 0.2, p = 0.04). In study IV, there was a higher percent of women who participated in water exercise and who thus reduced their arm limb volume (p=0.029), BMI (p=0.047) and self-reported swelling (p= 0.031). Women in land exercise improved their DASH scores (p=0.047) and outer rotation in the shoulder (p= 0.001). Conclusions: Lower Limb Lymphedema has a negative impact on quality of life, affects sleep and daily life activities, yet few women seek professional help. Self-care involves physical, psychological and social aspects and acceptance may have an influence on if and how the women do self-care. Almost 60 % of the women performed self-care every day despite the fact that 50 % of them reported that self-care did not help. Furthermore, at risk of not taking care of themselves with self-care were women with low well-being, women who reported difficulties in accepting their body and women with ethnicity other than Swedish. We found that a greater percent of women decreased their secondary lymphedema volume, BMI and frequency of swelling after engaging in water exercise than in land exercise. In the land group, improvements were shown in daily shoulder function, and in outer rotation of the shoulder. Implications: It is important to actively ask patients at risk for lower limb lymphedema about early signs of lymphedema and then help them to get early treatment. We could do more to empower the patients to see the good things within themselves and have an open dialogue about obstacles, frustration and guilt about not doing enough in the field of self-care. Social support can increase the patients’ self-esteem. Low well-being, negative body-image and ethnicity other than Swedish can be factors worth registering in medical records so they can be taken into consideration in helping vulnerable individuals adjust to self-care. Water-based exercise can be appropriate treatment influencing and improving limb volume and BMI. Land-based exercise can be appropriate treatment resulting in improved shoulder function in these patients. Adequate evidence-based programs are needed.
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| 4. |
- Martin, Francis, et al.
(author)
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The genome of Laccaria bicolor provides insights into mycorrhizal symbiosis
- 2008
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In: Nature. - : Springer Science and Business Media LLC. - 0028-0836 .- 1476-4687. ; 452:7183, s. 7-88
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Journal article (peer-reviewed)abstract
- Mycorrhizal symbioses -- the union of roots and soil fungi -- are universal in terrestrial ecosystems and may have been fundamental to land colonization by plants1,2. Boreal, temperate, and montane forests all depend upon ectomycorrhizae1. Identification of the primary factors that regulate symbiotic development and metabolic activity will therefore open the door to understanding the role of 2 ectomycorrhizae in plant development and physiology, allowing the full ecological significance of this symbiosis to be explored. Here, we report the genome sequence of the ectomycorrhizal basidiomycete Laccaria bicolor (Fig. 1) and highlight gene sets involved in rhizosphere colonization and symbiosis. This 65-million-base genome assembly contains ~ 20,000 predicted protein-encoding genes and a very large number of transposons and repeated sequences. We detected unexpected genomic features most notably a battery of effector-type small secreted proteins (SSP) with unknown function, several of which are only expressed in symbiotic tissues. The most highly expressed SSP accumulates in the proliferating hyphae colonizing the host root. The ectomycorrhizae-specific proteins likely play a decisive role in the establishment of the symbiosis. The unexpected observation that the genome of L. bicolor lacks carbohydrate-active enzymes involved in degradation of plant cell walls, but maintains the ability to degrade non-plant cell walls, reveals the dual saprotrophic and biotrophic lifestyle of the mycorrhizal fungus which enables it to grow within both soil and living plant roots. The predicted gene inventory of the L. bicolor genome, therefore, points to previously unknown mechanisms of symbiosis operating in biotrophic mycorrhizal fungi. The availability of this genome provides an unparalleled opportunity to develop a deeper understanding of the processes by which symbionts interact with plants within their ecosystem in order to perform vital functions in the carbon and nitrogen cycles that are fundamental to sustainable plant productivity.
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| 5. |
- Reuterswärd, Philippa, et al.
(author)
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Levels of human proteins in plasma as indicators for acute severe pediatric malaria
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Other publication (other academic/artistic)abstract
- BackgroundExisting low resource diagnostics for malaria infection suffer from sensitivity and specificity issues while lacking sufficient prognostic value. Identifying human host proteins could improve the possibilities to predict the risk of development of acute severe malaria. This will possible enable improved treatment and thereby lead to a decrease in mortality of malaria infected children. Furthermore, discovering host proteins with altered levels during active infection could generate leads to better understand host-parasite interaction.ResultsHere, we have analyzed a total of 541 pediatric plasma samples that were collected from community controls and individuals with mild or severe malaria in Rwanda. Protein profiles of these plasma samples were generated with an antibody-based suspension bead array containing 255 antibodies targeting 115 human proteins. We present 22 proteins with a strong discriminatory capacity (adjusted p-values below 10-19) for separating malaria cases from community controls. This panel of proteins contains among others acute phase proteins and proteins connected to cell adhesion and migration. Among these, three proteins showed lower plasma levels in the group of malaria-infected individuals compared to the control group. One of these proteins is the anti-adhesive secreted protein acidic and cysteine rich (SPARC) with possible connections to parasite cytoadhesion. A multi-protein panel of six proteins, including SPARC, could differentiate between controls and malaria cases with an AUC of 0.98. Furthermore, a panel of 37 proteins, including proteins associated to erythrocyte membranes, was identified as candidates for separation of mild and severe malaria patients (adjusted pvalues below 0.05).ConclusionThe herein identified set of human proteins has a significant discriminatory capacity between community controls and malaria cases. We also present proteins offering the possibility to enable stratification and risk prediction for the development of severe malaria. This constitutes an important set that could enable enhanced understanding and thereby also possibilities for better treatment of acute severe pediatric malaria.
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| 6. |
- Reuterswärd, Philippa, et al.
(author)
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Levels of human proteins in plasma associated with acute paediatric malaria
- 2018
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In: Malaria Journal. - : BMC. - 1475-2875. ; 17
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Journal article (peer-reviewed)abstract
- Background: The intimate interaction between the pathophysiology of the human host and the biology of the Plasmodium falciparum parasite results in a wide spectrum of disease outcomes in malaria. Development of severe disease is associated with a progressively augmented imbalance in pro- and anti-inflammatory responses to high parasite loads and sequestration of parasitized erythrocytes. Although these phenomena collectively constitute common denominators for the wide variety of discrete severe malaria manifestations, the mechanistic rationales behind discrepancies in outcome are poorly understood. Exploration of the human pathophysiological response by variations in protein profiles in plasma presents an excellent opportunity to increase the understanding. This is ultimately required for better prediction, prevention and treatment of malaria, which is essential for ongoing elimination and eradication efforts. Results: An affinity proteomics approach was used to analyse 541 paediatric plasma samples collected from community controls and patients with mild or severe malaria in Rwanda. Protein profiles were generated with an antibody-based suspension bead array containing 255 antibodies targetting 115 human proteins. Here, 57 proteins were identified with significantly altered levels (adjusted p-values<0.001) in patients with malaria compared to controls. From these, the 27 most significant proteins (adjusted p-values<10(-14)) were selected for a stringent analysis approach. Here, 24 proteins showed elevated levels in malaria patients and included proteins involved in acute inflammatory response as well as cell adhesion. The remaining three proteins, also implicated in immune regulation and cellular adhesivity, displayed lower abundance in malaria patients. In addition, 37 proteins (adjusted p-values<0.05) were identified with increased levels in patients with severe compared to mild malaria. This set includes, proteins involved in tissue remodelling and erythrocyte membrane proteins. Collectively, this approach has been successfully used to identify proteins both with known and unknown association with different stages of malaria. Conclusion: In this study, a high-throughput affinity proteomics approach was used to find protein profiles in plasma linked to P. falciparum infection and malaria disease progression. The proteins presented herein are mainly involved in inflammatory response, cellular adhesion and as constituents of erythrocyte membrane. These findings have a great potential to provide increased conceptual understanding of host-parasite interaction and malaria pathogenesis.
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| 7. |
- Warrén Stomberg, Margareta, et al.
(author)
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Postoperative pain management on surgical wards-impact of database documentation of anesthesia organized services.
- 2003
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In: Pain management nursing : official journal of the American Society of Pain Management Nurses. - : Elsevier. - 1524-9042 .- 1532-8635. ; 4:4, s. 155-64
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Journal article (peer-reviewed)abstract
- Postoperative pain management (POPM) should be based on an organization exploiting existing expertise and documenting the outcome of the POPM in each individual patient. The aims of the present study were to evaluate the adequacy of database documentation of POPM of an anesthesia organized, nurse-based, anesthesiologist-supervised acute pain service (APS) on surgical wards and to assess to what extent the information obtained was continuously used to improve practice. From 2890 registered cases in the database (patient controlled analgesia, n = 1975; epidural analgesia [EDA], n = 915), a homogeneous two-year sample of documentation charts from use of EDA for POPM in connection with major, open, abdominal surgical procedures (n = 381) was chosen for detailed analysis. The data charts contained information on patient data, drug dosage, total amount of infused drug, duration of EDA treatment, occurrence of side effects, and patient's level of satisfaction. The database information was easily accessible making assessment of relevant aspects of the routines, including associations between analgesic technique, patient related factors, and satisfaction with the services, immediately available. Only 58% of the data charts were properly completed and fed into the database but the clinical safety of the missing nondatabase documented sample was not found jeopardized. Although the database documentation routines were considered to fulfill basic requirements of data collection and monitoring of the appropriateness of POPM, they were not found to function optimally. The reason seemed to be inadequate feedback of information between the parties involved in the POPM services. The present study stresses the importance of establishing routines for adequate, continuous feedback of recorded audit data from the APS team to the surgical wards for the maintenance of a high level of compliance with accepted guidelines.
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