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Thall CR, Jensen G, Wright C, Baker S, Meade R. The role of hospital-based family support teams in improving the quality of the organ donation process. Transplant Proc 1997; 29:3252-3. [PMID: 9414703 DOI: 10.1016/s0041-1345(97)00898-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Melchior T, Hildebrant P, Køber L, Jensen G, Torp-Pedersen C. Do diabetes mellitus and systemic hypertension predispose to left ventricular free wall rupture in acute myocardial infarction? Am J Cardiol 1997; 80:1224-5. [PMID: 9359558 DOI: 10.1016/s0002-9149(97)00646-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Diabetes and systemic hypertension had no influence on left ventricular free wall rupture complicating acute myocardial infarction. Age <65 years and a history of coronary artery disease offers some protection from protection.
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Jensen JS, Feldt-Rasmussen B, Borch-Johnsen K, Clausen P, Appleyard M, Jensen G. Microalbuminuria and its relation to cardiovascular disease and risk factors. A population-based study of 1254 hypertensive individuals. J Hum Hypertens 1997; 11:727-32. [PMID: 9416983 DOI: 10.1038/sj.jhh.1000459] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Microalbuminuria has been proposed as a potential atherosclerotic risk factor in hypertensive individuals. The aim of this cross-sectional population study was to analyse whether microalbuminuria is related to a higher prevalence of cardiovascular disease, and a more atherogenic risk profile, and reversely related to the use of antihypertensive drugs. In a major health screening at the State University Hospital in Copenhagen, including urinary albumin excretion, glomerular filtration rate, blood pressure (BP), electrocardiogram, body mass index, plasma lipoproteins, fibrinogen, and albumin, and information regarding a history of acute myocardial infarction, smoking, and antihypertensive drugs, 1254 participants without diabetes mellitus or renal/urinary tract disease had arterial hypertension. Age range was 30-70 years. Microalbuminuria (nocturnal urinary albumin excretion >15 microg/min) occurred in 5%, and cardiovascular disease (previous acute myocardial infarction or electrocardiographic Q-waves) also in 5% of the study population. Microalbuminuric hypertensive subjects were characterized by higher age and systolic BP, and a male predominance, as compared to normoalbuminuric hypertensive subjects. The frequency of cardiovascular disease was similar in the two groups. In contrast, when analysed as a continuous variable, a one unit increase in the logarithmically transformed urinary albumin excretion significantly increased the likelihood of cardiovascular disease (odds ratio [95% confidence interval] 1.32 (1.02-1.70); P < 0.05), and this relation was independent of age, sex, and conventional atherosclerotic risk factors. Participants who were effectively treated with antihypertensive drugs did not have a lower urinary albumin excretion than insufficiently treated or untreated participants. It is concluded that slightly elevated albumin excretion in the urine is not only a pressure-dependent functional phenomenon in the glomerular vessel walls, but associated with permanent atherosclerotic abnormalities in the entire vascular system.
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Xu Z, Jensen G, Yen TS. Activation of hepatitis B virus S promoter by the viral large surface protein via induction of stress in the endoplasmic reticulum. J Virol 1997; 71:7387-92. [PMID: 9311817 PMCID: PMC192084 DOI: 10.1128/jvi.71.10.7387-7392.1997] [Citation(s) in RCA: 128] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Hepatitis B virus (HBV) codes for three forms of surface protein. The minor, large form is translated from transcripts specified by the preS1 promoter, while the middle and small forms are translated from transcripts specified by the downstream S promoter. When the large surface protein is overexpressed, the secretion of both subviral and virion particles is blocked within the secretory pathway. We show here that overexpression of the large surface protein leads to up to a 10-fold activation of the S promoter but not of an unrelated promoter. Neither the middle nor the small surface protein, nor a secretable form of the large surface protein, activates the S promoter, but agents that induce endoplasmic reticulum (ER) stress have an effect similar to that of the large surface protein. The large surface protein also activates the S promoter in the context of the entire viral genome. Therefore, it appears that HBV has evolved a feedback mechanism, such that ER stress induced by accumulation of the large surface protein increases the synthesis of the middle and small surface proteins, which in combination with the large surface protein can form mixed, secretable particles. In addition, like other agents that induce ER stress, the large surface protein can activate the cellular grp78 and grp94 promoters, raising the possibility that it may alter the physiology of the host cell.
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Wittrup H, Tybjærg-Hansen A, Steffensen R, Deeb S, Brunzell J, Jensen G, Nordestgaard B. 1.P.319 A common mutation T(−93)→G in the promoter of the lipoprotein lipase gene is associated with elevated plasma triglycerides in both genders and with ischemic heart disease in men. The Copenhagen City Heart Study. Atherosclerosis 1997. [DOI: 10.1016/s0021-9150(97)88498-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nordestgaard BG, Abildgaard S, Wittrup HH, Steffensen R, Jensen G, Tybjaerg-Hansen A. Heterozygous lipoprotein lipase deficiency: frequency in the general population, effect on plasma lipid levels, and risk of ischemic heart disease. Circulation 1997; 96:1737-44. [PMID: 9323055 DOI: 10.1161/01.cir.96.6.1737] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Patients with mutations on both alleles of the lipoprotein lipase gene resulting in complete lipoprotein lipase deficiency exhibit the chylomicronemia syndrome with severe hypertriglyceridemia and increased risk of pancreatitis and possibly of ischemic heart disease. This study examined frequency, lipid levels, and risk of ischemic heart disease for heterozygous carriers of lipoprotein lipase mutations known to cause the chylomicronemia syndrome in the homozygous state. METHODS AND RESULTS Two mutations were screened for in 9259 individuals in a general population sample and in 948 patients with verified ischemic heart disease. The percent frequencies of heterozygous individuals with the Gly188-->Glu and Ile194-->Thr substitutions in the general population were 0.06% (95% CI, 0.04% to 0.23%) and 0% (95% CI, 0.00% to 0.12%), respectively. The Gly188-->Glu substitution was associated with an increase in plasma triglycerides of 0.8+/-0.3 mmol/L (mean+/-SEM) and a decrease in plasma HDL cholesterol, apo A-I, and glucose levels of 0.45+/-0.07 mmol/L, 17+/-6 mg/dL, and 1.1+/-0.2 mmol/L, respectively. On multiple logistic regression analysis allowing for age, sex, plasma cholesterol, plasma lipoprotein (a), hypertension, diabetes mellitus, smoking, and body mass index, both plasma triglycerides and HDL cholesterol levels were independent predictors of ischemic heart disease. Finally, the Gly188-->Glu substitution was more common among patients with verified ischemic heart disease (percent frequency of heterozygous individuals, 0.32%) than among individuals from the general population (odds ratio, 4.9; 95% CI, 1.2 to 19.6). The effects of the Gly188-->Glu substitution were more pronounced than those of the common Asn291-->Ser substitution. CONCLUSIONS Heterozygous lipoprotein lipase deficiency due to the Gly188-->Glu substitution appears to increase plasma triglycerides and reduce HDL levels and may thereby predispose carriers to ischemic heart disease.
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Agerholm-Larsen B, Tybjaerg-Hansen A, Frikke-Schmidt R, Grønholdt ML, Jensen G, Nordestgaard BG. ACE gene polymorphism as a risk factor for ischemic cerebrovascular disease. Ann Intern Med 1997; 127:346-55. [PMID: 9273825 DOI: 10.7326/0003-4819-127-5-199709010-00002] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Researchers have suggested that the deletional allele of the ACE (angiotensin-converting enzyme) gene insertion-deletion polymorphism is a potent risk factor for myocardial infarction. This association could not be confirmed in the Copenhagen City Heart Study, in which 10,150 persons were studied. The ACE gene polymorphism has also recently been suggested as a potent risk factor for ischemic cerebrovascular disease. OBJECTIVE To investigate the association between ACE gene polymorphism and ischemic cerebrovascular disease. DESIGN Two case-referent studies and a cross-sectional study. SETTING University hospital in Copenhagen, Denmark. PARTICIPANTS Case-referent study 1: 35 women and 38 men who developed ischemic cerebrovascular disease before 50 years of age compared with 1454 women and 1737 men from a general population sample. Case-referent study 2: 82 women and 137 men with ischemic cerebrovascular disease and carotid stenosis greater than 40% compared with 4273 women and 3091 men from the general population sample. Cross-sectional study of the general population sample: 67 women and 93 men with ischemic cerebrovascular disease compared with 4077 women and 3156 men without such disease. MEASUREMENTS Genotype; age; body mass index; smoking habits; levels of lipids, lipoproteins, apolipoproteins, and fibrinogen; and diagnosis of hypertension, diabetes mellitus, and ischemic cerebrovascular disease. RESULTS Odds ratios for ischemic cerebrovascular disease by ACE genotype classes were not significantly different from 1.0 in women or men in any of the three studies, separately or combined. In a logistic regression analysis that controlled for age and conventional cardiovascular risk factors, odds ratios in either sex still did not significantly differ from 1.0 in any study, separately or combined. CONCLUSION In two case-referent studies, a cross-sectional study, and the three studies combined, no statistically significant difference was found in the development of ischemic cerebrovascular disease between genotype classes of the ACE gene polymorphism in women or men.
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Rask-Madsen C, Jensen G, Køber L, Melchior T, Torp-Pedersen C, Hildebrand P. Age-related mortality, clinical heart failure, and ventricular fibrillation in 4259 Danish patients after acute myocardial infarction. Eur Heart J 1997; 18:1426-31. [PMID: 9458448 DOI: 10.1093/oxfordjournals.eurheartj.a015468] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIMS To evaluate the prognosis of patients > or = 80 years old, we analysed a large, community-based population with acute myocardial infarction who received intensive observation and similar pharmacotherapy regardless of age. METHODS AND RESULTS In a 12-year period, before the introduction of thrombolysis, 4259 consecutive patients hospitalized with acute myocardial infarction from the same hospital in Denmark were prospectively registered. Their complications and mortality in hospital, and 1 and 5 years after discharge were analysed retrospectively. Overall, in-hospital mortality was 11% for patients less than < 50 years old, 22% for patients 60-69 years old and 43% for patients > or = 80 years old. Two thirds of patients > or = 80 years old had heart failure, and cardiogenic shock was twice as common in this age group than in patients 60-69 years. Heart failure was a strong independent risk, factor for post-discharge mortality, particularly in the oldest age groups. Four out of eight patients > or = 80 years survived one year if discharged alive after experiencing in-hospital ventricular fibrillation. CONCLUSION The life-saving potential of preventing or treating heart failure seems considerable even in the oldest patient groups. Patients > or = 80 years old who survive in-hospital ventricular fibrillation have an acceptable prognosis 1 year post-discharge.
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Hippe M, Vestbo J, Bjerg AM, Borch-Johnsen K, Appleyard M, Hein HO, Andersen PK, Jensen G, Sørensen TI. Cardiovascular risk factor profile in subjects with familial predisposition to myocardial infarction in Denmark. J Epidemiol Community Health 1997; 51:266-71. [PMID: 9229055 PMCID: PMC1060471 DOI: 10.1136/jech.51.3.266] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
STUDY OBJECTIVES To identify possible modifiable mediators of familial predisposition to myocardial infarction (MI) by assessing the risk factor profile in individuals without MI in relation to parental occurrence of MI. DESIGN AND METHODS Cross sectional survey of the general population. The odds of an adverse cardiovascular risk factor profile in subjects reporting parental occurrence of MI versus subjects not reporting parental occurrence were estimated by logistic regression models. SETTING The Copenhagen Centre for Prospective Population Studies, where subjects investigated in three Danish prospective population studies are integrated. PARTICIPANTS Subjects were 9306 females and 11,091 males aged 20-75 years with no history of MI. A total of 1370 subjects reported maternal MI and 2583 reported paternal MI. MAIN RESULTS Increased systolic and diastolic blood pressure, increased cholesterol level, low ratio between high density lipoprotein (HDL) and total cholesterol (TC), and heavy smoking, were more frequent in subjects with parental occurrence of MI than in controls irrespective of sex and age of the subjects. Maternal MI was more predictive for increased cholesterol and decreased HDL/ TC ratio than paternal MI, and the risk of an increased cholesterol level was higher in subjects aged 20-39 years than in older subjects. No differences in body mass index, triglycerides, and physical inactivity were observed. CONCLUSIONS Subjects free of previous MI who reported a parental occurrence of MI had an adverse cardiovascular risk factor profile regarding systolic and diastolic blood pressure, total cholesterol, the ratio between HDL and total cholesterol, and smoking. Thus, these modifiable risk factors may be mediators of the familial predisposition to MI.
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Agerholm-Larsen B, Nordestgaard BG, Steffensen R, Sørensen TI, Jensen G, Tybjaerg-Hansen A. ACE gene polymorphism: ischemic heart disease and longevity in 10,150 individuals. A case-referent and retrospective cohort study based on the Copenhagen City Heart Study. Circulation 1997; 95:2358-67. [PMID: 9170397 DOI: 10.1161/01.cir.95.10.2358] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Homozygosity for the deletion allele (D) of the angiotensin-converting enzyme (ACE) gene insertion-deletion polymorphism has been suggested to be a potent risk factor for myocardial infarction. With one exception, the samples studied so far have been small and/or ethnically heterogeneous, and most investigators have studied men only. METHODS AND RESULTS We investigated the association between ACE genotype and myocardial infarction as well as other manifestations of ischemic heart disease for both women and men in a case-referent study (n = 10,150) as well as in a retrospective cohort study (n = 7263). The cohort was from the ethnically homogeneous Danish population. Case subjects were from the same geographic area and had ischemic heart disease. Irrespective of the assumed degree of relative penetrance of the D allele, the odds ratios were not significantly different from 1.0 (P > .05) for ischemic heart disease, severe stenosis on coronary angiography, or myocardial infarction. There was also no association between ACE genotype and phenotypic variation in recognized risk factors for ischemic heart disease. Finally, the relative frequency of the D allele did not change as a function of age in subjects aged from 20 to > or = 80 years. CONCLUSIONS In two large studies, a case-referent study and a retrospective cohort study in an ethnically homogeneous white population, there was no evidence for a statistically significant difference in the development of myocardial infarction or any other manifestations of ischemic heart disease between genotype classes of the ACE gene polymorphism in either women or men.
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Chernoff R, Bruner D, Fitz P, Gannon J, Glade M, Hausman P, Howell WH, Jensen G, Stallings V, Wallach S, Zeisel S. Credentials available in human clinical nutrition: a report of the Intersociety Committee on Nutrition Certification. Am J Clin Nutr 1997; 65:1562-6. [PMID: 9157790 DOI: 10.1093/ajcn/65.5.1562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Hampton JR, van Veldhuisen DJ, Kleber FX, Cowley AJ, Ardia A, Block P, Cortina A, Cserhalmi L, Follath F, Jensen G, Kayanakis J, Lie KI, Mancia G, Skene AM. Randomised study of effect of ibopamine on survival in patients with advanced severe heart failure. Second Prospective Randomised Study of Ibopamine on Mortality and Efficacy (PRIME II) Investigators. Lancet 1997; 349:971-7. [PMID: 9100622 DOI: 10.1016/s0140-6736(96)10488-8] [Citation(s) in RCA: 284] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Drugs that improve symptoms in patients with heart failure must also be assessed for their effects on survival. Ibopamine stimulates DA-1 and DA-2 receptors and causes peripheral and renal vasodilatation; the drug improves symptoms of heart failure. We assessed the effect of ibopamine on survival in patients with advanced heart failure in a multicentre, randomised placebo-controlled study. METHODS Patients with advanced severe heart failure (New York Heart Association classes III and IV) and evidence of severe left-ventricular disease, who were already receiving optimum treatment for heart failure, were randomly allocated oral ibopamine 100 mg three times daily or placebo. The primary endpoint was all-cause mortality. The study was designed to recruit 2200 patients, and the minimum duration of treatment would be 6 months. We did intention-to-treat and on-treatment analyses; a post-hoc subgroup analysis was also done. FINDINGS After we had recruited 1906 patients the trial was stopped early, because of an excess of deaths among patients in the ibopamine group. 232 (25%) of 953 patients in the ibopamine group died, compared with 193 (20%) of 953 patients in the placebo group (relative risk 1.26 [95% CI 1.04-1.53], p = 0.017). The average length of follow-up was 347 days in the ibopamine group and 363 days in the placebo group. In multivariate analysis, only the use of antiarrhythmic drugs at baseline was a significant independent predictor of increased fatality in ibopamine-treated patients. INTERPRETATION Ibopamine seems to increase the risk of death among patients with advanced heart failure who are already receiving optimum therapy, but the reasons for this increase are not clear. Our finding that antiarrhythmic treatment was a significant predictor of increased mortality in ibopamine-treated patients may be important, but exploratory analyses must be interpreted with caution.
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Chernoff R, Bruner D, Fitz P, Gannon J, Glade M, Hansman P, Howell WH, Jensen G, Stallings V, Wallach S, Zeisel S. Credentials available in human clinical nutrition: a report of the Intersociety Committee on Nutrition Certification. J Am Coll Nutr 1997; 16:184-8. [PMID: 9100221 DOI: 10.1080/07315724.1997.10718671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Jensen JS, Borch-Johnsen K, Feldt-Rasmussen B, Appleyard M, Jensen G. Urinary albumin excretion and history of acute myocardial infarction in a cross-sectional population study of 2,613 individuals. JOURNAL OF CARDIOVASCULAR RISK 1997; 4:121-5. [PMID: 9304493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Preliminary studies have suggested that microalbuminuria--a slightly increased urinary excretion of albumin--is a risk factor for atherosclerosis. The aim of this study was to examine whether an association exists between urinary excretion of albumin and a history of acute myocardial infarction, in a major population sample. METHODS The study was performed as a part of the 3rd Copenhagen City Heart Study, Denmark, 1992-1994, and included 2,613 participants aged 30-70 years, and without diabetes mellitus, renal or urinary tract disease or haematuria. The study programme included measurement of urinary albumin excretion rate, acquisition of information regarding previous acute myocardial infarction (verified by the Danish Hospital Register) and tobacco and alcohol consumption, 12-lead resting electrocardiogram, and measurement of blood pressure, body mass index, waist:hip ratio, plasma concentrations of total cholesterol, HDL cholesterol and fibrinogen, serum albumin concentration and glomerular filtration rate. RESULTS Among the participants, 3.6% presented with a history of acute myocardial infarction. There was a positive association between urinary albumin excretion rate (logarithmically transformed) and acute myocardial infarction (odds ratio 1.35, 95% confidence interval 1.08 to 1.70, n = 2, 613; P = 0.01), which was independent of age, sex conventional atherosclerotic risk factors, and glomerular filtration rate. The odds ratio for acute myocardial infarction associated with microalbuminuria (urinary albumin excretion rate exceeding the upper decile in the entire study population) was 2.06 (95% confidence interval 1.20 to 3.55, n = 2,613; P = 0.009). CONCLUSION There exists a positive and independent association between urinary excretion of albumin and a history of acute myocardial infarction. Follow-up analyses should determine the time sequence of this association.
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Meterissian SH, Kontogiannea M, Po J, Jensen G, Ferdinand B. Apoptosis induced in human colorectal carcinoma by anti-Fas antibody. Ann Surg Oncol 1997; 4:169-75. [PMID: 9084855 DOI: 10.1007/bf02303801] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Apoptosis or programmed cell death has been shown to play an important role in the progression from polyps to carcinomas. Fas/APO-1 is a cell surface protein that can induce apoptosis in a variety of cell types upon specific binding. In this study seven human colorectal carcinoma (HCRC) cell lines of varying differentiation were analyzed for cell surface Fas expression. Fas-mediated apoptosis, and correlation of apoptosis with bcl-2 expression. METHODS AND RESULTS Using flow cytometry, all seven lines expressed varying amounts of cell surface Fas antigen. Exposure to anti-Fas antibody induced cell death in all the cell lines, albeit to varying degrees. The rate of apoptosis was quantitated using flow cytometry with propidium iodide staining of nuclear DNA. The poorly differentiated cell lines had a significantly decreased (p < 0.05) anti-Fas sensitivity as compared with the well-differentiated lines. Measurement of bcl-2 expression by flow cytometry showed an inverse correlation with anti-Fas sensitivity. CONCLUSIONS This study confirms that HCRC cell lines express Fas antigen and, more importantly, provides the first evidence that exposure to anti-Fas antibody can induce apoptosis. Fas-mediated apoptosis in HCRC cell lines may be regulated by bcl-2 and may correlate with the degree of differentiation.
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Friedenberg F, Jensen G, Gujral N, Braitman LE, Levine GM. Serum albumin is predictive of 30-day survival after percutaneous endoscopic gastrostomy. JPEN J Parenter Enteral Nutr 1997; 21:72-4. [PMID: 9084008 DOI: 10.1177/014860719702100272] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) tubes have been used since 1980 in patients who require prolonged enteral feeding. PURPOSE To identify factors associated with poor survival (defined as survival < 30 days) post-PEG. METHODS We assessed a cohort of 64 patients consecutively referred for a percutaneous endoscopic gastrostomy tube in a single, tertiary care hospital. Prior to PEG tube placement, we evaluated relevant clinical variables in each patient to determine their effect on 30-day mortality. RESULTS Of the cohort, 43 of 64 (67.2%) survived at least 30 days after tube placement. One death was attributable to tube placement. Bivariate analyses showed that 30-day survival correlated directly with serum albumin (r = .253; p = .049) and inversely with creatinine (r = -0.255; p = .042). Using multivariable logistic regression analysis, only albumin was identified as an independent predictor of 30-day survival (p = .044). Eighty-three percent of patients with a serum albumin > or = 3.0 g/dL survived 30 days compared with 58% with an albumin < 3.0, a difference of 25% (95% CI, -2% to 54%; p = .07). CONCLUSIONS In conclusion, serum albumin appears to be a predictor of early survival in individuals undergoing percutaneous endoscopic gastrostomy tube placement.
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Jensen JS, Clausen P, Borch-Johnsen K, Jensen G, Feldt-Rasmussen B. Detecting microalbuminuria by urinary albumin/creatinine concentration ratio. Nephrol Dial Transplant 1997; 12 Suppl 2:6-9. [PMID: 9269691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Microalbuminuria, i.e. a subclinical increase of the albumin excretion rate in urine, may be a novel atherosclerotic risk factor. This study aimed to test whether microalbuminuria can be identified by measurement of urinary albumin concentration or urinary albumin/creatinine concentration ratio, instead of the usual measurement of the albumin excretion rate in a timed urine collection. METHODS All 2579 subjects analysed were screened in a population based epidemiological study. Participants with diabetes mellitus, renal disease, haematuria, or urinary tract infection were not included. Urinary albumin (Ualb) and creatinine (Ucreat) concentrations were measured in an overnight collected sample by enzyme-linked immunosorbent and colorimetric assays, respectively. Urinary albumin excretion rate (UAER) and urinary albumin/creatinine concentration ratio (Ualb/Ucreat) were calculated. RESULTS The correlation between Ualb and UAER was 0.72 (n = 2579, P < 0.001), and the correlation between Ualb/Ucreat and UAER was 0.81 (n = 2579, P < 0.001). In the detection of microalbuminuria, the nosographic sensitivity and specificity, and the diagnostic specificity were 58%, 97%, and 66% for Ualb, and 73%, 97%, and 73% for Ualb/Ucreat, respectively. CONCLUSIONS It is concluded that measurement of the albumin/creatinine concentration ratio is a specific and quite sensitive alternative to measurement of the urinary albumin excretion rate in timed collections, when screening for microalbuminuria.
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Schrader SL, Dressing B, Blue R, Jensen G, Miller D, Zawada ET. The Medication Reduction Project: combating polypharmacy in South Dakota elders through community-based interventions. SOUTH DAKOTA JOURNAL OF MEDICINE 1996; 49:441-8. [PMID: 8997150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The Medication Reduction Project (MED RED) is a community-based program addressing polypharmacy issues in elders. Using educational presentations and one-on-one medication reviews conducted by a pharmacist specializing in geriatrics, MED RED reached over 1,100 older adults in rural and urban southeastern South Dakota communities during 1993. Analysis of the longitudinal data indicate that older adults participating in one-on-one reviews were on fewer medications, had dosage reductions, were more likely to take their medications as directed, and increased their use of non-pharmacological alternatives. These elders also reported feeling better, spent less money per month on medications, and offered indications of improved functioning and increased levels of independence. These findings suggest that education about medication use is a dynamic tool in empowering community-based older adults to be assertive participants in their own health care.
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Osler M, Sørensen TI, Sørensen S, Rostgaard K, Jensen G, Iversen L, Kristensen TS, Madsen M. Trends in mortality, incidence and case fatality of ischaemic heart disease in Denmark, 1982-1992. Int J Epidemiol 1996; 25:1154-61. [PMID: 9027519 DOI: 10.1093/ije/25.6.1154] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND In Denmark, as in many other Western countries, a decline in mortality from ischaemic heart disease (IHD) has been observed. The present study assesses whether the decline in IHD mortality is due to a decrease in incidence and/or case-fatality, and whether parallel changes occurred in the various manifestations of IHD requiring hospitalization. METHODS The National Patient Register of hospital discharges and the Causes-of-Death Register were linked and all cases of first admission for IHD including AMI and fatal first manifestations of IHD since 1977 in the entire Danish population were identified. Cases of AMI and IHD were considered as incident cases if no admission for these diagnoses had occurred during the preceding 5 years. Sex-specific, age-standardized annual mortality, incidence and case-fatality rates of AMI (ICD8 code 410), narrowly defined IHD (NIHD, ICD8 codes 410-4) and broadly defined IHD (BIHD, ICD8 codes 410-4, 427 and 795-6) were calculated for the period 1982-1992. RESULTS During the entire period the age-standardized mortality of AMI, NIHD and BIHD decreased in both men and women. The incidence of AMI and NIHD decreased, while the incidence of BIHD remained constant. Case fatality of AMI decreased in both men and women, while case fatality of NIHD and BIHD decreased in men and in women aged 0-64 years only. CONCLUSION The declining mortality from IHD in Denmark may be partly due to declining incidence as well as declining case fatality, but changes in disease manifestation or diagnostic drift may also contribute because more broadly defined diagnostic groups showed less or no decline in incidence.
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Jensen G, Wandall DA, Gaarslev K, Panavas S, Gutschik E. Antibiotic resistance in Shigella and Salmonella in a region of Lithuania. Eur J Clin Microbiol Infect Dis 1996; 15:872-6. [PMID: 8997561 DOI: 10.1007/bf01691220] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
To gather information on the antibiotic susceptibility of Shigella and Salmonella in the Baltic countries, 98 Shigella and 100 Salmonella isolates collected consecutively in 1994 were examined. All Shigella isolates were resistant to at least two of 12 antibacterial agents: 100% were resistant to oxytetracycline, 92% to trimethoprim/sulfamethoxazole, 64% to chloramphenicol, and 64% to ampicillin. Five different resistance patterns were observed.
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Jensen G, Bross JE. Clostridium difficile and sucralfate. Infect Control Hosp Epidemiol 1996; 17:712-3. [PMID: 8934235 DOI: 10.1086/647213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Berger CS, Cayner J, Jensen G, Mizrahi T, Scesny A, Trachtenberg J. The changing scene of social work in hospitals: a report of a national study by the Society for Social Work Administrators in Health Care and NASW. HEALTH & SOCIAL WORK 1996; 21:167-177. [PMID: 8854120 DOI: 10.1093/hsw/21.3.167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The Society for Social Work Administrators in Health Care and NASW collaborated on a national study of the changes affecting social work services in a sample of 340 hospitals drawn from the member list of the American Hospital Association. The findings suggest that the changes affecting social work need to be viewed within the context of the dramatic changes occurring in the hospital and health care field. Although social work departments are experiencing decreases, these decreases often are not occurring at the same rate as those within the hospital overall. Growth is occurring in the types and scope of services. Social work is not being singled out for change, but it is critical that these trends continue to be monitored and proactive strategies used to enhance social work viability within a changing hospital environment.
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Larsen J, Sykulski R, Jensen G, Dössegger L, Trimarco B, Moccetti T, Glogar D, Schelling A, Bosma AH. Adaptive changes in the acute haemodynamic effects of cilazapril during chronic treatment. Comparison with long-term clinical effect. Eur J Clin Pharmacol 1996; 50:433-41. [PMID: 8858268 DOI: 10.1007/s002280050137] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To study the adaptive changes in the acute haemodynamic response to ACE inhibition during chronic treatment in CHF. METHODS The acute and chronic effects of oral cilazapril (CLZ) treatment, an ACE-inhibitor with prolonged duration on haemodynamic measures (PCWP, PAP, RAP, CI and SVR) and clinical parameters (Quality-of-Life and NYHA class) were investigated in a double-blind, randomised, placebo-controlled trial in CHF. One hundred and thirty five patients (112 completing) in NYHA Classes II-III, on digitalis and diuretic treatment, were randomised after 2 weeks of placebo run-in, to receive either placebo or CLZ 0.5 mg, 1.0 mg or 2.5 mg daily for 12 weeks, followed by 2 week placebo wash-out. Haemodynamic studies, including exercise tests before and 3 h after medication, were performed on the first and last days of treatment. Measurements were performed at rest and at the maximum exercise level. RESULTS In ACEI-naive patients oral CLZ 0.5 and 1 mg/d caused a dose dependent decrease in PCWP and diastolic PAP, and a significant reduction of SVR mg. A slight increase in CI was observed in all groups. The maximum effect was observed 3-5 h post dose. After 12 weeks of oral treatment, the acute response was similar but was attenuated relative to the first dose. Exercise tolerance improved in a dose dependent manner. The NYHA classification remained unchanged or improved in the majority of patients. Entry into the 2.5 mg group had to be terminated at an early stage due to severe adverse events observed after the first dose. CONCLUSION During chronic treatment, the haemodynamic response to oral cilazapril was attenuated, indicating that continued clinical improvement in patients with CHF on CLZ is independent of to its acute haemodynamic effects.
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Becker U, Deis A, Sørensen TI, Grønbaek M, Borch-Johnsen K, Müller CF, Schnohr P, Jensen G. Prediction of risk of liver disease by alcohol intake, sex, and age: a prospective population study. Hepatology 1996; 23:1025-9. [PMID: 8621128 DOI: 10.1002/hep.510230513] [Citation(s) in RCA: 573] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The association between self-reported alcohol intake and the risk of future liver disease was studied in a large population-based prospective cohort with 12-year follow-up. Alcohol intake was assessed in 13,285 men and women aged 30 to 79 years by a self-administered questionnaire. Diagnoses indicating alcohol-induced liver disease (n = 261) or alcohol-induced cirrhosis (n = 124) were obtained from death certificates and the hospital discharge register, and data were analyzed by multiplicative Poisson regression models. The total cumulated observation time was 130,558 person-years. The overall incidence rates of alcohol-induced cirrhosis were 0.2% per year in men and 0.03% per year in women. The nadir of the estimated relative risk of developing liver disease was observed at an alcohol intake of 1 to 6 beverages per week, and above this level a steep increase in relative risk was observed. The risk function was independent of age and stable over time. The level of alcohol intake above which the relative risk was significantly greater than 1 was observed at 7 to 13 beverages per week for women and 14 to 27 beverages per week for men. Women had a significantly higher relative risk of developing alcohol-related liver disease than men for any given level of alcohol intake. We observed a dose-dependent increase in relative risk of developing alcohol-induced liver disease for both men and women, with the steepest increase among women. In the general population, self-reported current alcohol intake is a good predictor of the future risk of alcohol-induced liver disease.
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