Sahlgrenska University Hospital

Gothenburg, Sweden

Sahlgrenska University Hospital

Gothenburg, Sweden
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News Article | May 8, 2017
Site: www.eurekalert.org

A stringently designed web form with questions about foot ulcers, deformities and neuropathy will soon be brought into use to better protect the feet of people with diabetes. The tool is a result of research conducted at Sahlgrenska Academy. "One of the reasons why patients in the risk zone are not detected in time is that there is no standardised procedure of foot examination which means risk assessment is subjective," says Doctor of Philosophy Ulla Hellstrand Tang, a certified prosthetist and orthotist with long experience in the care of diabetes patients with feet problems. "Foot ulcers are a common cause of amputation for people with diabetes. The National Board of Health and Welfare recommends diabetics to have their feet checked but routines are inadequate and there are large regional differences," says Ulla Hellstrand Tang. In her research, Hellstrand Tang has now developed a simple, standardised e-health tool for the risk assessment of feet. Clear descriptions and pictures guide the person through the 22 self-examination steps so there can be no uncertainty about the patient's status. The patient is asked questions about, for example, mobility, foot ulcers, numbness and degree of perspiration. Reduced foot perspiration may indicate a nerve injury. Likewise, the presence of a bunion (hallux valgus), hammer toe or other deformity is examined, and so on. All the question variables have been scientifically tested so that a certain condition is always given the same classification and treatment recommendation. In the autumn, Sahlgrenska University Hospital in Gothenburg will start to use the D-Foot tool and it is hoped that other clinics will do the same. "I am very pleased that the tool is being taken into use so soon and can thereby help patients," says Ulla Hellstrand Tang. She has also investigated which aids best protect patients' feet from unnecessarily high pressure. In a two-year study, about a hundred patients tested both prefabricated and individually designed insoles. Pressure was measured regularly at seven different measuring points under the feet. The heels were subjected to the strongest pressure. "It was shown that a personally designed insole gives a closer fit around the heel cushion, provides support to a larger area, and reduces pressure significantly more than a traditional, prefabricated insole does," says Ulla Hellstrand Tang. "However, we could also see that combinations of good shoes and prefabricated insoles created good support and acceptable pressure for some people. A patient whose feet are in relatively good shape can begin by using a cheaper and simpler insole. The advantage of this is that the patient's treatment is completed after just one visit and no return appointment after two-three weeks is necessary," she says.


News Article | May 22, 2017
Site: www.eurekalert.org

Earlier discovery of cancer and greater precision in the treatment process are the objectives of a new method developed by researchers at Sahlgrenska Academy and Boston University. Investments are now being made to roll out this innovation across healthcare and broaden the scope of the research in this field. "We can screen at-risk patient groups, and we also plan to spot the cancer patients who are relapsing so that we can adapt their treatment," says Anders Ståhlberg, docent in molecular medicine and corresponding author for two articles about the method. The technique was created based on the fact that people with cancer also have DNA from tumor cells circulating in the blood, molecules that can be discovered in a regular blood sample long before the tumor is visible via imaging such as tomography, MRI, X-ray and ultrasound. The researchers have now increased the sensitivity of detecting tumor DNA in blood thousand-fold by eliminating the background noise from the measurements using "DNA barcoding". "One of the benefits of the technique is that it makes use of available instrumentation, which means it can be applied in most labs. We are not first in the world to show that barcoding concept works, but in our case we have developed a fast and flexible method that is simple, flexible and cost-effective to use," says Anders Ståhlberg. In articles in Nature Protocols and Nucleic Acids Research, he and his colleagues talk about how the ultra-sensitive mutation analyses find individual tumor cell molecules among 10,000 healthy molecules. The method is now also being implemented as a generic platform at Sahlgrenska University Hospital by the Wallenberg Center for Molecular and Translational Medicine at University of Gothenburg, in close collaboration with the hospital, and with the backing of Astra Zeneca and Region Västra Götaland. "The method has major potential and should soon be ready for patients. However, first the application need to be tested on patient material in clinical studies, there really is no way around that," says Göran Landberg, professor and director of the Wallenberg Center, who has the task of bringing research and clinical work together. "We work together closely both at the hospital and the university, and with Astra Zeneca. These efforts are completely in line with our ambitions," says Göran Landberg. Screening of at-risk groups for certain types of cancer, leading to earlier diagnosis, is being described as an area with major potential, both with regard to saving lives and saving money within healthcare. No tissue samples are needed for the method, and the tumor does not even need to be located. It can also be used in the calibration of chemotherapy treatments, and help to avoid problematic under- and overdosage. It can also be used to discover whether a patient is becoming resistant to a certain cancer drug, according to Anders Ståhlberg. "There is a great need for something like this in this area. After all, targeted treatments work well for some patients at the moment, but not others. We hope to be able to find out how well a treatment is going, detect relapses at an early stage and improve our options with regard to changing treatments," he says.


News Article | May 22, 2017
Site: phys.org

"We can screen at-risk patient groups, and we also plan to spot the cancer patients who are relapsing so that we can adapt their treatment," says Anders Ståhlberg, docent in molecular medicine and corresponding author for two articles about the method. The technique was created based on the fact that people with cancer also have DNA from tumor cells circulating in the blood, molecules that can be discovered in a regular blood sample long before the tumor is visible via imaging such as tomography, MRI, X-ray and ultrasound. The researchers have now increased the sensitivity of detecting tumor DNA in blood thousand-fold by eliminating the background noise from the measurements using "DNA barcoding". "One of the benefits of the technique is that it makes use of available instrumentation, which means it can be applied in most labs. We are not first in the world to show that barcoding concept works, but in our case we have developed a fast and flexible method that is simple, flexible and cost-effective to use," says Anders Ståhlberg. In articles in Nature Protocols and Nucleic Acids Research, he and his colleagues talk about how the ultra-sensitive mutation analyses find individual tumor cell molecules among 10,000 healthy molecules. The method is now also being implemented as a generic platform at Sahlgrenska University Hospital by the Wallenberg Center for Molecular and Translational Medicine at University of Gothenburg, in close collaboration with the hospital, and with the backing of Astra Zeneca and Region Västra Götaland. "The method has major potential and should soon be ready for patients. However, first the application need to be tested on patient material in clinical studies, there really is no way around that," says Göran Landberg, professor and director of the Wallenberg Center, who has the task of bringing research and clinical work together. "We work together closely both at the hospital and the university, and with Astra Zeneca. These efforts are completely in line with our ambitions," says Göran Landberg. Screening of at-risk groups for certain types of cancer, leading to earlier diagnosis, is being described as an area with major potential, both with regard to saving lives and saving money within healthcare. No tissue samples are needed for the method, and the tumor does not even need to be located. It can also be used in the calibration of chemotherapy treatments, and help to avoid problematic under- and overdosage. It can also be used to discover whether a patient is becoming resistant to a certain cancer drug, according to Anders Ståhlberg. "There is a great need for something like this in this area. After all, targeted treatments work well for some patients at the moment, but not others. We hope to be able to find out how well a treatment is going, detect relapses at an early stage and improve our options with regard to changing treatments," he says. Explore further: Researchers use math to develop personalized chemo treatments


News Article | July 12, 2017
Site: www.eurekalert.org

There is effective protection against hip fracture for the many elderly people whose skeleton is declining in strength, as a side effect of cortisone treatment. If patients receive the osteoporosis medication alendronate, it reduces the risk of hip fracture by 65 percent, as a study published in The Journal of the American Medical Association (JAMA) reveals. "The low number of people who receive this protective treatment is often due to a lack of knowledge and procedures in this area within the healthcare system," says Mattias Lorentzon, a professor of geriatric medicine at the Sahlgrenska Academy's Institute of Medicine, and a senior physician at Sahlgrenska University Hospital. Hip fractures usually affect older people and often lead to disability, a worse quality of life and premature death. For many aged 80 or over, the combination of extensive surgery, immobility and long hospital stays, with a risk of infection, blood clots and confusion, is simply too much. Cortisone treatment to counteract inflammation conditions such as rheumatoid or muscular arthritis, meanwhile, doubles the risk of hip fracture. This latest study has revealed, however, that just one in four patients treated with cortisone receive the osteoporosis medication alendronate. The aforementioned study was made possible by interlinking several registers in Sweden, namely Senior Alert, the patient register, the drug register, the cause of death register and the population register. From a base group of over 400,000 elderly patients, 1802 were prescribed alendronate after starting treatment with the cortisone preparation prednisolone in tablet form. They had been taking the drug for at least three months, at a dosage of at least five milligrams per day. The group with matched controls, which also consisted of 1802 people, took prednisolone tablets, but did not receive the protective alendronate treatment. Of those who took cortisone tablets, but did not receive protective treatment, 4.1 percent had broken their hip after around 15 months (1.3 years). In the group that also received alendronate (the protective substance), the equivalent figure was 1.5 percent. This represented a significant reduction in the risk, i.e. 65 percent less, covering other fractures too. "If a patient receives the protective treatment, the risk of suffering a new fracture, and in particular the new hip fractures that we are really keen to prevent, reduces dramatically," says Kristian Axelsson, co-author and doctoral candidate, who also works as a resident physician in the orthopedics department at Skaraborgs Hospital. "The number of patients receiving the treatment is quite low at present, but we are hoping this study will mean more prednisolone patients will receive the fracture-preventing treatment," he continues. Really Helps to Avoid It Most hip fractures occur in older women. The average age in the study was around 80 years, and seven out of ten of the patients were women. There was no increased risk of side effects linked to the alendronate treatment, and for Mattias Lorentzon, it is clear what the study has achieved. "This drug costs around SEK 200 per person per year, which is nothing really, thanks to the fact that it's a generic drug for which no patent is outstanding. It's unlikely any company will invest large amounts of money on a randomized trial to investigate whether it prevents hip fractures in cortisone patients. It perhaps wouldn't be too ethical either, because there is already indirect evidence that it should work," he tells us. "That's why we wanted to look at the question at issue as part of a major retrospective observational study. The data we now have really supports the argument that it provides effective protection against hip fracture, one of the most costly complaints within the Swedish healthcare system, and something that many people of this age die from. It really helps if you can avoid it," he concludes.


In addition, the analysis highlighted that a meaningful proportion of patients in every region experienced suboptimal control of their PD symptoms, including bradykinesia, dyskinesia, fluctuations, tremor, and immobility. Uncontrolled symptomology in PD has been associated with increased healthcare costs and reduce patient quality of life. "This exploratory study shows the power of continuous objective measurement in PD and how a rich dataset like this could be used to identify and target unmet needs and thereby enhance healthcare benchmarking in the disease," said Peter Lynch, Head of Global Market Access, Reimbursement and Health Economics for GKC and the presenting author of the study. "Up until now, we believe that a collection of truly objective Parkinson's patient symptoms like this has not existed, and we believe it may offer a rich resource for researchers to understand the disease more deeply." Use of continuous objective measurement in routine clinical care of PD enables the identification and quantification of motor symptoms and allows clinicians to assess and track patient's symptoms over time. Treating PD presents challenges as patients' symptoms can fluctuate from day to day and even throughout the course of a day. People with PD rely heavily on their own interpretation of their symptoms, as well as evaluation from their doctors to understand how their disease is progressing and act to optimize their medication regimens. The PKG provides an objective measure of patients' symptoms, allowing physicians to objectively assess symptoms and help make decisions about when to alter treatment. "Even though literature suggests that more than 75 percent of PD patients develop motor fluctuations, no one knows how large the need for dose adjustments or advanced treatments really is," said Filip Bergquist, associate professor in the department of neurology at Sahlgrenska University Hospital in Sweden and a co-author on the poster. "This descriptive study indicates that there is substantial room for improvement, and it should be followed by population based studies as well as evaluations of whether the availability of objective measurements will improve outcomes." About Global Kinetics Corporation Global Kinetics is a commercial-stage digital health company revolutionizing the management of Parkinson's disease by providing the first continuous and objective measurement of patients' symptoms in everyday environments. The company's Personal KinetiGraph™ (PKG™) is a patient-friendly, algorithm-based system that records body movements and other symptoms over the course of many days and creates data-driven reports that empower more personalized treatment and management decisions—with the goal of leading to a higher quality of life for patients. Global Kinetics continues to pursue partnerships with major pharmaceutical and medical technology companies to help measure the efficacy of new and advanced therapies for the world's most widespread movement disorder. To view the original version on PR Newswire, visit:http://www.prnewswire.com/news-releases/global-kinetics-corporation-big-data-highlights-unmet-needs--global-variations-in-parkinsons-disease-300475006.html


Immunicum AB (publ) Announces Last Patient Last Visit in the Ongoing Phase I/II Hepatocellular Carcinoma Study Immunicum AB (publ; First North Premier: IMMU.ST), a biopharmaceutical company advancing a novel immuno-oncology treatment against a range of solid tumors, today announced the last patient last visit in the ongoing Phase I/II study of ilixadencel in hepatocellular carcinoma (HCC). The open label study enrolled eighteen patients and was conducted at the Sahlgrenska University Hospital at Gothenburg University. Topline results from the study following data analysis are anticipated before the end of the year. Ilixadencel, formerly known as INTUVAX, is a cancer immune primer developed for the treatment of solid tumors and is currently also being investigated in an ongoing Phase II trial in renal cell carcinoma (MERECA) as well as a Phase I/II study in gastrointestinal stromal tumors. "Today's announcement continues the significant progress we have made within our clinical programs this year to demonstrate ilixadencel's therapeutic potential as an off-the-shelf immune primer in solid tumors. HCC in particular is a very severe type of cancer with limited treatment options and a strong demand for novel, innovative therapies such as ilixadencel," said Peter Suenaert, MD, PhD, Immunicum's Chief Medical Officer. "Especially in this rapidly advancing type of cancer, the ability to extend survival by even a few months is a positive benefit. The interim results we presented at the SITC Annual meeting last November were promising and we look forward to the complete results, which we hope to communicate before end of year." The open-label phase I/II trial was initiated by Immunicum in 2013 to investigate safety and efficacy of ilixadencel, Immunicum's lead cancer immune primer, as second and first line therapy in HCC. Conducted at the Sahlgrenska University Hospital at Gothenburg University, the primary objective of the study is to investigate safety of the cell therapy product. Secondary objectives include immunological response and initial signs of efficacy on overall survival. In total, eighteen patients were enrolled in the study, seventeen with advanced HCC and one with bile-duct cancer (following protocol amendment). All patients were treated with at least one intratumoral dose of ilixadencel either as a monotherapy or in combination with first line treatment sorafenib. Interim results presented at the SITC Annual meeting in November 2016 demonstrated a good safety and tolerability profile. More information on the study can be found on the clinicaltrial.gov page through the following link: https://www.clinicaltrials.gov/ct2/show/NCT01974661?term=Immunicum&rank=3 About hepatocellular carcinoma Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide and the most common cause of death in people with liver cirrhosis. Progression is very rapid and prognosis is poor due to the inability to completely remove the tumor through surgery in most cases. Malignant transformation of liver cells may occur as a consequence of various origins, such as chronic viral hepatitis, alcohol, and metabolic disorders. About ilixadencel Ilixadencel cell therapy product (formerly known as INTUVAX®) is an off-the-shelf cancer immune primer, developed for the treatment of solid tumors. Its active ingredient is activated allogeneic dendritic cells, derived from healthy blood donors. Intratumoral injection of these cells is expected to lead to an inflammatory response which in turn leads to tumor-specific activation of the patient's cytotoxic T-lymphocytes. For more information, please contact: MacDougall Biomedical Communications Gretchen Schweitzer or Stephanie May Telephone: +49 89 2424 3494 or +49 175 5711562 E-mail: gschweitzer@macbiocom.com or smay@macbiocom.com


Ben-Menachem E.,Sahlgrenska University Hospital
Epilepsia | Year: 2014

The ultimate treatment goal in epilepsy therapy is always freedom from seizures with as few treatment adverse effects as possible. If seizures persist with the first monotherapy, alternative monotherapy with another antiepileptic drug (AED) should be considered. Continuing seizures should lead to a reevaluation of differential diagnosis and adherence. Epilepsy surgery as an alternative therapy may be suitable in selected cases. If the diagnosis of epilepsy is established and epilepsy surgery is not appropriate, AED treatment should be optimized. Evidence for how to proceed is lacking. Concepts such as rational polytherapy have been advocated but remain speculative concerning better efficacy based on the use of AEDs with differing modes of action. A variety of new AEDs including rufinamide, lacosamide, vigabatrin, perampanel, and retigabine have been recently introduced in the United States. They are briefly characterized in this update review. © 2014 International League Against Epilepsy.


Andersson J.,Sahlgrenska University Hospital
The British journal of surgery | Year: 2013

Previous studies comparing laparoscopic and open surgical techniques have reported improved health-related quality of life (HRQL). This analysis compared HRQL 12 months after laparoscopic versus open surgery for rectal cancer in a subset of a randomized trial. The setting was a multicentre randomized trial (COLOR II) comparing laparoscopic and open surgery for rectal cancer. Involvement in the HRQL study of COLOR II was optional. Patients completed the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-CR38, and EuroQol - 5D (EQ-5D™) before surgery, and 4 weeks, 6, 12 and 24 months after operation. Analysis was done according to the manual for each instrument. Of 617 patients in hospitals participating in the HRQL study of COLOR II, 385 were included. The HRQL deteriorated to moderate/severe degrees after surgery, gradually returning to preoperative values over time. Changes in EORTC QLQ-C30 and QLQ-CR38, and EQ-5D™ were not significantly different between the groups regarding global health score or any of the dimensions or symptoms at 4 weeks, 6 or 12 months after surgery. In contrast to previous studies in patients with colonic cancer, HRQL after rectal cancer surgery was not affected by surgical approach. Registration number: NCT0029779 (http://www.clinicaltrials.gov). © 2013 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.


The Nordic Myeloma Study Group conducted an open randomized trial to compare bortezomib as consolidation therapy given after high-dose therapy and autologous stem cell transplantation (ASCT) with no consolidation in bortezomib-naive patients with newly diagnosed multiple myeloma. Overall, 370 patients were centrally randomly assigned 3 months after ASCT to receive 20 doses of bortezomib given during 21 weeks or no consolidation. The hypothesis was that consolidation therapy would prolong progression-free survival (PFS). The PFS after randomization was 27 months for the bortezomib group compared with 20 months for the control group (P = .05). Fifty-one of 90 patients in the treatment group compared with 32 of 90 controls improved their response after randomization (P = .007). No difference in overall survival was seen. Fatigue was reported more commonly by the bortezomib-treated patients in self-reported quality-of-life (QOL) questionnaires, whereas no other major differences in QOL were recorded between the groups. Consolidation therapy seemed to be beneficial for patients not achieving at least a very good partial response (VGPR) but not for patients in the ≥ VGPR category at randomization. Consolidation with bortezomib after ASCT in bortezomib-naive patients improves PFS without interfering with QOL. This trial was registered at www.clinicaltrials.gov as #NCT00417911.


Hagman A.,Sahlgrenska University Hospital
Human reproduction (Oxford, England) | Year: 2013

Do women with Turner karyotype have increased mortality and morbidity in the years after childbirth? No mortality occurred during pregnancy and follow-up in women with Turner karyotype, but a higher rate of circulatory and endocrine diseases and a high risk of aortic aneurysm were confirmed. Pregnancies in women with Turner karyotype are high-risk pregnancies with an increased risk of maternal mortality from aortic dissection and morbidity from hypertensive disorders. A retrospective Swedish population-based registry study of 124 women with Turner karyotype born between 1957 and 1987 and who gave birth between 1973 and 2010. Women with Turner karyotype without childbirth (n = 378) were selected as controls. A second control group consisted of women from the Swedish Medical Birth Register (MBR) (n = 1230) matched for maternal age, number of children and year of birth of the first child. Women with Turner karyotype were identified in the Swedish Genetic Turner Register. Data were obtained by using the unique personal identification number with cross linkage to the Swedish MBR, the Cause of Death Register, the National Patient Register and the Swedish Cancer Register. Hazard ratio (HR) with 95% confidence interval (CI) was used in the analysis of morbidity. No mortality occurred in women with Turner karyotype and childbirth. Diseases of the circulatory system occurred more often in women with Turner syndrome under the age of 40 years compared with the MBR control group (HR 4.59; 95% CI 2.75-7.66) but was similar at or above the age of 40 years. Morbidity from circulatory diseases was increased before pregnancy (HR 3.83; 95% CI 1.02-14.43) and during pregnancy or within 1 year after (HR 5.78; 95% CI 1.94-17.24), but was similar after 1 or more years after delivery (HR 1.91; 95% CI 0.74-4.96). Aortic aneurysm occurred in 11/502 (2.2%) women with Turner karyotype and in three women (2.4%) during pregnancy. The long-term follow-up showed that aortic dissection was a common cause of death in young women with Turner karyotype without childbirth. A thorough cardiac evaluation before pregnancy in women with Turner karyotype is of utmost importance. Although this was a population-based registry study performed over a period of more than 20 years, a much longer follow-up and larger series are needed to assess rare events. The study also lacks information on phenotype and mode of conception in women with Turner karyotype. Women who gave birth probably represent a selection of healthier women with Turner karyotype. The high risk of aortic aneurysm in young women with Turner karyotype is in agreement with the literature.

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