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Smedby KE, Wästerlid T, Tham E, Haider Z, Joelsson J, Thorvaldsdottir B, Krstic A, Wahlin BE, Foroughi-Asl H, Karlsson C, Eloranta S, Saft L, Palma M, Kwiecinska A, Hansson L, Österborg A, Wirta V, Rassidakis G, Sander B, Sonnevi K, Rosenquist R. The BioLymph study - implementing precision medicine approaches in lymphoma diagnostics, treatment and follow-up: feasibility and first results. Acta Oncol 2023; 62:560-564. [PMID: 37415362 DOI: 10.1080/0284186x.2023.2218556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/16/2023] [Indexed: 07/08/2023]
Affiliation(s)
- K E Smedby
- Dept of Hematology, Karolinska University Hospital Solna, Sweden
- Dept of Medicine Solna, div of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - T Wästerlid
- Dept of Hematology, Karolinska University Hospital Solna, Sweden
- Dept of Medicine Solna, div of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - E Tham
- Dept of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Dept of Clinical Genetics, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Z Haider
- Dept of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - J Joelsson
- Dept of Hematology, Karolinska University Hospital Solna, Sweden
- Dept of Medicine Solna, div of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - B Thorvaldsdottir
- Dept of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - A Krstic
- Dept of Clinical Genetics, Karolinska University Hospital Solna, Stockholm, Sweden
| | - B E Wahlin
- Dept of Hematology, Karolinska University Hospital Solna, Sweden
- Dept of Medicine Huddinge, Karolinska Institutet
| | | | - C Karlsson
- Dept of Hematology, Karolinska University Hospital Solna, Sweden
- Dept of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - S Eloranta
- Dept of Medicine Solna, div of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - L Saft
- Dept of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - M Palma
- Dept of Hematology, Karolinska University Hospital Solna, Sweden
- Dept of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - A Kwiecinska
- Dept of Clinical Pathology and Cancer Diagnostics, Karolinska University Laboratory, Solna and Huddinge, Sweden
| | - L Hansson
- Dept of Hematology, Karolinska University Hospital Solna, Sweden
- Dept of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - A Österborg
- Dept of Hematology, Karolinska University Hospital Solna, Sweden
- Dept of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - V Wirta
- Science for Life Laboratory, Dept of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Science for Life Laboratory, Royal Insititute of Technology, Stockholm, Sweden
- Genomic Medicine Center Karolinska, Karolinska University Hospital, Stockholm, Sweden
| | - G Rassidakis
- Dept of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Dept of Clinical Pathology and Cancer Diagnostics, Karolinska University Laboratory, Solna and Huddinge, Sweden
| | - B Sander
- Dept of Clinical Pathology and Cancer Diagnostics, Karolinska University Laboratory, Solna and Huddinge, Sweden
- Dept of Laboratory Medicine, Karolinska Institutet Stockholm, Sweden
| | - K Sonnevi
- Dept of Hematology, Karolinska University Hospital Solna, Sweden
- Dept of Medicine Huddinge, Karolinska Institutet
| | - R Rosenquist
- Dept of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Dept of Clinical Genetics, Karolinska University Hospital Solna, Stockholm, Sweden
- Genomic Medicine Center Karolinska, Karolinska University Hospital, Stockholm, Sweden
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2
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Niroomand A, Ghaidan H, Hallgren O, Hansson L, Larsson H, Wagner D, Mackova M, Halloran K, Hyllén S, Lindstedt S. Corticotropin releasing hormone as an identifier of bronchiolitis obliterans syndrome. Sci Rep 2022; 12:8413. [PMID: 35589861 PMCID: PMC9120482 DOI: 10.1038/s41598-022-12546-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 04/26/2022] [Indexed: 11/30/2022] Open
Abstract
Lung transplantion (LTx) recipients have low long-term survival and a high incidence of bronchiolitis obliterans syndrome (BOS), an inflammation of the small airways in chronic rejection of a lung allograft. There is great clinical need for a minimally invasive biomarker of BOS. Here, 644 different proteins were analyzed to detect biomarkers that distinguish BOS grade 0 from grades 1–3. The plasma of 46 double lung transplant patients was analyzed for proteins using a high-component, multiplex immunoassay that enables analysis of protein biomarkers. Proximity Extension Assay (PEA) consists of antibody probe pairs which bind to targets. The resulting polymerase chain reaction (PCR) reporter sequence can be quantified by real-time PCR. Samples were collected at baseline and 1-year post transplantation. Enzyme-linked immunosorbent assay (ELISA) was used to validate the findings of the PEA analysis across both time points and microarray datasets from other lung transplantation centers demonstrated the same findings. Significant decreases in the plasma protein levels of CRH, FERC2, IL-20RA, TNFB, and IGSF3 and an increase in MMP-9 and CTSL1 were seen in patients who developed BOS compared to those who did not. In this study, CRH is presented as a novel potential biomarker in the progression of disease because of its decreased levels in patients across all BOS grades. Additionally, biomarkers involving the remodeling of the extracellular matrix (ECM), such as MMP-9 and CTSL1, were increased in BOS patients.
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Affiliation(s)
- Anna Niroomand
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.,Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden.,Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Haider Ghaidan
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden.,Lund Stem Cell Center, Lund University, Lund, Sweden.,Department of Cardiothoracic Surgery and Transplantation, Skåne University Hospital, 221 85, Lund, Sweden
| | - Oskar Hallgren
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Lennart Hansson
- Department of Pulmonology and Transplantation, Skåne University Hospital, Lund, Sweden
| | - Hillevi Larsson
- Department of Pulmonology and Transplantation, Skåne University Hospital, Lund, Sweden
| | - Darcy Wagner
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden.,Lund Stem Cell Center, Lund University, Lund, Sweden.,Department of Experimental Medical Sciences, Lung Bioengineering and Regeneration, Lund University, Lund, Sweden
| | - Martina Mackova
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Kieran Halloran
- Alberta Transplant Applied Genomics Center, University of Alberta, Edmonton, Canada
| | - Snejana Hyllén
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Cardiothoracic Anaesthesia and Intensive Care, Skåne University Hospital, Lund, Sweden
| | - Sandra Lindstedt
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden. .,Department of Clinical Sciences, Lund University, Lund, Sweden. .,Lund Stem Cell Center, Lund University, Lund, Sweden. .,Department of Cardiothoracic Surgery and Transplantation, Skåne University Hospital, 221 85, Lund, Sweden.
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3
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Lindstedt S, Grins E, Larsson H, Nilsson J, Akbarshahi H, Silva I, Hyllen S, Wagner D, Sjögren J, Hansson L, Ederoth P, Gustafsson R. Lung transplant after 6 months on ECMO support for SARS-CoV-2-induced ARDS complicated by severe antibody-mediated rejection. BMJ Open Respir Res 2021; 8:8/1/e001036. [PMID: 34544734 PMCID: PMC8453592 DOI: 10.1136/bmjresp-2021-001036] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 06/25/2021] [Accepted: 09/03/2021] [Indexed: 12/28/2022] Open
Abstract
There have been a few reports of successful lung transplantation (LTx) in patients with SARS-CoV-2-induced acute respiratory distress syndrome (ARDS); however, all reports were with rather short follow-up. Here we present a 62-year-old man without prior lung diseases. Following SARS-CoV-2-induced ARDS and 6 months of extracorporeal membrane oxygenation, he underwent LTx. 3 months post-transplantation he developed acute hypoxia requiring emergency intubation. Chest imaging showed acute rejection, and de novo DQ8-DSA was discovered. He was treated with a high dose of corticosteroids and plasmapheresis and was extubated 4 days later, yet the de novo DQ8-DSA remained. After sessions of plasmapheresis and rituximab, the levels of de novo DQ8-DSA remained unchanged. Nine months post-transplantation the patient died of respiratory failure. We herein discuss the decision to transplant, the transplantation itself and the postoperative course with severe antibody-mediated rejection. In addition, we evaluated the histological changes of the explanted lungs and compared these with end-stage idiopathic pulmonary fibrosis tissue, where both similarities and differences are seen. With the current case experience, one might consider close monitoring regarding DSA, and gives further support that LTx should only be considered for very carefully selected patients.
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Affiliation(s)
- Sandra Lindstedt
- Department of Cardiothoracic Surgery and Transplantation, Skåne University Hospital Lund, Lund, Sweden .,Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - Edgar Grins
- Department of Cardiothoracic Anaesthesia and Intensive Care, Lund University Hospital, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Hillevi Larsson
- Department of Pulmonology and Transplantation, Lund University Hospital, Lund, Sweden
| | - Johan Nilsson
- Department of Cardiothoracic Surgery and Transplantation, Skåne University Hospital Lund, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Hamid Akbarshahi
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Pulmonology and Transplantation, Lund University Hospital, Lund, Sweden
| | - Iran Silva
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden.,Department of Experimental Medical Sciences, Lung Bioengineering and Regeneration, Lund University, Lund, Sweden
| | - Snejana Hyllen
- Department of Cardiothoracic Anaesthesia and Intensive Care, Lund University Hospital, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Darcy Wagner
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden.,Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Johan Sjögren
- Department of Cardiothoracic Surgery and Transplantation, Skåne University Hospital Lund, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Lennart Hansson
- Department of Pulmonology and Transplantation, Skåne University Hospital Lund, Lund, Sweden
| | - Per Ederoth
- Department of Cardiothoracic Anaesthesia and Intensive Care, Lund University Hospital, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Ronny Gustafsson
- Department of Cardiothoracic Surgery and Transplantation, Skåne University Hospital Lund, Lund, Sweden
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4
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Riise G, Magnusson J, Larsson H, Hansson L, Ingemansson R, Dellgren G. [Lungtransplantation in Sweden - over 1 200 patients transplanted since 1990]. Lakartidningen 2020; 117:20015. [PMID: 32969482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Lung transplantation is an accepted treatment for end stage lung diseases and performed at two national centers in Sweden - Gothenburg and Lund. Since the start in 1990 over 1 200 patients have been transplanted. The indications are severe progressive lung diseases with short expected survival or severe negative effects on daily life. There are several contraindications among which severe other organ disease, recent malignancy or psychiatric disease are most important. The most common causes for lung transplantation are chronic obstructive pulmonary disease (COPD), interstitial pulmonary disease, cystic fibrosis and pulmonary hypertension. Long term survival after 5 years is 63 %, and after 10 years 48 %, which is better than the results reported in the international registry (57 % and 36 % respectively). Lung transplantation is today a therapy for end stage pulmonary diseases with acceptable survival results. It is likely that the number of patients will increase in the future.
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Affiliation(s)
- Gerdt Riise
- adjungerad professor, överläkare, Lungmedicin, Sahlgrenska universitetssjukhuset
| | - Jesper Magnusson
- med dr, överläkare, Transplantationscentrum, Sahlgrenska universitetssjukhuset
| | - Hillevi Larsson
- med dr, överläkare, Lungmedicin, Skånes universitetssjukhus, Lund
| | - Lennart Hansson
- med dr, överläkare, Lungmedicin, Skånes universitetssjukhus, Lund
| | | | - Göran Dellgren
- adjungerad professor, universitetsöverläkare, Transplantationscentrum, Sahlgrenska universitetssjukhuset
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5
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Bozovic G, Larsson H, Wuttge DM, Håkansson M, Hansson L, Ingemansson R, Brunnström H, Andréasson K. Successful lung transplantation in a patient with rheumatoid arthritis suffering from obliterative bronchiolitis. Scand J Rheumatol 2020; 49:334-335. [PMID: 32295451 DOI: 10.1080/03009742.2020.1727006] [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: 10/24/2022]
Affiliation(s)
- G Bozovic
- Department of Medical Imaging and Physiology, Skane University Hospital , Lund, Sweden
| | - H Larsson
- Department of Respiratory Medicine and Allergology, Skane University Hospital , Lund, Sweden
| | - D M Wuttge
- Section of Rheumatology, Department of Clinical Sciences, Lund University , Lund, Sweden
| | - M Håkansson
- Section of Pulmonology, Helsingborg Hospital , Helsingborg, Sweden
| | - L Hansson
- Department of Respiratory Medicine and Allergology, Skane University Hospital , Lund, Sweden
| | - R Ingemansson
- Department of Cardiothoracic Surgery, Skane University Hospital , Lund, Sweden
| | - H Brunnström
- Laboratory Medicine Region Skane, Pathology, Department of Clinical Sciences Lund, Lund University , Lund, Sweden
| | - K Andréasson
- Section of Rheumatology, Department of Clinical Sciences, Lund University , Lund, Sweden
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Saarento O, Kastrup M, Hansson L. The Nordic comparative study on sectorized psychiatry: characteristics of repeat users of emergency outpatient services in two Nordic psychiatric services. A 1-year follow-up study. Eur Psychiatry 2020; 13:35-40. [DOI: 10.1016/s0924-9338(97)86749-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/1997] [Accepted: 09/02/1997] [Indexed: 10/18/2022] Open
Abstract
SummaryTo characterise frequent use of psychiatric emergency outpatients services, this paper reports results from a prospective investigation of use of psychiatric services by new patients in two Nordic psychiatric services, Frederiksberg in Denmark and Oulu in Finland. One year treated incidence cohorts were used. Total number of patients included was 1,055. The repeat user was defined as a patient having at least three emergency outpatient contacts during a 1-year follow-up. The repeat users constituted 15.8% of the sample and 70.8% of all the emergency contacts in Frederiksberg. In Oulu the respective figures were 9.3% and 33.8%. The number of planned outpatient contacts or the number of hospital admissions of the repeat users did not differ from the non-repeaters. Repeaters in Frederiksberg were more likely to be self-referrals, male, divorced or unmarried, living with their parents, without their own housing, unemployed, aged between 25 and 44 years, and to have a diagnosis of dependency or personality disorder. In Oulu they did not differ from the other patients with regard to sociodemographic or diagnostic characteristics.
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7
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Svensson B, Hansson L. Perceived curative factors and their relationship to outcome: a study of schizophrenic patients in a comprehensive treatment program based on cognitive therapy. Eur Psychiatry 2020; 13:365-71. [DOI: 10.1016/s0924-9338(99)80704-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/1998] [Revised: 08/31/1998] [Accepted: 09/16/1998] [Indexed: 10/18/2022] Open
Abstract
SummaryTwenty-eight schizophrenic and other long-term mentally ill patients who were given cognitive therapy sessions twice a week in the context of a comprehensive inpatient treatment program were assessed every 5 weeks regarding perceived curative factors. The assessments were made by a self-rating questionnaire (Curative Factors Questionnaire [CFQ]) and a qualitative assessment from the patients of what they perceived as helpful in treatment. The results showed that milieu therapeutic elements and therapy sessions were perceived as the most helpful throughout the treatment period. No correlations were found between patient characteristics and perceived curative factors. The factors “instillation of hope”, “problem solution” and “learning I’m not alone” as rated in the initial phase of treatment showed a positive relationship with a favourable outcome of treatment at discharge.
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8
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Hansson L, Lind T, Öhlund I, Wiklund U, Rydberg A. Increased abdominal fat mass and high fat consumption in young school children with congenital heart disease: results from a case‐control study. J Hum Nutr Diet 2020; 33:566-573. [DOI: 10.1111/jhn.12739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- L. Hansson
- Department of Clinical Sciences, Paediatrics Umeå University Umeå Sweden
| | - T. Lind
- Department of Clinical Sciences, Paediatrics Umeå University Umeå Sweden
| | - I. Öhlund
- Department of Clinical Sciences, Paediatrics Umeå University Umeå Sweden
| | - U. Wiklund
- Department of Radiation Sciences Biomedical Engineering Umeå University Umeå Sweden
| | - A. Rydberg
- Department of Clinical Sciences, Paediatrics Umeå University Umeå Sweden
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9
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Stjärne Aspelund A, Hammarström H, Inghammar M, Larsson H, Hansson L, Riise GC, Friman V, Christensson B, Påhlman LI. Microbiological findings in bronchoalveolar lavage fluid from lung transplant patients in Sweden. Transpl Infect Dis 2018; 20:e12973. [PMID: 30107073 PMCID: PMC7169803 DOI: 10.1111/tid.12973] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 07/19/2018] [Accepted: 07/25/2018] [Indexed: 11/30/2022]
Abstract
Background Lung transplant patients experience a high risk of airway infections and microbial colonization of the lung due to constant exposure to the environment through inhaled microorganisms, denervation, reduced ciliary transport, and decreased cough. Methods In this nationwide prospective study on Swedish lung transplant patients, we evaluated the microbiological panorama of bacteria, fungi, and virus found in bronchoalveolar lavage fluid (BALF) obtained the first year after lung transplantation (LTx). Differences in microbiological findings depending of concomitant signs of infection and background factors were assessed. Results A total of 470 bronchoscopies from 126 patients were evaluated. Sixty‐two percent (n = 293) of BALF samples had positive microbiological finding(s). Forty‐six percent (n = 217) had bacterial growth, 29% (n = 137) fungal growth, and 9% (n = 43) were positive in viral PCR. In 38% of BALF samples (n = 181), a single microbe was found, whereas a combination of bacteria, fungi or virus was found in 24% (n = 112) of bronchoscopies. The most common microbiological findings were Candida albicans, Pseudomonas aeruginosa and coagulase negative Staphylococcus (in 42 (33%), 36 (29%), and 25 (20%) patients, respectively). Microbiological findings were similar in BALF from patients with and without signs of lung infection and the frequency of multidrug resistant (MDR) bacteria was low. No significant association was found between background factors and time to first lung infection. Conclusion This study gives important epidemiologic insights and reinforces that microbiological findings have to be evaluated in the light of clinical symptoms and endobronchial appearance in the assessment of lung infections in lung transplant patients.
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Affiliation(s)
- Anna Stjärne Aspelund
- Division of Infection Medicine, Hospital of Helsingborg, Helsingborg, Sweden.,Division of Infection Medicine, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
| | - Helena Hammarström
- Department of Infectious Diseases, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Malin Inghammar
- Division of Infection Medicine, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
| | - Hillevi Larsson
- Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Lennart Hansson
- Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Gerdt C Riise
- Department of Respiratory Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Vanda Friman
- Department of Infectious Diseases, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Bertil Christensson
- Division of Infection Medicine, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
| | - Lisa I Påhlman
- Division of Infection Medicine, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
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Auråen H, Schultz HHL, Hämmäinen P, Riise GC, Larsson H, Hansson L, Dellgren G, Perch M, Geiran O, Fiane AE, Iversen M, Holm AM. Urgent lung allocation system in the Scandiatransplant countries. J Heart Lung Transplant 2018; 37:1403-1409. [PMID: 30241891 DOI: 10.1016/j.healun.2018.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 03/13/2018] [Revised: 06/26/2018] [Accepted: 08/01/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Throughout the world, the scarcity of donor organs makes optimal allocation systems necessary. In the Scandiatransplant countries, organs for lung transplantation are allocated nationally. To ensure shorter wait time for critically ill patients, the Scandiatransplant urgent lung allocation system (ScULAS) was introduced in 2009, giving supranational priority to patients considered urgent. There were no pre-defined criteria for listing a patient as urgent, but each center was granted only 3 urgent calls per year. This study aims to explore the characteristics and outcome of patients listed as urgent, assess changes associated with the implementation of ScULAS, and describe how the system was utilized by the member centers. METHODS All patients listed for lung transplantation at the 5 Scandiatransplant centers 5 years before and after implementation of ScULAS were included. RESULTS After implementation, 8.3% of all listed patients received urgent status, of whom 81% were transplanted within 4 weeks. Patients listed as urgent were younger, more commonly had suppurative lung disease, and were more often on life support compared with patients without urgent status. For patients listed as urgent, post-transplant graft survival was inferior at 30 and 90 days. Although there were no pre-defined criteria for urgent listing, the system was not utilized at its maximum. CONCLUSIONS ScULAS rapidly allocated organs to patients considered urgent. These patients were younger and more often had suppurative lung disease. Patients with urgent status had inferior short-term outcome, plausibly due to the higher proportion on life support before transplantation.
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Affiliation(s)
- Henrik Auråen
- Department of Respiratory Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hans Henrik L Schultz
- Department of Cardiology, Section for Lung Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Pekka Hämmäinen
- Department of Cardiothoracic Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Gerdt C Riise
- Department of Respiratory Medicine, Institute of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hillevi Larsson
- Division of Respiratory Medicine and Allergology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Lennart Hansson
- Division of Respiratory Medicine and Allergology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Göran Dellgren
- Department of Cardiothoracic Surgery and Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Michael Perch
- Department of Cardiology, Section for Lung Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Odd Geiran
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Cardiothoracic Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Arnt E Fiane
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Cardiothoracic Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Martin Iversen
- Department of Cardiology, Section for Lung Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Are Martin Holm
- Department of Respiratory Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
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11
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Greer M, Berastegui C, Jaksch P, Benden C, Aubert J, Roux A, Lhuillier E, Hirschi S, Reynaud-Gaubert M, Philit F, Claustre J, LePalud P, Stern M, Knoop C, Vos R, Verschuuren E, Fisher A, Riise G, Hansson L, Iversen M, Hämmäinen P, Wedel H, Smits J, Gottlieb J, Holm AM. Lung transplantation after allogeneic stem cell transplantation: a pan-European experience. Eur Respir J 2018; 51:51/2/1701330. [DOI: 10.1183/13993003.01330-2017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 12/01/2017] [Indexed: 01/08/2023]
Abstract
Late-onset noninfectious pulmonary complications (LONIPCs) affect 6% of allogeneic stem cell transplantation (SCT) recipients within 5 years, conferring subsequent 5-year survival of 50%. Lung transplantation is rarely performed in this setting due to concomitant extrapulmonary morbidity, excessive immunosuppression and concerns about recurring malignancy being considered contraindications. This study assesses survival in highly selected patients undergoing lung transplantation for LONIPCs after SCT.SCT patients undergoing lung transplantation at 20 European centres between 1996 and 2014 were included. Clinical data pre- and post-lung transplantation were reviewed. Propensity score-matched controls were generated from the Eurotransplant and Scandiatransplant registries. Kaplan–Meier survival analysis and Cox proportional hazard regression models evaluating predictors of graft loss were performed.Graft survival at 1, 3 and 5 years of 84%, 72% and 67%, respectively, among the 105 SCT patients proved comparable to controls (p=0.75). Sepsis accounted for 15 out of 37 deaths (41%), with prior mechanical ventilation (HR 6.9, 95% CI 1.0–46.7; p<0.001) the leading risk factor. No SCT-specific risk factors were identified. Recurring malignancy occurred in four patients (4%). Lung transplantation <2 years post-SCT increased all-cause 1-year mortality (HR 7.5, 95% CI 2.3–23.8; p=0.001).Lung transplantation outcomes following SCT were comparable to other end-stage diseases. Lung transplantation should be considered feasible in selected candidates. No SCT-specific factors influencing outcome were identified within this carefully selected patient cohort.
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Stjärne Aspelund A, Hammarström H, Inghammar M, Larsson H, Hansson L, Christensson B, Påhlman LI. Heparin-binding protein, lysozyme, and inflammatory cytokines in bronchoalveolar lavage fluid as diagnostic tools for pulmonary infection in lung transplanted patients. Am J Transplant 2018; 18:444-452. [PMID: 28787761 PMCID: PMC5813223 DOI: 10.1111/ajt.14458] [Citation(s) in RCA: 24] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 07/21/2017] [Accepted: 07/29/2017] [Indexed: 01/25/2023]
Abstract
Pulmonary infection is a common complication after lung transplantation, and early detection is crucial for outcome. However, the condition can be clinically difficult to diagnose and to distinguish from rejection. The aim of this prospective study was to evaluate heparin-binding protein (HBP), lysozyme, and the cytokines interleukin (IL)-1β, IL-6, IL-8, IL-10 and tumor necrosis factor (TNF) in bronchoalveolar lavage fluid (BALF) as potential biomarkers for pulmonary infection in lung-transplanted patients. One hundred thirteen BALF samples from 29 lung transplant recipients were collected at routine scheduled bronchoscopies at 3 and 6 months, or on clinical indication. Samples were classified into no, possible, probable, or definite infection at the time of sampling. Rejection was defined by biopsy results. HBP, lysozyme, and cytokines were analyzed in BALF and correlated to likelihood of infection and rejection. All biomarkers were significantly increased in BALF during infection, whereas patients with rejection presented low levels that were comparable to noninfection samples. HBP, IL-1β, and IL-8 were the best diagnostic markers of infection with area under the receiver-operating characteristic curve values of 0.88, 0.91, and 0.90, respectively. In conclusion, HBP, IL-1β, and IL-8 could be useful diagnostic markers of pulmonary infection in lung-transplanted patients.
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Affiliation(s)
- Anna Stjärne Aspelund
- Department of Infection ControlSkåne CountyLundSweden,Division of Infection MedicineDepartment of Clinical Sciences LundLund UniversitySkåne University HospitalLundSweden
| | - Helena Hammarström
- Department of Infectious DiseasesSahlgrenska Academy at University of GothenburgGöteborgSweden
| | - Malin Inghammar
- Division of Infection MedicineDepartment of Clinical Sciences LundLund UniversitySkåne University HospitalLundSweden
| | - Hillevi Larsson
- Division of Respiratory Medicine and AllergologyDepartment of Clinical SciencesLund UniversitySkåne University HospitalLundSweden
| | - Lennart Hansson
- Division of Respiratory Medicine and AllergologyDepartment of Clinical SciencesLund UniversitySkåne University HospitalLundSweden
| | - Bertil Christensson
- Division of Infection MedicineDepartment of Clinical Sciences LundLund UniversitySkåne University HospitalLundSweden
| | - Lisa I. Påhlman
- Division of Infection MedicineDepartment of Clinical Sciences LundLund UniversitySkåne University HospitalLundSweden
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Fakhro M, Broberg E, Algotsson L, Hansson L, Koul B, Gustafsson R, Wierup P, Ingemansson R, Lindstedt S. Double lung, unlike single lung transplantation might provide a protective effect on mortality and bronchiolitis obliterans syndrome. J Cardiothorac Surg 2017; 12:100. [PMID: 29178919 PMCID: PMC5702105 DOI: 10.1186/s13019-017-0666-5] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/16/2017] [Indexed: 12/19/2022] Open
Abstract
Background Survival after lung transplantation (LTx) is often limited by bronchiolitis obliterans syndrome (BOS). Method Survey of 278 recipients who underwent LTx. The endpoint used was BOS (BOS grade ≥ 2), death or Re-lung transplantation (Re-LTx) assessed by competing risk regression analyses. Results The incidence of BOS grade ≥ 2 among double LTx (DLTx) recipients was 16 ± 3% at 5 years, 30 ± 4% at 10 years, and 37 ± 5% at 20 years, compared to single LTx (SLTx) recipients whose corresponding incidence of BOS grade ≥ 2 was 11 ± 3%, 20 ± 4%, and 24 ± 5% at 5, 10, and 20 years, respectively (p > 0. 05). The incidence of BOS grade ≥ 2 by major indications ranked in descending order: other, PF, CF, COPD, PH and AAT1 (p < 0. 05). The mortality rate by major indication ranked in descending order: COPD, PH, AAT1, PF, Other and CF (p < 0. 05). Conclusion No differences were seen in the incidence of BOS grade ≥ 2 regarding type of transplant, however, DLTx recipients showed a better chance of survival despite developing BOS compared to SLTx recipients. The highest incidence of BOS was seen among CF, PF, COPD, PH, and AAT1 recipients in descending order, however, CF and PF recipients showed a better chance of survival despite developing BOS compared to COPD, PH, and AAT1 recipients.
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Affiliation(s)
- Mohammed Fakhro
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden.
| | - Ellen Broberg
- Department of Thoracic Intensive Care and Anesthesia, Skåne University Hospital, Lund University, Lund, Sweden
| | - Lars Algotsson
- Department of Thoracic Intensive Care and Anesthesia, Skåne University Hospital, Lund University, Lund, Sweden
| | - Lennart Hansson
- Department of Pulmonary Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Bansi Koul
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ronny Gustafsson
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Per Wierup
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Richard Ingemansson
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Sandra Lindstedt
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
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Gilljam M, Nyström U, Dellgren G, Skog I, Hansson L. Survival after lung transplantation for cystic fibrosis in Sweden. Eur J Cardiothorac Surg 2017; 51:571-576. [PMID: 28364441 DOI: 10.1093/ejcts/ezw328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 04/28/2016] [Accepted: 08/29/2016] [Indexed: 01/27/2023] Open
Abstract
Objectives In Sweden, lung transplantation has been performed in patients with end-stage lung disease since 1990. We assessed survival after lung transplantation for cystic fibrosis (CF) with focus on early mortality and outcome for patients infected with certain multiresistant bacteria, considered a relative contraindication for lung transplantation. Methods Review of CF and transplant databases and patient charts. The Kaplan-Meier method and log-rank test were used for survival analysis and group comparison. Results From November 1991 to December 2014, 115 transplantations were performed in 106 CF patients (9 retransplantations): 3 heart-lung, 106 double lung-, 1 double lobar- and 5 single lung transplantations, constituting 13% (115/909) of all lung-transplant procedures performed in Sweden. The mean age at surgery was 31 (SD 10, range 10-61) years and there were 48% females. Overall 1-year survival after lung transplantation for CF was 86.4%, 5-year survival was 73.7% and 10-year survival was 62.4%. The mean and median survival after transplantation were 13.1 (95% confidence interval (CI): 11-15.3) and 14.6 (95% CI: 9.3-19.8) years, respectively, and there was no significant difference for gender or transplant centre. Extracorporeal membrane oxygenation was used as a bridge to transplantation in 11 cases and five patients received reconditioned lungs. Vascular and infectious complications contributed to eight deaths within the first three postoperative months. The mean survival for 14 patients infected pretransplant with Mycobacterium abscessus or Burkholderia cepacia complex was 8.8 (95% CI: 6.1-11.6) years compared to 13.2 (95% CI: 10.9-15.8) years for patients negative for these bacteria. Nineteen patients (14% of all listed), of whom three were listed for retransplantation, died while waiting a median time of 94 days (range 4 days-2.5 years) after listing. Conclusions Survival after lung transplantation in Sweden is good, also for patients with pretransplant infection with M. abscessus or B. cepacia complex, and comparable to international data.
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Affiliation(s)
- Marita Gilljam
- Department of Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ulla Nyström
- Department of Cardiothoracic Surgery and Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Göran Dellgren
- Department of Cardiothoracic Surgery and Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ingrid Skog
- Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund, Sweden
| | - Lennart Hansson
- Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund, Sweden
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15
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Gilljam M, De Monestrol I, Hansson L, Krantz C, Lindblad A. 298 Liver transplantation for CF in Sweden. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30637-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Greer M, Riise GC, Hansson L, Perch M, Hämmäinen P, Roux A, Hirschi S, Lhuillier E, Reynaud-Gaubert M, Philit F, Claustre J, Stern M, Gottlieb J, Holm AM. Dichotomy in pulmonary graft-versus-host disease evident among allogeneic stem-cell transplant recipients undergoing lung transplantation. Eur Respir J 2016; 48:1807-1810. [DOI: 10.1183/13993003.01121-2016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 08/04/2016] [Indexed: 11/05/2022]
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17
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Affiliation(s)
- C. Henderson
- Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - H. Stuart
- Centre for Health Services and Policy ResearchAbramsky HallQueen's UniversityKingstonONCanada
| | - L. Hansson
- Department of Health SciencesLund UniversityLundSweden
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Hansson L, Stjernswärd S, Svensson B. Changes in attitudes, intended behaviour, and mental health literacy in the Swedish population 2009-2014: an evaluation of a national antistigma programme. Acta Psychiatr Scand 2016; 134 Suppl 446:71-9. [PMID: 27426648 DOI: 10.1111/acps.12609] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [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] [Accepted: 05/19/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Public stigma of mental illness is still a major problem where numerous population studies during the last decade have mainly shown no improvements. A Swedish national antistigma campaign has been running 2010-2014. The aim of this study was to investigate changes in public stigma during this period as compared to baseline in 2009. METHODS Yearly population surveys were made between 2009 and 2014 including assessments of mental health literacy, attitudes, and intended future behaviour. Two surveys were made, one including a nationally representative sample and one including a representative sample from three original campaign regions. Multiple regression analyses, also including age, gender, education, and familiarity with mental illness were made to investigate yearly changes in public stigma compared to baseline. RESULTS Mental health literacy improved significantly in the campaign regions between 2009 and 2014, as did intended future behaviour. Attitudes toward mental illness also improved significantly. Improvements were also shown in the national population surveys, but the time pattern of these compared to that of the original campaign regions indicated that these changes took place mainly after the campaign had been extended to a further five Swedish regions. CONCLUSION The results of our surveys suggest that a campaign primarily based on social contact theory and involving people with lived experience of mental illness may, even in a rather short-term perspective, have a significant positive impact on mental health literacy, attitudes, and intentions of social contact with people with mental illness.
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Affiliation(s)
- L Hansson
- Department of Health Sciences, Lund University, Lund, Sweden
| | - S Stjernswärd
- Department of Health Sciences, Lund University, Lund, Sweden
| | - B Svensson
- Department of Health Sciences, Lund University, Lund, Sweden
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Rolandsson Enes S, Andersson Sjöland A, Skog I, Hansson L, Larsson H, Le Blanc K, Eriksson L, Bjermer L, Scheding S, Westergren-Thorsson G. MSC from fetal and adult lungs possess lung-specific properties compared to bone marrow-derived MSC. Sci Rep 2016; 6:29160. [PMID: 27381039 PMCID: PMC4933903 DOI: 10.1038/srep29160] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 06/16/2016] [Indexed: 12/24/2022] Open
Abstract
Mesenchymal stromal cells (MSC) are multipotent cells with regenerative and immune-modulatory properties. Therefore, MSC have been proposed as a potential cell-therapy for bronchiolitis obliterans syndrome (BOS). On the other hand, there are publications demonstrating that MSC might be involved in the development of BOS. Despite limited knowledge regarding the functional role of tissue-resident lung-MSC, several clinical trials have been performed using MSC, particularly bone marrow (BM)-derived MSC, for various lung diseases. We aimed to compare lung-MSC with the well-characterized BM-MSC. Furthermore, MSC isolated from lung-transplanted patients with BOS were compared to patients without BOS. Our study show that lung-MSCs are smaller, possess a higher colony-forming capacity and have a different cytokine profile compared to BM-MSC. Utilizing gene expression profiling, 89 genes including lung-specific FOXF1 and HOXB5 were found to be significantly different between BM-MSC and lung-MSC. No significant differences in cytokine secretion or gene expression were found between MSC isolated from BOS patients compared recipients without BOS. These data demonstrate that lung-resident MSC possess lung-specific properties. Furthermore, these results show that MSC isolated from lung-transplanted patients with BOS do not have an altered phenotype compared to MSC isolated from good outcome recipients.
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Affiliation(s)
- Sara Rolandsson Enes
- Department of Experimental Medical Science, Lung Biology Unit, Lund University, Lund, Sweden
| | | | - Ingrid Skog
- Department of Respiratory Medicine and Allergology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Lennart Hansson
- Department of Respiratory Medicine and Allergology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Hillevi Larsson
- Department of Respiratory Medicine and Allergology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Katarina Le Blanc
- Division of Clinical Immunology; Centre for Allogeneic Stem Cell Transplantation, Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden
| | - Leif Eriksson
- Department of Experimental Medical Science, Lung Biology Unit, Lund University, Lund, Sweden
| | - Leif Bjermer
- Department of Respiratory Medicine and Allergology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Stefan Scheding
- Lund Stem Cell Center, Lund University, Lund, Sweden.,Department of Hematology, Skåne University Hospital, Lund, Sweden
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Gullestad L, Eiskjaer H, Gustafsson F, Riise GC, Karason K, Dellgren G, Rådegran G, Hansson L, Gude E, Bjørtuft Ø, Jansson K, Schultz HH, Solbu D, Iversen M. Long-term outcomes of thoracic transplant recipients following conversion to everolimus with reduced calcineurin inhibitor in a multicenter, open-label, randomized trial. Transpl Int 2016; 29:819-29. [DOI: 10.1111/tri.12783] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 01/20/2016] [Accepted: 04/07/2016] [Indexed: 12/24/2022]
Affiliation(s)
- Lars Gullestad
- Department of Cardiology; Oslo University Hospital Rikshospitalet; Oslo Norway
- Faculty of Medicine; K.G. Jebsen Cardiac Research Centre and Center for Heart Failure Research; University of Oslo; Oslo Norway
| | - Hans Eiskjaer
- Department of Cardiology; Aarhus University Hospital; Skejby Aarhus Denmark
| | - Finn Gustafsson
- Department of Cardiology; Rigshospitalet; Copenhagen Denmark
| | - Gerdt C. Riise
- Department of Respiratory Medicine; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Kristjan Karason
- Department of Cardiology and Transplant Institute; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Göran Dellgren
- Department of Cardiology and Transplant Institute; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Göran Rådegran
- Department of Clinical Sciences Lund, Cardiology; Lund University and the Section for Heart Failure and Valvular Disease; Skåne University Hospital; Lund Sweden
| | - Lennart Hansson
- Department of Respiratory Medicine; Lund University Hospital and Skåne University Hospital; Lund Sweden
| | - Einar Gude
- Department of Cardiology; Oslo University Hospital Rikshospitalet; Oslo Norway
- Faculty of Medicine; K.G. Jebsen Cardiac Research Centre and Center for Heart Failure Research; University of Oslo; Oslo Norway
| | - Øystein Bjørtuft
- Department of Respiratory Medicine; Oslo University Hospital Rikshospitalet; Oslo Norway
| | - Kjell Jansson
- Department of Cardiology, Heart Center; University Hospital; Linkoping Sweden
| | - Hans Henrik Schultz
- Division of Lung Transplantation; Department of Cardiology; Rigshospitalet; Copenhagen Denmark
| | | | - Martin Iversen
- Division of Lung Transplantation; Department of Cardiology; Rigshospitalet; Copenhagen Denmark
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Fakhro M, Ingemansson R, Skog I, Algotsson L, Hansson L, Koul B, Gustafsson R, Wierup P, Lindstedt S. 25-year follow-up after lung transplantation at Lund University Hospital in Sweden: superior results obtained for patients with cystic fibrosis. Interact Cardiovasc Thorac Surg 2016; 23:65-73. [PMID: 27052747 DOI: 10.1093/icvts/ivw078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 11/12/2015] [Accepted: 02/17/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES In Sweden, two centres perform lung transplantation for a population of about 9 million and the entire population is covered for lung transplantation by government health insurance. Lund University Hospital is one of these centres. This retrospective report reviews the 25-year experience of the Skåne University Hospital Lung Transplant Program with particular emphasis on short-term outcome and long-term survival but also between different subgroups of patients and types of transplant [single-lung transplantation (SLTx) versus double-lung transplantation (DLTx)] procedure performed. METHODS Between January 1990 and June 2014, 278 patients underwent lung transplantation at the Skåne University Hospital Sweden. DLTx was performed in 172 patients, SLTx was performed in 97 patients and heart-lung transplantation was performed in 9 patients. In addition, 15 patients required retransplantation (7 DLTx and 8 SLTx). RESULTS Overall 1-, 5-, 10-, 15- and 20-year survival rates were 88, 65, 49, 37 and 19% for the whole cohort. DLTx recipients showed 1-, 5-, 10- and 20-year survival rates of 90, 71, 60 and 30%, compared with SLTx recipients with 1-, 5-, 10- and 20-year survival rates of 83, 57, 34 and 6% (P < 0.05), respectively. Comparing the use of intraoperative extracorporeal membrane oxygenation, extracorporeal circulation (ECC) and no circulatory support in the aspect of survival, a significant difference in favour of intraoperative ECC was seen. CONCLUSIONS Superior long-term survival rates were seen in recipients diagnosed with cystic fibrosis, α1-antitrypsin deficiency and pulmonary hypertension. DLTx showed better results compared with SLTx especially at 10 years post-transplant. In the present study, we present cumulative incidence rates of bronchiolitis obliterans syndrome of 15% at 5 years, 26% at 10 years and 32% at 20 years post-transplant; these figures are in line with the lowest rates presented internationally.
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Affiliation(s)
- Mohammed Fakhro
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Richard Ingemansson
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ingrid Skog
- Department of Pulmonary Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Lars Algotsson
- Department of Thoracic Intensive Care and Anesthesia, Skåne University Hospital, Lund University, Lund, Sweden
| | - Lennart Hansson
- Department of Pulmonary Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Bansi Koul
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ronny Gustafsson
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Per Wierup
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Sandra Lindstedt
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
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23
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Berglind D, Hansson L, Tynelius P, Rasmussen F. Levels of objectively measured physical activity and sedentary behavior in the PRIMROSE trial. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv174.068] [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: 11/12/2022] Open
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Bjorklund A, Carlsten M, Liu L, Schaffer M, Watz E, Palma M, Hansson L, Mollgard L, Cooley S, Miller J, Ljungman P, Hellstrom-Lindberg E, Ljunggren H, Malmberg K. 54 ADOPTIVELY TRANSFERRED HAPLOIDENTICAL NK CELLS AGAINST REFRACTORY MDS, HIGH-RISK MDS AND REFRACTORY AML AS A BRIDGE TO TRANSPLANTATION. COMPLETE REMISSION ASSOCIATED WITH DETECTABLE NK CELLS. Leuk Res 2015. [DOI: 10.1016/s0145-2126(15)30055-2] [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: 11/15/2022]
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Forsman AK, Wahlbeck K, Aaro LE, Alonso J, Barry MM, Brunn M, Cardoso G, Cattan M, de Girolamo G, Eberhard-Gran M, Evans-Lacko S, Fiorillo A, Hansson L, Haro JM, Hazo JB, Hegerl U, Katschnig H, Knappe S, Luciano M, Miret M, Nordentoft M, Obradors-Tarrago C, Pilgrim D, Ruud T, Salize HJ, Stewart-Brown SL, Tomasson K, van der Feltz-Cornelis CM, Ventus DBJ, Vuori J, Varnik A. Research priorities for public mental health in Europe: recommendations of the ROAMER project. Eur J Public Health 2015; 25:249-54. [DOI: 10.1093/eurpub/cku232] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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26
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Hansson L, Öhlund I, Lind T, Stecksén-Blicks C, Rydberg A. Dietary intake in infants with complex congenital heart disease: a case-control study on macro- and micronutrient intake, meal frequency and growth. J Hum Nutr Diet 2014; 29:67-74. [DOI: 10.1111/jhn.12285] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- L. Hansson
- Department of Clinical Science; Pediatric Unit Umeå University; Umeå Sweden
| | - I. Öhlund
- Department of Clinical Science; Pediatric Unit Umeå University; Umeå Sweden
| | - T. Lind
- Department of Clinical Science; Pediatric Unit Umeå University; Umeå Sweden
| | - C. Stecksén-Blicks
- Department of Odontology; Pediatric Dentistry Umeå University; Umeå Sweden
| | - A. Rydberg
- Department of Clinical Science; Pediatric Unit Umeå University; Umeå Sweden
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27
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Tanash HA, Riise GC, Ekström MP, Hansson L, Piitulainen E. Survival benefit of lung transplantation for chronic obstructive pulmonary disease in Sweden. Ann Thorac Surg 2014; 98:1930-5. [PMID: 25443001 DOI: 10.1016/j.athoracsur.2014.07.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 07/05/2014] [Accepted: 07/14/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND Lung transplantation (LTx) is a therapeutic option for patients with life-threatening chronic obstructive pulmonary disease (COPD) that is refractory to conventional therapies. The survival benefit of LTx for COPD is difficult to assess. The aim of this study was to evaluate the Swedish series of LTx performed to treat COPD and to identify differences in outcome between COPD related to severe alpha-1-antitrypsin deficiency (AATD) and COPD with normal alpha-1-antitrypsin (AAT) levels. METHODS We retrospectively reviewed the data of 342 patients (128 AATD and 214 non-AATD) receiving lung transplants for end stage COPD from 1990 through 2012. RESULTS The majority (71%) of patients received a single lung transplant. The median survival time after LTx for all COPD patients was 9 years (95% confidence interval [CI]: 8 to 10). Non-AATD recipients had a shorter survival time than AATD recipients, 6 years (95% CI: 5.0 to 8.8) versus 12 years (95% CI: 9.6 to 13.5, p = 0.000). Mortality was higher among non-AATD recipients after adjusting for age, pack-years of smoking, body mass index, oxygen therapy use, exercise capacity, donor age, cytomegalovirus mismatch, and transplant type (hazard ratio 1.70, 95% CI: 1.02 to 2.82). The 5-year and 10-year survival rates for the AATD recipients were 75% and 59%, respectively, compared with 60% and 31% for the non-AATD recipients. Early deaths were mainly due to cardio/cerebrovascular accidents and sepsis, and late deaths to bronchiolitis obliterans syndrome and pulmonary infections. CONCLUSIONS Survival after LTx is significantly better for patients with severe AATD and end stage COPD than for the patients with COPD related to cigarette smoking.
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Affiliation(s)
- Hanan A Tanash
- Department of Respiratory Medicine, Skåne University Hospital, Lund University, Lund.
| | - Gerdt C Riise
- Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg
| | - Magnus P Ekström
- Department of Respiratory Medicine, Blekinge Hospital Karlskrona, Lund University, Lund, Sweden
| | - Lennart Hansson
- Department of Respiratory Medicine, Skåne University Hospital, Lund University, Lund
| | - Eeva Piitulainen
- Department of Respiratory Medicine, Skåne University Hospital, Lund University, Lund
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28
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Qvist T, Gilljam M, Jönsson B, Taylor-Robinson D, Jensen-Fangel S, Wang M, Svahn A, Kötz K, Hansson L, Hollsing A, Hansen CR, Finstad PL, Pressler T, Høiby N, Katzenstein TL. Epidemiology of nontuberculous mycobacteria among patients with cystic fibrosis in Scandinavia. J Cyst Fibros 2014; 14:46-52. [PMID: 25178871 PMCID: PMC4298356 DOI: 10.1016/j.jcf.2014.08.002] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 08/08/2014] [Accepted: 08/08/2014] [Indexed: 11/28/2022]
Abstract
Background Nontuberculous mycobacteria (NTM) are an emerging threat to cystic fibrosis (CF) patients but their epidemiology is not well described. Methods In this retrospective observational study we identified all Scandinavian CF patients with a positive NTM culture from airway secretions from 2000 to the end of 2012 and used national CF databases to describe microbiological and clinical characteristics. Results During the 13-year period 157 (11%) CF patients were culture positive for NTM at least once. Mycobacterium abscessus complex (MABSC) (45%) and Mycobacterium avium complex (MAC) (32%) were the predominant species with geographical differences in distribution. Younger patients were more prone to MABSC (p < 0.01). Despite treatment, less than one-third of MABSC patients with repeated positive cultures cleared their infection and a quarter had a lung transplant or died. Conclusion NTM are significant CF pathogens and are becoming more prevalent in Scandinavia. MABSC and MAC appear to target distinct patient groups. Having multiple positive cultures despite treatment conveys a poor outcome.
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Affiliation(s)
- Tavs Qvist
- Copenhagen CF Center, Department of Infectious Diseases, University Hospital Rigshospitalet, Denmark.
| | - Marita Gilljam
- Gothenburg CF Center, Department of Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bodil Jönsson
- Clinical Microbiology Laboratories, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | - Mikala Wang
- Department of Clinical Microbiology, Aarhus University Hospital, Denmark
| | - Anita Svahn
- Department of Clinical Microbiology, Karolinska University Hospital, Solna, Sweden
| | - Karsten Kötz
- Gothenburg CF Center, Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lennart Hansson
- Lund CF Center, Department of Respiratory Medicine and Allergology, Skane University Hospital, Sweden
| | | | - Christine R Hansen
- Department of Pediatrics, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Pål L Finstad
- Norwegian Resource Centre for Cystic Fibrosis, Oslo University Hospital, Oslo, Norway
| | - Tania Pressler
- Copenhagen CF Center, Department of Infectious Diseases, University Hospital Rigshospitalet, Denmark
| | - Niels Høiby
- Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Terese L Katzenstein
- Copenhagen CF Center, Department of Infectious Diseases, University Hospital Rigshospitalet, Denmark
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Hansson L, Lindberg U, Inghammar M, Skog I. WS8.6 Bacterial flora in the airways after lung transplantation in patients with cystic fibrosis. J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60057-6] [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: 10/25/2022]
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Eketorp Sylvan S, Lundin J, Ipek M, Palma M, Karlsson C, Hansson L. Alemtuzumab (anti-CD52 monoclonal antibody) as single-agent therapy in patients with relapsed/refractory chronic lymphocytic leukaemia (CLL)—a single region experience on consecutive patients. Ann Hematol 2014; 93:1725-33. [DOI: 10.1007/s00277-014-2105-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 05/07/2014] [Indexed: 10/25/2022]
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Rolandsson S, Andersson Sjöland A, Brune JC, Li H, Kassem M, Mertens F, Westergren A, Eriksson L, Hansson L, Skog I, Bjermer L, Scheding S, Westergren-Thorsson G. Primary mesenchymal stem cells in human transplanted lungs are CD90/CD105 perivascularly located tissue-resident cells. BMJ Open Respir Res 2014; 1:e000027. [PMID: 25478178 PMCID: PMC4212711 DOI: 10.1136/bmjresp-2014-000027] [Citation(s) in RCA: 35] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 04/17/2014] [Accepted: 04/21/2014] [Indexed: 12/21/2022] Open
Abstract
Background Mesenchymal stem cells (MSC) have not only been implicated in the development of lung diseases, but they have also been proposed as a future cell-based therapy for lung diseases. However, the cellular identity of the primary MSC in human lung tissues has not yet been reported. This study therefore aimed to identify and characterise the ‘bona fide’ MSC in human lungs and to investigate if the MSC numbers correlate with the development of bronchiolitis obliterans syndrome in lung-transplanted patients. Methods Primary lung MSC were directly isolated or culture-derived from central and peripheral transbronchial biopsies of lung-transplanted patients and evaluated using a comprehensive panel of in vitro and in vivo assays. Results Primary MSC were enriched in the CD90/CD105 mononuclear cell fraction with mesenchymal progenitor frequencies of up to four colony-forming units, fibroblast/100 cells. In situ staining of lung tissues revealed that CD90/CD105 MSCs were located perivascularly. MSC were tissue-resident and exclusively donor lung-derived even in biopsies obtained from patients as long as 16 years after transplantation. Culture-derived mesenchymal stromal cells showed typical in vitro MSC properties; however, xenotransplantation into non-obese diabetic/severe combined immunodeficient (NOD/SCID) mice showed that lung MSC readily differentiated into adipocytes and stromal tissues, but lacked significant in vivo bone formation. Conclusions These data clearly demonstrate that primary MSC in human lung tissues are not only tissue resident but also tissue-specific. The identification and phenotypic characterisation of primary lung MSC is an important first step in identifying the role of MSC in normal lung physiology and pulmonary diseases.
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Affiliation(s)
- Sara Rolandsson
- Department of Experimental Medical Science, Lung Biology Unit , Lund University , Lund , Sweden
| | | | - Jan C Brune
- Lund Stem Cell Center, Lund University , Lund , Sweden
| | - Hongzhe Li
- Lund Stem Cell Center, Lund University , Lund , Sweden
| | - Moustapha Kassem
- Department of Endocrinology, Molecular Endocrinology Laboratory (KMEB) , University of Southern Denmark , Odense , Denmark
| | - Fredrik Mertens
- Department of Clinical Genetics , University and Regional Laboratories, Lund University , Lund , Sweden
| | - Albert Westergren
- School of Health and Society, Kristianstad University , Lund , Sweden
| | - Leif Eriksson
- Department of Respiratory Medicine and Allergology , Lund University and Skåne University Hospital , Lund , Sweden
| | - Lennart Hansson
- Department of Respiratory Medicine and Allergology , Lund University and Skåne University Hospital , Lund , Sweden
| | - Ingrid Skog
- Department of Respiratory Medicine and Allergology , Lund University and Skåne University Hospital , Lund , Sweden
| | - Leif Bjermer
- Department of Respiratory Medicine and Allergology , Lund University and Skåne University Hospital , Lund , Sweden
| | - Stefan Scheding
- Lund Stem Cell Center, Lund University , Lund , Sweden ; Department of Hematology , Skåne University Hospital , Lund , Sweden
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Sylvan SE, Lundin J, Ipek M, Palma M, Karlsson C, Hansson L. P27. Alemtuzumab (anti-CD52 monoclonal antibody) as single-agent therapy in patients with relapsed/refractory chronic lymphocytic leukaemia (CLL) – a single region experience on consecutive patients. J Immunother Cancer 2014. [PMCID: PMC4072199 DOI: 10.1186/2051-1426-2-s2-p18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
Recent field experiments with impregnated wooden sticks have demonstrated a pronounced use by small rodents of mineral supplies, especially sodium, and such findings seemed related to vole damage to forestry seedlings. Consumption of the bark of experimentally introduced aspen twigs and of sodium-impregnated sticks by voles (mainly or onlyMicrotus agrestis) correlated significantly on clear-cuts but not on unmanipulated abandoned fields. Such a correlation appeared when abandoned fields were cut continuously in summer. At vole peak densities, bark of pine seedlings experimentally fertilized with sodium was consumed but not bark of seedlings fertilized with calcium or control seedlings. Field pine seedlings attacked by voles had significantly higher levels of calcium, sodium, and phosphorus than the nearest untouched seedling. However, sodium and phosphorus contents correlated strongly. Sodium and calcium supply to voles in laboratory feeding trials did not diminish the moderate interest in pine bark. Such conditions are, however, assumed to mimic a situation of bark sampling in low-density populations. Sodium, and possibly also calcium, requirements are concluded to be partial determinants of the destructive bark consumption by voles at the peaks of their multiannual population cycles.
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Affiliation(s)
- L Hansson
- Department of Wildlife Ecology, Swedish University of Agricultural Sciences, 5-750 07, Uppsala, Sweden
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Krjukova J, Hansson L, Meyer P, Gilljam M, Lindblad A, Eriksson-Hollsin A, Vebert-Olesen H, Pressler T, Finstad PL, Mared L, Hjelte L. 252 Survey of malignancies at Scandinavian CF centers. J Cyst Fibros 2013. [DOI: 10.1016/s1569-1993(13)60393-8] [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: 10/26/2022]
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Holm AM, Riise GC, Hansson L, Brinch L, Bjørtuft Ø, Iversen M, Simonsen S, Fløisand Y. Lung transplantation for bronchiolitis obliterans syndrome after allo-SCT. Bone Marrow Transplant 2012; 48:703-7. [DOI: 10.1038/bmt.2012.197] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Hansson L, Svensson B, Björkman T. Quality of life of the mentally ill. Reliability of the Swedish version of the Lancashire Quality of life profile. Eur Psychiatry 2012; 13:231-4. [PMID: 19698631 DOI: 10.1016/s0924-9338(98)80010-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/1997] [Accepted: 05/15/1998] [Indexed: 11/16/2022] Open
Abstract
There has been a growing interest in the quality of life (QoL) of the mentally ill, subsequently a number of instruments to measure QoL have been developed. One of the measures of QoL which has received considerable attention is the Lancashire QoL Profile (LQOLP). The present study investigated test-retest reliability and internal consistency in the Swedish translation of the LQOLP using a cross-sectional sample of 29 inpatients. The results showed that test-retest reliability of subjective life satisfaction in the nine life domains covered by the LQOLP was satisfactory in seven of the domains, and acceptable in two (social relations and religion). Test-retest reliability for total subjective satisfaction score, global well-being, and an interviewer rated QoL were all on a satisfactory level (r > 0.80). The internal consistency and homogeneity of the total subjective QoL scale and the nine life domain subscales was satisfactory except for the social relations scale, where it was somewhat low.
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Holm A, Riise G, Hansson L, Bjørtuft Ø, Brinch L, Simonsen S, Fløisand Y. 147 Lung Transplantation for Chronic Graft Versus Host Disease after Allogeneic Stem Cell Transplantation. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.151] [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: 10/28/2022] Open
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Heimburg K, Skog I, Hansson L. 224 Physical Capacity and Health Related Quality of Life before and One Year after Lung Transplantation. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.231] [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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Andersson-Sjöland A, Thiman L, Nihlberg K, Hallgren O, Rolandsson S, Skog I, Mared L, Hansson L, Eriksson L, Bjermer L, Westergren-Thorsson G. Fibroblast phenotypes and their activity are changed in the wound healing process after lung transplantation. J Heart Lung Transplant 2011; 30:945-54. [PMID: 21624839 DOI: 10.1016/j.healun.2011.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 03/01/2011] [Accepted: 04/10/2011] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Lung transplantation (LTx) is established as a life-saving treatment in end-stage lung disease. However, long-term survival is hampered by the development of chronic rejection, almost synonymous with bronchiolitis obliterans syndrome (BOS). The rejection is characterized by deposition of extracellular matrix in small airways. Fibroblasts/myofibroblasts are the main producers of extracellular matrix molecules such as proteoglycans. This study compared fibroblast phenotype and activity in the wound healing process at different points after LTx in patients who later did, or did not, develop BOS. METHODS Distally derived fibroblasts from patients 6 and 12 months after LTx and from healthy controls were analyzed for production of the proteoglycans versican, perlecan, biglycan, and decorin, with and without transforming growth factor (TGF)-β(1). Fibroblast migration and proliferation were also studied. RESULTS At 6 and 12 months after LTx, versican production was higher in fibroblasts from LTx patients (p < 0.01 p < 0.01) than from controls. Fibroblasts from patients who later developed BOS were more responsive to TGF-β(1)-induced synthesis of versican and biglycan than patients without signs of rejection (p < 0.05). Production of perlecan and decorin was negatively correlated with fibroblast proliferation in fibroblasts at 6 months after LTx. In a more detailed case study of 2 patients, one with and one without BOS, the altered proteoglycan profile was associated with impaired lung function. CONCLUSIONS LTx changes the phenotype of fibroblasts to a non-proliferative but extracellular matrix-producing cell due to wound healing involving TGF-β(1). If not controlled, this may lead to development of BOS.
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Joergensen R, Hansson L, Zoffmann V, Munk-Joergensen P. Improving insight in patients diagnosed with schizophrenia and understanding insight from a patient perspective - a mixed methods study. Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)73115-7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The method Guided Self-Determination (GSD), originally developed and proven effective in difficult diabetes care, has been adjusted to patients with schizophrenia. Currently a randomised controlled study investigates if the method GSD has effect on the outcomes insight, self-esteem, recovery, psychopathology and social functioning when applied in psychiatric care in 3 Assertive Outreach Teams and 3 Psychosis Teams.As an extension from the RCT we just started a qualitative study using Classic Grounded Theory. The overall approach is a Mixed Methods Approach with a Sequential Explanatory Strategy.The RCT hypothesize that the method GSD improves both clinical and cognitive insight in patients, measured by Birchwood Insight Scale and Beck Cognitive Insight Scale that both are self-rating scales. Lack of insight into illness is often associated with patients diagnosed with schizophrenia. Also poorer treatment compliance, clinical outcome, social functioning and response to vocational rehabilitation are linked to lack of insight.In the literature lack of insight is a complex and multi dimensional phenomenon with disagreement on etiology but always described and investigated from health professionals’ perspective. Both insight self-rating scales are also developed by and represent health professionals’ perspective on insight. Apparently it appears that the patients’ perspective and understanding of insight is missing in the literature.The qualitative study will both aim on identifying patients’ perspective on insight, emerging in a grounded theory and the grounded theory elaborating on the results on clinical and cognitive insight from the RCT.The poster will illustrate the two designs in a Mixed Methods Approach.
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Ohlson S, Duong-Thi MD, Bergström M, Fex T, Hansson L, Pedersen L, Guazotti S, Isaksson R. Toward high-throughput drug screening on a chip-based parallel affinity separation platform. J Sep Sci 2011; 33:2575-81. [PMID: 20730836 DOI: 10.1002/jssc.201000314] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
High-throughput screening of compound libraries, including the study of fragments, has become one of the cornerstones in modern drug discovery research. During this process hits are defined that may be developed into valuable leads and eventually into possible drug candidates. In this paper, we have demonstrated that parallel zonal weak affinity chromatography in microcolumns on a chip offers a possible screening format for weakly binding ligands toward a protein target. We used albumin as a model system because this transport protein is well established as a binder (both weak and strong) for drug substances. Bovine serum albumin was immobilized on microparticulate diolsilica particles and then packed into a 24-channel cartridge, which served as the separation platform. Analysis of the obtained chromatograms yielded information about affinity even in the millimolar range. Employing this approach, thousands of substances can be screened in just a day. We feel confident that zonal affinity chromatography will provide a useful technology in the future for performing high-throughput screening.
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Affiliation(s)
- Sten Ohlson
- School of Natural Sciences, Linnaeus University, Kalmar, Sweden.
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Hansson L, Lithell H, Skoog I, Bánki CM, Breteler M, Castaigne A, Correia M, Degaute JP, Elmfeldt D, Engedal K, Farsang C, Ferro J, Hachinski V, Hofman A, James OFW, Krisin E, Leeman M, de Leeuw PW, Leys D, Lobo A, Nordby G, Olofsson B, Opolski G, Prince M, Reischies FM, Rosenfeld JB, Ruilope L, Salerno J, Tilvis R J, Trenkwalder P, Zanchetti A. Study on COgnition and Prognosis in the Elderly (SCOPE): Baseline Characteristics. Blood Press 2010. [DOI: 10.1080/080370500453483999] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Matthiessen P, Hansson L, Sjödahl R, Rutegård J. Anastomotic-vaginal fistula (AVF) after anterior resection of the rectum for cancer--occurrence and risk factors. Colorectal Dis 2010; 12:351-7. [PMID: 19220383 DOI: 10.1111/j.1463-1318.2009.01798.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [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: 12/11/2022]
Abstract
OBJECTIVE The aim of the study was to assess recto-vaginal fistula (RVF) after anterior resection of the rectum for cancer with regard to occurrence and risk factors. METHOD All female patients [median age 69.5 years, Union Internationale centre le Cancer (UICC) cancer stage IV in 10%] who developed a symptomatic RVF (n = 20) after anterior resection of the rectum for cancer from three separate cohorts of patients were identified and compared with those who developed conventional symptomatic leakage (n = 32), and those who did not leak (n = 338). Patient demography and perioperative data were compared between these three groups. Fourteen patient-related and surgery-related variables thought to be possible risk factors for RVF (anastomotic-vaginal fistula) were analysed. RESULTS Symptomatic anastomotic leakage occurred in 52 (13.3%) of 390 patients. Twenty (5.1%) had an anastomotic-vaginal fistula (AVF) and 32 (8.2%) conventional leakage (CL). Patients with AVF required unscheduled re-operation and defunctioning stoma as often as those with CL. AVF was diagnosed later and more often after discharge from hospital compared with CL. Patients with AVF had lower anastomoses and decreased BMI compared with those with CL. Risk factors for AVF in multivariate analysis were anastomosis < 5 cm above the anal verge (P = 0.001), preoperative radiotherapy (P = 0.004), and UICC cancer stage IV (P = 0.005). Previous hysterectomy was a risk factor neither for AVF nor for CL. CONCLUSION Anastomotic-vaginal fistula forms a significant part of all symptomatic leakages after low anterior resection for cancer in women. Although diagnosed later, the need for abdominal re-operation and defunctioning stoma was not different from patients with CL. Risk factors for AVF included low anastomosis, preoperative radiotherapy and UICC cancer stage IV.
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Affiliation(s)
- P Matthiessen
- Department of Surgery, Orebro University Hospital, Orebro, Sweden.
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Hansson L, Huunan-Seppala A, Mattila A. The Content of Calcium, Magnesium, Copper, Zinc, Lead and Chromium in the Blood of Patients with Rheumatoid Arthritis. Scand J Rheumatol 2009. [DOI: 10.1080/03009747509095612] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lundberg B, Hansson L, Wentz E, Björkman T. Are stigma experiences among persons with mental illness, related to perceptions of self-esteem, empowerment and sense of coherence? J Psychiatr Ment Health Nurs 2009; 16:516-22. [PMID: 19594673 DOI: 10.1111/j.1365-2850.2009.01418.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [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: 11/27/2022]
Abstract
The aim of the study was to explore the relationship between stigmatizing rejection experiences and self-related variables. Our hypothesis was that rejection experiences would be negatively associated with perceptions of self-esteem, empowerment and sense of coherence. A cross-sectional study assessing rejection experiences, empowerment, sense of coherence and self-esteem was performed, including 200 persons in current or earlier contact with mental health services. The results showed that experiences of rejection were negatively associated with sense of coherence, empowerment and self-esteem. This exploratory investigation suggests that experiences of rejection might be a target for coping interventions. Mental health nurses are in a key position to identify patients' experiences of stigma and by that to understand what consequences of devaluation/discrimination can have for the afflicted.
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Affiliation(s)
- B Lundberg
- Health Sciences Centre, Lund University, Lund, Sweden.
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Eklund M, Hansson L. Features of the Ward Atmosphere in a Psychiatric Day Care Unit Based on Occupational Therapy – a Comparative Study. Scand J Occup Ther 2009. [DOI: 10.3109/11038129509106672] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
A novel design for intervention studies is presented, the so called PROBE study (Prospective Randomized Open, Blinded End-point). This design is compared to the classical double-blind design. Among the advantages of the PROBE design are lower cost and greater similarity to standard clinical practice, which should make the results more easily applicable in routine medical care. Since end-points are evaluated by a blinded end-point committee it is obvious that there should be no difference between the two types of trials in this regard.
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Affiliation(s)
- L Hansson
- Department of Medicine, University of Göteborg, Ostra Hospital, Sweden
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