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Browsing Artikler, rapporter og annet (klinisk medisin) by Author
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Nieder, Carsten; Marienhagen, Kirsten; Dalhaug, Astrid; Norum, Jan (Journal article; Tidsskriftartikkel; Peer reviewed, 16-Jul-2008)[+][-]
Abstract: Newly developed systemic treatment regimens might lead to improved survival also in the subgroup of breast cancer patients that harbour brain metastases. In order to examine this hypothesis, a matched pairs analysis was performed that involved one group of patients, which were treated after these new drugs were introduced, and one group of patients, which were treated approximately 10 years earlier. The two groups were well balanced for the known prognostic factors age, KPS, extracranial disease status, and recursive partitioning analysis class, as well as for the extent of brain treatment. The results show that the use of systemic chemotherapy has increased over time, both before and after the diagnosis of brain metastases. However, such treatment was performed nearly exclusively in those patients with brain metastases that belonged to the prognostically more favourable groups. Survival after whole-brain radiotherapy has remained unchanged in patients without further active treatment. It has improved in prognostically better patients and especially patients that received active treatment, where the 1-year survival rates have almost doubled. As these patient groups were small, confirmation of the results in other series should be attempted. Nevertheless, the present results are compatible with the hypothesis that improved systemic therapy might contribute to prolonged survival in patients with brain metastases from breast cancer. URI: http://hdl.handle.net/10037/1702 File(s) in this item: 1
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Nieder, Carsten; Mehta, Minesh P. (Journal article; Peer reviewed; Tidsskriftartikkel, 04-Mar-2009)[+][-]
Abstract: Background: This review addresses the strengths and weaknesses of 6 different prognostic indices, published since the Radiation Therapy Oncology Group (RTOG) developed and validated the widely used 3-tiered prognostic index known as recursive partitioning analysis (RPA) classes, i.e. between 1997 and 2008. In addition, other analyses of prognostic factors in groups of patients, which typically are underrepresented in large trials or databases, published in the same time period are reviewed.
Methods: Based on a systematic literature search, studies with more than 20 patients were included. The methods and results of prognostic factor analyses were extracted and compared. The authors discuss why current data suggest a need for a more refined index than RPA.
Results: So far, none of the indices has been derived from analyses of all potential prognostic factors. The 3 most recently published indices, including the RTOG's graded prognostic assessment (GPA), all expanded from the primary 3-tiered RPA system to a 4-tiered system. The authors' own data confirm the results of the RTOG GPA analysis and support further evaluation of this tool.
Conclusion: This review provides a basis for further refinement of the current prognostic indices by identifying open questions regarding, e.g., performance of the ideal index, evaluation of new candidate parameters, and separate analyses for different cancer types. Unusual primary tumors and their potential differences in biology or unique treatment approaches are not well represented in large pooled analyses.URI: http://hdl.handle.net/10037/2189 File(s) in this item: 1
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Marienhagen, Kirsten; Nieder, Carsten; Astner, Sabrina T.; Molls, Michael (Journal article; Tidsskriftartikkel; Peer reviewed, 07-Apr-2009)[+][-]
Abstract: Background: Prognostic scores might be useful tools both in clinical practice and clinical trials, where they can be used as stratification parameter. The available scores for patients with brain metastases have never been tested specifically in patients with primary breast cancer. It is therefore unknown which score is most appropriate for these patients.
Methods: Five previously published prognostic scores were evaluated in a group of 83 patients with brain metastases from breast cancer. All patients had been treated with whole-brain radiotherapy with or without radiosurgery or surgical resection. In addition, it was tested whether the parameters that form the basis of these scores actually have a prognostic impact in this biologically distinct group of brain metastases patients.
Results: The scores that performed best were the recursive partitioning analysis (RPA) classes and the score index for radiosurgery (SIR). However, disagreement between the parameters that form the basis of these scores and those that determine survival in the present group of patients and many reported data from the literature on brain metastases from breast cancer was found. With the four statistically significant prognostic factors identified here, a 3-tiered score can be created that performs slightly better than RPA and SIR. In addition, a 4-tiered score is also possible, which performs better than the three previous 4-tiered scores, incl. graded prognostic assessment (GPA) score and basic score for brain metastases (BSBM).
Conclusion: A variety of prognostic models describe the survival of patients with brain metastases from breast cancer to a more or less satisfactory degree. However, the standard brain metastases scores might not fully appreciate the unique biology and time course of this disease, e.g., compared to lung cancer. It appears possible that inclusion of emerging prognostic factors will improve the results and allow for development and validation of a consensus score for broad clinical application. The model that is based on the authors own patient group, which is not large enough to fully evaluate a large number of potential prognostic factors, is meant to illustrate this point rather than to provide the definitive score.URI: http://hdl.handle.net/10037/2190 File(s) in this item: 1
article.pdf (259.0Kb) -
Haukland, E; Nieder, Carsten; Pawinski, Adam; Dalhaug, Astrid (Journal article; Tidsskriftartikkel; Peer reviewed, 2010)[+][-]
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Nieder, Carsten; Marienhagen, Kirsten; Geinitz, Hans; Grosu, Anca L. (Journal article; Tidsskriftartikkel; Peer reviewed, 2011)[+][-]
Abstract: We evaluated the performance of the new 4-tiered melanoma-specific graded prognostic assessment (GPA) score and the previously published general GPA score in patients with brain metastases from malignant melanoma managed with different approaches including best supportive care. Materials and Methods: Retrospective analysis of 51 patients. Compared with the original analysis of the melanoma-specific GPA score, these patients were more representative of the general population of patients with brain metastases from this disease. The present data confirmed that both scores identify patients with favorable prognosis who might be candidates for focal treatments. However, survival in the 2 unfavorable prognostic subgroups defined by the melanoma-specific GPA was not significantly different. Median survival in the melanoma-specific GPA classes was 3.1, 3.7, 7.5, and 12.7 months. Karnofsky performance status (KPS) and serum lactatdehydrogenase (LDH) level significantly predicted survival. In order to select the right patient to the right treatment and avoid overtreatment and suboptimal resource utilization in patients with very limited survival, improved prognostic tools are needed. The melanoma-specific GPA does not include extracranial disease extent or surrogate markers such as LDH. We suggest that a combination of KPS <70 and elevated LDH might better predict short survival than any of the GPA scores. This hypothesis should be confirmed in larger studies. URI: http://hdl.handle.net/10037/3950 File(s) in this item: 1
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Nieder, Carsten; Pawinski, Adam; Dalhaug, Astrid; Andratschke, Nicolaus (Journal article; Tidsskriftartikkel; Peer reviewed, 2012)[+][-]
Abstract: Treatment of non-small cell lung cancer (NSCLC) is challenging in many ways. One of the problems is disappointing local control rates in larger volume disease. Moreover, the likelihood of both nodal and distant spread increases with primary tumour (T-) stage. Many patients are elderly and have considerable comorbidity. Therefore, aggressive combined modality treatment might be contraindicated or poorly tolerated. In many cases with larger tumour volume, sufficiently high radiation doses can not be administered because the tolerance of surrounding normal tissues must be respected. Under such circumstances, simultaneous administration of radiosensitizing agents, which increase tumour cell kill, might improve the therapeutic ratio. If such agents have a favourable toxicity profile, even elderly patients might tolerate concomitant treatment. Based on sound preclinical evidence, several relatively small studies have examined radiotherapy (RT) with cetuximab in stage III NSCLC. Three different strategies were pursued: 1) RT plus cetuximab (2 studies), 2) induction chemotherapy followed by RT plus cetuximab (2 studies) and 3) concomitant RT and chemotherapy plus cetuximab (2 studies). Radiation doses were limited to 60-70 Gy. As a result of study design, in particular lack of randomised comparison between cetuximab and no cetuximab, the efficacy results are difficult to interpret. However, strategy 1) and 3) appear more promising than induction chemotherapy followed by RT and cetuximab. Toxicity and adverse events were more common when concomitant chemotherapy was given. Nevertheless, combined treatment appears feasible. The role of consolidation cetuximab after RT is uncertain. A large randomised phase III study of combined RT, chemotherapy and cetuximab has been initiated. URI: http://hdl.handle.net/10037/4681 File(s) in this item: 1
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Nieder, Carsten; Grosu, Anca L.; Mehta, Minesh P. (Journal article; Tidsskriftartikkel; Peer reviewed, 2012)[+][-]
Abstract: High and continuously increasing research activity related to different aspects of prevention, prediction, diagnosis and treatment of brain metastases has been performed between 1990 and 2010. One of the major databases contains 2695 scientific articles that were published during this time period. Different measures of impact, visibility, and quality of published research are available, each with its own pros and cons. For this overview, article citation rate was chosen. Results. Among the 10 most cited articles, 7 reported on randomized clinical trials. Nine covered surgical or radiosurgical approaches and the remaining one a widely adopted prognostic score. Overall, 30 randomized clinical trials were published between 1990 and 2010, including those with phase II design and excluding duplicate publications, for example, after longer followup or with focus on secondary endpoints. Twenty of these randomized clinical trials were published before 2008. Their median number of citations was 110, range 13–1013, compared to 5-6 citations for all types of publications. Annual citation rate appeared to gradually increase during the first 2-3 years after publication before reaching high levels. Conclusions. A large variety of preclinical and clinical topics achieved high numbers of citations. However, areas such as quality of life, side effects, and end-of-life care were underrepresented. Efforts to increase their visibility might be warranted. URI: http://hdl.handle.net/10037/4942 File(s) in this item: 1
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Nieder, Carsten; Pawinski, Adam; Dalhaug, Astrid (Journal article; Tidsskriftartikkel; Peer reviewed, 2012)[+][-]
Abstract: Research activity related to different aspects of prevention, prediction, diagnosis and treatment of brain metastases has increased during recent years. One of the major databases (Scopus) contains 942 scientific articles that were published during the 5-year time period 2006–2010. Of these, 195 (21%) reported on single patient cases and 12 (1%) were reports of 2 cases. Little is known about their influence on advancement of the field or scientific merits. Do brain metastases case reports attract attention and provide stimuli for further research or do they go largely unrecognized? Different measures of impact, visibility and quality of published research are available, each with its own pros and cons. For the present evaluation, article citation rate was chosen. The median number of citations overall and stratified by year of publication was 0, except for the year 2006 when it was 2. As compared to other articles, case reports remained more often without citation (p<0.05 except for 2006 data). All case reports with 10 or more citations (n = 6) reported on newly introduced anticancer drugs, which commonly are prescribed to treat extracranial metastases, and the responses observed in single patients with brain metastases. Average annual numbers of citations were also calculated. The articles with most citations per year were the same six case reports mentioned above (the only ones that obtained more than 2.0 citations per year). Citations appeared to gradually increase during the first two years after publication but remained on a generally low or modest level. It cannot be excluded that case reports without citation provide interesting information to some clinicians or researchers. Apparently, case reports describing unexpected therapeutic success gain more attention, at least in terms of citation, than others. URI: http://hdl.handle.net/10037/4943 File(s) in this item: 1
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Nieder, Carsten; Marienhagen, Kirsten; Dalhaug, Astrid; Norum, Jan (Journal article; Tidsskriftartikkel; Peer reviewed, 2012)[+][-]
Abstract: Accurate prognostic information is desirable when counselling patients with brain metastases regarding their therapeutic options and life expectancy. Based on previous studies, we selected serum lactate dehydrogenase (LDH) as a promising factor on which we perform a pilot study investigating methodological aspects of biomarker studies in patients with brain metastases, before embarking on large-scale studies that will look at a larger number of candidate markers in an expanded patient cohort. For this retrospective analysis, 100 patients with available information on LDH treated with palliative whole-brain radiotherapy were selected. A comprehensive evaluation of different LDH-based variables was performed in uni- and multivariate tests. Probably, the most intriguing finding was that LDH kinetics might be more important, or at least complement, information obtained from a single measurement immediately before radiotherapy. LDH and performance status outperformed several other variables that are part of prognostic models such as recursive partitioning analyses classes and graded prognostic assessment score. LDH kinetics might reflect disease behaviour in extracranial metastatic and primary sites without need for comprehensive imaging studies and is a quite inexpensive diagnostic test. Based on these encouraging results, confirmatory studies in a larger cohort of patients are warranted. URI: http://hdl.handle.net/10037/4944 File(s) in this item: 1
article.pdf (594.3Kb) -
Nielsen, Kåre Nolde; Åm, Trond Grønli; Nydal, Rune (Journal article; Tidsskriftartikkel; Peer reviewed, 2011)[+][-]
Abstract: This work describes the nano field inNorway as currently emerging in the dynamics between two forms of nano research activities described along a centre-periphery axis. 1) There are strategic research initiatives committed to redeem the envisioned potential of the field by means of social and material reorganisation of existing research activities. This activity is seen as central as it is one of our premises that the standard circulating nano vision implies such a work of reorganisation. The fact that nano is often taken as a paradigmatic example of the shift from Mode-1 to Mode-2 research, supports this assumption. 2) In parallel to this activity, a wide variety of research projects pursuing nano strategies are being funded. We regard such research activity as peripheral in so far as the activity is not marked by being committed to the circulating nano vision, as may often be the case. In the process of reorganising, this article argues, the research activity at the periphery provides a crucial arena for discussing and validatingwhat is to be achieved through the work of reorganisation that takes place at the centre. Our analysis is informed by two Norwegian cases. We examine a major nano research initiative at a Norwegian university as a centre and a research project utilising nanoparticles in fish vaccines as a periphery. URI: http://hdl.handle.net/10037/3963 File(s) in this item: 1
article.pdf (193.9Kb) -
Malm, Dag; Nilssen, Øivind (Journal article; Tidsskriftartikkel; Peer reviewed, 23-Jul-2008)[+][-]
Abstract: Alpha-mannosidosis is an inherited lysosomal storage disorder characterized by immune deficiency, facial and skeletal abnormalities, hearing impairment, and intellectual disability. It occurs in approximately 1 of 500,000 live births. The children are often born apparently normal, and their condition worsens progressively. Some children are born with ankle equinus or develop hydrocephalus in the first year of life. Main features are immune deficiency (manifested by recurrent infections, especially in the first decade of life), skeletal abnormalities (mild-to-moderate dysostosis multiplex, scoliosis and deformation of the sternum), hearing impairment (moderate-to-severe sensorineural hearing loss), gradual impairment of mental functions and speech, and often, periods of psychosis. Associated motor function disturbances include muscular weakness, joint abnormalities and ataxia. The facial trait include large head with prominent forehead, rounded eyebrows, flattened nasal bridge, macroglossia, widely spaced teeth, and prognathism. Slight strabismus is common. The clinical variability is significant, representing a continuum in severity. The disorder is caused by lysosomal alpha-mannosidase deficiency. Alpha-mannosidosis is inherited in an autosomal recessive fashion and is caused by mutations in the MAN2B1 gene located on chromosome 19 (19 p13.2-q12). Diagnosis is made by measuring acid alpha-mannosidase activity in leukocytes or other nucleated cells and can be confirmed by genetic testing. Elevated urinary secretion of mannose-rich oligosaccharides is suggestive, but not diagnostic. Differential diagnoses are mainly the other lysosomal storage diseases like the mucopolysaccharidoses. Genetic counseling should be given to explain the nature of the disease and to detect carriers. Antenatal diagnosis is possible, based on both biochemical and genetic methods. The management should be pro-active, preventing complications and treating manifestations. Infections must be treated frequently. Otolaryngological treatment of fluid in the middle ear is often required and use of hearing aids is invariably required. Early educational intervention for development of social skills is needed and physiotherapy is important to improve bodily function. Orthopedic surgery may be necessary. The long-term prognosis is poor. There is an insidiously slow progression of neuromuscular and skeletal deterioration over several decades, making most patients wheel-chair dependent. No patients manage to be completely socially independent. Many patients are over 50 years of age. URI: http://hdl.handle.net/10037/2139 File(s) in this item: 1
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Nissen, Trygve; Wynn, Rolf (Journal article; Tidsskriftartikkel; Peer reviewed, 2012)[+][-]
Abstract: Clinical case reporting in the form of case reports and case series reports has always been an integral part of medical literature. From the late 1970s the genre appeared to fall from grace and was marginalized in many medical journals. There was controversy as to its value as a research method. From the late 1990s and onwards, there has been an increased demand for and publication of case reports and case series. The various causes for its decline and subsequent return are discussed with an emphasis on the recent historical context. URI: http://hdl.handle.net/10037/4924 File(s) in this item: 1
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Berntson, L.; Nordal, Ellen Berit; Damgård, M.; Andersson-Gäre, B.; Herlin, T.; Nielsen, S.; Rygg, M.; Zak, M.; Fasth, A. (Conference object; Konferansebidrag, 15-Sep-2008)[+][-]
Description: Poster presentatiopn at 15th Paediatric Rheumatology European Society (PreS) Congress London, UK. 14–17 September 2008 URI: http://hdl.handle.net/10037/2357 File(s) in this item: 1
article.pdf (135.8Kb) -
Norum, Jan; Dalhaug, Astrid; Pawinski, Adam; Nieder, Carsten (Journal article; Tidsskriftartikkel, 2007)[+][-]
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Norum, Jan; Elsbak, Trond M (Journal article; Tidsskriftartikkel; Peer reviewed, 2011)[+][-]
Abstract: Air ambulance service in Norway has been upgraded during the last years. European regulations concerning pilots’ working time and new treatment guidelines/strategies have called for more resources. The objective was to describe and analyse the two supplementary air ambulance [fixed wing (FW) and rotor wing (RW)] alternatives’ activity during the study period (2002-2008). Furthermore we aimed to compare our findings with reports from other north European regions. This is a retrospective analysis. The air ambulance fleet’s activity according to the electronic patient record database of “Luftambulansetjenesten ANS” (LABAS) was analysed. The subject was the fleet’s operations in northern Norway, logistics, and patients handled. Type of flight, distances, frequency, and patients served were the main outcome measures. A significant increase (45%) in the use of RW and a shift in FW operations (less primary and more secondary) were revealed. The shift in FW operations reflected the centralisation of several health care services [i.e. percutaneous cardiac intervention (PCI), trauma, and cancer surgery] during the study period. Cardiovascular disease (CVD) and injuries were the main diagnoses and constituted half of all operations. CVD was the most common cause of FW operations and injuries of the RW ones. The number of air ambulance operations was 16 per 1,000 inhabitants. This was more frequent than in other north European regions. The use of air ambulances and especially RW was significantly increased during the study period. The change in secondary FW operations reflected centralisation of medical care. When health care services are centralised, air ambulance services must be adjusted to the new settings. URI: http://hdl.handle.net/10037/3951 File(s) in this item: 1
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Norum, Jan; Tjeldnes, Knut; Ramsvik, Arnborg (Journal article; Tidsskriftartikkel, 2012)[+][-]
Abstract: There has been an increased request for intensive training and rehabilitation of patients with brain damage in Norway. These programs are demanding with regard to personnel, travelling, time and economic resources. We aimed to indicate cost and gain to make these programs cost-effective. A retrospective study included all patients referred to the Northern Norway Regional Health Authority (NNRHA) trust during the nine years period 2003-2011. All referrals to the NNRHA trust for the economic coverage of foreign based rehabilitation or habilitation programs (The Advanced Bio-Mechanical Rehabilitation (ABR), Institutes of Achievement of Human Potential program (IAHP) (Doman method), Family Hope Center (FHC) program and the Kozijavkin method) were included. 17 patients were detected and 15 fulfilled the inclusion criteria for funding. Median age was 8 years (1-31 years). Cost from the specialist health care point of view was calculated. A cut-off limit of €57,000/quality adjusted life year (QALY) and a 4% discount rate was employed. The undiscounted cost per patient enrolled was calculated €133,210 (discounted €121,348). To make these therapies cost effective, a total of at least 2.13 QALYs (2.34 undiscounted QALYs) must be gained per patient enrolled. Such a gain could not be indicated and we doubt it is achievable. Non-proven intensive training programs for patients with brain damage are costly. As long as their effect has not been documented, health care services should not spend resources on these programs outside clinical trials. URI: http://hdl.handle.net/10037/4894 File(s) in this item: 1
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Nieder, Carsten; Norum, Jan (Journal article; Tidsskriftartikkel; Peer reviewed, 30-Sep-2008)[+][-]
Abstract: Case presentation: This is an unusual case where a 49-year old female patient with known schizophrenia, paranoid type and a history of early-stage breast cancer, which was treated more than 6 years earlier, attempted suicide. Computed tomography and magnetic resonance imaging after this incident revealed the presence of multiple brain metastases as the first symptomatic site of recurrent cancer. Further staging lead to the diagnosis of lung, hilar and mediastinal lymph node metastases and histology confirmed estrogen receptor-positive metastatic cancer. Treatment consisted of whole-brain radiotherapy and letrozole. Twenty-one months later, the patient is in continued partial remission. URI: http://hdl.handle.net/10037/2141 File(s) in this item: 1
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Norum, Jan; Elsbak, Trond M (Journal article; Tidsskriftartikkel; Peer reviewed, 2011)[+][-]
Abstract: Air ambulance services in the Arctic have to deal with remote locations, long distances, rough weather conditions and seasonable darkness. Despite these challenges, the people living in the area expect a high quality of specialist health care. The objective of this study was to analyse the air ambulance operations performed in the Norwegian Arctic and study variations in diagnoses and flight patterns around the year. A retrospective analysis. All air ambulance operations performed during the time 1999 – 2009 period were analysed. The subjects were patients transported and flights performed. The primary outcome measures were patients’ diagnoses and task patterns around the year. A total of 345 patients were transported and 321 flights performed. Coronary heart and vascular disease, bone fractures and infections were the most common diagnoses. Most patients (85%) had NACA score 3 or 4. Half of all fractures occurred in April and August. Most patients were males (66%), and one fourth was not Norwegian. The median flying time (one way) was 3 h 33 m. Ten percent of the flights were delayed, and only 14% were performed between midnight and 8.00 AM. The period April to August was the busiest one (58% of operations). Norway has run a safe air ambulance service in the Arctic for the last 11 years. In the future more shipping and polar adventure operations may influence the need for air ambulances, especially during summer and autumn. URI: http://hdl.handle.net/10037/3964 File(s) in this item: 1
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Nossent, Johannes C; Koldingsnes, Wenche (Journal article; Tidsskriftartikkel; Peer reviewed, 2008)[+][-]
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Nygård, Ingvild Engdal; Mortensen, Kim Erlend; Hedegaard, Jakob; Conley, Lene N; Kalstad, Trine; Bendixen, Christian; Revhaug, Arthur (Journal article; Tidsskriftartikkel; Peer reviewed, 2012)[+][-]
Abstract: After partial hepatectomy (PHx), the liver regeneration process terminates when the normal liver-mass/body-weight ratio of 2.5% has been re-established. To investigate the genetic regulation of the terminating phase of liver regeneration, we performed a 60% PHx in a porcine model. Liver biopsies were taken at the time of resection, after three weeks and upon termination the sixth week. Gene expression profiles were obtained using porcine oligonucleotide microarrays. Our study reveals the interactions between genes regulating the cell cycle, apoptosis and angiogenesis, and the role of Transforming Growth Factor-β (TGF-β) signalling towards the end of liver regeneration. Microarray analysis revealed a dominance of genes regulating apoptosis towards the end of regeneration. Caspase Recruitment Domain-Containing Protein 11 (CARD11) was up-regulated six weeks after PHx, suggesting the involvement of the caspase system at this time. Zinc Finger Protein (ZNF490) gene, with a potential negative effect on cell cycle progression, was only up-regulated at three and six weeks after PHx indicating a central role at this time. TGF-β regulation was not found to be significantly affected in the terminating phase of liver regeneration. Vasohibin 2 (VASH2) was down-regulated towards the end of regeneration, and may indicate a role in preventing a continued vascularization process. CARD11, ZNF490 and VASH2 are differentially expressed in the termination phase of liver regeneration. The lack of TGF-β up-regulation suggests that signalling by TGF-β is not required for termination of liver regeneration. Description: This article is part of Ingvild E. Nygård's doctoral thesis. Available in Munin at http://hdl.handle.net/10037/4858 URI: http://hdl.handle.net/10037/4895 File(s) in this item: 1
article.pdf (747.3Kb)
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