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Andrén P, Sampaio F, Ringberg H, Wachtmeister V, Warnström M, Isomura K, Aspvall K, Lenhard F, Hall CL, Davies EB, Murphy T, Hollis C, Feldman I, Bottai M, Serlachius E, Andersson E, Fernández de la Cruz L, Mataix-Cols D. Internet-Delivered Exposure and Response Prevention for Pediatric Tourette Syndrome: 12-Month Follow-Up of a Randomized Clinical Trial. JAMA Netw Open 2024; 7:e248468. [PMID: 38700867 PMCID: PMC11069081 DOI: 10.1001/jamanetworkopen.2024.8468] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/27/2024] [Indexed: 05/06/2024] Open
Abstract
Importance Behavior therapy is a recommended intervention for Tourette syndrome (TS) and chronic tic disorder (CTD), but availability is limited and long-term effects are uncertain. Objective To investigate the long-term efficacy and cost-effectiveness of therapist-supported, internet-delivered exposure and response prevention (ERP) vs psychoeducation for youths with TS or CTD. Design, Setting, And Participants This 12-month controlled follow-up of a parallel group, superiority randomized clinical trial was conducted at a research clinic in Stockholm, Sweden, with nationwide recruitment. In total, 221 participants aged 9 to 17 years with TS or CTD were enrolled between April 26, 2019, and April 9, 2021, of whom 208 (94%) provided 12-month follow-up data. Final follow-up data were collected on June 29, 2022. Outcome assessors were masked to treatment allocation throughout the study. Interventions A total of 111 participants were originally randomly allocated to 10 weeks of therapist-supported, internet-delivered ERP and 110 participants to therapist-supported, internet-delivered psychoeducation. Main Outcomes And Measures The primary outcome was within-group change in tic severity, measured by the Total Tic Severity Score of the Yale Global Tic Severity Scale (YGTSS-TTSS), from the 3-month follow-up to the 12-month follow-up. Treatment response was defined as 1 (very much improved) or 2 (much improved) on the Clinical Global Impression-Improvement scale. Analyses were intention-to-treat and followed the plan prespecified in the published study protocol. A health economic evaluation was performed from 3 perspectives: health care organization (including direct costs for treatment provided in the study), health care sector (additionally including health care resource use outside of the study), and societal (additionally including costs beyond health care [eg, parent's absenteeism from work]). Results In total, 221 participants were recruited (mean [SD] age, 12.1 [2.3] years; 152 [69%] male). According to the YGTSS-TTSS, there were no statistically significant changes in tic severity from the 3-month to the 12-month follow-up in either group (ERP coefficient, -0.52 [95% CI, -1.26 to 0.21]; P = .16; psychoeducation coefficient, 0.00 [95% CI, -0.78 to 0.78]; P > .99). A secondary analysis including all assessment points (baseline to 12-month follow-up) showed no statistically significant between-group difference in tic severity from baseline to the 12-month follow-up (coefficient, -0.38 [95% CI, -1.11 to 0.35]; P = .30). Treatment response rates were similar in both groups (55% in ERP and 50% in psychoeducation; odds ratio, 1.25 [95% CI, 0.73-2.16]; P = .42) at the 12-month follow-up. The health economic evaluation showed that, from a health care sector perspective, ERP produced more quality-adjusted life years (0.01 [95% CI, -0.01 to 0.03]) and lower costs (adjusted mean difference -$84.48 [95% CI, -$440.20 to $977.60]) than psychoeducation at the 12-month follow-up. From the health care organization and societal perspectives, ERP produced more quality-adjusted life years at higher costs, with 65% to 78% probability of ERP being cost-effective compared with psychoeducation when using a willingness-to-pay threshold of US $79 000. Conclusions And Relevance There were no statistically significant changes in tic severity from the 3-month through to the 12-month follow-up in either group. The ERP intervention was not superior to psychoeducation at any time point. While ERP was not superior to psychoeducation alone in reducing tic severity at the end of the follow-up period, ERP is recommended for clinical implementation due to its likely cost-effectiveness and support from previous literature. Trial Registration ClinicalTrials.gov Identifier: NCT03916055.
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Affiliation(s)
- Per Andrén
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Clinical Sciences, Lund, Lund University, Lund, Sweden
| | - Filipa Sampaio
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Helene Ringberg
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Vera Wachtmeister
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Moa Warnström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Kayoko Isomura
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Kristina Aspvall
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Fabian Lenhard
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Charlotte L. Hall
- National Institute for Health and Care Research MindTech MedTech Co-Operative, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health and Care Research Nottingham Biomedical Research Centre, Institute of Mental Health, Mental Health and Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom
| | - E. Bethan Davies
- National Institute for Health and Care Research MindTech MedTech Co-Operative, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Tara Murphy
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children, Great Ormond Street, London, United Kingdom
| | - Chris Hollis
- National Institute for Health and Care Research MindTech MedTech Co-Operative, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health and Care Research Nottingham Biomedical Research Centre, Institute of Mental Health, Mental Health and Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom
| | - Inna Feldman
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Matteo Bottai
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Eva Serlachius
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Sciences, Lund, Lund University, Lund, Sweden
| | - Erik Andersson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Clinical Sciences, Lund, Lund University, Lund, Sweden
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Tidblad A, Bottai M, Smedby KE, Albertsson-Wikland K, Sävendahl L. Long-term risk of neoplastic events after childhood growth hormone treatment: a population-based cohort study in Sweden. Front Endocrinol (Lausanne) 2024; 15:1360139. [PMID: 38505755 PMCID: PMC10948557 DOI: 10.3389/fendo.2024.1360139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/19/2024] [Indexed: 03/21/2024] Open
Abstract
Background Increased risk of neoplastic events after recombinant human growth hormone (rhGH) treatment in childhood has been an ongoing concern but long-term safety data are limited. Methods A nationwide population-based cohort study in Sweden of patients treated with rhGH during childhood between 1985-2010, due to isolated growth hormone deficiency (GHD), small for gestational age (SGA) and idiopathic short stature (ISS). The comparison group consisted of 15 age-, sex-, and region-matched controls per patient, randomly selected from the general population. Data on neoplastic events and covariates, such as gestational age, birth weight, birth length, socioeconomic status, and height at study start, were collected through linkage with population-based registers. The cohort was followed for neoplastic events until the end of 2020. Results 53,444 individuals (3,408 patients; 50,036 controls) were followed for up to 35 years, with a median follow-up of 19.8 years and a total of 1,050,977 person-years. Patients showed a moderately increased hazard ratio (HR) for neoplastic events overall compared to controls (HR 1.28, 95% CI: 1.12-1.46), but only significant for males (HR 1.39, 95% CI: 1.17-1.66) and not females (HR 1.15, 95% CI: 0.94-1.41). Longer treatment duration was associated with an increased HR, but no association was found between neoplastic events and mean or cumulative dose. No increased risk of malignant neoplasms was observed for the patients compared to matched controls (HR 0.91 95% CI: 0.66-1.26). Conclusion No association was found between rhGH treatment during childhood for GHD, SGA, or ISS and malignant neoplastic events in early to mid-adulthood. A moderate increase in overall neoplastic events was observed due to an increased number of events in male patients.
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Affiliation(s)
- Anders Tidblad
- Department of Women’s and Children’s Health, Karolinska Institutet and Division of Pediatric Endocrinology, Karolinska University Hospital, Solna, Sweden
| | - Matteo Bottai
- Unit of Biostatistics, Department of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Karin E. Smedby
- Division of Clinical Epidemiology (KEP), Department of Medicine Solna, Karolinska Institutet, and Department of Hematology, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Kerstin Albertsson-Wikland
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Lars Sävendahl
- Department of Women’s and Children’s Health, Karolinska Institutet and Division of Pediatric Endocrinology, Karolinska University Hospital, Solna, Sweden
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3
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Rautiola J, Björklund J, Zelic R, Edgren G, Bottai M, Nilsson M, Vincent PH, Fredholm H, Falconer H, Sjövall A, Nilsson PJ, Wiklund P, Aly M, Akre O. Risk of Postoperative Ischemic Stroke and Myocardial Infarction in Patients Operated for Cancer. Ann Surg Oncol 2024; 31:1739-1748. [PMID: 38091152 PMCID: PMC10838243 DOI: 10.1245/s10434-023-14688-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/13/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND Risk assessment for ischemic stroke (IS) and myocardial infarction (MI) is done routinely before surgery, but the increase in risks associated with surgery is not known. The aim of this study is to assess the risk of arterial ischemic events during the first year after oncological surgery. METHODS We used Swedish healthcare databases to identify 443,300 patients who underwent cancer surgery between 1987 and 2016 and 4,127,761 matched comparison subjects. We estimated odds ratios (ORs) for myocardial infarction and ischemic stroke during the hospitalization with logistic regression and calculated 1-year cumulative incidences and hazard ratios (HRs) with 95% confidence intervals (CIs) for the outcomes after discharge. RESULTS The cumulative incidences of myocardial infarction and ischemic stroke during the first postoperative year were 1.33% and 1.25%, respectively. In the comparison cohort, the corresponding 1-year cumulative incidences were 1.04% and 1.00%. During the hospitalization, the OR for myocardial infarction was 8.81 (95% CI 8.24-9.42) and the OR for ischemic stroke was 6.71 (95% CI 6.22-7.23). After discharge, the average HR during follow-up for 365 days was 0.90 (95% CI 0.87-0.93) for myocardial infarction and 1.02 (95% CI 0.99-1.05) for ischemic stroke. CONCLUSIONS We found an overall increased risk of IS and MI during the first year after cancer surgery that was attributable to events occurring during the hospitalization period. After discharge from the hospital, the overall risk of myocardial infarction was lower among the cancer surgery patients than among matched comparison subjects.
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Affiliation(s)
- Juhana Rautiola
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden.
| | - Johan Björklund
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Renata Zelic
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Gustaf Edgren
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, Stockholm, Sweden
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Nilsson
- Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Per Henrik Vincent
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Hanna Fredholm
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Falconer
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Annika Sjövall
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Per J Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Wiklund
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Markus Aly
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Olof Akre
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
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Rautiola J, Björklund J, Zelic R, Edgren G, Bottai M, Nilsson M, Vincent PH, Fredholm H, Falconer H, Sjövall A, Nilsson PJ, Wiklund P, Aly M, Akre O. ASO Author Reflections: Arterial Ischemic Events Following Cancer Surgery: Where Do We Stand? Ann Surg Oncol 2024; 31:1789-1790. [PMID: 38206503 PMCID: PMC10838233 DOI: 10.1245/s10434-023-14816-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Juhana Rautiola
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden.
| | - Johan Björklund
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Renata Zelic
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Gustaf Edgren
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet and Department of Cardiology, Södersjukhuset, Stockholm, Sweden
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Nilsson
- Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Per Henrik Vincent
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Hanna Fredholm
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Falconer
- Department of Pelvic Cancer, Karolinska University Hospital and Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Annika Sjövall
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Per J Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Wiklund
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Markus Aly
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Olof Akre
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
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Björklund J, Rautiola J, Zelic R, Edgren G, Bottai M, Nilsson M, Vincent PH, Fredholm H, Falconer H, Sjövall A, Nilsson PJ, Wiklund P, Aly M, Akre O. Risk of Venous Thromboembolic Events After Surgery for Cancer. JAMA Netw Open 2024; 7:e2354352. [PMID: 38306100 PMCID: PMC10837742 DOI: 10.1001/jamanetworkopen.2023.54352] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/11/2023] [Indexed: 02/03/2024] Open
Abstract
Importance The risks and benefits of thromboprophylaxis therapy after cancer surgery are debated. Studies that determine thrombosis risk after cancer surgery with high accuracy are needed. Objectives To evaluate 1-year risk of venous thromboembolic events after major cancer surgery and how these events vary over time. Design, Setting, and Participants This register-based retrospective observational matched cohort study included data on the full population of Sweden between 1998 and 2016. All patients who underwent major surgery for cancer of the bladder, breast, colon or rectum, gynecologic organs, kidney and upper urothelial tract, lung, prostate, or gastroesophageal tract were matched in a 1:10 ratio with cancer-free members of the general population on year of birth, sex, and county of residence. Data were analyzed from February 13 to December 5, 2023. Exposure Major surgery for cancer. Main Outcomes and Measures The main outcome was incidence of venous thromboembolic events within 1 year after the surgery. Crude absolute risks and risk differences of events within 1 year and adjusted time-dependent cause-specific hazard ratios (HRs) of postdischarge events were calculated. Results A total of 432 218 patients with cancer (median age, 67 years [IQR, 58-75 years]; 68.7% women) and 4 009 343 cancer-free comparators (median age, 66 years [IQR, 57-74 years]; 69.3% women) were included in the study. The crude 1-year cumulative risk of pulmonary embolism was higher among the cancer surgery population for all cancers, with the following absolute risk differences: for bladder cancer, 2.69 percentage points (95% CI, 2.33-3.05 percentage points); for breast cancer, 0.59 percentage points (95% CI 0.55-0.63 percentage points); for colorectal cancer, 1.57 percentage points (95% CI, 1.50-1.65 percentage points); for gynecologic organ cancer, 1.32 percentage points (95% CI, 1.22-1.41 percentage points); for kidney and upper urinary tract cancer, 1.38 percentage points (95% CI, 1.21-1.55 percentage points); for lung cancer, 2.61 percentage points (95% CI, 2.34-2.89 percentage points); for gastroesophageal cancer, 2.13 percentage points (95% CI, 1.89-2.38 percentage points); and for prostate cancer, 0.57 percentage points (95% CI, 0.49-0.66 percentage points). The cause-specific HR of pulmonary embolism comparing patients who underwent cancer surgery with matched comparators peaked just after discharge and generally plateaued 60 to 90 days later. At 30 days after surgery, the HR was 10 to 30 times higher than in the comparison cohort for all cancers except breast cancer (colorectal cancer: HR, 9.18 [95% CI, 8.03-10.50]; lung cancer: HR, 25.66 [95% CI, 17.41-37.84]; breast cancer: HR, 5.18 [95% CI, 4.45-6.05]). The hazards subsided but never reached the level of the comparison cohort except for prostate cancer. Similar results were observed for deep vein thrombosis. Conclusions and Relevance This cohort study found an increased rate of venous thromboembolism associated with cancer surgery. The risk persisted for about 2 to 4 months postoperatively but varied between cancer types. The increased rate is likely explained by the underlying cancer disease and adjuvant treatments. The results highlight the need for individualized venous thromboembolism risk evaluation and prophylaxis regimens for patients undergoing different surgery for different cancers.
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Affiliation(s)
- Johan Björklund
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Juhana Rautiola
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Renata Zelic
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Gustaf Edgren
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, Stockholm, Sweden
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Nilsson
- Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Per Henrik Vincent
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Hanna Fredholm
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Falconer
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Annika Sjövall
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Per J. Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Wiklund
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Markus Aly
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Olof Akre
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
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Saygin D, Glaubitz S, Zeng R, Bottai M, de Visser M, Dimachkie MM, Fiorentino D, Gerhardson I, Kuwana M, Miller FW, Needham M, Rider LG, Salem Y, Schlüter S, Shinjo SK, Wang G, Werth VP, Aggarwal R, Lundberg IE. Performance of the 2017 EULAR/ACR Classification Criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups: a scoping review. Clin Exp Rheumatol 2024; 42:403-412. [PMID: 38436279 PMCID: PMC11095985 DOI: 10.55563/clinexprheumatol/vuc5py] [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: 10/30/2023] [Accepted: 01/22/2024] [Indexed: 03/05/2024]
Abstract
The 2017 EULAR/ACR classification criteria for adult/juvenile idiopathic inflammatory myopathies (IIM) were established using a data-driven approach by an international group of myositis experts to allow classification of IIM and its major subtypes. Since their publication, the performance of the criteria has been tested in multiple cohorts worldwide and significant limitations have been identified. Moreover, the understanding and classification of IIM have evolved since 2017. This scoping review was undertaken as part of a large international project to revise the EULAR/ACR criteria and aims to i) summarise the evidence from the current literature on the performance characteristics of the 2017 EULAR/ACR classification criteria in various cohorts and IIM subtypes, and ii) delineate the factors that need to be considered in the revision of the classification criteria. A systematic search of Medline (via PubMed), Cumulative Index to Nursing and Allied Health Literature, and conference abstract archives was conducted independently by three investigators for studies on the EULAR/ACR criteria published between October 2017 and January 2023. This scoping review of 19 articles and 13 abstracts revealed overall good performance characteristics of the EULAR/ACR criteria for IIM, yet deficiencies in lack of inclusion of certain IIM subtypes, such as immune mediated necrotising myopathy, amyopathic dermatomyositis, antisynthetase syndrome and overlap myositis. Published modifications that may improve the performance characteristics of the criteria for classification of IIM subtypes were also summarised. The results of this review suggest that a revision of the EULAR/ACR criteria is warranted.
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Affiliation(s)
- Didem Saygin
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, PA, USA
| | - Stefanie Glaubitz
- Department of Neurology, University Medical Center Göttingen, Germany
| | - Rachel Zeng
- Department of Neurology, University Medical Center Göttingen, Germany
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marianne de Visser
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Mazen M Dimachkie
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - David Fiorentino
- Department of Dermatology, Stanford University School of Medicine, Redwood City, CA, USA
| | | | - Masataka Kuwana
- Department of Allergy and Rheumatology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Frederick W Miller
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Merrilee Needham
- Department of Neurology, Fiona Stanley Hospital, IIID Murdoch University and University of Notre Dame, Perth, Australia
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Yasser Salem
- Physical Therapy Program, Hofstra University, Hemstead, NY, USA
| | - Silke Schlüter
- Diagnosegruppe Myositis, Deutsche Gesellschaft für Muskelkranke, Freiburg, Germany
| | - Samuel K Shinjo
- Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de São Paulo, Brazil
| | - Guochun Wang
- Department of Rheumatology, The Key Laboratory of Myositis, China-Japan Friendship Hospital, Beijing, China
| | - Victoria P Werth
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, and Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA
| | - Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, PA, USA.
| | - Ingrid E Lundberg
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm; and Department of Gastroenterology, Dermatology and Rheumatology, Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
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7
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He S, Lundberg B, Hallberg J, Klevebro S, Pershagen G, Eneroth K, Melén E, Bottai M, Gruzieva O. Joint association of air pollution exposure and inflammation-related proteins in relation to infant lung function. Int J Hyg Environ Health 2024; 255:114294. [PMID: 37952388 DOI: 10.1016/j.ijheh.2023.114294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/21/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND AND AIM Systemic inflammation is one potential mechanism underlying negative impact of air pollution on lung function. Levels of inflammation-related proteins have the potential to characterize infants' susceptibility to air pollution induced lung function impairment. This study aimed to examine the interplay between air pollution exposure and inflammation-related proteins on lung function in 6-months-old infants. METHODS In the EMIL birth cohort from Stockholm (n = 82), dynamic spirometry, along with measurement of plasma levels of 92 systemic inflammation-related proteins (Olink Proseek Multiplex Inflammation panel) have been carried out in infants aged six months. Time-weighted average exposure to particles with an aerodynamic diameter of <10 μm (PM10), <2.5 μm (PM2.5), and nitrogen dioxide (NO2) at residential addresses from birth and onwards was estimated via validated dispersion models. To characterize the abnormality of inflammation-related protein profile, for each protein in each infant, we calculated the relative deviance of the protein level from age- and sex-specific median in terms of its age- and sex-specific interquartile range (IQR), followed by computing the absolute value of the smallest relative deviance, "minimum absolute deviance". Using linear regression models, interaction of air pollution and the abnormal inflammatory profile on lung function was estimated on the additive scale. RESULTS We found joint association of PM exposure and an abnormal inflammatory protein profile in relation to FEV0.5 and FVC. For 0.1 unit increase in minimum absolute deviance, one IQR increase in PM10 was associated with 85.9 ml (95% CI: -122.9, -48.9) additional decrease in FEV0.5, and 72.3 ml (95% CI: -121.5, -23.2) additional decrease in FVC. Similar results were obtained with PM2.5 exposure, while less apparent for NO2. CONCLUSIONS Early life air pollution exposure and abnormal inflammation-related protein profiles may interact synergistically towards lower lung function in infants.
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Affiliation(s)
- Shizhen He
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Björn Lundberg
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Jenny Hallberg
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Susanna Klevebro
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Eneroth
- Environment and Health Administration, SLB-analys, Stockholm, Sweden
| | - Erik Melén
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Matteo Bottai
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Olena Gruzieva
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
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8
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Ekvall KO, Bottai M. Concave likelihood-based regression with finite-support response variables. Biometrics 2023; 79:2286-2297. [PMID: 36128638 DOI: 10.1111/biom.13760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 09/14/2022] [Indexed: 11/28/2022]
Abstract
We propose a unified framework for likelihood-based regression modeling when the response variable has finite support. Our work is motivated by the fact that, in practice, observed data are discrete and bounded. The proposed methods assume a model which includes models previously considered for interval-censored variables with log-concave distributions as special cases. The resulting log-likelihood is concave, which we use to establish asymptotic normality of its maximizer as the number of observations n tends to infinity with the number of parameters d fixed, and rates of convergence of L1 -regularized estimators when the true parameter vector is sparse and d and n both tend to infinity withlog ( d ) / n → 0 $\log (d) / n \rightarrow 0$ . We consider an inexact proximal Newton algorithm for computing estimates and give theoretical guarantees for its convergence. The range of possible applications is wide, including but not limited to survival analysis in discrete time, the modeling of outcomes on scored surveys and questionnaires, and, more generally, interval-censored regression. The applicability and usefulness of the proposed methods are illustrated in simulations and data examples.
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Affiliation(s)
- K O Ekvall
- Department of Statistics, University of Florida, Gainesville, Florida, USA
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - M Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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9
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Hu J, Serra‐Picamal X, Bakker G, Van Troys M, Winograd‐Katz S, Ege N, Gong X, Didan Y, Grosheva I, Polansky O, Bakkali K, Van Hamme E, van Erp M, Vullings M, Weiss F, Clucas J, Dowbaj AM, Sahai E, Ampe C, Geiger B, Friedl P, Bottai M, Strömblad S. Multisite assessment of reproducibility in high-content cell migration imaging data. Mol Syst Biol 2023; 19:e11490. [PMID: 37063090 PMCID: PMC10258559 DOI: 10.15252/msb.202211490] [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: 12/02/2022] [Revised: 03/27/2023] [Accepted: 03/30/2023] [Indexed: 04/18/2023] Open
Abstract
High-content image-based cell phenotyping provides fundamental insights into a broad variety of life science disciplines. Striving for accurate conclusions and meaningful impact demands high reproducibility standards, with particular relevance for high-quality open-access data sharing and meta-analysis. However, the sources and degree of biological and technical variability, and thus the reproducibility and usefulness of meta-analysis of results from live-cell microscopy, have not been systematically investigated. Here, using high-content data describing features of cell migration and morphology, we determine the sources of variability across different scales, including between laboratories, persons, experiments, technical repeats, cells, and time points. Significant technical variability occurred between laboratories and, to lesser extent, between persons, providing low value to direct meta-analysis on the data from different laboratories. However, batch effect removal markedly improved the possibility to combine image-based datasets of perturbation experiments. Thus, reproducible quantitative high-content cell image analysis of perturbation effects and meta-analysis depend on standardized procedures combined with batch correction.
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Affiliation(s)
- Jianjiang Hu
- Department of Biosciences and NutritionKarolinska InstitutetStockholmSweden
| | | | - Gert‐Jan Bakker
- Department of Medical BioSciencesRadboud University Medical CenterNijmegenThe Netherlands
| | | | - Sabina Winograd‐Katz
- Department of Immunology and Regenerative BiologyWeizmann Institute of ScienceRehovotIsrael
| | - Nil Ege
- The Francis Crick InstituteLondonUK
| | - Xiaowei Gong
- Department of Biosciences and NutritionKarolinska InstitutetStockholmSweden
| | - Yuliia Didan
- Department of Biosciences and NutritionKarolinska InstitutetStockholmSweden
| | - Inna Grosheva
- Department of Immunology and Regenerative BiologyWeizmann Institute of ScienceRehovotIsrael
| | - Omer Polansky
- Department of Immunology and Regenerative BiologyWeizmann Institute of ScienceRehovotIsrael
| | - Karima Bakkali
- Department of Biomolecular MedicineGhent UniversityGhentBelgium
| | | | - Merijn van Erp
- Department of Medical BioSciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Manon Vullings
- Department of Medical BioSciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Felix Weiss
- Department of Medical BioSciencesRadboud University Medical CenterNijmegenThe Netherlands
| | | | | | | | - Christophe Ampe
- Department of Biomolecular MedicineGhent UniversityGhentBelgium
| | - Benjamin Geiger
- Department of Immunology and Regenerative BiologyWeizmann Institute of ScienceRehovotIsrael
| | - Peter Friedl
- Department of Medical BioSciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental MedicineKarolinska InstitutetStockholmSweden
| | - Staffan Strömblad
- Department of Biosciences and NutritionKarolinska InstitutetStockholmSweden
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10
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Bottai M. Scientific practice in medical research. Acta Paediatr 2023. [PMID: 37194735 DOI: 10.1111/apa.16818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 05/05/2023] [Indexed: 05/18/2023]
Affiliation(s)
- Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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11
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Xie SH, Santoni G, Bottai M, Gottlieb-Vedi E, Lagergren P, Lagergren J. Prediction of conditional survival in esophageal cancer in a population-based cohort study. Int J Surg 2023; 109:1141-1148. [PMID: 36999825 PMCID: PMC10389626 DOI: 10.1097/js9.0000000000000347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/06/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND The authors aimed to produce a prediction model for survival at any given date after surgery for esophageal cancer (conditional survival), which has not been done previously. MATERIALS AND METHODS Using joint density functions, the authors developed and validated a prediction model for all-cause and disease-specific mortality after surgery with esophagectomy, for esophageal cancer, conditional on postsurgery survival time. The model performance was assessed by the area under the receiver operating characteristic curve (AUC) and risk calibration, with internal cross-validation. The derivation cohort was a nationwide Swedish population-based cohort of 1027 patients treated in 1987-2010, with follow-up throughout 2016. This validation cohort was another Swedish population-based cohort of 558 patients treated in 2011-2013, with follow-up throughout 2018. RESULTS The model predictors were age, sex, education, tumor histology, chemo(radio)therapy, tumor stage, resection margin status, and reoperation. The medians of AUC after internal cross-validation in the derivation cohort were 0.74 (95% CI: 0.69-0.78) for 3-year all-cause mortality, 0.76 (95% CI: 0.72-0.79) for 5-year all-cause mortality, 0.74 (95% CI: 0.70-0.78) for 3-year disease-specific mortality, and 0.75 (95% CI: 0.72-0.79) for 5-year disease-specific mortality. The corresponding AUC values in the validation cohort ranged from 0.71 to 0.73. The model showed good agreement between observed and predicted risks. Complete results for conditional survival any given date between 1 and 5 years of surgery are available from an interactive web-tool: https://sites.google.com/view/pcsec/home . CONCLUSION This novel prediction model provided accurate estimates of conditional survival any time after esophageal cancer surgery. The web-tool may help guide postoperative treatment and follow-up.
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Affiliation(s)
- Shao-Hua Xie
- School of Public Health and Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital
| | - Giola Santoni
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Eivind Gottlieb-Vedi
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital
| | - Pernilla Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London
| | - Jesper Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital
- School of Cancer and Pharmaceutical Sciences, Guy’s Hospital Campus, King’s College London, London, UK
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12
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Castedal M, Schult A, Kotopouli MI, Bottai M, Franck J, Ericzon BG, Stål P, Stokkeland K. Alcohol as a risk factor for mortality in liver transplant patients in Sweden. Scand J Gastroenterol 2023; 58:269-275. [PMID: 36093679 DOI: 10.1080/00365521.2022.2121938] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Liver transplantation (LT) is the only available cure for end-stage liver disease and one of the best treatment options for hepatocellular carcinomas (HCC). Patients with known alcohol-associated cirrhosis (AC) are routinely assessed for alcohol dependence or abuse before LT. Patients with other liver diseases than AC may consume alcohol both before and after LT. The aim of this study was to assess the effects of alcohol drinking before and after LT on patient and graft survival regardless of the etiology of liver disease. MATERIALS AND METHODS Between April 2012 and December 2015, 200 LT-recipients were interviewed using the Lifetime Drinking History and the Addiction Severity Index questionnaire. Patients were categorized as having AC, n = 24, HCC and/or hepatitis C cirrhosis (HCV), n = 69 or other liver diseases, n = 107. Patients were monitored and interviewed by transplantation-independent staff for two years after LT with questions regarding their alcohol consumption. Patient and graft survival data were retrieved in October 2019. RESULTS Patients with AC had an increased hazard ratio (HR) for death after LT (crude HR: 4.05, 95% CI: 1.07-15.33, p = 0.04) and for graft loss adjusted for age and gender (adjusted HR: 3.24, 95% CI 1.08-9.77, p = 0.04) compared to the other patients in the cohort. There was no significant effect of the volume of alcohol consumed before or after LT on graft loss or overall survival. CONCLUSION Patients transplanted for AC have a worse prognosis, but we found no correlation between alcohol consumed before or after LT and graft or patient survival.
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Affiliation(s)
- Maria Castedal
- The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Andreas Schult
- The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Ioanna Kotopouli
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden
| | - Johan Franck
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Bo-Göran Ericzon
- Division of Transplantation Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Department of Transplantation Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Per Stål
- Unit of Liver Diseases, Department of Upper GI Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Knut Stokkeland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Centre for Dependency Disorders, Stockholm, Sweden
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13
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Wang G, Hallberg J, Faner R, Koefoed HJ, Kebede Merid S, Klevebro S, Björkander S, Gruzieva O, Pershagen G, van Hage M, Guerra S, Bottai M, Georgelis A, Gehring U, Bergström A, Vonk JM, Kull I, Koppelman GH, Agusti A, Melén E. Plasticity of Individual Lung Function States from Childhood to Adulthood. Am J Respir Crit Care Med 2023; 207:406-415. [PMID: 36409973 PMCID: PMC9940138 DOI: 10.1164/rccm.202203-0444oc] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 11/21/2022] [Indexed: 11/23/2022] Open
Abstract
Rationale: Recent evidence highlights the importance of optimal lung development during childhood for health throughout life. Objectives: To explore the plasticity of individual lung function states during childhood. Methods: Prebronchodilator FEV1 z-scores determined at age 8, 16, and 24 years in the Swedish population-based birth cohort BAMSE (Swedish abbreviation for Child [Barn], Allergy, Milieu, Stockholm, Epidemiological study) (N = 3,069) were used. An unbiased, data-driven dependent mixture model was applied to explore lung function states and individual state chains. Lung function catch-up was defined as participants moving from low or very low states to normal or high or very high states, and growth failure as moving from normal or high or very high states to low or very low states. At 24 years, we compared respiratory symptoms, small airway function (multiple-breath washout), and circulating inflammatory protein levels, by using proteomics, across states. Models were replicated in the independent Dutch population-based PIAMA (Prevention and Incidence of Asthma and Mite Allergy) cohort. Measurements and Main Results: Five lung function states were identified in BAMSE. Lung function catch-up and growth failure were observed in 74 (14.5%) BAMSE participants with low or very low states and 36 (2.4%) participants with normal or high or very high states, respectively. The occurrence of catch-up and growth failure was replicated in PIAMA. Early-life risk factors were cumulatively associated with the very low state, as well as with catch-up (inverse association) and growth failure. The very low state as well as growth failure were associated with respiratory symptoms, airflow limitation, and small airway dysfunction at adulthood. Proteomics identified IL-6 and CXCL10 (C-X-C motif chemokine 10) as potential biomarkers of impaired lung function development. Conclusions: Individual lung function states during childhood are plastic, including catch-up and growth failure.
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Affiliation(s)
- Gang Wang
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Sichuan, China
- Department of Clinical Science and Education, Södersjukhuset
- Institute of Environmental Medicine, and
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jenny Hallberg
- Department of Clinical Science and Education, Södersjukhuset
- Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Rosa Faner
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS)
| | | | | | - Susanna Klevebro
- Department of Clinical Science and Education, Södersjukhuset
- Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | | | - Olena Gruzieva
- Institute of Environmental Medicine, and
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Göran Pershagen
- Institute of Environmental Medicine, and
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Marianne van Hage
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Stefano Guerra
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona
- ISGlobal, Barcelona, Spain
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Antonios Georgelis
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Ulrike Gehring
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; and
| | - Anna Bergström
- Institute of Environmental Medicine, and
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Judith M. Vonk
- Groningen Research Institute for Asthma and COPD (GRIAC) and
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Inger Kull
- Department of Clinical Science and Education, Södersjukhuset
- Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Gerard H. Koppelman
- Groningen Research Institute for Asthma and COPD (GRIAC) and
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Alvar Agusti
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS)
- Cátedra de Salud Respiratoria and
- Respiratory Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Erik Melén
- Department of Clinical Science and Education, Södersjukhuset
- Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
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14
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Hagström H, Yan J, Talbäck M, Andreasson A, Walldius G, Bottai M, Hammar N. Improved prediction of 10-year risk of severe liver disease in the general population using commonly available biomarkers. Aliment Pharmacol Ther 2023; 57:418-425. [PMID: 36566508 PMCID: PMC10107149 DOI: 10.1111/apt.17374] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/03/2022] [Accepted: 12/11/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Estimating the risk for cirrhosis in the general population is complex. Existing prediction tools are in general unsatisfactory. AIMS To explore if using commonly available biomarkers can improve the commonly used FIB-4 score in the identification of subgroups at risk of cirrhosis. METHODS We used laboratory and clinical data on 126,925 individuals aged 35-79 years in Stockholm, Sweden, undergoing health examinations from 1985 to 1996. We used Swedish nationwide registries to ascertain 10-year cumulative incidence of severe liver disease, a composite of diagnoses corresponding to cirrhosis and its complications. We considered combinations of biomarkers associated with severe liver disease to identify subgroups with different risk profiles. RESULTS During an average follow-up of 9.3 years, we ascertained 630 incident cases of severe liver disease (0.5%). Age, the FIB-4 score, diabetes or impaired glucose and gamma-glutamyl transferase (gGT) were the most relevant characteristics for classifying risk profiles. Using these factors, we identified 24 groups with a cumulative incidence of severe liver disease at 10 years ranging from 0.2% (age 35-65, low FIB-4, no diabetes or impaired glucose and normal gGT) to 32.1% (age 35-65, high FIB-4, diabetes or impaired glucose and high gGT). CONCLUSIONS Identification of subjects at increased risk of severe liver disease in the general population using the FIB-4 score can be substantially improved by adding age and specific biomarkers commonly available in the primary care setting. These parameters should be considered for inclusion in the development of future risk prediction models.
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Affiliation(s)
- Hannes Hagström
- Division of Hepatology, Department of Upper GI, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Jacinth Yan
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mats Talbäck
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Andreasson
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Psychology, Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Göran Walldius
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Hammar
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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15
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Lundberg IE, Miller FW, Rider LG, Werth VP, Tjärnlund A, Bottai M. Response to: 'Correspondence on 'EULAR/ACR classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups'' by Irfan et al. Ann Rheum Dis 2023; 82:e41. [PMID: 33441297 DOI: 10.1136/annrheumdis-2020-219436] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 01/26/2023]
Affiliation(s)
- Ingrid E Lundberg
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - Frederick W Miller
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland, USA
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland, USA
| | - Victoria P Werth
- Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Medicine, Corporal Michael J Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Anna Tjärnlund
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - Matteo Bottai
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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16
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Gémes K, Holm J, Frumento P, Almondo G, Bottai M, Friberg E, Alexanderson K. A prognostic model for predicting the duration of 20,049 sickness absence spells due to shoulder lesions in a population-based cohort in Sweden. PLoS One 2023; 18:e0280048. [PMID: 36662745 PMCID: PMC9858371 DOI: 10.1371/journal.pone.0280048] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 12/20/2022] [Indexed: 01/21/2023] Open
Abstract
MAIN OBJECTIVE Sickness absence duration for shoulder lesion patients is difficult to prognosticate, and scientific evidence for the sick-listing practice is lacking. Our objective was to develop a clinically implementable prediction model for the duration of a sickness absence spell due to shoulder lesions. METHODS All new sickness absence spells due to shoulder lesions (ICD-10-code: M75) issued in the period January 2010-June 2012 that were longer than 14 days were identified through the nationwide sickness absence insurance register. Information on predictors was linked from four other nationwide registers. Piecewise-constant hazards regression models were fitted to predict duration of sickness absence. The model was developed and validated using split sample validation. Variable selection was based on log-likelihood loss ranking when excluding a variable from the model. The model was evaluated using calibration plots and the c-statistic. RESULTS 20 049 sickness absence spells were identified, of which 34% lasted >90 days. Predictors included in the model were age, sex, geographical region, occupational status, educational level, birth country, specialized healthcare at start of the spell, number of sickness absence days in the last 12 months, and specialized healthcare the last 12 months, before start date of the index sickness absence spell. The model was satisfactorily specified and calibrated. Overall c-statistic was 0.54 (95% CI 0.53-0.55). C-statistic for predicting durations >90, >180, and >365 days was 0.61, 0.66, and 0.74, respectively. SIGNIFICANCE The model can be used to predict the duration of sickness absence due to shoulder lesions. Covariates had limited predictive power but could discriminate the very long sickness absence spells from the rest.
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Affiliation(s)
- Katalin Gémes
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Johanna Holm
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Frumento
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gino Almondo
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Emilie Friberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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17
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He S, Klevebro S, Baldanzi G, Pershagen G, Lundberg B, Eneroth K, Hedman AM, Andolf E, Almqvist C, Bottai M, Melén E, Gruzieva O. Ambient air pollution and inflammation-related proteins during early childhood. Environ Res 2022; 215:114364. [PMID: 36126692 DOI: 10.1016/j.envres.2022.114364] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND AIM Experimental studies show that short-term exposure to air pollution may alter cytokine concentrations. There is, however, a lack of epidemiological studies evaluating the association between long-term air pollution exposure and inflammation-related proteins in young children. Our objective was to examine whether air pollution exposure is associated with inflammation-related proteins during the first 2 years of life. METHODS In a pooled analysis of two birth cohorts from Stockholm County (n = 158), plasma levels of 92 systemic inflammation-related proteins were measured by Olink Proseek Multiplex Inflammation panel at 6 months, 1 year and 2 years of age. Time-weighted average exposure to particles with an aerodynamic diameter of <10 μm (PM10), <2.5 μm (PM2.5), and nitrogen dioxide (NO2) at residential addresses from birth and onwards was estimated via validated dispersion models. Stratified by sex, longitudinal cross-referenced mixed effect models were applied to estimate the overall effect of preceding air pollution exposure on combined protein levels, "inflammatory proteome", over the first 2 years of life, followed by cross-sectional protein-specific bootstrapped quantile regression analysis. RESULTS We identified significant longitudinal associations of inflammatory proteome during the first 2 years of life with preceding PM2.5 exposure, while consistent associations with PM10 and NO2 across ages were only observed among girls. Subsequent protein-specific analyses revealed significant associations of PM10 exposure with an increase in IFN-gamma and IL-12B in boys, and a decrease in IL-8 in girls at different percentiles of proteins levels, at age 6 months. Several inflammation-related proteins were also significantly associated with preceding PM10, PM2.5 and NO2 exposures, at ages 1 and 2 years, in a sex-specific manner. CONCLUSIONS Ambient air pollution exposure influences inflammation-related protein levels already during early childhood. Our results also suggest age- and sex-specific differences in the impact of air pollution on children's inflammatory profiles.
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Affiliation(s)
- Shizhen He
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Susanna Klevebro
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden; Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Gabriel Baldanzi
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Björn Lundberg
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden; Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Kristina Eneroth
- Environment and Health Administration, SLB-analys, Stockholm, Sweden
| | - Anna M Hedman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ellika Andolf
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Matteo Bottai
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Erik Melén
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden; Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Olena Gruzieva
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
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18
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Andrén P, Holmsved M, Ringberg H, Wachtmeister V, Isomura K, Aspvall K, Lenhard F, Hall CL, Davies EB, Murphy T, Hollis C, Sampaio F, Feldman I, Bottai M, Serlachius E, Andersson E, Fernández de la Cruz L, Mataix-Cols D. Therapist-Supported Internet-Delivered Exposure and Response Prevention for Children and Adolescents With Tourette Syndrome: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2225614. [PMID: 35969401 PMCID: PMC9379743 DOI: 10.1001/jamanetworkopen.2022.25614] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The availability of behavior therapy for individuals with Tourette syndrome (TS) and chronic tic disorder (CTD) is limited. OBJECTIVE To determine the efficacy and cost-effectiveness of internet-delivered exposure and response prevention (ERP) for children and adolescents with TS or CTD. DESIGN, SETTING, AND PARTICIPANTS This single-masked, parallel group, superiority randomized clinical trial with nationwide recruitment was conducted at a research clinic in Stockholm, Sweden. Out of 615 individuals assessed for eligibility, 221 participants meeting diagnostic criteria for TS or CTD and aged 9 to 17 years were included in the study. Enrollment began in April 2019 and ended in April 2021. Data were analyzed between October 2021 and March 2022. INTERVENTIONS Participants were randomized to 10 weeks of therapist-supported internet-delivered ERP for tics (111 participants) or to therapist-supported internet-delivered education for tics (comparator group, 110 participants). MAIN OUTCOMES AND MEASURES The primary outcome was change in tic severity from baseline to the 3-month follow-up as measured by the Total Tic Severity Score of the Yale Global Tic Severity Scale (YGTSS-TTSS). YGTSS-TTSS assessors were masked to treatment allocation. Treatment response was operationalized as a score of 1 ("Very much improved") or 2 ("Much improved") on the Clinical Global Impression-Improvement scale. RESULTS Data loss was minimal, with 216 of 221 participants (97.7%) providing primary outcome data. Among randomized participants (152 [68.8%] boys; mean [SD] age, 12.1 [2.3] years), tic severity improved significantly, with a mean reduction of 6.08 points on the YGTSS-TTSS in the ERP group (mean [SD] at baseline, 22.25 [5.60]; at 3-month follow-up, 16.17 [6.82]) and 5.29 in the comparator (mean [SD] at baseline, 23.01 [5.92]; at 3-month follow-up, 17.72 [7.11]). Intention-to-treat analyses showed that the 2 groups improved similarly over time (interaction effect, -0.53; 95% CI, -1.28 to 0.22; P = .17). Significantly more participants were classified as treatment responders in the ERP group (51 of 108 [47.2%]) than in the comparator group (31 of 108 [28.7%]) at the 3-month follow-up (odds ratio, 2.22; 95% CI, 1.27 to 3.90). ERP resulted in more treatment responders at little additional cost compared with structured education. The incremental cost per quality-adjusted life-year gained was below the Swedish willingness-to-pay threshold, at which ERP had a 66% to 76% probability of being cost-effective. CONCLUSIONS AND RELEVANCE Both interventions were associated with clinically meaningful improvements in tic severity, but ERP led to higher response rates at little additional cost. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03916055.
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Affiliation(s)
- Per Andrén
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Moa Holmsved
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Helene Ringberg
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | | | - Kayoko Isomura
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Kristina Aspvall
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Fabian Lenhard
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Charlotte L. Hall
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Queen’s Medical Centre, Nottingham, United Kingdom
- National Institute for Health and Care Research MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, Division of Psychiatry and Applied Psychology, University of Nottingham, Innovation Park, Triumph Road, Nottingham, United Kingdom
- National Institute for Health and Care Research Nottingham Biomedical Research Centre, Institute of Mental Health, Mental Health and Clinical Neurosciences, University of Nottingham, Innovation Park, Nottingham, United Kingdom
| | - E. Bethan Davies
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Queen’s Medical Centre, Nottingham, United Kingdom
- National Institute for Health and Care Research MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, Division of Psychiatry and Applied Psychology, University of Nottingham, Innovation Park, Triumph Road, Nottingham, United Kingdom
| | - Tara Murphy
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children National Health Service Foundation Trust, Great Ormond Street, London, United Kingdom
| | - Chris Hollis
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Queen’s Medical Centre, Nottingham, United Kingdom
- National Institute for Health and Care Research MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, Division of Psychiatry and Applied Psychology, University of Nottingham, Innovation Park, Triumph Road, Nottingham, United Kingdom
- National Institute for Health and Care Research Nottingham Biomedical Research Centre, Institute of Mental Health, Mental Health and Clinical Neurosciences, University of Nottingham, Innovation Park, Nottingham, United Kingdom
| | - Filipa Sampaio
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Inna Feldman
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Matteo Bottai
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Eva Serlachius
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Child and Adolescent Psychiatry, Department of Clinical Sciences, Medical Faculty, Lund University, Lund, Sweden
| | - Erik Andersson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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19
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Columbu S, Frumento P, Bottai M. Modeling sign concordance of quantile regression residuals with multiple outcomes. Int J Biostat 2022:ijb-2022-0020. [DOI: 10.1515/ijb-2022-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 06/15/2022] [Indexed: 11/15/2022]
Abstract
Abstract
Quantile regression permits describing how quantiles of a scalar response variable depend on a set of predictors. Because a unique definition of multivariate quantiles is lacking, extending quantile regression to multivariate responses is somewhat complicated. In this paper, we describe a simple approach based on a two-step procedure: in the first step, quantile regression is applied to each response separately; in the second step, the joint distribution of the signs of the residuals is modeled through multinomial regression. The described approach does not require a multidimensional definition of quantiles, and can be used to capture important features of a multivariate response and assess the effects of covariates on the correlation structure. We apply the proposed method to analyze two different datasets.
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20
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Gongora M, Stranne J, Johansson E, Bottai M, Thellenberg Karlsson C, Brasso K, Hansen S, Jakobsen H, Jäderling F, Lindberg H, Lilleby W, Meidahl Petersen P, Mirtti T, Olsson M, Rannikko A, Røder MA, Henrik Vincent P, Akre O. Characteristics of Patients in SPCG-15—A Randomized Trial Comparing Radical Prostatectomy with Primary Radiotherapy plus Androgen Deprivation Therapy in Men with Locally Advanced Prostate Cancer. EUR UROL SUPPL 2022; 41:63-73. [PMID: 35813256 PMCID: PMC9257646 DOI: 10.1016/j.euros.2022.04.013] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 11/28/2022] Open
Abstract
Background There is no high-grade evidence for surgery as primary treatment for locally advanced prostate cancer. The SPCG-15 study is the first randomized trial comparing surgical treatment with radiotherapy. Objective To describe the baseline characteristics of the first 600 randomized men in the SPCG-15 study. The study will compare mortality and functional outcomes. Design, setting, and participants This study is a Scandinavian prospective, open, multicenter phase III randomized clinical trial aiming to randomize 1200 men. Intervention Radical prostatectomy with or without consecutive radiotherapy (experimental) and radiotherapy with neoadjuvant androgen deprivation therapy (standard of care). Outcome measurements and statistical analysis Cause-specific survival, metastasis-free survival, overall survival, and patient-reported bowel function, sexual health, and lower urinary tract symptoms were measured. Results and limitations The distribution of characteristics was similar in the two study arms. The median age was 67 yr (range 45–75 yr). Among the operated men, 36% had pT3a stage of disease and 39% had pT3b stage. International Society of Urological Pathology grades 2, 3, 4, and 5 were prevalent in 21%, 35%, 7%, and 27%, respectively. Half of the men (51%) in the surgery arm had no positive lymph nodes. The main limitation is the pragmatic design comparing the best available practice at each study site leading to heterogeneity of treatment regimens within the study arms. Conclusions We have proved that randomization between surgery and radiotherapy for locally advanced prostate cancer is feasible. The characteristics of the study population demonstrate a high prevalence of advanced disease, well-balanced comparison groups, and a demography mirroring the Scandinavian population of men with prostate cancer at large. Patient summary This study, which has recruited >600 men, compares radiotherapy with surgery for prostate cancer, and an analysis at the time of randomization indicates that the study will be informative and generalizable to most men with locally advanced but not metastasized prostate cancer.
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Affiliation(s)
- Magdalena Gongora
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
- Corresponding author. Department of Molecular Molecule and Surgery, Karolinska Institutet, Solna, GKS D1:05, 171 76 Stockholm, Sweden. Tel. +46733018726.
| | - Johan Stranne
- Department of Urology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva Johansson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Klaus Brasso
- Department of Urology, Center for Cancer and Organ Diseases, Copenhagen Prostate Cancer Center, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Steinbjørn Hansen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Henrik Jakobsen
- Department of Urology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Fredrik Jäderling
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Radiology, Capio S:t Görans Hospital, Stockholm, Sweden
| | - Henriette Lindberg
- Department of Oncology, Copenhagen University Hospital − Herlev and Gentofte, Herlev, Denmark
| | | | | | - Tuomas Mirtti
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- iCAN-Digital Precision Cancer Medicine Flagship, Helsinki, Finland
| | - Mats Olsson
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Antti Rannikko
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Urology, Faculty of Medicine and Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Martin Andreas Røder
- Department of Urology, Center for Cancer and Organ Diseases, Copenhagen Prostate Cancer Center, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Per Henrik Vincent
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Olof Akre
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
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21
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Andrén P, Fernández de la Cruz L, Isomura K, Lenhard F, Hall CL, Davies EB, Murphy T, Hollis C, Sampaio F, Feldman I, Bottai M, Serlachius E, Andersson E, Mataix-Cols D. Correction: Efficacy and cost-effectiveness of therapist-guided internet-delivered behaviour therapy for children and adolescents with Tourette syndrome: study protocol for a single-blind randomised controlled trial. Trials 2022; 23:541. [PMID: 35773723 PMCID: PMC9245208 DOI: 10.1186/s13063-022-06483-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Per Andrén
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Gävlegatan 22, 113 30, Stockholm, Sweden.
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
| | - Lorena Fernández de la Cruz
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Gävlegatan 22, 113 30, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Kayoko Isomura
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Gävlegatan 22, 113 30, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Fabian Lenhard
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Gävlegatan 22, 113 30, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Charlotte L Hall
- Institute of Mental Health, Mental Health & Clinical Neurosciences, University of Nottingham, Nottingham, UK
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, Mental Health & Clinical Neurosciences, University of Nottingham, Innovation Park, Triumph Road, Nottingham, UK
| | - E Bethan Davies
- Institute of Mental Health, Mental Health & Clinical Neurosciences, University of Nottingham, Nottingham, UK
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, Mental Health & Clinical Neurosciences, University of Nottingham, Innovation Park, Triumph Road, Nottingham, UK
| | - Tara Murphy
- UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London, WC1N 1EH, UK
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
| | - Chris Hollis
- Institute of Mental Health, Mental Health & Clinical Neurosciences, University of Nottingham, Nottingham, UK
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, Mental Health & Clinical Neurosciences, University of Nottingham, Innovation Park, Triumph Road, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Innovation Park, Triumph Road, Nottingham, UK
| | - Filipa Sampaio
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Inna Feldman
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Matteo Bottai
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Eva Serlachius
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Gävlegatan 22, 113 30, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Erik Andersson
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Gävlegatan 22, 113 30, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - David Mataix-Cols
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Gävlegatan 22, 113 30, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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22
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Ekvall KO, Bottai M. Confidence regions near singular information and boundary points with applications to mixed models. Ann Stat 2022. [DOI: 10.1214/22-aos2177] [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: 11/19/2022]
Affiliation(s)
- Karl Oskar Ekvall
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet
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23
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Lissing M, Vassiliou D, Floderus Y, Harper P, Bottai M, Kotopouli M, Hagström H, Sardh E, Wahlin S. Risk of primary liver cancer in acute hepatic porphyria patients: A matched cohort study of 1244 individuals. J Intern Med 2022; 291:824-836. [PMID: 35112415 PMCID: PMC9311710 DOI: 10.1111/joim.13463] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The acute hepatic porphyrias (AHP) are associated with a risk of primary liver cancer (PLC), but risk estimates are unclear, and what AHP characteristics that predict PLC risk are unknown. In this register-based, matched cohort study, we assessed the PLC risk in relation to biochemical and clinical porphyria severity, genotype, age, and sex. METHODS All patients in the Swedish porphyria register with acute intermittent porphyria (AIP), variegate porphyria (VP), or hereditary coproporphyria (HCP) during 1987-2015 were included. This AHP cohort was compared with age-, sex-, and county-matched reference individuals from the general population. National register-based hospital admissions for AHP were used to indicate the clinical severity. For AIP, the most common AHP type, patients were stratified by genotype and urinary porphobilinogen (U-PBG). Incident PLC data were collected from national health registers. RESULTS We identified 1244 individuals with AHP (1063 [85%] AIP). During a median follow-up of 19.5 years, we identified 108 incident PLC cases, including 83 AHP patients (6.7%) and 25 of 12,333 reference individuals (0.2%). The adjusted hazard ratio for AHP-PLC was 38.0 (95% confidence interval: 24.3-59.3). Previously elevated U-PBG and hospitalizations for porphyria, but not AIP genotype or sex, were associated with increased PLC risk. Patients aged >50 years with previously elevated U-PBG (n = 157) had an annual PLC incidence of 1.8%. CONCLUSION This study confirmed a high PLC risk and identified a strong association with clinical and biochemical AIP activity. Regular PLC surveillance is motivated in patients older than 50 years with a history of active AIP.
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Affiliation(s)
- Mattias Lissing
- Hepatology Division, Department of Upper GI Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Daphne Vassiliou
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden.,Centre for Inherited Metabolic Diseases (CMMS), Porphyria Centre Sweden, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Ylva Floderus
- Centre for Inherited Metabolic Diseases (CMMS), Porphyria Centre Sweden, Karolinska University Hospital, Stockholm, Sweden.,Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Pauline Harper
- Centre for Inherited Metabolic Diseases (CMMS), Porphyria Centre Sweden, Karolinska University Hospital, Stockholm, Sweden.,Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marianna Kotopouli
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hannes Hagström
- Hepatology Division, Department of Upper GI Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.,Unit for Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Eliane Sardh
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden.,Centre for Inherited Metabolic Diseases (CMMS), Porphyria Centre Sweden, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Staffan Wahlin
- Hepatology Division, Department of Upper GI Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
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24
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Bottai M, Kim T, Lieberman B, Luta G, Peña E. On Optimal Correlation-Based Prediction. AM STAT 2022. [DOI: 10.1080/00031305.2022.2051604] [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: 11/01/2022]
Affiliation(s)
- Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Taeho Kim
- Department of Statistics, University of Haifa, Haifa Israel
| | | | - George Luta
- Department of Biostatistics, Bioinformatics & Biomathematics, Georgetown University, Washington, DC
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
- The Parker Institute, Copenhagen University Hospital, Frederiksberg, Denmark
| | - Edsel Peña
- Department of Statistics, University of South Carolina, Columbia, SC
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25
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Almskog LM, Wikman A, Svensson J, Bottai M, Kotormán M, Wahlgren CM, Wanecek M, van der Linden J, Ågren A. Hypercoagulation Detected by Rotational Thromboelastometry Predicts Mortality in COVID-19: A Risk Model Based on a Prospective Observational Study. TH Open 2022; 6:e50-e59. [PMID: 35265789 PMCID: PMC8901374 DOI: 10.1055/a-1725-9221] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/15/2021] [Indexed: 12/02/2022]
Abstract
Background Severe disease due to the novel coronavirus disease 2019 (COVID-19) has been shown to be associated with hypercoagulation. The aim of this study was to assess the Rotational Thromboelastometry (ROTEM) as a marker of coagulopathy in hospitalized COVID-19 patients. Methods This was a prospective, observational study where patients hospitalized due to a COVID-19 infection were eligible for inclusion. Conventional coagulation tests and ROTEM were taken after hospital admission, and patients were followed for 30 days. A prediction model, including variables ROTEM EXTEM-MCF (Maximum Clot Firmness) which in previous data has been suggested a suitable marker of hypercoagulation, age, and respiratory frequency, was developed using logistic regression to evaluate the probability of death. Results Out of the 141 patients included, 18 (13%) died within 30 days. In the final prediction model, the risk of death within 30 days for a patient hospitalized due to COVID-19 was increased with increased EXTEM-MCF, age, and respiratory frequency. Longitudinal ROTEM data in the severely ill subpopulation showed enhanced hypercoagulation. In an in vitro analysis, no heparin effect on EXTEM-coagulation time (CT) was observed, supporting a severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) effect on prolonged initiation of coagulation. Conclusion Here, we show that hypercoagulation measured with ROTEM predicts 30-day mortality in COVID-19. Longitudinal ROTEM data strengthen the hypothesis of hypercoagulation as a driver of severe disease in COVID-19. Thus, ROTEM may be a useful tool to assess disease severity in COVID-19 and could potentially guide anticoagulation therapy.
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Affiliation(s)
- Lou M. Almskog
- Department of Anaesthesiology and Intensive Care, Capio St. Göran's Hospital, Stockholm, Sweden,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden,Address for correspondence Lou M. Almskog Department of Molecular Medicine and Surgery, Karolinska University HospitalStockholm, 171 67Sweden
| | - Agneta Wikman
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden,Department of CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Svensson
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, Stockholm, Sweden
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mariann Kotormán
- Department of Anaesthesiology and Intensive Care, Capio St. Göran's Hospital, Stockholm, Sweden
| | - Carl-Magnus Wahlgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden,Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Michael Wanecek
- Department of Anaesthesiology and Intensive Care, Capio St. Göran's Hospital, Stockholm, Sweden,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Jan van der Linden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden,Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Ågren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden,Coagulation Unit, Hematology Centre, Karolinska University Hospital, Stockholm, Sweden,Department of Clinical Sciences, Danderyd Hospital and Karolinska Institutet, Stockholm, Sweden
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26
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Lundström L, Flygare O, Andersson E, Enander J, Bottai M, Ivanov VZ, Boberg J, Pascal D, Mataix-Cols D, Rück C. Effect of Internet-Based vs Face-to-Face Cognitive Behavioral Therapy for Adults With Obsessive-Compulsive Disorder: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e221967. [PMID: 35285923 PMCID: PMC9907343 DOI: 10.1001/jamanetworkopen.2022.1967] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Cognitive behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) is a highly specialized treatment that is in short supply worldwide. OBJECTIVES To investigate whether both therapist-guided and unguided internet-based CBT (ICBT) are noninferior to face-to-face CBT for adults with OCD, to conduct a health economic evaluation, and to determine whether treatment effects were moderated by source of participant referral. DESIGN, SETTING, AND PARTICIPANTS This study is a single-blinded, noninferiority, randomized clinical trial, with a full health economic evaluation, conducted between September 2015 and January 2020, comparing therapist-guided ICBT, unguided ICBT, and individual face-to-face CBT for adults with OCD. Follow-up data were collected up to 12 months after treatment. The study was conducted at 2 specialist outpatient OCD clinics in Stockholm, Sweden. Participants included a consecutive sample of adults with a primary diagnosis of OCD, either self-referred or referred by a clinician. Data analysis was performed from June 2019 to January 2022. INTERVENTIONS Guided ICBT, unguided ICBT, and face-to-face CBT delivered over 14 weeks. MAIN OUTCOMES AND MEASURES The primary end point was the change in OCD symptom severity from baseline to 3-month follow-up. The noninferiority margin was 3 points on the masked assessor-rated Yale-Brown Obsessive Compulsive Scale. RESULTS A total of 120 participants were enrolled (80 women [67%]; mean [SD] age, 32.24 [9.64] years); 38 were randomized to the face-to-face CBT group, 42 were randomized to the guided ICBT group, and 40 were randomized to the unguided ICBT group. The mean difference between therapist-guided ICBT and face-to-face CBT at the primary end point was 2.10 points on the Yale-Brown Obsessive Compulsive Scale (90% CI, -0.41 to 4.61 points; P = .17), favoring face-to-face CBT, meaning that the primary noninferiority results were inconclusive. The difference between unguided ICBT and face-to-face CBT was 5.35 points (90% CI, 2.76 to 7.94 points; P < .001), favoring face-to-face CBT. The health economic analysis showed that both guided and unguided ICBT were cost-effective compared with face-to-face CBT. Source of referral did not moderate treatment outcome. The most common adverse events were anxiety (30 participants [25%]), depressive symptoms (20 participants [17%]), and stress (11 participants [9%]). CONCLUSIONS AND RELEVANCE The findings of this randomized clinical trial of ICBT vs face-to-face CBT for adults with OCD do not conclusively demonstrate noninferiority. Therapist-guided ICBT could be a cost-effective alternative to in-clinic CBT for adults with OCD in scenarios where traditional CBT is not readily available; unguided ICBT is probably less efficacious but could be an alternative when providing remote clinician support is not feasible. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02541968.
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Affiliation(s)
- Lina Lundström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, Stockholm, Sweden
| | - Oskar Flygare
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Andersson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jesper Enander
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, Stockholm, Sweden
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Volen Z. Ivanov
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, Stockholm, Sweden
| | - Julia Boberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, Stockholm, Sweden
| | - Diana Pascal
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, Stockholm, Sweden
| | - David Mataix-Cols
- Child and Adolescent Psychiatry Research Center, Department of Clinical Neuroscience, Stockholm Health Care Services, Region Stockholm, Karolinska Institutet Stockholm, Sweden
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, Stockholm, Sweden
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27
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Carlsson S, Bottai M, Lantz A, Bjartell A, Hugosson J, Steineck G, Stranne J, Wiklund P, Haglind E, Akre O. Lymph swelling after radical prostatectomy and pelvic lymph node dissection. BJU Int 2022; 129:695-698. [PMID: 35132753 PMCID: PMC9313832 DOI: 10.1111/bju.15702] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/11/2022] [Accepted: 01/21/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Stefan Carlsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Matteo Bottai
- Division of Biostatistics, IMM, Karolinska Institutet, Stockholm, Sweden
| | - Anna Lantz
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden.,Division of Biostatistics, IMM, Karolinska Institutet, Stockholm, Sweden
| | - Anders Bjartell
- Department of Urology, Skåne University Hospital, Malmö, Sweden.,Department of Translational Medicine, Division of Urological Cancers, Faculty of Medicine, Lund University, Sweden
| | - Jonas Hugosson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Department of Urology Gothenburg, Sweden
| | - Gunnar Steineck
- Department of Oncology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Johan Stranne
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Department of Urology Gothenburg, Sweden
| | - Peter Wiklund
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden.,Department of Urology, Icahn School of Medicine at Mount Sinai Health System, New York, NY, USA
| | - Eva Haglind
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Scandinavian Surgical Outcomes Research Group, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital/Östra, Department of Surgery, Gothenburg, Sweden
| | - Olof Akre
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
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28
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Wodaje T, Littmann K, Häbel H, Bottai M, Bäck M, Parini P, Brinck J. Plasma Lipoprotein(a) measured in routine clinical care and the association with incident calcified aortic valve stenosis during a 14-year observational period. Atherosclerosis 2022; 349:175-182. [DOI: 10.1016/j.atherosclerosis.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/23/2022] [Accepted: 02/11/2022] [Indexed: 11/25/2022]
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29
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Carlsson S, Bottai M, Lantz A, Bjartell A, Hugosson J, Steineck G, Stranne J, Wiklund P, Haglind E, Akre O. Lymph swelling after radical prostatectomy and pelvic lymph node dissection. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01237-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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30
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Milton A, Schandl A, Larsson I, Wallin E, Savilampi J, Meijers K, Joelsson‐Alm E, Bottai M, Sackey P. Caregiver burden and emotional wellbeing in informal caregivers to ICU survivors-A prospective cohort study. Acta Anaesthesiol Scand 2022; 66:94-102. [PMID: 34582048 DOI: 10.1111/aas.13988] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 06/07/2021] [Accepted: 09/03/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Informal caregivers to intensive care unit (ICU) survivors may develop post-intensive care syndrome family (PICS-F), including depression, anxiety and post-traumatic stress (PTS). Our primary aim was to investigate associations between caregiver burden in informal caregivers cohabiting with ICU survivors and patients' physical and psychological outcomes. METHODS A prospective, multicentre cohort study in four ICUs in Sweden. Adults cohabiting with ICU patients included in a previous study were eligible for inclusion. Three months post-ICU, informal caregivers received questionnaires assessing caregiver burden, health-related quality of life (HRQL) and symptoms of depression, anxiety and PTS. In parallel, patients reported their three-month physical and psychological status via validated questionnaires. The primary outcome of this study was to compare caregiver burden in informal caregivers to patients with and without adverse physical and psychological outcomes 3 months post-ICU. Secondary outcomes were correlations between caregiver burden and informal caregivers' mental HRQL. RESULTS Among 62 included informal caregivers, 55 (89%) responded to the follow-up questionnaires. Caregiver burden was higher among informal caregivers to patients with an adverse outcome, compared to informal caregivers to patients without an adverse outcome, caregiver burden scale score mean (±standard deviation) 52 (11) and 41 (13) respectively (p = 0.003). There was strong negative correlation between caregiver burden and informal caregivers' mental HRQL (rs -0.74, p < 0.001). CONCLUSION Informal caregivers to ICU survivors with adverse physical or psychological outcome experience a higher caregiver burden. A higher caregiver burden correlates with worse caregiver mental HRQL. ICU follow-up programs should consider screening and follow-up of informal caregivers for mental health problems.
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Affiliation(s)
- Anna Milton
- Department of Physiology and Pharmacology Karolinska Institutet Solna Sweden
- Department of Perioperative Medicine and Intensive care Karolinska University Hospital Stockholm Sweden
| | - Anna Schandl
- Department of Molecular Medicine and Surgery Karolinska Institutet Solna Sweden
| | | | - Ewa Wallin
- Department of Surgical Sciences Uppsala University Uppsala Sweden
| | - Johanna Savilampi
- Department of Anaesthesiology and Intensive care Örebro University Hospital Örebro Sweden
| | - Katarina Meijers
- Department of Anaesthesiology and Intensive care Södersjukhuset Stockholm Sweden
| | - Eva Joelsson‐Alm
- Department of Anaesthesiology and Intensive care Södersjukhuset Stockholm Sweden
| | - Matteo Bottai
- Institute of Environmental Medicine Karolinska Institutet Solna Sweden
| | - Peter Sackey
- Department of Physiology and Pharmacology Karolinska Institutet Solna Sweden
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31
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Matusevicius M, Cooray C, Holmin S, Bottai M, Ahmed N. Association between systolic blood pressure course and outcomes after stroke thrombectomy. BMJ Neurol Open 2021; 3:e000183. [PMID: 34870205 PMCID: PMC8603273 DOI: 10.1136/bmjno-2021-000183] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/03/2021] [Indexed: 11/22/2022] Open
Abstract
Background Systolic blood pressure (SBP) after endovascular thrombectomy (EVT) for large artery occlusive stroke is dynamic, requiring adaptable early prediction tools for improving outcomes. We investigated if post-EVT SBP course was associated with outcomes. Methods EVT-treated patients who had a stroke at Karolinska University Hospital, Stockholm, Sweden, were included in the study during 12 February 2018–11 February 2020. SBP was recorded during the first 24 hours after EVT. Primary outcome was functional independence defined by a Modified Rankin Scale score of 0–2 at 3 months. Secondary outcomes were death by 3 months, symptomatic intracranial haemorrhage and any intracranial haemorrhage. Patients with favourable outcomes were used as a reference SBP course in mixed linear effects models and compared with SBP courses of patients with unfavourable outcomes using the empirical best linear unbiased predictor, measuring deviations from the reference SBP course using the random effects. We tested model predictive stability for SBP measurements of only 18, 12 or 6 hours after EVT. Results 374 patients were registered, with mean age 71, median NIHSS score of 15, and 53.2% men. Deviating from a linear SBP course starting at 130 mm Hg and decreasing to 123 mm Hg at 24 hours after EVT was associated with lower chances of functional independence (adjusted OR 0.53, 95% CI 0.29 to 0.88, for reaching either 99 or 147 mm Hg at 24 hours after EVT). All SBP course models for the remaining outcomes did not show statistical significance. Functional independence models showed stable predictive values for all time periods. Conclusion Deviating from a linear SBP course was associated with lower chances of 3-month functional independence.
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Affiliation(s)
- Marius Matusevicius
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Research and Education, Karolinska University Hospital, Stockholm, Sweden
| | - Charith Cooray
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Neurophysiology, Karolinska University Hospital, Stockholm, Sweden
| | - Staffan Holmin
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Niaz Ahmed
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
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32
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Andrén P, de la Cruz LF, Isomura K, Lenhard F, Hall CL, Davies EB, Murphy T, Hollis C, Sampaio F, Feldman I, Bottai M, Serlachius E, Andersson E, Mataix-Cols D. Efficacy and cost-effectiveness of therapist-guided internet-delivered behaviour therapy for children and adolescents with Tourette syndrome: study protocol for a single-blind randomised controlled trial. Trials 2021; 22:669. [PMID: 34593015 PMCID: PMC8481317 DOI: 10.1186/s13063-021-05592-z] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 09/01/2021] [Indexed: 11/21/2022] Open
Abstract
Background Treatment guidelines recommend behaviour therapy (BT) for patients with Tourette syndrome (TS) and chronic tic disorder (CTD). However, BT is rarely accessible due to limited availability of trained therapists and long travel distances to specialist clinics. Internet-delivered BT has the potential of overcoming these barriers through remote delivery of treatment with minimal therapist support. In the current protocol, we outline the design and methods of a randomised controlled trial (RCT) evaluating an internet-delivered BT programme referred to as BIP TIC. The trial’s primary objective is to determine the clinical efficacy of BIP TIC for reducing tic severity in young people with TS/CTD, compared with an active control intervention. Secondary objectives are to investigate the 12-month durability of the treatment effects and to perform a health economic evaluation of the intervention. Methods In this single-blind superiority RCT, 220 participants (9–17 years) with TS/CTD throughout Sweden will be randomised to 10–12 weeks of either therapist-supported internet-delivered BT based on exposure with response prevention (BIP TIC) or therapist-supported internet-delivered education. Data will be collected at baseline, 3 and 5 weeks into the treatment, at post-treatment, and 3, 6, and 12 months post-treatment. The primary endpoint is the 3-month follow-up. The primary outcome is tic severity as measured by the Yale Global Tic Severity Scale – Total Tic Severity Score. Treatment response is operationalised as scores of “Very much improved” or “Much improved” on the Clinical Global Impression – Improvement scale, administered at the primary endpoint. Outcome assessors will be blind to treatment condition at all assessment points. A health economic evaluation of BIP TIC will be performed, both in the short term (primary endpoint) and the long term (12-month follow-up). There are no planned interim analyses. Discussion Participant recruitment started on 26 April 2019 and finished on 9 April 2021. The total number of included participants was 221. The final participant is expected to reach the primary endpoint in September 2021 and the 12-month follow-up in June 2022. Data analysis for the primary objective will commence after the last participant reaches the primary endpoint. Trial registration ClinicalTrials.gov NCT03916055. Registered on 16 April 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05592-z.
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Affiliation(s)
- Per Andrén
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22, 113 30, Stockholm, Sweden. .,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22, 113 30, Stockholm, Sweden.,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Kayoko Isomura
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22, 113 30, Stockholm, Sweden.,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Fabian Lenhard
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22, 113 30, Stockholm, Sweden.,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Charlotte L Hall
- Institute of Mental Health, Mental Health & Clinical Neurosciences, University of Nottingham, Nottingham, UK.,NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, Mental Health & Clinical Neurosciences, University of Nottingham, Innovation Park, Triumph Road, Nottingham, UK
| | - E Bethan Davies
- Institute of Mental Health, Mental Health & Clinical Neurosciences, University of Nottingham, Nottingham, UK.,NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, Mental Health & Clinical Neurosciences, University of Nottingham, Innovation Park, Triumph Road, Nottingham, UK
| | - Tara Murphy
- UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London, WC1N 1EH, UK.,Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
| | - Chris Hollis
- Institute of Mental Health, Mental Health & Clinical Neurosciences, University of Nottingham, Nottingham, UK.,NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, Mental Health & Clinical Neurosciences, University of Nottingham, Innovation Park, Triumph Road, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Innovation Park, Triumph Road, Nottingham, UK
| | - Filipa Sampaio
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Inna Feldman
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Matteo Bottai
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Eva Serlachius
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22, 113 30, Stockholm, Sweden.,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Erik Andersson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22, 113 30, Stockholm, Sweden.,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22, 113 30, Stockholm, Sweden.,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Keselman B, Berglund A, Ahmed N, Bottai M, von Euler M, Holmin S, Laska AC, Mathé JM, Sjöstrand C, Eriksson EE, Mazya MV. The Stockholm Stroke Triage Project: Outcomes of Endovascular Thrombectomy Before and After Triage Implementation. Stroke 2021; 53:473-481. [PMID: 34583527 DOI: 10.1161/strokeaha.121.034195] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE The Stockholm Stroke Triage System (SSTS) is a prehospital algorithm for detection of endovascular thrombectomy (EVT)-eligible patients, combining symptom severity assessment and ambulance-to-hospital teleconsultation, leading to a decision on primary stroke center bypass. In the Stockholm Region (6 primary stroke centers, 1 EVT center), SSTS implementation in October 2017 reduced onset-to-EVT time by 69 minutes. We compared clinical outcomes before and after implementation of SSTS in an observational study. METHODS We prospectively recruited patients transported by Code Stroke ambulance within the Stockholm region under the SSTS, treated with EVT during October 2017 to October 2019, and compared to EVT patients from 2 previous years. OUTCOMES shift in modified Rankin Scale (mRS) scores, mRS score 0 to 1, mRS score 0 to 2, and death (all 3 months), National Institutes of Health Stroke Scale (NIHSS) score change 24-hour post-EVT, recanalization (Thrombolysis in Cerebral Infarction 2b-3), and symptomatic intracranial hemorrhage. mRS outcomes were adjusted for age and baseline NIHSS. RESULTS Patients with EVT in the SSTS group (n=244) were older and had higher baseline NIHSS versus historical controls (n=187): median age 74 (interquartile range, 63-81) versus 71 (61-78); NIHSS score 17 (11.5-21) versus 15 (10-20). During SSTS, median onset-to-puncture time was 136 versus 205 minutes (P<0.001). Adjusted common odds ratio for lower mRS in SSTS patients was 1.7 (95% CI, 1.2-2.3) versus controls. During SSTS, 83/240 (34.6%) versus 44/186 (23.7%) reached 3-month mRS score 0 to 1 (P=0.014), adjusted common odds ratio 2.3 (95% CI, 1.4-3.6). Median NIHSS change 24-hour post-EVT was 6 versus 4 (P=0.005). Differences in Thrombolysis in Cerebral Infarction, symptomatic intracranial hemorrhage, and death were nonsignificant. CONCLUSIONS With an onset to arterial puncture time reduction by 69 minutes, outcomes in thrombectomy-treated patients improved significantly after region-wide large artery occlusion triage system implementation. These results warrant replication studies in other geographic and organizational circumstances.
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Affiliation(s)
- Boris Keselman
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden. (B.K., A.B., N.A., C.S., E.E.E., M.V.M.).,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. (B.K., A.B., N.A., S.H., J.M.M., C.S., E.E.E., M.V.M.)
| | - Annika Berglund
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden. (B.K., A.B., N.A., C.S., E.E.E., M.V.M.).,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. (B.K., A.B., N.A., S.H., J.M.M., C.S., E.E.E., M.V.M.)
| | - Niaz Ahmed
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden. (B.K., A.B., N.A., C.S., E.E.E., M.V.M.).,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. (B.K., A.B., N.A., S.H., J.M.M., C.S., E.E.E., M.V.M.)
| | - Matteo Bottai
- Unit of Biostatistics, Karolinska Institutet, Stockholm, Sweden. IMM (M.B.)
| | - Mia von Euler
- Department of Clinical Science and Education, Karolinska Institutet Stroke Research Network at Södersjukhuset, Stockholm, Sweden (M.v.E.).,School of Medicine, Örebro University, Sweden (M.v.E.)
| | - Staffan Holmin
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden. (S.H.).,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. (B.K., A.B., N.A., S.H., J.M.M., C.S., E.E.E., M.V.M.)
| | - Ann-Charlotte Laska
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden. (A.-C.L.)
| | - Jan M Mathé
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. (B.K., A.B., N.A., S.H., J.M.M., C.S., E.E.E., M.V.M.).,Department of Neurology, Capio St Göran's Hospital, Stockholm, Sweden (J.M.M.)
| | - Christina Sjöstrand
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden. (B.K., A.B., N.A., C.S., E.E.E., M.V.M.).,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. (B.K., A.B., N.A., S.H., J.M.M., C.S., E.E.E., M.V.M.)
| | - Einar E Eriksson
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden. (B.K., A.B., N.A., C.S., E.E.E., M.V.M.).,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. (B.K., A.B., N.A., S.H., J.M.M., C.S., E.E.E., M.V.M.)
| | - Michael V Mazya
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden. (B.K., A.B., N.A., C.S., E.E.E., M.V.M.).,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. (B.K., A.B., N.A., S.H., J.M.M., C.S., E.E.E., M.V.M.)
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Sandström A, Snowden JM, Bottai M, Stephansson O, Wikström AK. Routinely collected antenatal data for longitudinal prediction of preeclampsia in nulliparous women: a population-based study. Sci Rep 2021; 11:17973. [PMID: 34504221 PMCID: PMC8429420 DOI: 10.1038/s41598-021-97465-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 06/08/2021] [Accepted: 08/23/2021] [Indexed: 02/05/2023] Open
Abstract
The objective was to evaluate the sequentially updated predictive capacity for preeclampsia during pregnancy, using multivariable longitudinal models including data from antenatal care. This population-based cohort study in the Stockholm-Gotland Counties, Sweden, included 58,899 pregnancies of nulliparous women 2008-2013. Prospectively collected data from each antenatal care visit was used, including maternal characteristics, reproductive and medical history, and repeated measurements of blood pressure, weight, symphysis-fundal height, proteinuria, hemoglobin and blood glucose levels. We used a shared-effects joint longitudinal model including all available information up until a given gestational length (week 24, 28, 32, 34 and 36), to update preeclampsia prediction sequentially. Outcome measures were prediction of preeclampsia, preeclampsia with delivery < 37, and preeclampsia with delivery ≥ 37 weeks' gestation. The area under the curve (AUC) increased with gestational length. AUC for preeclampsia with delivery < 37 weeks' gestation was 0.73 (95% CI 0.68-0.79) at week 24, and increased to 0.87 (95% CI 0.84-0.90) in week 34. For preeclampsia with delivery ≥ 37 weeks' gestation, the AUC in week 24 was 0.65 (95% CI 0.63-0.68), but increased to 0.79 (95% CI 0.78-0.80) in week 36. The addition of routinely collected clinical measurements throughout pregnancy improve preeclampsia prediction and may be useful to individualize antenatal care.
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Affiliation(s)
- Anna Sandström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. .,Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. .,Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden. .,Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA. .,Department of Medicine Solna, Karolinska Institutet, Clinical Epidemiology Division T2, Karolinska University Hospital, 171 76, Stockholm, Sweden.
| | - Jonathan M Snowden
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA.,School of Public Health, Oregon Health and Science University-Portland State University, Portland, OR, USA
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Olof Stephansson
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden
| | - Anna-Karin Wikström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Wang G, Hallberg J, Merid SK, Klevebro S, Björkander S, Gruzieva O, Faner R, Agusti A, Bottai M, Georgellis A, Bergström A, Kull I, Melén E. Longitudinal modelling of lung function trajectories from childhood to early adulthood in the BAMSE cohort. Epidemiology 2021. [DOI: 10.1183/13993003.congress-2021.oa1318] [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: 11/05/2022]
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Littmann K, Hagström E, Häbel H, Bottai M, Eriksson M, Parini P, Brinck J. Plasma lipoprotein(a) measured in the routine clinical care is associated to atherosclerotic cardiovascular disease during a 14-year follow-up. Eur J Prev Cardiol 2021; 28:2038-2047. [PMID: 34343284 DOI: 10.1093/eurjpc/zwab016] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/13/2020] [Accepted: 01/20/2021] [Indexed: 01/22/2023]
Abstract
AIMS To investigate plasma lipoprotein(a) [Lp(a)] levels measured in routine clinical care and their association with mortality and cardiovascular disease. METHODS AND RESULTS This retrospective registry-based observational cohort study includes all individuals with plasma Lp(a) results measured at the Karolinska University Laboratory 2003-17. Outcome data were captured in national outcome registries. Levels of Lp(a) expressed in mass or molar units were examined separately. In adjusted Cox regression models, association between deciles of plasma Lp(a) concentrations, mortality, and cardiovascular outcomes were assessed. A total of 23 398 individuals [52% females, mean (standard deviation) age 55.5 (17.2) years, median Lp(a) levels 17 mg/dL or 19.5 nmol/L] were included. Individuals with an Lp(a) level >90th decile (>90 mg/dL or >180 nmol/L) had hazard ratios (95% confidence interval) of 1.25 (1.05-1.50) for major adverse cardiovascular events (P = 0.013), 1.37 (1.14-1.64) for atherosclerotic cardiovascular disease (P = 0.001), and 1.62 (1.28-2.05) for coronary artery disease (P ≤ 0.001), compared to individuals with Lp(a) ≤50th decile. No association between Lp(a) and mortality, peripheral artery disease, or ischaemic stroke was observed. CONCLUSION High Lp(a) levels are associated with adverse cardiovascular disease outcomes also in individuals with Lp(a) measured in routine clinical care. This supports the 2019 ESC/EAS recommendation to measure Lp(a) at least once during lifetime to assess cardiovascular risk and implies the need for intensive preventive therapy in patients with elevated Lp(a).
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Affiliation(s)
- Karin Littmann
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Clinical Chemistry, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Huddinge, Karolinska Institutet, H7 Medicine Huddinge, 171 77 Stockholm, Sweden.,Medical Unit of Endocrinology, Theme Inflammation and Infection, Karolinska University Hospital, Stockholm, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Henrike Häbel
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mats Eriksson
- Department of Medicine Huddinge, Karolinska Institutet, H7 Medicine Huddinge, 171 77 Stockholm, Sweden.,Medical Unit of Endocrinology, Theme Inflammation and Infection, Karolinska University Hospital, Stockholm, Sweden
| | - Paolo Parini
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Medicine Huddinge, Karolinska Institutet, H7 Medicine Huddinge, 171 77 Stockholm, Sweden.,Medical Unit of Endocrinology, Theme Inflammation and Infection, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Brinck
- Department of Medicine Huddinge, Karolinska Institutet, H7 Medicine Huddinge, 171 77 Stockholm, Sweden.,Medical Unit of Endocrinology, Theme Inflammation and Infection, Karolinska University Hospital, Stockholm, Sweden
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Ortaglia A, McDonald SM, Wirth MD, Sui X, Bottai M. Differential Age-Related Declines in Cardiorespiratory Fitness Between People With and Without Type 2 Diabetes Mellitus. Mayo Clin Proc Innov Qual Outcomes 2021; 5:743-752. [PMID: 34368628 PMCID: PMC8327133 DOI: 10.1016/j.mayocpiqo.2021.06.005] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective To assess the extent to which the established age-related decline in cardiorespiratory fitness (CRF) is augmented in adult men with type 2 diabetes mellitus (T2DM). Participants and Methods This study used data from the Aerobics Center Longitudinal Study, conducted between September 18, 1974, and August 3, 2006, in primarily non-Hispanic white, middle-to-upper class adults. The analyses were restricted to adult men with complete data on age, CRF, and T2DM (35,307 participants). Quantile regression models were used to estimate age-related differences in CRF, estimated using a maximal treadmill test, between persons with and without T2DM. Smoking status and birth cohort served as covariates. Results Age-related declines in CRF were observed in men with and without T2DM. For men younger than 60 years, at low-mid percentiles of the CRF distribution the magnitude of the age-related decline in CRF was significantly higher (P-values=.00, .02) in men with T2DM than in those without T2DM. At upper percentiles, the decline with age between the 2 groups was virtually identical. Significant declines in CRF in men 45 years or younger were observed only at high levels of CRF for those without T2DM and at low levels of CRF for those with T2DM (P-values .00, .04). Conclusion This study reported that men younger than 60 years with T2DM at the low-mid CRF percentiles experience an accelerated age-related decline in CRF. Men younger than 60 years with T2DM exhibiting high levels of CRF experienced a decline in CRF comparable to men without T2DM. This study highlights the importance of incorporating sufficient levels of exercise or activity to maintain high CRF in men with T2DM.
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Affiliation(s)
- Andrew Ortaglia
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - Samantha M McDonald
- Department of Foundational Sciences and Research, School of Dental Medicine, East Carolina University, Greenville, NC
| | - Michael D Wirth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia.,College of Nursing, Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia
| | - Xuemei Sui
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Abstract
This paper introduces the event-probability function, a measure of occurrence of an event of interest over time, defined as the instantaneous probability of an event at a given time point conditional on having survived until that point. Unlike the hazard function, the event-probability function is a proper probability. This paper describes properties and interpretation of the event-probability function, presents its connection with other popular functions, such as the hazard and survival functions, proposes practical flexible proportional-odds models for estimating conditional event-probabilities given covariates with possibly censored and truncated observations, discusses the theoretical and computational aspects of parameter estimation, and applies the proposed models for assessing mortality in patients with metastatic renal carcinoma from a randomized clinical trial.
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Affiliation(s)
- Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Andrea Discacciati
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Giola Santoni
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Holm J, Frumento P, Almondo G, Gémes K, Bottai M, Alexanderson K, Friberg E, Farrants K. Predicting the duration of sickness absence due to knee osteoarthritis: a prognostic model developed in a population-based cohort in Sweden. BMC Musculoskelet Disord 2021; 22:603. [PMID: 34215239 PMCID: PMC8254363 DOI: 10.1186/s12891-021-04400-8] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 05/25/2021] [Indexed: 11/28/2022] Open
Abstract
Background Predicting the duration of sickness absence (SA) among sickness absent patients is a task many sickness certifying physicians as well as social insurance officers struggle with. Our aim was to develop a prediction model for prognosticating the duration of SA due to knee osteoarthritis. Methods A population-based prospective study of SA spells was conducted using comprehensive microdata linked from five Swedish nationwide registers. All 12,098 new SA spells > 14 days due to knee osteoarthritis in 1/1 2010 through 30/6 2012 were included for individuals 18–64 years. The data was split into a development dataset (70 %, nspells =8468) and a validation data set (nspells =3690) for internal validation. Piecewise-constant hazards regression was performed to prognosticate the duration of SA (overall duration and duration > 90, >180, or > 365 days). Possible predictors were selected based on the log-likelihood loss when excluding them from the model. Results Of all SA spells, 53 % were > 90 days and 3 % >365 days. Factors included in the final model were age, sex, geographical region, extent of sickness absence, previous sickness absence, history of specialized outpatient healthcare and/or inpatient healthcare, employment status, and educational level. The model was well calibrated. Overall, discrimination was poor (c = 0.53, 95 % confidence interval (CI) 0.52–0.54). For predicting SA > 90 days, discrimination as measured by AUC was 0.63 (95 % CI 0.61–0.65), for > 180 days, 0.69 (95 % CI 0.65–0.71), and for SA > 365 days, AUC was 0.75 (95 % CI 0.72–0.78). Conclusion It was possible to predict patients at risk of long-term SA (> 180 days) with acceptable precision. However, the prediction of duration of SA spells due to knee osteoarthritis has room for improvement. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04400-8.
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Affiliation(s)
- Johanna Holm
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Paolo Frumento
- Department of Political Sciences, University of Pisa, Via F. Serafini 3, 56126, Pisa, Italy
| | - Gino Almondo
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Katalin Gémes
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Kristina Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Emilie Friberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Kristin Farrants
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
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Aspvall K, Andersson E, Melin K, Norlin L, Eriksson V, Vigerland S, Jolstedt M, Silverberg-Mörse M, Wallin L, Sampaio F, Feldman I, Bottai M, Lenhard F, Mataix-Cols D, Serlachius E. Effect of an Internet-Delivered Stepped-Care Program vs In-Person Cognitive Behavioral Therapy on Obsessive-Compulsive Disorder Symptoms in Children and Adolescents: A Randomized Clinical Trial. JAMA 2021; 325:1863-1873. [PMID: 33974020 PMCID: PMC8114140 DOI: 10.1001/jama.2021.3839] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE In most countries, young people with obsessive-compulsive disorder have limited access to specialist cognitive behavioral therapy (CBT), a first-line treatment. OBJECTIVE To investigate whether internet-delivered CBT implemented in a stepped-care model is noninferior to in-person CBT for pediatric obsessive-compulsive disorder. DESIGN, SETTING AND PARTICIPANTS A randomized clinical noninferiority trial conducted at 2 specialist child and adolescent mental health clinics in Sweden. Participants included 152 individuals aged 8 to 17 years with obsessive-compulsive disorder. Enrollment began in October 2017 and ended in May 2019. Follow-up ended in April 2020. INTERVENTIONS Participants randomized to the stepped-care group (n = 74) received internet-delivered CBT for 16 weeks. Nonresponders at the 3-month follow-up were then offered a course of traditional face-to-face treatment. Participants randomized to the control group (n = 78) immediately received in-person CBT for 16 weeks. Nonresponders at the 3-month follow-up received additional face-to-face treatment. MAIN OUTCOMES AND MEASURES The primary outcome was the masked assessor-rated Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) score at the 6-month follow-up. The scale includes 10 items rated from 0 (no symptoms) to 4 (extreme symptoms), yielding a total score range of 0 to 40, with higher scores indicating greater severity. Assessors were masked to treatment allocation at pretreatment, posttreatment, 3-month follow-up, and 6-month follow-up assessments. The predefined noninferiority margin was 4 points on the CY-BOCS. RESULTS Among the 152 randomized participants (mean age, 13.4 years; 94 [62%] females), 151 (99%) completed the trial. At the 3-month follow-up, 34 participants (46%) in the stepped-care group and 23 (30%) in the in-person CBT group were nonresponders. At the 6-month follow-up, the CY-BOCS score was 11.57 points in the stepped-care group vs 10.57 points in the face-to-face treatment group, corresponding to an estimated mean difference of 0.91 points ([1-sided 97.5% CI, -∞ to 3.28]; P for noninferiority = .02). Increased anxiety (30%-36%) and depressive symptoms (20%-28%) were the most frequently reported adverse events in both groups. There were 2 unrelated serious adverse events (1 in each group). CONCLUSIONS AND RELEVANCE Among children and adolescents with obsessive-compulsive disorder, treatment with an internet-delivered CBT program followed by in-person CBT if necessary compared with in-person CBT alone resulted in a noninferior difference in symptoms at the 6-month follow-up. Further research is needed to understand the durability and generalizability of these findings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03263546.
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Affiliation(s)
- Kristina Aspvall
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Erik Andersson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Karin Melin
- Institute Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Child and Adolescent Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lisa Norlin
- Region Västra Götaland, Department of Child and Adolescent Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Viktor Eriksson
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Sarah Vigerland
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Maral Jolstedt
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | | | - Lena Wallin
- Region Västra Götaland, Department of Child and Adolescent Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Filipa Sampaio
- Department of Public Health and Caring Sciences, Uppsala Universitet, Uppsala, Sweden
| | - Inna Feldman
- Department of Public Health and Caring Sciences, Uppsala Universitet, Uppsala, Sweden
| | - Matteo Bottai
- Divison of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Fabian Lenhard
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Eva Serlachius
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Kvillemo PK, Chen L, Bottai M, Frumento P, Almondo G, Mittendorfer-Rutz E, Friberg E, Alexanderson KAE. Sickness absence and disability pension among women with breast cancer: a population-based cohort study from Sweden. BMC Public Health 2021; 21:697. [PMID: 33836707 PMCID: PMC8033713 DOI: 10.1186/s12889-021-10703-1] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 03/24/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Women's return to work after diagnosis of breast cancer (BC) is becoming more prevalent. However, register-based national investigation on sickness absence (SA) and disability pension (DP) in BC women is lacking. The aim of the study was to explore SA and DP before and after a first BC diagnosis and the possibility to predict new cancer-related SA by using disease-related and sociodemographic factors. METHODS A longitudinal register study of the 3536 women in Sweden aged 19-64 with a first BC diagnosis in 2010 was conducted by linkage of five nationwide registers. Particularly, detailed information on SA and DP was obtained from the National Social Insurance Agency. Descriptive statistics on SA and DP 2 years before through 3 years after the BC diagnosis were performed. The risk of having a new SA spell due to BC or BC-related diagnoses was modeled using logistic regression. RESULTS The proportion of women with SA increased during the year following the BC diagnosis date and declined over the next 2 years to proportions before diagnosis. At the time of BC diagnosis, half of the women began a new SA spell > 14 days with cancer, cancer-related, or mental diagnosis. Disease-related and sociodemographic factors including occupational sector, living area, age, cancer stage, educational level, and number of previous SA days showed statistical significance (p < 0.05) in predicting a new SA around BC diagnosis. By using these factors, it was possible to correctly predict 67% of the new SA spell. CONCLUSIONS SA among women with BC was elevated mainly in the first year after diagnosis. New SA following BC diagnosis can accurately be predicted.
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Affiliation(s)
- Pia K Kvillemo
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Lingjing Chen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Frumento
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Political Sciences, University of Pisa, Pisa, Italy
| | - Gino Almondo
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Emilie Friberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Kristina A E Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
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Frumento P, Bottai M, Fernández-Val I. Parametric Modeling of Quantile Regression Coefficient Functions With Longitudinal Data. J Am Stat Assoc 2021. [DOI: 10.1080/01621459.2021.1892702] [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: 10/22/2022]
Affiliation(s)
- Paolo Frumento
- Department of Political Sciences, University of Pisa, Pisa, Italy
| | - Matteo Bottai
- Unit of Biostatistics, Karolinska Institutet, Institute of Environmental Medicine, Stockholm, Sweden
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Krakowski I, Bottai M, Habel H, Masucci G, Girnita A, Smedby KE, Eriksson H. Corrigendum: Impact of modern systemic therapies and clinical markers on treatment outcome for metastatic melanoma in a real-world setting. J Eur Acad Dermatol Venereol 2021; 35:1407. [PMID: 34004068 DOI: 10.1111/jdv.17209] [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: 11/29/2022]
Affiliation(s)
- I Krakowski
- Department of Dermatology/Theme inflammation, Karolinska University Hospital, Stockholm, Sweden.,Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - M Bottai
- Institute of Environmental Medicine, Karolinska Instinewtutet, Stockholm, Sweden
| | - H Habel
- Institute of Environmental Medicine, Karolinska Instinewtutet, Stockholm, Sweden
| | - G Masucci
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.,Skin Cancer Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden.,Department of Oncology/Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - A Girnita
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.,Skin Cancer Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - K E Smedby
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden.,Department of Medicine Solna, Division of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - H Eriksson
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.,Skin Cancer Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden.,Department of Oncology/Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
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Jarrick S, Lundberg S, Stephansson O, Symreng A, Bottai M, Höijer J, Ludvigsson JF. Pregnancy outcomes in women with immunoglobulin A nephropathy: a nationwide population-based cohort study. J Nephrol 2021. [PMID: 33683676 DOI: 10.1007/s40620‐021‐00979‐2] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Immunoglobulin A nephropathy (IgAN) incidence peaks in childbearing age. Data on pregnancy outcomes in women with IgAN are limited. METHODS We performed a register-based cohort study in a nationwide cohort of women with biopsy-verified IgAN in Sweden, comparing 327 pregnancies in 208 women with biopsy-verified IgAN and 1060 pregnancies in a matched reference population of 622 women without IgAN, with secondary comparisons with sisters to IgAN women. Adverse pregnancy outcomes, identified by way of the Swedish Medical Birth Register, were compared through multivariable logistic regression and presented as adjusted odds ratios (aORs). Main outcome was preterm birth (< 37 weeks). Secondary outcomes were preeclampsia, small for gestational age (SGA), low 5-min Apgar score (< 7), fetal or infant loss, cesarean section, and gestational diabetes. RESULTS We found that IgAN was associated with an increased risk of preterm birth (13.1% vs 5.6%; aOR = 2.69; 95% confidence interval [CI] = 1.52-4.77), preeclampsia (13.8% vs 4.2%; aOR = 4.29; 95%CI = 2.42-7.62), SGA birth (16.0% vs 11.1%; aOR = 1.84; 95%CI = 1.17-2.88), and cesarean section (23.9% vs 16.2%; aOR = 1.74, 95%CI = 1.14-2.65). Absolute risks were low for intrauterine (0.6%) or neonatal (0%) death and for low 5-min Apgar score (1.5%), and did not differ from the reference population. Sibling comparisons suggested increased risks of preterm birth, preeclampsia, and SGA in IgAN, but not of cesarean section. CONCLUSION We conclude that although most women with IgAN will have a favorable pregnancy outcome, they are at higher risk of preterm birth, preeclampsia and SGA. Intensified supervision during pregnancy is warranted.
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Affiliation(s)
- Simon Jarrick
- Department of Pediatrics, Örebro University Hospital, 701 85, Örebro, Sweden.
- Faculty of Health and Medicine, Örebro University, Örebro, Sweden.
| | - Sigrid Lundberg
- Department of Nephrology, Danderyd Hospital, Stockholm, Sweden
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Olof Stephansson
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Adina Symreng
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Matteo Bottai
- Division of Biostatisitcs, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Höijer
- Division of Biostatisitcs, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jonas F Ludvigsson
- Department of Pediatrics, Örebro University Hospital, 701 85, Örebro, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Jarrick S, Lundberg S, Stephansson O, Symreng A, Bottai M, Höijer J, Ludvigsson JF. Pregnancy outcomes in women with immunoglobulin A nephropathy: a nationwide population-based cohort study. J Nephrol 2021; 34:1591-1598. [PMID: 33683676 PMCID: PMC8494659 DOI: 10.1007/s40620-021-00979-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/22/2021] [Indexed: 01/05/2023]
Abstract
Background Immunoglobulin A nephropathy (IgAN) incidence peaks in childbearing age. Data on pregnancy outcomes in women with IgAN are limited. Methods We performed a register-based cohort study in a nationwide cohort of women with biopsy-verified IgAN in Sweden, comparing 327 pregnancies in 208 women with biopsy-verified IgAN and 1060 pregnancies in a matched reference population of 622 women without IgAN, with secondary comparisons with sisters to IgAN women. Adverse pregnancy outcomes, identified by way of the Swedish Medical Birth Register, were compared through multivariable logistic regression and presented as adjusted odds ratios (aORs). Main outcome was preterm birth (< 37 weeks). Secondary outcomes were preeclampsia, small for gestational age (SGA), low 5-min Apgar score (< 7), fetal or infant loss, cesarean section, and gestational diabetes. Results We found that IgAN was associated with an increased risk of preterm birth (13.1% vs 5.6%; aOR = 2.69; 95% confidence interval [CI] = 1.52–4.77), preeclampsia (13.8% vs 4.2%; aOR = 4.29; 95%CI = 2.42–7.62), SGA birth (16.0% vs 11.1%; aOR = 1.84; 95%CI = 1.17–2.88), and cesarean section (23.9% vs 16.2%; aOR = 1.74, 95%CI = 1.14–2.65). Absolute risks were low for intrauterine (0.6%) or neonatal (0%) death and for low 5-min Apgar score (1.5%), and did not differ from the reference population. Sibling comparisons suggested increased risks of preterm birth, preeclampsia, and SGA in IgAN, but not of cesarean section. Conclusion We conclude that although most women with IgAN will have a favorable pregnancy outcome, they are at higher risk of preterm birth, preeclampsia and SGA. Intensified supervision during pregnancy is warranted. Supplementary Information The online version contains supplementary material available at 10.1007/s40620-021-00979-2.
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Affiliation(s)
- Simon Jarrick
- Department of Pediatrics, Örebro University Hospital, 701 85, Örebro, Sweden. .,Faculty of Health and Medicine, Örebro University, Örebro, Sweden.
| | - Sigrid Lundberg
- Department of Nephrology, Danderyd Hospital, Stockholm, Sweden.,Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Olof Stephansson
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Adina Symreng
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Matteo Bottai
- Division of Biostatisitcs, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Höijer
- Division of Biostatisitcs, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jonas F Ludvigsson
- Department of Pediatrics, Örebro University Hospital, 701 85, Örebro, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Ahmed N, Lees KR, von Kummer R, Holmin S, Escudero-Martinez I, Bottai M, Jansen O, Wahlgren N. The SITS Open Study: A Prospective, Open Label Blinded Evaluation Study of Thrombectomy in Clinical Practice. Stroke 2021; 52:792-801. [PMID: 33563015 DOI: 10.1161/strokeaha.120.031031] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We designed SITS (Safe Implementation of Treatment in Stroke) Open to determine benefit and safety of thrombectomy in clinical practice for large artery occlusion stroke, using selected stent retrievers plus standard care versus standard care alone. METHODS SITS Open was a prospective, open, blinded evaluation, international, multicenter, controlled, nonrandomized registry study. Centers lacking access to thrombectomy contributed controls. Primary end point was categorical shift in modified Rankin Scale score at 3 months in the per protocol (PP) population. Principal secondary outcomes were symptomatic intracranial hemorrhage, functional independency (modified Rankin Scale score 0-2) and death at 3 months. Patients independently evaluated by video-recorded modified Rankin Scale interviews blinded to treatment or center identity by central core laboratory were regarded as PP population. Propensity score matching with covariate adjusted analysis was performed. RESULTS During 2014 to 2017, 293 patients (257 thrombectomy, 36 control) from 26 centers in 10 countries fulfilled intention-to-treat and 200 (170 thrombectomy, 30 control) PP criteria; enrollment of controls was limited by rapid uptake of thrombectomy. In PP analysis, median age was 71 versus 71 years, and baseline National Institutes of Health Stroke Scale 17 versus 17 in the thrombectomy and control arms, respectively. The propensity score matching analysis for PP showed a significant shift for modified Rankin Scale at 3 months favoring the thrombectomy group (odds ratio, 3.8 [95% CI, 1.61-8.95]; P=0.002). Regarding safety, there were 4 cases of symptomatic intracranial hemorrhage in the thrombectomy group (2.4%) and none in the control group. CONCLUSIONS In clinical practice, thrombectomy for patients with large artery occlusion stroke is superior to standard of care in our study. Registration: URL: https://www.clinicaltrials.gov. Unique Identifier: NCT02326428.
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Affiliation(s)
- Niaz Ahmed
- Department of Neurology (N.A.), Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience (N.A., S.H., N.W.), Karolinska Institutet, Stockholm, Sweden
| | - Kennedy R Lees
- School of Medicine, Dentistry and Nursing, University of Glasgow, United Kingdom (K.R.L.)
| | - Rudiger von Kummer
- Department of Diagnostic and Interventional Neuroradiology, University of Dresden, Germany (R.v.K.)
| | - Staffan Holmin
- Department of Neuroradiology (S.H.), Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience (N.A., S.H., N.W.), Karolinska Institutet, Stockholm, Sweden
| | - Irene Escudero-Martinez
- Department of Neurology, University Hospital Virgen del Rocío, Sevilla, Spain (I.E.-M.).,Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Spain (I.E.-M.)
| | - Matteo Bottai
- Institute of Environmental Medicine, Biostatistics (M.B.), Karolinska Institutet, Stockholm, Sweden
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany (O.J.)
| | - Nils Wahlgren
- Department of Clinical Neuroscience (N.A., S.H., N.W.), Karolinska Institutet, Stockholm, Sweden
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Abstract
IMPORTANCE Concerns about the cardiovascular safety of recombinant human growth hormone (rhGH) treatment in childhood have recently been raised; however, long-term studies are limited. OBJECTIVE To investigate the long-term risk of overall and severe cardiovascular events in patients previously treated with rhGH in childhood and whether there is an association with treatment duration or dose. DESIGN, SETTING, AND PARTICIPANTS This nationwide population-based cohort study included patients treated with rhGH during childhood from January 1, 1985, to December 31, 2010, in Sweden, with follow-up through December 31, 2014. Included patients were treated with rhGH owing to isolated growth hormone deficiency (GHD), small for gestational age (SGA), and idiopathic short stature (ISS). For each patient, 15 age-, sex-, and region-based matched control individuals were randomly selected from the general population as a comparison group. Data on cardiovascular outcomes and covariates including gestational age, birth weight, birth length, socioeconomic status, and height were obtained through linkage with several health care and population-based registers. Data were analyzed from January 1, 1985, to December 31, 2014. EXPOSURES Treatment with rhGH during childhood and adolescence (aged 0-18 years). MAIN OUTCOMES AND MEASURES The primary outcome was the first cardiovascular event recorded after the start of follow-up, and the secondary outcome was the first severe cardiovascular event. RESULTS A total of 53 444 individuals (3408 patients and 50 036 controls; 67.7% men; mean [SD] age at study end, 25.1 [8.2] years) were followed up for as long as 25 years (median follow-up, 14.9 [range, 0-25] years; total, 795 125 person-years). Among 1809 recorded cardiovascular events, the crude incidence rates were 25.6 events per 10 000 person-years for patients and 22.6 events per 10 000 person-years for controls. The adjusted hazard ratio (HR) for all cardiovascular events was higher in patients compared with controls (HR, 1.69; 95% CI, 1.30-2.19), especially for women (HR, 2.05; 95% CI, 1.31-3.20) compared with men (HR, 1.55; 95% CI, 1.12-2.13). All subgroups had increased HRs (SGA, 1.97 [95% CI, 1.28-3.04]; GHD, 1.66 [95% CI, 1.21-2.26]; and ISS, 1.55 [95% CI, 1.01-2.37]). Longer duration of rhGH treatment (HR, 2.08; 95% CI, 1.35-3.20) and total cumulative dose (HR, 2.05; 95% CI, 1.18-3.55) were associated with higher risk for overall cardiovascular disease. The adjusted HR for severe cardiovascular disease was 2.27 (95% CI, 1.01-5.12). CONCLUSIONS AND RELEVANCE In this cohort study, treatment with rhGH during childhood due to GHD, SGA, or ISS was associated with increased risks of cardiovascular events in early adulthood, particularly in women; however, conclusions of causality are still limited and the absolute risk remains low.
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Affiliation(s)
- Anders Tidblad
- Division of Pediatric Endocrinology, Department of Women’s and Children’s Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Matteo Bottai
- Unit of Biostatistics, Department of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Helle Kieler
- Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kerstin Albertsson-Wikland
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Lars Sävendahl
- Division of Pediatric Endocrinology, Department of Women’s and Children’s Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Rönnberg C, Lugaajju A, Nyman A, Hammar U, Bottai M, Lautenbach MJ, Sundling C, Kironde F, Persson KEM. A longitudinal study of plasma BAFF levels in mothers and their infants in Uganda, and correlations with subsets of B cells. PLoS One 2021; 16:e0245431. [PMID: 33465125 PMCID: PMC7815132 DOI: 10.1371/journal.pone.0245431] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 01/03/2021] [Indexed: 01/05/2023] Open
Abstract
Malaria is a potentially life-threatening disease with approximately half of the world’s population at risk. Young children and pregnant women are hit hardest by the disease. B cells and antibodies are part of an adaptive immune response protecting individuals continuously exposed to the parasite. An infection with Plasmodium falciparum can cause dysregulation of B cell homeostasis, while antibodies are known to be key in controlling symptoms and parasitemia. BAFF is an instrumental cytokine for the development and maintenance of B cells. Pregnancy alters the immune status and renders previously clinically immune women at risk of severe malaria, potentially due to altered B cell responses associated with changes in BAFF levels. In this prospective study, we investigated the levels of BAFF in a malaria-endemic area in mothers and their infants from birth up to 9 months. We found that BAFF-levels are significantly higher in infants than in mothers. BAFF is highest in cord blood and then drops rapidly, but remains significantly higher in infants compared to mothers even at 9 months of age. We further correlated BAFF levels to P. falciparum-specific antibody levels and B cell frequencies and found a negative correlation between BAFF and both P. falciparum-specific and total proportions of IgG+ memory B cells, as well as CD27− memory B cells, indicating that exposure to both malaria and other diseases affect the development of B-cell memory and that BAFF plays a part in this. In conclusion, we have provided new information on how natural immunity against malaria is formed.
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Affiliation(s)
- Caroline Rönnberg
- Department of Microbiology, Tumor, and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Division of Infectious Diseases, Department of Medicine Solna, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Allan Lugaajju
- Department of Microbiology, Tumor, and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Makerere University, Kampala, Uganda
| | - Anna Nyman
- Department of Laboratory Medicine, Lund University, Skåne University Hospital, Lund, Sweden
| | - Ulf Hammar
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Maximilian Julius Lautenbach
- Division of Infectious Diseases, Department of Medicine Solna, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Christopher Sundling
- Division of Infectious Diseases, Department of Medicine Solna, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Fred Kironde
- Makerere University, Kampala, Uganda
- Habib Medical School, Islamic University in Uganda (IUIU), Mbale, Uganda
| | - Kristina E. M. Persson
- Department of Laboratory Medicine, Lund University, Skåne University Hospital, Lund, Sweden
- * E-mail:
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49
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Lepzien R, Liu S, Czarnewski P, Nie M, Österberg B, Baharom F, Pourazar J, Rankin G, Eklund A, Bottai M, Kullberg S, Blomberg A, Grunewald J, Smed-Sörensen A. Monocytes in sarcoidosis are potent tumour necrosis factor producers and predict disease outcome. Eur Respir J 2021; 58:13993003.03468-2020. [PMID: 33446605 PMCID: PMC8295505 DOI: 10.1183/13993003.03468-2020] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 09/11/2020] [Accepted: 12/17/2020] [Indexed: 11/21/2022]
Abstract
Background Pulmonary sarcoidosis is an inflammatory disease characterised by granuloma formation and heterogeneous clinical outcome. Tumour necrosis factor (TNF) is a pro-inflammatory cytokine contributing to granuloma formation and high levels of TNF have been shown to associate with progressive disease. Mononuclear phagocytes (MNPs) are potent producers of TNF and highly responsive to inflammation. In sarcoidosis, alveolar macrophages have been well studied. However, MNPs also include monocytes/monocyte-derived cells and dendritic cells, which are poorly studied in sarcoidosis, despite their central role in inflammation. Objective To determine the role of pulmonary monocyte-derived cells and dendritic cells during sarcoidosis. Methods We performed in-depth phenotypic, functional and transcriptomic analysis of MNP subsets from blood and bronchoalveolar lavage (BAL) fluid from 108 sarcoidosis patients and 30 healthy controls. We followed the clinical development of patients and assessed how the repertoire and function of MNP subsets at diagnosis correlated with 2-year disease outcome. Results Monocytes/monocyte-derived cells were increased in blood and BAL of sarcoidosis patients compared to healthy controls. Interestingly, high frequencies of blood intermediate monocytes at time of diagnosis associated with chronic disease development. RNA sequencing analysis showed highly inflammatory MNPs in BAL of sarcoidosis patients. Furthermore, frequencies of BAL monocytes/monocyte-derived cells producing TNF without exogenous stimulation at time of diagnosis increased in patients that were followed longitudinally. In contrast to alveolar macrophages, the frequency of TNF-producing BAL monocytes/monocyte-derived cells at time of diagnosis was highest in sarcoidosis patients that developed progressive disease. Conclusion Our data show that pulmonary monocytes/monocyte-derived cells are highly inflammatory and can be used as a predictor of disease outcome in sarcoidosis patients. Phenotypic, transcriptomic and functional mapping of blood and pulmonary mononuclear phagocytes in sarcoidosis patients found that frequency and function of pulmonary monocytes at time of diagnosis predict 2-year outcome in sarcoidosishttps://bit.ly/2JX8fhr
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Affiliation(s)
- Rico Lepzien
- Division of Immunology and Allergy, Dept of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Sang Liu
- Division of Immunology and Allergy, Dept of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Paulo Czarnewski
- Dept of Biochemistry and Biophysics, National Bioinformatics Infrastructure Sweden, Science for Life Laboratory, Stockholm University, Stockholm, Sweden
| | - Mu Nie
- Division of Immunology and Allergy, Dept of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Björn Österberg
- Division of Immunology and Allergy, Dept of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Faezzah Baharom
- Division of Immunology and Allergy, Dept of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jamshid Pourazar
- Dept of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Gregory Rankin
- Dept of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Anders Eklund
- Division of Respiratory Medicine, Dept of Medicine Solna and Centre for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Dept of Respiratory Medicine, Theme Inflammation and Infection, Karolinska University Hospital, Stockholm, Sweden
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Susanna Kullberg
- Division of Respiratory Medicine, Dept of Medicine Solna and Centre for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Dept of Respiratory Medicine, Theme Inflammation and Infection, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Blomberg
- Dept of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Johan Grunewald
- Division of Respiratory Medicine, Dept of Medicine Solna and Centre for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Dept of Respiratory Medicine, Theme Inflammation and Infection, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Smed-Sörensen
- Division of Immunology and Allergy, Dept of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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50
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Acevedo N, Scala G, Merid SK, Frumento P, Bruhn S, Andersson A, Ogris C, Bottai M, Pershagen G, Koppelman GH, Melén E, Sonnhammer E, Alm J, Söderhäll C, Kere J, Greco D, Scheynius A. DNA Methylation Levels in Mononuclear Leukocytes from the Mother and Her Child Are Associated with IgE Sensitization to Allergens in Early Life. Int J Mol Sci 2021; 22:ijms22020801. [PMID: 33466918 PMCID: PMC7830007 DOI: 10.3390/ijms22020801] [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] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 12/23/2022] Open
Abstract
DNA methylation changes may predispose becoming IgE-sensitized to allergens. We analyzed whether DNA methylation in peripheral blood mononuclear cells (PBMC) is associated with IgE sensitization at 5 years of age (5Y). DNA methylation was measured in 288 PBMC samples from 74 mother/child pairs from the birth cohort ALADDIN (Assessment of Lifestyle and Allergic Disease During INfancy) using the HumanMethylation450BeadChip (Illumina). PBMCs were obtained from the mothers during pregnancy and from their children in cord blood, at 2 years and 5Y. DNA methylation levels at each time point were compared between children with and without IgE sensitization to allergens at 5Y. For replication, CpG sites associated with IgE sensitization in ALADDIN were evaluated in whole blood DNA of 256 children, 4 years old, from the BAMSE (Swedish abbreviation for Children, Allergy, Milieu, Stockholm, Epidemiology) cohort. We found 34 differentially methylated regions (DMRs) associated with IgE sensitization to airborne allergens and 38 DMRs associated with sensitization to food allergens in children at 5Y (Sidak p ≤ 0.05). Genes associated with airborne sensitization were enriched in the pathway of endocytosis, while genes associated with food sensitization were enriched in focal adhesion, the bacterial invasion of epithelial cells, and leukocyte migration. Furthermore, 25 DMRs in maternal PBMCs were associated with IgE sensitization to airborne allergens in their children at 5Y, which were functionally annotated to the mTOR (mammalian Target of Rapamycin) signaling pathway. This study supports that DNA methylation is associated with IgE sensitization early in life and revealed new candidate genes for atopy. Moreover, our study provides evidence that maternal DNA methylation levels are associated with IgE sensitization in the child supporting early in utero effects on atopy predisposition.
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Affiliation(s)
- Nathalie Acevedo
- Department of Clinical Science and Education, Karolinska Institutet, and Sachs’ Children and Youth Hospital, Södersjukhuset, SE-118 83 Stockholm, Sweden; (N.A.); (S.K.M.); (E.M.); (J.A.)
- Institute for Immunological Research, University of Cartagena, 130014 Cartagena, Colombia
| | - Giovanni Scala
- Department of Biology, University of Naples Federico II, 80138 Napoli, Italy;
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland;
- Institute of Biosciences and Medical Technologies (BioMediTech), Tampere University, 33520 Tampere, Finland
| | - Simon Kebede Merid
- Department of Clinical Science and Education, Karolinska Institutet, and Sachs’ Children and Youth Hospital, Södersjukhuset, SE-118 83 Stockholm, Sweden; (N.A.); (S.K.M.); (E.M.); (J.A.)
| | - Paolo Frumento
- Department of Political Sciences, University of Pisa, 56126 Pisa, Italy;
| | - Sören Bruhn
- Department of Medicine Solna, Translational Immunology Unit, Karolinska Institutet, SE-171 77 Stockholm, Sweden; (S.B.); (A.A.)
| | - Anna Andersson
- Department of Medicine Solna, Translational Immunology Unit, Karolinska Institutet, SE-171 77 Stockholm, Sweden; (S.B.); (A.A.)
| | - Christoph Ogris
- Stockholm Bioinformatics Center, Department of Biochemistry and Biophysics, Stockholm University, Science for Life Laboratory, SE-17121 Solna, Sweden; (C.O.); (E.S.)
- Institute of Computational Biology, Helmholtz Center Munich, 85764 Neuherberg, Germany
| | - Matteo Bottai
- Institute of Environmental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden; (M.B.); (G.P.)
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden; (M.B.); (G.P.)
| | - Gerard H. Koppelman
- Section of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
- Groningen Research Institute of Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Erik Melén
- Department of Clinical Science and Education, Karolinska Institutet, and Sachs’ Children and Youth Hospital, Södersjukhuset, SE-118 83 Stockholm, Sweden; (N.A.); (S.K.M.); (E.M.); (J.A.)
- Institute of Environmental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden; (M.B.); (G.P.)
| | - Erik Sonnhammer
- Stockholm Bioinformatics Center, Department of Biochemistry and Biophysics, Stockholm University, Science for Life Laboratory, SE-17121 Solna, Sweden; (C.O.); (E.S.)
| | - Johan Alm
- Department of Clinical Science and Education, Karolinska Institutet, and Sachs’ Children and Youth Hospital, Södersjukhuset, SE-118 83 Stockholm, Sweden; (N.A.); (S.K.M.); (E.M.); (J.A.)
| | - Cilla Söderhäll
- Department of Biosciences and Nutrition, Karolinska Institutet, SE-171 77 Stockholm, Sweden; (C.S.); (J.K.)
- Department of Women’s and Children’s Health, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Juha Kere
- Department of Biosciences and Nutrition, Karolinska Institutet, SE-171 77 Stockholm, Sweden; (C.S.); (J.K.)
- Folkhälsan Research Institute, Stem Cells and Metabolism Research Program, University of Helsinki, 00014 Helsinki, Finland
| | - Dario Greco
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland;
- Institute of Biosciences and Medical Technologies (BioMediTech), Tampere University, 33520 Tampere, Finland
- Institute of Biotechnology, University of Helsinki, FI-00014 Helsinki, Finland
| | - Annika Scheynius
- Department of Clinical Science and Education, Karolinska Institutet, and Sachs’ Children and Youth Hospital, Södersjukhuset, SE-118 83 Stockholm, Sweden; (N.A.); (S.K.M.); (E.M.); (J.A.)
- Science for Life Laboratory, Karolinska Institutet, SE-171 65 Solna, Sweden
- Correspondence:
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