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| 7. |
- Holmberg, Carl Jacob, et al.
(author)
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The efficacy of immune checkpoint blockade for melanoma in-transit with or without nodal metastases - A multicenter cohort study
- 2022
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In: EUROPEAN JOURNAL OF CANCER. - : Elsevier BV. - 0959-8049 .- 1879-0852. ; 40:16
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Journal article (peer-reviewed)abstract
- Purpose: Guidelines addressing melanoma in-transit metastasis (ITM) recommend immune checkpoint inhibitors (ICI) as a first-line treatment option, despite the fact that there are no efficacy data available from prospective trials for exclusively ITM disease. The study aims to analyze the outcome of patients with ITM treated with ICI based on data from a large cohort of patients treated at international referral clinics. Methods: A multicenter retrospective cohort study of patients treated between January 2015 and December 2020 from Australia, Europe, and the USA, evaluating treatment with ICI for ITM with or without nodal involvement (AJCC8 N1c, N2c, and N3c) and without distant disease (M0). Treatment was with PD-1 inhibitor (nivolumab or pembrolizumab) and/or CTLA-4 inhibitor (ipilimumab). The response was evaluated according to the RECIST criteria modified for cutaneous lesions. Results: A total of 287 patients from 21 institutions in eight countries were included. Immunotherapy was first-line treatment in 64 (22%) patients. PD-1 or CTLA-4 inhibitor monotherapy was given in 233 (81%) and 23 (8%) patients, respectively, while 31 (11%) received both in combination. The overall response rate was 56%, complete response (CR) rate was 36%, and progressive disease (PD) rate was 32%. Median PFS was ten months (95% CI 7.4-12.6 months) with a one-, two-, and five-year PFS rate of 48%, 33%, and 18%, respectively. Median MSS was not reached, and the one-, two-, and five-year MSS rates were 95%, 83%, and 71%, respectively. Conclusion: Systemic immunotherapy is an effective treatment for melanoma ITM. Future studies should evaluate the role of systemic immunotherapy in the context of multimodality therapy, including locoregional treatments such as surgery, intralesional therapy, and regional therapies.
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- Fagher, K., et al.
(author)
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Preparing for snow-sport events at the Paralympic Games in Beijing in 2022 : recommendations and remaining questions
- 2022
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In: BMJ Open Sport & Exercise Medicine. - : BMJ. - 2055-7647. ; 8:1
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Research review (peer-reviewed)abstract
- During the 2022 Winter Paralympic Games in Beijing, the Para snow-sport events will be held at high altitudes and in possibly cold conditions while also requiring adjustment to several time zones. Furthermore, the ongoing COVID-19 pandemic may lead to suboptimal preparations. Another concern is the high rate of injuries that have been reported in the Para alpine and snowboard events. In addition to these challenges, Para athletes various impairments may affect both sports-specific demands and athlete health. However, the group of Para snow-sport athletes is an understudied population. Accordingly, this perspective paper summarises current knowledge to consider when preparing for the Paralympic Games in Beijing and point out important unanswered questions. We here focus specifically on how sport-specific demands and impairment-related considerations are influenced by altitude acclimatisation, cold conditions, travel fatigue and jetlag, complications due to the COVID-19 pandemic, and injury prevention and sports safety considerations. As Para athletes with spinal cord injury, limb deficiency, cerebral palsy and visual impairment account for the majority of the Para snow-sport athletes, the focus is mainly on these impairment groups. In brief, we highlight the extra caution required to ensure athlete health, performance and sports safety among Para athletes participating in the snow-sport events in the 2022 Beijing Paralympic Games. Although there is an urgent need for more high-quality research focusing on Para winter athletes, we hope these non-consensus recommendations will help prepare for the 2022 Beijing Paralympic Winter Games.
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- Appelbom, S, et al.
(author)
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The Rapid Implementation of a Psychological Support Model for Frontline Healthcare Workers During the COVID-19 Pandemic: A Case Study and Process Evaluation
- 2021
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In: Frontiers in psychiatry. - : Frontiers Media SA. - 1664-0640. ; 12, s. 713251-
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Journal article (peer-reviewed)abstract
- The COVID-19 pandemic highlighted the need for psychological support initiatives directed toward frontline healthcare workers, which can be rapidly and sustainably implemented during an infectious disease outbreak. The current case study presents a comprehensive model of psychological support that was implemented at an intensive care unit (ICU) during the first wave of the COVID-19 pandemic. The psychological support model aimed at promoting a resilient stress reaction among frontline staff by protecting physical, social, and psychological resources. The initiatives, targeting different groups of workers, included education and training, peer support, psychologist-supervised and unsupervised group sessions, on-boarding for transferred staff, manager support, and individual sessions for workers experiencing strong stress reactions. The results of the process evaluation of this rapid implementation suggest that peer support initiatives as well as daily group sessions were the most appreciated forms of psychological support. Psychologists involved in organizing and providing the support highlighted several aspects of a successful implementation of the support model: offering support during work hours (preferably after shift), positive attitude of line managers that framed support initiatives as a team effort, and involvement of experienced psychologists able to quickly adjust the content of the support according to the current needs. The study also identified two main problems of the current implementation: the lack of efficient planning due to the use of volunteer work and the need for more structural resources on the organizational level to ensure long-term sustainability of the support model and its implementation among all groups of healthcare staff. The current case study highlights the importance of establishing permanent structural resources and routines for psychological support integrated in clinical practice by healthcare organizations to improve both rapid and sustainable response to future crises.
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| 15. |
- Forsberg, A., et al.
(author)
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Once-only colonoscopy or two rounds of faecal immunochemical testing 2 years apart for colorectal cancer screening (SCREESCO): preliminary report of a randomised controlled trial
- 2022
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In: Lancet Gastroenterology & Hepatology. - : Elsevier BV. - 2468-1253. ; 7:6, s. 513-521
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Journal article (peer-reviewed)abstract
- Background Screening for colorectal cancer is done with lower gastrointestinal endoscopy or stool-based tests. There is little evidence from randomised trials to show primary colonoscopy reduces mortality in colorectal cancer We aimed to investigate the effect of screening with once-only colonoscopy or two rounds of faecal immunochemical test screening on colorectal cancer mortality and incidence. Methods We did a randomised controlled trial in Sweden (SCREESCO). Residents in 18 of 21 regions who were age 60 years in the year of randomisation were identified from a population register maintained by the Swedish Tax Agency. A statistician with no further involvement in the trial used a randomised block method to assign individuals to once-only colonoscopy, two rounds of faecal immunochemical testing (OC-Sensor; 2 years apart), or a control group (no intervention; standard diagnostic pathways), in a ratio of 1:6 for colonoscopy versus control and 1:2 for faecal immunochemical testing versus control. Masking was not possible due to the nature of the trial. The primary endpoints of the trial are colorectal cancer mortality and colorectal cancer incidence. Here, we report preliminary participation rates, baseline findings, and adverse events from March, 2014, to December, 2020, in the two intervention groups after completion of recruitment and screening, up to the completion of the second faecal immunochemical testing round. Analyses were done in the intention-to-screen population, defined as all individuals who were randomly assigned to the respective study group. This study is registered with Clinical Trials.gov, NCT02078804. Findings Between March 1, 2014, and Dec 31, 2020, 278 280 people were induded in the study; 31 140 were assigned to the colonoscopy group, 60 300 to the faecal immunochemical test group, and 186 840 to the control group. 10 679 (35.1%) of 30 400 people who received an invitation for colonoscopy participated. 33 383 (55.5%) of 60 137 people who received a postal faecal immunochemical test participated. In the intention-to-screen analysis, colorectal cancer was detected in 49 (0.16%) of 31140 people in the colonoscopy group versus 121 (0. 20%) of 60 300 in the faecal immunochemical test group (relative risk [RR] 0.78, 95% CI 0.56-1.09). Advanced adenomas were detected in 637 (2.05%) people in the colonoscopy group and 968 (1.61%) in the faecal immunochemical test group (RR 1.27, 95% CI 1.15-1.41). Colonoscopy detected more right-sided advanced adenomas than faecal immunochemical testing. There were two perforations and 15 major bleeds in 16 555 colonoscopies. No intervention-related deaths occurred. Interpretation The diagnostic yield and the low number of adverse events indicate that the design from this trial, both for once-only colonoscopy and faecal immunochemical test screening, could be transferred to a population-based screening service if a benefit in disease-specific mortality is subsequently shown. Copyright (C) 2022 Elsevier Ltd. All rights reserved.
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| 16. |
- Hadid, L. Z., et al.
(author)
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Ambipolar electrostatic field in negatively charged dusty plasma
- 2022
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In: Journal of Plasma Physics. - : Cambridge University Press. - 0022-3778 .- 1469-7807. ; 88:2
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Journal article (peer-reviewed)abstract
- We study the effect of negatively charged dust on the magnetic-field-aligned polarisation electrostatic field (E-parallel to) using Cassini's RPWS/LP in situ measurements during the `ring-grazing' orbits. We derive a general expression for E-parallel to and estimate for the first time in situ parallel to E-parallel to parallel to (approximately 10(-5) V m(-1)) near the Janus and Epimetheus rings. We further demonstrate that the presence of the negatively charged dust close to the ring plane (vertical bar Z vertical bar less than or similar to 0.11 R-s) amplifies parallel to E-parallel to parallel to by at least one order of magnitude and reverses its direction due to the effect of the charged dust gravitational and inertial forces. Such reversal confines the electrons at the magnetic equator within the dusty region, around 0.047 R-s above the ring plane. Furthermore, we discuss the role of the collision terms, in particular the ion-dust drag force, in amplifying E-parallel to. These results imply that the charged dust, as small as nanometres in size, can have a significant influence on the plasma transport, in particular ambipolar diffusion along the magnetic field lines, and so their presence must be taken into account when studying such dynamical processes.
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| 17. |
- Holmberg, M. K. G., et al.
(author)
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Cassini-Plasma Interaction Simulations Revealing the Cassini Ion Wake Characteristics : Implications for In-Situ Data Analyses and Ion Temperature Estimates
- 2021
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In: Journal of Geophysical Research - Space Physics. - : American Geophysical Union (AGU). - 2169-9380 .- 2169-9402. ; 126:8
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Journal article (peer-reviewed)abstract
- We have used Spacecraft Plasma Interaction Software (SPIS) simulations to study the characteristics (i.e., dimensions, ion depletion, and evolution with the changing spacecraft attitude) of the Cassini ion wake. We focus on two regions, the plasma disk at 4.5-€“4.7 RS, where the most prominent wake structure will be formed, and at 7.6 RS, close to the maximum distance at which a wake structure can be detected in the Cassini Langmuir probe (LP) data. This study also reveals how the ion wake and the spacecraft plasma interaction have impacted the Cassini LP measurements in the studied environments, for example, with a strong decrease in the measured ion density but with minor interference from the photoelectrons and secondary electrons originating from the spacecraft. The simulated ion densities and spacecraft potentials are in very good agreement with the LP measurements. This shows that SPIS is an excellent tool to use for analyses of LP data, when spacecraft material properties and environmental parameters are known and used correctly. The simulation results are also used to put constraints on the ion temperature estimates in the inner magnetosphere of Saturn. The best agreement between the simulated and measured ion density is obtained using an ion temperature of 8 eV at ∼4.6 RS. This study also shows that SPIS simulations can be used in order to better constrain plasma parameters in regions where accurate measurements are not available.
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| 20. |
- Huybrighs, H. L. F., et al.
(author)
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An Active Plume Eruption on Europa During Galileo Flyby E26 as Indicated by Energetic Proton Depletions
- 2020
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In: Geophysical Research Letters. - : American Geophysical Union (AGU). - 0094-8276 .- 1944-8007. ; 47:10
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Journal article (peer-reviewed)abstract
- Strong depletions of energetic protons (115-244 keV) were observed during Galileo flyby E26 of Europa. We simulate the flux of energetic protons using a Monte Carlo particle backtracing code and show that energetic proton depletions during E26 are reproduced by taking into account the perturbations of the electromagnetic fields calculated by magnetohydrodynamic (MHD) simulations and charge exchange with a global atmosphere and plume. A depletion feature occurring shortly after closest approach is driven by plume associated charge exchange, or a combination with plume associated field perturbations. We therefore conclude, with a new method and independent data set, that Galileo could have encountered a plume during E26.
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| 21. |
- Huybrighs, H. L. F., et al.
(author)
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Reply to Comment on "An Active Plume Eruption on Europa During Galileo Flyby E26 as Indicated by Energetic Proton Depletions"
- 2021
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In: Geophysical Research Letters. - : American Geophysical Union (AGU). - 0094-8276 .- 1944-8007. ; 48:18
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Journal article (peer-reviewed)abstract
- In Huybrighs et al. (2020, https://doi.org/10.1029/2020gl087806) we investigated energetic proton depletions along Galileo's Europa flyby E26. Based on a particle tracing analysis, we proposed that depletions are caused by perturbed electromagnetic fields combined with atmospheric charge exchange and possible plumes. One depletion feature identified as a plume signature was shown to be an artifact (Jia et al., 2021, https://doi.org/10.1029/2020gl091550). Despite that, here we emphasize that Huybrighs et al. (2020, https://doi.org/10.1029/2020gl087806) demonstrates that plumes can cause proton depletions and that these features should be sought after. Furthermore, the conclusions on the importance of perturbed electromagnetic fields and atmospheric charge exchange on the depletions are unaffected. We suggest that the artifact's cause is a mistagging of protons as heavier ions by EPD. The artifact prevents us from confirming or excluding that there is a plume-associated depletion. We also address comments on the MHD simulations and demonstrate that 540-1,040 keV losses are not necessarily inconsistent with 115-244 keV losses by plume-associated charge exchange. Plain Language Summary In Huybrighs et al. (2020, https://doi.org/10.1029/2020gl087806) we identified why fast protons were disappearing during Europa flyby E26 by Galileo. Beyond impacting on the surface, we identified several contributing factors: First, perturbed electromagnetic fields resulting from the interaction of Europa's atmosphere with the magnetospheric plasma, which deflect the protons. Second, atmospheric charge exchange. We also showed that a water plume eruption could cause a region in which disappearances occur due to a combination of charge exchange and magnetic deflections. We identified a 20s decrease of protons as evidence of such a plume. However, an artifact in the data reported by Jia et al. (2021, https://doi.org/10.1029/2020gl091550) coincides with this 20s moment and prevents us from reaching a conclusion on the occurrence of a plume-associated depletion. We emphasize that our conclusions on the importance of perturbed fields and charge exchange are unaffected, as the artifact only affects a short segment of the data we analyzed. Furthermore, our results demonstrate that plumes can cause proton depletions and that these features should be sought after in the data.
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| 22. |
- Jahnson, S., et al.
(author)
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Thromboembolism in Muscle-Invasive Bladder Cancer. A Population-based Nationwide Study
- 2021
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In: Bladder Cancer. - : IOS Press. - 2352-3727 .- 2352-3735. ; 7:2, s. 161-171
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Journal article (peer-reviewed)abstract
- BACKGROUND: Routine VTE prophylaxis within 30 days of radical cystectomy (RC) for urinary bladder cancer (UBC) is used to protect from venous thromboembolism (VTE). However, randomized studies and nationwide population-based studies are lacking. OBJECTIVE: To study VTE and risk factors for VTE in muscle-invasive UBC in a nationwide population-based series, with a focus on the association with RC with and without chemotherapy. MATERIALS AND METHODS: We studied all patients with clinical stage T2-T4 UBC diagnosed 1997 to 2014 in the Bladder Cancer Data Base Sweden (BladderBaSe). Previous VTE events and risk factors for VTE were registered from 1987. Cox regression analyses and Kaplan-Meier curves were performed to study risk factors for VTE and cumulative incidence of VTE. RESULTS: In 9720 patients (71% males) with a median age of 74 years 546 (5.6%) had VTE after diagnosis. In Cox analyses controlling for patient's and tumour characteristics, and risk factors for VTE, VTE after diagnosis and first treatment date were associated with chemotherapy with or without RC. Cumulative incidence of VTE increased during 24 months after diagnosis and first treatment date. VTE were less common in patients with previous cardiovascular disease. CONCLUSION: VTE was commonly observed after 30 days from diagnosis and from first treatment date in patients with T2-T4 UBC, particularly after chemotherapy. The findings suggest that long-term intervention studies of benefit and possible harms of VTE prophylaxis after UBC should be undertaken.
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- Josefsson, Andreas, 1979, et al.
(author)
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Effect of docetaxel added to bicalutamide in Hormone-Naive non-metastatic prostate cancer with rising PSA, a randomized clinical trial (SPCG-14)
- 2023
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In: Acta Oncologica. - 0284-186X. ; 62:4, s. 372-380
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Journal article (peer-reviewed)abstract
- BackgroundHistorically, endocrine therapy was used in a range of scenarios in patients with rising PSA, both as a treatment for locally advanced non-metastatic prostate cancer and PSA recurrence following curative intended therapy. In the present study the objective was to investigate if chemotherapy added to endocrine therapy could improve progression-free survival (PFS).Materials and MethodsPatients with hormone-naive, non-metastatic prostate cancer and rising prostate-specific antigen (PSA), enrolled from Sweden, Denmark, the Netherlands, and Finland, were randomized to long-term bicalutamide (150 mg daily) or plus docetaxel (75 mg/m(2), q3w, 8-10 cycles) without prednisone, after stratification for the site, prior local therapy or not, and PSA doubling time. The primary endpoint was 5-year PFS analyzed with a stratified Cox proportional hazards regression model on intention to treat basis.ResultsBetween 2009 and 2018, a total of 348 patients were randomized; 315 patients had PSA relapse after radical treatment, 33 patients had no prior local therapy. Median follow-up was 4.9 years (IQR 4.0-5.1). Adding docetaxel improved PFS (HR 0.68, 95% CI 0.50-0.93; p = 0.015). Docetaxel showed an advantage for patients with PSA relapse after prior local therapy (HR 0.67, 95% CI 0.49-0.94; p = 0.019). One event of neutropenic infection/fever occurred in 27% of the patients receiving docetaxel. Limitations were slow recruitment, lack of enrolling patients without radical local treatment, and too short follow-up for evaluation of overall survival in patients with PSA relapse.ConclusionDocetaxel improved PFS in patients starting bicalutamide due to PSA relapse after local therapy or localized disease without local therapy. Confirmatory studies of the efficacy of docetaxel in the setting of PSA-only relapse in addition to endocrine therapies may be justified if longer follow-up will show increased metastatic-free survival.
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| 25. |
- Liedberg, F., et al.
(author)
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Preoperative upper tract invasive diagnostic modalities are associated with intravesical recurrence following surgery for upper tract urothelial carcinoma : A population-based study
- 2023
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In: European Urology. - : Elsevier. - 0302-2838 .- 1873-7560. ; 83:Suppl. 1, s. S720-S721
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Journal article (other academic/artistic)abstract
- Introduction & Objectives: Evidence based mainly on small retrospective series points to an increased risk of intravesical recurrence (IVR) after preoperative diagnostic ureteroscopy (URS) in upper tract urothelial carcinoma (UTUC). We investigated if preoperative invasive diagnostic modalities (IDM) are associated with IVR after radical surgery for UTUC. Secondly, risk of death from urothelial cancer and all causes was investigated.Materials & Methods: We investigated a population-based cohort of 1038 consecutive patients subjected to radical surgery for UTUC 2015–2019 in Sweden, using the Bladder Cancer Data Base Sweden (BladderBaSe 2.0), comprising all patients in the Swedish National Registry of Urinary Bladder Cancer. Risk estimates of IVR, death from urothelial cancer, and all causes following IDM (antegrade/retrograde uretero-pyelography and/or selective urine cytology/barbotage, and URS with or without concomitant biopsy) was assessed using multivariable Cox regression models adjusted for age, gender, clinical tumour stage, tumour location (renal pelvis/ureter/both), ipsilateral bladder cuff excision, previous bladder cancer, comorbidity, and educational level.Results: The study included 536 cases with and 502 without preoperative IDM. IDM was associated with increased risk of IVR (HR 1.24, 95% CI 1.03-1.52) and risk of urothelial cancer death (HR 1.56, CI 1.12-2.18), compared to no IDM after a median follow-up of 1.3 yrs. Stratified analysis for tumor location showed that IDM was associated with risk of IVR in ureteric cancer (HR 1.66, 95% CI 1.21-2.28) but not in renal pelvic cancer (HR 1.07, 95% CI 0.81-1.41). Limitations include the observational setting and the lack of information on tumour grade, multifocality and preoperative hydronephrosis.Conclusions: Worse outcomes for patients subjected to preoperative IDM highlight the need for carefully considering diagnostic decisions for UTUC patients, specifically in tumours located in the ureter.
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| 27. |
- Lydahl, Doris, 1986, et al.
(author)
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Doing data together - affective relations and mobile ethnography in home visits
- 2021
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In: Qualitative Research. - : SAGE Publications. - 1468-7941 .- 1741-3109. ; 21:4, s. 515-530
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Journal article (peer-reviewed)abstract
- This article is concerned with the doing and production of data. We ask how data are made in intimate spaces such as the home in collaboration with the different parties involved in home-based care and services. The article builds on ethnographic field notes from 73 home visits, in the context of home-based mental health, substance abuse and social care for adults in Finland and Sweden. Drawing on affect theory, the article aims to foreground aspects of the production of data and research that are often edited out of the research process. In so doing, we argue that the production of data would not be possible without the active and affective collaboration of all parties involved in home visits. Thus, the article scrutinizes in detail the efforts made by different parties, such as researchers, clients and workers to do and produce data. While we study an atypical setting of institutional interaction, we contend that affects and affective relations gain particular importance in the home.
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