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Background: To our knowledge, no studies of the possible association of early life environment with snoring in adulthood have been published. We aimed to investigate whether early life environment is associated with snoring later in life.Methods: A questionnaire including snoring frequency in adulthood and environmental factors in early life was obtained from 16,190 randomly selected men and women, aged 25-54 years, in Sweden, Norway, Iceland, Denmark and Estonia (response rate 74%).Results: A total of 15,556 subjects answered the questions on snoring. Habitual snoring, defined as loud and disturbing snoring at least 3 nights a week, was reported by 18%. Being hospitalized for a respiratory infection before the age of two years (adjusted odds ratio (OR) = 1.27; 95% confidence interval (CI) 1.01-1.59), suffering from recurrent otitis as a child (OR = 1.18; 95%CI 1.05-1.33), growing up in a large family (OR = 1.04; 95%CI 1.002-1.07) and being exposed to a dog at home as a newborn (OR = 1.26; 95%CI 1.12-1.42) were independently related to snoring later in life and independent of a number of possible confounders in adulthood. The same childhood environmental factors except household size were also related with snoring and daytime sleepiness combined.Conclusion: The predisposition for adult snoring may be partly established early in life. Having had severe airway infections or recurrent otitis in childhood, being exposed to a dog as a newborn and growing up in a large family are environmental factors associated with snoring in adulthood. [ABSTRACT FROM AUTHOR]

Objectives: Almost half of all patients diagnosed with uveal melanoma will die of metastatic disease. This has been attributed to early seeding of micrometastases. We investigate the presence, density, organ involvement, and characteristics of micrometastases of uveal melanoma in tissue obtained at autopsy of patients with and without coexisting macrometastases., Methods: Patients diagnosed with primary uveal melanoma at a national referral center between 1960 and 2020 (n = 4,282) were cross-referenced with autopsy registers at nearby hospitals. Eleven patients were included. Formalin-fixed, paraffin-embedded tissue samples obtained during autopsy were examined with routine histology, immunohistochemistry, and immunomagnetic separation., Results: Micrometastases were detected in 5 of 5 patients with and in 5 of 6 patients without coexisting macrometastases. Micrometastases were identified in several sites, including lungs, kidneys, myocardium, and bone marrow. Their highest density per mm2 of tissue was seen in the liver. Of 11 examined patients, 2 had at least 1 BAP-1-positive metastasis. All micrometastases had immune cell infiltrates and no or very low proliferative activity., Conclusions: We demonstrate multiorgan involvement of apparently dormant micrometastases in patients with uveal melanoma. This suggests that micrometastases are present in nearly all patients diagnosed with primary uveal melanoma, regardless of coexisting macrometastases., (© American Society for Clinical Pathology, 2023.)

Objectives: Pulmonary manifestations in RA are common comorbidities. Interstitial lung disease (ILD), both idiopathic and in RA, has been associated with several genetic variants. We assessed pulmonary fibrosis (PF) in an inception cohort of RA patients in relation to genetic variants and disease-related factors., Methods: A total of 1466 early RA patients were consecutively included and followed prospectively from the index date until death or 31 December 2016. Clinical and laboratory data and treatment were continuously registered according to the Swedish Rheumatology Quality Register. DNA was available from 1184 patients and 571 151 genome-wide single-nucleotide polymorphisms (SNPs) were analysed. Thirteen identified genetic variants were extracted. At follow-up, the patients answered a questionnaire regarding disease progression and lung involvement that was validated by reviewing medical records and analysing radiological examinations., Results: The prevalence of PF was 5.6% and the annualized incidence rate was 5.0/1000 (95% CI 3.80, 6.54). Four SNPs were associated with PF in RA: rs35705950 [MUC5B; OR 2.5 (95% CI 1.5, 4.0), adjusted P-value = 0.00016, q-value = 0.0021]; rs111521887 [TOLLIP; OR 1.9 (95% CI 1.3, 2.8), adjusted P-value = 0.0014, q-value = 0.0092]; rs2609255 [FAM13A; OR 1.7 (95% CI 1.1, 2.5), adjusted P-value = 0.013, q-value = 0.055] and rs2736100 [TERT; OR 1.5 (95% CI 1.0, 2.2), adjusted P-value = 0.046, q-value = 0.15]. Older age and RF positivity were associated with increased risk, while MTX treatment was associated with a lower risk of PF., Conclusions: Development of PF in an inception cohort of RA patients was associated with 4 of 12 ILD risk genes. RA-related factors except for age at diagnosis and RF positivity were of limited importance in PF development., (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology.)

Background: Some earlier studies have found indications of significant changes in cardiometabolic risk factors in children born after assisted reproductive technology (ART). Most of these studies are based on small cohorts with high risk of selection bias. In this study, we compared the risk of cardiovascular disease, obesity, and type 2 diabetes between singleton children born after ART and singleton children born after spontaneous conception (SC)., Methods and Findings: This was a large population-based cohort study of individuals born in Norway, Sweden, Finland, and Denmark between 1984 and 2015. Data were obtained from national ART and medical birth registers and cross-linked with data from national patient registers and other population-based registers in the respective countries. In total, 122,429 children born after ART and 7,574,685 children born after SC were included. Mean (SD) maternal age was 33.9 (4.3) years for ART and 29.7 (5.2) for SC, 67.7% versus 41.8% were primiparous, and 45.2% versus 32.1% had more than 12 years of education. Preterm birth (<37 weeks 0 days) occurred in 7.9% of children born after ART and 4.8% in children born after SC, and 5.7% versus 3.3% had a low birth weight (<2,500 g). Mean (SD) follow-up time was 8.6 (6.2) years for children born after ART and 14.0 (8.6) years for children born after SC. In total, 135 (0.11%), 645 (0.65%), and 18 (0.01%) children born after ART were diagnosed with cardiovascular disease (ischemic heart disease, cardiomyopathy, heart failure, or cerebrovascular disease), obesity or type 2 diabetes, respectively. The corresponding values were 10,702 (0.14%), 30,308 (0.74%), and 2,919 (0.04%) for children born after SC. In the unadjusted analysis, children born after ART had a significantly higher risk of any cardiovascular disease (hazard ratio [HR] 1.24; 95% CI 1.04-1.48; p = 0.02), obesity (HR 1.13; 95% CI 1.05-1.23; p = 0.002), and type 2 diabetes (HR 1.71; 95% CI 1.08-2.73; p = 0.02). After adjustment, there was no significant difference between children born after ART and children born after SC for any cardiovascular disease (adjusted HR [aHR]1.02; 95% CI 0.86-1.22; p = 0.80) or type 2 diabetes (aHR 1.31; 95% CI 0.82-2.09; p = 0.25). For any cardiovascular disease, the 95% CI was reasonably narrow, excluding effects of a substantial magnitude, while the 95% CI for type 2 diabetes was wide, not excluding clinically meaningful effects. For obesity, there was a small but significant increased risk among children born after ART (aHR 1.14; 95% CI 1.06-1.23; p = 0.001). Important limitations of the study were the relatively short follow-up time, the limited number of events for some outcomes, and that the outcome obesity is often not considered as a disease and therefore not caught by registers, likely leading to an underestimation of obesity in both children born after ART and children born after SC., Conclusions: In this study, we observed no difference in the risk of cardiovascular disease or type 2 diabetes between children born after ART and children born after SC. For obesity, there was a small but significant increased risk for children born after ART., Trial Registration Number: ISRCTN11780826., Competing Interests: The authors have declared that no competing interests exist.

The goal is to examine the risk of conception mode-type-1 diabetes using different survival analysis modelling approaches and examine if there are differentials in the risk of type-1 diabetes between children from fresh and frozen-thawed embryo transfers. We aimed to compare the performances and fitness of different survival analysis regression models with the Cox proportional hazard (CPH) model used in an earlier study. The effect of conception modes and other prognostic factors on type-1 diabetes among children conceived either spontaneously or by assisted reproductive technology (ART) and its sub-groups was modelled in the earlier study. We used the information on all singleton children from the Swedish Medical Birth Register hosted by the Swedish National Board of Health and Welfare, 1985 to 2015. The main explanatory variable was the mode of conception. We applied the CPH, parametric and flexible parametric survival regression (FPSR) models to the data at 5% significance level. Loglikelihood, Akaike and Bayesian information criteria were used to assess model fit. Among the 3,138,540 singletons, 47,938 (1.5%) were conceived through ART (11,211 frozen-thawed transfer and 36,727 fresh embryo transfer). In total, 18,118 (0.58%) of the children had type-1 diabetes, higher among (0.58%) those conceived spontaneously than the ART-conceived (0.42%). The median (Interquartile range (IQR)) age at onset of type-1 diabetes among spontaneously conceived children was 10 (14-6) years, 8(5-12) for ART, 6 (4-10) years for frozen-thawed embryo transfer and 9 (5-12) years for fresh embryo transfer. The estimates from the CPH, FPSR and parametric PH models are similar. There was no significant difference in the risk of type-1 diabetes among ART- and spontaneously conceived children; FPSR: (adjusted Hazard Ratio (aHR) = 1.070; 95% Confidence Interval (CI):0.929-1.232, p = 0.346) vs CPH: (aHR = 1.068; 95%CI: 0.927-1.230, p = 0.361). A sub-analysis showed that the adjusted hazard of type-1 diabetes was 37% (aHR = 1.368; 95%CI: 1.013-1.847, p = 0.041) higher among children from frozen-thawed embryo transfer than among children from spontaneous conception. The hazard of type-1 diabetes was higher among children whose mothers do not smoke (aHR = 1.296; 95%CI:1.240-1.354, p<0.001) and of diabetic mothers (aHR = 6.419; 95%CI:5.852-7.041, p<0.001) and fathers (aHR = 8.808; 95%CI:8.221-9.437, p<0.001). The estimates from the CPH, parametric models and the FPSR model were close. This is an indication that the models performed similarly and any of them can be used to model the data. We couldn't establish that ART increases the risk of type-1 diabetes except when it is subdivided into its two subtypes. There is evidence of a greater risk of type-1 diabetes when conception is through frozen-thawed transfer., Competing Interests: The authors have declared that no competing interests exist.

Study Question: Do children conceived after ICSI have similar school performance as children born after IVF?, Summary Answer: Children born after ICSI have similar school performance compared to children born after IVF., What Is Known Already: Studies concerning the cognitive skills of children born after ICSI have shown diverging results., Study Design, Size, Duration: This nationwide, register-based cohort study included all singleton children born after ICSI (n = 6953), IVF (n = 11 713) or spontaneous conception (SC) (n = 2 022 995), in Sweden between 1985 and 2006., Participants/materials, Setting, Methods: Singleton children born after ICSI were identified in national IVF registers, cross-linked with the Medical Birth Register (MBR), the National Patient Register (NPR) and the Swedish Cause of Death Register (CDR) for characteristics and medical outcomes. Data on school performance, parental education and other parental characteristics were obtained through cross-linking to the National School Registry and to Statistics Sweden. The main control group, which consisted of children born after IVF, was identified in the national IVF registries while the second control group, consisting of children born after SC, was identified from the MBR. Simple and multivariable linear regression was used for analysis of continuous variables, and logistic regression was used for the analysis of binary outcomes. Adjustments were made for sex, year of birth, maternal smoking during pregnancy, parental age, parity, parental region of birth, parental level of education and frozen embryo transfer., Main Results and the Role of Chance: In the adjusted analyses, there was no significant difference between ICSI and IVF children for total score (adjusted odds ratios (AORs) 1.03; 95% CI -0.22 to 2.28; P = 0.11), specific subjects, qualifying for secondary school (AOR 1.02; 95% CI 0.82-1.26; P = 0.87) or poor school performance (AOR 0.92; 95% CI 0.75-1.14; P = 0.47). In the third grade, children born after ICSI had a significantly lower chance of passing all of the subtests in Mathematics (AOR 0.89; 0.83-0.96; P = 0.002) and Swedish (AOR 0.92; 0.85-0.99; P = 0.02) compared to children born after SC. When cross-linking children with missing data on school performances (2.1% for ICSI, 2.0% for IVF and 2.3% for SC) with the Cerebral Palsy Follow-up Register (CPUP) for cerebral palsy, 2.7% of ICSI children, 5.7% of IVF children and 1.7% of SC children without registered education were found. When cross-linking children with missing data on school performances with the NPR for mental retardation, 29.9% of ICSI children, 32.6% of IVF children and 35.0% of SC children with missing data were registered under such a diagnosis., Limitations, Reasons for Caution: The main limitation was that test scores were missing in a small percentage in both ICSI and IVF children. Although we were able to cross-link this subpopulation with the CPUP and the NPR, these diagnoses only partly explained the missing scores. Other limitations were unmeasured and unknown possible confounders, such as information about infertility diagnoses and indication for ICSI, were not available., Wider Implications of the Findings: These findings are important to most countries where IVF and ICSI are used since there may be differences in choice of procedure. In recent years, there has been an increasing trend towards using ICSI not only for treatment of male infertility but also when the sperm quality is normal. Our results indicate that the school performance of children born after ICSI is reassuring., Study Funding/competing Interest(s): Financial support was received through Sahlgrenska University Hospital (ALFGBG - 70 940), Hjalmar Svensson Research Foundation and Nordforsk, project number 71 450. None of the authors declare any conflict of interest., Trial Registration Number: N/A., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Study Question: Is school performance in children conceived after assisted reproductive technology (ART) comparable to those conceived after spontaneous conception (SC)?, Summary Answer: Singleton children born after ART performed better in the crude analysis than singleton children born after SC although after adjustment, small differences were observed in total scores in favour of SC children., What Is Known Already: While it is well known that ART children, also singletons, have an adverse perinatal outcome, studies on cognitive skills in ART children are inconsistent and only few studies have been published on school performances. Although these studies indicate good school performances in ART children many studies suffer from low participation rate and few participants., Study Design, Size, Duration: This retrospective population-based cohort study included all singleton children in Sweden, born after ART (n = 8323) or SC (n = 1 499 667), between 1985 and 2001., Participants/materials, Setting, Methods: Singleton children born after ART, identified in national IVF registries, were cross-linked with the Medical Birth Registry (MBR), the National Patient Registry (NPR) and the Swedish Cause of Death Registry (CDR) for characteristics and medical outcomes. Data on school performances, parental education and other parental characteristics was obtained through cross-linking to the National School Register and to Statistics Sweden. The control group was identified from the MBR and consisted of all singletons born after SC during the same time period. The primary outcome was school performance after 9 years at primary school and based on a mean total score of 16 subjects (0-320). The secondary outcomes were the mean school grade in specific subjects (mathematics, Swedish, English, physical education), 'qualified to enter secondary school' (i.e. approved in mathematics, Swedish and English) and 'poor school performance' (total score <160). Since the distribution of school grades was skewed, percentiles were used. Simple and multivariable linear regression was used for analysis of percentiles and logistic regression was used for the corresponding analysis of binary outcomes. Adjustments were made for child gender and year of birth, maternal age, parity, maternal smoking, paternal age, parental region of birth, parental education and socioeconomic class., Main Results and the Role of Chance: Data on 1 507 990 singletons in the ninth grade and registered by the Swedish School Authority were included. In the crude analysis, mean total scores were significantly higher for ART children (mean total score 230.2 (SD 57.2), corresponding to mean percentiles 60.2 (SD 27.7)), than for their SC counterparts (mean total score of 209.7 (SD 63.9), corresponding to mean percentiles 50.2 (SD 29.0)). However, after adjustments for several confounders, SC children had a significant advantage (adjusted mean difference [percentiles] -0.72, 95% confidence interval [CI] -1.31 to -0.12; P = 0.018). When analysing boys and girls together, no significant difference between children born after ART and children born after SC was found in mathematics, Swedish, English or physical education. Neither was there any significant difference between ART children and SC children in qualifying for secondary school (adjusted odds ratio [AOR] 1.05; 95% CI 0.95-1.17, P = 0.35) or in poor school performance (AOR 0.98; 95% CI, 0.89-1.09, P = 0.73). When cross-linking children with missing data on school performances (2.7% for ART and 2.8% for SC) with the NPR for mental disability, 35% of ART and 34% of SC children with missing data, were registered under such a diagnosis., Limitations, Reasons for Caution: The main limitation was that test scores were missing in a small percentage in both ART and SC children. Although we were able to crosslink this subpopulation with the NPR using codes for mental disability, such diagnosis only partly explained the missing scores. Other limitations are residual confounding caused by unknown confounders., Wider Implications of the Findings: The findings are generally reassuring and indicate, in the crude analysis, that school performances of ART children compared to children born after SC are better. After adjustment small differences were observed in total scores in favour of SC children. There were no significant differences, when analysing boys and girls together in specific subjects, in secondary school qualification or poor school performance., Study Funding/competing Interest(s): Financial support was received through Sahlgrenska University Hospital (ALFGBG-70 940), Hjalmar Svensson Research Foundation and Nordforsk, project number 71450. None the authors declare any conflict of interest.

Background: The radiation dose for patients can be reduced with many methods and one way is to use abdominal compression. In this study, the radiation dose and image quality for a new patient-controlled compression device were compared with conventional compression and compression in the prone position ., Purpose: To compare radiation dose and image quality of patient-controlled compression compared with conventional and prone compression in general radiography., Material and Methods: An experimental design with quantitative approach. After obtaining the approval of the ethics committee, a consecutive sample of 48 patients was examined with the standard clinical urography protocol. The radiation doses were measured as dose-area product and analyzed with a paired t-test. The image quality was evaluated by visual grading analysis. Four radiologists evaluated each image individually by scoring nine criteria modified from the European quality criteria for diagnostic radiographic images., Results: There was no significant difference in radiation dose or image quality between conventional and patient-controlled compression. Prone position resulted in both higher dose and inferior image quality., Conclusion: Patient-controlled compression gave similar dose levels as conventional compression and lower than prone compression. Image quality was similar with both patient-controlled and conventional compression and was judged to be better than in the prone position.

Background Iterative reconstruction (IR) is a recent reconstruction algorithm for computed tomography (CT) that can be used instead of the standard algorithm, filtered back projection (FBP), to reduce radiation dose and/or improve image quality. Purpose To evaluate and compare the image quality of low-dose CT of the lumbar spine reconstructed with IR to conventional FBP, without further reduction of radiation dose. Material and Methods Low-dose CT on 55 patients was performed on a Siemens scanner using 120 kV tube voltage, 30 reference mAs, and automatic dose modulation. From raw CT data, lumbar spine CT images were reconstructed with a medium filter (B41f) using FBP and four levels of IR (levels 2-5). Five reviewers scored all images on seven image quality criteria according to the European guidelines on quality criteria for CT, using a five-grade scale. A side-by-side comparison was also performed. Results There was significant improvement in image quality for IR (levels 2-4) compared to FBP. According to visual grading regression, odds ratios of all criteria with 95% confidence intervals for IR2, IR3, IR4, and IR5 were: 1.59 (1.39-1.83), 1.74 (1.51-1.99), 1.68 (1.46-1.93), and 1.08 (0.94-1.23), respectively. In the side-by-side comparison of all reconstructions, images with IR (levels 2-4) received the highest scores. The mean overall CTDI vol was 1.70 mGy (SD 0.46; range, 1.01-3.83 mGy). Image noise decreased in a linear fashion with increased strength of IR. Conclusion Iterative reconstruction at levels 2, 3, and 4 improves image quality of low-dose CT of the lumbar spine compared to FPB.

Objective: To evaluate metal artefact reduction (MAR) techniques from four CT vendors in hip prosthesis imaging., Methods: Bilateral hip prosthesis phantom images, obtained by using MAR algorithms for single-energy CT data or dual-energy CT (DECT) data and by monoenergetic reconstructions of DECT data, were visually graded by five radiologists using 10 image quality criteria. Comparisons between the MAR images and a reference image were performed for each scanner separately. Ordinal probit regression analysis was used., Results: The MAR algorithms in general improved the image quality based on the majority of the criteria (up to between 8/10 and 10/10) with a statistical improvement in overall image quality (p < 0.001). However, degradation of image quality, such as new artefacts, was seen in some cases. A few monoenergetic reconstruction series improved the image quality (p < 0.004) for one of the DECT scanners, but it was only improved for some of the criteria (up to 5/10). Monoenergetic reconstructions resulted in worse image quality for the majority of the criteria (up to 7/10) for the other DECT scanner., Conclusion: The MAR algorithms improved the image quality of the hip prosthesis CT images. However, since additional artefacts and degradation of image quality were seen in some cases, all algorithms should be carefully evaluated for every clinical situation. Monoenergetic reconstructions were in general concluded to be insufficient for reducing metal artefacts., Advances in Knowledge: Qualitative evaluation of the usefulness of several MAR techniques from different vendors in CT imaging of hip prosthesis.

Objectives: Abdominal radiography is frequently used in acute abdominal non-traumatic pain despite the availability of more advanced diagnostic modalities. This study evaluates the diagnostic accuracy of low-dose CT compared with abdominal radiography, at similar radiation dose levels., Methods: Fifty-eight patients were imaged with both methods and were reviewed independently by three radiologists. The reference standard was obtained from the diagnosis in medical records. Sensitivity and specificity were calculated. A systematic review was performed after a literature search, finding a total of six relevant studies including the present., Results: Overall sensitivity with 95 % CI for CT was 75 % (66-83 %) and 46 % (37-56 %) for radiography. Specificity was 87 % (77-94 %) for both methods. In the systematic review the overall sensitivity for CT varied between 75 and 96 % with specificity from 83 to 95 % while the overall sensitivity for abdominal radiography varied between 30 and 77 % with specificity 75 to 88 %., Conclusions: Based on the current study and available evidence, low-dose CT has higher diagnostic accuracy than abdominal radiography and it should, where logistically possible, replace abdominal radiography in the workup of adult patients with acute non-traumatic abdominal pain., Key Points: • Low-dose CT has a higher diagnostic accuracy than radiography. • A systematic review shows that CT has better diagnostic accuracy than radiography. • Radiography has no place in the workup of acute non-traumatic abdominal pain.

Background: Lumbar spine radiography is often performed instead of CT for radiation dose concerns., Purpose: To compare image quality and diagnostic information from low dose lumbar spine CT at an effective dose of about 1 mSv with lumbar spine radiography., Material and Methods: Fifty-one patients were examined by both methods. Five reviewers scored all examinations on eight image quality criteria using a five-graded scale and also assessed three common pathologic changes., Results: Low dose CT scored better than radiography on the following: sharp reproduction of disc profile and vertebral end-plates (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.3-2.5), intervertebral foramina and pedicles (OR, 4.3; 95% CI, 3.1-5.9), intervertebral joints (OR, 139; 95% CI, 59-326), spinous and transverse processes (OR, 7.0; 95% CI, 4.3-11.2), sacro-iliac joints (OR, 4.2; 95% CI, 3.2-5.7), reproduction of the adjacent soft tissues (OR, 2.9; 95% CI, 2.1-4.0), and absence of any obscuring superimposed gastrointestinal gas and contents (OR, 188; 95% CI, 66-539). Radiography scored better on sharp reproduction of cortical and trabecular bone (OR, 0.3; 95% CI, 0.2-0.4). The reviewers visualized disk degeneration, spondylosis/diffuse idiopathic skeletal hyperostosis (DISH) and intervertebral joint osteoarthritis more clearly and were more certain with low dose CT. Mean time to review low dose CT was 204 s (95% CI, 194-214 s.), radiography 152 s (95% CI, 146-158 s.). The effective dose for low dose CT was 1.0-1.1 mSv, for radiography 0.7 mSv., Conclusion: Low dose lumbar spine CT at about 1 mSv has superior image quality to lumbar spine radiography with more anatomical and diagnostic information., (© The Foundation Acta Radiologica 2015.)

Study Question: What is the child morbidity after IVF in women who have received a kidney transplant?, Summary Answer: Overall, obstetric outcome and morbidity in children of women who had undergone renal transplantation and IVF treatment were favourable., What Is Known Already: There are several studies of the obstetric outcome in women with spontaneous conception after solid organ transplantation as well as studies of obstetric outcome after IVF in general. There are only a few case reports of women with kidney or pancreas-kidney transplantation and deliveries after IVF treatment., Study Design, Size, Duration: A population-based retrospective register study was carried out in Sweden including all women with solid organ transplantation and deliveries after IVF; however, only women with kidney transplants were recruited. It also included information on all singleton deliveries after kidney transplantation and spontaneous conception between 1973 and 2012., Participants/materials, Setting and Methods: We cross-linked the IVF registers with the Medical Birth Register, the Patient Register and the Cause of Death Register. Study group 1 consisted of women with kidney transplantation and deliveries after IVF treatment. Study group 2 consisted of women with kidney transplantation and singleton deliveries after spontaneous conception. Group 3 (control group to singletons in study group 1) consisted of women without organ transplantation and with singleton deliveries after IVF, matched for maternal age, parity and date of birth. Group 4 (control group to study group 2) consisted of women without organ transplantation and with singleton deliveries after spontaneous conception, matched for maternal age, parity and year of birth., Main Results and the Role of Chance: Seven singletons and one set of twins were born after organ transplantation and IVF. All women in this group had renal transplants. Among singletons, two (28.6%) were preterm births (PTB), one (14.3%) had very low birthweight (VLBW) (672 g) and one (14.3%) was small for gestational age (SGA). Two infants had minor birth defects. One woman developed pre-eclampsia (14.3%). Mean age at follow-up of the children was 9.7 years (SD 4.2). Two children were diagnosed with hyperactivity disorders. There were 199 singletons born after renal transplantation and spontaneous conception. The rates of pre-eclampsia (23.6%), PTB (48.5%), LBW (43.7%) and SGA (21.2%) were significantly higher in pregnancies of women with renal transplants who had conceived spontaneously than in pregnancies where there was no transplantation and conception was spontaneous. Neonatal morbidity, early neonatal and infant mortality were all significantly higher. No increase in birth defects was seen. Mean age at follow-up of the children was 14.7 years (SD 9.4). Acute bronchitis, systemic lupus erythematosus and hyperactivity disorders were more common in children delivered to women with renal transplantation than in children delivered to women with no transplanted organs. Otherwise, long-term child morbidity was comparable., Limitations, Reasons for Caution: The women who had received renal transplants and who had given birth after IVF were a small group and may represent a selected group of comparatively healthy women., Wider Implications of the Findings: The results are important to transplant recipients with infertility problems. Neonatal outcomes after maternal renal transplantation and spontaneous conception were in agreement with the literature. Long-term follow-up of this group of children has long been asked for and findings are included in this report., Study Funding/competing Interests: No conflict of interest was reported. The study was supported by grants from Swedish Association of Local Authorities and Regions and by grants from the University of Gothenburg/Sahlgrenska University hospital (LUA/ALF 70940)., (© The Author 2014. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Background: Lumbar spine radiography has limited diagnostic value but low radiation dose compared with computed tomography (CT). The average effective radiation dose from lumbar spine radiography is about 1.1 mSv. Low-dose lumbar spine CT may be an alternative to increase the diagnostic value at low radiation dose, around 1 mSv., Purpose: To determine the optimal settings for low-dose lumbar spine CT simultaneously aiming for the highest diagnostic image quality possible., Material and Methods: An ovine lower thoracic and lumbar spine phantom, with all soft tissues around the vertebrae preserved except the skin, was placed in a 20 L plastic container filled with water. The phantom was scanned repeatedly with various technical settings; different tube potential, reference mAs, and with different convolution filters. Five radiologists evaluated the image quality according to a modification of the European guidelines for multislice computed tomography (MSCT) quality criteria for lumbar spine CT 2004. In a visual comparison the different scans were also ranked subjectively according to perceived image quality. Image noise and contrast were measured., Results: A tube potential of 120 kV with reference mAs 30 and medium or medium smooth convolution filter gave the best image quality at a sub-millisievert dose level, i.e. with an effective dose comparable to that from lumbar spine radiography., Conclusion: Low-dose lumbar spine CT thus opens a possibility to substitute lumbar spine radiography with CT without obvious increase in radiation dose., (© The Foundation Acta Radiologica 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)

We have investigated the temperature induced micelle-to-vesicle transition in a binary non-ionic surfactant/water system, for which the spontaneous curvature decreases with increasing temperature. Temperature jumps with variable rate were performed in a microwave oven, from a micellar phase at 5°C to a lamellar phase region at 35°C, passing a liquid-liquid two phase region where dilute and concentrated micellar solutions coexist. It is shown that the obtained vesicle size decreases with increasing heating rate through this two phase region. Moreover, we demonstrate that there exists a minimum vesicle radius, Rv(∗), as is also predicted by theory. In the present system we find Rv(∗)≈50nm, in reasonable agreement with a theoretical estimate., (Copyright © 2013 Elsevier Inc. All rights reserved.)

In the optimization process of lumbar spine examinations, factorial experiments were performed addressing the question of whether the effective dose can be reduced and the image quality maintained by adjusting the image processing parameters. A 2k-factorial design was used which is a systematic and effective method of investigating the influence of many parameters on a result variable. Radiographic images of a Contrast Detail phantom were exposed using the default settings of the process parameters for lumbar spine examinations. The image was processed using different settings of the process parameters. The parameters studied were ROI density, gamma, detail contrast enhancement (DCE), noise compensation, unsharp masking and unsharp masking kernel (UMK). The images were computer analysed and an image quality figure (IQF) was calculated and used as a measurement of the image quality. The parameters with the largest influence on image quality were noise compensation, unsharp masking, unsharp masking kernel and detail contrast enhancement. There was an interaction between unsharp masking and kernel indicating that increasing the unsharp masking improved the image quality when combined with a large kernel size. Combined with a small kernel size however the unsharp masking had a deteriorating effect. Performing a factorial experiment gave an overview of how the image quality was influenced by image processing. By adjusting the level of noise compensation, unsharp masking and kernel, the IQF was improved to a 30% lower effective dose.

The aim of the present study was to investigate the remission rate of adult asthma in a general population sample in relation to age, sex, asthma symptoms, allergic rhinitis and smoking. A follow-up of the random population samples from the European Community Respiratory Health Survey in Northern Europe was conducted from 1999-2001 on 1,153 individuals (aged 26-53 yrs) with reported asthma. Remission was defined as no asthmatic symptoms in two consecutive years and no current use of asthma medication. Remission rates per 1,000 person-yrs were calculated and Cox regression models, adjusting for confounders, were used to estimate hazard ratios (HR) with 95% confidence intervals (CI). An average remission rate of 20.2 per 1,000 person-yrs was found. There was no significant difference according to sex; the remission rates were 21.7 and 17.8 per 1,000 person-yrs in females and males, respectively. An increased remission rate was observed among subjects who quit smoking during the observation period. Subjects not reporting any asthma symptom at baseline had an increased remission rate. In the Cox regression model, ex-smoking (HR 1.65, 95% CI 1.01-2.71) was associated with increased remission rate, and reporting any asthma symptom at baseline was associated with decreased remission rate (HR 0.7, 95% CI 0.40-0.90). In conclusion, the present prospective longitudinal study showed that quitting smoking and the presence of mild disease appeared to favour remission.

Objective: Some studies have shown an association between lower maternal age at delivery and increased asthma in children and young adults. It is unclear whether this represents an effect of maternal ageing or a protective effect of siblings. In a North-European population based study, we investigated whether mother's age at delivery was associated with risk for asthma and hay fever in adult offspring, taking into account relevant confounders., Methods: A total of 16,190 subjects (74%) aged 23-54 yr answered a postal questionnaire in a follow-up of the European Community Respiratory Health Survey (ECRHS I)., Results: The associations of maternal age at delivery with hay fever, respiratory symptoms and diagnosed asthma were analysed using logistic regression, adjusting for household size, dwelling, parental education, centre, gender, adult hay fever, smoking, age and body mass index (BMI). The adjusted odds ratios (95% CI) for wheeze with breathlessness, wheeze without a cold and asthma in the offspring were 0.94 (0.90-0.99), 0.89 (0.86-0.94) and 0.92 (0.88-0.97), respectively, per 5 yr increase in maternal age. No heterogeneity between centres was found (p=0.84). The estimates remained similar in sub-sample analyses when adjusting for siblings, maternal smoking (n=3109) and for birth weight (n=1686). Hay fever was more common among those with the youngest and oldest mothers., Conclusions: In this large North-European multi-centre study, asthma was less common with increasing maternal age. This effect was consistent between centres and persisted with adjustment for several potential confounders, suggesting that the association may possibly be explained by biological changes related to maternal ageing.

Background: Respiratory symptoms are related to anxiety and depression in several cross-sectional studies but the association has not been explored in longitudinal studies., Study Objectives: To prospectively study the change in dyspnea in relation to symptoms of anxiety and depression over a 9-year time period., Methods: The study comprised of 515 adults from a population sample who had participated in the European Commission Respiratory Health Survey (ECRHS) I in 1991-1992 and in the ECRHS II in 1999-2000. The questionnaire included a modified British Medical Research Council Scale for dyspnea grading and the Hospital Anxiety and Depression scale questionnaire., Results: The prevalence of dyspnea was 10.7% in the first and 12.6% in the second survey. Symptoms of depression was an independent determinants for dyspnea in both surveys (OR (95% CI) 3.72 (1.51-9.17) and 3.40 (1.49-7.80), respectively). In subjects that did not have dyspnea at the first survey onset of symptoms of anxiety (OR 3.53 (1.03-12.1)) and depression (OR 12.2 (3.97-37.5)) were significantly related to having dyspnea at the second survey, whereas onset of dyspnea was not significantly associated with developing symptoms of anxiety or depression when each disorder was entered separately., Conclusion: Our data indicates that there is a causal relationship between development of symptoms of anxiety and depression and dyspnea. Psychological status is therefore an important factor to consider both when evaluating the results of epidemiological respiratory studies and in clinical settings when treating patients that have dyspnea.

To find if factorial experiments can be used in the optimisation of diagnostic imaging, a factorial experiment was performed to investigate some of the factors that influence image quality, kerma area product (KAP) and effective dose (E). In a factorial experiment the factors are varied together instead of one at a time, making it possible to discover interactions between the factors as well as major effects. The factors studied were tube potential, tube loading, focus size and filtration. Each factor was set to two levels (low and high). The influence of the factors on the response variables (image quality, KAP and E) was studied using a direct digital detector. The major effects of each factor on the response variables were estimated as well as the interaction effects between factors. The image quality, KAP and E were mainly influenced by tube loading, tube potential and filtration. There were some active interactions, for example, between tube potential and filtration and between tube loading and filtration. The study shows that factorial experiments can be used to predict the influence of various parameters on image quality and radiation dose.

Several studies have identified obesity as a risk factor for asthma in both children and adults. An increased prevalence of asthma in subjects with gastro-oesophageal reflux (GOR) and obstructive sleep apnoea syndrome has also been reported. The aim of this investigation was to study obesity, nocturnal GOR and snoring as independent risk factors for onset of asthma and respiratory symptoms in a Nordic population. In a 5-10 yr follow-up study of the European Community Respiratory Health Survey in Iceland, Norway, Denmark, Sweden and Estonia, a postal questionnaire was sent to previous respondents. A total of 16,191 participants responded to the questionnaire. Reported onset of asthma, wheeze and night-time symptoms as well as nocturnal GOR and habitual snoring increased in prevalence along with the increase in body mass index (BMI). After adjusting for nocturnal GOR, habitual snoring and other confounders, obesity (BMI >30) remained significantly related to the onset of asthma, wheeze and night-time symptoms. Nocturnal GOR was independently related to the onset of asthma and in addition, both nocturnal GOR and habitual snoring were independently related to onset of wheeze and night-time symptoms. This study adds evidence to an independent relationship between obesity, nocturnal gastro-oesophageal reflux and habitual snoring and the onset of asthma and respiratory symptoms in adults.

Studies of birth characteristics and respiratory outcomes show contradictory findings. We wanted to investigate the association of birth weight with adult lung function as well as asthma symptoms while addressing the influence of demographic and environmental factors. Data was collected from the birth records of 1683 men and women born in 1947-1973 who were included in 6 Nordic-Baltic population samples investigated within the European Community Respiratory Health Survey (ECRHS). In the adults, an increase in birth weight from below 2500 g to above 4000 g was associated with an increase from 96% to 104% predicted one-second forced expiratory volume (P<0.01) and from 1.00% to 107% predicted forced vital capacity (P<0.01). However, birth weight was not associated with symptoms of asthma. After adjustment for birth length, gender, age, study centre, adult BMI, allergic rhinitis, parental and adult tobacco smoke exposure in multivariate regression analyses, birth weight was not associated with adult lung function or asthma symptoms. Further sub-sample analyses revealed no influence of gestational age, gender, age or geographical area. In this historic prospective cohort study an association was neither found between birth weight and adult lung function nor between birth weight and asthma symptoms.

The aim of this study was to assess the influence of some risk factors for onset and remission of allergic rhinitis and asthma in Swedish adults. A random sample of 1,370 subjects, age 20 to 44 yr was investigated by means of postal questionnaires in 1990 and 1993. Skin prick tests were conducted in 1991-1992. The association between risk factors and onset or remission of allergic rhinitis and asthma was estimated using multivariate logistic regression analysis. Onset of allergic rhinitis was associated with sensitization to birch (odds ratio [OR] = 6.5), Parietaria (OR = 7.4); and pets (OR = 3.0) and with female sex (OR = 1.9). Onset of asthma was associated with allergic rhinitis (OR = 4.9), sensitization to pets (OR = 2.4); and with smoking (OR = 3.0). Onset of asthma was strongly associated with allergic rhinitis among atopics (OR = 5.7), but onset of asthma and rhinitis also tended to be related among nonatopics (OR = 3.5). A strong association between smoking and onset of asthma was found among nonatopics (OR = 5.7). In conclusion, sensitization to pollens and pets were risk factors for onset of allergic rhinitis, whereas allergic rhinitis, sensitization to pets, and smoking were risk factors for onset of asthma.

Work disability due to respiratory disease, especially asthma, is common and costly among working age adults. The goal of this analysis was to characterize the risk factors for such disability. We analyzed data from the Swedish part of the European Community Respiratory Health Survey (ECRHS), a random population-based sample of adults age 20 to 44, enriched with symptomatic subjects at increased likelihood of having asthma. We analyzed structured interview data available for 2,065 subjects and further analyzed methacholine challenge and skin prick test data for 1,562 of these. We defined respiratory work disability as reported job change or work loss due to breathing affected by a job. We used binary generalized linear modeling with a log link to estimate disability risk. Eighty-four subjects (4%) reported such work disability. This increased to 13% among those with asthma (45 of 350 subjects). Adjusting for covariates, occupations at high risk for asthma were associated with disability (prevalence ratio [PR] 1.8; 95% confidence interval [CI] 1.1 to 3.0), as was self-reported regular exposure to environmental tobacco smoke (ETS) at work (PR 1.8; 95% CI 1.1 to 3.1) and self- reported job exposure to vapors, gases, dust, or fumes (VGDF) (PR 4.3; 95% CI 2.2 to 8.6). Workplace ETS exposure was also associated with methacholine challenge-positive asthma reported to be symptomatic at work among male subjects (PR 4. 2; 95% CI 1.8 to 9.8), whereas high asthma-risk occupations were associated with this outcome among female subjects (PR 2.7; 95% CI 1. 05 to 7.1). Respiratory work disability, defined as breathing-related job change due to work loss, was associated with workplace exposures themselves, even after taking into account other covariates. Better control of workplace exposures, including workplace ETS, may reduce work disability caused by respiratory conditions, especially adult asthma.

Background: The results from a population study on respiratory symptoms and bronchial hyperresponsiveness in relation to symptoms of food intolerance and sensitization to food allergens are reported., Methods: The study included 1,812 men and women, aged 20 to 44 years and residents in three areas of Sweden who participated in the European Community Respiratory Health Survey. The prevalence of IgE sensitization to egg white, fish, wheat, peanut, soy, and milk was assayed by CAP-RAST and the prevalence of symptoms of food intolerance was determined by a standardized questionnaire., Results: The study group included a random sample of 1,397 subjects from the general population at the three centers. Of these, 85 (6%) had specific IgE antibodies to one of the food allergens and 345 (25%) reported symptoms of food intolerance. After enrichment with subjects suffering from symptoms of asthma, the sample included a total of 1,812 individuals of which 144 subjects had specific IgE antibodies to one or more of the food allergens studied. Of these 144, 52% reported food intolerance but only 16% related the symptoms to any of the food allergens in the panel. Sensitization to food allergens was more common in atopic subjects, subjects reporting current asthma, and subjects with bronchial hyperresponsiveness (P < .001). These associations remained significant after adjustment for the degree of allergic sensitization, whether defined as the number of positive skin prick tests or as total serum IgE levels., Conclusions: Although sensitization to food allergens is not uncommon in adults, the correlation to specific symptoms of food intolerance is weak. Sensitization to food allergens may have special relevance to asthma and bronchial hyperresponsiveness.

A study of the occurrence of asthma in six areas in four Nordic countries showed 18-25 percent of the populations investigated to have had wheezing or whistling in the airways during the previous 12-month period, and 2-3 percent to have had asthma attacks. The use of anti-asthmatics was found to have differed from one to another of the areas included in the study, and the result suggest the difference to depend upon corresponding differences in the extent to which an active approach to treatment was adopted for the care of patients with asthmatic problems.

Bronchoalveolar lavage was performed in 62/63 patients with suspected pulmonary tuberculosis and gastric lavage in 60 of the 63. Mycobacteria could be cultured from 14 of the patients. Cultures on bronchoalveolar lavage were positive in 13 of them, while gastric lavage was positive in only 7. Our conclusion is that bronchoalveolar lavage should be performed instead of gastric lavage when pulmonary tuberculosis is suspected.

Tuberculosis can be a risk to staff and students in the autopsy room. We report three medical students and one technician who were infected with tuberculosis during two autopsies. In both cases pulmonary tuberculosis had not been diagnosed before death.

The selenium content in milk of dairy cows from different countries varies between 2 and 60 micrograms/kg, because of differences in the selenium content in the feeds. With an increasing selenium content in the feed a decreasing part is secreted into the milk. A bigger part is utilized from natural selenium compounds in the feed than from selenite. In own investigations milk from Swedish cows had significantly lower selenium content during summer and autumn than during winter and spring (p less than 0,0001). The LS-means between different regions also differed significantly (p less than 0,0001). From the autumn of 1980 the feed manufacturers have been allowed to add sodium-selenite to concentrates and mineral feeds in amounts permitting a selenium content of 0,1 mg/kg DM in the total ration of dairy cows. The year after the selenium fortification was allowed, the LS-means for the selenium content of milk were 1 microgram/kg higher than the year before (p less than 0,001). In the southern parts of Sweden the selenium content was 8-10 and in the central and northern parts 7-9 micrograms/kg. These means were substantially lower than the figure of 15 micrograms/kg which was reported from the central part of Sweden two decades ago. The low selenium content in the milk during summer in some parts of Sweden could possibly mean that there is still a risk of selenium deficiency among the cattle. Anyhow the milk will not always cover the selenium requirement of the sucking or milkfed calf.