1
|
Christensen MG, Jacobsen KK, Nilsson C, Jepsen R, Thygesen L, Suetta C, Holm EA. Prevalence and population characteristics associated with frailty in a rural low socioeconomic area in Denmark: the Lolland-Falster Health Study. BMJ Open 2024; 14:e073754. [PMID: 38453201 PMCID: PMC10921517 DOI: 10.1136/bmjopen-2023-073754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 02/09/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Frailty is a major geriatric syndrome that predicts increased vulnerability to minor stressor events and adverse outcomes such as falls, fractures, disability and death. The prevalence of frailty among individuals above the age of 65 varies widely with an overall weighted prevalence of 10.7%. OBJECTIVES The purpose of this study was to examine the prevalence of prefrailty and frailty in community-dwelling older adults from the regions of Lolland-Falster, which is one of the most socioeconomically disadvantaged areas of Denmark with lower income and lower life expectancy compared with the general Danish population. Moreover, the objective was to find selected individual characteristics associated with frailty. DESIGN An observational, cross-sectional registry-based population study with data from the regions of Lolland-Falster collected between February 2016 and February 2020. RESULTS The study included 19 000 individuals. There were 10 154 above the age of 50 included for analysis. Prevalence of frailty in the age group of 50-64 years was 4.7% and 8.7% in the age group of 65 years and above.The study demonstrates associations between frailty and high age, female gender, low education level, low income, smoking, living alone, frequency of seeing one's children and getting help when needed. These associations are comparable with findings from other studies. CONCLUSION The syndrome of frailty consists of not only physiological and medical issues but also education, life conditions such as living alone and living in poverty and how you evaluate your own health.
Collapse
Affiliation(s)
| | - Katja Kemp Jacobsen
- Department of Technology, Faculty of Health and Technology, University College Copenhagen, Copenhagen, Denmark
| | - Charlotte Nilsson
- Public Health, University of Copenhagen, København K, Denmark
- Institut for Folkesundhedsvidenskab, Københavns Universitet, Kobenhavns, Denmark
| | - Randi Jepsen
- Lolland-Falster Health Study, Nykøbing F Sygehus, Nykobing, Denmark
| | | | - Charlotte Suetta
- Geriatric Research Unit, Department of Geriatric and Palliative Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Kobenhavn, Denmark
- Geriatric Research Unit, Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, Kobenhavn, Denmark
| | - Ellen Astrid Holm
- Internal Medicine, Zealand University Hospital Koge, Koge, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Kobenhavns, Denmark
| |
Collapse
|
2
|
Hansen J, Hansen H, Nilsson C, Ekholm O, Molsted S. Association between educational level and self-reported musculoskeletal pain and physical functioning in Danes 60-70 years old from 2010 to 2017: a longitudinal analysis of trends over time on data from the Danish Health and Morbidity Survey. BMJ Open 2023; 13:e073523. [PMID: 37914297 PMCID: PMC10626833 DOI: 10.1136/bmjopen-2023-073523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 10/13/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVES The aims of this study were to investigate the association between educational level and musculoskeletal pain and physical function, respectively, in persons 60-70 years old, and to investigate if the association changed from 2010 to 2017. DESIGN AND PARTICIPANTS This is a sex-stratified, cross-sectional study based on data from the Danish Health and Morbidity Survey in 2010 (n=15 165) and in 2017 (n=14 022).Self-reported data from respondents who were 60-70 years old and reported data for pain or physical function, sociodemographic, education and behavioural factors were included. PRIMARY OUTCOME MEASURES Prevalence of pain and physical limitations. RESULTS Among men, a high educational level was associated with reduced odds of pain compared with low educational level (OR 0.56 (95% CI 0.41; 0.74)). Medium and high educational levels were associated with reduced odds of pain in women (0.74 (0.59; 0.92) and 0.64 (0.41; 1.00), respectively). High educational level was associated with reduced odds of physical limitations in men (0.35 (0.19; 0.65)) and women (0.33 (0.14; 0.78)). The interaction terms between time and education were not associated with pain and physical function, respectively. CONCLUSION High education was associated with reduced musculoskeletal pain and reduced limitations of physical function. The association between education and musculoskeletal pain and physical function did not change significantly over time. Musculoskeletal pain during the past 14 days and chronic pain among old men and women 60-70 years and their level of physical function contribute to important knowledge of a group near the retirement age. The future perspectives illustrate trends and importance of focusing on adapting job accommodations for senior workers.
Collapse
Affiliation(s)
- Jeanette Hansen
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, University College Copenhagen, Copenhagen, Denmark
| | - Henrik Hansen
- Respiratory Research Unit, Department of Respiratory Medicine, Hvidovre Hospital, Hvidovre, Denmark
| | - Charlotte Nilsson
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Ola Ekholm
- Department of Clinical Research, Nordsjællands Hospital, Copenhagen, Denmark
| | - Stig Molsted
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
3
|
Toit GD, Nilsson C, Vereda-Ortiz A, Norval D, Scurlock A, Ciaccio C. ORAL IMMUNOTHERAPY IN CHILDREN WITH PEANUT ALLERGY ALONE OR WITH OTHER FOOD ALLERGY IN PALISADE. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
4
|
Nilsson C, Sjöberg V, Grandin A, Karlsson S, Allard B, von Kronhelm T. Phosphorus speciation in sewage sludge from three municipal wastewater treatment plants in Sweden and their ashes after incineration. Waste Manag Res 2022; 40:1267-1276. [PMID: 34920692 DOI: 10.1177/0734242x211065231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Given the high efficiency in phosphorus removal at municipal wastewater treatment plants (MMWWTP), sewage sludge constitutes a promising resource for phosphorus (P) recovery. Sewage sludge is, however, a complex matrix and its direct use as fertiliser is limited by its content of metals/metalloids and organic pollutants. In order to increase its usability as a potential resource of P, there is a need for increased knowledge on phosphorus speciation in these matrices. The sludge composition is highly influenced by local conditions (i.e. wastewater composition and treatment method), and it is therefore important to study sludge from several MMWWTPs. In this study, three different protocols for sequential extraction were utilised to investigate the chemical speciation of phosphorus in sludge from three different MMWWTP sludges in Sweden, as well as in corresponding ashes following incineration. The results showed that the total amounts of phosphorus ranged from 26 to 32 mg g-1 sludge (dry weight), of which 79-94% was inorganically bound (IP). In the sludge, 21-30% of the IP was associated with calcium (Ca-P), which is the preferred species for fertiliser production. Following incineration, this fraction increased to 54-56%, mainly due to transformation of iron-associated phosphorus (Fe-P), while aluminium-associated species of phosphorus (Al-P) remained unaltered. The results from this study confirm that incineration is a suitable treatment for sewage sludge in terms of potential phosphorus recovery.
Collapse
Affiliation(s)
- Charlotte Nilsson
- MTM Research Centre, Örebro University, Örebro, Sweden
- Fortum Waste Solutions AB, Kumla, Sweden
| | | | - Anna Grandin
- MTM Research Centre, Örebro University, Örebro, Sweden
| | | | - Bert Allard
- MTM Research Centre, Örebro University, Örebro, Sweden
| | | |
Collapse
|
5
|
Frederiksen KS, Cooper C, Frisoni GB, Frölich L, Georges J, Kramberger MG, Nilsson C, Passmore P, Mantoan Ritter L, Religa D, Schmidt R, Stefanova E, Verdelho A, Vandenbulcke M, Winblad B, Waldemar G. A European Academy of Neurology guideline on medical management issues in dementia. Eur J Neurol 2020; 27:1805-1820. [PMID: 32713125 PMCID: PMC7540303 DOI: 10.1111/ene.14412] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/12/2020] [Accepted: 06/13/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Dementia is one of the most common disorders and is associated with increased morbidity, mortality and decreased quality of life. The present guideline addresses important medical management issues including systematic medical follow-up, vascular risk factors in dementia, pain in dementia, use of antipsychotics in dementia and epilepsy in dementia. METHODS A systematic review of the literature was carried out. Based on the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework, we developed a guideline. Where recommendations based on GRADE were not possible, a good practice statement was formulated. RESULTS Systematic management of vascular risk factors should be performed in patients with mild to moderate dementia as prevention of cerebrovascular pathology may impact on the progression of dementia (Good Practice statement). Individuals with dementia (without previous stroke) and atrial fibrillation should be treated with anticoagulants (weak recommendation). Discontinuation of opioids should be considered in certain individuals with dementia (e.g. for whom there are no signs or symptoms of pain or no clear indication, or suspicion of side effects; Good Practice statement). Behavioral symptoms in persons with dementia should not be treated with mild analgesics (weak recommendation). In all patients with dementia treated with opioids, assessment of the individual risk-benefit ratio should be performed at regular intervals. Regular, preplanned medical follow-up should be offered to all patients with dementia. The setting will depend on the organization of local health services and should, as a minimum, include general practitioners with easy access to dementia specialists (Good Practice statement). Individuals with dementia and agitation and/or aggression should be treated with atypical antipsychotics only after all non-pharmacological measures have been proven to be without benefit or in the case of severe self-harm or harm to others (weak recommendation). Antipsychotics should be discontinued after cessation of behavioral disturbances and in patients in whom there are side effects (Good Practice statement). For treatment of epilepsy in individuals with dementia, newer anticonvulsants should be considered as first-line therapy (Good Practice statement). CONCLUSION This GRADE-based guideline offers recommendations on several important medical issues in patients with dementia, and thus adds important guidance for clinicians. For some issues, very little or no evidence was identified, highlighting the importance of further studies within these areas.
Collapse
Affiliation(s)
- K. S. Frederiksen
- Department of NeurologyDanish Dementia Research CenterRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - C. Cooper
- Department of Clinical Educational and Health PsychologyUniversity College LondonLondonUK
| | - G. B. Frisoni
- Memory ClinicUniversity Hospital of GenevaUniversity of GenevaGenevaSwitzerland
| | - L. Frölich
- Department of Geriatric PsychiatryZentralinstitut für Seelische Gesundheit MannheimMedical Faculty MannheimUniversity of HeidelbergMannheimGermany
| | | | - M. G. Kramberger
- Department of NeurologyCenter for Cognitive ImpairmentsUniversity Medical Center Ljubljana, and Medical facultyUniversity of LjubljanaLjubljanaSlovenia
| | - C. Nilsson
- Department of Neurology and Rehabilitation MedicineSkåne University HospitalLundSweden
- Clinical Memory Research UnitDepartment of Clinical SciencesLund UniversityMalmöSweden
| | | | - L. Mantoan Ritter
- Epilepsy CentreKing's College NHS Foundation TrustKing´s College LondonLondonUK
| | - D. Religa
- Division of Clinical GeriatricsDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetNeo, StockholmSweden
- Karolinska University HospitalTheme AgingHuddingeSweden
| | - R. Schmidt
- University Clinic for NeurologyMedical University of GrazGrazAustria
| | - E. Stefanova
- Medical FacultyNeurology clinic CCSUniversity of BelgradeBelgradeSerbia
| | - A. Verdelho
- Department of Neurosciences and Mental HealthCHLNorte‐Hospital de Santa MariaIMMISAMBFaculty of MedicineUniversity of LisbonLisbonPortugal
| | - M. Vandenbulcke
- Department of NeurosciencesKU LeuvenGeriatric PsychiatryUniversity Hospitals LeuvenLeuvenBelgium
| | - B. Winblad
- Karolinska University HospitalTheme AgingHuddingeSweden
- Division of NeurogeriatricsDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetBioClinicumSolnaSweden
| | - G. Waldemar
- Department of NeurologyDanish Dementia Research CenterRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| |
Collapse
|
6
|
Almasoudi W, Puschmann A, Nilsson C. Co-occurrence of leukoencephalopathy with ataxia and SPG56 in one family. Parkinsonism Relat Disord 2020. [DOI: 10.1016/j.parkreldis.2020.06.408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
7
|
Björkander S, Carvalho-Queiroz C, Hallberg J, Persson JO, Johansson MA, Nussbaum B, Jenmalm MC, Nilsson C, Sverremark-Ekström E. Childhood allergy is preceded by an absence of gut lactobacilli species and higher levels of atopy-related plasma chemokines. Clin Exp Immunol 2020; 202:288-299. [PMID: 32652542 PMCID: PMC7670166 DOI: 10.1111/cei.13494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/21/2020] [Accepted: 06/30/2020] [Indexed: 11/14/2022] Open
Abstract
Alterations in the composition and reduced diversity of the infant microbiome are associated with allergic disease in children. Further, an altered microbiota is linked to immune dysregulation, including skewing of different T helper (Th) subsets, which is also seen in atopic individuals. The aim of this study was, therefore, to investigate the associations between gut lactobacilli and Th‐related plasma factors in allergy development during childhood. A total of 194 children with known allergy status at 1 year of age were followed to 10 years of age. We used real‐time polymerase chain reaction (PCR) to investigate the presence of three lactobacilli species (Lactobacillus casei, L. paracasei, L. rhamnosus) in infant fecal samples (collected between 1 week and 2 months of age) from a subgroup of children. Plasma chemokines and cytokines were quantified at 6 months and at 1, 2, 5 and 10 years of age with Luminex or enzyme‐linked immunosorbent assay (ELISA). Fractional exhaled nitrogen oxide (FeNO) was measured and spirometry performed at 10 years of age. The data were analysed by non‐parametric testing and a logistic regression model adjusted for parental allergy. An absence of these lactobacilli and higher levels of the chemokines BCA‐1/CXCL13, CCL17/TARC, MIP‐3α/CCL20 and MDC/CCL22 in plasma at 6 months of age preceded allergy development. The presence of lactobacilli associated with lower levels of atopy‐related chemokines during infancy, together with higher levels of interferon (IFN)‐γ and lower FeNO during later childhood. The results indicate that the presence of certain lactobacilli species in the infant gut may influence allergy‐related parameters in the peripheral immune system, and thereby contribute to allergy protection.
Collapse
Affiliation(s)
- S Björkander
- Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - C Carvalho-Queiroz
- Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
| | - J Hallberg
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Stockholm, Sweden.,Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - J-O Persson
- Department of Mathematics, Stockholm University, Stockholm, Sweden
| | - M A Johansson
- Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
| | - B Nussbaum
- Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
| | - M C Jenmalm
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - C Nilsson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - E Sverremark-Ekström
- Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
| |
Collapse
|
8
|
Dereke J, Nilsson C, Strevens H, Landin-Olsson M, Hillman M. Pregnancy-associated plasma protein-A2 levels are increased in early-pregnancy gestational diabetes: a novel biomarker for early risk estimation. Diabet Med 2020; 37:131-137. [PMID: 31340069 DOI: 10.1111/dme.14088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2019] [Indexed: 01/13/2023]
Abstract
AIM To determine whether pregnancy-associated plasma protein-A2 levels are increased in early pregnancies complicated by gestational diabetes and whether gestation age influences levels. The possible use of pregnancy-associated plasma protein-A2 as a pre-screening biomarker to reduce the need for performing oral glucose tolerance tests in pregnant women was also investigated. METHODS Pregnant women were diagnosed with gestational diabetes in early pregnancy after a 2-hour 75 g oral glucose tolerance test in the catchment area of Skåne University Hospital, Lund, Sweden during 2011-2015 (n = 99). Age- and BMI-matched pregnant women without diabetes were recruited at similar gestational ages from maternal healthcare centres in the same geographical area during 2014-2015 to act as controls (n = 100). Circulating pregnancy-associated plasma protein-A2 was analysed in participant serum using commercially available enzyme-linked immunosorbent assay kits. RESULTS Circulating pregnancy-associated plasma protein-A2 was increased in women diagnosed with gestational diabetes [13.5 (9.58-18.8) ng/ml] compared with controls [8.11 (5.74-11.3) ng/ml; P < 0.001]. Pregnancy-associated plasma protein-A2 was associated with gestational diabetes independent of age, BMI, C-peptide and adiponectin (P < 0.001). Pregnancy-associated plasma protein-A2 as a pre-screening biomarker to identify women at a decreased risk of gestational diabetes resulted in a negative predictive value of 99.7%, with a sensitivity of 96% and a specificity of 30% at a cut-off level of 6 ng/ml. CONCLUSIONS This is the first study to show increased pregnancy-associated plasma protein-A2 levels in gestational diabetes. Pregnancy-associated plasma protein-A2 also shows promise as a pre-screening biomarker with the potential to reduce the need for performing oral glucose tolerance tests in early pregnancy. Future prospective cohort studies in a larger group of both high- and low-risk women are, however, needed to further confirm this observation.
Collapse
Affiliation(s)
- J Dereke
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Diabetes Research Laboratory, Lund, Sweden
| | - C Nilsson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Diabetes Research Laboratory, Lund, Sweden
- Department of Paediatrics, Helsingborg Hospital, Helsingborg, Sweden
| | - H Strevens
- Department of Obstetrics, Skåne University Hospital Lund, Lund, Sweden
| | - M Landin-Olsson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Diabetes Research Laboratory, Lund, Sweden
- Department of Endocrinology, Skåne University Hospital Lund, Lund, Sweden
| | - M Hillman
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Diabetes Research Laboratory, Lund, Sweden
| |
Collapse
|
9
|
Abstract
OBJECTIVES Frailty is a major clinical geriatric syndrome associated with serious adverse events including functional disability, falls, hospitalisation, increased morbidity and mortality. The aim of this study was to study associations between a frailty phenotype and frailty characteristics well known from the literature. DESIGN Registry-based cross-sectional study. SETTING The target population consists of inhabitants above the age of 50 living in the Danish municipalities of Lolland and Guldborgsund. Excluded are incapacitated people, inhabitants unable to understand Danish or English and inhabitants without a permanent residence. PARTICIPANTS 7327 individuals aged 50+ years were included. OUTCOME MEASURES We examined associations between the frailty measurement and factors known to be associated with frailty: sex, age, income insufficiency, education, comorbidity, self-assessed health, morbidity and mortality. RESULTS 7327 individuals aged 50+ years were included. Of these, 6.5% had ≥3 frailty components (frail), 46.7% had 1-2 components (prefrail) and 46.9% had none (non-frail). Those who were frail were older and more likely female than those who were non-frail or prefrail. There was a stepwise decrease in educational level, and in self-assessed health with increasing frailty status, and a stepwise increase in difficulty in making ends meet, number of hospital contacts and mortality with increasing frailty status, p<0.0001 for each comparison. Compared with individuals who were non-frail, mortality was higher among those who were prefrail (HR: 2.90; 95% CI: 1.30 to 6.43) or frail (HR: 8.21; 95% CI: 3.37 to 20.0). CONCLUSIONS Based on these findings, we consider the Lolland-Falster Health Study frailty assessment a valid instrument demonstrating the same characteristics as other validated frailty measures concerning associations with sex, age, income insufficiency, education, comorbidity, self-assessed health, morbidity and mortality. TRIAL REGISTRATION NUMBER NCT02482896.
Collapse
Affiliation(s)
| | - Randi Jepsen
- Lolland-Falster Helath Study, Nykøbing F Sygehus, Nykobing, Denmark
| | | | - Charlotte Nilsson
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ellen Holm
- Internal Medicine, Nykøbing F Sygehus, Nykobing, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Kobenhavns, Denmark
| |
Collapse
|
10
|
Cardoso F, Bartlett JMS, Slaets L, van Deurzen CHM, van Leeuwen-Stok E, Porter P, Linderholm B, Hedenfalk I, Schröder C, Martens J, Bayani J, van Asperen C, Murray M, Hudis C, Middleton L, Vermeij J, Punie K, Fraser J, Nowaczyk M, Rubio IT, Aebi S, Kelly C, Ruddy KJ, Winer E, Nilsson C, Lago LD, Korde L, Benstead K, Bogler O, Goulioti T, Peric A, Litière S, Aalders KC, Poncet C, Tryfonidis K, Giordano SH. Characterization of male breast cancer: results of the EORTC 10085/TBCRC/BIG/NABCG International Male Breast Cancer Program. Ann Oncol 2019; 29:405-417. [PMID: 29092024 DOI: 10.1093/annonc/mdx651] [Citation(s) in RCA: 202] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Male breast cancer (BC) is rare, managed by extrapolation from female BC. The International Male BC Program aims to better characterize and manage this disease. We report the results of part I, a retrospective joint analysis of cases diagnosed during a 20-year period. Methods Patients with follow-up and tumor samples, treated between 1990 and 2010, in 93 centers/9 countries. Samples were centrally analyzed in three laboratories (the United Kingdom, the Netherlands and the United States). Results Of 1822 patients enrolled, 1483 were analyzed; 63.5% were diagnosed between 2001 and 2010, 57 (5.1%) had metastatic disease (M1). Median age at diagnosis: 68.4 years. Of 1054 M0 cases, 56.2% were node-negative (N0) and 48.5% had T1 tumors; 4% had breast conserving surgery (BCS), 18% sentinel lymph-node biopsy; half received adjuvant radiotherapy; 29.8% (neo)adjuvant chemotherapy and 76.8% adjuvant endocrine therapy (ET), mostly tamoxifen (88.4%). Per central pathology, for M0 tumors: 84.8% ductal invasive carcinomas, 51.5% grade 2; 99.3% estrogen receptor (ER)-positive; 81.9% progesterone receptor (PR)-positive; 96.9% androgen receptor (AR)-positive [ER, PR or AR Allred score ≥3]; 61.1% Ki67 expression low (<14% positive cells); using immunohistochemistry (IHC) surrogates, 41.9% were Luminal-A-like, 48.6% Luminal-B-like/HER-2-negative, 8.7% HER-2-positive, 0.3% triple negative. Median follow-up: 8.2 years (0.0-23.8) for all, 7.2 years (0.0-23.2), for M0, 2.6 years (0.0-12.7) for M1 patients. A significant improvement over time was observed in age-corrected BC mortality. BC-specific-mortality was higher for men younger than 50 years. Better overall (OS) and recurrence-free survival (RFS) were observed for highly ER+ (P = 0.001), highly PR+ (P = 0.002), highly AR+ disease (P = 0.019). There was no association between OS/RFS and HER-2 status, Ki67, IHC subtypes nor grade. Conclusions Male BC is usually ER, PR and AR-positive, Luminal B-like/HER2-negative. Of note, 56% patients had T1 tumors but only 4% had BCS. ER was highly positive in >90% of cases but only 77% received adjuvant ET. ER, PR and AR were associated with OS and RFS, whereas grade, Ki67 and IHC surrogates were not. Significant improvement in survival over time was observed.
Collapse
Affiliation(s)
- F Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal; European Organisation for Research and Treatment of Cancer-Breast Cancer Group, Toronto, Canada.
| | - J M S Bartlett
- Transformative Pathology, Ontario Institute for Cancer Research, Toronto, Canada; University of Edinburgh, Edinburgh, UK
| | - L Slaets
- European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - C H M van Deurzen
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands; Dutch Breast Cancer Research Group (BOOG), The Netherlands
| | | | - P Porter
- Divisions of Human Biology and Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, USA; Department of Pathology, University of Washington, Seattle, USA
| | - B Linderholm
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden; Swedish Association of Breast Oncologists (SABO), Lund University, Lund, Sweden
| | - I Hedenfalk
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - C Schröder
- Dutch Breast Cancer Research Group (BOOG), The Netherlands; Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - J Martens
- Dutch Breast Cancer Research Group (BOOG), The Netherlands; Breast Cancer Genomics and Proteomics Lab, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J Bayani
- Transformative Pathology, Ontario Institute for Cancer Research, Toronto, Canada
| | - C van Asperen
- Dutch Breast Cancer Research Group (BOOG), The Netherlands; Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - M Murray
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York
| | - C Hudis
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York; Weill Cornell Medical College, New York
| | - L Middleton
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - J Vermeij
- Department of Medical Oncology, Hospital Network Antwerp (ZNA), Antwerp, Belgium
| | - K Punie
- Department of General Medical Oncology, UZ Leuven, Leuven, Belgium
| | - J Fraser
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - M Nowaczyk
- Specialist Hospital, St. Wojciech, Gdansk, Poland
| | - I T Rubio
- Breast Surgical Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - S Aebi
- Swiss Group for Clinical Cancer Research (SAKK), Switzerland
| | - C Kelly
- All Ireland Cooperative Oncology Research Group (ICORG), Ireland
| | - K J Ruddy
- Department of Oncology, Mayo Clinic, Rochester, USA
| | - E Winer
- Dana-Farber Cancer Institute, Boston, USA
| | - C Nilsson
- Department of Oncology, Västmanlands Hospital, Västerås, Sweden; Swedish Association of Breast Oncologists (SABO), Sweden
| | - L Dal Lago
- Department of Medical Oncology, Jules Bordet Institute, Brussels, Belgium
| | - L Korde
- University of Washington, Seattle, USA
| | - K Benstead
- Department of Oncology, Cheltenham General Hospital, UK
| | - O Bogler
- Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, USA
| | - T Goulioti
- Breast International Group, Brussels, Belgium
| | - A Peric
- European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - S Litière
- European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - K C Aalders
- European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - C Poncet
- European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - K Tryfonidis
- European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - S H Giordano
- Departments of Health Services Research and Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA
| |
Collapse
|
11
|
Bayani J, Poncet C, Yao CQ, Crozier C, Anouk N, Piper T, Cunningham C, Sobol M, Aebi S, Benstead K, Bogler O, Dal Lago L, Fraser J, Hilbers FH, Hedenfalk I, Korde L, Linderholm B, Martens J, Middleton L, Murray M, Kelly C, Nilsson C, Nowaczyk M, Peeters S, Peric A, Porter P, Schröder C, Rubio IT, Ruddy KJ, van Asperen C, Van Den Weyngaert D, van Deurzen C, van Leeuwen-Stok E, Vermeij J, Winer E, Boutros PC, Giordano SH, Cardoso F, Bartlett JM. Abstract P6-19-01: Evaluation of multiple transcriptomic gene risk signatures in male breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-19-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Male breast cancer (MBC) is a rare disease accounting for less than 1% of all breast cancers (BC) and 1% of all cancers in males. The clinical management is largely extrapolated from female BC. Several multigene assays are increasingly used to guide clinical treatment decisions in female BC, however there is little data on the utility of these tests in MBC.
Methods: Here we present the gene expression results of 380 M0, ER+ve, HER2-ve MBCs enrolled in the Part 1 (retrospective joint analysis) International Male Breast Cancer Program of 1483 patients diagnosed between 1990-2010 (Cardoso et al. Annals of Oncology, 2018). Using a custom Nanostring™ panel comprised of the genes from the commercial risk tests Prosigna®, OncotypeDx® and Mammaprint®, risk scores and intrinsic subtyping data were generated to recapitulate the commercial tests as described by Bayani and Yao et al (npjBreast Cancer, 2017). Survival outcomes by risk classification were analyzed using Cox models with time-dependent covariates when the proportional hazard assumption was not met and adjusted for clinical and treatment variables.
Results: Prosigna-like risk scores identified 99 (26.1%) as low-risk, 159 (41.8%) as intermediate-risk, and 122 (32.1%) as high-risk. Using the TAILORx cut-off (25) for OncotypeDx-like risk of recurrence scoring, 158 (41.6%) were identified as low-risk, while 222 (58.4%) were identified as high-risk. MammaPrint-like results identified 175 (46.1%) as low-risk and 205 (53.9%) as high-risk. Overall, patients classified as high-risk had higher grade, more nodal involvement, larger tumors, and more frequently treated with chemotherapy than low-risk patients. Survival analyses demonstrated clear clinical utility for each test, showing patients at high-risk with poor relapse-free survival (RFS) as compared to patients classified as low-risk: Prosigna-like RFS at 3-years (HR=2.20, 95% CI, 1.28-3.80); Oncotype-like RFS at 3-years (HR=1.92, 95% CI, 1.17-3.17); MammaPrint-like RFS (HR=1.51, 95% CI, 1.00-2.27); with similar findings for distant relapse-free survival (DRFS) and overall survival (OS). Across outcomes and all gene signatures, patients with concordant Low/Low risk classification had better prognosis than those with concordant High/High risk classification. PAM50 intrinsic subtyping identified 147 (38.7%) as Luminal A, 57 (15.0%) as Luminal B, 80 (21.1%) as Her2-enriched and 96 (25.3%) as Basal-like; showing overall 34.5% concordance to clinic-pathological subtyping by central pathology (95% CI, 29.7%-39.5%). Comparison between the tests in the MBC cohort and a comparable cohort of female BC from the Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial processed in the same way will be presented.
Conclusion: Common transcriptomic assays designed to assess residual risk, validated in female BC, provide similar information in male BC patients. Not surprisingly, disagreement between test results at the individual patient level was observed. To our knowledge, this is the largest study of MBC assayed to generate risk scores of the current commercial BC tests to demonstrate their clinical utility and their differences and similarity to female BC.
This work has been funded by the Breast Cancer Research Foundation (BCRF).
Citation Format: Bayani J, Poncet C, Yao CQ, Crozier C, Anouk N, Piper T, Cunningham C, Sobol M, Aebi S, Benstead K, Bogler O, Dal Lago L, Fraser J, Hilbers FH, Hedenfalk I, Korde L, Linderholm B, Martens J, Middleton L, Murray M, Kelly C, Nilsson C, Nowaczyk M, Peeters S, Peric A, Porter P, Schröder C, Rubio IT, Ruddy KJ, van Asperen C, Van Den Weyngaert D, van Deurzen C, van Leeuwen-Stok E, Vermeij J, Winer E, Boutros PC, Giordano SH, Cardoso F, Bartlett JM. Evaluation of multiple transcriptomic gene risk signatures in male breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-19-01.
Collapse
Affiliation(s)
- J Bayani
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - C Poncet
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - CQ Yao
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - C Crozier
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - N Anouk
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - T Piper
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - C Cunningham
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - M Sobol
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - S Aebi
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - K Benstead
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - O Bogler
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - L Dal Lago
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - J Fraser
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - FH Hilbers
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - I Hedenfalk
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - L Korde
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - B Linderholm
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - J Martens
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - L Middleton
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - M Murray
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - C Kelly
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - C Nilsson
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - M Nowaczyk
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - S Peeters
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - A Peric
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - P Porter
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - C Schröder
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - IT Rubio
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - KJ Ruddy
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - C van Asperen
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - D Van Den Weyngaert
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - C van Deurzen
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - E van Leeuwen-Stok
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - J Vermeij
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - E Winer
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - PC Boutros
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - SH Giordano
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - F Cardoso
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - JM Bartlett
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| |
Collapse
|
12
|
Muraro A, Fernandez-Rivas M, Beyer K, Cardona V, Clark A, Eller E, Hourihane JO, Jutel M, Sheikh A, Agache I, Allen KJ, Angier E, Ballmer-Weber B, Bilò MB, Bindslev-Jensen C, Camargo CA, Cianferoni A, DunnGalvin A, Eigenmann PA, Halken S, Hoffmann-Sommergruber K, Lau S, Nilsson C, Poulsen LK, Rueff F, Spergel J, Sturm G, Timmermans F, Torres MJ, Turner P, van Ree R, Wickman M, Worm M, Mills ENC, Roberts G. The urgent need for a harmonized severity scoring system for acute allergic reactions. Allergy 2018; 73:1792-1800. [PMID: 29331045 DOI: 10.1111/all.13408] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2017] [Indexed: 11/29/2022]
Abstract
The accurate assessment and communication of the severity of acute allergic reactions are important to patients, clinicians, researchers, the food industry, and public health and regulatory authorities. Severity has different meanings to different stakeholders with patients and clinicians rating the significance of particular symptoms very differently. Many severity scoring systems have been generated, most focusing on the severity of reactions following exposure to a limited group of allergens. They are heterogeneous in format, none has used an accepted developmental approach, and none has been validated. Their wide range of outcome formats has led to difficulties with interpretation and application. Therefore, there is a persisting need for an appropriately developed and validated severity scoring system for allergic reactions that work across the range of allergenic triggers and address the needs of different stakeholder groups. We propose a novel approach to develop and then validate a harmonized scoring system for acute allergic reactions, based on a data-driven method that is informed by clinical and patient experience and other stakeholders' perspectives. We envisage two formats: (i) a numerical score giving a continuum from mild to severe reactions that are clinically meaningful and are useful for allergy healthcare professionals and researchers, and (ii) a three-grade-based ordinal format that is simple enough to be used and understood by other professionals and patients. Testing of reliability and validity of the new approach in a range of settings and populations will allow eventual implementation of a standardized scoring system in clinical studies and routine practice.
Collapse
|
13
|
Markovic G, Bartfai A, Ekholm J, Nilsson C, Schult ML, Löfgren M. Daily management of attention dysfunction two–four years after brain injury and early cognitive rehabilitation with attention process training: a qualitative study. Neuropsychol Rehabil 2018; 30:523-544. [DOI: 10.1080/09602011.2018.1482770] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Gabriela Markovic
- Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Aniko Bartfai
- Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Jan Ekholm
- Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| | - Charlotte Nilsson
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Marie-Louise Schult
- Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Monika Löfgren
- Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| |
Collapse
|
14
|
Martens JWM, Sieuwerts A, Ponchet C, Smid M, de Weerd V, Slaets L, Piper T, van Deurzen CHM, Schroder CP, Stangle C, Kloosterman W, van Leeuwen-Stok E, Nilsson C, Vermeij J, Peeters S, Goulioti T, Nowaczyk M, Aebi S, Rubio IT, Kelly C, Bayani J, Porter P, Murray M, Hudis C, Middleton L, Korde L, Ruddy K, Winer E, Bogler O, van den Weyngaert D, dal Lago L, Fraser J, Benstead K, van Asperen C, Linderholm B, Hedenfalk I, Tryfonidis K, Giordano S, Bartlett J, Cardoso F. Abstract PD7-12: Molecular subtyping of male breast cancer by the International male breast cancer program (IMBC): EORTC 10085/TBCRC 0-29/BIG 2-07/NABCG/BOOG 2009-04. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-pd7-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction. Male breast cancer (male BC) is a rare disease for which disease management is extrapolated from females. IMBC, an international consortium, which previously reported on clinico-pathological aspects, now reports on molecular subgroups revealed by RNA sequencing and their relation to patient outcome.
Methods. Tumor samples from the retrospective MALE BC registry diagnosed between 1990-2010 and with pathology and outcome data (relapse-free- (RFS) and overall survival (OS)) were included (n=699). To allow the discovery of prognostic features, we selected, stratified for known risk factors (TN stage, grade, age at diagnose and adjuvant endocrine treatment), from the cohort 152 cases with poor (RFS <= 4 yrs) and good outcome (RFS > 7yrs) evenly distributed. Here, we report RNA sequencing results of the first 73 cases, 38 with poor and 35 with good outcome. RNA sequencing reads were used to generate gene expression values and to report transcripts carrying driver mutations. Unsupervised clustering identified subgroups and within subgroups differentially expressed genes were identified. The reported prognostic male BC subgroups M1 and M2 (Johansson BCR 2012(14):R31) were also annotated. All identified subgroups were related to outcome using logistic regression (p-value using Wald test).
Results. Unsupervised clustering revealed 2 main subgroups of which group 1 was enriched for expression of ER target genes, WNT3 and genes from amplicons known for female BC, e.g. 19p13 (CCNE1), 8q24 (MYC), and 11q13 (CCND1). The biology of the smaller group 2 was less defined but TGFβ2 expression was high as were various kallikreins (KLK) including interestingly KLK3 (prostate specific antigen). Other known amplified regions [(8p11 (FGFR1), 20q13 (ZNF217) and 12q15 (MDM2)] and mutated transcripts [PIK3CA (H1047R/L/Q; E542K, E545K, N345K; 16% of cases), TP53 and SF3B1 (K700E) (2% of cases)] were identified. Profound tumor infiltrate gene expression was present in 5% of cases and one third of cases expressed proliferation markers. Except for TP53, none of these latter characteristics were unevenly distributed among the 2 main subgroups. ER and AR were highly correlated, particularly in group 1. The two main groups could be further subdivided. Group 1 comprised 3 subgroups of which subgroup 1a expressed TFF1/3 and NAT1, well-known ER targets, while subgroups 1b and 1c expressed other ER targets,respectively BEX1 and PITX1. HOXC cluster expression differentiated subgroup 1b from 1a and 1c. None of these intrinsic subgroups were, however, related to RFS. The previously reported M2 subgroup, which largely segregated with subclusters 1a and 1b, was associated with a better RFS than the M1 subgroup (OR=2.9; 95%CI 1.1-7.5; p-value=0.03).
Conclusions. 1) Intrinsic subtypes of male BC were revealed and their subgrouping is defined by ER associated subsets of genes. 2) The association of the reported M2 subgroup of male BC with longer RFS was validated; 3) Currently identified biological characteristics of male BC may improve future treatments. The full report on 152 cases including a comparison to female BC will be presented at the conference.
This research was funded by Breast Cancer Research Foundation
Citation Format: Martens JWM, Sieuwerts A, Ponchet C, Smid M, de Weerd V, Slaets L, Piper T, van Deurzen CHM, Schroder CP, Stangle C, Kloosterman W, van Leeuwen-Stok E, Nilsson C, Vermeij J, Peeters S, Goulioti T, Nowaczyk M, Aebi S, Rubio IT, Kelly C, Bayani J, Porter P, Murray M, Hudis C, Middleton L, Korde L, Ruddy K, Winer E, Bogler O, van den Weyngaert D, dal Lago L, Fraser J, Benstead K, van Asperen C, Linderholm B, Hedenfalk I, Tryfonidis K, Giordano S, Bartlett J, Cardoso F. Molecular subtyping of male breast cancer by the International male breast cancer program (IMBC): EORTC 10085/TBCRC 0-29/BIG 2-07/NABCG/BOOG 2009-04 [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD7-12.
Collapse
Affiliation(s)
- JWM Martens
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - A Sieuwerts
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - C Ponchet
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - M Smid
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - V de Weerd
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - L Slaets
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - T Piper
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - CHM van Deurzen
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - CP Schroder
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - C Stangle
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - W Kloosterman
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - E van Leeuwen-Stok
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - C Nilsson
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - J Vermeij
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - S Peeters
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - T Goulioti
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - M Nowaczyk
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - S Aebi
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - IT Rubio
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - C Kelly
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - J Bayani
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - P Porter
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - M Murray
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - C Hudis
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - L Middleton
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - L Korde
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - K Ruddy
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - E Winer
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - O Bogler
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - D van den Weyngaert
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - L dal Lago
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - J Fraser
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - K Benstead
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - C van Asperen
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - B Linderholm
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - I Hedenfalk
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - K Tryfonidis
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - S Giordano
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - J Bartlett
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - F Cardoso
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| |
Collapse
|
15
|
Nilsson C, Hessman E, Sjöblom H, Dencker A, Jangsten E, Mollberg M, Patel H, Sparud-Lundin C, Wigert H, Begley C. Definitions, measurements and prevalence of fear of childbirth: a systematic review. BMC Pregnancy Childbirth 2018; 18:28. [PMID: 29329526 PMCID: PMC5766978 DOI: 10.1186/s12884-018-1659-7] [Citation(s) in RCA: 174] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 01/07/2018] [Indexed: 11/22/2022] Open
Abstract
Background Fear of Childbirth (FOC) is a common problem affecting women’s health and wellbeing, and a common reason for requesting caesarean section. The aims of this review were to summarise published research on prevalence of FOC in childbearing women and how it is defined and measured during pregnancy and postpartum, and to search for useful measures of FOC, for research as well as for clinical settings. Methods Five bibliographic databases in March 2015 were searched for published research on FOC, using a protocol agreed a priori. The quality of selected studies was assessed independently by pairs of authors. Prevalence data, definitions and methods of measurement were extracted independently from each included study by pairs of authors. Finally, some of the country rates were combined and compared. Results In total, 12,188 citations were identified and screened by title and abstract; 11,698 were excluded and full-text of 490 assessed for analysis. Of these, 466 were excluded leaving 24 papers included in the review, presenting prevalence of FOC from nine countries in Europe, Australia, Canada and the United States. Various definitions and measurements of FOC were used. The most frequently-used scale was the W-DEQ with various cut-off points describing moderate, severe/intense and extreme/phobic fear. Different 3-, 4-, and 5/6 point scales and visual analogue scales were also used. Country rates (as measured by seven studies using W-DEQ with ≥85 cut-off point) varied from 6.3 to 14.8%, a significant difference (chi-square = 104.44, d.f. = 6, p < 0.0001). Conclusions Rates of severe FOC, measured in the same way, varied in different countries. Reasons why FOC might differ are unknown, and further research is necessary. Future studies on FOC should use the W-DEQ tool with a cut-off point of ≥85, or a more thoroughly tested version of the FOBS scale, or a three-point scale measurement of FOC using a single question as ‘Are you afraid about the birth?’ In this way, valid comparisons in research can be made. Moreover, validation of a clinical tool that is more focussed on FOC alone, and easier than the longer W-DEQ, for women to fill in and clinicians to administer, is required. Electronic supplementary material The online version of this article (10.1186/s12884-018-1659-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- C Nilsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, S-501 90, Borås, Sweden. .,Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, -405 30, Gothenburg, SE, Sweden.
| | - E Hessman
- Biomedical Library, Gothenburg University Library at University of Gothenburg, Box 416, -405 30, Gothenburg, SE, Sweden
| | - H Sjöblom
- Biomedical Library, Gothenburg University Library at University of Gothenburg, Box 416, -405 30, Gothenburg, SE, Sweden
| | - A Dencker
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, -405 30, Gothenburg, SE, Sweden
| | - E Jangsten
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, -405 30, Gothenburg, SE, Sweden
| | - M Mollberg
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, -405 30, Gothenburg, SE, Sweden
| | - H Patel
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, -405 30, Gothenburg, SE, Sweden
| | - C Sparud-Lundin
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, -405 30, Gothenburg, SE, Sweden
| | - H Wigert
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, -405 30, Gothenburg, SE, Sweden
| | - C Begley
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, -405 30, Gothenburg, SE, Sweden.,Chair of Nursing and Midwifery, School of Nursing and Midwifery,Trinity College Dublin, 24, D'Olier St. Dublin 2, Dublin, Ireland
| |
Collapse
|
16
|
Ali T, Nilsson C, Weuve J, Rajan K, Mendes de Leon C. LONGITUDINAL EFFECTS OF SOCIAL NETWORK DIVERSITY ON MORTALITY AND DISABILITY AMONG ELDERLY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T. Ali
- University of Michigan, Ann Arbor, Michigan,
| | - C. Nilsson
- University of Copenhagen, Copenhagen, Denmark,
| | - J. Weuve
- Boston University, Boston, Massachusetts,
| | | | | |
Collapse
|
17
|
Lethin C, Renom Guiteras A, Zwakhalen S, Soto Martin M, Saks K, Zabalegui A, Nilsson C, Karlsson S. PSYCHOLOGICAL WELL-BEING AMONG INFORMAL CAREGIVERS CARING FOR PERSONS WITH DEMENTIA LIVING AT HOME. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.5082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- C. Lethin
- Lund University, Faculty of Medicine, Lund, Sweden,
| | | | - S. Zwakhalen
- Department of Health Services Research, Maastricht University, Maastricht, Netherlands
| | - M. Soto Martin
- Alzheimers disease Research and Clinical Centre in Toulouse, Toulouse, France,
| | - K. Saks
- Department of internal medicine, University of Tartu, Tartu, Estonia,
| | | | - C. Nilsson
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund, Sweden,
| | - S. Karlsson
- Lund University, Faculty of Medicine, Lund, Sweden,
| |
Collapse
|
18
|
Høj Jørgensen T, Lund R, Siersma V, Nilsson C. SOCIAL INEQUALITY IN DECLINE IN PHYSICAL FUNCTION AND MORTALITY AMONG OLDER ADULTS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T. Høj Jørgensen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark,
| | - R. Lund
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark,
| | - V. Siersma
- Section and Research Unit of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - C. Nilsson
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark,
| |
Collapse
|
19
|
Hinkula J, Petkov S, Ljungberg K, Hallengärd D, Bråve A, Isaguliants M, Falkeborn T, Sharma S, Liakina V, Robb M, Eller M, Moss B, Biberfeld G, Sandström E, Nilsson C, Markland K, Blomberg P, Wahren B. HIVIS-DNA or HIVISopt-DNA priming followed by CMDR vaccinia-based boosts induce both humoral and cellular murine immune responses to HIV. Heliyon 2017; 3:e00339. [PMID: 28721397 PMCID: PMC5496381 DOI: 10.1016/j.heliyon.2017.e00339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 06/19/2017] [Indexed: 02/08/2023] Open
Abstract
Background In order to develop a more effective prophylactic HIV-1 vaccine it is important optimize the components, improve Envelope glycoprotein immunogenicity as well as to explore prime-boost immunization schedules. It is also valuable to include several HIV-1 subtype antigens representing the world-wide epidemic. Methods HIVIS-DNA plasmids which include Env genes of subtypes A, B and C together with Gag subtypes A and B and RTmut/Rev of subtype B were modified as follows: the Envelope sequences were shortened, codon optimized, provided with an FT4 sequence and an immunodominant region mutated. The reverse transcriptase (RT) gene was shortened to contain the most immunogenic N-terminal fragment and fused with an inactivated viral protease vPR gene. HIVISopt-DNA thus contains fewer plasmids but additional PR epitopes compared to the native HIVIS-DNA. DNA components were delivered intradermally to young Balb/c mice once, using a needle-free Biojector® immediately followed by dermal electroporation. Vaccinia-based MVA-CMDR boosts including Env gene E and Gag-RT genes A were delivered intramuscularly by needle, once or twice. Results Both HIVIS-DNA and HIVISopt-DNA primed humoral and cell mediated responses well. When boosted with heterologous MVA-CMDR (subtypes A and E) virus inhibitory neutralizing antibodies were obtained to HIV-1 subtypes A, B, C and AE. Both plasmid compositions boosted with MVA-CMDR generated HIV-1 specific cellular responses directed against HIV-1 Env, Gag and Pol, as measured by IFNγ ELISpot. It was shown that DNA priming augmented the vector MVA immunological boosting effects, the HIVISopt-DNA with a trend to improved (Env) neutralization, the HIVIS-DNA with a trend to better (Gag) cell mediated immune reponses. Conclusions HIVIS-DNA was modified to obtain HIVISopt-DNA that had fewer plasmids, and additional epitopes. Even with one DNA prime followed by two MVA-CMDR boosts, humoral and cell-mediated immune responses were readily induced by priming with either DNA construct composition. Priming by HIV-DNA augmented neutralizing antibody responses revealed by boosting with the vaccinia-based heterologous sequences. Cellular and antibody responses covered selected strains representing HIV-1 subtypes A, B, C and CRF01_AE. We assume this is related to the inclusion of heterologous full genes in the vaccine schedule.
Collapse
Affiliation(s)
- J Hinkula
- Department of Clinical and Experimental Medicine, Linköping University, 58183 Linköping, Sweden.,Department of Microbiology Tumor and Cell Biology, Karolinska Institutet, 17177 Stockholm, Sweden
| | - S Petkov
- Department of Microbiology Tumor and Cell Biology, Karolinska Institutet, 17177 Stockholm, Sweden
| | - K Ljungberg
- Department of Microbiology Tumor and Cell Biology, Karolinska Institutet, 17177 Stockholm, Sweden
| | - D Hallengärd
- Department of Microbiology Tumor and Cell Biology, Karolinska Institutet, 17177 Stockholm, Sweden
| | - A Bråve
- Department of Microbiology Tumor and Cell Biology, Karolinska Institutet, 17177 Stockholm, Sweden
| | - M Isaguliants
- Department of Microbiology Tumor and Cell Biology, Karolinska Institutet, 17177 Stockholm, Sweden
| | - T Falkeborn
- Department of Clinical and Experimental Medicine, Linköping University, 58183 Linköping, Sweden
| | - S Sharma
- Department of Clinical and Experimental Medicine, Linköping University, 58183 Linköping, Sweden
| | - V Liakina
- Faculty of Medicine, Vilnius University 2, 08661 Vilnius, Lithuania
| | - M Robb
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, 20892 MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, 20892 MD, USA
| | - M Eller
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, 20892 MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, 20892 MD, USA
| | - B Moss
- Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, 20892 MD, USA
| | - G Biberfeld
- Department of Microbiology Tumor and Cell Biology, Karolinska Institutet, 17177 Stockholm, Sweden
| | - E Sandström
- Department of South Hospital, Karolinska Institutet, 11883 Stockholm, Sweden
| | - C Nilsson
- Department of Microbiology Tumor and Cell Biology, Karolinska Institutet, 17177 Stockholm, Sweden
| | - K Markland
- Clinical Research Center and Vecura, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - P Blomberg
- Clinical Research Center and Vecura, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - B Wahren
- Department of Microbiology Tumor and Cell Biology, Karolinska Institutet, 17177 Stockholm, Sweden
| |
Collapse
|
20
|
Brandström J, Vetander M, Lilja G, Johansson SGO, Sundqvist AC, Kalm F, Nilsson C, Nopp A. Individually dosed omalizumab: an effective treatment for severe peanut allergy. Clin Exp Allergy 2017; 47:540-550. [DOI: 10.1111/cea.12862] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 10/27/2016] [Accepted: 11/01/2016] [Indexed: 11/28/2022]
Affiliation(s)
- J. Brandström
- Department of Clinical Science and Education; Södersjukhuset; Karolinska Institutet; Stockholm Sweden
- Sachs’ Children and Youth Hospital; Södersjukhuset; Stockholm Sweden
| | - M. Vetander
- Sachs’ Children and Youth Hospital; Södersjukhuset; Stockholm Sweden
- Center for Allergy Research; Karolinska Institutet; Stockholm Sweden
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
| | - G. Lilja
- Department of Clinical Science and Education; Södersjukhuset; Karolinska Institutet; Stockholm Sweden
- Sachs’ Children and Youth Hospital; Södersjukhuset; Stockholm Sweden
| | - S. G. O. Johansson
- Department of Medicine; Immunology and Allergy Unit; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - A.-C. Sundqvist
- Department of Clinical Science and Education; Södersjukhuset; Karolinska Institutet; Stockholm Sweden
- Sachs’ Children and Youth Hospital; Södersjukhuset; Stockholm Sweden
| | - F. Kalm
- Department of Medicine; Immunology and Allergy Unit; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
- Division of Proteomics and Nanobiotechnology; School of Biotechnology; Royal Institute of Technology; Stockholm Sweden
| | - C. Nilsson
- Department of Clinical Science and Education; Södersjukhuset; Karolinska Institutet; Stockholm Sweden
- Sachs’ Children and Youth Hospital; Södersjukhuset; Stockholm Sweden
- Center for Allergy Research; Karolinska Institutet; Stockholm Sweden
| | - A. Nopp
- Department of Medicine; Immunology and Allergy Unit; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| |
Collapse
|
21
|
Morentin Gutierrez P, Gyte A, deSchoolmeester J, Ceuppens P, Swales J, Stacey C, Eriksson JW, Sjöstrand M, Nilsson C, Leighton B. Continuous inhibition of 11β-hydroxysteroid dehydrogenase type I in adipose tissue leads to tachyphylaxis in humans and rats but not in mice. Br J Pharmacol 2015. [PMID: 26218540 DOI: 10.1111/bph.13251] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND PURPOSE 11β-hydroxysteroid dehydrogenase type I (11β-HSD1), a target for Type 2 diabetes mellitus, converts inactive glucocorticoids into bioactive forms, increasing tissue concentrations. We have compared the pharmacokinetic-pharmacodynamic (PK/PD) relationship of target inhibition after acute and repeat administration of inhibitors of 11β-HSD1 activity in human, rat and mouse adipose tissue (AT). EXPERIMENTAL APPROACH Studies included abdominally obese human volunteers, rats and mice. Two specific 11β-HSD1 inhibitors (AZD8329 and COMPOUND-20) were administered as single oral doses or repeat daily doses for 7-9 days. 11β-HSD1 activity in AT was measured ex vivo by conversion of (3) H-cortisone to (3) H-cortisol. KEY RESULTS In human and rat AT, inhibition of 11β-HSD1 activity was lost after repeat dosing of AZD8329, compared with acute administration. Similarly, in rat AT, there was loss of inhibition of 11β-HSD1 activity after repeat dosing with COMPOUND-20 with continuous drug cover, but effects were substantially reduced if a 'drug holiday' period was maintained daily. Inhibition of 11β-HSD1 activity was not lost in mouse AT after continuous cover with COMPOUND-20 for 7 days. CONCLUSIONS AND IMPLICATIONS Human and rat AT, but not mouse AT, exhibited tachyphylaxis for inhibition of 11β-HSD1 activity after repeat dosing. Translation of observed efficacy in murine disease models to human for 11β-HSD1 inhibitors may be misleading. Investigators of the effects of 11β-HSD1 inhibitors should confirm that desired levels of enzyme inhibition in AT can be maintained over time after repeat dosing and not rely on results following a single dose.
Collapse
Affiliation(s)
| | - A Gyte
- AstraZeneca R&D, Mereside, Alderley Park, Macclesfield, SK10 4TG, UK
| | - J deSchoolmeester
- AstraZeneca R&D, Mereside, Alderley Park, Macclesfield, SK10 4TG, UK
| | - P Ceuppens
- AstraZeneca R&D, Mereside, Alderley Park, Macclesfield, SK10 4TG, UK
| | - J Swales
- AstraZeneca R&D, Mereside, Alderley Park, Macclesfield, SK10 4TG, UK
| | - C Stacey
- AstraZeneca R&D, Mereside, Alderley Park, Macclesfield, SK10 4TG, UK
| | - J W Eriksson
- AstraZeneca R&D, Mölndal, Sweden.,Department of Medical Sciences, Uppsala University, 751 85, Uppsala, Sweden
| | | | | | - B Leighton
- AstraZeneca R&D, Mereside, Alderley Park, Macclesfield, SK10 4TG, UK
| |
Collapse
|
22
|
Brandström J, Nopp A, Johansson SGO, Lilja G, Sundqvist AC, Borres MP, Nilsson C. Basophil allergen threshold sensitivity and component-resolved diagnostics improve hazelnut allergy diagnosis. Clin Exp Allergy 2015; 45:1412-8. [DOI: 10.1111/cea.12515] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 02/09/2015] [Accepted: 02/13/2015] [Indexed: 11/27/2022]
Affiliation(s)
- J. Brandström
- Department of Clinical Science and Education, Södersjukhuset; Karolinska Institutet; Stockholm Sweden
- Sachs′ Children and Youth Hospital, Södersjukhuset; Stockholm Sweden
| | - A. Nopp
- Department of Medicine; Clinical Immunology and Allergy Unit; Karolinska Institutet, and Hospital; Stockholm Sweden
| | - S. G. O. Johansson
- Department of Medicine; Clinical Immunology and Allergy Unit; Karolinska Institutet, and Hospital; Stockholm Sweden
| | - G. Lilja
- Department of Clinical Science and Education, Södersjukhuset; Karolinska Institutet; Stockholm Sweden
- Sachs′ Children and Youth Hospital, Södersjukhuset; Stockholm Sweden
| | - A.-C. Sundqvist
- Department of Clinical Science and Education, Södersjukhuset; Karolinska Institutet; Stockholm Sweden
- Sachs′ Children and Youth Hospital, Södersjukhuset; Stockholm Sweden
| | - M. P. Borres
- Thermo Fisher Scientific; Uppsala Sweden
- Department of Women′s and Children′s Health; Uppsala University; Uppsala Sweden
| | - C. Nilsson
- Department of Clinical Science and Education, Södersjukhuset; Karolinska Institutet; Stockholm Sweden
- Sachs′ Children and Youth Hospital, Södersjukhuset; Stockholm Sweden
| |
Collapse
|
23
|
Glintborg B, Højgaard P, Hetland M, Chrysidis S, Espesen J, Holland-Fischer M, Johansen F, Jensen J, Hansen I, Hansen T, Kollerup G, Krogh N, Loft A, Lorenzen T, Mosborg P, Nilsson C, Nordin H, Oeftiger S, Pelck R, Rasmussen C, Unger B, Dreyer L. THU0241 Association Between Tobacco Smoking and Response to Tumor Necrosis Factor Alpha Inhibitor Treatment in Ankylosing Spondylitis: Results from the Danish Nationwide Danbio Registry. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
24
|
Glaumann S, Nilsson C, Asarnoj A, Movérare R, Johansson SGO, Borres MP, Lilja G, Nopp A. IgG4 antibodies and peanut challenge outcome in children IgE-sensitized to peanut. Pediatr Allergy Immunol 2015; 26:386-9. [PMID: 25779767 DOI: 10.1111/pai.12370] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- S Glaumann
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. .,Södersjukhuset, Sachs' Children and Youth Hospital, Stockholm, Sweden.
| | - C Nilsson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Södersjukhuset, Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - A Asarnoj
- Astrid Lindgren Children's Hospital, Department of Pediatric Pulmonology and Allergy, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Clinical Immunology and Allergy Unit, Karolinska Institutet and Hospital, Stockholm, Sweden
| | - R Movérare
- Thermo Fisher Scientific, Uppsala, Sweden.,Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden
| | - S G O Johansson
- Department of Medicine, Clinical Immunology and Allergy Unit, Karolinska Institutet and Hospital, Stockholm, Sweden
| | - M P Borres
- Thermo Fisher Scientific, Uppsala, Sweden.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - G Lilja
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Södersjukhuset, Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - A Nopp
- Department of Medicine, Clinical Immunology and Allergy Unit, Karolinska Institutet and Hospital, Stockholm, Sweden
| |
Collapse
|
25
|
Vetander M, Ly DH, Håkansson N, Lilja G, Nilsson C, Östblom E, Wickman M, Bergström A. Recurrent reactions to food among children at paediatric emergency departments: epidemiology of allergic disease. Clin Exp Allergy 2014; 44:113-20. [PMID: 24118652 DOI: 10.1111/cea.12203] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 09/19/2013] [Accepted: 09/15/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Knowledge about repeated food reactions in paediatric emergency departments (ED) is sparse. OBJECTIVE To investigate the incidence and potential risk factors for repeated ED visits for food-allergic reactions among children with a prior ED visit due to reactions to food. METHODS A total of 358 children with ED visits at paediatric hospitals in Stockholm due to reactions to foods during 2007 (index-reaction) were investigated in relation to recurrent reactions until 30 June 2010. Adjusted Cox proportional hazard models were used to compute relative risks (RR) and 95% confidence intervals (CI). RESULTS A total of 80 children had 116 ED revisits over a period of 873 patient-years, yielding an incidence rate of 9 per 100 patient-years. Known food allergy before the index ED visit in 2007 increased the risk for ED revisits (RR = 2.30, 95% CI 1.35-3.94). Likewise, prescription of adrenaline auto-injector before the index-reaction increased the risk (RR = 2.02, 95% CI 1.17-3.49). Twenty-one percent of the children had more severe reactions at the revisit, 38% less severe and 41% had reactions of comparable severity. However, among 44% of the children with comparable or less severe reaction at revisit, early treatment with adrenaline hampered the classification of change in severity. CONCLUSIONS AND CLINICAL RELEVANCE Previously known food allergy and prior prescription of adrenaline are significant risk factors for ED revisits among children with a prior ED visit due to reactions to food. Our results indicate that the severity of the index-reaction cannot be used to predict the severity of the relapse.
Collapse
Affiliation(s)
- M Vetander
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Beyer K, Bindslev-Jensen C, Cardona V, Dubois A, duToit G, Eigenmann P, Fernandez Rivas M, Halken S, Hickstein L, Høst A, Knol E, Lack G, Marchisotto MJ, Niggemann B, Nwaru BI, Papadopoulos NG, Poulsen LK, Santos AF, Skypala I, Schoepfer A, Van Ree R, Venter C, Worm M, Vlieg-Boerstra B, Panesar S, de Silva D, Soares-Weiser K, Sheikh A, Ballmer-Weber BK, Nilsson C, de Jong NW, Akdis CA. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy 2014; 69:1008-25. [PMID: 24909706 DOI: 10.1111/all.12429] [Citation(s) in RCA: 767] [Impact Index Per Article: 76.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2014] [Indexed: 12/11/2022]
Abstract
Food allergy can result in considerable morbidity, impact negatively on quality of life, and prove costly in terms of medical care. These guidelines have been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Guidelines for Food Allergy and Anaphylaxis Group, building on previous EAACI position papers on adverse reaction to foods and three recent systematic reviews on the epidemiology, diagnosis, and management of food allergy, and provide evidence-based recommendations for the diagnosis and management of food allergy. While the primary audience is allergists, this document is relevant for all other healthcare professionals, including primary care physicians, and pediatric and adult specialists, dieticians, pharmacists and paramedics. Our current understanding of the manifestations of food allergy, the role of diagnostic tests, and the effective management of patients of all ages with food allergy is presented. The acute management of non-life-threatening reactions is covered in these guidelines, but for guidance on the emergency management of anaphylaxis, readers are referred to the related EAACI Anaphylaxis Guidelines.
Collapse
|
27
|
Højgaard P, Glintborg B, Hetland M, Hansen T, Nilsson C, Lage-Hansen P, Petersen M, Holland-Fisher M, Loft A, Andersen B, Adelsten T, Jensen J, Omerovic E, Christensen R, Tarp U, Østgaard R, Dreyer L. SAT0409 Association between Tobacco Smoking and Response to Tumor Necrosis Factor Alpha Inhibitor Treatment in Psoriatic Arthritis: Results from the Danbio Registry. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
28
|
Mänty M, Møller A, Nilsson C, Lund R, Christensen U, Avlund K. Association of physical workload and leisure time physical activity with incident mobility limitations: a follow-up study. Occup Environ Med 2014; 71:543-8. [PMID: 24879373 DOI: 10.1136/oemed-2013-101883] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To examine individual as well as joint associations of physical workload and leisure time physical activity with incident mobility limitations in initially well-functioning middle-aged workers. METHODS This study is based on 6-year follow-up data of the Danish Longitudinal Study on Work, Unemployment and Health. Physical workload was reported at baseline and categorised as light, moderate or heavy. Baseline leisure time physical activity level was categorised as sedentary or active following the current recommendations on physical activity. Incidence of mobility limitations in climbing stairs and running among initially well-functioning workers (n=3202 and n=2821, respectively) was assessed during follow-up. RESULTS Higher workload increased whereas active leisure time decreased the risk of developing mobility limitations. The incidence of limitations increased progressively with higher workload regardless of level of leisure time physical activity, although the risks tended to be higher among those with sedentary leisure time compared with their active counterparts. All in all, the risk for onset of mobility limitations was highest among those with heavy workload combined with sedentary leisure time and lowest among those with light workload combined with active leisure time. CONCLUSIONS Although leisure time physical activity prevents development of mobility decline, high workload seems to accelerate the progression of mobility limitations among both those with active and sedentary leisure time. Therefore, efforts should be made to recommend people to engage in physical activity regardless of their physical workload.
Collapse
Affiliation(s)
- M Mänty
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland
| | - A Møller
- Department of Occupational Medicine, Køge Hospital, Køge, Denmark The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark National Research Centre for the Working Environment, Copenhagen, Denmark
| | - C Nilsson
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - R Lund
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - U Christensen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - K Avlund
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark The Danish Aging Research Centre, Universities of Odense, Aarhus and Copenhagen, Denmark
| |
Collapse
|
29
|
Denison H, Nilsson C, Löfgren L, Himmelmann A, Mårtensson G, Knutsson M, Al-Shurbaji A, Tornqvist H, Eriksson JW. Diacylglycerol acyltransferase 1 inhibition with AZD7687 alters lipid handling and hormone secretion in the gut with intolerable side effects: a randomized clinical trial. Diabetes Obes Metab 2014; 16:334-43. [PMID: 24118885 DOI: 10.1111/dom.12221] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 08/21/2013] [Accepted: 09/30/2013] [Indexed: 02/02/2023]
Abstract
AIM Inhibition of diacylglycerol acyltransferase 1 (DGAT1) is a potential treatment modality for patients with type 2 diabetes mellitus and obesity, based on preclinical data suggesting it is associated with insulin sensitization and weight loss. This randomized, placebo-controlled, phase 1 study in 62 overweight or obese men explored the effects and tolerability of AZD7687, a reversible and selective DGAT1 inhibitor. METHODS Multiple doses of AZD7687 (1, 2.5, 5, 10 and 20 mg/day, n = 6 or n = 12 for each) or placebo (n = 20) were administered for 1 week. Postprandial serum triacylglycerol (TAG) was measured for 8 h after a standardized 45% fat meal. Glucagon-like peptide-1 (GLP-1) and peptide YY (PYY) were measured and a paracetamol challenge was performed to assess gastric emptying. RESULTS Dose-dependent reductions in postprandial serum TAG were demonstrated with AZD7687 doses ≥5 mg compared with placebo (p < 0.01). Significant (p < 0.001) increases in plasma GLP-1 and PYY levels were seen at these doses, but no clear effect on gastric emptying was demonstrated at the end of treatment. With AZD7687 doses >5 mg/day, gastrointestinal (GI) side effects increased; 11/18 of these participants discontinued treatment owing to diarrhoea. CONCLUSIONS Altered lipid handling and hormone secretion in the gut were demonstrated during 1-week treatment with the DGAT1 inhibitor AZD7687. However, the apparent lack of therapeutic window owing to GI side effects of AZD7687, particularly diarrhoea, makes the utility of DGAT1 inhibition as a novel treatment for diabetes and obesity questionable.
Collapse
|
30
|
Hansen ÅM, Darsø L, Manty M, Nilsson C, Christensen U, Lund R, Holtermann A, Avlund K. Psychosocial factors at work and the development of mobility limitations among adults in Denmark. Scand J Public Health 2014; 42:417-24. [PMID: 24637677 DOI: 10.1177/1403494814527526] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM Psychosocial factors in the working environment have been shown to be associated with mobility limitations, but this has not yet been confirmed in a Danish population. We aimed to examine how psychosocial factors at work are related to developing mobility limitations in Denmark. METHODS This study is based on data from 2952 middle-aged men and women without mobility limitations in 2000. RESULTS We found increased risk of incident mobility limitations during 6-year follow up among men who often perceived high work pace (OR 5.45, 95% CI 1.21-24.52) vs. never, who only sometimes or/never perceived the work to be meaningful (OR 6.54, 95% CI 1.55-27.55) vs. always, and who sometimes perceived high emotional demands at work (OR 7.85, 95% CI 1.78-34.65) vs. never. Among women, lower risk of incident mobility limitations was observed among those who in 2000 perceived high work pace sometimes (OR 0.46, 95% CI 0.24-0.87) or often (OR 0.43, 95% CI 0.22-0.85) vs. never in 2000. Also, women who always or often experienced high emotional demands had an increased risk. CONCLUSIONS The most important finding was that high work pace was strongly associated with increased risk of mobility limitations among men, but associated with lower risk of mobility limitations among women. This knowledge may be used to better target interventions among men and women in midlife from physical deterioration later in life.
Collapse
Affiliation(s)
- Åse Marie Hansen
- Department of Public Health, University of Copenhagen, Denmark National Research Centre for Working Environment, Copenhagen, Denmark
| | - Lilie Darsø
- Department of Public Health, University of Copenhagen, Denmark
| | - Minna Manty
- Department of Public Health, University of Copenhagen, Denmark Center for Healthy Ageing, University of Copenhagen, Denmark
| | - Charlotte Nilsson
- Department of Public Health, University of Copenhagen, Denmark Center for Healthy Ageing, University of Copenhagen, Denmark
| | | | - Rikke Lund
- Department of Public Health, University of Copenhagen, Denmark Center for Healthy Ageing, University of Copenhagen, Denmark
| | | | - Kirsten Avlund
- Department of Public Health, University of Copenhagen, Denmark Center for Healthy Ageing, University of Copenhagen, Denmark Danish Aging Research Center, Universities of Aarhus, Southern Denmark (Odense) and Copenhagen, Denmark
| |
Collapse
|
31
|
Santillo AF, Nilsson C, Englund E. von Economo neurones are selectively targeted in frontotemporal dementia. Neuropathol Appl Neurobiol 2014; 39:572-9. [PMID: 23346995 PMCID: PMC3749467 DOI: 10.1111/nan.12021] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 01/18/2013] [Indexed: 11/28/2022]
Abstract
Background von Economo neurones (VEN) are bipolar neurones located in the anterior cingulate cortex (ACC) and the frontoinsular cortex (FI), areas affected early in behavioural variant frontotemporal dementia (bvFTD), in which VEN may constitute a selectively vulnerable cellular population. Aim A previous study has shown a selective loss of VEN in FTD above other neurones in the ACC of FTD. The aim of this study was to confirm this finding in a larger cohort, using a different methodology, and to examine VEN loss in relation to neuropathological severity and molecular pathology. Methods VEN and neighbouring neurones (NN) were quantified in layers Va and Vb of the right dorsal ACC in 21 cases of bvFTD, 10 cases of Alzheimer's disease (AD) and 10 non-demented controls (NDC). Results A marked VEN reduction was seen in all FTD cases. In the neuropathologically early cases of FTD (n = 13), VEN/10 000 NN was significantly reduced by 53% compared with NDC (P < 0.001) and 41% compared with AD (P = 0.019), whereas AD patients showed a non-significant 30% reduction of VEN/10 000 NN compared with NDC. VEN reduction was present in all protein pathology subgroups. Discussion In conclusion, this study confirms selective sensitivity of VEN in FTD and suggests that VEN loss is an early event in the neurodegenerative process.
Collapse
Affiliation(s)
- A F Santillo
- Geriatric Psychiatric Unit, Department of Clinical Sciences, Lund University, Lund, Sweden.
| | | | | |
Collapse
|
32
|
Kjaergaard M, Nilsson C, Rosendal A, Nielsen MO, Raun K. Maternal chocolate and sucrose soft drink intake induces hepatic steatosis in rat offspring associated with altered lipid gene expression profile. Acta Physiol (Oxf) 2014; 210:142-53. [PMID: 23782871 DOI: 10.1111/apha.12138] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 03/01/2013] [Accepted: 06/13/2013] [Indexed: 12/11/2022]
Abstract
AIM According to the World Diabetes Foundation, there is an urgent need to investigate the impact of maternal health and nutrition during pregnancy to understand the background for the accelerating incidence of obesity and type 2 diabetes. In this study, we specifically concentrated on the role of overfeeding during different developmental periods. METHODS Sprague-Dawley rats were offered chow or high-fat/high-sucrose diet (chow plus chocolate and soft drink) during gestation and lactation. At birth, offspring were randomly cross-fostered within each dietary group into small and normal litter sizes until weaning, giving four dietary groups. RESULTS At postnatal day 1, offspring from high-fat/high-sucrose-fed dams were heavier and had increased hepatic triglycerides (TG), hepatic glycogen, blood glucose and plasma insulin compared with offspring from chow-fed dams. Hepatic genes involved in lipid oxidation, VLDL transport and insulin receptor were down-regulated, whereas FGF21 expression was up-regulated. Independent of postnatal litter size, offspring from high-fat/high-sucrose-fed dams aged 21 days had still increased hepatic TG and up-regulated FGF21 expression, while plasma insulin started to decrease. Litter size reduction in offspring from high-fat/high-sucrose-fed dams further increased body weight and adiposity, and up-regulated genes involved in hepatic mitochondrial lipid oxidation and VLDL transport compared with all other groups. Litter size reduction did not have any impact on body weight gain and adiposity in offspring born to chow-fed dams. CONCLUSION Our results suggest that supplementation of chocolate and soft drink during gestation and lactation contributes to early onset of hepatic steatosis associated with changes in hepatic gene expression and lipid handling.
Collapse
Affiliation(s)
- M. Kjaergaard
- Department of Type 2 Diabetes Pharmacology; Novo Nordisk A/S; Maaloev Denmark
- Department of Veterinary Clinical and Animal Sciences; Faculty of Health and Medical Sciences; University of Copenhagen; Frederiksberg Denmark
| | - C. Nilsson
- Uppsala University Innovation, Uppsala Science Park; Uppsala Sweden
| | - A. Rosendal
- Department of Assay Technology; Novo Nordisk A/S; Maaloev Denmark
| | - M. O. Nielsen
- Department of Veterinary Clinical and Animal Sciences; Faculty of Health and Medical Sciences; University of Copenhagen; Frederiksberg Denmark
| | - K. Raun
- Department of Type 2 Diabetes Pharmacology; Novo Nordisk A/S; Maaloev Denmark
| |
Collapse
|
33
|
Johansson I, Lauss M, Holm K, Nilsson C, Fjällskog ML, Ringnér M, Hedenfalk I. Abstract P1-17-01: Whole genome methylation patterns in male and female breast cancer – Unexpected findings. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p1-17-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Male breast cancer (MBC) is a rare disease, accounting for less than 1% of all breast cancer cases. Although it is similar to female breast cancer (FBC) in many ways, distinct differences in incidence, age distribution, levels of hormone receptors, prognosis and survival have been reported. In a recent gene expression profiling study of MBC we described two new subgroups (Luminal M1 and M2, respectively) that did not resemble any of the intrinsic subgroups reported in FBC, and as such may be specific to breast cancer in men. Luminal M1 tumors (70% of the MBC tumors) seemed to be more aggressive and were associated with worse prognosis and also appeared to have a less activated estrogen receptor (ER) pathway, while Luminal M2 tumors (30% of the MBC tumors) displayed an up-regulated immune response and a more activated ER pathway. This despite >90% of the MBCs being ER positive by immunohistochemistry. Due to the rarity of the disease, no large comprehensive trials for optimizing patient management have been conducted to date. Recommendations for management of MBC are therefore extrapolated from knowledge of FBC.
The aim of this study was to assess genome wide methylation profiles in primary human MBC and compare them with the transcriptionally derived subgroups, Luminal M1 and M2, as well as FBC. Epigenetic changes are known to be involved in tumorigenesis and methylation may influence the expression of cancer related genes and are potential druggable targets.
We used Illumina's 450K arrays to measure global methylation profiles in 47 MBC and 215 FBC tumors, representing all subgroups of male and female breast cancers.
Unsupervised hierarchical clustering of the most variable probes among the MBC tumors revealed two stable subgroups. The methylation patterns differed significantly between the groups and were associated with the transcriptional subgroups Luminal M1 and M2. When the MBC and FBC tumors were analyzed together using the most variable probes, three stable clusters were identified. The Basal-like FBC tumors formed one cluster and the other two clusters were associated with Luminal A and B FBC tumors, respectively, while the HER2 FBCs were split between the Luminal A and B clusters. The majority of the Luminal M1 tumors clustered with the Luminal Bs while the Luminal M2 tumors clustered with the Luminal As. However, the majority of the MBC tumors were grouped together within the clusters rather than being interspersed with the FBC tumors, suggesting that they differed from the FBC tumors in the respective clusters. Interestingly, the Luminal M2 MBCs and Basal-like FBCs displayed a significantly higher frequency of hypomethylation compared to all other subgroups, despite Luminal M1 tumors being more similar to Basal-like tumors on a transcriptional level than the Luminal M2 tumors.
To summarize, we have described two subgroups of MBC based on genome wide methylation patterns, closely resembling the transcriptional subgroups, and associated with different tumor biological features of potential clinical relevance. These findings further suggest that MBC is not readily defined using conventional criteria applied to FBC.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-17-01.
Collapse
Affiliation(s)
- I Johansson
- Lund University, Lund, Sweden; Uppsala University, Uppsala, Sweden
| | - M Lauss
- Lund University, Lund, Sweden; Uppsala University, Uppsala, Sweden
| | - K Holm
- Lund University, Lund, Sweden; Uppsala University, Uppsala, Sweden
| | - C Nilsson
- Lund University, Lund, Sweden; Uppsala University, Uppsala, Sweden
| | - M-L Fjällskog
- Lund University, Lund, Sweden; Uppsala University, Uppsala, Sweden
| | - M Ringnér
- Lund University, Lund, Sweden; Uppsala University, Uppsala, Sweden
| | - I Hedenfalk
- Lund University, Lund, Sweden; Uppsala University, Uppsala, Sweden
| |
Collapse
|
34
|
Nilsson C, Renman G, Westholm LJ, Renman A, Drizo A. Effect of organic load on phosphorus and bacteria removal from wastewater using alkaline filter materials. Water Res 2013; 47:6289-6297. [PMID: 24001604 DOI: 10.1016/j.watres.2013.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 07/18/2013] [Accepted: 08/01/2013] [Indexed: 06/02/2023]
Abstract
The organic matter released from septic tanks can disturb the subsequent step in on-site wastewater treatment such as the innovative filters for phosphorus removal. This study investigated the effect of organic load on phosphorus (P) and bacteria removal by reactive filter materials under real-life treatment conditions. Two long-term column experiments were conducted at very short hydraulic residence times (average ~5.5 h), using wastewater with high (mean ~120 mg L(-1)) and low (mean ~20 mg L(-1)) BOD7 values. Two alkaline filter materials, the calcium-silicate material Polonite and blast furnace slag (BFS), were tested for the removal capacity of total P, total organic carbon (TOC) and Enterococci. Both experiments showed that Polonite removed P significantly (p < 0.01) better than BFS. An increase in P removal efficiency of 29.3% was observed for the Polonite filter at the lower concentration of BOD7 (p < 0.05). Polonite was also better than BFS with regard to removal of TOC, but there were no significant differences between the two filter materials with regard to removal of Enterococci. The reduction in Enterococci was greater in the experiment using wastewater with high BOD7, an effect attributable to the higher concentration of bacteria in that wastewater. Overall, the results demonstrate the importance of extensive pre-treatment of wastewater to achieve good phosphorus removal in reactive bed filters and prolonged filter life.
Collapse
Affiliation(s)
- Charlotte Nilsson
- Department of Land and Water Resources Engineering, Royal Institute of Technology, Teknikringen 76, SE-100 44 Stockholm, Sweden.
| | | | | | | | | |
Collapse
|
35
|
Nilsson C, Lakshmanan R, Renman G, Rajarao GK. Efficacy of reactive mineral-based sorbents for phosphate, bacteria, nitrogen and TOC removal--column experiment in recirculation batch mode. Water Res 2013; 47:5165-5175. [PMID: 23866147 DOI: 10.1016/j.watres.2013.05.056] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 05/24/2013] [Accepted: 05/30/2013] [Indexed: 06/02/2023]
Abstract
Two mineral-based materials (Polonite and Sorbulite) intended for filter wells in on-site wastewater treatment were compared in terms of removal of phosphate (PO4-P), total inorganic nitrogen (TIN), total organic carbon (TOC) and faecal indicator bacteria (Escherichia coli and Enterococci). Using an innovative, recirculating system, septic tank effluent was pumped at a hydraulic loading rate of 3000 L m(2) d(-1) into triplicate bench-scale columns of each material over a 90-day period. The results showed that Polonite performed better with respect to removal of PO4-P, retaining on average 80% compared with 75% in Sorbulite. This difference was attributed to higher CaO content in Polonite and its faster dissolution. Polonite also performed better in terms of removal of bacteria because of its higher pH value. The total average reduction in E. coli was 60% in Polonite and 45% in Sorbulite, while for Enterococci the corresponding value was 56% in Polonite and 34% in Sorbulite. Sorbulite removed TIN more effectively, with a removal rate of 23%, while Polonite removed 11% of TIN, as well as TOC. Organic matter (measured as TOC) was accumulated in the filter materials but was also released periodically. The results showed that Sorbulite could meet the demand in removing phosphate and nitrogen with reduced microbial release from the wastewater treatment process.
Collapse
Affiliation(s)
- Charlotte Nilsson
- Department of Land and Water Resources Engineering, Royal Institute of Technology, Teknikringen 76, SE-100 44 Stockholm, Sweden.
| | | | | | | |
Collapse
|
36
|
Glaumann S, Hermansson LL, Mascialino B, Hubben G, Borres MP, Nilsson C. Is molecular allergology cost-effective and cost saving in children with suspected peanut allergy compared to double blind placebo controlled food challenge (DBPCFC), open oral food challenge and skin prick test in Sweden? Clin Transl Allergy 2013. [PMCID: PMC3723478 DOI: 10.1186/2045-7022-3-s3-p124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
37
|
Nilsson C, Nopp A, Wickman M, Johansson G, Lilja G. Treatment of life-threatening food allergy. Clin Transl Allergy 2013. [PMCID: PMC3723487 DOI: 10.1186/2045-7022-3-s3-o8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
38
|
Nilsson N, Sjolander S, Morita E, Berthold M, Hedlin G, Borres M, Nilsson C. Diagnostic value of IgE antibodies to ω-5 gliadin, HMW-glutenin and gliadins in wheat challenged children. Clin Transl Allergy 2013. [PMCID: PMC3723583 DOI: 10.1186/2045-7022-3-s3-p116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
39
|
Karimi M, Dimitriou M, Nilsson C, Jansson M, Matsson H, Unneberg P, Lehmann S, Kere J, Hellström-Lindberg E. P-110 Evaluation of a high throughput mutation-screening strategy in myelodysplastic syndrome patients and acute myeloid leukemia using Halogenomics™ targeted-gene enrichment technology. Leuk Res 2013. [DOI: 10.1016/s0145-2126(13)70158-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
40
|
Denison H, Nilsson C, Kujacic M, Löfgren L, Karlsson C, Knutsson M, Eriksson JW. Proof of mechanism for the DGAT1 inhibitor AZD7687: results from a first-time-in-human single-dose study. Diabetes Obes Metab 2013; 15:136-43. [PMID: 22950654 DOI: 10.1111/dom.12002] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 07/30/2012] [Accepted: 09/02/2012] [Indexed: 01/29/2023]
Abstract
AIMS Inhibition of diacylglycerol acyltransferase 1 (DGAT1), which catalyses the final step in triacylglycerol (TAG) assembly, is suggested as a treatment for type 2 diabetes and obesity based on animal data indicating insulin sensitization and weight reduction. This first-time-in-human single ascending dose study explored the safety, tolerability, pharmacokinetics and pharmacodynamics of the selective DGAT1 inhibitor AZD7687. METHODS Eighty healthy male subjects were enrolled. In each of 10 cohorts, six subjects received the same dose of AZD7687 orally (range across cohorts 1-60 mg) and two placebo. Plasma AZD7687 exposure was measured repeatedly. Postprandial serum TAG excursion was measured during 8 h after a standardized mixed meal with fat energy content of 60% (SMM 60%; five cohorts, 1-20 mg), before (baseline) and after dosing, to assess effects on gut DGAT1 activity. RESULTS AZD7687 markedly reduced postprandial TAG excursion with a steep concentration-effect relationship. Incremental TAG AUC (area under the serum concentration vs. time curve) following SMM 60% was decreased >75% from baseline at doses ≥5 mg (p < 0.0001 vs. placebo). Serum levels of diacylglycerol, specifically measured with mass spectrometry, did not increase after AZD7687 administration. Nausea, vomiting and diarrhoea were reported with increasing doses and they limited dose escalation. Lowering of SMM fat content to 45 or 30% in five cohorts gradually reduced the frequency of gastrointestinal symptoms at a given dose of AZD7687. CONCLUSIONS The attenuating effect of AZD7687 on postprandial TAG excursion provides proof of mechanism with respect to gut DGAT1 inhibition. However, dose and diet-related gastrointestinal side effects may impact further development of DGAT1 inhibitors.
Collapse
|
41
|
Nilsson N, Nilsson C, Hedlin G, Johansson S, Borres M, Nopp A. Combining Analyses of Basophil Allergen Threshold Sensitivity, CD-sens, and IgE Antibodies to Hydrolyzed Wheat, ω-5 Gliadin and Timothy Grass Enhances the Prediction of Wheat Challenge Outcome. Int Arch Allergy Immunol 2013; 162:50-7. [DOI: 10.1159/000350923] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 03/20/2013] [Indexed: 11/19/2022] Open
|
42
|
Abstract
AIMS Gestational diabetes mellitus affects approximately 7% of all pregnant women. Some of these women develop autoantibodies that are generally characteristic of Type 1 diabetes. Autoantibodies targeting glutamic acid decarboxylase and tyrosine phosphatase-like protein are the most frequently reported. A recently identified autoantigen in Type 1 diabetes is zinc transporter 8. Some reports suggest that the frequency of zinc transporter 8 antibodies is as high as glutamic acid decarboxylase antibodies in Type 1 diabetes and thus a good diagnostic marker for autoimmune diabetes. There are currently no reports of zinc transporter 8 antibodies in gestational diabetes. The aim of this pilot study was to investigate the frequency of zinc transporter 8 antibodies in patients at clinical onset of gestational diabetes mellitus. METHODS Subjects included in this pilot study were all diagnosed with gestational diabetes at Skåne University Hospital, Lund, Sweden, 2009-2010 (n = 193). Sera samples were analysed for antibodies using a commercial enzyme-linked immunosorbent assay according to the manufacturers' instructions. RESULTS We found that 19/193 patients with gestational diabetes, diagnosed in 2009-2010, were positive for at least one autoantibody. Glutamic acid decarboxylase was the most common single autoantibody (52.6%; 10/19), followed by zinc transporter 8 (21.1%; 4/19) and tyrosine phosphatase-like protein (15.8%; 3/19). Combinations of two or more antibodies were rare (10.5%; 2/19). CONCLUSIONS In this study, we found that zinc transporter 8 added 2.1% (4/193) of autoantibody positivity in women with gestational diabetes who were negative for glutamic acid decarboxylase and tyrosine phosphatase-like protein antibodies. Glutamic acid decarboxylase was still the most prevalent autoantibody in gestational diabetes, but, as zinc transporter 8 was present even in the absence of glutamic acid decarboxylase, this autoantibody could be an important independent marker of autoimmunity in gestational diabetes.
Collapse
Affiliation(s)
- J Dereke
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | | | | | | |
Collapse
|
43
|
Joachim A, Nilsson C, Aboud S, Lyamuya EF, Robb M, Marovich M, Ochsenbauer C, Wahren B, Sandström E, Biberfeld G, Ferrari G, Polonis VR. Antibody-mediated inhibition of HIV-1 elicited by HIV-I DNA priming and boosting with heterologous HIV-1 recombinant MVA in healthy Tanzanian adults. Retrovirology 2012. [PMCID: PMC3441839 DOI: 10.1186/1742-4690-9-s2-o53] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
44
|
Katinger D, Jeffs S, Altmann F, Cope A, McKay P, Almond N, Sandström E, Hejdeman B, Biberfeld G, Nilsson C, Hallengärd D, Wahren B, Lehner T, Singh M, Lewis DJ, Lacey C, Shattock R. CN54gp140: product characteristics, peclinical and clinical use - recombinant glycoprotein for HIV immunization. Retrovirology 2012. [PMCID: PMC3441960 DOI: 10.1186/1742-4690-9-s2-p351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
45
|
Bauer A, Podola L, Haule A, Sudi L, Nilsson C, Mann P, Missanga M, Kaluwa B, Maboko L, Lueer C, Mwakatima M, Aboud S, Bakari M, Currier J, Robb M, Joseph S, McCormack S, Lyamuya E, Wahren B, Sandström E, Biberfeld G, Hoelscher M, Kroidl A, Geldmacher C. Preferential targeting of conserved Gag regions after vaccination with a heterologous DNA prime Modified Vaccinia Ankara boost HIV vaccine regime. Retrovirology 2012. [PMCID: PMC3441414 DOI: 10.1186/1742-4690-9-s2-p330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
46
|
Podola L, Bauer A, Haule A, Sudi L, Nilsson C, Godoy-Ramirez K, Mann P, Missanga M, Kaluwa B, Maboko L, Lueer C, Mwakatima M, Aboud S, Bakari M, Currier J, Robb M, McCormack S, Joseph S, Lyamuya E, Hoelscher M, Wahren B, Sandström E, Biberfeld G, Geldmacher C, Kroidl A. Breadth, phenotype and functionality of Gag-specific T cell responses induced by a heterologous DNA/MVA prime-boost HIV-1 vaccine regimen. Retrovirology 2012. [PMCID: PMC3441674 DOI: 10.1186/1742-4690-9-s2-p273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
47
|
Munseri P, Kroidl A, Nilsson C, Moshiro C, Aboud S, Joachim A, Geldmacher C, Aris E, Buma D, Lyamuya E, Gotch F, Godoy-Ramirez K, Pallangyo K, Maboko L, Marovich M, Robb M, Hoelscher M, Janabi M, Mann P, Joseph S, Mfinanga S, Stoehr W, Mhalu F, Wahren B, Biberfeld G, McCormack S, Sandstrom E, Bakari M. Priming with a “simplified regimen” of HIV-1 DNA vaccine is as good as a “standard regimen” when boosted with heterologous HIV-1 MVA vaccine. Retrovirology 2012. [PMCID: PMC3441944 DOI: 10.1186/1742-4690-9-s2-p108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
48
|
Vetander M, Helander D, Flodström C, Ostblom E, Alfvén T, Ly DH, Hedlin G, Lilja G, Nilsson C, Wickman M. Anaphylaxis and reactions to foods in children--a population-based case study of emergency department visits. Clin Exp Allergy 2012; 42:568-77. [PMID: 22417215 DOI: 10.1111/j.1365-2222.2011.03954.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Information about acute reactions to foods among children is limited. OBJECTIVE To describe the overall incidence of anaphylaxis in a paediatric emergency department (ED) setting and to describe reactions to foods in relation to sex and age, clinical characteristics and management. METHODS In a review of medical records, children with ED visits at any of three paediatric hospitals in Stockholm County during 2007 were targeted. Inclusion criteria were any adverse reaction to foods or anaphylaxis. RESULTS 383 children fulfilled the inclusion criteria of which 371 had had reactions to foods. The incidence of anaphylaxis was 32 per 100 000 person years irrespective of cause and food was involved in 92%. Tree nuts, particular cashew, and peanut were the most common eliciting foods, and in children under 3 years, reactions to these two food allergens were as common as reactions to milk and egg. Pollen-allergic children seemed to be admitted due to food-induced anaphylaxis more often during the deciduous tree pollen season compared with the rest of the year (P = 0.015). Symptoms from the lower airways occurred in 49% of children with anaphylaxis but without underlying asthma compared with 72% of children with anaphylaxis and asthma, P < 0.01. CONCLUSIONS AND CLINICAL RELEVANCE Reactions to peanut and tree nuts are as common as reactions to milk and egg in early life. Concomitant exposure to airborne allergens seems to increase the risk of anaphylaxis to foods. Among children with anaphylaxis, wheeze is prevalent even in children without asthma diagnosis.
Collapse
Affiliation(s)
- M Vetander
- Department of Paediatrics, Sachs' Children's Hospital, Södersjukhuset, Sjukhusbacken 10, Stockholm, Sweden.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Asarnoj A, Glaumann S, Elfström L, Lilja G, Lidholm J, Nilsson C, Wickman M. Anaphylaxis to Peanut in a Patient Predominantly Sensitized to Ara h 6. Int Arch Allergy Immunol 2012; 159:209-12. [DOI: 10.1159/000336027] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 12/19/2011] [Indexed: 11/19/2022] Open
|
50
|
Sverremark-Ekström E, Hultgren EH, Borres MP, Nilsson C. Peanut sensitization during the first 5 yr of life is associated with elevated levels of peanut-specific IgG. Pediatr Allergy Immunol 2012; 23:224-9. [PMID: 22509759 DOI: 10.1111/j.1399-3038.2012.01290.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Allergen-specific IgE antibodies are implicated in allergic diseases while allergen-specific IgG antibodies have been proposed to prevent allergic reactions. The objective for this study was to study whether the immune response (IgG and IgG4) to peanut differs in IgE-sensitized and non-sensitized young children. METHODS A total of 239 children have been followed prospectively from birth to 5 yr of age. The levels of IgG and IgG4 to peanut, Ara h 2, and Ara h 8 were analyzed at 2 and 5 yr of age and related to IgE sensitization and peanut consumption. RESULTS The levels of peanut-specific IgG and IgG4 were significantly higher in peanut-sensitized children at 2 and 5 yr of age when compared with non-sensitized children and children sensitized to other food/inhalant allergens. A strong correlation was seen between levels of peanut-specific IgG/IgG4-ratios and peanut-specific IgE at 5 yr of age. Children avoiding peanuts, a subgroup of the peanut sensitized, had statistically significant higher levels of IgE to peanut and a tendency of higher IgG and IgG4 levels to peanut. In the avoidance group, significant correlations between IgE and IgG/IgG4 to peanut were found compared with children eating peanuts. CONCLUSION Peanut-specific IgG or IgG4 levels were elevated in peanut-sensitized children especially those avoiding peanuts. In our study, IgG and IgG4 do not seem to indicate tolerance or protection from sensitization.
Collapse
Affiliation(s)
- E Sverremark-Ekström
- Department of Immunology, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
| | | | | | | |
Collapse
|