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Stockholm South, Sweden

Amu S.,Karolinska Institutet | Lavy-Shahaf G.,Bar - Ilan University | Cagigi A.,Karolinska Institutet | Hejdeman B.,Stockholm South General Hospital | And 4 more authors.

Background: Aged individuals respond poorly to vaccination and have a higher risk of contracting infections in comparison to younger individuals; whether age impacts on the composition and function of B cell subpopulations relevant for immune responses is still controversial. It is also not known whether increased age during HIV-1 infection further synergizes with the virus to alter B cell subpopulations. In view of the increased number of HIV-1 infected patients living to high age as a result of anti-retroviral treatment this is an important issue to clarify.Results: In this work we evaluated the distribution of B cell subpopulations in young and aged healthy individuals and HIV-1 infected patients, treated and naïve to treatment. B cell populations were characterized for the expression of inhibitory molecules (PD-1 and FcRL4) and activation markers (CD25 and CD69); the capacity of B cells to respond to activation signals through up-regulation of IL-6 expression was also evaluated. Increased frequencies of activated and tissue-like memory B cells occurring during HIV-1 infection are corrected by prolonged ART therapy. Our findings also reveal that, in spite of prolonged treatment, resting memory B cells in both young and aged HIV-1 infected patients are reduced in number, and all memory B cell subsets show a low level of expression of the activation marker CD25.Conclusions: The results of our study show that resting memory B cells in ART-treated young and aged HIV-1 infected patients are reduced in number and memory B cell subsets exhibit low expression of the activation marker CD25. Aging per se in the HIV-1 infected population does not worsen impairments initiated by HIV-1 in the memory B cell populations of young individuals. © 2014 Amu et al.; licensee BioMed Central Ltd. Source

Larsson C.,Karolinska Institutet | Saltvedt S.,Stockholm South General Hospital | Edman G.,Karolinska Institutet | Wiklund I.,Karolinska Institutet | Andolf E.,Karolinska Institutet
Sexual and Reproductive Healthcare

Objective: To evaluate the impact of personality, socio-demographic and obstetric factors on birth experience in a cohort of healthy first-time mothers. A second aim was to compare a visual analogue scale and Wijma Delivery Experience Questionnaire B as instruments evaluating birth experience. Material and methods: In total, 541 women were prospectively followed from the end of pregnancy until 9 months postpartum. Socio-demographic, psychological and somatic data as well as personality characteristics were collected. Experience of delivery was measured with a visual analogue scale and with Wijma Delivery Experience Questionnaire B. Sixty-three variables were considered to be associated with the experience of delivery. Nineteen of these, found to be significantly associated with birth experience, were entered in a logistic regression analysis. Results: The logistic regression analysis showed that a memory of pain during birth, high usage of analgesics postpartum, long hospital stay, worry in late pregnancy and high self-rated irritation were related to a more negative birth experience, while high confidence in the midwife was related to a more positive experience. The correlation between experiences of delivery rated by Wijma Delivery Experience Questionnaire B and the visual analogue scale was 0.52 (p<0.001). Conclusion: To help women to cope with pain during and after birth could be an important factor to improve birth experience. Even though the correlation between the visual analogue scale and Wijma Delivery Experience Questionnaire B was moderate, the visual analogue scale could be used as a simple method for screening of birth experience. © 2010 Elsevier B.V. Source

Sutterlin S.,Uppsala University | Tano E.,Uppsala University | Bergsten A.,Stockholm South General Hospital | Tallberg A.-B.,Uppsala University Hospital | Melhus A.,Uppsala University
Acta Dermato-Venereologica

Silver-based dressings have been used extensively in wound management in recent years, but data on their antimicrobial activity in the clinical setting are limited. In order to explore their effects on chronic leg ulcer flora, 14 ulcers were cultured after at least 3 weeks treatment with Aquacel Ag ® or Acticoat ®. Phenotypic and genetic silver resistance were investigated in a total of 56 isolates. Silver-based dressings had a limited effect on primary wound pathogens, which were present in 79% of the cultures before, and 71% after, treatment. One silver-resistant Enterobacter cloacae strain was identified (silver nitrate minimal inhibitory concentration (MIC) > 512 mg/l, positive for silE, silS and silP). Further studies in vitro showed that inducible silver-resistance was more frequent in Enterobacteriaceae with cephalosporin-resistance and that silver nitrate had mainly a bacteriostatic effect on Staphylococcus aureus. Monitoring of silver resistance should be considered in areas where silver is used extensively. © 2012 Acta Dermato-Venereologica. Source

Pensieroso S.,San Raffaele Scientific Institute | Galli L.,San Raffaele Scientific Institute | Nozza S.,San Raffaele Scientific Institute | Ruffin N.,Karolinska Institutet | And 8 more authors.

Objectives: During HIV-1 infection, the development, phenotype, and functionality of B cells are impaired. Transitional B cells and aberrant B-cell populations arise in blood, whereas a declined percentage of resting memory B cells is detected. Our study aimed at pinpointing the demographic, immunological, and viral factors driving these pathological findings, and the role of antiretroviral therapy in reverting these alterations. Design: B-cell phenotype and correlating factors were evaluated. Methods: Variations in B-cell subsets were evaluated by flow cytometry in HIV-1-infected individuals naive to therapy, elite controllers, and patients treated with antiretroviral drugs (virological control or failure). Multivariable analysis was performed to identify variables independently associated with the B-cell alterations. Results: Significant differences were observed among patients' groups in relation to all B-cell subsets. Resting memory B cells were preserved in patients naive to therapy and elite controllers, but reduced in treated patients. Individuals naive to therapy and experiencing multidrug failure, as well as elite controllers, had significantly higher levels of activated memory B cells compared to healthy controls. In the multivariate analysis, plasma viral load and nadir CD4+ T cells independently correlated with major B-cell alterations. Coinfection with hepatitis C but not hepatitis B virus also showed an impact on specific B-cell subsets. Successful protracted antiretroviral treatment led to normalization of all B-cell subsets with exception of resting memory B cells. Conclusion: Our results indicate that viremia and nadir CD4+ T cells are important prognostic markers of B-cell perturbations and provide evidence that resting memory B-cell depletion during chronic infection is not reverted upon successful antiretroviral therapy. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

Larsson C.,Karolinska Institutet | Saltvedt S.,Stockholm South General Hospital | Wiklund I.,Karolinska Institutet | Andolf E.,Karolinska Institutet
Journal of Obstetrics and Gynaecology Canada

Objective: To compare maternal medical outcome after planned vaginal delivery and planned Caesarean section. Methods: We conducted a prospective cohort study of healthy primiparous women in Stockholm, Sweden, who were either scheduled for a planned Caesarean section (for breech presentation or at maternal request) or admitted for a vaginal delivery. Data were analyzed according to intended mode of delivery. Results: A total of 541 women were included in the study; of these, 247 had a Caesarean section and 294 a vaginal delivery. There were sociodemographic differences between the groups. No difference in mean estimated blood loss or rate of infection was found Complications in the planned Caesarean section group were lower than previously reported. The difference in estimated blood loss between women undergoing planned Caesarean section and women who had a vaginal delivery was not more than 7%. Morbidity in the planned vaginal delivery group was mostly due to operative interventions The Caesarean section group had a longer hospital stay than women who delivered vaginally. Conclusion: We found no difference in short-term medical outcomes between primiparous women undergoing planned Caesarean section and those undergoing planned vaginal delivery after analysis according to the intended mode of delivery. © 2011 Society of Obstetricians and Gynaecologists of Canada. Source

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