| 1. |
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| 2. |
- Enocsson, Helena, et al.
(författare)
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Soluble urokinase plasminogen activator receptor (suPAR) levels predict damage accrual in patients with recent-onset systemic lupus erythematosus
- 2020
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Ingår i: Journal of Autoimmunity. - : Elsevier BV. - 0896-8411 .- 1095-9157. ; 106
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The soluble urokinase plasminogen activator receptor (suPAR) has potential as a prognosis and severity biomarker in several inflammatory and infectious diseases. In a previous cross-sectional study, suPAR levels were shown to reflect damage accrual in cases of systemic lupus erythematosus (SLE). Herein, we evaluated suPAR as a predictor of future organ damage in recent-onset SLE. Methods: Included were 344 patients from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort who met the 1997 American College of Rheumatology classification criteria with 5-years of follow-up data available. Baseline sera from patients and age- and sex-matched controls were assayed for suPAR. Organ damage was assessed annually using the SLICC/ACR damage index (SDI). Results: The levels of suPAR were higher in patients who accrued damage, particularly those with SDI≥2 at 5 years (N = 32, 46.8% increase, p = 0.004), as compared to patients without damage. Logistic regression analysis revealed a significant impact of suPAR on SDI outcome (SDI≥2; OR = 1.14; 95% CI 1.03–1.26), also after adjustment for confounding factors. In an optimized logistic regression to predict damage, suPAR persisted as a predictor, together with baseline disease activity (SLEDAI-2K), age, and non-Caucasian ethnicity (model AUC = 0.77). Dissecting SDI into organ systems revealed higher suPAR levels in patients who developed musculoskeletal damage (SDI≥1; p = 0.007). Conclusion: Prognostic biomarkers identify patients who are at risk of acquiring early damage and therefore need careful observation and targeted treatment strategies. Overall, suPAR constitutes an interesting biomarker for patient stratification and for identifying SLE patients who are at risk of acquiring organ damage during the first 5 years of disease.
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| 3. |
- Johansson, Edvin, et al.
(författare)
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Perfusion assessment with bolus differentiation : a technique applicable to hyperpolarized tracers
- 2004
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Ingår i: Magnetic Resonance in Medicine. - : Wiley. - 0740-3194 .- 1522-2594. ; 52:5, s. 51-1043
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Tidskriftsartikel (refereegranskat)abstract
- A new technique for assessing tissue blood flow using hyperpolarized tracers, based on the fact that the magnetization of a hyperpolarized substance can be destroyed permanently, is described. Assessments of blood flow with this technique are inherently insensitive to arterial delay and dispersion, and allow for quantification of the transit time and dispersion in the arteries that supply the investigated tissue. Renal cortical blood flow was studied in six rabbits using a 13C-labeled compound (2-hydroxyethylacrylate) that was polarized by the parahydrogen-induced polarization (PHIP) technique. The renal cortical blood flow was estimated to be 5.7/5.4 +/- 1.6/1.3 ml/min per milliliter of tissue (mean +/- SD, right/left kidney), and the mean transit time and dispersion in the renal arteries were determined to be 1.47/1.42 +/- 0.07/0.07 s and 1.78/1.93 +/- 0.40/0.42 s2, respectively.
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| 4. |
- Jönsson, Bo-Anders, et al.
(författare)
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EMERALD & EMIT – worldwide computer aided education and training packages in medical physics
- 2005
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Ingår i: CAL-laborate. - 1443-4482. ; 13:June, s. 10-15
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Tidskriftsartikel (refereegranskat)abstract
- This paper describes the development of two web based education and training packages EMERALD and EMIT designed to meet the training needs of professional medical physicists. The programme has been developed over a number of years by collaboration between hospitals and universities across Europe. The programme concentrates on assisting competence development in five initial areas; diagnostic radiology, nuclear medicine, magnetic resonance tomography, ultrasound and radiotherapy. Each of the topic areas includes around 50 training tasks in 5 hypertext workbooks, which are supplemented by an image database relevant to each topic. The training materials have been extensively refereed during their development and are now in use in 65 countries across the globe. Initial evaluation has shown that the material enhances the training experience and produces a more consistent output.
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| 5. |
- Salomonsson, T., et al.
(författare)
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Abnormal cerebral hemodynamics and blood-brain barrier permeability detected with perfusion MRI in systemic lupus erythematosus patients
- 2023
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Ingår i: NeuroImage: Clinical. - : Elsevier BV. - 2213-1582. ; 38
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI) has previously shown alterations in cerebral perfusion in patients with systemic lupus erythematosus (SLE). However, the results have been inconsistent, in particular regarding neuropsychiatric (NP) SLE. Thus, we investigated perfusion-based measures in different brain regions in SLE patients with and without NP involvement, and additionally, in white matter hyperintensities (WMHs), the most common MRI pathology in SLE patients. Materials and methods: We included 3 T MRI images (conventional and DSC) from 64 female SLE patients and 19 healthy controls (HC). Three different NPSLE attribution models were used: the Systemic Lupus International Collaborating Clinics (SLICC) A model (13 patients), the SLICC B model (19 patients), and the American College of Rheumatology (ACR) case definitions for NPSLE (38 patients). Normalized cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were calculated in 26 manually drawn regions of interest and compared between SLE patients and HC, and between NPSLE and non-NPSLE patients. Additionally, normalized CBF, CBV and MTT, as well as absolute values of the blood-brain barrier leakage parameter (K2) were investigated in WMHs compared to normal appearing white matter (NAWM) in the SLE patients. Results: After correction for multiple comparisons, the most prevalent finding was a bilateral significant decrease in MTT in SLE patients compared to HC in the hypothalamus, putamen, right posterior thalamus and right anterior insula. Significant decreases in SLE compared to HC were also found for CBF in the pons, and for CBV in the bilateral putamen and posterior thalamus. Significant increases were found for CBF in the posterior corpus callosum and for CBV in the anterior corpus callosum. Similar patterns were found for both NPSLE and non-NPSLE patients for all attributional models compared to HC. However, no significant perfusion differences were revealed between NPSLE and non-NPSLE patients regardless of attribution model. The WMHs in SLE patients showed a significant increase in all perfusion-based metrics (CBF, CBV, MTT and K2) compared to NAWM. Conclusion: Our study revealed perfusion differences in several brain regions in SLE patients compared to HC, independently of NP involvement. Furthermore, increased K2 in WMHs compared to NAWM may indicate blood-brain barrier dysfunction in SLE patients. We conclude that our results show a robust cerebral perfusion, independent from the different NP attribution models, and provide insight into potential BBB dysfunction and altered vascular properties of WMHs in female SLE patients. Despite SLE being most prevalent in females, a generalization of our conclusions should be avoided, and future studies including all sexes are needed.
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| 6. |
- Walhelm, T., et al.
(författare)
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FACTORS ASSOCIATED WITH SURVIVAL AND DISCONTINUATION OF ANTIMALARIAL AGENTS IN SYSTEMIC LUPUS ERYTHEMATOSUS : RESULTS FROM A SWEDISH LONGITUDINAL REGISTRY
- 2023
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Ingår i: Annals of the Rheumatic Diseases. - : HighWire Press. - 0003-4967 .- 1468-2060. ; 82:Suppl. 1, s. 902-903
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Hydroxychloroquine (HCQ) and chloroquine, referred to as antimalarial agents (AMA), are cornerstone drugs in systemic lupus erythematosus (SLE), which inhibit type I interferon release via toll-like receptor binding and increasing the pH in plasmacytoid dendritic cell lysosomes [1]. AMA use has established benefits in SLE, such as improved prognosis and decelerated accrual of organ damage. Use of HCQ is safe for most patients and serious side-effects are uncommon, even during pregnancy. Medical therapy to prevent repeated disease flares is of essential weight in the treatment of SLE. However, it is well-known that non-adherence to prescription of AMA is a considerable problem [2].Objectives: The aim of this cross-sectional study was to investigate the frequency of AMA prescription, and evaluate factors associated with ongoing use and discontinuation of AMA in a Swedish SLE population.Methods: We retrieved data from the Clinical Lupus Register in North-Eastern Gothia (Swedish acronym: KLURING), a longitudinal research and quality registry, including all prevalent and incident cases of SLE in the Östergötland County from 2008 onwards. All included subjects fulfilled the validated 1982 American College of Rheumatology (ACR) and/or the 2012 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria and had been diagnosed from 1963 onwards. Factors associated with ongoing use and discontinuation of AMA were investigated using logistic regression analysis, Mann-Whitney U test and chi-square test.Results: A total of 328 subjects were included in the analysis. The mean age at diagnosis was 40.0 years (range: 3–85; standard deviation [SD]: 17.7) and 85.7% were females. The mean SLICC/ACR damage index (SDI) score at last visit was 2.0 (range: 0—11; SD: 2.5). In total, 92.4% had used AMA at some point during their disease course (“ever” users; Table 1). Data from the last available visit indicated that 73.2% were currently prescribed AMA, exclusively HCQ, yielding a daily mean HCQ dose of 228.0 mg (range: 100—400; SD: 71.0). Among individuals who had discontinued AMA, 25.9% had developed a contraindication, mostly on ophthalmological basis (33.3%). Less common reasons were cardiac conditions (19.0%) and renal failure (9.5%). Subjective side-effects were also common; the most frequently reported were gastrointestinal symptoms (n=20/37). Most common patient-related factor associated with discontinuation was intentional non-adherence (e.g., low motivation; 8/11). Patients who had discontinued AMA showed a higher SDI score at the last visit (mean: 2.9; SD: 2.8; mean follow-up: 20.0 years) compared with patients on AMA (mean: 1.4; SD: 1.8; p=0.001; mean follow-up: 15.3 years). Those who fulfilled the immunological disorder ACR criterion (ACR-10) were more likely to continue on AMA (p=0.003). No significant differences were found regarding gender or smoking status. Conclusion: The vast majority of patients in KLURING had been exposed to AMA, and approximately 25% discontinued AMA therapy during follow-up. The main reason for discontinuation were therapy-related factors, such as contraindications and experience of side-effects. Above 50% of the reported side-effects that led to discontinuation were gastrointestinal symptoms. The group of discontinued AMA users accrued more damage over time.References:[1]Crow MK, Rönnblom L. Type I interferons in host defence and inflammatory diseases. Lupus Sci Med 2019;6:e000336[2]Costedoat-Chalumeau N, Houssiau F, Izmirly P, et al. A Prospective International Study on Adherence to Treatment in 305 Patients With Flaring SLE: Assessment by Drug Levels and Self-Administered Questionnaires. Clin Pharmacol Ther 2018;103:1074-1082
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| 7. |
- Wirestam, Lina, 1986-, et al.
(författare)
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Osteopontin and disease activity in patients with recent-onset systemic Lupus Erythematosus : Results from the SLICC Inception Cohort
- 2019
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Ingår i: Journal of Rheumatology. - : The Journal of Rheumatology. - 0315-162X .- 1499-2752. ; 46:5, s. 492-500
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Tidskriftsartikel (refereegranskat)abstract
- Objective. In cross-sectional studies, elevated osteopontin (OPN) levels have been proposed to reflect, and/or precede, progressive organ damage and disease severity in systemic lupus erythematosus (SLE). We aimed, in a cohort of patients with recent-onset SLE, to determine whether raised serum OPN levels precede damage and/or are associated with disease activity or certain disease phenotypes. Methods. We included 344 patients from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort who had 5 years of followup data available. All patients fulfilled the 1997 American College of Rheumatology (ACR) criteria. Baseline sera from patients and from age- and sex-matched population-based controls were analyzed for OPN using ELISA. Disease activity and damage were assessed at each annual followup visit using the SLE Disease Activity Index 2000 (SLEDAI-2K) and the SLICC/ACR damage index (SDI), respectively. Results. Compared to controls, baseline OPN was raised 4-fold in SLE cases (p < 0.0001). After relevant adjustments in a binary logistic regression model, OPN levels failed to significantly predict global damage accrual defined as SDI ≥ 1 at 5 years. However, baseline OPN correlated with SLEDAI-2K at enrollment into the cohort (r = 0.27, p < 0.0001), and patients with high disease activity (SLEDAI-2K ≥ 5) had raised serum OPN (p < 0.0001). In addition, higher OPN levels were found in patients with persistent disease activity (p = 0.0006), in cases with renal involvement (p < 0.0001) and impaired estimated glomerular filtration rate (p = 0.01). Conclusion. The performance of OPN to predict development of organ damage was not impressive. However, OPN associated significantly with lupus nephritis and with raised disease activity at enrollment, as well as over time.
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