| 1. |
- Enkirch, Theresa, et al.
(author)
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Hepatitis A outbreak linked to imported frozen strawberries by sequencing, Sweden and Austria, June to September 2018
- 2018
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In: Eurosurveillance. - : European Centre for Disease Prevention and Control. - 1025-496X .- 1560-7917. ; 23:41
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Journal article (peer-reviewed)abstract
- Between June-September 2018, 20 hepatitis A cases were notified in six counties in Sweden. Combined epidemiological and microbiological investigations identified imported frozen strawberries produced in Poland as the source of the outbreak. Sequence analysis confirmed the outbreak strain IB in the strawberries with 100 % identity and the respective batch was withdrawn. Sharing the sequence information internationally led to the identification of 14 additional cases in Austria, linked to strawberries from the same producer.
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| 2. |
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| 3. |
- Bergström, Ida, et al.
(author)
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Annexin A1 in blood mononuclear cells from patients with coronary artery disease : Its association with inflammatory status and glucocorticoid sensitivity
- 2017
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In: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 12:3
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Journal article (peer-reviewed)abstract
- Annexin A1 (AnxA1) is a key player in resolution of inflammation and a mediator of glucocorticoid actions. In atherosclerotic tissue, increased expression of AnxA1 has been associated with protective plaque-stabilizing effects. Here, we investigated the expression of AnxA1 in peripheral blood mononuclear cells (PBMCs) from patients with coronary artery disease (CAD). Blood was collected from 57 patients with stable CAD (SCAD) and 41 healthy controls. We also included a minor group (n = 10) with acute coronary syndrome (ACS). AnxA1 mRNA was measured in PBMCs. Expression of AnxA1 protein (total and surface-bound) and glucocorticoid receptors (GR) were detected in PBMC subsets by flow cytometry. Also, salivary cortisol, interleukin(IL)-6 and IL-10 in plasma, and LPS-induced cytokine secretion from PBMCs, with or without dexamethasone, were assessed. AnxA1 mRNA was found to be slightly increased in PBMCs from SCAD patients compared with controls. However, protein expression of AnxA1 or GRs in PBMC subsets did not differ between SCAD patients and controls, despite SCAD patients showing a more proinflammatory cytokine profile ex vivo. Only surface expression of AnxA1 on monocytes correlated with dexamethasone-mediated suppression of cytokines. In ACS patients, a marked activation of AnxA1 was seen involving both gene expression and translocation of protein to cell surface probably reflecting a rapid glucocorticoid action modulating the acute inflammatory response in ACS. To conclude, surface expression of AnxA1 on monocytes may reflect the degree of glucocorticoid sensitivity. Speculatively, "normal" surface expression of AnxA1 indicates that anti-inflammatory capacity is impaired in SCAD patients.
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| 4. |
- Chung, Rosanna W S, et al.
(author)
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Lutein exerts anti-inflammatory effects in patients with coronary artery disease.
- 2017
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In: Atherosclerosis. - : Elsevier. - 0021-9150 .- 1879-1484. ; 262, s. 87-93
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Journal article (peer-reviewed)abstract
- BACKGROUND AND AIMS: Many coronary artery disease (CAD) patients exhibit chronic low-grade inflammation. Carotenoids are anti-oxidants with potential anti-inflammatory properties. Here, we first assessed relationships between interleukin (IL)-6 and individual carotenoids in plasma from CAD patients. Based on the results, we proceeded to assess anti-inflammatory effects of one carotenoid, lutein, in peripheral blood mononuclear cells (PBMCs) from CAD patients.METHODS: Lutein + zeaxanthin (isomers with lutein being dominant), β-cryptoxanthin, lycopene, α- and β-carotene and IL-6 were measured in plasma from 134 patients with stable angina (SA) and 59 patients with acute coronary syndrome. In 42 patients, plasma measurements were also performed 3 months after coronary intervention. PBMCs from SA patients were pre-treated with lutein (1, 5 and 25 μM) for 24 h followed by 24 h incubation ± lipopolysaccharide (LPS). Cell pellets were collected for IL-6, IL-1β and TNF mRNA and intracellular lutein. Cytokine secretion was measured in cell media.RESULTS: Only lutein + zeaxanthin were inversely correlated with IL-6 in SA patients at baseline (r = -0.366, p < 0.001) and follow-up (r = -0.546, p < 0.001). Ex vivo, lutein was taken up by PBMCs from SA patients in a dose- and time-dependent manner. Pre-treatment with lutein dose-dependently lowered LPS-induced secretion of IL-6, IL-1β (p < 0.01) and TNF (p < 0.05), and also reduced IL-6, IL-1β and TNF mRNA expression (p < 0.05).CONCLUSIONS: Clinical findings highlighted the inverse association between lutein and IL-6 in CAD patients. Anti-inflammatory effects of lutein in PBMCs from CAD patients were consolidated in ex vivo experiments. Taken together, these results show that lutein has the potential to play a role in resolution of chronic inflammation in CAD patients.
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| 5. |
- Claesson, Lena, et al.
(author)
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Expert Competence in Remote Diagnostics : Industrial Interests, Educational Goals, Flipped Classroom & Laboratory Settings
- 2018
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In: Online Engineering & Internet of Things. - Cham : Springer. - 9783319643526 - 9783319643519 ; , s. 438-451
-
Conference paper (peer-reviewed)abstract
- The manufacturing industry are dependent of engineering expertise. Currently the ability to supply the industry with engineering graduates and staff that have an up-to- date and relevant competences might be considered as a challenge for the society. In this paper an education approach is presented where academia - industry - research institutes cooperate around the development and implementation of master level courses. The methods applied to reach the educational goals, concerning expert competence within remote diagnostics, have been on site and remote lectures given by engineering, medical and metrology experts. The pedagogical approach utilized has been flipped classroom. The main results show that academic courses developed in cooperation with industry requires flexibility, time and effort from the involved partners. The evaluation interviews indicate that student are satisfied with the courses and pedagogical approach but suggests more reconciliation meetings for course development. Labs early in the course was considered good, and division of labs at the system and the component level. However further long- term studies of evaluation of impact is necessary.
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| 6. |
- Ekdahl, Anna-Lena, et al.
(author)
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Matematik i förskoleklassen VA-MER : Ett samverkansprojekt mellan Vaggeryds kommun och Mathematics Education Research
- 2019
-
Conference paper (other academic/artistic)abstract
- De senaste åren har en rad förändringar gällande förskoleklassen genomförts. Den 1 juli 2016 fick förskoleklassen en egen del i läroplanen och från och med läsåret 2018/19 blev förskoleklassen obligatorisk och omfattas nu av skolplikten. Det förändrade uppdraget i förskoleklassen samt det obligatoriska kartläggningsmaterialet, har ökat lärares behov av att möta uppdraget. Kartläggningsmaterialet i matematiskt tänkande ska hjälpa lärare att tidigt identifiera elever som visar en indikation på att inte nå de kunskapskrav som sen ska uppnås i årskurs 3 i grundskolan. Däremot saknas direkta implikationer för undervisning som stimulerar alla elevers möjlighet att utveckla sina förmågor i matematik.I ett nystartat samverkansprojekt mellan Vaggeryds kommun och Högskolan för Lärande och Kommunikation kommer kommunens alla lärare i förskoleklass att arbeta tillsammans med forskare tillhörande forskargruppen i matematik (MER-gruppen), i syfte att stärka likvärdighet i utbildningen inom Vaggeryd kommun.Syftet med projektet är att se hur en pedagogisk verksamhet i samverkan med forskare kan bidra till att lärarna:utvecklar förmågan att diskutera ämnesinnehåll i matematikundervisningen,utvecklar förmågan att utifrån kartläggningsmaterialet diskutera didaktiska implikationerna för undervisning,gemensamt bygger ett fundament i matematikundervisningen, med stöd av aktuell forskning, i syfte att utveckla alla elevers förmågor i matematik.Erfarenheter från ett nyligen avslutat forskningsprojekt där lärare och forskare i tätt samarbete genomförde och reflekterade över undervisningsaktiviteter, visar att detta verkade vara en framgångsrik modell för att utveckla undervisning. Därför väljs ett liknande upplägg i detta samverkansprojekt.I den inledande fasen av projektet träffas lärargruppen och forskarna en gång per månad. Träffarna förläggs på kommunens skolor. De påbörjade samtalen mellan deltagarna i samverkansprojektet visar att det finns ett stort behov av att diskutera matematikundervisning och att utveckla ett målinriktat arbete som främjar alla elevers möjligheter att lära matematik.
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| 7. |
- Eskilsson, Lena, et al.
(author)
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Film Tourism collaborations: a critical analysis of INTERREG destination development projects
- 2018
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In: The Routledge Handbook on Popular Culture and Tourism. - 9781138678354 - 9781315559018
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Book chapter (peer-reviewed)abstract
- This chapter discusses the different stakeholders that take part in film tourism development projects, how do they collaborate, and what is actually possible to achieve? It is a critical analysis especially when it comes to the selection of stakeholders, the project process and potential outcomes in EU-funded INTERREG projects. The analysis contributes to enhance the knowledge about the different stakeholders involved. It is evident that a new stakeholder has emerged in film tourism development projects; film commissions. Moreover, the analysis shows that it is important that a diverse range of partners collaborate. However, organizations sometimes weak knowledge of the phenomenon in play as well as of each other’s work creates problems especially in the beginning. The idea of measurability is another complicating factor since there are conflicting understandings of what is possible to measure within collaborating organizations. There is also a search for best cases that can be used as role models that totally neglects local characteristics, which raises questions of transferability. What can be concluded is that projects such as these can make a difference to single destinations with for example new policies being developed, local and international networks created and possibilities for new tourism development.
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| 8. |
- Hasib, Lekbira, et al.
(author)
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Functional and homeostatic defects of regulatory T cells in patients with coronary artery disease
- 2016
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In: Journal of Internal Medicine. - : WILEY-BLACKWELL. - 0954-6820 .- 1365-2796. ; 279:1, s. 63-77
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Journal article (peer-reviewed)abstract
- ObjectiveRegulatory T cells (Tregs) are considered atheroprotective, and low levels have been associated with the acute coronary syndrome (ACS), particularly non-ST elevation (NSTE)-ACS. However, the functional properties as well as homeostasis of Tregs are mainly unknown in coronary artery disease (CAD). Here, we investigated the composition and functional properties of naive (n) and memory (m)Tregs in patients with NSTE-ACS and in patients 6-12months post-ACS. MethodsBased on the expression of CD25, FOXP3, CD127, CD45RA, CD39 and CTLA-4, Tregsubsets were defined by flow cytometry in whole blood or isolated CD4(+) T cells. The functional properties of nTregs and mTregs were examined in terms of proliferative capacity and modulation of cytokine secretion. To understand the potential consequences of Treg defects, we also investigated correlations with lipopolysaccharide (LPS)-induced cytokine secretion and ultrasound-defined carotid atherosclerosis. ResultsBoth NSTE-ACS and post-ACS patients exhibited reduced levels of nTregs (P<0.001) compared with healthy control subjects, but without compensatory increases in mTregs. Both nTregs and mTregs from patients showed significantly lower replicative rates and impaired capacity to modulate T-cell proliferation and secretion of interferon-gamma and IL-10. The Treg defect was also associated with LPS-induced cytokine secretion and increased burden of carotid atherosclerosis. ConclusionOur results demonstrate a functional and homeostatic Treg defect in patients with NSTE-ACS and also in stabilized patients 6-12months after ACS. Moreover, this defect was associated with a subclinical proinflammatory and atherogenic state. We believe that the failure to preserve Treg function and homeostasis reflects a need for immune-restoring strategies in CAD.
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| 9. |
- Hofmeister, Wolfgang, et al.
(author)
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CTNND2-a candidate gene for reading problems and mild intellectual disability.
- 2015
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In: Journal of Medical Genetics. - : BMJ. - 0022-2593 .- 1468-6244. ; 52:2, s. 111-22
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Journal article (peer-reviewed)abstract
- BACKGROUND: Cytogenetically visible chromosomal translocations are highly informative as they can pinpoint strong effect genes even in complex genetic disorders.METHODS AND RESULTS: Here, we report a mother and daughter, both with borderline intelligence and learning problems within the dyslexia spectrum, and two apparently balanced reciprocal translocations: t(1;8)(p22;q24) and t(5;18)(p15;q11). By low coverage mate-pair whole-genome sequencing, we were able to pinpoint the genomic breakpoints to 2 kb intervals. By direct sequencing, we then located the chromosome 5p breakpoint to intron 9 of CTNND2. An additional case with a 163 kb microdeletion exclusively involving CTNND2 was identified with genome-wide array comparative genomic hybridisation. This microdeletion at 5p15.2 is also present in mosaic state in the patient's mother but absent from the healthy siblings. We then investigated the effect of CTNND2 polymorphisms on normal variability and identified a polymorphism (rs2561622) with significant effect on phonological ability and white matter volume in the left frontal lobe, close to cortical regions previously associated with phonological processing. Finally, given the potential role of CTNND2 in neuron motility, we used morpholino knockdown in zebrafish embryos to assess its effects on neuronal migration in vivo. Analysis of the zebrafish forebrain revealed a subpopulation of neurons misplaced between the diencephalon and telencephalon.CONCLUSIONS: Taken together, our human genetic and in vivo data suggest that defective migration of subpopulations of neuronal cells due to haploinsufficiency of CTNND2 contribute to the cognitive dysfunction in our patients.
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| 10. |
- Jansson, Anna, et al.
(author)
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Återvinning av plast från bygg- och rivningsprocesser.
- 2019
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Reports (other academic/artistic)abstract
- This report is one delivery (Work package 3) within the project CONSTRUCTIVATE focused on plastics construction materials and their recycling possibilities.Aim and objective of this part of the project was to compile the types of plastics present in construction and demolition waste (CDW) and investigate which can and should be recycled based on technical opportunities, environmental impact and economic aspects (such as market potential). Some material fractions were selected and methods to improve the recyclability and evaluate the material quality were studied. Some demonstrator products were manufactured in order to show some examples for use of the CDW material.Methods used were literature studies, market analysis, interviews, study visits and practical tests. The practical tests included material collection, manufacturing of test objects and evaluation of the product quality, for example fire resistance and mechanical strength.The conclusion is that it is technically possible and environmentally and economically justified to collect and recycle most building products in plastic, especially in construction. For installation waste, there are already collection systems for both plastic floors and plastic pipes. However, relatively little of the waste is collected in these systems. Therefore, given the great environmental benefits, it is very positive that projects have now started to develop both of these collection systems. An important prerequisite for recycling to increase is that builders and property owners begin to demand that the waste is collected. In order to have a good impact on the system, both project managers and floor contractors must take an active responsibility in this.During demolition and renovation, there may be obstacles if the products are joined or contaminated with other materials. Here, technology has been developed to be able to remove e.g. filler and glue from floors and we see that this development continues for more products. Another obstacle to old products may be the content of substances that are currently regulated at EU level or undesirable for other reasons. Processes are now being developed to remove these old plastic additives, but it is also important that we get a balanced discussion about the levelling between climate benefit and the content of undesirable chemicals in the recycling of long-life products. If recycling can be done safely, this should be given priority because the climate benefits are so great. Another obstacle to really old plastic products may be that they have started to break down and have poorer properties. Here it is important to develop chemical recycling as a complement to the mechanical in order to be able to recycle all plastic products from the construction sector.In construction, packaging plastic is present in significant quantities and it is therefore an interesting fraction to collect and recycle to new plastic packaging or plastic bags, or alternatively to wooden plastic composites. As a result of CONSTRUCTIVATE, a six-month-long project has started to create a circular system for packaging plastic from the construction industry, Cirem.Practical experiments were made to investigate the use of recycled plastic pipes for new pipes (cable protection pipes and optocable pipes) and for plastic profiles (nail strip and © RISE Research Institutes of Swedenjoint strip). Plastic packaging and construction plastic from two construction sites were collected, and recycled into wood fiber composites (VPC materials). The noise reduction plank produced from this material showed good mechanical properties.Washing tests with old PVC-flooring succeeded in dissolving and washing away glue residue from these floorings. This is important because then even glued floors can be recycled to new floor mats. In 2019, Tarkett launched a method to remove glue and putty on an industrial scale and began to recycle floors from demolition/renovation.As a result of CONSTRUCTIVATE, new projects have been started to study certain products in more detail. CiREM will develop a collection and recycling system for building foil and packaging plastic. Several players in the construction industry participate. The Repipe demo project will demonstrate a collection and recycling system for plastic pipes in southern Sweden. About 30 players in the industry participate. Both projects are funded by Re: Source. The Swedish Environmental Protection Agency is financing a development of the recycling system GBR Floor Recycling to increase the recycling of plastic floors in the Swedish market.
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| 11. |
- Johansson, Linda, et al.
(author)
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Concentration of antibodies against Porphyromonas gingivalis is increased before the onset of symptoms of rheumatoid arthritis
- 2016
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In: Arthritis Research & Therapy. - : BioMed Central. - 1478-6362. ; 18
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Journal article (peer-reviewed)abstract
- Background: The periodontal pathogen Porphyromonas gingivalis is hypothesized to be important in rheumatoid arthritis (RA) aetiology by inducing production of anti-citrullinated protein antibodies (ACPA). We have shown that ACPA precede RA onset by years, and that anti-P. gingivalis antibody levels are elevated in RA patients. The aim of this study was to investigate whether anti-P. gingivalis antibodies pre-date symptom onset and ACPA production. Methods: A case-control study (251 cases, 198 controls) was performed within the Biobank of Northern Sweden. Cases had donated blood samples (n = 422) before the onset of RA symptoms by 5.2 (6.2) years (median (interquartile range)). Blood was also collected from 192 RA patients following diagnosis. Antibodies against P. gingivalis virulence factor arginine gingipainB (RgpB), and a citrullinated peptide (CPP3) derived from the P. gingivalis peptidylarginine deiminase enzyme, were analysed by ELISA. Results: Anti-RgpB IgG levels were significantly increased in pre-symptomatic individuals (mean +/- SEM; 152.7 +/- 14.8 AU/ml) and in RA patients (114.4 +/- 16.9 AU/ml), compared with controls (p < 0.001). Anti-CPP3 antibodies were detected in 5 % of pre-symptomatic individuals and in 8 % of RA patients, with elevated levels in both subsets (4.33 +/- 0.59 and 9.29 +/- 1.81 AU/ml, respectively) compared with controls (p < 0.001). Anti-CPP3 antibodies followed the ACPA response, with increasing concentrations over time, whilst anti-RgpB antibodies were elevated and stable in the pre-symptomatic individuals with a trend towards lower levels after RA diagnosis. Conclusions: Anti-P. gingivalis antibody concentrations were significantly increased in RA patients compared with controls, and were detectable years before onset of symptoms of RA, supporting an aetiological role for P. gingivalis in the development of RA.
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| 12. |
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| 13. |
- Jonasson, Lena, et al.
(author)
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Stress-induced release of the S100A8/A9 alarmin is elevated in coronary artery disease patients with impaired cortisol response
- 2017
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In: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 7:1
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Journal article (peer-reviewed)abstract
- Psychological stress is thought to be an important trigger of cardiovascular events, yet the involved pathways and mediators are largely unknown. Elevated systemic levels of the pro-inflammatory alarmin S100A8/A9 correlate with poor prognosis in coronary artery disease (CAD) patients. Here, we investigated the links between S100A8/A9 release and parameters of anti-inflammatory glucocorticoid secretion in two different cohorts subjected to a psychological stress test. In the first cohort of 60 CAD patients, psychological stress induced a rapid increase of circulating S100A8/A9. This rapid S100A8/A9 response strongly correlated with elevated evening saliva cortisol levels, suggesting an association with a dysregulated hypothalamic-pituitary-adrenal (HPA) axis. In the second cohort of 27 CAD patients and 28 controls, elevated S100A8/A9 levels were still detectable 24 h after stress in 40% of patients and 36% of controls, with a tendency for higher levels in patients. The sustained S100A8/A9 response was associated with a poor rapid cortisol release after stress in patients, but not in the control group. Our findings reveal for the first time that acute psychological stress induces elevated levels of S100A8/A9. We also provide hypothesis-generating evidence that dysregulated cortisol secretion in CAD patients might be associated with an exaggerated pro-inflammatory S100A8/A9 response.
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| 14. |
- Jönsson, Simon, et al.
(author)
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Glucocorticoid sensitivity and inflammatory status of peripheral blood mononuclear cells in patients with coronary artery disease
- 2018
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In: Annals of Medicine. - : TAYLOR & FRANCIS LTD. - 0785-3890 .- 1365-2060. ; 50:3, s. 260-268
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Journal article (peer-reviewed)abstract
- Objective: Mechanisms behind sustained inflammation in patients with coronary artery disease (CAD) are not clarified but hypothalamus-pituitary-adrenal (HPA) axis dysfunction may have a role. Here, we investigated whether inflammatory status of peripheral blood mononuclear cells (PBMCs) was associated with altered glucocorticoid sensitivity in CAD patients. Methods: In 55 CAD patients and 30 controls, mRNA levels of GR-alpha, GR-beta, NF-kappa B, I kappa B alpha, MMP-9 and TIMP-1 were measured in PBMCs. Suppressive effects of dexamethasone on GR-alpha, GR-beta, NF-kappa B, I kappa B alpha, MMP-9 and TIMP-1 mRNA levels were assessed in PBMCs ex vivo. Salivary cortisol was repeatedly measured over 3 days. Results: GR-alpha mRNA levels were higher in CAD patients than in controls, 0.50 (0.38-0.59) versus 0.26 (0.18-0.37), pamp;lt;.001, while GR-beta mRNA levels were equally low in both groups. GR-alpha mRNA expression was associated with inflammatory gene expression and, also, with flatter diurnal cortisol rhythm. In both patients and controls, dexamethasone suppressed gene expression of NF-B, IB, MMP-9 and TIMP-1 (p amp;lt; .001). Dexamethasone also reduced GR-alpha mRNA levels (p amp;lt; .001), while LPS increased it (p amp;lt; .001). Conclusions: PBMCs from CAD patients displayed an inflammatory gene expression profile. This was not explained by reduced glucocorticoid sensitivity. Instead, inflammation was associated with increased expression of GR-alpha mRNA, suggesting a hypocortisolemic state.
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| 15. |
- Jönsson, Simon, 1983-
(author)
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Leukocyte-derived matrix metalloproteinase-9 in patients with coronary artery disease : Associations with psychological stress and glucocorticoid sensitivity
- 2015
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Doctoral thesis (other academic/artistic)abstract
- Inflammation is closely associated with development of atherosclerosis. The proteolytic enzyme matrix metalloproteinase (MMP)-9 is considered to play a prominent role in this process. MMP-9 has also been introduced as a marker for plaque vulnerability. Still, the possible mechanisms behind altered levels of MMP-9 and its tissue inhibitors (TIMPs) in patients with atherosclerotic disease remain unclear. The general aim of this thesis was to compare leukocyte-derived MMP-9 and TIMPs in patients with coronary artery disease (CAD) and healthy controls and to further relate the findings to psychological stress and glucocorticoid sensitivity.Levels of leukocyte-derived MMP-9 and TIMP-1 showed a significant difference between CAD patients and controls. Neutrophils in CAD patients were more prone to release MMP-9 and furthermore, PBMCs in patients expressed higher levels of MMP-9 and TIMP-1 and -2 mRNA than PBMCs in controls while there were no differences in plasma or serum levels. The increase in leukocyte-derived levels of MMP-9 and TIMPs indicate the presence of preactivated leukocytes in CAD.Inflammation has been proposed as a mechanistic link between cardiovascular risk and depressive symptoms. We investigated whether the overexpression of leukocyte-derived MMP-9 and TIMPs in CAD patients was associated with psychological factors. Patients exhibited sustained elevations in depressive symptoms, however, these symptoms were not related to any MMP-9 or TIMP variables. The findings suggest that overexpression of leukocyte-derived MMP-9 and TIMPs and elevated depressive scores represent two parallel phenomena in CAD.Chronic inflammation may be associated with reduced glucocorticoid sensitivity. We found that PBMCs in CAD patient expressed significantly increased levels of glucocorticoid receptor (GR)-α mRNA, whereas GR-β mRNA levels did not differ between patients and controls. Moreover, in ex vivo assays, dexamethasone efficiently suppressed MMP-9 and TIMPs equally or even more in patients compared to controls. The findings provide evidence for enhanced glucocorticoid sensitivity in CAD patients and also suggest that a state of relative hypocortisolism may contribute to the overexpression of leukocyte-derived MMP-9 and TIMPs.Lastly, we explored the release of MMP-9, TIMPs and cortisol in response to acute mental stress in CAD patients. Patients who exhibited a significant stress-induced increase in serum MMP-9 also exhibited an altered cortisol response. Moreover, the susceptibility to stressinduced increase in serum MMP-9 was associated with shorter leukocyte telomere length and atherosclerotic plaque burden. The findings highlight the existence of a high-risk group which may be in need of improved diagnostic and therapeutic strategies.
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| 16. |
- Kaasalainen, Hanna, et al.
(author)
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Impact of declining oxygen conditions on metal(loid) release from partially oxidized waste rock
- 2019
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In: Environmental Science and Pollution Research. - : Springer. - 0944-1344 .- 1614-7499. ; 26:20, s. 20712-20730
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Journal article (peer-reviewed)abstract
- The best available technology for preventing the formation of acid drainage water from the sulfidic waste rock at mine closure aims to limit the oxygen access to the waste. There is, however, a concern that contaminants associated with secondary minerals become remobilized due to changing environmental conditions. Metal(loid) mobility from partially oxidized sulfidic waste rock under declining and limited oxygen conditions was studied in unsaturated column experiments. The concentrations of sulfate and metal(loid)s peaked coincidently with declining oxygen conditions from 100 to < 5 sat-% and to a lesser extent following a further decrease in the oxygen level during the experiment. However, the peak concentrations only lasted for a short time and were lower or in the similar concentration range as in the leachate from a reference column leached under atmospheric conditions. Despite the acid pH (~ 3), the overall quality of the leachate formed under limited oxygen conditions clearly improved compared with atmospheric conditions. In particular, the release of As was two orders of magnitude lower, while cationic metals such as Fe, Cu, Mn, and Zn also decreased, although to a lesser extent. Decreased sulfide oxidation is considered the primary reason for the improved water quality under limited oxygen conditions. Another reason may be the immobility of Fe with the incorporation of metal(loid)s in Fe(III) minerals, in contrast to the expected mobilization of Fe. The peaking metal(loid) concentrations are probably due to remobilization from solid Fe(III)-sulfate phases, while the relatively high concentrations of Al, Mn, and Zn under limited oxygen conditions were due to release from the adsorbed/exchangeable fraction. Despite the peaking metal(loid) concentrations during declining oxygen conditions, it is clear that the primary remediation goal is to prevent further sulfide oxidation.
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| 17. |
- Lagerberg, Tove B, et al.
(author)
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An Investigation of the Clinical Use of a Single-Word Procedure to Assess Intelligibility (Swedish Test of Intelligibility for Children) and an Evaluation of the Validity and Reliability of the Intelligibility in Context Scale
- 2019
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In: Journal of Speech Language and Hearing Research. - : American Speech Language Hearing Association. - 1092-4388 .- 1558-9102. ; 62:3, s. 668-681
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Journal article (peer-reviewed)abstract
- Purpose: Intelligibility is a core concept of speech-language pathology, central both to the assessment of speech disorders and to intervention in such disorders. One purpose of this study was to investigate the reliability and usability of a single-word assessment procedure, the Swedish Test of Intelligibility for Children (STI-CH), in a clinical setting. Another purpose was to investigate the validity and reliability of an assessment method designed to assess functional intelligibility: the Intelligibility in Context Scale (ICS). Method: Thirty children aged 4;1-10;1 years; months were recruited from speech-language pathology clinics in Western Sweden. Each child's treating speech-language pathologist served as listener in the STI-CH assessment while the ICS was completed by each child's parents. External listeners (2 last-year speech-language pathology students) were used to assess the validity of the speech-language pathology. Results: The mean duration of the test procedure for the STI-CH was about 19 min, and 57% of the test sessions were reported as difficult. There was a weak but statistically significant correlation between the results from the STI-CH and the ICS (r = .40, p < .05), and both methods showed high reliability in terms of interlistener reliability (intraclass correlation exceeding .97) and internal consistency, respectively. Conclusions: The STI-CH had high reliability and was time efficient but had some procedural problems. The ICS had moderate validity but high reliability. The STI-CH is promising for clinical use but needs to be developed further. The validity of the ICS can be discussed and needs to be further investigated.
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| 18. |
- Ljungcrantz, Desireé, 1982-
(author)
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Skrubbsår : Berättelser om ur hiv föreställs och erfars i samtida Sverige
- 2017
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Doctoral thesis (other academic/artistic)abstract
- Avhandlingen är en tvärvetenskaplig kulturstudie som utforskar föreställningar om och erfarenheter av hiv som kronisk sjukdom i Sverige under 2005–2014. Analysen av ett antal hiv-berättelser sker tillsammans med en teoretisk sammanflätning i form av den queera sårbarhetens och sjukdomens fenomenologi, samt genom de feministiska figurationerna hiv-tröskeln, skrubbsår, plåster och gruskorn. Materialet utgörs av djupintervjuer, autofiktiva texter och populärkulturella representationer. I djupintervjuer med personer som har hiv och i autofiktiva texter undersöks när och hur hiv görs och blir påtagligt i vardagslivet. Genom läsningar av de populärkulturella berättelserna Hur kunde hon?, Ophelias resa, Mitt positiva liv och Positiv undersöker avhandlingen hur protagonisterna och hiv gestaltas, vad som bygger dramaturgin samt hur normaliserande skildringar riskerar att (åter)skapa normativa gränser. Förhandlingar med normlinjer berör återkommande respektabilitet och begäret att framstå som en lyckad och lycklig individ, men även att ha ett levbart liv. Hiv-berättelser innehåller återkommande känslor som rädsla, skam och mononormativ melankoli. De utgör skrubbsår skapade i mötet med andra personer, samhällsinstitutioner och de föreställningar om hiv som finns i samhället. Likt gruskorn skrubbar föreställningarna oss. Det medför olika former av undvikande och ensamhetsorienteringar. Plåster, det vill säga individuella strategier av att exponera hiv och att distansera sig från den yttre blicken på självet görs tillsammans med och skapar känslor såsom lättnad, stolthet och ilska. Skrubbsår erbjuder en diskussion kring vardagligt hiv-görande, hur vi blir med hiv tillsammans med andra personer, normer, institutioner och samhällets skam- och kontrollmekanismer, samt hur känslor samskapar hiv. Genom ett poetiskt och skönlitterärt skrivande utgör scener och fiktiva karaktärer, baserade på intervjuer, och den autofiktiva alter-egoberättaren Desideria ett icke-distanserat och kännbart gestaltande av det relationella hiv-blivandet.
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| 19. |
- Lundberg, Anna, et al.
(author)
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Activation-induced FOXP3 isoform profile in peripheral CD4+T cells is associated with coronary artery disease
- 2017
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In: Atherosclerosis. - : ELSEVIER IRELAND LTD. - 0021-9150 .- 1879-1484. ; 267, s. 27-33
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Journal article (peer-reviewed)abstract
- Background and aims: The expression of FOXP3 isoforms affects regulatory T (Treg) cell function. Reduced Treg cell function has been associated with coronary artery disease (CAD). However, alternative splicing of FOXP3 in CAD has not been investigated. Methods: FOXP3 splice variants and IL17A transcripts in peripheral blood mononuclear cells from stable CAD patients and healthy controls were quantified, and FOXP3 isoform expression in response to T cell receptor (TCR) stimulation or LDL was analyzed by flow cytometry. Results: Compared to healthy controls, CAD patients expressed significantly more FOXP3 transcripts that included exon 2, whereas alternative splicing of exon 7 in correlation with IL17A expression was reduced. Moreover, TCR stimulation, as well as exposure to LDL, decreased alternative splicing of FOXP3 in CD4+ T cells in vitro. Conclusions: Our results demonstrate that blood mononuclear cells in stable CAD patients express a ratio of FOXP3 isoforms that is characteristic for activated CD4+ T cells. (C) 2017 Elsevier B.V. All rights reserved.
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| 20. |
- Lundberg, Anna, et al.
(author)
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Stress-induced release of matrix metalloproteinase-9 in patients with coronary artery disease: The possible influence of cortisol
- 2016
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In: Psychoneuroendocrinology. - : PERGAMON-ELSEVIER SCIENCE LTD. - 0306-4530 .- 1873-3360. ; 73, s. 117-124
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Journal article (peer-reviewed)abstract
- Stress and inflammation are both important risk factors for coronary artery disease (CAD). However, the susceptibility to stress-induced inflammation and its determinants have been little explored in patients with CAD. Here, our aim was to study the stress-induced inflammatory response, more precisely the early release of matrix metalloproteinase (MMP)-9, and its association with cortisol response in patients with CAD. Sixty-four patients underwent a standardized laboratory stress test. The stress-induced release of MMP-9 was closely associated with the release of other neutrophil-associated proteins, MMP-8 and myeloperoxidase (MPO). It also showed a large variation among patients, as did cortisol. Twenty minutes after stress, a negative association between changes in MMP-9 and cortisol was seen (p amp;lt; 0.01). In vitro, dexamethasone reduced the IL-8-mediated release of MMP-9 from neutrophils, indicating that glucocorticoids may exert rapid effects on neutrophil activation. Further characterization of patients revealed that stress-induced release of MMP-9 was related to leukocyte telomere shortening and increased ultrasound assessed plaque occurrence in the carotid arteries, but not to other characteristics such as age, gender or psychological background factors. The susceptibility to stress-induced release of MMP-9 may thus have impact on disease phenotype. Stress tests can be useful to identify CAD patients in need of novel prevention and treatment strategies. (C) 2016 Published by Elsevier Ltd.
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| 21. |
- Lundberg, Jenny, 1976-, et al.
(author)
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Early Signs of Diabetes Explored from an Engineering Perspective
- 2019
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In: Smart Industry & Smart Education. - Cham : Springer. - 9783319956787 - 9783319956770 ; , s. 22-31
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Conference paper (peer-reviewed)abstract
- Undetected diabetes is a global issue, estimated to over 200 million persons affected. Engineering opportunities in capturing early signs of diabetes has a potential due to the complexity to interpret early signs and link it to diabetes. Persons with untreated diabetes are doubled in risk of getting cardiovascular diseases and may also suffer other consequent diseases. In Sweden, approximately 450 thousand have diabetes where 80-90% are of type 2 with 1/4 unaware of it, i.e. approx. 100 thousand. Screening approaches, searching specifically for diabetes in persons not showing symptoms has been initiated with positive results. However, some general drawbacks of screening such as false sense of security are an issue. In this publication, we focus upon in home measurements and empowering of the individual in identifying early signs of diabetes. The methods in this publication are to gather data, evaluate and give suggestion if clinical test to confirm or reject diabetes. In home measurements, education process with companies for innovation possibilities.
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| 22. |
- Lundgren, Pia, 1967, et al.
(author)
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Aggressive Posterior Retinopathy of Prematurity Is Associated with Multiple Infectious Episodes and Thrombocytopenia
- 2017
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In: Neonatology. - : S. Karger AG. - 1661-7800 .- 1661-7819. ; 111:1, s. 79-85
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Journal article (peer-reviewed)abstract
- © 2016 S. Karger AG, BaselBackground: The most severe form of rapidly progressing retinopathy of prematurity (ROP) is termed aggressive posterior ROP (APROP). APROP frequently causes severe visual impairment in affected preterm infants despite timely and appropriate laser treatment. Objectives: We investigated the postnatal characteristics associated with APROP development in a national Swedish cohort. Methods: This retrospective, 1:1 matched case-control study included all infants that developed APROP in zone 1 (n = 9) between 2008 and 2012. Control infants, matched for gestational age and birth weight, developed ROP no worse than stage 2 (n = 9). We retrieved data from medical records on infant birth characteristics, postnatal morbidities, and blood analyses from birth to the first ROP treatment. Infectious episodes included sepsis, C-reactive protein ≥10 mg/l, and other clinical signs of infection that required antibiotic treatment. A platelet count <100 × 109/l was considered to be thrombocytopenia. Results: All APROP cases postnatally developed at least two infectious episodes, one in the first month and one around the time of ROP diagnosis. All APROP cases exhibited thrombocytopenia in the first month, and 6/9 exhibited thrombocytopenia around the time of ROP diagnosis. Compared to the controls, APROP cases more frequently developed necrotizing enterocolitis (8/9 vs. 1/9; p < 0.01) and sepsis (9/9 vs. 3/9; p < 0.01), and they had significantly lower median platelet counts (90 × 109/l, range 4-459, vs. 158 × 109/l, range 20-500; p < 0.001). Conclusion: Multiple infectious episodes and thrombocytopenia, particularly around the time of ROP diagnosis, were associated with APROP development.
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| 23. |
- Mahmood, Zeid, et al.
(author)
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Salivary and plasma levels of matrix metalloproteinase-9 and myeloperoxidase at rest and after acute physical exercise in patients with coronary artery disease
- 2019
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In: PLOS ONE. - : PUBLIC LIBRARY SCIENCE. - 1932-6203. ; 14:2
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Journal article (peer-reviewed)abstract
- Background Low-grade systemic inflammation is a predictor of recurrent cardiac events in patients with coronary artery disease (CAD). Plasma proteins such as matrix metalloproteinase (MMP)-9 and myeloperoxidase (MPO) have been shown to reflect basal as well as stress-induced inflammation in CAD. Measurements of MMP-9 and MPO in saliva might pose several advantages. Therefore, we investigated whether salivary levels of MMP-9 and MPO corresponded to plasma levels in patients with coronary artery disease (CAD), both at rest and after acute physical exercise. Methods A bicycle ergometer test was used as a model for stress-induced inflammation. Twenty-three CAD patients performed the test on two occasions 3-6 months apart. Whole unstimulated saliva was collected before, directly after and 30 min after exercise while plasma was collected before and after 30 min. MMP-9 and MPO in saliva and plasma were determined by Luminex. Results MMP-9 and MPO levels were 2- to 4-fold higher in saliva than in plasma. Amongst the saliva samples, and also to a great extent amongst the plasma samples, the levels of both types of protein showed strong intercorrelations between the levels at rest and after exercise during the two visits. However, there were no (or weak) correlations between salivary and plasma MMP-9 and none between salivary and plasma MPO. Conclusion We conclude that salivary diagnostics cannot be used to assess systemic levels of MMP-9 and MPO in CAD patients, neither at rest nor after acute physical exercise.
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| 24. |
- Petersson, Joel, et al.
(author)
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Physiological recycling of endogenous nitrate by oral bacteria regulates gastric mucus thickness
- 2015
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In: Free Radical Biology & Medicine. - : Elsevier BV. - 0891-5849 .- 1873-4596. ; 89, s. 241-247
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Journal article (peer-reviewed)abstract
- Background: Inorganic nitrate from exogenous and endogenous sources is accumulated in saliva, reduced to nitrite by oral bacteria and further converted to nitric oxide (NO) and other bioactive nitrogen oxides in the acidic gastric lumen. To further explore the role of oral microbiota in this process we examined the gastric mucus layer in germ free (GF) and conventional mice given different doses of nitrate and nitrite. Methods: Mice were given either nitrate (100 mg/kg/d) or nitrite (0.55-11 mg/kg/d) in the drinking water for 7 days, with the lowest nitrite dose resembling the levels provided by swallowing of fasting saliva. The gastric mucus layer was measured in vivo. Results: GF animals were almost devoid of the firmly adherent mucus layer compared to conventional mice. Dietary nitrate increased the mucus thickness in conventional animals but had no effect in GF mice. In contrast, nitrite at all doses, restored the mucus thickness in GF mice to the same levels as in conventional animals. The nitrite-mediated increase in gastric mucus thickness was not inhibited by the soluble guanylyl cyclase inhibitor ODQ. Mice treated with antibiotics had significantly thinner mucus than controls. Additional studies on mucin gene expression demonstrated down regulation of Muc5ac and Much in germ free mice after nitrite treatment. Conclusion: Oral bacteria remotely modulate gastric mucus generation via bioactivation of salivary nitrate. In the absence of a dietary nitrate intake, salivary nitrate originates mainly from NO synthase. Thus, oxidized NO from the endothelium and elsewhere is recycled to regulate gastric mucus homeostasis.
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| 25. |
- Reed, Evan, et al.
(author)
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Antibodies to carbamylated alpha-enolase epitopes in rheumatoid arthritis also bind citrullinated epitopes and are largely indistinct from anti-citrullinated protein antibodies
- 2016
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In: Arthritis Research & Therapy. - : Springer Science and Business Media LLC. - 1478-6362. ; 18
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Journal article (peer-reviewed)abstract
- Background: In addition to anti-citrullinated protein antibodies (ACPAs), antibodies targeting carbamylated (i.e., homocitrullinated) proteins (anti-CarP antibodies) have been described in rheumatoid arthritis (RA). However, the extent to which anti-CarP antibodies are truly distinct from ACPA remains unclear, and few studies have focused on specific autoantigens. Here, we examine cross-reactivity between ACPA and anti-CarP antibodies, in the context of the candidate autoantigen a-enolase. Methods: Cross-reactivity was examined by immunoblotting of citrullinated and carbamylated proteins using purified ACPA; and by peptide absorption experiments, using the citrullinated alpha-enolase peptide CEP-1 and a homocitrulline-containing version (carb-CEP-1) in ELISA. The population-based case-control cohort EIRA (n = 2836 RA; 373 controls) was screened for reactivity with CEP-1 and carb-CEP-1, using the ISAC multiplex array. Associations between anti-CarP antibodies, smoking and genetic risk factors were analysed using unconditional logistic regression models. Differences in antibody levels were investigated using the Mann-Whitney U test. Results: Affinity-purified ACPA was found to bind carbamylated proteins and homocitrulline-containing peptides, demonstrating definitive cross-reactivity between ACPA and anti-CarP antibodies. Anti-carb-CEP-1 reactivity in EIRA was almost exclusively confined to the CEP-1-positive subset, and this group of RA patients (21 %) displayed a particularly strong ACPA response with marked epitope spreading. The small RA subset (3 %) with homocitrulline reactivity in the absence of citrulline reactivity did not associate with smoking or risk genes, and importantly had significantly lower anti-carb-CEP-1 antibody levels. Conclusion: Our data presented herein cast doubt on the specificity of anti-CarP antibodies in RA, which we posit may be a subset of cross-reactive ACPA.
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| 26. |
- Rising Holmström, Malin, lektor, 1966-, et al.
(author)
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Nurses’ experiences of prehospital care encounters with children in pain
- 2019
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In: International Emergency Nursing. - : Elsevier BV. - 1755-599X .- 1878-013X. ; 43, s. 23-28
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Journal article (peer-reviewed)abstract
- Background: Pain relief in children is a complex issue, partly an ethical dilemma and due to a lack of nursing competence. There are few studies regarding prehospital care encounters with children in pain. Aim: The aim of this study was to describe nurses’ experiences in prehospital care encounters with children in pain and the specific related challenges. Method: This study has a qualitative design. Eighteen Swedish nurses participated in three focus group interviews analysed using qualitative content analysis. Findings: The findings consist of a theme, “A challenge to shift focus and adjust to the child”, and three categories describing prehospital care encounters with children in pain: “Being receptive and focusing on care,” “Developing a trusting relationship,” and “Providing professional nursing care.” Caring for children in pain was stressful for the nurses. The nurses described how they had to shift focus and used different methods to build trust, such as playfulness, making eye contact, attracting curiosity, and using the parents to create trust. The also had to adjust to the child regarding dosages and materials. Conclusion: Nurses has to be practically, mentally, and theoretically prepared to care for children with prehospital pain. It is essential to evaluate the administration of adequate pain relief to children, and more evidence-based knowledge is necessary concerning the different modes of administering pain-relieving drugs to prehospital children.
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| 27. |
- Shan, Chunling, 1986-, et al.
(author)
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Integration of controlled-source and radio-magnetotellurics, electrical resistivity tomography and reflection seismics to delineate 3D structures of a quick-clay landslide site in southwest Sweden
- 2016
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In: Geophysics. - 0016-8033 .- 1942-2156. ; 81:1, s. B13-B29
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Journal article (other academic/artistic)abstract
- Three-dimensional radio magnetotelluric (RMT), controlled-source radio magnetotelluric (CSRMT), electrical resistivity tomography (ERT), and high-resolution reflection seismic data were acquired at a quick-clay landslide site close to the Göta River in southwest Sweden. These data were collected with the main objectives of evaluating the performance of each method and delineating different subsurface materials down to the bedrock, which in turn control a peculiar and hazardous retrogressive-type landslide. These materials consist of mainly marine clays, quick clays, sand to gravel and the crystalline bedrock. The RMT, CSRMT and ERT data were inverted separately using 3D inversion schemes and the independent results from 3D processing of reflection seismic data together with the existing geotechnical data were used for their interpretations. The 3D CSRMT resistivity model shows the highest depth penetration and well resolves the geometry of the bedrock. The RMT and ERT models, however, show better resolution closer to the surface because of their denser data coverage compared with the CSRMT data. Considerable correlations in resolving a coarse-grained layer and the bedrock were observed between the CSRMT model and the 3D reflection seismic data. Because an Occam-type regularization was used in the inversion, the lateral and depth extent of the quick clays cannot accurately be determined just by using the resistivity models. The depth to the top of the resistive crystalline bedrock is to some extent uncertain. Comparisons with the borehole data suggest that the resistivity models are poor in resolving the sharp boundary between the quick clays and their underlying more resistive coarse-grained materials. The upper boundary of the more conductive marine clays underlain by the coarse-grain materials was well modeled by the CSRMT data. This study illustrates the potentials of 3D geophysical data especially when different types are collected and particularly for better site characterizations.
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| 28. |
- Stattin, Eva-Lena, et al.
(author)
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A novel ECEL1 mutation expands the phenotype of distal arthrogryposis multiplex congenita type 5D to include pretibial vertical skin crease
- 2018
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In: American Journal of Medical Genetics. Part A. - : WILEY. - 1552-4825 .- 1552-4833. ; 176:6, s. 1405-1410
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Journal article (peer-reviewed)abstract
- Arthrogryposis multiplex congenita (AMC) is a heterogeneous disorder characterized by multiple joint contractures often in association with other congenital abnormalities. Pretibial linear vertical creases are a rare finding associated with arthrogryposis, and the etiology of the specific condition is unknown. We aimed to genetically and clinically characterize a boy from a consanguineous family, presenting with AMC and pretibial vertical linear creases on the shins. Whole exome sequencing and variant analysis revealed homozygous novel missense variants of ECEL1 (c.1163T > C, p.Leu388Pro, NM_004826) and MUSK (c.2572C > T, p.Arg858Cys, NM_005592). Both variants are predicted to have deleterious effects on the protein function, with amino acid positions highly conserved among species. The variants segregated in the family, with healthy mother, father, and sister being heterozygous carriers and the index patient being homozygous for both mutations. We report on a unique patient with a novel ECEL1 homozygous mutation, expanding the phenotypic spectrum of Distal AMC Type 5D to include vertical linear skin creases. The homozygous mutation in MUSK is of unknown clinical significance. MUSK mutations have previously shown to cause congenital myasthenic syndrome, a neuromuscular disorder with defects in the neuromuscular junction.
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| 29. |
- Tobin, Nicholas P., et al.
(author)
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PAM50 provides prognostic information when applied to the lymph node metastases of advanced breast cancer patients
- 2017
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In: Clinical Cancer Research. - 1078-0432. ; 23:23, s. 7225-7231
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Journal article (peer-reviewed)abstract
- Purpose: Transcriptional pathway activity and the molecular subtypes of breast cancer metastases have been shown to significantly influence patient postrelapse survival. Here, we further determine the relevance of clinically employed gene signatures in the advanced breast cancer (ABC) setting. Experimental Design: Sufficient RNA for expression profiling was obtained from distant metastatic or inoperable locoregional relapse tissue by fine-needle aspiration from 109 patients of the Swedish TEX clinical trial. Gene signatures (GGI, 70 gene, recurrence score, cell-cycle score, risk of recurrence score, and PAM50) were applied to all metastases, and their relationship to long- (5-year) and short-term (1.5-year) postrelapse survival at all and locoregional lymph nodes (n = 40) versus other metastatic sites (n = 69) combined was assessed using Kaplan–Meier and/or multivariate Cox regression analyses. Results: The majority of metastases were classified into intermediate or high-risk groups by all signatures, and a significant association was found between metastatic signature subgroups and primary tumor estrogen receptor status and histologic grade (P < 0.05). When considering all sites of metastasis, only PAM50 was statistically significant in Kaplan–Meier analysis (Log-rank P = 0.008 and 0.008 for long- and short-term postrelapse breast cancer–specific survival, respectively). This significance remained in both uni- and multivariate models when restricting analyses to lymph node metastases only, and a similar trend was observed in other metastatic sites combined, but did not reach formal significance. Conclusions: Our findings are the first to demonstrate that the PAM50 signature can provide prognostic information from the lymph node metastases of ABC patients.
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| 30. |
- Widarsson, Margareta, et al.
(author)
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'Paddling upstream' : Fathers' involvement during pregnancy as described by expectant fathers and mothers
- 2015
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In: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 24:7-8, s. 1059-1068
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Journal article (peer-reviewed)abstract
- Aims and objectives: To describe the perspectives of expectant mothers and fathers on fathers' involvement during pregnancy. Background: Becoming a father is a major life event and paternal involvement during pregnancy has a positive influence on the family. However, research into both expectant mothers' and fathers' perspectives on fathers' involvement during pregnancy is relatively scarce. Design: A descriptive qualitative study was used. Methods: Thirty expectant parents (20 women and 10 men) were interviewed either as part of one of four focus groups or in an individual interview. Qualitative content analysis was performed on the interview transcripts. Results: A theme of 'Paddling upstream' emerged as an expression of the latent content of the interviews concerning perspectives on fathers' involvement. Five sub-themes described the manifest content: trying to participate, trying to be understanding, trying to learn, trying to be a calming influence and trying to find a balanced life. Expectant parents suggested several ways to improve fathers' involvement and to meet parents' need for shared involvement. Conclusion: Expectant mothers and fathers wanted the father to be more involved in the pregnancy. Although fathers attempted different strategies, they did not always perceive what was expected of them and encountered many barriers as they tried to navigate through this unique experience. The best support for the father was the mother. Expectant parents wanted their healthcare to include the father more thoroughly and to focus on the whole family. Relevance to clinical practice: Prenatal care professionals can overcome barriers that prevent paternal involvement. Although fathers are not able to engage in the pregnancy on the same level as the mother, we suggest that their specific needs also be recognised through an increased awareness of gender norms in healthcare.
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