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Bollino M, Geppert B, Lönnerfors C, Persson J. A selective anatomically based lymph node sampling can replace a side specific pelvic lymphadenectomy in endometrial cancer with failed sentinel node mapping. Eur J Cancer 2024; 204:114049. [PMID: 38657525 DOI: 10.1016/j.ejca.2024.114049] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/26/2024] [Accepted: 04/04/2024] [Indexed: 04/26/2024]
Abstract
AIM To evaluate the locations of metastatic pelvic sentinel nodes (SLN) and the proportion of SLNs outside and within defined typical anatomical positions along the upper paracervical lymphatic pathway (UPP). PATIENTS AND METHODS Consecutive women with endometrial cancer (EC) of all risk groups underwent pelvic SLN-detection using cervically injected indocyanine green (ICG). A strict anatomically based algorithm and definitions of SLNs was adhered to. The positions of ICG-defined SLNs were intraoperatively depicted on an anatomical chart. All SLNs were examined using ultrastaging and immunohistochemistry. The proximal third of the obturator fossa and the interiliac area were defined as typical positions. The parauterine lymphovascular tissue (PULT) was separately removed. The proportions of metastatic SLNs, overall and isolated, typically, and atypically positioned were analyzed per woman. RESULTS A median of two (range 1-12) SLN metastases along the UPP including the PULT were found in 162 women. 41 of 162 women (25.3 %) had isolated metastases in the obturator fossa harboring 49.1 % of all SLN metastases. Three women (1,9 %) had isolated PULT metastases. SLN metastases outside typical positions were identified in 28/162 women (17.3 %); isolated metastases were seen in seven women (4.3 %), so 95.7 % of pelvic node positive women had at least one metastatic SLN located at a typical position. CONCLUSION A selective removal of lymph nodes at typical proximal obturator and interiliac positions and the PULT can replace a full side specific pelvic LND when SLN mapping is unsuccessful. The obturator fossa is the predominant location for metastatic disease.
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Affiliation(s)
- Michele Bollino
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital Lund, Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology, Lund, Sweden
| | - Barbara Geppert
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital Lund, Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology, Lund, Sweden
| | - Celine Lönnerfors
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital Lund, Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology, Lund, Sweden
| | - Jan Persson
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital Lund, Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology, Lund, Sweden.
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2
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Dos Santos Dias M, Biniskos N, Dos Santos FJ, Schmalzl K, Persson J, Bourdarot F, Marzari N, Blügel S, Brückel T, Lounis S. Topological magnons driven by the Dzyaloshinskii-Moriya interaction in the centrosymmetric ferromagnet Mn 5Ge 3. Nat Commun 2023; 14:7321. [PMID: 37951946 PMCID: PMC10640582 DOI: 10.1038/s41467-023-43042-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/31/2023] [Indexed: 11/14/2023] Open
Abstract
The phase of the quantum-mechanical wave function can encode a topological structure with wide-ranging physical consequences, such as anomalous transport effects and the existence of edge states robust against perturbations. While this has been exhaustively demonstrated for electrons, properties associated with the elementary quasiparticles in magnetic materials are still underexplored. Here, we show theoretically and via inelastic neutron scattering experiments that the bulk ferromagnet Mn5Ge3 hosts gapped topological Dirac magnons. Although inversion symmetry prohibits a net Dzyaloshinskii-Moriya interaction in the unit cell, it is locally allowed and is responsible for the gap opening in the magnon spectrum. This gap is predicted and experimentally verified to close by rotating the magnetization away from the c-axis with an applied magnetic field. Hence, Mn5Ge3 realizes a gapped Dirac magnon material in three dimensions. Its tunability by chemical doping or by thin film nanostructuring defines an exciting new platform to explore and design topological magnons. More generally, our experimental route to verify and control the topological character of the magnons is applicable to bulk centrosymmetric hexagonal materials, which calls for systematic investigation.
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Affiliation(s)
- M Dos Santos Dias
- Peter Grünberg Institut and Institute for Advanced Simulation, Forschungszentrum Jülich & JARA, D-52425, Jülich, Germany.
- Faculty of Physics, University of Duisburg-Essen and CENIDE, D-47053, Duisburg, Germany.
- Scientific Computing Department, STFC Daresbury Laboratory, Warrington, WA4 4AD, UK.
| | - N Biniskos
- Forschungszentrum Jülich GmbH, Jülich Centre for Neutron Science at MLZ, Lichtenbergstr. 1, D-85748, Garching, Germany.
- Charles University, Faculty of Mathematics and Physics, Department of Condensed Matter Physics, Ke Karlovu 5, 121 16, Praha, Czech Republic.
| | - F J Dos Santos
- Laboratory for Materials Simulations, Paul Scherrer Institut, 5232, Villigen, PSI, Switzerland.
- Theory and Simulation of Materials (THEOS), and National Centre for Computational Design and Discovery of Novel Materials (MARVEL), École Polytechnique Fédérale de Lausanne, 1015, Lausanne, Switzerland.
| | - K Schmalzl
- Forschungszentrum Jülich GmbH, Jülich Centre for Neutron Science at ILL, 71 Avenue des Martyrs, F-38000, Grenoble, France
| | - J Persson
- Forschungszentrum Jülich GmbH, Jülich Centre for Neutron Science (JCNS-2) and Peter Grünberg Institut (PGI-4), JARA-FIT, D-52425, Jülich, Germany
| | - F Bourdarot
- Université Grenoble Alpes, CEA, IRIG, MEM, MDN, F-38000, Grenoble, France
| | - N Marzari
- Laboratory for Materials Simulations, Paul Scherrer Institut, 5232, Villigen, PSI, Switzerland
- Theory and Simulation of Materials (THEOS), and National Centre for Computational Design and Discovery of Novel Materials (MARVEL), École Polytechnique Fédérale de Lausanne, 1015, Lausanne, Switzerland
| | - S Blügel
- Peter Grünberg Institut and Institute for Advanced Simulation, Forschungszentrum Jülich & JARA, D-52425, Jülich, Germany
| | - T Brückel
- Forschungszentrum Jülich GmbH, Jülich Centre for Neutron Science (JCNS-2) and Peter Grünberg Institut (PGI-4), JARA-FIT, D-52425, Jülich, Germany
| | - S Lounis
- Peter Grünberg Institut and Institute for Advanced Simulation, Forschungszentrum Jülich & JARA, D-52425, Jülich, Germany
- Faculty of Physics, University of Duisburg-Essen and CENIDE, D-47053, Duisburg, Germany
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Stanasiuk C, Milting H, Homm S, Persson J, Holtz L, Wittmer A, Fox H, Laser T, Knöll R, Pohl GM, Paluszkiewicz L, Jakob T, Bachmann-Mennenga B, Henzler D, Grautoff S, Veit G, Klingel K, Hori E, Kellner U, Karger B, Schlepper S, Pfeiffer H, Gummert J, Gärtner A, Tiesmeier J. Blood taken immediately after fatal resuscitation attempts yields higher quality DNA for genetic studies as compared to autopsy samples. Int J Legal Med 2023; 137:1569-1581. [PMID: 36773088 PMCID: PMC10421769 DOI: 10.1007/s00414-023-02966-7] [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] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/03/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND The out-of-hospital cardiac arrest (OHCA) in the young may be associated with a genetic predisposition which is relevant even for genetic counseling of relatives. The identification of genetic variants depends on the availability of intact genomic DNA. DNA from autopsy may be not available due to low autopsy frequencies or not suitable for high-throughput DNA sequencing (NGS). The emergency medical service (EMS) plays an important role to save biomaterial for subsequent molecular autopsy. It is not known whether the DNA integrity of samples collected by the EMS is better suited for NGS than autopsy specimens. MATERIAL AND METHODS DNA integrity was analyzed by standardized protocols. Fourteen blood samples collected by the EMS and biomaterials from autopsy were compared. We collected 172 autopsy samples from different tissues and blood with postmortem intervals of 14-168 h. For comparison, DNA integrity derived from blood stored under experimental conditions was checked against autopsy blood after different time intervals. RESULTS DNA integrity and extraction yield were higher in EMS blood compared to any autopsy tissue. DNA stability in autopsy specimens was highly variable and had unpredictable quality. In contrast, collecting blood samples by the EMS is feasible and delivered comparably the highest DNA integrity. CONCLUSIONS Isolation yield and DNA integrity from blood samples collected by the EMS is superior in comparison to autopsy specimens. DNA from blood samples collected by the EMS on scene is stable at room temperature or even for days at 4 °C. We conclude that the EMS personnel should always save a blood sample of young fatal OHCA cases died on scene to enable subsequent genetic analysis.
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Affiliation(s)
- Caroline Stanasiuk
- Erich and Hanna Klessmann-Institute for Cardiovascular Research and Development, Heart- and Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Georgstr. 11, D-32545, Bad Oeynhausen, Germany
| | - Hendrik Milting
- Erich and Hanna Klessmann-Institute for Cardiovascular Research and Development, Heart- and Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Georgstr. 11, D-32545, Bad Oeynhausen, Germany.
| | - Sören Homm
- Institute for Anesthesiology, Intensive Care- and Emergency Medicine, Johannes Wesling Hospital Minden, MKK-Hospital, Campus OWL, Ruhr-University Bochum, Bochum, Germany
| | - Jan Persson
- Institute for Anesthesiology, Intensive Care- and Emergency Medicine, Johannes Wesling Hospital Minden, MKK-Hospital, Campus OWL, Ruhr-University Bochum, Bochum, Germany
| | - Lars Holtz
- Emergency Department, Herford Hospital, Campus OWL, Ruhr-University Bochum, Bochum, Germany
| | - Axel Wittmer
- Institute for Pathology, Herford Hospital, Campus OWL, Ruhr-University Bochum, Bochum, Germany
| | - Henrik Fox
- Clinic for Thoracic and Cardiovascular Surgery, Heart- and Diabetes Center NRW, D-32545 Bad Oeynhausen, University Hospital of the Ruhr-University Bochum, Bochum, Germany
| | - Thorsten Laser
- Center for Congenital Heart Diseases, Heart and Diabetes Center NRW, 32545 Bad Oeynhausen, University Hospital of the Ruhr-University Bochum, Bochum, Germany
| | - Ralph Knöll
- Karolinska Institute, University Hospital, Myocardial Genetic, 14157, Huddinge, Sweden
| | - Greta Marie Pohl
- Erich and Hanna Klessmann-Institute for Cardiovascular Research and Development, Heart- and Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Georgstr. 11, D-32545, Bad Oeynhausen, Germany
| | - Lech Paluszkiewicz
- Clinic for Thoracic and Cardiovascular Surgery, Heart- and Diabetes Center NRW, D-32545 Bad Oeynhausen, University Hospital of the Ruhr-University Bochum, Bochum, Germany
| | - Thomas Jakob
- Intensive Care and Emergency Medicine, Herford Hospital, Campus OWL, Ruhr-University Bochum, University Clinic for Anesthesiology, Bochum, Germany
- Present address: Clinic for Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Medicine, Bielefeld Hospital, University Hospital Eastern Westphalia-Lippe, Bielefeld University, Bielefeld, Germany
| | - Bernd Bachmann-Mennenga
- Institute for Anesthesiology, Intensive Care- and Emergency Medicine, Johannes Wesling Hospital Minden, MKK-Hospital, Campus OWL, Ruhr-University Bochum, Bochum, Germany
| | - Dietrich Henzler
- Intensive Care and Emergency Medicine, Herford Hospital, Campus OWL, Ruhr-University Bochum, University Clinic for Anesthesiology, Bochum, Germany
| | - Steffen Grautoff
- Emergency Department, Herford Hospital, Campus OWL, Ruhr-University Bochum, Bochum, Germany
| | - Gunter Veit
- Institute for Anesthesiology, Intensive Care- and Emergency Medicine, Johannes Wesling Hospital Minden, MKK-Hospital, Campus OWL, Ruhr-University Bochum, Bochum, Germany
| | - Karin Klingel
- Institute for Pathology and Neuropathology, University Hospital Tuebingen, D-72076, Tuebingen, Germany
| | - Erika Hori
- Institute for Pathology, Johannes Wesling Hospital Minden, MKK-Hospital, D-32429 Minden, Campus OWL, Ruhr-University Bochum, Bochum, Germany
| | - Udo Kellner
- Institute for Pathology, Johannes Wesling Hospital Minden, MKK-Hospital, D-32429 Minden, Campus OWL, Ruhr-University Bochum, Bochum, Germany
| | - Bernd Karger
- Institute for Forensic Medicine, University Hospital, Wilhelms-University Muenster, Muenster, Germany
| | - Stefanie Schlepper
- Institute for Forensic Medicine, University Hospital, Wilhelms-University Muenster, Muenster, Germany
| | - Heidi Pfeiffer
- Institute for Forensic Medicine, University Hospital, Wilhelms-University Muenster, Muenster, Germany
| | - Jan Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Heart- and Diabetes Center NRW, D-32545 Bad Oeynhausen, University Hospital of the Ruhr-University Bochum, Bochum, Germany
| | - Anna Gärtner
- Erich and Hanna Klessmann-Institute for Cardiovascular Research and Development, Heart- and Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Georgstr. 11, D-32545, Bad Oeynhausen, Germany
| | - Jens Tiesmeier
- Erich and Hanna Klessmann-Institute for Cardiovascular Research and Development, Heart- and Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Georgstr. 11, D-32545, Bad Oeynhausen, Germany
- Institute for Anesthesiology, Intensive Care- and Emergency Medicine, Luebbecke MKK-Hospital, Campus OWL, Ruhr-University Bochum, Bochum, Germany
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Palmér C, Wallin A, Persson J, Aronsson M, Blennow K. Effective communications on invasive alien species: Identifying communication needs of Swedish domestic garden owners. J Environ Manage 2023; 340:117995. [PMID: 37100004 DOI: 10.1016/j.jenvman.2023.117995] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/13/2023] [Accepted: 04/19/2023] [Indexed: 05/12/2023]
Abstract
Invasive alien species threaten biodiversity with domestic gardens acting as a major pathway for the introduction of alien species. Even though the Nordic region is not currently a hotspot for biological invasions, the number of invasions in the Nordic area has been predicted to increase due to climate change. Given a time lag between introduction and invasion, many non-invasive horticultural alien species already introduced into gardens may become invasive in the future. This study aimed to identify the communication needs of Swedish garden owners regarding their management of invasive alien species. A survey among domestic garden owners, informed by topic specialists and local area experts, and interviews with garden owners were conducted in three different bio-climatic areas in a latitudinal gradient across Sweden. The questions targeted invasive alien species and their relations to biodiversity loss and climate change, as well as measures taken to control these species. Analysing the survey data collected in relation to measures taken to control invasive species, Bayesian Additive Regression Tree (BART) modelling was used to identify geographically varying communication needs of the domestic garden owners. In all study areas, the garden owners' measures taken to control invasive alien species were correlated with their strength of beliefs in having experienced local biodiversity loss. A majority of the garden owners were, moreover, uncertain about the impact of climate change on the invasiveness of alien species. In addition, the garden owners' capacity for identifying invasive alien species was often in need of improvement, in particular with respect to the species Impatiens glandulifera, Reynoutria japonica and Rosa rugosa. The results suggest that the evidence-based guidelines for effective communications we developed, have the potential to help communicators meet the local communication needs of garden owners across Sweden, in relation to the management of invasive alien garden species.
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Affiliation(s)
- C Palmér
- Department of Landscape Architecture, Planning and Management, Swedish University of Agricultural Sciences, Sweden
| | - A Wallin
- Division of Cognitive Science, Department of Philosophy, Lund University, Sweden
| | - J Persson
- Department of Philosophy, Lund University, Sweden
| | - M Aronsson
- Swedish Species Information Centre, Swedish University of Agricultural Sciences, Sweden
| | - K Blennow
- Department of Landscape Architecture, Planning and Management, Swedish University of Agricultural Sciences, Sweden; Department of Physical Geography and Ecosystem Science, Lund University, Sweden.
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Lönnerfors C, Persson J. Can robotic-assisted surgery support enhanced recovery programs? Best Pract Res Clin Obstet Gynaecol 2023; 90:102366. [PMID: 37356336 DOI: 10.1016/j.bpobgyn.2023.102366] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 06/03/2023] [Indexed: 06/27/2023]
Abstract
Enhanced recovery after surgery (ERAS) protocols comprise a multimodal approach to optimize patient outcome and recovery. ERAS guidelines recommend minimally invasive surgery (MIS) when possible. Key components in MIS include preoperative patient education and optimization; multimodal and narcotic-sparing analgesia; prophylactic measures regarding nausea, infection, and venous thrombosis; maintenance of euvolemia; and promotion of the early activity. ERAS protocols in MIS improve outcome mainly in terms of reduced length of stay and subsequently reduced cost. In addition, ERAS protocols in MIS reduce postoperative pain and nausea, increase patient satisfaction, and might reduce the rate of postoperative complications. Robotic surgery supports ERAS through facilitating MIS in complex procedures where laparotomy is an alternative approach.
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Affiliation(s)
- Celine Lönnerfors
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Skåne University Hospital, Lund, Sweden; Lund University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology, Lund, Sweden.
| | - Jan Persson
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Skåne University Hospital, Lund, Sweden; Lund University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology, Lund, Sweden.
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6
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Cibula D, Rosaria Raspollini M, Planchamp F, Centeno C, Chargari C, Felix A, Fischerová D, Jahnn-Kuch D, Joly F, Kohler C, Lax S, Lorusso D, Mahantshetty U, Mathevet P, Raj Naik M, Nout RA, Oaknin A, Peccatori F, Persson J, Querleu D, Rubio Bernabé S, Schmid MP, Stepanyan A, Svintsitskyi V, Tamussino K, Zapardiel I, Lindegaard J. ESGO/ESTRO/ESP Guidelines for the management of patients with cervical cancer - Update 2023. Radiother Oncol 2023; 184:109682. [PMID: 37336614 DOI: 10.1016/j.radonc.2023.109682] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
In 2018, the European Society of Gynecological Oncology (ESGO) jointly with the European Society for Radiotherapy and Oncology (ESTRO) and the European Society of Pathology (ESP) published evidence-based guidelines for the management of patients with cervical cancer. Given the large body of new evidence addressing the management of cervical cancer, the three sister societies jointly decided to update these evidence-based guidelines. The update includes new topics to provide comprehensive guidelines on all relevant issues of diagnosis and treatment in cervical cancer. To serve on the expert panel (27 experts across Europe) ESGO/ESTRO/ESP nominated practicing clinicians who are involved in managing patients with cervical cancer and have demonstrated leadership through their expertise in clinical care and research, national and international engagement, profile, and dedication to the topics addressed. To ensure the statements were evidence based, new data identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the international development group. Before publication, the guidelines were reviewed by 155 independent international practitioners in cancer care delivery and patient representatives. These updated guidelines are comprehensive and cover staging, management, follow-up, long-term survivorship, quality of life and palliative care. Management includes fertility sparing treatment, early and locally advanced cervical cancer, invasive cervical cancer diagnosed on a simple hysterectomy specimen, cervical cancer in pregnancy, rare tumors, recurrent and metastatic diseases. The management algorithms and the principles of radiotherapy and pathological evaluation are also defined.
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Affiliation(s)
- David Cibula
- Department of Obstetrics and Gynecology, Charles University, First Faculty of Medicine, Prague, Czech Republic; General University Hospital in Prague, Prague, Czech Republic.
| | | | | | - Carlos Centeno
- Department of Palliative Medicine, University of Navarra, Pamplona, Spain
| | - Cyrus Chargari
- Service d'Oncologie Radiothérapie, Hôpital Universitaire Pitié Salpêtrière, Paris, France
| | - Ana Felix
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal; Universidade Nova de Lisboa, Lisboa, Portugal
| | - Daniela Fischerová
- Department of Obstetrics and Gynecology, Charles University, First Faculty of Medicine, Prague, Czech Republic; General University Hospital in Prague, Prague, Czech Republic
| | - Daniela Jahnn-Kuch
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Florence Joly
- François Baclesse Centre de Lutte Contre le Cancer, Caen, France
| | - Christhardt Kohler
- Asklepios Clinic Altona, Hamburg, Germany; Asklepios Comprehensive Tumor Center, Hamburg, Germany
| | - Sigurd Lax
- Hospital Graz II, Graz, Austria; Johannes Kepler Universitat Linz, Linz, Austria
| | - Domenica Lorusso
- Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy; Catholic University of Sacred Heart, Rome, Italy
| | - Umesh Mahantshetty
- Homi Bhabha Cancer Hospital and Research Centre, Visakhapatnam, Andhra Pradesh, India
| | | | - Mr Raj Naik
- Northern Gynaecological Oncology Centre, Gateshead, UK
| | - Remi A Nout
- Radiotherapy, Erasmus MC Cancer Centre, Rotterdam, the Netherlands; University Medical Center, Rotterdam, the Netherlands
| | - Ana Oaknin
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Jan Persson
- Department of Obstetrics and Gynecology, Lund University Hosptial, Lund, Sweden; Skåne University Hospital Lund, Lund, Sweden
| | - Denis Querleu
- Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy; University Hospitals Strasbourg, Strasbourg, France
| | | | - Maximilian P Schmid
- Department of Radiation Oncology, Medical University of Vienna, Wien, Austria
| | - Artem Stepanyan
- Gynecologic Oncology, Nairi Medical Center, Yerevan, Armenia
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7
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Cibula D, Raspollini MR, Planchamp F, Centeno C, Chargari C, Felix A, Fischerová D, Jahnn-Kuch D, Joly F, Kohler C, Lax S, Lorusso D, Mahantshetty U, Mathevet P, Naik R, Nout RA, Oaknin A, Peccatori F, Persson J, Querleu D, Bernabé SR, Schmid MP, Stepanyan A, Svintsitskyi V, Tamussino K, Zapardiel I, Lindegaard J. ESGO/ESTRO/ESP Guidelines for the management of patients with cervical cancer - Update 2023. Virchows Arch 2023:10.1007/s00428-023-03552-3. [PMID: 37145263 DOI: 10.1007/s00428-023-03552-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 04/20/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/06/2023]
Abstract
In 2018, the European Society of Gynecological Oncology (ESGO) jointly with the European Society for Radiotherapy and Oncology (ESTRO) and the European Society of Pathology (ESP) published evidence-based guidelines for the management of patients with cervical cancer. Given the large body of new evidence addressing the management of cervical cancer, the three sister societies jointly decided to update these evidence-based guidelines. The update includes new topics to provide comprehensive guidelines on all relevant issues of diagnosis and treatment in cervical cancer.To serve on the expert panel (27 experts across Europe) ESGO/ESTRO/ESP nominated practicing clinicians who are involved in managing patients with cervical cancer and have demonstrated leadership through their expertise in clinical care and research, national and international engagement, profile, and dedication to the topics addressed. To ensure the statements were evidence based, new data identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the international development group. Before publication, the guidelines were reviewed by 155 independent international practitioners in cancer care delivery and patient representatives.These updated guidelines are comprehensive and cover staging, management, follow-up, long-term survivorship, quality of life and palliative care. Management includes fertility sparing treatment, early and locally advanced cervical cancer, invasive cervical cancer diagnosed on a simple hysterectomy specimen, cervical cancer in pregnancy, rare tumors, recurrent and metastatic diseases. The management algorithms and the principles of radiotherapy and pathological evaluation are also defined.
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Affiliation(s)
- David Cibula
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, Prague, 121 08, Czech Republic.
- General University Hospital in Prague, Prague, Czech Republic.
| | | | | | - Carlos Centeno
- Department of Palliative Medicine, University of Navarra, Pamplona, Spain
| | - Cyrus Chargari
- Service d'Oncologie Radiothérapie, Hôpital Universitaire Pitié Salpêtrière, Paris, France
| | - Ana Felix
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal
- Universidade Nova de Lisboa, Lisboa, Portugal
| | - Daniela Fischerová
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, Prague, 121 08, Czech Republic
- General University Hospital in Prague, Prague, Czech Republic
| | - Daniela Jahnn-Kuch
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Florence Joly
- François Baclesse Centre de Lutte Contre le Cancer, Caen, France
| | - Christhardt Kohler
- Asklepios Clinic Altona, Hamburg, Germany
- Asklepios Comprehensive Tumor Center, Hamburg, Germany
| | - Sigurd Lax
- Hospital Graz II, Graz, Austria
- Johannes Kepler Universitat Linz, Linz, Austria
| | - Domenica Lorusso
- Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Umesh Mahantshetty
- Homi Bhabha Cancer Hospital and Research Centre, Visakhapatnam, Andhra Pradesh, India
| | | | - Raj Naik
- Northern Gynaecological Oncology Centre, Gateshead, UK
| | - Remi A Nout
- Radiotherapy, Erasmus MC Cancer Centre, Rotterdam, The Netherlands
- University Medical Center, Rotterdam, The Netherlands
| | - Ana Oaknin
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Jan Persson
- Department of Obstetrics and Gynecology, Lund University Hosptial, Lund, Sweden
- Skåne University Hospital Lund, Lund, Sweden
| | - Denis Querleu
- Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy
- University Hospitals Strasbourg, Strasbourg, France
| | | | - Maximilian P Schmid
- Department of Radiation Oncology, Medical University of Vienna, Wien, Austria
| | - Artem Stepanyan
- Gynecologic Oncology, Nairi Medical Center, Yerevan, Armenia
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Cibula D, Raspollini MR, Planchamp F, Centeno C, Chargari C, Felix A, Fischerová D, Jahnn-Kuch D, Joly F, Kohler C, Lax S, Lorusso D, Mahantshetty U, Mathevet P, Naik R, Nout RA, Oaknin A, Peccatori F, Persson J, Querleu D, Bernabé SR, Schmid MP, Stepanyan A, Svintsitskyi V, Tamussino K, Zapardiel I, Lindegaard J. ESGO/ESTRO/ESP Guidelines for the management of patients with cervical cancer - Update 2023. Int J Gynecol Cancer 2023; 33:649-666. [PMID: 37127326 PMCID: PMC10176411 DOI: 10.1136/ijgc-2023-004429] [Citation(s) in RCA: 51] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
In 2018, the European Society of Gynecological Oncology (ESGO) jointly with the European Society for Radiotherapy and Oncology (ESTRO) and the European Society of Pathology (ESP) published evidence-based guidelines for the management of patients with cervical cancer. Given the large body of new evidence addressing the management of cervical cancer, the three sister societies jointly decided to update these evidence-based guidelines. The update includes new topics to provide comprehensive guidelines on all relevant issues of diagnosis and treatment in cervical cancer.To serve on the expert panel (27 experts across Europe) ESGO/ESTRO/ESP nominated practicing clinicians who are involved in managing patients with cervical cancer and have demonstrated leadership through their expertise in clinical care and research, national and international engagement, profile, and dedication to the topics addressed. To ensure the statements were evidence based, new data identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the international development group. Before publication, the guidelines were reviewed by 155 independent international practitioners in cancer care delivery and patient representatives.These updated guidelines are comprehensive and cover staging, management, follow-up, long-term survivorship, quality of life and palliative care. Management includes fertility sparing treatment, early and locally advanced cervical cancer, invasive cervical cancer diagnosed on a simple hysterectomy specimen, cervical cancer in pregnancy, rare tumors, recurrent and metastatic diseases. The management algorithms and the principles of radiotherapy and pathological evaluation are also defined.
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Affiliation(s)
- David Cibula
- Department of Obstetrics and Gynecology, Charles University, First Faculty of Medicine, Prague, Czech Republic
- General University Hospital in Prague, Prague, Czech Republic
| | | | | | - Carlos Centeno
- Department of Palliative Medicine, University of Navarra, Pamplona, Spain
| | - Cyrus Chargari
- Service d'Oncologie Radiothérapie, Hôpital Universitaire Pitié Salpêtrière, Paris, France
| | - Ana Felix
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal
- Universidade Nova de Lisboa, Lisboa, Portugal
| | - Daniela Fischerová
- Department of Obstetrics and Gynecology, Charles University, First Faculty of Medicine, Prague, Czech Republic
- General University Hospital in Prague, Prague, Czech Republic
| | - Daniela Jahnn-Kuch
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Florence Joly
- François Baclesse Centre de Lutte Contre le Cancer, Caen, France
| | - Christhardt Kohler
- Asklepios Clinic Altona, Hamburg, Germany
- Asklepios Comprehensive Tumor Center, Hamburg, Germany
| | - Sigurd Lax
- Hospital Graz II, Graz, Austria
- Johannes Kepler Universitat Linz, Linz, Austria
| | - Domenica Lorusso
- Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Umesh Mahantshetty
- Homi Bhabha Cancer Hospital and Research Centre, Visakhapatnam, Andhra Pradesh, India
| | | | - Raj Naik
- Northern Gynaecological Oncology Centre, Gateshead, UK
| | - Remi A Nout
- Radiotherapy, Erasmus MC Cancer Centre, Rotterdam, The Netherlands
- University Medical Center, Rotterdam, The Netherlands
| | - Ana Oaknin
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Jan Persson
- Department of Obstetrics and Gynecology, Lund University Hosptial, Lund, Sweden
- Skåne University Hospital Lund, Lund, Sweden
| | - Denis Querleu
- Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy
- University Hospitals Strasbourg, Strasbourg, France
| | | | - Maximilian P Schmid
- Department of Radiation Oncology, Medical University of Vienna, Wien, Austria
| | - Artem Stepanyan
- Gynecologic Oncology, Nairi Medical Center, Yerevan, Armenia
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Wenzel HHB, Hardie AN, Moncada-Torres A, Høgdall CK, Bekkers RLM, Falconer H, Jensen PT, Nijman HW, van der Aa MA, Martin F, van Gestel AJ, Lemmens VEPP, Dahm-Kähler P, Alfonzo E, Persson J, Ekdahl L, Salehi S, Frøding LP, Markauskas A, Fuglsang K, Schnack TH. A federated approach to identify women with early-stage cervical cancer at low risk of lymph node metastases. Eur J Cancer 2023; 185:61-68. [PMID: 36965329 DOI: 10.1016/j.ejca.2023.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/22/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVE Lymph node metastases (pN+) in presumed early-stage cervical cancer negatively impact prognosis. Using federated learning, we aimed to develop a tool to identify a group of women at low risk of pN+, to guide the shared decision-making process concerning the extent of lymph node dissection. METHODS Women with cervical cancer between 2005 and 2020 were identified retrospectively from population-based registries: the Danish Gynaecological Cancer Database, Swedish Quality Registry for Gynaecologic Cancer and Netherlands Cancer Registry. Inclusion criteria were: squamous cell carcinoma, adenocarcinoma or adenosquamous carcinoma; The International Federation of Gynecology and Obstetrics 2009 IA2, IB1 and IIA1; treatment with radical hysterectomy and pelvic lymph node assessment. We applied privacy-preserving federated logistic regression to identify risk factors of pN+. Significant factors were used to stratify the risk of pN+. RESULTS We included 3606 women (pN+ 11%). The most important risk factors of pN+ were lymphovascular space invasion (LVSI) (odds ratio [OR] 5.16, 95% confidence interval [CI], 4.59-5.79), tumour size 21-40 mm (OR 2.14, 95% CI, 1.89-2.43) and depth of invasion>10 mm (OR 1.81, 95% CI, 1.59-2.08). A group of 1469 women (41%)-with tumours without LVSI, tumour size ≤20 mm, and depth of invasion ≤10 mm-had a very low risk of pN+ (2.4%, 95% CI, 1.7-3.3%). CONCLUSION Early-stage cervical cancer without LVSI, a tumour size ≤20 mm and depth of invasion ≤10 mm, confers a low risk of pN+. Based on an international privacy-preserving analysis, we developed a useful tool to guide the shared decision-making process regarding lymph node dissection.
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Affiliation(s)
- Hans H B Wenzel
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
| | - Anna N Hardie
- Department of Pelvic Cancer, Karolinska University Hospital and Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Arturo Moncada-Torres
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Claus K Høgdall
- Department of Gynaecology, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ruud L M Bekkers
- Department of Obstetrics and Gynaecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, the Netherlands
| | - Henrik Falconer
- Department of Pelvic Cancer, Karolinska University Hospital and Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Pernille T Jensen
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Hans W Nijman
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Maaike A van der Aa
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Frank Martin
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Anna J van Gestel
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Valery E P P Lemmens
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Pernilla Dahm-Kähler
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital and Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Emilia Alfonzo
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital and Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan Persson
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital and Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology, Lund, Sweden
| | - Linnea Ekdahl
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital and Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology, Lund, Sweden
| | - Sahar Salehi
- Department of Pelvic Cancer, Karolinska University Hospital and Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Ligita P Frøding
- Department of Gynaecology, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Katrine Fuglsang
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Tine H Schnack
- Department of Gynaecology, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Gynaecology, Odense University Hospital, Odense, Denmark
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Razumova Z, Bizzarri N, Pletnev A, Theofanakis C, Selcuk I, van der Steen-Banasik E, Gonzalez Martin A, Persson J. 22nd meeting of the European Society of Gynaecological Oncology (ESGO 2021) report. Int J Gynecol Cancer 2022; 32:1363-1369. [PMID: 36198434 DOI: 10.1136/ijgc-2022-003593] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This is a report from the 22nd Meeting of the European Society of Gynaecological Oncology, held October 23-25, 2021. The 3-day event offered an educational experience covering the major scientific and clinical advances in gynecological oncology. The Congress program included different session formats, including guidelines updates and state-of-the-art lectures. This article provides an overview of the main Congress activities as well as of the most important studies that were presented at the event for the first time.
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Affiliation(s)
- Zoia Razumova
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - Andrei Pletnev
- Department of Gynecology and Obstetrics, Faculty of Medicine and Health Sciences, University of Zielona Góra, Zielona Gora, Poland
| | - Charlampos Theofanakis
- Department of Gynaecological Oncology, General Hospital of Athens Alexandra, Athens, Greece
| | - Ilker Selcuk
- Gynecologic Oncology, Ankara City Hospital, Ankara, Turkey
| | | | - Antonio Gonzalez Martin
- Department of Medical Oncology, Clinica Universidad de Navarra, Madrid, Spain.,Centre for Applied Medical Research (CIMA), Pamplona, Spain
| | - Jan Persson
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences, Lund University Faculty of Medicine, Lund, Sweden
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Sharma T, Maehara A, Ben-Yehuda O, Maeng M, Kjoller-Hansen L, Engstrom T, Matsumura M, Frobert O, Persson J, Wiseth R, Larsen AI, James SK, Ali ZA, Stone GW, Erlinge D. Biomarkers associated with vulnerable plaques. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1292] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiovascular heart disease is the leading cause of mortality worldwide, with the rupture or thrombosis of an atherosclerotic plaque being the main reason behind an acute coronary syndrome. It has already been established that the morphology of atherosclerotic plaques determine their stability. A lipid rich lesion with a thin fibrous cap is more prone to rupture compared to solid fibrous lesions. In the PROSPECTII study we used Near infrared spectroscopy (NIRS) and Intravascular ultrasound (IVUS) to identify atherosclerotic plaques in the coronary arteries; NIRS-derived lipid core burden index (LCBI) and IVUS-derived plaque burden (PB) identified plaques that caused adverse cardiovascular events.
Purpose
Our aim is to find biomarkers associated with LCBI or PB, to understand the development of vulnerable plaques.
Methods
902 patients were enrolled in this study after successful percutaneous coronary intervention (PCI). A combined NIRS-IVUS catheter was then used to analyze approximately 200m of coronary arteries. Blood samples for biomarker analysis were taken before the PCI procedure and plasma levels of 182 proteins associated with cardiovascular disease were assessed using a novel method for measuring proximity extension assay. Adjusted linear regression models were calculated between the biomarkers and the outcomes of interest, followed by a false discovery rate (FDR) correction.
Results
We found 24 proteins associated with plaque burden and 28 proteins associated with LCBI after using a cut off of two tailed P value <0.05. An overlap of 8 biomarkers could be seen between the two groups. After adjusting the P values with FDR, Angiopoeitin like 3 (ANGPTL3) retained its association to LCBI, and Interleukin 18 receptor 1 (IL18R1) and colony stimulating factor 1 (CSF-1) to plaque burden.
Conclusion
We were able to identify different biomarker patterns associated with plaque burden compared to lipid rich vulnerable plaques. ANGPTL3 was shown to only have an association with lipid rich plaques and not with solid fibrous lesions which further supports its role in vulnerable plaques.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Abbott Vascular, Infraredx, and The Medicines Company
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Affiliation(s)
| | - A Maehara
- Columbia University Medical Center , New York , United States of America
| | - O Ben-Yehuda
- Cardiovascular Research Foundation , New York , United States of America
| | - M Maeng
- Aarhus University Hospital , Aarhus , Denmark
| | | | - T Engstrom
- University of Copenhagen , Copenhagen , Denmark
| | - M Matsumura
- Cardiovascular Research Foundation , New York , United States of America
| | - O Frobert
- Orebro University, Faculty of Health , Orebro , Sweden
| | - J Persson
- Danderyd University Hospital , Stockholm , Sweden
| | - R Wiseth
- St Olavs Hospital , Trondheim , Norway
| | - A I Larsen
- Stavanger University Hospital , Stavanger , Norway
| | - S K James
- Uppsala University Hospital and Uppsala Clinical Research Center , Uppsala , Sweden
| | - Z A Ali
- Columbia University Medical Center , New York , United States of America
| | - G W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute , New York , United States of America
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Loerstad S, Shekarestan S, Tehrani S, Jernberg T, Astrand P, Gille-Johnson P, Persson J. First sampled plasma troponin T is associated with one-year mortality in sepsis and septic shock, independent of age, gender, comorbidities, and clinically relevant biomarkers. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1486] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Patients with sepsis and septic shock often have elevated troponin T levels indicating acute myocardial injury. Studies investigating the relationship between troponin T levels as a predictor for mortality in sepsis have been contradictory.
Purpose
To investigate if the first in-hospital sampled plasma troponin T value is associated with one-year mortality in sepsis and septic shock independent of comorbidities, Sequential Organ Failure Assessment (SOFA)-score, Clinical Frailty Scale, Charlson Comorbidity Index (including age) and clinical biomarkers (e.g., serum lactate, creatinine, C-reactive protein).
Methods
Patients with sepsis and sepsis shock were included if they were admitted to the intermediate and intensive care units at our institution between 1st of March 2012 and 30th of September 2021, and if at least one troponin T value was recorded within the first two calendar days from symptom onset. Variables were collected from medical records. Normal troponin-T was defined as <15 ng/L. Elevated troponin T values were divided into quartiles (Q): Q1 15–35.9 ng/L, Q2 36–61.9 ng/L, Q3 62–125.9 ng/L and Q4 ≥126 ng/L. Kaplan-Meier stratified survival curves were plotted for normal levels and Qs of elevated troponin T. Multivariate Cox regression was used for multivariate analysis.
Results
586 patients were included and 529 (90%) had a first sampled troponin T ≥15 ng/L. 523 (89%) met the Sepsis-3 criteria for septic shock, the remainder met the criteria for sepsis. The mean age was 71 years and 220 (38%) were women. One-year mortality was 45% (n=264). Increasing levels of first sampled plasma troponin T were associated with higher hazard ratios (HR) for one-year mortality compared to normal levels (<15 ng/L): Q1 HR 5.29 (95% confidence interval [CI] 1.9–14.7); Q2 HR 7.47 (95% CI 2.71–20.6); Q3 HR 12.81 (95% CI 4.7–35.0); Q 4 HR 13.82 (95% CI 5.06–37.7) (Figure 1). Troponin T was independently associated with one-year mortality after adjustment for gender, plasma lactate, plasma CRP, prior atrial fibrillation, in-hospital onset atrial fibrillation, SOFA-score, CFS, and CCI (including age) (Table 1).
Conclusions
Elevated first sampled plasma troponin T in patients with sepsis and septic shock was associated with higher one-year mortality, independent of age, gender, comorbidities, and clinically relevant biomarkers. There was a risk gradient across the Qs of elevated troponin T with increasingly higher risk of death at one year per higher Q. Further studies are needed to ascertain whether elevated troponin T levels and clinical assessment scores can be used together in the clinical setting to identify patients for more aggressive treatment and cardiac work-up.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Region Stockholm
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Affiliation(s)
- S Loerstad
- Karolinska Institutet Danderyd Hospital , Stockholm , Sweden
| | | | - S Tehrani
- Karolinska Institutet Danderyd Hospital , Stockholm , Sweden
| | - T Jernberg
- Karolinska Institutet Danderyd Hospital , Stockholm , Sweden
| | - P Astrand
- Danderyd University Hospital , Stockholm , Sweden
| | | | - J Persson
- Karolinska Institutet Danderyd Hospital , Stockholm , Sweden
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13
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Shahed H, Sharma N, Angst M, Voigt J, Persson J, Gildenast H, Englert U, Chernyshov D, Tornroos K, Grzechnik A, Friese K. Elucidation of barocaloric effect in spin crossover compounds. Acta Cryst Sect A 2022. [DOI: 10.1107/s2053273322092932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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14
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Lührs O, Bollino M, Ekdahl L, Lönnerfors C, Geppert B, Persson J. Similar distribution of pelvic sentinel lymph nodes and nodal metastases in cervical and endometrial cancer. A prospective study based on lymphatic anatomy. Gynecol Oncol 2022; 165:466-471. [DOI: 10.1016/j.ygyno.2022.03.027] [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] [Received: 02/18/2022] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 11/26/2022]
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Brand RE, Persson J, Bratlie SO, Chung DC, Katona BW, Carrato A, Castillo M, Earl J, Kokkola A, Lucas AL, Moser AJ, DeCicco C, Mellby LD, King TC. Detection of Early-Stage Pancreatic Ductal Adenocarcinoma From Blood Samples: Results of a Multiplex Biomarker Signature Validation Study. Clin Transl Gastroenterol 2022; 13:e00468. [PMID: 35166713 PMCID: PMC8963856 DOI: 10.14309/ctg.0000000000000468] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/08/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The IMMray PanCan-d test combines an 8-plex biomarker signature with CA19-9 in a proprietary algorithm to detect pancreatic ductal adenocarcinoma (PDAC) in serum samples. This study aimed to validate the clinical performance of the IMMray PanCan-d test and to better understand test performance in Lewis-null (le/le) individuals who cannot express CA19-9. METHODS Serum samples from 586 individuals were analyzed with the IMMray PanCan-d biomarker signature and CA19-9 assay, including 167 PDAC samples, 203 individuals at high risk of familial/hereditary PDAC, and 216 healthy controls. Samples were collected at 11 sites in the United States and Europe. The study was performed by Immunovia, Inc (Marlborough, MA), and sample identity was blinded throughout the study. Test results were automatically generated using validated custom software with a locked algorithm and predefined decision value cutoffs for sample classification. RESULTS The IMMray PanCan-d test distinguished PDAC stages I and II (n = 56) vs high-risk individuals with 98% specificity and 85% sensitivity and distinguished PDAC stages I-IV vs high-risk individuals with 98% specificity and 87% sensitivity. We identified samples with a CA19-9 value of 2.5 U/mL or less as probable Lewis-null (le/le) individuals. Excluding these 55 samples from the analysis increased the IMMray PanCan-d test sensitivity to 92% for PDAC stages I-IV (n = 157) vs controls (n = 379) while maintaining specificity at 99%; test sensitivity for PDAC stages I and II increased from 85% to 89%. DISCUSSION These results demonstrate the IMMray PanCan-d blood test can detect PDAC with high specificity (99%) and sensitivity (92%).
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Affiliation(s)
- Randall E. Brand
- Division of Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA;
| | - Jan Persson
- Sahlgrenska University Hospital, Department of Surgery, Gothenburg, Sweden;
| | - Svein Olav Bratlie
- Sahlgrenska University Hospital, Department of Surgery, Gothenburg, Sweden;
| | - Daniel C. Chung
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA;
| | - Bryson W. Katona
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA;
| | - Alfredo Carrato
- Molecular Epidemiology and Predictive Markers in Cancer Group, Ramon y Cajal University Hospital, Alcala University, IRYCIS, CIBERONC, Madrid, Spain, Pancreatic Cancer Europe Chairperson, Brussels, Belgium
| | - Marién Castillo
- Molecular Epidemiology and Predictive Markers in Cancer Group, Ramón y Cajal University Hospital, IRYCIS, CIBERONC, Madrid, Spain;
| | - Julie Earl
- Molecular Epidemiology and Predictive Markers in Cancer Group, Ramón y Cajal University Hospital, IRYCIS, CIBERONC, Madrid, Spain;
| | - Arto Kokkola
- Helsinki University Hospital, Helsinki, Finland;
| | - Aimee L. Lucas
- Division of Gastroenterology, Mt. Sinai Medical Center, New York, New York, USA;
| | - A. James Moser
- Division of Surgical Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA;
| | - Corinne DeCicco
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA;
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Salvo G, Ramirez PT, Leitao MM, Cibula D, Wu X, Falconer H, Persson J, Perrotta M, Mosgaard BJ, Kucukmetin A, Berlev I, Rendon G, Liu K, Vieira M, Capilna ME, Fotopoulou C, Baiocchi G, Kaidarova D, Ribeiro R, Pedra-Nobre S, Kocian R, Li X, Li J, Pálsdóttir K, Noll F, Rundle S, Ulrikh E, Hu Z, Gheorghe M, Saso S, Bolatbekova R, Tsunoda A, Pitcher B, Wu J, Urbauer D, Pareja R. Open vs minimally invasive radical trachelectomy in early-stage cervical cancer: International Radical Trachelectomy Assessment Study. Am J Obstet Gynecol 2022; 226:97.e1-97.e16. [PMID: 34461074 PMCID: PMC9518841 DOI: 10.1016/j.ajog.2021.08.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/11/2021] [Accepted: 08/14/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Minimally invasive radical trachelectomy has emerged as an alternative to open radical hysterectomy for patients with early-stage cervical cancer desiring future fertility. Recent data suggest worse oncologic outcomes after minimally invasive radical hysterectomy than after open radical hysterectomy in stage I cervical cancer. OBJECTIVE We aimed to compare 4.5-year disease-free survival after open vs minimally invasive radical trachelectomy. STUDY DESIGN This was a collaborative, international retrospective study (International Radical Trachelectomy Assessment Study) of patients treated during 2005-2017 at 18 centers in 12 countries. Eligible patients had squamous carcinoma, adenocarcinoma, or adenosquamous carcinoma; had a preoperative tumor size of ≤2 cm; and underwent open or minimally invasive (robotic or laparoscopic) radical trachelectomy with nodal assessment (pelvic lymphadenectomy and/or sentinel lymph node biopsy). The exclusion criteria included neoadjuvant chemotherapy or preoperative pelvic radiotherapy, previous lymphadenectomy or pelvic retroperitoneal surgery, pregnancy, stage IA1 disease with lymphovascular space invasion, aborted trachelectomy (conversion to radical hysterectomy), or vaginal approach. Surgical approach, indication, and adjuvant therapy regimen were at the discretion of the treating institution. A total of 715 patients were entered into the study database. However, 69 patients were excluded, leaving 646 in the analysis. Endpoints were the 4.5-year disease-free survival rate (primary), 4.5-year overall survival rate (secondary), and recurrence rate (secondary). Kaplan-Meier methods were used to estimate disease-free survival and overall survival. A post hoc weighted analysis was performed, comparing the recurrence rates between surgical approaches, with open surgery being considered as standard and minimally invasive surgery as experimental. RESULTS Of 646 patients, 358 underwent open surgery, and 288 underwent minimally invasive surgery. The median (range) patient age was 32 (20-42) years for open surgery vs 31 (18-45) years for minimally invasive surgery (P=.11). Median (range) pathologic tumor size was 15 (0-31) mm for open surgery and 12 (0.8-40) mm for minimally invasive surgery (P=.33). The rates of pelvic nodal involvement were 5.3% (19 of 358 patients) for open surgery and 4.9% (14 of 288 patients) for minimally invasive surgery (P=.81). Median (range) follow-up time was 5.5 (0.20-16.70) years for open surgery and 3.1 years (0.02-11.10) years for minimally invasive surgery (P<.001). At 4.5 years, 17 of 358 patients (4.7%) with open surgery and 18 of 288 patients (6.2%) with minimally invasive surgery had recurrence (P=.40). The 4.5-year disease-free survival rates were 94.3% (95% confidence interval, 91.6-97.0) for open surgery and 91.5% (95% confidence interval, 87.6-95.6) for minimally invasive surgery (log-rank P=.37). Post hoc propensity score analysis of recurrence risk showed no difference between surgical approaches (P=.42). At 4.5 years, there were 6 disease-related deaths (open surgery, 3; minimally invasive surgery, 3) (log-rank P=.49). The 4.5-year overall survival rates were 99.2% (95% confidence interval, 97.6-99.7) for open surgery and 99.0% (95% confidence interval, 79.0-99.8) for minimally invasive surgery. CONCLUSION The 4.5-year disease-free survival rates did not differ between open radical trachelectomy and minimally invasive radical trachelectomy. However, recurrence rates in each group were low. Ongoing prospective studies of conservative management of early-stage cervical cancer may help guide future management.
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Ekdahl L, Crusensvärd M, Reynisson P, Lönnerfors C, Persson J. Quality of life and long-term clinical outcome following robot-assisted radical trachelectomy. Eur J Obstet Gynecol Reprod Biol 2021; 267:234-240. [PMID: 34837852 DOI: 10.1016/j.ejogrb.2021.11.018] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/31/2021] [Accepted: 11/10/2021] [Indexed: 11/26/2022]
Abstract
Quality of Life and long-term clinical outcome following robot-assisted radical trachelectomy. OBJECTIVES To evaluate quality of life (QoL) and long-term clinical outcome following robot-assisted radical trachelectomy (RRT). STUDY DESIGN Prospectively retrieved clinical data were rereviewed on all women planned for a fertility sparing RRT for early stage cervical cancer at Skåne University Hospital, Sweden between 2007 and 2020. QoL was assessed using the validated questionnaires EORTC QLQ-C30, QLQ-CX24 and the Swedish LYMQOL. RESULTS Data was analyzed from 49 women, 42 with a finalised RRT and seven with an aborted RRT due to nodal metastases (n = 3) or insufficient margins (n = 4). At a median follow-up time of 54 months one recurrence (2%) occurred (aborted RRT). According to QLQ-C30 the median global health status score was 75. The disease specific QLQ-C24 showed an impact on symptoms related to sexual function where sexual/vaginal functioning had a median score of 25 and 48% of patients reported worry that sex would cause physical pain. Despite this the functional items sexual activity and sexual enjoyment both had a median score of 66.7. Lymphoedema was reported in 45%, where 9% reported severe symptom with an impact on their QoL. No intraoperative complications and no postoperative complications ≥ Clavien Dindo grade III were observed. Twenty-two of 28 (79%) women who attempted to conceive were successful. A metronidazole/no intercourse regimen was applied between GW 15 + 0-21 + 6 in 26 of 28 pregnancies beyond first trimester resulting in a 92% term (≥GW 36 + 0) delivery rate. CONCLUSIONS Although robot-assisted radical trachelectomy in this cohort was associated with a low recurrence rate, a high fertility rate and an exceptionally high term delivery rate, women's quality of life was affected postoperatively, particularly with regards to their sexual well-being and lymphatic side-effects.
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Affiliation(s)
- Linnea Ekdahl
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital, Lund, Sweden; Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology, 22185 Lund, Sweden
| | - Malin Crusensvärd
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital, Lund, Sweden; Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology, 22185 Lund, Sweden
| | - Petur Reynisson
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital, Lund, Sweden; Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology, 22185 Lund, Sweden
| | - Celine Lönnerfors
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital, Lund, Sweden; Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology, 22185 Lund, Sweden
| | - Jan Persson
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital, Lund, Sweden; Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology, 22185 Lund, Sweden.
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18
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Concin N, Planchamp F, Abu-Rustum NR, Ataseven B, Cibula D, Fagotti A, Fotopoulou C, Knapp P, Marth C, Morice P, Querleu D, Sehouli J, Stepanyan A, Taskiran C, Vergote I, Wimberger P, Zapardiel I, Persson J. European Society of Gynaecological Oncology quality indicators for the surgical treatment of endometrial carcinoma. Int J Gynecol Cancer 2021; 31:1508-1529. [PMID: 34795020 DOI: 10.1136/ijgc-2021-003178] [Citation(s) in RCA: 9] [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] [Accepted: 10/20/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Quality of surgical care as a crucial component of a comprehensive multi-disciplinary management improves outcomes in patients with endometrial carcinoma, notably helping to avoid suboptimal surgical treatment. Quality indicators (QIs) enable healthcare professionals to measure their clinical management with regard to ideal standards of care. OBJECTIVE In order to complete its set of QIs for the surgical management of gynecological cancers, the European Society of Gynaecological Oncology (ESGO) initiated the development of QIs for the surgical treatment of endometrial carcinoma. METHODS QIs were based on scientific evidence and/or expert consensus. The development process included a systematic literature search for the identification of potential QIs and documentation of the scientific evidence, two consensus meetings of a group of international experts, an internal validation process, and external review by a large international panel of clinicians and patient representatives. QIs were defined using a structured format comprising metrics specifications, and targets. A scoring system was then developed to ensure applicability and feasibility of a future ESGO accreditation process based on these QIs for endometrial carcinoma surgery and support any institutional or governmental quality assurance programs. RESULTS Twenty-nine structural, process and outcome indicators were defined. QIs 1-5 are general indicators related to center case load, training, experience of the surgeon, structured multi-disciplinarity of the team and active participation in clinical research. QIs 6 and 7 are related to the adequate pre-operative investigations. QIs 8-22 are related to peri-operative standards of care. QI 23 is related to molecular markers for endometrial carcinoma diagnosis and as determinants for treatment decisions. QI 24 addresses the compliance of management of patients after primary surgical treatment with the standards of care. QIs 25-29 highlight the need for a systematic assessment of surgical morbidity and oncologic outcome as well as standardized and comprehensive documentation of surgical and pathological elements. Each QI was associated with a score. An assessment form including a scoring system was built as basis for ESGO accreditation of centers for endometrial cancer surgery.
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Affiliation(s)
- Nicole Concin
- Department of Gynecology and Obstetrics; Innsbruck Medical Univeristy, Innsbruck, Austria .,Department of Gynecology and Gynecological Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
| | | | - Nadeem R Abu-Rustum
- Department of Obstetrics and Gynecology, Memorial Sloann Kettering Cancer Center, New York, New York, USA
| | - Beyhan Ataseven
- Department of Gynecology and Gynecological Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany.,Department of Obstetrics and Gynaecology, University Hospital Munich (LMU), Munich, Germany
| | - David Cibula
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic
| | - Anna Fagotti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy
| | - Christina Fotopoulou
- Department of Gynaecologic Oncology, Imperial College London Faculty of Medicine, London, UK
| | - Pawel Knapp
- Department of Gynaecology and Gynaecologic Oncology, University Oncology Center of Bialystok, Medical University of Bialystok, Bialystok, Poland
| | - Christian Marth
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria
| | - Philippe Morice
- Department of Surgery, Institut Gustave Roussy, Villejuif, France
| | - Denis Querleu
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy.,Department of Obstetrics and Gynecologic Oncology, University Hospitals Strasbourg, Strasbourg, Alsace, France
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universitätzu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Artem Stepanyan
- Department of Gynecologic Oncology, Nairi Medical Center, Yerevan, Armenia
| | - Cagatay Taskiran
- Department of Obstetrics and Gynecology, Koç University School of Medicine, Ankara, Turkey.,Department of Gynecologic Oncology, VKV American Hospital, Istambul, Turkey
| | - Ignace Vergote
- Department of Gynecology and Obstetrics, Gynecologic Oncology, Leuven Cancer Institute, Catholic University Leuven, Leuven, Belgium
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, Technische Universität Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT/UCC), Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain
| | - Jan Persson
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund, Sweden.,Lund University, Faculty of Medicine, Clinical Sciences, Lund, Sweden
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Bratlie SO, Wennerblom J, Vilhav C, Persson J, Rangelova E. Resectable, borderline, and locally advanced pancreatic cancer-"the good, the bad, and the ugly" candidates for surgery? J Gastrointest Oncol 2021; 12:2450-2460. [PMID: 34790406 DOI: 10.21037/jgo-2020-slapc-04] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/10/2020] [Indexed: 12/31/2022] Open
Abstract
The possibility of surgical resection strongly overrules medical oncologic treatment and is the only modality, causa sine qua non, long-term survival can be achieved in patients with pancreatic cancer. For this reason, the clinical classification of local resectability, subdividing tumors into resectable, borderline resectable, and locally advanced cancer, that is very technical in nature, is the one most widely used and accepted. As multimodality treatment with potent agents, particularly in the neoadjuvant setting, seems to be stepping forward as the new standard of treatment of pancreatic cancer, the established technical surgical landmarks tend to get challenged. This review aims to highlight the grey zones in the current classifications for local tumor involvement with respect to the observed patient outcome in the current multimodality treatment era. It summarizes the latest reported series on the outcome of resected primary resectable, borderline and locally advanced pancreatic cancer, and particularly vascular resections during pancreatectomy, in the background of different types of neoadjuvant therapy. It also hints what the new horizons of cancer biology tend to reveal whenever the technical hinders start being pushed aside. The current calls for the necessity of re-classification of the clinical categories of pancreatic cancer, from technically oriented to biology-focused individualized approach, are being elucidated.
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Affiliation(s)
- Svein Olav Bratlie
- Section for Upper Abdominal Surgery, Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Surgery, The Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johanna Wennerblom
- Section for Upper Abdominal Surgery, Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Surgery, The Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Caroline Vilhav
- Section for Upper Abdominal Surgery, Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Surgery, The Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan Persson
- Section for Upper Abdominal Surgery, Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Surgery, The Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Elena Rangelova
- Section for Upper Abdominal Surgery, Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Surgery, The Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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20
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Lührs O, Ekdahl L, Geppert B, Lönnerfors C, Persson J. Resection of the upper paracervical lymphovascular tissue should be an integral part of a pelvic sentinel lymph node algorithm in early stage cervical cancer. Gynecol Oncol 2021; 163:289-293. [PMID: 34509298 DOI: 10.1016/j.ygyno.2021.08.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/28/2021] [Revised: 08/16/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate the prevalence of lymph nodes and lymph node metastases (LNMs) in the upper paracervical lymphovascular tissue (UPLT) in early stage cervical cancer. METHODS In this prospective study consecutive women with stage IA1-IB1 cervical cancer underwent a pelvic lymphadenectomy including identification of sentinel nodes (SLNs) as part of a nodal staging procedure in conjunction with a robotic radical hysterectomy (RRH) or robotic radical trachelectomy (RRT). Indocyanine green (ICG) was used as tracer. The UPLT was separately removed and defined as "SLN-parametrium" and, as all SLN tissue, subjected to ultrastaging and immunohistochemistry. Primary endpoint was prevalence of lymph nodes and metastatic lymph nodes in the UPLT. Secondary endpoints were complications associated with removal of the UPLT. RESULTS One hundred and forty-five women were analysed. Nineteen (13.1%) had pelvic LNMs, all identified by at least one metastatic SLN. In 76 women (52.4%) at least one UPLT lymph node was identified. Metastatic UPLT lymph nodes were identified in six women of which in three women (2.1% of all women and 15.8% of node positive women) without lateral pelvic LNMs. Thirteen women had lateral pelvic SLN LNMs with either no (n = 5) or benign (n = 8) UPLT lymph nodes. No intraoperative complications occurred due to the removal of the UPLT. CONCLUSION Removal of the UPLT should be an integral part of the SLN concept in early stage cervical cancer.
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Affiliation(s)
- Oscar Lührs
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Skåne University Hospital, Lund, Sweden; Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology, Lund, Sweden; Department of Obstetrics and Gynecology, Ystad Lasarett, Ystad, Sweden
| | - Linnea Ekdahl
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Skåne University Hospital, Lund, Sweden; Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology, Lund, Sweden
| | - Barbara Geppert
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Skåne University Hospital, Lund, Sweden; Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology, Lund, Sweden
| | - Céline Lönnerfors
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Skåne University Hospital, Lund, Sweden; Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology, Lund, Sweden
| | - Jan Persson
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Skåne University Hospital, Lund, Sweden; Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology, Lund, Sweden.
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21
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Kirkegård J, Al-Saiddi M, Bratlie SO, Coolsen M, de Haas RJ, den Dulk M, Fristrup C, Greve OJ, Harrison E, Koutouzi G, Miclea RL, Mortensen MB, Nijkamp MW, Persson J, Robertson FP, Slangen JJG, Søreide JA, Wigmore SJ, Mortensen FV. Intra-observer agreements in multidisciplinary team assessments of pancreatic cancer patients. J Surg Oncol 2021; 124:1402-1408. [PMID: 34490905 DOI: 10.1002/jso.26670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/20/2021] [Revised: 08/16/2021] [Accepted: 08/29/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND METHODS Treatment strategies for pancreatic cancer patients are made by a multidisciplinary team (MDT) board. We aimed to assess intra-observer variance at MDT boards. Participating units staged, assessed resectability, and made treatment allocations for the same patients as they did two years earlier. We disseminated clinical information and CT images of pancreatic cancer patients judged by one MDT board to have nonmetastatic pancreatic cancer to the participating units. All units were asked to re-assess the TNM stage, resectability, and treatment allocation for each patient. To assess intra-observer variance, we computed %-agreements for each participating unit, defined as low (<50%), moderate (50%-75%), and high (>75%) agreement. RESULTS Eighteen patients were re-assessed by six MDT boards. The overall agreement was moderate for TNM-stage (ranging from 50%-70%) and resectability assessment (53%) but low for treatment allocation (46%). Agreement on resectability assessments was low to moderate. Findings were similar but more pronounced for treatment allocation. We observed a shift in treatment strategy towards increasing use of neoadjuvant chemotherapy, particularly in patients with borderline resectable and locally advanced tumors. CONCLUSIONS We found substantial intra-observer agreement variations across six different MDT boards of 18 pancreatic cancer patients with two years between the first and second assessment.
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Affiliation(s)
- Jakob Kirkegård
- Department of Surgery, HPB Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Mohammed Al-Saiddi
- Department of Radiology, Stavanger University Hospital, Stavanger, Norway
| | - Svein Olav Bratlie
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marielle Coolsen
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Robbert J de Haas
- Department of Radiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Marcel den Dulk
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Claus Fristrup
- Department of Surgical Gastroenterology, Odense Pancreas Center, Odense University Hospital, Odense, Denmark
| | - Ole Jacob Greve
- Department of Radiology, Stavanger University Hospital, Stavanger, Norway
| | - Ewen Harrison
- Clinical Surgery, Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Giasemi Koutouzi
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden
| | - Razvan L Miclea
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Michael B Mortensen
- Department of Surgical Gastroenterology, Odense Pancreas Center, Odense University Hospital, Odense, Denmark
| | - Maarten W Nijkamp
- Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Jan Persson
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Francis P Robertson
- Clinical Surgery, Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Jules J G Slangen
- Department of Radiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Jon Arne Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Stephen J Wigmore
- Clinical Surgery, Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Frank V Mortensen
- Department of Surgery, HPB Research Unit, Aarhus University Hospital, Aarhus, Denmark
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22
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Ekdahl L, Paraghamian S, Madhuri TK, Eoh KJ, Butler-Manuel S, Kim YT, Boggess J, Persson J, Falconer H. Robotic-assisted radical trachelectomy for early-stage cervical cancer: reproductive outcomes. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)00739-3] [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: 11/17/2022]
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23
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Bodén R, Bengtsson J, Thörnblom E, Struckmann W, Persson J. Dorsomedial prefrontal theta burst stimulation to treat anhedonia, avolition, and blunted affect in schizophrenia or depression - a randomized controlled trial. J Affect Disord 2021; 290:308-315. [PMID: 34020205 DOI: 10.1016/j.jad.2021.04.053] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/12/2021] [Accepted: 04/25/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Intermittent theta burst stimulation (iTBS) over the dorsomedial prefrontal cortex (DMPFC) has shown promise in open-label trials of depression. METHODS In this randomized, double-blind, sham controlled trial we evaluate iTBS over the DMPFC for anhedonia, avolition, and blunted affect in patients with schizophrenia or depression. Active iTBS was delivered over the DMPFC with 1200 pulses per session, twice daily over ten weekdays at target intensity with an angled figure-of eight coil. Sham condition comprised the magnetically shielded side of the coil and simultaneous transcutaneous electrical nerve stimulation. Primary outcome was change on the Clinical Assessment Interview for Negative Symptoms (CAINS). RESULTS Twenty-eight patients were randomized to active iTBS and 28 to sham. Mean (standard deviation) change in CAINS score from baseline to the day after last treatment was -5.3 (8.1) in active iTBS and -2.1 (7.1) in sham. A linear model showed no significant effect of treatment, accounting for baseline scores p=.088. Sub analyses per diagnostic group showed a significant effect in patients with depression, p=.038, but not in the schizophrenia group, p=.850. However, overall depressive symptoms did not change significantly in patients with depression. There were three serious adverse events, all in the sham group. LIMITATIONS Possibly too short treatment course and few patients with schizophrenia. CONCLUSION In this first transdiagnostic randomized controlled trial of iTBS over DMPFC for anhedonia, avolition, and blunted affect it can be concluded that it was generally tolerable and safe but only more effective than sham in the subgroup of patients with depression.
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Affiliation(s)
- R Bodén
- Department of Neuroscience, Pychiatry, Uppsala University, Entrance 10, ground floor, Brain Stimulation Unit, SE- 751 85, Uppsala, Sweden.
| | - J Bengtsson
- Department of Neuroscience, Pychiatry, Uppsala University, Entrance 10, ground floor, Brain Stimulation Unit, SE- 751 85, Uppsala, Sweden
| | - E Thörnblom
- Department of Neuroscience, Pychiatry, Uppsala University, Entrance 10, ground floor, Brain Stimulation Unit, SE- 751 85, Uppsala, Sweden
| | - W Struckmann
- Department of Neuroscience, Pychiatry, Uppsala University, Entrance 10, ground floor, Brain Stimulation Unit, SE- 751 85, Uppsala, Sweden
| | - J Persson
- Department of Neuroscience, Pychiatry, Uppsala University, Entrance 10, ground floor, Brain Stimulation Unit, SE- 751 85, Uppsala, Sweden
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24
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Bernfort L, Persson J, Linderoth C, Ekberg K. Supervisor ratings of productivity loss associated with presenteeism and sick leave due to musculoskeletal disorders and common mental disorders in Sweden. Work 2021; 68:1091-1100. [PMID: 33843715 DOI: 10.3233/wor-213439] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Health problems due to musculoskeletal disorders (MSD) and common mental disorders (CMD) result in costs due to lost productivity. OBJECTIVE This study aimed to increase knowledge of employers' productivity loss due to employees' presenteeism and sickness absence. METHODS A web questionnaire was sent to employers of workers who were sick-listed for more than 30 days due to MSD or CMD, response rate: 50%, n = 198. Presenteeism and the impact on productivity before and after sick leave, and the performance of work tasks by replacement workers during sick leave, were measured using supervisors' ratings. RESULTS The average loss of productivity per sick-leave case amounted to almost 10 weeks, 53%of productivity loss was attributable to presenteeism and 47%to lower productivity by replacement workers. Employees with a CMD diagnosis had significantly higher presenteeism-related productivity loss than those with MSD. CONCLUSIONS Employers experienced substantial productivity loss associated with employees' presenteeism and sick leave. Whether the supervisory rating of presenteeism is preferable to employee self-rating needs to be studied further. The long duration of presenteeism is counter-productive to resource-efficient organisations and indicates the need for improved supervisory skills to identify workers with poor health, both before and after sick leave.
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Affiliation(s)
- Lars Bernfort
- Department of Health, Medicine and Caring Sciences, Division of Society and Health, Center for Medical Technology Assessment, Linköping University, Linköping, Sweden
| | - Jan Persson
- Department of Health, Medicine and Caring Sciences, Division of Society and Health, Center for Medical Technology Assessment, Linköping University, Linköping, Sweden
| | - Catharina Linderoth
- Department of Health, Medicine and Caring Sciences, Division of Society and Health, Unit of Public Health, Linköping University, Linköping, Sweden
| | - Kerstin Ekberg
- Department of Health, Medicine and Caring Sciences, Division of Society and Health, Unit of Public Health, Linköping University, Linköping, Sweden
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25
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Persson J, Lönnerfors C, Falconer H. Sentinel Lymph Node Concept in High-Risk Profile Endometrial Cancer. JAMA Surg 2021; 156:798-799. [PMID: 33950170 DOI: 10.1001/jamasurg.2021.1464] [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]
Affiliation(s)
- Jan Persson
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Skåne University Hospital, Lund University Faculty of Medicine, Clinical Sciences, Obstetrics and Gynaecology, Lund, Sweden
| | - Celine Lönnerfors
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Skåne University Hospital, Lund University Faculty of Medicine, Clinical Sciences, Obstetrics and Gynaecology, Lund, Sweden
| | - Henrik Falconer
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
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26
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Razumova Z, Bizzarri N, Kacperczyk-Bartnik J, Pletnev A, Gonzalez Martin A, Persson J. Report from the European Society of Gynaecological Oncology (ESGO) 2020 State-of-the-Art Virtual Meeting. Int J Gynecol Cancer 2021; 31:658-669. [PMID: 33811109 DOI: 10.1136/ijgc-2021-002577] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 11/04/2022] Open
Abstract
This is a report from the European Society of Gynaecological Oncology State-of-the-Art Virtual Meeting held December 14-16, 2020. The unique 3-day conference offered comprehensive state-of-the-art summaries on the major advances in the treatment of different types of gynecological cancers. Sessions opened with a case presentation followed by a keynote lecture and interactive debates with opinion leaders in the field. The speakers also presented scientific reviews on the clinical trial landscape in collaboration with the European Network of Gynecological Oncological Trial (ENGOT) groups. In addition, the new ESGO-ESRTO-ESP endometrial cancer guidelines were officially presented in public. This paper describes the key information and latest studies that were presented for the first time at the conference.
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Affiliation(s)
- Zoia Razumova
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Nicolò Bizzarri
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | | | - Andrei Pletnev
- Department of Gynaecological Oncology, N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Belarus
| | | | - Jan Persson
- Department of Obstetrics and Gynaecology, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Faculty of Medicine at Lund University, Lund, Sweden
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Zhai Q, Freund-Levi Y, Horn A, Fridenberger AC, Lager E, Montgomery S, Persson J. Physical training for patients with depression and anxiety - a randomized controlled study. Eur Psychiatry 2021. [PMCID: PMC9480390 DOI: 10.1192/j.eurpsy.2021.1828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionPharmaceutical treatment and psychotherapy constitute the most common treatment methods for depression and anxiety. Physical training has been shown to have comparable effect to cognitive behavioral therapy in treatment of mild to moderate depression and anxiety. Physically active individuals also show lower risks to develop depression and relapse in depression.ObjectivesThe objectives are to evaluate how physical activity can affect depressive and anxiety symptoms, by examining biomarkers in the blood and from the gut and also by measuring cognitive functions. Hopefully, this can lead to new treatment strategies for patients with depression and anxiety.Methods102 patients are randomized to two groups and undergo 12 weeks intervention as add-on to standard outpatient psychiatric treatment. The first group will participate in physical training three times per week and the other group will receive relaxation therapy on a weekly basis. Daily activity intensity will be measured before and at the last week of intervention with an accelerometer. Blood and faeces sample collection, symptom grading by clinician together with self-rating scales and cognitive screening will be performed at baseline, week 12 and one year of follow-up. The cognitive screenings are performed digitally in cooperation with Mindmore.ResultsThe RCT is currently recruiting patients at the Department of Psychiatry of Örebro University Hospital.Conclusions
The project aims to be holistic in its approach, combining the defining clinical psychiatric symptoms in patients who have both depression and anxiety with the finding and evaluation of new biomarkers from blood and gut to improve cognitive functions.DisclosureNo significant relationships.
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28
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Segarra-Vidal B, Persson J, Falconer H. Radical trachelectomy. Int J Gynecol Cancer 2021; 31:1068-1074. [PMID: 33707207 DOI: 10.1136/ijgc-2020-001782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 11/04/2022] Open
Abstract
Radical trachelectomy is the 'cornerstone' of fertility-sparing surgery in patients with early-stage cervical cancer wishing to preserve fertility. Growing evidence has demonstrated the oncologic safety and subsequent favorable pregnancy outcomes in well-selected cases. In the absence of prospective trials, the decision on the appropriate surgical approach (vaginal, open, or minimally invasive surgery) should be based on local resources and surgeons' preferences. Radical trachelectomy has the potential to preserve fertility in a large proportion of women with early-stage cervical cancer. However, prematurity and premature rupture of membranes are common obstetric complications after radical trachelectomy for cervical cancer. A multidisciplinary approach is crucial to optimize the balance between oncologic and obstetric outcomes. The purpose of this review is to provide an updated overview of the technical, oncologic, and obstetric aspects of radical trachelectomy.
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Affiliation(s)
| | - Jan Persson
- Department of Obstetrics and Gynecology, Lund University Hospital, Lund, Sweden
| | - Henrik Falconer
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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29
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Moloney K, Janda M, Frumovitz M, Leitao M, Abu-Rustum NR, Rossi E, Nicklin JL, Plante M, Lecuru FR, Buda A, Mariani A, Leung Y, Ferguson SE, Pareja R, Kimmig R, Tong PSY, McNally O, Chetty N, Liu K, Jaaback K, Lau J, Ng SYJ, Falconer H, Persson J, Land R, Martinelli F, Garrett A, Altman A, Pendlebury A, Cibula D, Altamirano R, Brennan D, Ind TE, De Kroon C, Tse KY, Hanna G, Obermair A. Development of a surgical competency assessment tool for sentinel lymph node dissection by minimally invasive surgery for endometrial cancer. Int J Gynecol Cancer 2021; 31:647-655. [PMID: 33664126 DOI: 10.1136/ijgc-2020-002315] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 12/09/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Sentinel lymph node dissection is widely used in the staging of endometrial cancer. Variation in surgical techniques potentially impacts diagnostic accuracy and oncologic outcomes, and poses barriers to the comparison of outcomes across institutions or clinical trial sites. Standardization of surgical technique and surgical quality assessment tools are critical to the conduct of clinical trials. By identifying mandatory and prohibited steps of sentinel lymph node (SLN) dissection in endometrial cancer, the purpose of this study was to develop and validate a competency assessment tool for use in surgical quality assurance. METHODS A Delphi methodology was applied, included 35 expert gynecological oncology surgeons from 16 countries. Interviews identified key steps and tasks which were rated mandatory, optional, or prohibited using questionnaires. Using the surgical steps for which consensus was achieved, a competency assessment tool was developed and subjected to assessments of validity and reliability. RESULTS Seventy percent consensus agreement standardized the specific mandatory, optional, and prohibited steps of SLN dissection for endometrial cancer and informed the development of a competency assessment tool. Consensus agreement identified 21 mandatory and three prohibited steps to complete a SLN dissection. The competency assessment tool was used to rate surgical quality in three preselected videos, demonstrating clear separation in the rating of the skill level displayed with mean skills summary scores differing significantly between the three videos (F score=89.4; P<0.001). Internal consistency of the items was high (Cronbach α=0.88). CONCLUSION Specific mandatory and prohibited steps of SLN dissection in endometrial cancer have been identified and validated based on consensus among a large number of international experts. A competency assessment tool is now available and can be used for surgeon selection in clinical trials and for ongoing, prospective quality assurance in routine clinical care.
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Affiliation(s)
- Kristen Moloney
- Gynaecologic Oncology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Monika Janda
- Centre for Health Services Research, The University of Queensland Faculty of Medicine, Brisbane, Queensland, Australia
| | - Michael Frumovitz
- Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mario Leitao
- Gynecology Service Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Emma Rossi
- Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - James L Nicklin
- Gynaecological Oncology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia
| | - Marie Plante
- Gynecology Oncology Service, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, Quebec, Canada
| | - Fabrice R Lecuru
- Surgical Oncology, Institute Curie, Paris, France.,Surgical Oncology Department for Breast and Gynecology, Universite de Paris, Paris, Île-de-France, France
| | - Alessandro Buda
- Department of Obstetrics and Gynecology, Università degli Studi Milano-Bicocca, San Gerardo Hospital, Monza, Italy.,Division of Gynecologic Oncology Italy, Ospedale Michele e Pietro Ferrero, Verduno (CN), Italy
| | - Andrea Mariani
- Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Yee Leung
- Obstetrics and Gynaecology, The University of Western Australia Faculty of Health and Medical Sciences, Perth, Western Australia, Australia
| | - Sarah Elizabeth Ferguson
- Gynecologic Oncology, University Health Network, Toronto, Ontario, Canada.,Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Rene Pareja
- Gynecologic Oncology, Instituto Nacional de Cancerologia, Bogota, Colombia.,Gynecologic Oncology, Clínica De Oncología Astorga, Medellín, Colombia
| | - Rainer Kimmig
- Gynecology and Obstetrics, University of Essen, Essen, Germany
| | | | - Orla McNally
- Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Victoria, Australia.,Victorian Comprehensive Cancer Centre, University of Melbourne, Parkville, Victoria, Australia
| | - Naven Chetty
- Gynaecologic Oncology, Mater Health Services Brisbane, South Brisbane, Queensland, Australia
| | - Kaijiang Liu
- Gynecology and Obstetrics, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Ken Jaaback
- Gynaecologic Oncology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Julio Lau
- Gynecology Oncology, Hospital General San Juan de Dios, Guatemala, Guatemala.,Gynecology Oncology, University of San Carlos de Guatemala Faculty of Medical Sciences, Guatemala, Guatemala
| | | | - Henrik Falconer
- Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.,Women's and Children's Health, Karolinska University Hospital, Stockholm, Sweden
| | - Jan Persson
- Obstetrics and Gynaecology, Skanes Universitetssjukhus Lund, Lund, Skåne, Sweden.,Clinical Sciences, Obstetrics and Gynaecology, Lund University Faculty of Medicine, Lund, Sweden
| | - Russell Land
- Gynaecologic Oncology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia
| | - Fabio Martinelli
- Gynaecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Garrett
- Gynaecologic Oncology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Alon Altman
- Gynecologic Oncology, University of Manitoba, Winnipeg, Manitoba, Canada.,Gynecologic Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Adam Pendlebury
- Gynaecological Oncology, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - David Cibula
- Gynecology and Obstetrics, Charles University First Faculty of Medicine, Praha, Praha, Czech Republic.,Gynecology and Obstetrics, General University Hospital in Prague, Praha, Czech Republic
| | - Roberto Altamirano
- Gynecology Oncology, Universidad de Chile, Santiago de Chile, Chile.,Gynecology Oncology, Hospital Clinico San Borja Arriaran, Santiago, Chile
| | - Donal Brennan
- Gynaecology Oncology, Mater Misericordiae University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Thomas Edward Ind
- Gynaecological Oncology, Royal Marsden NHS Foundation Trust, London, UK.,Gynaecology, St George's University of London, London, UK
| | - Cornelis De Kroon
- Gynecology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Ka Yu Tse
- Obstetrics and Gynaecology, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong
| | - George Hanna
- Surgery and Cancer, Imperial College London, London, UK
| | - Andreas Obermair
- Center for Clinical Research, Faculty of Medicine, University of Queensland, Herston, Queensland, Australia .,Queensland Centre for Gynaecologic Cancer Research, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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Rickardsson J, Gentili C, Holmström L, Zetterqvist V, Andersson E, Persson J, Lekander M, Ljótsson B, Wicksell RK. Internet-delivered acceptance and commitment therapy as microlearning for chronic pain: A randomized controlled trial with 1-year follow-up. Eur J Pain 2021; 25:1012-1030. [PMID: 33460240 DOI: 10.1002/ejp.1723] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 12/08/2020] [Accepted: 12/27/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Studies of Internet-delivered acceptance and commitment therapy (ACT) for chronic pain have shown small to moderate positive effects for pain interference and pain acceptance. Effects on pain intensity, depression, anxiety and quality of life (QoL) have been less favourable, and improvements for values and sleep are lacking. In this randomized controlled trial iACT - a novel format of Internet-ACT using daily microlearning exercises - was examined for efficacy compared to a waitlist condition. METHODS Adult participants (mean age 49.5 years, pain duration 18.1 years) with diverse chronic pain conditions were recruited via self-referral, and randomized to iACT (n = 57) or waitlist (n = 56). The primary outcome was pain interference. The secondary outcomes were QoL, depression, anxiety, insomnia and pain intensity. The process variables included psychological inflexibility and values. Post-assessments were completed by 88% (n = 100) of participants. Twelve-month follow-up assessments were completed by 65% (iACT only, n = 37). Treatment efficacy was analysed using linear mixed models and an intention-to-treat-approach. RESULTS Significant improvements in favour of iACT were seen for pain interference, depression, anxiety, pain intensity and insomnia, as well as process variables psychological inflexibility and values. Between-group effect sizes were large for pain interference (d = 0.99) and pain intensity (d = 1.2), moderate for anxiety and depressive symptoms and small for QoL and insomnia. For the process variables, the between-group effect size was large for psychological inflexibility (d = 1.0) and moderate for values. All improvements were maintained at 1-year follow-up. CONCLUSIONS Internet-ACT as microlearning may improve a broad range of outcomes in chronic pain. SIGNIFICANCE The study evaluates a novel behavioral treatment with positive results on pain interference, mood as well as pain intensity for longtime chronic pain sufferers. The innovative format of a digital ACT intervention delivered in short and experiential daily learnings may be a promising way forward.
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Affiliation(s)
- Jenny Rickardsson
- Functional Unit Behavioral Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Charlotte Gentili
- Functional Unit Behavioral Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Linda Holmström
- Functional Unit Behavioral Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health Karolinska Institutet, Stockholm, Sweden
| | - Vendela Zetterqvist
- Functional Unit Behavioral Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Erik Andersson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jan Persson
- Functional Unit Behavioral Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lekander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Rikard K Wicksell
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Ekdahl L, Wallin E, Alfonzo E, Reynisson P, Lönnerfors C, Dahm-Kähler P, Falconer H, Persson J. Increased Institutional Surgical Experience in Robot-Assisted Radical Hysterectomy for Early Stage Cervical Cancer Reduces Recurrence Rate: Results from a Nationwide Study. J Clin Med 2020; 9:jcm9113715. [PMID: 33228139 PMCID: PMC7699339 DOI: 10.3390/jcm9113715] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 10/16/2020] [Revised: 11/08/2020] [Accepted: 11/16/2020] [Indexed: 01/11/2023] Open
Abstract
The aim of this study was to evaluate the impact of institutional surgical experience on recurrence following robotic radical hysterectomy (RRH) for early stage cervical cancer. All women in Sweden who underwent an RRH for stage IA2-IB1 cervical cancer at tertiary referral centers from its implementation in December 2005 until June 2017 were identified using a Swedish nationwide register and local hospital registers. Registry data were controlled by a chart review of all women. Recurrence rates and patterns of recurrence were compared between early and late (≤50 vs. >50 procedures) institutional series. Six hundred and thirty-five women were included. Regression analysis identified a lower risk of recurrence with increased experience but without a clear cut off level. Among the 489 women who did not receive adjuvant radio chemotherapy (RC-T), the rate of recurrence was 3.6% in the experienced cohort (>50 procedures) compared to 9.3% in the introductory cohort (p < 0.05). This was also seen in tumors < 2 cm regardless of RC-T (p < 0.05), whereas no difference in recurrence was seen when analyzing all women receiving RC-T. In conclusion, the rate of recurrence following RRH for early stage cervical cancer decreased with increased institutional surgical experience, in tumors < 2 cm and in women who did not receive adjuvant RC-T.
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Affiliation(s)
- Linnea Ekdahl
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital, 22185 Lund, Sweden; (L.E.); (P.R.); (C.L.)
- Department of Clinical Sciences, Obstetrics and Gynaecology, Faculty of Medicine, Lund University, 22185 Lund, Sweden
| | - Emelie Wallin
- Department of Women’s and Children’s Health, Division of Neonatology, Obstetrics and Gynecology, Karolinska Institutet, 14186 Stockholm, Sweden; (E.W.); (H.F.)
- Department of Pelvic Cancer, Karolinska University Hospital, 14186 Stockholm, Sweden
| | - Emilia Alfonzo
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden; (E.A.); (P.D.-K.)
- Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, 41345 Gothenburg, Sweden
| | - Petur Reynisson
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital, 22185 Lund, Sweden; (L.E.); (P.R.); (C.L.)
- Department of Clinical Sciences, Obstetrics and Gynaecology, Faculty of Medicine, Lund University, 22185 Lund, Sweden
| | - Celine Lönnerfors
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital, 22185 Lund, Sweden; (L.E.); (P.R.); (C.L.)
- Department of Clinical Sciences, Obstetrics and Gynaecology, Faculty of Medicine, Lund University, 22185 Lund, Sweden
| | - Pernilla Dahm-Kähler
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden; (E.A.); (P.D.-K.)
- Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, 41345 Gothenburg, Sweden
| | - Henrik Falconer
- Department of Women’s and Children’s Health, Division of Neonatology, Obstetrics and Gynecology, Karolinska Institutet, 14186 Stockholm, Sweden; (E.W.); (H.F.)
- Department of Pelvic Cancer, Karolinska University Hospital, 14186 Stockholm, Sweden
| | - Jan Persson
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital, 22185 Lund, Sweden; (L.E.); (P.R.); (C.L.)
- Department of Clinical Sciences, Obstetrics and Gynaecology, Faculty of Medicine, Lund University, 22185 Lund, Sweden
- Correspondence: ; Tel.: +46-733522080; Fax: +46-46157868
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Gupta A, von Heymann C, Magnuson A, Alahuhta S, Fernando R, Van de Velde M, Mercier FJ, Schyns-van den Berg AMJV, Bryon B, Soetens F, Dewandre PY, Lambert G, Christiaen J, Schepers R, Van Houwe P, Kalmar A, Vanoverschelde H, Bauters M, Roofthooft E, Devroe S, Van de Velde M, Jadrijevic A, Jokic A, Marin D, Sklebar I, Mihaljević S, Kosinova M, Stourac P, Adamus M, Kufa C, Volfová I, Zaoralová B, Froeslev-Friis C, Mygil B, Krebs Albrechtsen C, Kavasmaa T, Alahuhta S, Mäyrä A, Mennander S, Rautaneva K, Hiekkanen T, Kontinen V, Linden K, Toivakka S, Boselli E, Greil PÉ, Mascle O, Courbon A, Lutz J, Simonet T, Barbier M, Hlioua T, Meniolle d’Hauthville F, Quintin C, Bouattour K, Lecinq A, Soued M, Bonnet MP, Carbonniere M, Fischer C, Picard PC, Bonnin M, Storme B, Bouthors AS, Detente T, Nguyen Troung M, Keita H, Nebout S, Osse L, Delmas A, Vial F, Kaufner L, Hoefing C, Mueller S, Becke K, Blobner M, Lewald H, Schaller SJ, Muggleton E, Bette B, Neumann C, Weber S, Grünewald M, Ohnesorge H, Helf A, Jelting Y, Kranke P, von Heymann C, Welfle S, Staikou C, Stavrianopoulou A, Tsaroucha A, Kalopita K, Loukeri A, Valsamidis D, Matsota P, Thorsteinsson A, Tome R, Eidelman LA, Davis A, Orbach-Zinger S, Ioscovich A, Ramona I, De Simone L, Pesetti B, Brazzi L, Zito A, Camorcia M, Della Rocca G, Aversano M, Frigo MG, Todde C, Morina Q, Macas A, Keraitiene G, Rimaitis K, Borg F, Tua C, Kuijpers-Visser AG, Schyns-van den Berg A, Hollmann MW, Van den Berg T, Koolen E, Dons I, van der Knijff A, van der Marel C, Ruysschaert N, Pelka M, Pluymakers C, Koopman S, Teunissen AJ, Cornelisse D, van Dasselaar N, Verdouw B, Beenakkers I, Dahl V, Hagen R, Vivaldi F, Eriksen JR, Wiszt R, Aslam Tayyaba N, Ringvold EM, Chutkowski R, Skirecki T, Wódarski B, Faria MA, Ferreira A, Sampaio AC, Ferreira I, Matias B, Teixeira J, Araujo R, Cabido H, Fortuna R, Lemos P, Cardoso C, Moura F, Pereira C, Pereira S, Tavares F, Vasconcelos P, Abecasis M, Lança F, Muchacho P, Ormonde L, Guedes-Araujo I, Pinho-Oliveira V, Paredes P, Bentes C, Gouveia F, Milheiro A, Castanheira C, Neves M, Pacheco V, Cortez M, Tranquada R, Tareco G, Furtado I, Pereira E, Marinho L, Seabra M, Bulasevic A, Kendrisic M, Jovanovic L, Pujić B, Kutlesic M, Grochova M, Simonova J, Pavlovic G, Rozman A, Blajic I, Graovac D, Stopar Pintraic T, Chiquito T, Monedero P, Carlos-Errea DJ, Guillén-Casbas R, Veiga-Gil L, Basso M, Garcia Bartolo C, Hernandez C, Ricol L, De Santos MP, Gràcia Solsona JA, López-Baamonde M, Magaldi Mendaña M, Plaza Moral AM, Vendrell M, Trillo L, Perez Garcia AR, Alamillo Salas C, Moret E, Ramió L, Aguilar Sanchez JL, Soler Pedrola M, Valldeperas Hernandez MI, Aldalur G, Bárcena E, Herrera J, Iturri F, Martínez A, Martínez L, Serna R, Gilsanz F, Guasch Arevalo E, Iannuccelli F, Latorre J, Rodriguez Roca C, Pérez Pardo OC, Sierra Biddle N, Suárez Cendaña C, Hernández González L, Remacha González C, Sánchez Nuez R, Anta D, Beleña JM, García-Cuadrado C, Garcia I, Manrique S, Suarez E, Hein A, Arbman E, Hansson H, Tillenius M, Al-Taie R, Ledin-Eriksson S, Lindén-Söndersö A, Rosén O, Austruma E, Gillberg L, Darvish B, Gupta A, Nordstöm JL, Persson J, Rosenberg J, Brühne L, Forshammar J, Ugarph Edfeldt M, Rolfsson H, Hellblom A, Levin K, Rabow S, Thorlacius K, Bansch P, Robertson (Baeriswyl) M, Stamer U, Mathivon S, Savoldelli G, Auf der Maur P, Filipovic M, Dullenkopf A, Brunner M, Girard T, Vonlanthen C, Ozbilgin S, Gunaydin D B, Corman Dincer P, Tas Tuna A. Management practices for postdural puncture headache in obstetrics: a prospective, international, cohort study. Br J Anaesth 2020; 125:1045-1055. [PMID: 33039123 DOI: 10.1016/j.bja.2020.07.061] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 04/01/2020] [Revised: 07/05/2020] [Accepted: 07/30/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Accidental dural puncture is an uncommon complication of epidural analgesia and can cause postdural puncture headache (PDPH). We aimed to describe management practices and outcomes after PDPH treated by epidural blood patch (EBP) or no EBP. METHODS Following ethics committee approval, patients who developed PDPH after accidental dural puncture were recruited from participating countries and divided into two groups, those receiving EBP or no EBP. Data registered included patient and procedure characteristics, headache symptoms and intensity, management practices, and complications. Follow-up was at 3 months. RESULTS A total of 1001 patients from 24 countries were included, of which 647 (64.6%) received an EBP and 354 (35.4%) did not receive an EBP (no-EBP). Higher initial headache intensity was associated with greater use of EBP, odds ratio 1.29 (95% confidence interval 1.19-1.41) per pain intensity unit increase. Headache intensity declined sharply at 4 h after EBP and 127 (19.3%) patients received a second EBP. On average, no or mild headache (numeric rating score≤3) was observed 7 days after diagnosis. Intracranial bleeding was diagnosed in three patients (0.46%), and backache, headache, and analgesic use were more common at 3 months in the EBP group. CONCLUSIONS Management practices vary between countries, but EBP was more often used in patients with greater initial headache intensity. EBP reduced headache intensity quickly, but about 20% of patients needed a second EBP. After 7 days, most patients had no or mild headache. Backache, headache, and analgesic use were more common at 3 months in patients receiving an EBP.
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Affiliation(s)
- Anil Gupta
- Department of Perioperative Medicine and Intensive Care and Institution of Physiology and Pharmacology, Karolinska Hospital and Karolinska Institutet, Stockholm, Sweden.
| | - Christian von Heymann
- Department of Anaesthesia, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Anders Magnuson
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Seppo Alahuhta
- Department of Anaesthesiology, Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Roshan Fernando
- Department of Anesthesiology and Intensive Care Medicine, The Womens Wellness and Research Centre, Doha, Qatar
| | | | - Frédéric J Mercier
- Département d'Anesthésie, Hôpital Antoine Béclère, AP-HP, Université Paris-Saclay, France
| | - Alexandra M J V Schyns-van den Berg
- Department of Anesthesiology, Albert Schweitzer Ziekenhuis, Dordrecht and Department of Anesthesiology, Leiden University Medical Centre, Leiden, The Netherlands
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Bengtsson J, Bodén R, Olsson EMG, Mårtensson J, Gingnell M, Persson J. Autonomic modulation networks in schizophrenia: The relationship between heart rate variability and functional and structural connectivity in the brain. Psychiatry Res Neuroimaging 2020; 300:111079. [PMID: 32283474 DOI: 10.1016/j.pscychresns.2020.111079] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 12/30/2022]
Abstract
Heart rate variability (HRV), a measurement of autonomic nervous system (ANS) activity, has been found reduced in schizophrenia. The anterior cingulate cortex (ACC), which is important in regulating the ANS, is structurally and functionally affected in schizophrenia. We investigate the relationship between HRV and functional and structural connectivity of the ACC in patients with schizophrenia and healthy controls. Ten patients with a diagnosis of schizophrenia and ten healthy controls were recruited. Heart rate was monitored in a naturalistic out-of-clinic setting. Magnetic resonance imaging (MRI) was performed, including resting-state functional MRI and diffusion tensor imaging. Patients with schizophrenia had significantly lower HRV compared to controls. A positive correlation between ACC connectivity with the bilateral cerebellum and HRV was found in the patients. HRV was also positively correlated with amplitude of low frequency fluctuations (ALFF) in the cerebellum, and with axial diffusivity in the middle cerebellar peduncle, in the patients. There was a significant negative relationship between antipsychotic medication dosage, HRV and all neuroimaging measures related to HRV. We conclude that ACC connectivity seems to be affected in schizophrenia, both structurally and functionally, and that the ACC-cerebellum connectivity, as well as cerebellar function, is associated with ANS regulation in patients with schizophrenia.
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Affiliation(s)
- J Bengtsson
- Dept. of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.
| | - R Bodén
- Dept. of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - E M G Olsson
- Dept. of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - J Mårtensson
- Dept. of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden; Dept. of Medical Physics, Uppsala University Hospital, Uppsala, Sweden
| | - M Gingnell
- Dept. of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - J Persson
- Dept. of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
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Sediqi E, Tsoposidis A, Wallenius V, Axelsson H, Persson J, Johnsson E, Lundell L, Kostic S. Laparoscopic Heller myotomy or pneumatic dilatation in achalasia: results of a prospective, randomized study with at least a decade of follow-up. Surg Endosc 2020; 35:1618-1625. [DOI: 10.1007/s00464-020-07541-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/26/2020] [Indexed: 12/20/2022]
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Bollino M, Geppert B, Lönnerfors C, Falconer H, Salehi S, Persson J. Pelvic sentinel lymph node biopsy in endometrial cancer-a simplified algorithm based on histology and lymphatic anatomy. Int J Gynecol Cancer 2020; 30:339-345. [PMID: 32075897 DOI: 10.1136/ijgc-2019-000935] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/07/2019] [Accepted: 12/26/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To achieve the full potential of sentinel lymph node (SLN) detection in endometrial cancer, both presumed low- and high-risk groups should be included. Perioperative resource use and complications should be minimized. Knowledge on distribution and common anatomical sites for metastatic SLNs may contribute to optimizing the concept while maintaining sensitivity. Proceeding from previous studies, simplified algorithms based on histology and lymphatic anatomy are proposed. METHODS Data on mapping rates and locations of pelvic SLNs (metastatic and non-metastatic) from two previous prospective SLN studies in women with endometrial cancer were retrieved. Cervically injected indocyanine green was used as a tracer and an ipsilateral re-injection was performed in case of non-display of the upper and/or lower paracervical pathways. A systematic surgical algorithm was followed with clearly defined SLNs depicted on an anatomical chart. In high-risk endometrial cancer patients, removal of SLNs was followed by a pelvic and para-aortic lymphadenectomy. RESULTS 423 study records were analyzed. The bilateral mapping rates of the upper and lower paracervical pathways were 88.9% and 39.7%, respectively. 72% of all SLNs were typically positioned along the upper paracervical pathway (interiliac and/or proximal obturator fossa) and 71 of 75 (94.6%) of pelvic node positive women had at least one metastatic SLN at either of these positions. Women with grade 1-2 endometroid cancers (n=275) had no isolated metastases along the lower paracervical pathway compared with two women with high-risk histologies (n=148). CONCLUSION SLNs along the upper paracervical pathway should be identified in all endometrial cancer histological subtypes; removal of nodes at defined typical positions along the upper paracervical pathway may replace a site-specific lymphadenectomy in case of non-mapping despite tracer re-injection. Detection of SLNs along the lower paracervical pathway can be restricted to high-risk histologies and a full pre-sacral lymphadenectomy should be performed in case of non-display.
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Affiliation(s)
- Michele Bollino
- Department of Obstetrics and Gynecology, Division of Gynecologic oncology, Skåne University Hospital and Lund University, Faculty of Medicine, Clinical Sciences, Lund, Sweden
| | - Barbara Geppert
- Department of Obstetrics and Gynecology, Division of Gynecologic oncology, Skåne University Hospital and Lund University, Faculty of Medicine, Clinical Sciences, Lund, Sweden
| | - Celine Lönnerfors
- Department of Obstetrics and Gynecology, Division of Gynecologic oncology, Skåne University Hospital and Lund University, Faculty of Medicine, Clinical Sciences, Lund, Sweden
| | - Henrik Falconer
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, and Department of Pelvic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Sahar Salehi
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, and Department of Pelvic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Jan Persson
- Department of Obstetrics and Gynecology, Division of Gynecologic oncology, Skåne University Hospital and Lund University, Faculty of Medicine, Clinical Sciences, Lund, Sweden
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Persson J, Fagevik Olsén M, Iresjö B, Smedh U. Body composition, sarcopenia, and quality of life in patients with oesophageal cancer before resection surgery and at follow‐up: a cohort study. JCSM Clinical Reports 2020. [DOI: 10.1002/crt2.9] [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: 11/12/2022] Open
Affiliation(s)
- Jan Persson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden
| | - Monika Fagevik Olsén
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden
| | - Britt‐Marie Iresjö
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden
| | - Ulrika Smedh
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden
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Lührs O, Ekdahl L, Lönnerfors C, Geppert B, Persson J. Combining Indocyanine Green and Tc99-nanocolloid does not increase the detection rate of sentinel lymph nodes in early stage cervical cancer compared to Indocyanine Green alone. Gynecol Oncol 2020; 156:335-340. [DOI: 10.1016/j.ygyno.2019.11.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/13/2019] [Accepted: 11/17/2019] [Indexed: 01/24/2023]
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Rickardsson J, Zetterqvist V, Gentili C, Andersson E, Holmström L, Lekander M, Persson M, Persson J, Ljótsson B, Wicksell RK. Internet-delivered acceptance and commitment therapy (iACT) for chronic pain-feasibility and preliminary effects in clinical and self-referred patients. Mhealth 2020; 6:27. [PMID: 32632365 PMCID: PMC7327284 DOI: 10.21037/mhealth.2020.02.02] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/11/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Acceptance and commitment therapy (ACT) is an evidence-based treatment to improve functioning and quality of life (QoL) for chronic pain patients, but outreach of this treatment is unsatisfactory. Internet-delivery has been shown to increase treatment access but there is limited evidence regarding feasibility and effectiveness of web-based ACT for chronic pain. The aim of the study was to evaluate and iterate a novel internet-delivered ACT program, iACT, in a clinical and a self-referred sample of chronic pain patients. The intervention was developed in close collaboration with patients. To enhance learning, content was organized in short episodes to promote daily engagement in treatment. In both the clinical and self-referred samples, three critical domains were evaluated: (I) feasibility (acceptability, practicality and usage); (II) preliminary efficacy on pain interference, psychological inflexibility, value orientation, QoL, pain intensity, anxiety, insomnia and depressive symptoms; and (III) potential treatment mechanisms. METHODS This was an open pilot study with two samples: 15 patients from a tertiary pain clinic and 24 self-referred chronic pain participants, recruited from October 2015 until January 2017. Data were collected via an online platform in free text and self-report measures, as well as through individual oral feedback. Group differences were analyzed with Chi square-, Mann-Whitney U- or t-test. Preliminary efficacy and treatment mechanism data were collected via self-report and analyzed with multilevel linear modeling for repeated measures. RESULTS Feasibility: patient feedback guided modifications to refine the intervention and indicated that iACT was acceptable in both samples. User insights provided input for both immediate and future actions to improve feasibility. Comprehensiveness, workability and treatment credibility were adequate in both samples. Psychologists spent on average 13.5 minutes per week per clinical patient, and 8 minutes per self-referred patient (P=0.004). Recruitment rate was 24 times faster in the self-referred sample (24 patients in 1 month, compared to 15 patients in 15 months, P<0.001) and the median distance to the clinic was 40 km in the clinical sample, and 426 km in the self-referred sample (P<0.001). Preliminary effects: post-assessments were completed by 26 participants (67%). Significant effects of time were seen from pre- to post-treatment across all outcome variables. Within group effect sizes (Cohen's d) at post-treatment ranged from small to large: pain interference (d=0.64, P<0.001), psychological inflexibility (d=1.43, P<0.001), value progress (d=0.72, P<0.001), value obstruction (d=0.42, P<0.001), physical QoL (d=0.41, P=0.005), mental QoL (d=0.67, P=0.005), insomnia (d=0.31, P<0.001), depressive symptoms (d=0.47, P<0.001), pain intensity (d=0.78, P=0.001) and anxiety (d=0.46, P<0.001). Improvements were sustained at 1-year follow-up. Psychological inflexibility and value progress were found to be potential treatment mechanisms. CONCLUSIONS The results from the present study suggests that iACT was feasible in both the clinical and the self-referred sample. Together with the positive preliminary results on all outcomes, the findings from this feasibility study pave the way for a subsequent large randomized efficacy trial.
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Affiliation(s)
- Jenny Rickardsson
- Functional Unit Behavioral Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Vendela Zetterqvist
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Charlotte Gentili
- Functional Unit Behavioral Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Andersson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Linda Holmström
- Functional Unit Behavioral Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lekander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Malin Persson
- Functional Unit Behavioral Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Jan Persson
- Functional Unit Behavioral Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Rikard K. Wicksell
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Cederström S, Lundman P, Folkersen L, Paulsson-Berne G, Karadimou G, Eriksson P, Caidahl K, Gabrielsen A, Jernberg T, Persson J, Tornvall P. New candidate genes for ST-elevation myocardial infarction. J Intern Med 2020; 287:66-77. [PMID: 31589004 DOI: 10.1111/joim.12976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite extensive research in atherosclerosis, the mechanisms of coronary atherothrombosis in ST-elevation myocardial infarction (STEMI) patients are undetermined. OBJECTIVES Our aim was to find candidate genes involved in STEMI by analysing leucocyte gene expression in STEMI patients, without the influence of secondary inflammation from innate immunity, which was assumed to be a consequence rather than the cause of coronary atherothrombosis. METHODS Fifty-one patients were included at coronary angiography because of STEMI. Arterial blood was sampled in the acute phase (P1), at 24-48 h (P2) and at 3 months (P3). Leucocyte RNA was isolated and gene expression analysis was performed by Affymetrix Human Transcriptome Array 2.0. By omission of up- or downregulated genes at P2, secondary changes from innate immunity were excluded. Genes differentially expressed in P1 when compared to the convalescent sample in P3 were determined as genes involved in STEMI. RESULTS Three genes were upregulated at P1 compared to P3; ABCG1 (P = 5.81 × 10-5 ), RAB20 (P = 3.69 × 10-5 ) and TMEM2 (P = 7.75 × 10-6 ) whilst four were downregulated; ACVR1 (P = 9.01 × 10-5 ), NFATC2IP (P = 8.86 × 10-5 ), SUN1 (P = 3.87 × 10-5 ) and TTC9C (P = 7.18 × 10-6 ). These genes were also highly expressed in carotid atherosclerotic plaques. CONCLUSIONS We found seven genes involved in STEMI. The study is unique regarding the blood sampling in the acute phase and omission of secondary expressed genes from innate immunity. However, the results need to be replicated by future studies.
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Affiliation(s)
- S Cederström
- Division of Cardiovascular medicine, Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital (KI DS), Stockholm, Sweden
| | - P Lundman
- Division of Cardiovascular medicine, Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital (KI DS), Stockholm, Sweden
| | - L Folkersen
- Sankt Hans Hospital, Capital Region Hospitals, Roskilde, Denmark
| | - G Paulsson-Berne
- Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, Sweden
| | - G Karadimou
- Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, Sweden
| | - P Eriksson
- Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, Sweden
| | - K Caidahl
- Department of Molecular Medicine and Surgery (MMK), Karolinska Institutet, Stockholm, Sweden.,Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - A Gabrielsen
- Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, Sweden
| | - T Jernberg
- Division of Cardiovascular medicine, Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital (KI DS), Stockholm, Sweden
| | - J Persson
- Division of Cardiovascular medicine, Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital (KI DS), Stockholm, Sweden
| | - P Tornvall
- Division of Cardiovascular medicine, Department of Clinical Science and Education, Södersjukhuset (KI SÖS), Karolinska Institutet, Stockholm, Sweden
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Qvist N, Bergström I, Åkerstedt T, Persson J, Konradsen H, Forss A. From being restrained to recapturing vitality: non-western immigrant women's experiences of undergoing vitamin D treatment after childbirth. Int J Qual Stud Health Well-being 2019; 14:1632111. [PMID: 31232674 PMCID: PMC6598479 DOI: 10.1080/17482631.2019.1632111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2019] [Indexed: 10/27/2022] Open
Abstract
Purpose: Vitamin D deficiency is a complex topic in human health and ill-health and has been studied in a variety of contexts and populations. Few studies examine Vitamin D deficiency among non-western immigrant women and even fewer examine women's perspective on daily life while living with low vitamin D levels after childbirth and undergoing vitamin D treatment. The aim was, therefore, to explore health and ill-health among non-western immigrant women living with low vitamin D levels after childbirth and reaching normalized levels after one year of vitamin D treatment. Method: An explorative qualitative study using qualitative content analysis. Six women aged 25 to 38 years, diagnosed with low 25-hydroxyvitamin D levels during pregnancy, were recruited after having undergone vitamin D treatment. Results: The women told about living a restrained life which gradually transformed into an experience of recaptured vitality. They also experienced a need for continuity in medication, as an interruption of treatment meant returning symptoms. Conclusion: In this study, non-western immigrant women described benefits in everyday life, increased strength, relieved pain and improved sleep quality. The findings can provide valuable knowledge for healthcare providers meeting women with physical weakness, musculoskeletal pain and/or poor sleep quality after childbirth. Further studies using a longitudinal design and larger samples are warranted.
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Affiliation(s)
- Ninni Qvist
- Osteoporosis Center, Inflammation & Infection Theme, Karolinska University Hospital Huddinge, Sweden
| | - Ingrid Bergström
- Osteoporosis Center, Inflammation & Infection Theme, Karolinska University Hospital Huddinge, Sweden
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Sweden
| | - Torbjörn Åkerstedt
- Stress Research Institute, Stockholm University, Sweden
- Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Jan Persson
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Sweden
- Behavioral Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Hanne Konradsen
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden
| | - Anette Forss
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden
- Department of Philosophy, Stony Brook University, New York, USA
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Persson J, Engström C, Bergquist H, Johnsson E, Smedh U. Validation of instruments for the assessment of dysphagia due to malignancy of the esophagus. Dis Esophagus 2019; 32:5267100. [PMID: 30596966 DOI: 10.1093/dote/doy125] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 11/27/2018] [Accepted: 11/30/2018] [Indexed: 12/11/2022]
Abstract
The aim of the study was to validate the Watson scale, the Ogilvie scale, and the Goldschmid scale for assessment of dysphagia due to malignancy of the esophagus. After translation of the scales to Swedish, 35 patients with dysphagia due to esophageal malignancy were asked to participate. On day 1, patients were asked to fill in the questionnaires. The patients also kept a food diary for 4 consecutive days, for assessment of actual swallowing ability. On day 10, the patients were asked to fill in the scales again, to control for individual variability. As an external control group, 29 healthy volunteers were asked to fill in the questionnaires once. External validation was done against actual swallowing ability, and against the European Organization for Research and Treatment of Cancer scales QLQ-C30 and QLQ-OG25, which are already validated quality of life scales for malignancy. Reliability in the categorical variables (Ogilvie and Goldschmid) showed weighted kappa values of 0.52 and 0.54, respectively. For the Watson scale and the Dysphagia module of QLQ-OG25, the intraclass correlation coefficients were 0.68 and 0.80, respectively. Correlations between all scales were good to excellent with values of correlation coefficients (rs) between 0.69 and 0.88, with the strongest correlations between the Ogilvie score and the dysphagia module in QLQ-OG25. These latter two scales had the strongest correlation to the food diary (rs = 0.72). Although the Ogilvie scale was superior, all the three scales showed good reliability and are thus judged to have good validity for assessment of dysphagia due to esophageal malignancy.
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Affiliation(s)
- J Persson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital
| | - C Engström
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital
| | - H Bergquist
- Department of ENT, Head and Neck Surgery, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - E Johnsson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital
| | - Ulrika Smedh
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital
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Tengbom J, Cederstrom S, Verouhis D, Sorensson P, Bohm F, Saleh N, Jernberg T, Lundman P, Eriksson P, Gabrielsen A, Caidahl K, Persson J, Folkersen L, Tornvall P, Pernow J. P6599Upregulation of protein and gene expression of arginase-1 in patients with ST elevation myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1187] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The mechanisms underlying rupture of a coronary atherosclerotic plaque and development of myocardial ischemia-reperfusion injury in ST-elevation myocardial infarction (STEMI) remain unknown. Increased arginase-1 activity leads to reduced nitric oxide production and increased formation of reactive oxygen species due to uncoupling of the endothelial nitric oxide synthase (eNOS). These events lead to endothelial dysfunction, plaque instability and increased susceptibility to ischemia-reperfusion injury in acute myocardial infarction. Experimental studies have shown that arginase-1 expression and activity are increased in atherosclerosis and during myocardial ischemia-reperfusion. Accordingly, inhibition of arginase-1 reduces atherosclerotic lesion development and limits the extent of infarct size during ischemia-reperfusion via an eNOS-dependent mechanism. Furthermore, arginase-1 inhibition improves endothelial function in patients with coronary artery disease but the potential role of arginase-1 in patients with STEMI is poorly understood.
Purpose
The purpose of the current study was to test the hypothesis that arginase-1 is upregulated and correlate to infarct size in STEMI patients.
Methods and results
Two independent cohorts of STEMI patients were included. In cohort 1, plasma and buffy coat leukocytes were collected from 53 STEMI patients at the time of arterial puncture for percutaneous coronary intervention, at 24–48 hours post STEMI and at 3 months post STEMI. Gene expression in leukocytes was determined in 51 patients with Affymetrix Human Transcriptome Array 2.0. In cohort 2, plasma was collected from 82 STEMI patients at admission and at 6 months for determination of plasma arginase-1. These patients underwent cardiac magnetic resonance imaging performed at day 4–7 and at 6 months post STEMI. Plasma arginase-1 levels were quantified with ELISA. Control blood samples were collected from 56 healthy age matched subjects. In cohort 1, ARG1 gene expression was four-fold higher in STEMI patients at admission compared to controls (Figure A). This expression returned to control levels within 3 months. Plasma arginase-1 levels were two times higher in STEMI patients at admission compared to controls, and remained elevated at 24–48 hours and at 3 months post STEMI (Figure B). The increase in plasma arginase-1 in STEMI patients was confirmed in cohort 2 (Figure C). Arginase-1 levels did not correlate with infarct size.
Conclusions
STEMI patients demonstrate increased gene expression and plasma levels of arginase-1 in the acute setting. In contrast to gene expression plasma arginase-1 levels remain significantly elevated over time. The markedly increased expression of arginase-1 already at admission may suggest a mechanistic role of arginase-1 in the development of STEMI. Further studies are needed to elucidate whether increased expression, induction and activity of arginase-1 are contributing factors for the development of STEMI.
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Affiliation(s)
- J Tengbom
- Karolinska Institute, Division of Cardiology, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - S Cederstrom
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - D Verouhis
- Karolinska Institute, Division of Cardiology, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - P Sorensson
- Karolinska Institute, Division of Cardiology, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - F Bohm
- Karolinska Institute, Division of Cardiology, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - N Saleh
- Karolinska Institute, Division of Cardiology, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - T Jernberg
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - P Lundman
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - P Eriksson
- Karolinska Institute, Department of Medicine, Solna (MedS), Karolinska University Hospital, Stockholm, Sweden
| | - A Gabrielsen
- Karolinska Institute, Department of Medicine, Solna (MedS), Karolinska University Hospital, Stockholm, Sweden
| | - K Caidahl
- Karolinska Institute, Department of Molecular Medicine and Surgery (MMK), Stockholm, Sweden
| | - J Persson
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | | | - P Tornvall
- Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset (KI SÖS), Stockholm, Sweden
| | - J Pernow
- Karolinska Institute, Division of Cardiology, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
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Persson J, Salehi S, Bollino M, Lönnerfors C, Falconer H, Geppert B. Pelvic Sentinel lymph node detection in High-Risk Endometrial Cancer (SHREC-trial)—the final step towards a paradigm shift in surgical staging. Eur J Cancer 2019; 116:77-85. [DOI: 10.1016/j.ejca.2019.04.025] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/22/2019] [Accepted: 04/10/2019] [Indexed: 10/26/2022]
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Falconer H, Palsdottir K, Stalberg K, Dahm-Kähler P, Ottander U, Lundin ES, Wijk L, Kimmig R, Jensen PT, Zahl Eriksson AG, Mäenpää J, Persson J, Salehi S. Robot-assisted approach to cervical cancer (RACC): an international multi-center, open-label randomized controlled trial. Int J Gynecol Cancer 2019; 29:1072-1076. [DOI: 10.1136/ijgc-2019-000558] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2019] [Indexed: 01/07/2023] Open
Abstract
BackgroundRadical hysterectomy with pelvic lymphadenectomy represents the standard treatment for early-stage cervical cancer. Results from a recent randomized controlled trial demonstrate that minimally invasive surgery is inferior to laparotomy with regards to disease-free and overall survival.Primary ObjectiveTo investigate the oncologic safety of robot-assisted surgery for early-stage cervical cancer as compared with standard laparotomy.Study HypothesisRobot-assisted laparoscopic radical hysterectomy is non-inferior to laparotomy in regards to recurrence-free survival with the advantage of fewer post-operative complications and superior patient-reported outcomes.Trial DesignProspective, multi-institutional, international, open-label randomized clinical trial. Consecutive women with early-stage cervical cancer will be assessed for eligibility and subsequently randomized 1:1 to either robot-assisted laparoscopic surgery or laparotomy. Institutional review board approval will be required from all participating institutions. The trial is coordinated from Karolinska University Hospital, Sweden.Major Inclusion/Exclusion CriteriaWomen over 18 with cervical cancer FIGO (2018) stages IB1, IB2, and IIA1 squamous, adenocarcinoma, or adenosquamous will be included. Women are not eligible if they have evidence of metastatic disease, serious co-morbidity, or a secondary invasive neoplasm in the past 5 years.Primary EndpointRecurrence-free survival at 5 years between women who underwent robot-assisted laparoscopic surgery versus laparotomy for early-stage cervical cancer.Sample SizeThe clinical non-inferiority margin in this study is defined as a 5-year recurrence-free survival not worsened by >7.5%. With an expected recurrence-free survival of 85%, the study needs to observe 127 events with a one-sided level of significance (α) of 5% and a power (1−β) of 80%. With 5 years of recruitment and 3 years of follow-up, the necessary number of events will be reached if the study can recruit a total of 768 patients.Estimated Dates for Completing Accrual and Presenting ResultsTrial launch is estimated to be May 2019 and the trial is estimated to close in May 2027 with presentation of data shortly thereafter.Trial RegistrationThe trial is registered at ClinicalTrials.gov (NCT03719547).
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Alfonzo E, Wallin E, Ekdahl L, Staf C, Rådestad AF, Reynisson P, Stålberg K, Falconer H, Persson J, Dahm-Kähler P. No survival difference between robotic and open radical hysterectomy for women with early-stage cervical cancer: results from a nationwide population-based cohort study. Eur J Cancer 2019; 116:169-177. [PMID: 31200323 DOI: 10.1016/j.ejca.2019.05.016] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/08/2019] [Accepted: 05/11/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of the study was to compare overall survival (OS) and disease-free survival (DFS) after open and robotic radical hysterectomy for early-stage cervical cancer. PATIENTS AND METHODS This was a nationwide population-based cohort study on all women with cervical cancer stage IA1-IB of squamous, adenocarcinoma or adenosquamous histological subtypes, from January 2011 to December 2017, for whom radical hysterectomy was performed. The Swedish Quality Register of Gynaecologic Cancer was used for identification. To ensure quality and conformity of data and to disclose patients not yet registered, hospital registries were reviewed and validated. Cox and propensity score regression analysis and univariable and multivariable regression analysis were performed in regard to OS and DFS. RESULTS There were 864 women (236 open and 628 robotic) included in the study. The 5-year OS was 92% and 94% and DFS was 84% and 88% for the open and robotic cohorts, respectively. The recurrence pattern was similar in both groups. Using propensity score analysis and matched cohorts of 232 women in each surgical group, no significant differences were seen in survival: 5-year OS of 92% in both groups (hazard ratio [HR], 1.00; 95% confidence interval [CI], 0.50-2.01) and DFS of 85% vs 84% in the open and robotic cohort, respectively (HR, 1.08; 95% CI, 0.66-1.78). In univariable and multivariable analysis with OS as the end-point, no significant factors were found, and in regard to DFS, tumour size (p < 0.001) and grade 3 (p = 0.02) were found as independent significant risk factors. CONCLUSION In a complete nationwide population-based cohort, where radical hysterectomy for early-stage cervical cancer is highly centralised, neither long-term survival nor pattern of recurrence differed significantly between open and robotic surgery.
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Affiliation(s)
- Emilia Alfonzo
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden; Department of Obstetrics & Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Medicinaregatan 3, 41390 Gothenburg, Sweden
| | - Emelie Wallin
- Department of Women's and Children's Health, Division of Obstetrics and Gynaecology, Karolinska University Hospital and Karolinska Institute, K 57 14186 Stockholm, Sweden
| | - Linnea Ekdahl
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology Skåne University Hospital 22185 Lund, Sweden; Lund University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology, 22185 Lund, Sweden
| | - Christian Staf
- Regional Cancer Centre Western Sweden, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Angelique Flöter Rådestad
- Department of Women's and Children's Health, Division of Obstetrics and Gynaecology, Karolinska University Hospital and Karolinska Institute, K 57 14186 Stockholm, Sweden
| | - Petur Reynisson
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology Skåne University Hospital 22185 Lund, Sweden; Lund University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology, 22185 Lund, Sweden
| | - Karin Stålberg
- Department of Women's and Children's Health, Uppsala University, 75185 Uppsala, Sweden
| | - Henrik Falconer
- Department of Women's and Children's Health, Division of Obstetrics and Gynaecology, Karolinska University Hospital and Karolinska Institute, K 57 14186 Stockholm, Sweden
| | - Jan Persson
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology Skåne University Hospital 22185 Lund, Sweden; Lund University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology, 22185 Lund, Sweden
| | - Pernilla Dahm-Kähler
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden; Department of Obstetrics & Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Medicinaregatan 3, 41390 Gothenburg, Sweden; Regional Cancer Centre Western Sweden, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden.
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Hambraeus J, Hambraeus KS, Persson J. Radiofrequency Denervation Improves Health-Related Quality of Life in Patients with Thoracic Zygapophyseal Joint Pain. Pain Med 2019; 19:914-919. [PMID: 29741743 DOI: 10.1093/pm/pnx142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective To describe a practical approach for the diagnosis and treatment of thoracic zygapophyseal joint pain and to present preliminary clinical data on the effects of this treatment approach on health-related quality of life. Design An observational study. Setting Specialist outpatient pain clinic in northern Sweden. Subjects Patients with long-term thoracic pain. Methods We describe a method of radiofrequency denervation of thoracic zygapophyseal joints. We compared health-related quality of life between patients who underwent radiofrequency denervation of thoracic zygapophyseal joints and patients who underwent radiofrequency denervation for lumbar and cervical zygapophyseal joint pain. Results Treatment according to the Spine Intervention Society Guidelines was performed on the lumbar region in 178 patients and in the cervical region in 55 patients. Another 82 patients were treated in the thoracic region with our proposed technique. A survival plot of improvements in health-related quality of life revealed that all three treatments were effective in 65% or more of patients. The improvement in health-related quality of life was maintained for 12 or more months after treatment in 47% to 51% of patients. Conclusions Our results suggest that radiofrequency denervation of thoracic zygapophyseal joint pain is as effective as radiofrequency denervation, the standard treatment, for lumbar and cervical zygapophyseal joint pain. If these results can be confirmed by other centers, radiofrequency denervation is likely to become more widely available for the treatment of thoracic zygapophyseal joint pain.
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Affiliation(s)
| | | | - Jan Persson
- Department of Anesthesia and Intensive Care, Pain Clinic, Karolinska University Hospital, Stockholm, Sweden
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Kirkegård J, Aahlin EK, Al-Saiddi M, Bratlie SO, Coolsen M, de Haas RJ, den Dulk M, Fristrup C, Harrison EM, Mortensen MB, Nijkamp MW, Persson J, Søreide JA, Wigmore SJ, Wik T, Mortensen FV. Multicentre study of multidisciplinary team assessment of pancreatic cancer resectability and treatment allocation. Br J Surg 2019; 106:756-764. [PMID: 30830974 DOI: 10.1002/bjs.11093] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/09/2018] [Accepted: 11/26/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Multidisciplinary team (MDT) meetings have been adopted widely to ensure optimal treatment for patients with cancer. Agreements in tumour staging, resectability assessments and treatment allocation between different MDTs were assessed. METHODS Of all patients referred to one hospital, 19 patients considered to have non-metastatic pancreatic cancer for evaluation were selected randomly for a multicentre study of MDT decisions in seven units across Northern Europe. Anonymized clinical information and radiological images were disseminated to the MDTs. All patients were reviewed by the MDTs for radiological T, N and M category, resectability assessment and treatment allocation. Each MDT was blinded to the decisions of other teams. Agreements were expressed as raw percentages and Krippendorff's α values, both with 95 per cent confidence intervals. RESULTS A total of 132 evaluations in 19 patients were carried out by the seven MDTs (1 evaluation was excluded owing to technical problems). The level of agreement for T, N and M categories ranged from moderate to near perfect (46·8, 61·1 and 82·8 per cent respectively), but there was substantial variation in assessment of resectability; seven patients were considered to be resectable by one MDT but unresectable by another. The MDTs all agreed on either a curative or palliative strategy in less than half of the patients (9 of 19). Only fair agreement in treatment allocation was observed (Krippendorff's α 0·31, 95 per cent c.i. 0·16 to 0·45). There was a high level of agreement in treatment allocation where resectability assessments were concordant. CONCLUSION Considerable disparities in MDT evaluations of patients with pancreatic cancer exist, including substantial variation in resectability assessments.
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Affiliation(s)
- J Kirkegård
- Department of Surgery, Hepatopancreatobiliary (HPB) Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - E K Aahlin
- Department of Gastrointestinal and HPB Surgery, University Hospital of Northern Norway, Breivika, Norway
| | - M Al-Saiddi
- Department of Radiology, Stavanger University Hospital, Stavanger, Norway
| | - S O Bratlie
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - M Coolsen
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - R J de Haas
- Department of Radiology, University Medical Centre Groningen, Groningen, the Netherlands
| | - M den Dulk
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Surgery, RWTH University Hospital, Aachen, Germany
| | - C Fristrup
- Odense Pancreas Centre, Department of Surgical Gastroenterology, Odense University Hospital, Odense, Denmark
| | - E M Harrison
- Department of Clinical Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - M B Mortensen
- Odense Pancreas Centre, Department of Surgical Gastroenterology, Odense University Hospital, Odense, Denmark
| | - M W Nijkamp
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - J Persson
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - J A Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - S J Wigmore
- Department of Clinical Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - T Wik
- Department of Radiology, University Hospital of Northern Norway, Breivika, Norway
| | - F V Mortensen
- Department of Surgery, Hepatopancreatobiliary (HPB) Research Unit, Aarhus University Hospital, Aarhus, Denmark
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Persson J, Struckmann W, Gingnell M, Bodén R. Depressive symptoms reduction following intermittent theta burst stimulation over dorsomedial prefrontal cortex is related to resting-state connectivity modulation: Preliminary findings from a double blinded sham controlled trial. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.630] [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: 11/16/2022] Open
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Salvo G, Ramirez PT, Leitao M, Cibula D, Fotopoulou C, Kucukmetin A, Rendon G, Perrotta M, Ribeiro R, Vieira M, Baiocchi G, Falconer H, Persson J, Wu X, Căpilna ME, Ioanid N, Mosgaard BJ, Berlev I, Kaidarova D, Olawaiye AB, Liu K, Nobre SP, Kocian R, Saso S, Rundle S, Noll F, Tsunoda AT, Palsdottir K, Li X, Ulrikh E, Hu Z, Pareja R. International radical trachelectomy assessment: IRTA study. Int J Gynecol Cancer 2019; 29:635-638. [PMID: 30765489 DOI: 10.1136/ijgc-2019-000273] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 11/19/2018] [Revised: 01/03/2019] [Accepted: 01/08/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Radical trachelectomy is considered a viable option for fertility preservation in patients with low-risk, early-stage cervical cancer. Standard approaches include laparotomy or minimally invasive surgery when performing radical trachelectomy. PRIMARY OBJECTIVE To compare disease-free survival between patients with FIGO (2009) stage IA2 or IB1 (≤2cm) cervical cancer who underwent open versus minimally invasive (laparoscopic or robotic) radical trachelectomy. STUDY HYPOTHESIS We hypothesize that minimally invasive radical trachelectomy has similar oncologic outcomes to those of the open approach. STUDY DESIGN This is a collaborative, multi-institutional, international, retrospective study. Patients who underwent a radical trachelectomy and lymphadenectomy between January 1, 2005 and December 31, 2017 will be included. Institutional review board approval will be required. Each institution will be provided access to a study-specific REDCap (Research Electronic Data Capture) database maintained by MD Anderson Cancer Center and will be responsible for entering patient data. INCLUSION CRITERIA Patients with squamous, adenocarcinoma, or adenosquamous cervical cancer FIGO (2009) stages IA2 and IB1 (≤2 cm) will be included. Surgery performed by the open approach or minimally invasive approach (laparoscopy or robotics). Tumor size ≤2 cm, by physical examination, ultrasound, MRI, CT, or positron emission tomography (at least one should confirm a tumor size ≤2 cm). Centers must contribute at least 15 cases of radical trachelectomy (open, minimally invasive, or both). EXCLUSION CRITERIA Prior neoadjuvant chemotherapy or radiotherapy to the pelvis for cervical cancer at any time, prior lymphadenectomy, or pelvic retroperitoneal surgery, pregnant patients, aborted trachelectomy (intra-operative conversion to radical hysterectomy), or vaginal approach. PRIMARY ENDPOINT The primary endpoint is disease-free survival measured as the time from surgery until recurrence or death due to disease. To evaluate the primary objective, we will compare disease-free survival among patients with FIGO (2009) stage IA2 or IB1 (≤2cm) cervical cancer who underwent open versus minimally invasive radical trachelectomy. SAMPLE SIZE An estimated 535 patients will be included; 256 open and 279 minimally invasive radical trachelectomy. Previous studies have shown that recurrence rates in the open group range from 3.8% to 7.6%. Assuming that the 4.5-year disease-free survival rate for patients who underwent open surgery is 95.0%, we have 80% power to detect a 0.44 HR using α level 0.10. This corresponds to an 89.0% disease-free survival rate at 4.5 years in the minimally invasive group.
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Affiliation(s)
- Gloria Salvo
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Pedro T Ramirez
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mario Leitao
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - David Cibula
- General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | | | - Gabriel Rendon
- Instituto de Cancerologia de las Americas, Medellin, Colombia
| | - Myriam Perrotta
- Ginecologia y Obstetricia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Reitan Ribeiro
- IOP Instituto de Oncologia do Parana, Curitiba, Brazil.,Hospital Erasto Gaertner, Curitiba, Brazil
| | | | | | | | | | - Xiaohua Wu
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Mihai Emil Căpilna
- First Clinic of Obstetrics and Gynecology, University of Medicine and Pharmacy of Târgu Mureş, Târgu Mureş, Romania
| | - Nicolae Ioanid
- The Regional Institute of Oncology of Iasi, Iasi, Romania
| | | | - Igor Berlev
- North-Western State Medical University. N.N. Petrov Research Institute of Oncology, Saint-Petersburg, Russian Federation
| | - Dilyara Kaidarova
- Kazahskij naucno-issledovatel'skij institut onkologii i radiologii, Almaty, Kazakhstan
| | | | - Kaijiang Liu
- RenJi Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Roman Kocian
- General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Srdjan Saso
- Department of Gynecologic Oncology, Imperial College London, London, UK
| | | | - Florencia Noll
- Ginecologia y Obstetricia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Audrey Tieko Tsunoda
- IOP Instituto de Oncologia do Parana, Curitiba, Brazil.,Hospital Erasto Gaertner, Curitiba, Brazil
| | | | - Xiaoqi Li
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Elena Ulrikh
- North-Western State Medical University. N.N. Petrov Research Institute of Oncology, Saint-Petersburg, Russian Federation
| | - Zhijun Hu
- RenJi Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rene Pareja
- Oncological surgery, Clinica Astorga, Envigado, Colombia.,Instituto Nacional del Cancer, Bogota, Colombia
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Ueda P, Bodil Svennblad B, James S, Alfredsson J, Erlinge D, Omerovic E, Persson J, Ravn-Fischer A, Tornvall P, Jernberg T, Varenhorst C. 1400External validation of the DAPT score in nationwide real-world data: ischemic and bleeding events following coronary stent implantation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/13/2022] Open
Affiliation(s)
- P Ueda
- Karolinska Institute, Clinical Epidemiology Unit, Department of Medicine, Stockholm, Sweden
| | | | - S James
- Uppsala Clinical Research Center, Uppsala, Sweden
| | - J Alfredsson
- Linkoping University Hospital, Linkoping, Sweden
| | - D Erlinge
- Skane University Hospital, Lund, Sweden
| | | | - J Persson
- Danderyd University Hospital, Stockholm, Sweden
| | | | - P Tornvall
- South Hospital Stockholm, Stockholm, Sweden
| | - T Jernberg
- Danderyd University Hospital, Stockholm, Sweden
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