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Dickson EA, Ng O, Keeler BD, Wilcock A, Brookes MJ, Acheson AG. The ICaRAS randomised controlled trial: Intravenous iron to treat anaemia in people with advanced cancer - feasibility of recruitment, intervention and delivery. Palliat Med 2023; 37:372-383. [PMID: 36609173 PMCID: PMC10021128 DOI: 10.1177/02692163221145604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Anaemia is highly prevalent in people with advanced, palliative cancer yet sufficiently effective and safe treatments are lacking. Oral iron is poorly tolerated, and blood transfusion offers only transient benefits. Intravenous iron has shown promise as an effective treatment for anaemia but its use for people with advanced, palliative cancer lacks evidence. AIMS To assess feasibility of the trial design according to screening, recruitment, and attrition rates. To evaluate the efficacy of intravenous iron to treat anaemia in people with solid tumours, receiving palliative care. DESIGN A multicentre, randomised, double blind, placebo-controlled trial of intravenous iron (ferric derisomaltose, Monofer®). Outcomes included trial feasibility, change in blood indices, and change in quality of life via three validated questionnaires (EQ5D5L, QLQC30, and the FACIT-F) over 8 weeks. (ISRCTN; 13370767). SETTING/PARTICIPANTS People with anaemia and advanced solid tumours who were fatigued with a performance status ⩽2 receiving support from a specialist palliative care service. RESULTS 34 participants were randomised over 16 months (17 iron, 17 placebo). Among those eligible 47% of people agreed to participate and total study attrition was 26%. Blinding was successful in all participants. There were no serious adverse reactions. Results indicated that intravenous iron may be efficacious at improving participant haemoglobin, iron stores and select fatigue specific quality of life measures compared to placebo. CONCLUSION The trial was feasible according to recruitment and attrition rates. Intravenous iron increased haemoglobin and may improve fatigue specific quality of life measures compared to placebo. A definitive trial is required for confirmation.
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Affiliation(s)
- Edward A Dickson
- National Institute for Health Research
Biomedical Research Centre in Gastrointestinal and Liver Diseases, Nottingham
University Hospitals NHS Trust, Nottingham, UK
- Department of Colorectal Surgery,
Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham,
UK
| | - Oliver Ng
- Department of Colorectal Surgery,
Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham,
UK
| | - Barrie D Keeler
- Milton Keynes University Hospitals NHS
Foundation Trust, Milton Keynes, UK
- The University of Buckingham,
Buckingham, MK18 1EG, UK
| | - Andrew Wilcock
- Department of Palliative Care,
University of Nottingham, Nottingham, UK
| | - Matthew J Brookes
- Department of Gastroenterology, Royal
Wolverhampton NHS Trust, Wolverhampton, UK
- Faculty of Science and Engineering,
University of Wolverhampton, Wolverhampton, UK
| | - Austin G Acheson
- National Institute for Health Research
Biomedical Research Centre in Gastrointestinal and Liver Diseases, Nottingham
University Hospitals NHS Trust, Nottingham, UK
- Department of Colorectal Surgery,
Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham,
UK
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Wallace O, Summers S, Quimby J, Lappin M. Short-term postprandial changes in select serum biochemistry analytes in healthy adult cats. J Feline Med Surg 2022; 24:e459-e464. [PMID: 36219454 PMCID: PMC10812365 DOI: 10.1177/1098612x221121929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the magnitude, duration and significance of postprandial changes to select serum biochemistry analytes in healthy adult cats in the 12 h period after a meal. METHODS Nine adult research cats fed commercial food were included. Blood samples were taken after a 12 h fast (hour 0), cats were offered and consumed a meal, and postprandial samples were obtained over a 12 h period starting 2 h after the baseline blood draw (hours 2, 4, 6, 8, 10 and 12). Serum samples were run on a Roche Cobas C501 chemistry analyzer to obtain concentrations of blood urea nitrogen (BUN), creatinine, phosphorus, total calcium, bicarbonate, cholesterol, magnesium, sodium, potassium and chloride. Serum concentrations of each analyte at hours 2, 4, 6, 8, 10 and 12 were compared with concentrations prior to feeding. RESULTS Serum concentration for at least one postprandial time point was different from baseline fasted concentration for BUN (hour 2, P = 0.006; hour 4, P <0.0001; hour 6, P = 0.002; hour 8, P = 0.026), phosphorus (hour 2, P = 0.019), bicarbonate (hours 2, 4, 6, 8 and 10; all P <0.01), glucose (hour 12, P = 0.014), magnesium (hour 10, P = 0.029) and chloride (hour 2, P = 0.026; hour 4, P = 0.044; hour 12, P = 0.019). No significant difference was seen at any postprandial sampling point compared with baseline for serum creatinine, total calcium, cholesterol, sodium or potassium concentrations. CONCLUSIONS AND RELEVANCE Short-term postprandial serum concentrations of BUN, phosphorus, bicarbonate and chloride differed at multiple time points within a 12 h period compared with the fasted state at baseline, with most values remaining within the reference intervals. Veterinarians should be aware of these alterations, though they are unlikely to be mistaken for pathological disease states in healthy adult cats.
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Affiliation(s)
- Olivia Wallace
- College of Veterinary Medicine, Department of Clinical Sciences, Oregon State University, Corvallis, OR, USA
| | - Stacie Summers
- College of Veterinary Medicine, Department of Clinical Sciences, Oregon State University, Corvallis, OR, USA
| | - Jessica Quimby
- College of Veterinary Medicine, Department of Clinical Sciences, The Ohio State University, Columbus, OH, USA
| | - Michael Lappin
- College of Veterinary Medicine, Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
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3
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Díaz Vértiz JJ, Ducoing Watty AM, Melo AL, Webels RW, Maldonado-Reséndiz RI. Hematological and Plasma Biochemical Reference Values for Captive White-Fronted Parrots (Amazona albifrons) in México. J Avian Med Surg 2022; 36:233-241. [DOI: 10.1647/20-00048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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4
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The Effect of Diurnal Variation on Laboratory Tests. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2022. [DOI: 10.30621/jbachs.1122518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective: Commonly used biochemical tests in blood samples may be measured at any time of day. This study investigated the existence and clinical significance of diurnal variations in some of routine parameters to facilitate accurate and reliable decision-making in diagnosis and follow-up.
Materials and Methods: Blood samples were collected from 17 healthy volunteers who were 18-50 years of age (11 men, 6 women) on the same day at 9:00 am, 12:00 am, 3:00 pm, 6:00 pm, and 12:00 pm. Samples collected at 9:00 am were regarded as baseline. The results of 19 biochemical parameters in blood samples obtained at 12.00 am, 3.00 pm, 6.00 pm and 12.00 pm were statistically and clinically compared with the results at 9.00 am baseline sample.
Results: Total protein, creatinine, aspartate transaminase, alanine transaminase, alkaline phosphatase and gamma glutamyl transferase showed no clinically significant variation within the day, but clinically significant changes were observed in levels of glucose, total cholesterol, HDL-cholesterol, triglyceride, total bilirubin (TBIL), direct bilirubin (DBIL), albumin, blood urea nitrogen, uric acid, sodium, potassium, chloride and amylase. Especially, BUN changed by maximum 20-30%, TBIL, DBIL and triglyceride maximum 40-50% within the day.
Conclusion: The results of our study suggest that clinicians should consider the timing of blood sampling and the diurnal variations in BUN, TBIL, DBIL and triglyceride parameters during diagnosis and treatment follow-up. Sampling throughout the day seems to pose no problem for other tests with limited diurnal variation.
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Kovaleva EV, Eremkina AK, Krupinova JA, Mirnaya SS, Kim IV, Kuznetzov NS, Andreeva EN, Karonova TL, Kryukova IV, Mudunov AM, Sleptcov IV, Melnichenko GA, Mokrysheva NG, Dedov II. [Review of clinical practice guidelines for hypoparathyroidism]. ACTA ACUST UNITED AC 2021; 67:68-83. [PMID: 34533015 DOI: 10.14341/probl12800] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 11/06/2022]
Abstract
Hypoparathyroidism is a rare disorder characterized by the absent or inappropriately decreased serum parathyroid hormone in the parathyroid glands, which is accompanied by impaired calcium-phosphorus metabolism.The main etiology of hypoparathyroidism remains damage or removal of the parathyroid glands during neck surgery. In view of the incidence of thyroid cancer, primary hyperparathyroidism and other pathologies of the neck organs, which radical treatment can lead to the parathyroid gland impairment, an increased number of patients with hypoparathyroidism is expected. Autoimmune hypoparathyroidism is the second most common form of the disease, usually occurring as part of type 1 autoimmune polyglandular syndrome. Autoimmune hypoparathyroidism usually occurs in childhood and is characterized by a severe course of the disease, especially in the case of concomitant malabsorption syndrome.Chronic hypoparathyroidism of any etiology requires lifelong multicomponent therapy, as well as careful monitoring and an individual approach to choose the optimal treatment strategy. In the absence of adequate follow-up, the risks of long-term complications significantly increase, particularly in the renal, cardiovascular systems; in the soft tissues and in the brain, it could lead to visual disturbances; pathology of the musculoskeletal system with a decreased bone remodeling and a potential risk of fractures, as well as to the neurocognitive disorders and an impaired health-related quality of life.Timely diagnosis, rational medical therapy and management strategy may reduce the risks of short-term and long-term complications, frequency of hospitalizations and disability of patients, as well as improve the prognosis.This review covers the main issues of Russian guidelines for the management of chronic hypoparathyroidism, approved in 2021, including laboratory and instrumental evaluation, treatment approaches and follow-up. This guidelines also include the recommendations for special groups of patients: with acute hypocalcemia, hypoparathyroidism during pregnancy.
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Affiliation(s)
| | | | | | | | - I V Kim
- Endocrinology Research Center
| | | | | | - T L Karonova
- National Medical Research Center. V. A. Almazova
| | - I V Kryukova
- Moscow Regional Research Clinical Institute. M.F. Vladimirskogo
| | - A M Mudunov
- National Medical Research Center of Oncology named after V.I. N.N. Blokhin
| | - I V Sleptcov
- Clinic of high medical technologies. N.I. Pirogov St. Petersburg State University
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6
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Nijssen EC, Rennenberg R, Nelemans P, van Ommen V, Wildberger JE. Post-Contrast Acute Kidney Injury and Intravenous Prophylactic Hydration: An Update. ROFO-FORTSCHR RONTG 2020; 193:151-159. [PMID: 33327033 DOI: 10.1055/a-1248-9178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Despite tremendous improvement in molecular properties over the last century, intravascular injection of iodinated contrast material may still have systemic and hemodynamic consequences. Patients with pre-existing renal insufficiency may be at risk for acute kidney injury, which may be associated with an increased risk of the need for dialysis and mortality in the long term. Many questions as to the physiological pathways, optimal definition, and incidence of contrast-induced acute kidney injury remain open. These uncertainties are reflected in the changing landscape of this field in terms of nomenclature, research, and clinical practice. METHODS Clinical practice guidelines for the prevention of post-contrast acute kidney injury all recommend giving prophylaxis in the form of intravenous hydration to high-risk patients. Solid evidence for this strategy is lacking. This article gives an overview of the changing landscape of post-contrast acute kidney injury and prophylactic intravenous hydration, with the aim of supporting informed decision-making in clinical practice. RESULTS Recent data have caused a shift in guideline recommendations: 90 % of patients formerly considered high-risk for contrast-induced acute kidney injury no longer qualify for prophylaxis. The remaining high-risk patients, with severe chronic kidney disease, represent a vulnerable population for whom intravenous hydration may provide some benefits but also carries risk. CONCLUSION Intravenous hydration may benefit 'new' high-risk patients. However, it also confers risk. A dual approach to screening patients will help avoid this risk in clinical practice. KEY POINTS · Intravenous hydration is the cornerstone for preventing contrast-induced acute kidney injury. · Solid evidence is lacking; recent data caused a shift in guideline recommendations. · Intravenous hydration may benefit 'new' high-risk patients with severe chronic kidney disease; however, it also confers risk. · A dual approach to screening patients will help avoid this risk in clinical practice. CITATION FORMAT · Nijssen E, Rennenberg R, Nelemans P et al. Post-Contrast Acute Kidney Injury and Intravenous Prophylactic Hydration: An Update. Fortschr Röntgenstr 2021; 193: 151 - 159.
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Affiliation(s)
- Estelle Claire Nijssen
- Radiology & Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Roger Rennenberg
- Internal Medicine, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Patty Nelemans
- Epidemiology, Maastricht University, Maastricht, Netherlands
| | - Vincent van Ommen
- Cardiology, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Joachim E Wildberger
- Radiology & Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, Netherlands
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7
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Gong J, Wang HX, Lao YH, Hu H, Vatan N, Guo J, Ho TC, Huang D, Li M, Shao D, Leong KW. A Versatile Nonviral Delivery System for Multiplex Gene-Editing in the Liver. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2020; 32:e2003537. [PMID: 33053221 PMCID: PMC8274731 DOI: 10.1002/adma.202003537] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 09/25/2020] [Indexed: 05/23/2023]
Abstract
Recent advances in CRISPR present attractive genome-editing toolsets for therapeutic strategies at the genetic level. Here, a liposome-coated mesoporous silica nanoparticle (lipoMSN) is reported as an effective CRISPR delivery system for multiplex gene-editing in the liver. The MSN provides efficient loading of Cas9 plasmid as well as Cas9 protein/guide RNA ribonucleoprotein complex (RNP), while liposome-coating offers improved serum stability and enhanced cell uptake. Hypothesizing that loss-of-function mutation in the lipid-metabolism-related genes pcsk9, apoc3, and angptl3 would improve cardiovascular health by lowering blood cholesterol and triglycerides, the lipoMSN is used to deliver a combination of RNPs targeting these genes. When targeting a single gene, the lipoMSN achieved a 54% gene-editing efficiency, besting the state-of-art Lipofectamine CRISPRMax. For multiplexing, lipoMSN maintained significant gene-editing at each gene target despite reduced dosage of target-specific RNP. By delivering combinations of targeting RNPs in the same nanoparticle, synergistic effects on lipid metabolism are observed in vitro and vivo. These effects, such as a 50% decrease in serum cholesterol after 4 weeks of post-treatment with lipoMSN carrying both pcsk9 and angptl3-targeted RNPs, could not be reached with a single gene-editing approach. Taken together, this lipoMSN represents a versatile platform for the development of efficient, combinatorial gene-editing therapeutics.
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Affiliation(s)
- Jing Gong
- Department of Biomedical Engineering, Columbia University, New York, NY, 10027, USA
| | - Hong-Xia Wang
- Department of Biomedical Engineering, Columbia University, New York, NY, 10027, USA
| | - Yeh-Hsing Lao
- Department of Biomedical Engineering, Columbia University, New York, NY, 10027, USA
| | - Hanze Hu
- Department of Biomedical Engineering, Columbia University, New York, NY, 10027, USA
| | - Naazanene Vatan
- Department of Biomedical Engineering, Columbia University, New York, NY, 10027, USA
| | - Jonathan Guo
- Department of Biomedical Engineering, Columbia University, New York, NY, 10027, USA
| | - Tzu-Chieh Ho
- Department of Biomedical Engineering, Columbia University, New York, NY, 10027, USA
| | - Dantong Huang
- Department of Biomedical Engineering, Columbia University, New York, NY, 10027, USA
| | - Mingqiang Li
- Department of Biomedical Engineering, Columbia University, New York, NY, 10027, USA
- Laboratory of Biomaterials and Translational Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, China
| | - Dan Shao
- Department of Biomedical Engineering, Columbia University, New York, NY, 10027, USA
- Institute of Life Sciences, School of Biomedical Science and Engineering and National Engineering Research Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou, Guangdong, 510006, China
| | - Kam W Leong
- Department of Biomedical Engineering, Columbia University, New York, NY, 10027, USA
- Department of Systems Biology, Columbia University Medical Center, New York, NY, 10032, USA
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8
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Alberty R, PupiŠ M, VachalÍk V, BÁtovskÝ M. Diurnal variation in red blood cell variables in athletes after single and repeated bouts of exercise. J Sports Med Phys Fitness 2020; 61:269-279. [PMID: 33092322 DOI: 10.23736/s0022-4707.20.11174-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to examine the diurnal and exercise-related changes in red blood cell variables which serve as indirect markers of doping in sports. METHODS Ten men and 7 women, all undoped highly trained endurance athletes aged 19-34 years, were included in the study. Before and on the day with single and repeated bouts of exercise, blood samples were collected at 07:00, 09:00, 13:00, 18:00, and 21:00, at least 2 hours after exercise. Hemoglobin (Hb), hematocrit (Hct), and the reticulocytes % (Ret%) were determined by flow cytometry. Changes in OFF-hr score were also calculated and repeated-measures ANOVA was used to compare diurnal differences. RESULTS In overall, the mean Hb decreased continuously by 4.5 and 3.3% (all P<0.001) over the day with single and repeated bouts of exercise, respectively. Corresponding values for the decline in Hct were 4.2 and 5.9% (all P<0.001). In contrast, the Ret% showed no apparent diurnal rhythm but single and repeated bouts of exercise increased the relative Ret% in the evening by 12.4 and 16.7% (P<0.01), respectively. Then the calculated OFF-hr score was reduced by 6.2 and 9.8% (all P<0.01) at the end of the day. CONCLUSIONS These results confirmed the normal diurnal pattern in the examined red blood cell variables in response to exercise in highly trained athletes. Furthermore, they showed noticeable between-subject variability and the possible risk of a false suspicion of blood doping in undoped athletes after repeated bouts of exercise.
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Affiliation(s)
- Roman Alberty
- Department of Biology and Ecology, Matej Bel University, Banská Bystrica, Slovakia -
| | - Martin PupiŠ
- Department of Physical Education and Sports, Matej Bel University, Banská Bystrica, Slovakia
| | - Vladimír VachalÍk
- Diagnostic Laboratory, Military Sports Center Dukla, Banská Bystrica, Slovakia
| | - Miloš BÁtovskÝ
- Diagnostic Laboratory, Military Sports Center Dukla, Banská Bystrica, Slovakia
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Cundy T, Que L, Hassan IM, Hughes L. Bisphosphonate-Induced Deterioration of Osteomalacia in Undiagnosed Adult Fanconi Syndrome. JBMR Plus 2020; 4:e10374. [PMID: 32803107 PMCID: PMC7422711 DOI: 10.1002/jbm4.10374] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/28/2020] [Accepted: 05/26/2020] [Indexed: 12/16/2022] Open
Abstract
We describe two women with a misdiagnosed fracturing bone disease who were treated erroneously with i.v. zoledronate. Over the next year, they suffered marked clinical and radiographic deterioration in skeletal disease. Both were eventually diagnosed with hypophosphatemic osteomalacia secondary to acquired Fanconi syndrome (caused by light-chain myeloma in one case and tenofovir treatment in the other). Appropriate treatment with phosphate supplementation was instituted with clinical improvement. These cases illustrate the importance of not missing osteomalacia in adults presenting with fractures, and the potentially damaging effects of treatment with long-acting inhibitors of bone resorption in these circumstances. © 2020 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Tim Cundy
- Department of Endocrinology Greenlane Clinical Centre Auckland New Zealand
| | - Lorna Que
- Nuclear Medicine, Department of Radiology Auckland City Hospital Auckland New Zealand
| | - Ibrahim M Hassan
- Nuclear Medicine, Department of Radiology Auckland City Hospital Auckland New Zealand
| | - Louise Hughes
- Department of Anatomical Pathology Concord Hospital Sydney Australia
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10
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Vítek L. Bilirubin as a signaling molecule. Med Res Rev 2020; 40:1335-1351. [PMID: 32017160 DOI: 10.1002/med.21660] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/12/2019] [Accepted: 01/24/2020] [Indexed: 12/24/2022]
Abstract
For long time bilirubin was only considered as a potentially dangerous sign of liver diseases, but it now appears clear that it is also a powerful signaling molecule. Together with potent antioxidant activities that were only reported in the last few decades, many other biological effects have now been clearly described. These include especially profound inhibitory effects on almost all effectors of the immune system, with their clinical consequences in the bilirubin-mediated protection against autoimmune and inflammatory diseases. Separate from these, bilirubin activates various nuclear and cytoplasmic receptors, resembling the endocrine activities of actual hormonal substances. This is true for the "classical" hepatic nuclear receptors, including the aryl hydrocarbon receptor, or the constitutive androstane receptor; and also for some lesser-explored receptors such as peroxisome proliferator-activated receptors α and γ; Mas-related G protein-coupled receptor; or other signaling molecules including fatty acid binding protein 1, apolipoprotein D, or reactive oxygen species. All of these targets have broad metabolic effects, which in turn may offer protection against obesity, diabetes mellitus, and other metabolic diseases. The (mostly experimental) data are also supported by clinical evidence. In fact, data from the last three decades have convincingly demonstrated the protective effects of mildly elevated serum bilirubin concentrations against various "diseases of civilization." Additionally, even tiny, micromolar changes of serum bilirubin concentrations have been associated with substantial alteration in the risks of these diseases. It is highly likely that all of the biological activities of bilirubin have yet to be exhaustively explored, and thus we can expect further clinical discoveries about this evolutionarily old molecule into the future.
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Affiliation(s)
- Libor Vítek
- 4th Department of Internal Medicine and Institute of Medical Biochemistry and Laboratory Diagnostics, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
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Bilirubin as a predictor of diseases of civilization. Is it time to establish decision limits for serum bilirubin concentrations? Arch Biochem Biophys 2019; 672:108062. [DOI: 10.1016/j.abb.2019.108062] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 06/20/2019] [Accepted: 07/01/2019] [Indexed: 11/23/2022]
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12
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Vitek L, Bellarosa C, Tiribelli C. Induction of Mild Hyperbilirubinemia: Hype or Real Therapeutic Opportunity? Clin Pharmacol Ther 2019; 106:568-575. [PMID: 30588615 DOI: 10.1002/cpt.1341] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/03/2018] [Indexed: 01/04/2023]
Abstract
Observational epidemiological studies showed that mild hyperbilirubinemia has beneficial effects on the prevention of cardiovascular disease, type 2 diabetes mellitus, and metabolic syndrome. In mammals, bilirubin plays a major role as a potent antioxidant. Uridine 5'-diphospho-glucuronosyl transferase (UGT)1A1 variants coding for bilirubin UDP-glucuronosyl transferase resulting in mild hyperbilirubinemia (as in Gilbert syndrome (GS)) may confer a strong genetic advantage. Strategies to boost bioavailability of bilirubin or to mimic GS represent an attractive approach to prevent many oxidative stress and inflammation-mediated diseases. Even a tiny, micromolar increase in serum bilirubin concentrations substantially decreases the risk of oxidative stress-mediated diseases. There are several possible ways to achieve this, including lifestyle changes, changes in dietary patterns, regular physical activities, or use of chemical drug or of specific plant products either in the form of regular food items or nutraceuticals. Further basic and experimental research is required to fully uncover this promising therapeutic field.
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Affiliation(s)
- Libor Vitek
- Institute of Medical Biochemistry and Laboratory Diagnostics and 4th Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Cristina Bellarosa
- Fondazione Italiana Fegato ONLUS, AREA Science Park-Basovizza, Trieste, Italy
| | - Claudio Tiribelli
- Fondazione Italiana Fegato ONLUS, AREA Science Park-Basovizza, Trieste, Italy
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Abou El Hassan M, Delvin E, Elnenaei MO, Hoffman B. Diurnal rhythm in clinical chemistry: An underrated source of variation. Crit Rev Clin Lab Sci 2018. [DOI: 10.1080/10408363.2018.1519522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Mohamed Abou El Hassan
- Clinical Chemistry Division, Provincial Laboratory Services, Queen Elizabeth Hospital, Charlottetown, Canada
- Department of Pathology, Dalhousie University, Halifax, Canada
| | - Edgard Delvin
- CHU Ste-Justine Research Centre, Gastroenterology, Hepatology and Nutrition Division, Montreal, Canada
- Faculty of Medicine, Department of Biochemistry, University of Montreal, Montreal, Canada
| | - Manal O. Elnenaei
- Department of Pathology, Dalhousie University, Halifax, Canada
- Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority (NSHA), Halifax, Canada
| | - Barry Hoffman
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
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Robison S, Karur GR, Wald RM, Thavendiranathan P, Crean AM, Hanneman K. Noninvasive hematocrit assessment for cardiovascular magnetic resonance extracellular volume quantification using a point-of-care device and synthetic derivation. J Cardiovasc Magn Reson 2018; 20:19. [PMID: 29544519 PMCID: PMC5856214 DOI: 10.1186/s12968-018-0443-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 03/05/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Calculation of cardiovascular magnetic resonance (CMR) extracellular volume (ECV) requires input of hematocrit, which may not be readily available. The purpose of this study was to evaluate the diagnostic accuracy of ECV calculated using various noninvasive measures of hematocrit compared to ECV calculated with input of laboratory hematocrit as the reference standard. METHODS One hundred twenty three subjects (47.7 ± 14.1 years; 42% male) were prospectively recruited for CMR T1 mapping between August 2016 and April 2017. Laboratory hematocrit was assessed by venipuncture. Noninvasive hematocrit was assessed with a point-of-care (POC) device (Pronto-7® Pulse CO-Oximeter®, Masimo Personal Health, Irvine, California, USA) and by synthetic derivation based on the relationship with blood pool T1 values. Left ventricular ECV was calculated with input of laboratory hematocrit (Lab-ECV), POC hematocrit (POC-ECV), and synthetic hematocrit (synthetic-ECV), respectively. Statistical analysis included Wilcoxon signed-rank test, Bland-Altman analysis, receiver-operating curve analysis and intra-class correlation (ICC). RESULTS There was no significant difference between Lab-ECV and POC-ECV (27.1 ± 4.7% vs. 27.3 ± 4.8%, p = 0.106), with minimal bias and modest precision (bias - 0.18%, 95%CI [- 2.85, 2.49]). There was no significant difference between Lab-ECV and synthetic-ECV (26.7 ± 4.4% vs. 26.5 ± 4.3%, p = 0.084) in subjects imaged at 1.5 T, although bias was slightly higher and limits of agreement were wider (bias 0.23%, 95%CI [- 2.82, 3.27]). For discrimination of abnormal Lab-ECV ≥30%, POC-ECV had good diagnostic performance (sensitivity 85%, specificity 96%, accuracy 94%, and AUC 0.902) and synthetic-ECV had moderate diagnostic performance (sensitivity 71%, specificity 98%, accuracy 93%, and AUC 0.849). POC-ECV had excellent test-retest (ICC 0.994, 95%CI[0.987, 0.997]) and inter-observer agreement (ICC 0.974, 95%CI[0.929, 0.991]). CONCLUSIONS Myocardial ECV can be accurately and reproducibly calculated with input of hematocrit measured using a noninvasive POC device, potentially overcoming an important barrier to implementation of ECV. Further evaluation of synthetic ECV is required prior to clinical implementation.
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Affiliation(s)
- Sean Robison
- Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1PMB-298, Toronto, ON M5G 2N2 Canada
| | - Gauri Rani Karur
- Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1PMB-298, Toronto, ON M5G 2N2 Canada
| | - Rachel M. Wald
- Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1PMB-298, Toronto, ON M5G 2N2 Canada
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Paaladinesh Thavendiranathan
- Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1PMB-298, Toronto, ON M5G 2N2 Canada
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Andrew M. Crean
- Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1PMB-298, Toronto, ON M5G 2N2 Canada
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Kate Hanneman
- Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1PMB-298, Toronto, ON M5G 2N2 Canada
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15
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Engert LC, Weiler U, Pfaffinger B, Stefanski V, Schmucker SS. Diurnal rhythms in peripheral blood immune cell numbers of domestic pigs. DEVELOPMENTAL AND COMPARATIVE IMMUNOLOGY 2018; 79:11-20. [PMID: 29017838 DOI: 10.1016/j.dci.2017.10.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 10/05/2017] [Accepted: 10/05/2017] [Indexed: 06/07/2023]
Abstract
Diurnal rhythms within the immune system are considered important for immune competence. Until now, they were mostly studied in humans and rodents. However, as the domestic pig is regarded as suitable animal model and due to its importance in agriculture, this study aimed to characterize diurnal rhythmicity in porcine circulating leukocyte numbers. Eighteen pigs were studied over periods of up to 50 h. Cosinor analyses revealed diurnal rhythms in cell numbers of most investigated immune cell populations in blood. Whereas T cell, dendritic cell, and eosinophil counts peaked during nighttime, NK cell and neutrophil counts peaked during daytime. Relative amplitudes of cell numbers in blood differed in T helper cell subtypes with distinctive differentiation states. Mixed model analyses revealed that plasma cortisol concentration was negatively associated with cell numbers of most leukocyte types, except for NK cells and neutrophils. The observed rhythms mainly resemble those found in humans and rodents.
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Affiliation(s)
- Larissa C Engert
- Behavioral Physiology of Livestock, Institute of Animal Science, University of Hohenheim, Garbenstr. 17, 70599 Stuttgart, Germany
| | - Ulrike Weiler
- Behavioral Physiology of Livestock, Institute of Animal Science, University of Hohenheim, Garbenstr. 17, 70599 Stuttgart, Germany
| | - Birgit Pfaffinger
- Behavioral Physiology of Livestock, Institute of Animal Science, University of Hohenheim, Garbenstr. 17, 70599 Stuttgart, Germany
| | - Volker Stefanski
- Behavioral Physiology of Livestock, Institute of Animal Science, University of Hohenheim, Garbenstr. 17, 70599 Stuttgart, Germany
| | - Sonja S Schmucker
- Behavioral Physiology of Livestock, Institute of Animal Science, University of Hohenheim, Garbenstr. 17, 70599 Stuttgart, Germany.
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16
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Nguyen LT, Buse JD, Baskin L, Sadrzadeh SH, Naugler C. Influence of diurnal variation and fasting on serum iron concentrations in a community-based population. Clin Biochem 2017; 50:1237-1242. [DOI: 10.1016/j.clinbiochem.2017.09.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 09/15/2017] [Accepted: 09/21/2017] [Indexed: 11/28/2022]
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17
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Sartini C, Whincup PH, Wannamethee SG, Jefferis BJ, Lennon L, Lowe GDO, Welsh P, Sattar N, Morris RW. Associations of time of day with cardiovascular disease risk factors measured in older men: results from the British Regional Heart Study. BMJ Open 2017; 7:e018264. [PMID: 29133328 PMCID: PMC5695475 DOI: 10.1136/bmjopen-2017-018264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE We estimated associations of time of day with cardiovascular disease (CVD) risk factors measured in older men. METHODS CVD risk factors (markers of inflammation and haemostasis, and cardiac markers) were measured on one occasion between 08:00 and 19:00 hours in 4252 men aged 60-79 years from the British Regional Heart Study. Linear models were used to estimate associations between time of day and risk factors. When an association was found, we examined whether the relationship between risk factors and cardiovascular mortality was affected by the adjustment for time of day using survival analyses. RESULTS N-terminal pro-brain natriuretic peptide (NT-proBNP) levels increased by 3.3% per hour (95% CI 1.9% to 4.8%), interleukin-6 (IL-6) increased by 2.6% per hour (95% CI 1.8% to 3.4%), while tissue plasminogen activator (t-PA) decreased by 3.3% per hour (95% CI 3.7% to 2.9%); these associations were unaffected by adjustment for possible confounding factors. The percentages of variation in these risk factors attributable to time of day were less than 2%. In survival analyses, the association of IL-6, NT-proBNP and t-PA with cardiovascular mortality was not affected by the adjustment for time of day. C reactive protein, fibrinogen, D-dimer, von Willebrand factor and cardiac troponin T showed no associations with time of day. CONCLUSIONS In older men, markers of inflammation (IL-6), haemostasis (t-PA) and a cardiac marker (NT-proBNP) varied by time of day. The contribution of time of day to variations in these markers was small and did not appear to be relevant for the CVD risk prediction.
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Affiliation(s)
- Claudio Sartini
- Department of Primary Care & Population Health, University College London, London, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's University of London, London, UK
| | - S Goya Wannamethee
- Department of Primary Care & Population Health, University College London, London, UK
| | - Barbara J Jefferis
- Department of Primary Care & Population Health, University College London, London, UK
| | - Lucy Lennon
- Department of Primary Care & Population Health, University College London, London, UK
| | - Gordon DO Lowe
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK
| | - Paul Welsh
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK
| | - Naveed Sattar
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK
| | - Richard W Morris
- Centre for Academic Primary Care, Schoolof Social and Community Medicine, University of Bristol, Bristol, UK
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18
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Yoon S, Rhee SJ, Heo SJ, Oh TY, Yoon SH, Cho JY, Lee S, Yu KS. Comparable pharmacokinetics and pharmacodynamics of two epoetin alfa formulations Eporon ® and Eprex ® following a single subcutaneous administration in healthy male volunteers. DRUG DESIGN DEVELOPMENT AND THERAPY 2017; 11:3127-3135. [PMID: 29138535 PMCID: PMC5667778 DOI: 10.2147/dddt.s142673] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose This study aimed to assess and compare the pharmacokinetic (PK) and pharmacodynamic (PD) properties following a single subcutaneous injection of epoetin alfa (Eporon®) with those of the comparator (Eprex®) in healthy male subjects. Subjects and methods A randomized, double-blind, two-sequence, crossover study was conducted. Subjects were randomly assigned to receive a single dose, that is, 4,000 IU, of the test or comparator epoetin alfa. After 4 weeks, all subjects received the alternative formulation. The primary PK parameters, maximum observed concentration (Cmax) and area under the curve extrapolated to infinity (AUCinf), were calculated with the serum erythropoietin (EPO) concentrations from blood samples collected for 144 h after dosing. The reticulocyte, hematocrit, hemoglobin and red blood cell counts were measured up to 312 h as PD markers. The primary PD parameters, maximum observed effect (Emax) and area under the effect curve (AUEC), were obtained from the baseline-corrected reticulocyte count. The serum EPO concentration and the reticulocyte count were used to assess the concentration–response relationship. The tolerability and immunogenicity profiles were assessed together. Results Forty-two subjects completed the study. The mean EPO concentration–time profiles were comparable between the two formulations. The geometric mean ratios (90% CI) of the Cmax and AUCinf were 0.908 (0.843–0.978) and 1.049 (0.999–1.101), respectively, both of which were within the regulatory range of 0.80–1.25. Additionally, the PD and tolerability profiles were similar between the two formulations. The time-matched serum EPO concentration and PD markers presented a counterclockwise hysteresis, suggesting a time delay between the measured concentration and the response. Both formulations were well tolerated, and production of anti-drug antibodies was not observed. Conclusion The two epoetin alfa formulations had similar PK, PD and tolerability profiles. Furthermore, both formulations had a similar time-matched serum EPO concentration and erythropoietic response profile. Thus, the two formulations are expected to be used interchangeably in clinical settings.
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Affiliation(s)
- Sumin Yoon
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul
| | - Su-Jin Rhee
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul
| | | | | | - Seo Hyun Yoon
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul
| | - Joo-Youn Cho
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul
| | - SeungHwan Lee
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul.,Clinical Trials Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung-Sang Yu
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul.,Clinical Trials Center, Seoul National University Hospital, Seoul, Republic of Korea
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19
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Ahmed AE, Ali YZ, Al-Suliman AM, Albagshi JM, Al Salamah M, Elsayid M, Alanazi WR, Ahmed RA, McClish DK, Al-Jahdali H. The prevalence of abnormal leukocyte count, and its predisposing factors, in patients with sickle cell disease in Saudi Arabia. J Blood Med 2017; 8:185-191. [PMID: 29123434 PMCID: PMC5661844 DOI: 10.2147/jbm.s148463] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction High white blood cell (WBC) count is an indicator of sickle cell disease (SCD) severity, however, there are limited studies on WBC counts in Saudi Arabian patients with SCD. The aim of this study was to estimate the prevalence of abnormal leukocyte count (either low or high) and identify factors associated with high WBC counts in a sample of Saudi patients with SCD. Methods A cross-sectional and retrospective chart review study was carried out on 290 SCD patients who were routinely treated at King Fahad Hospital in Hofuf, Saudi Arabia. An interview was conducted to assess clinical presentations, and we reviewed patient charts to collect data on blood test parameters for the previous 6 months. Results Almost half (131 [45.2%]) of the sample had abnormal leukocyte counts: low WBC counts 15 (5.2%) and high 116 (40%). High WBC counts were associated with shortness of breath (P=0.022), tiredness (P=0.039), swelling in hands/feet (P=0.020), and back pain (P=0.007). The mean hemoglobin was higher in patients with normal WBC counts (P=0.024), while the mean hemoglobin S was high in patients with high WBC counts (P=0.003). After adjustment for potential confounders, predictors of high WBC counts were male gender (adjusted odds ratio [aOR]=3.63) and patients with cough (aOR=2.18), low hemoglobin (aOR=0.76), and low heart rate (aOR=0.97). Conclusion Abnormal leukocyte count was common: approximately five in ten Saudi SCD patients assessed in this sample. Male gender, cough, low hemoglobin, and low heart rate were associated with high WBC count. Strategies targeting high WBC count could prevent disease complication and thus could be beneficial for SCD patients.
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Affiliation(s)
- Anwar E Ahmed
- College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Yosra Z Ali
- King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | | | | | - Majid Al Salamah
- College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohieldin Elsayid
- College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Wala R Alanazi
- Al-Maarefa College for Science and Technology, Riyadh, Saudi Arabia
| | | | - Donna K McClish
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Hamdan Al-Jahdali
- College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdulaziz Medical City, Riyadh, Saudi Arabia
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20
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Daily Rhythms of Blood Parameters in Broiler Chickens Reared under Tropical Climate Conditions. J Circadian Rhythms 2017; 15:5. [PMID: 30210559 PMCID: PMC5624059 DOI: 10.5334/jcr.151] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Several studies carried out on humans and other mammals show that the temporal organisation of haematological parameters in the blood exhibit daily rhythms; however, such studies have been rare in poultry reared under a natural photoperiod. The present study investigated the occurrence of daily rhythms in blood parameters of broiler chickens kept under tropical climatic conditions. Ten 6-7-week-old broiler chickens served as subjects of the study. They were kept in standard individual cages under natural light-dark cycle and given access to feed and water ad libitum. Two milliliters of blood was collected from each bird via intravenous cannulae inserted into the wing vein. The blood samples were collected every 4 h over a 24-h period, starting from 09:00 h on the first day and completed at 09:00 h on the second day. The blood samples were analysed for erythrocyte, total and differential leucocyte counts. A trigonometric statistical model according to the single cosinor procedure was used to describe the periodic parameters and their acrophases, and ANOVA was used to determine significant differences. The results demonstrated the existence of daily rhythms in packed cell volume, haemoglobin, white blood cell, red blood cell, heterophil, lymphocyte, eosinophil and monocyte counts, while total protein displayed no rhythm. The characteristics of the haematological parameters showed that the acrophases were restricted to the light phase of the light/dark cycle, precisely at 09:00 h, except for eosinophil and heterophil counts, which had acrophases at 21:00 h. The amplitudes of the blood parameters varied, with packed cell volume having the greatest amplitude of 4.2 ± 0.5, closely followed by lymphocyte (3.4 ± 0.5) and heterophil (2.3 ± 0.2) counts. In conclusion, the results of the study demonstrated the existence of daily rhythms with diurnal acrophases in blood parameters of broiler chickens kept under natural photoperiods and tropical conditions.
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21
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Breithaupt-Groegler K, Coch C, Coenen M, Donath F, Erb-Zohar K, Francke K, Goehler K, Iovino M, Kammerer KP, Mikus G, Rengelshausen J, Sourgens H, Schinzel R, Sudhop T, Wensing G. Who is a 'healthy subject'?-consensus results on pivotal eligibility criteria for clinical trials. Eur J Clin Pharmacol 2017; 73:409-416. [PMID: 28064353 PMCID: PMC5350217 DOI: 10.1007/s00228-016-2189-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 12/20/2016] [Indexed: 11/22/2022]
Abstract
Introduction/Methods A discussion forum was hosted by the German not-for-profit Association for Applied Human Pharmacology (AGAH e.V.) to critically review key eligibility criteria and stopping rules for clinical trials with healthy subjects, enrolling stakeholders from the pharmaceutical industry, contract research organisations, academia, ethics committees and competent authority. Results Pivotal eligibility criteria were defined for trials with new investigational medicinal products (IMPs) or with clinically established IMPs. In general, a pulse rate ranging between 50 and 90 beats/min is recommended for first-in-human (FIH) trials, while wider ranges seem acceptable for trials with clinically established IMPs, provided there are no indications of thyroid dysfunction. Hepatic laboratory parameters not to exceed the upper limit of normal (ULN) comprise ALT (alanine aminotransferase) and AST (aspartate aminotransferase) in FIH trials, whereas slight elevations (10% above ULN) seem acceptable in trials with clinically established IMPs without known hepatotoxicity. A normal renal function is required for any clinical trial in healthy subjects. A risk-adapted approach for stopping rules was adopted. Stopping rules for an individual subject are one adverse event of severe intensity or one serious adverse event. In case of a severe adverse event, some stakeholders demand a causal relationship with the IMP (i.e. an adverse reaction). Stopping rules for a cohort are one serious adverse reaction or ≥50% of subjects experiencing any adverse reaction of moderate or severe intensity. Consequences The application of this consensus resulted in a reduction in protocol deficiencies issued by the competent authority.
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Affiliation(s)
| | - Christoph Coch
- Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Martin Coenen
- Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Frank Donath
- SocraTec Research and Development GmbH, D-99084, Erfurt, Germany
| | | | - Klaus Francke
- National Association of Statutory Health Insurance Funds, Medicinal Product Department, 10117, Berlin, Germany
| | - Karin Goehler
- Gruenenthal GmbH, Gruenenthal Innovation-Development-Clinical Development-Clinical Pharmacology, D-52099, Aachen, Germany
| | - Mario Iovino
- Boehringer Ingelheim Pharma GmbH & Co. KG, Translational Medicine and Clinical Pharmacology, D-88397, Biberach/Riss, Germany
| | - Klaus Peter Kammerer
- Boehringer Ingelheim Pharma GmbH & Co. KG, Translational Medicine and Clinical Pharmacology, D-88397, Biberach/Riss, Germany
| | - Gerd Mikus
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, D-69120, Heidelberg, Germany
| | - Jens Rengelshausen
- Gruenenthal GmbH, Gruenenthal Innovation-Research-Translational Science & Strategy-Early Clinical Science, D-52078, Aachen, Germany
| | | | | | - Thomas Sudhop
- Federal Institute for Drugs and Medical Devices (BfArM), D-53175, Bonn, Germany
| | - Georg Wensing
- Bayer Pharma AG, Pharmaceutical Division Clinical Pharmacology Cardiovascular/Hematology (Primary Care), D-42096, Wuppertal, Germany
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Emberson JR, Whincup PH, Morris RW, Walker M, Lowe GDO, Rumley A. Extent of regression dilution for established and novel coronary risk factors: results from the British Regional Heart Study. ACTA ACUST UNITED AC 2016; 11:125-34. [PMID: 15187816 DOI: 10.1097/01.hjr.0000114967.39211.e5] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Imprecision in measurement of risk factors leads to underestimation of associations with disease outcomes (through regression dilution bias). We examine the extent of this bias for established and novel risk factors for coronary heart disease (CHD) and consider the consequences for CHD prevention. DESIGN Prospective cardiovascular study of middle-aged British men followed up over 20 years. METHODS Repeated measurements of blood lipids, blood pressure and insulin were available at intervals of 1 week, 4, 16 and 20 years; repeated measurements of homocysteine and haemostatic factors were available over 1 week and 4 years. RESULTS The use of single baseline measures of both established and novel risk factors in analysis results in marked underestimation of risk associations, increasing over time. The use of a single baseline measurement of total cholesterol results in a 47% (95% confidence interval 44 to 50%) underestimation of its association with CHD risk during the third decade of follow-up; for diastolic blood pressure the corresponding underestimation is 76% (95% confidence interval 73 to 78%). Ignoring the consequences of regression dilution can also lead to error in the assessment of other risk markers, even those measured precisely. CONCLUSIONS The importance of risk factors for CHD can be greatly underestimated by using a single baseline measure in prospective study analyses. Studies that wish to estimate associations between disease risk and usual exposure levels need to take regression dilution effects into account. Failure to do so can lead to serious misinterpretation of the importance of CHD risk factors.
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Affiliation(s)
- Jonathan R Emberson
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, NW3 2PF, UK.
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23
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Naiken S, Griffiths MA, Hurdial JR, Narainapoulle S, Honess P. Reference intervals for biochemical and haematological analytes of juvenile captive-bred long-tailed macaques (Macaca fascicularis) from Mauritius with examination of the effects of individual characteristics using principal component analysis. J Med Primatol 2016; 45:277-289. [PMID: 27506181 DOI: 10.1111/jmp.12224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Mauritian cynomolgus macaque (Macaca fascicularis) is widely used in biomedical research. Determining reference intervals for biochemical and haematological analytes provides an important tool for clinical diagnosis and pre-clinical research. METHODS Blood samples from 736 Mauritian long-tailed macaques were analysed to determine reference intervals of 13 biochemical and 10 haematological analytes. The need for partitioning the reference interval between males and females was determined. To examine the variation associated with age, body weight and sex on the analytes, our correlating, multivariate data set was first reduced using principal component analysis, and then the effect of these characteristics on factor scores was examined using GLM analysis. RESULTS Partitioning of reference intervals, based on sex, was recommended for albumin, alkaline phosphatase and mean corpuscular haemoglobin. Sex significantly influenced the concentration of lymphocytes, granulocytes and white blood cells. CONCLUSION These findings provide useful reference data for research involving Mauritian long-tailed macaques.
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Affiliation(s)
| | | | | | | | - Paul Honess
- Bioculture (Mauritius) Ltd, Senneville, Mauritius
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Rudyk M, Fedorchuk O, Susak Y, Nowicky Y, Skivka L. Introduction of antineoplastic drug NSC631570 in an inpatient and outpatient setting: Comparative evaluation of biological effects. Asian J Pharm Sci 2016. [DOI: 10.1016/j.ajps.2016.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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25
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Bäckman S, Larjo A, Soikkeli J, Castrén J, Ihalainen J, Syrjälä M. Season and time of day affect capillary blood hemoglobin level and low hemoglobin deferral in blood donors: analysis in a national blood bank. Transfusion 2016; 56:1287-94. [DOI: 10.1111/trf.13578] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 02/12/2016] [Accepted: 02/12/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Sari Bäckman
- Finnish Red Cross Blood Service; Helsinki Finland
| | - Antti Larjo
- Finnish Red Cross Blood Service; Helsinki Finland
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26
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Unique chloride-sensing properties of WNK4 permit the distal nephron to modulate potassium homeostasis. Kidney Int 2016; 89:127-34. [PMID: 26422504 PMCID: PMC4814375 DOI: 10.1038/ki.2015.289] [Citation(s) in RCA: 188] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/13/2015] [Accepted: 07/31/2015] [Indexed: 11/09/2022]
Abstract
Dietary potassium deficiency activates thiazide-sensitive sodium chloride cotransport along the distal nephron. This may explain, in part, the hypertension and cardiovascular mortality observed in individuals who consume a low-potassium diet. Recent data suggest that plasma potassium affects the distal nephron directly by influencing intracellular chloride, an inhibitor of the with-no-lysine kinase (WNK)-Ste20p-related proline- and alanine-rich kinase (SPAK) pathway. As previous studies used extreme dietary manipulations, we sought to determine whether the relationship between potassium and NaCl cotransporter (NCC) is physiologically relevant and clarify the mechanisms involved. We report that modest changes in both dietary and plasma potassium affect NCC in vivo. Kinase assay studies showed that chloride inhibits WNK4 kinase activity at lower concentrations than it inhibits activity of WNK1 or WNK3. Also, chloride inhibited WNK4 within the range of distal cell chloride concentration. Mutation of a previously identified WNK chloride-binding motif converted WNK4 effects on SPAK from inhibitory to stimulatory in mammalian cells. Disruption of this motif in WNKs 1, 3, and 4 had different effects on NCC, consistent with the three WNKs having different chloride sensitivities. Thus, potassium effects on NCC are graded within the physiological range, which explains how unique chloride-sensing properties of WNK4 enable it to mediate effects of potassium on NCC in vivo.
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Alsaadi K, Voss S, Kraiem S, Alwahaibi A, Alyazedi S, Dbes N, Goebel R, Mohamed-Ali V, Alsowaidi S, Seyam A, Bashraheel A, Alsayrafi M, Georgakopoulos C. The effect of fasting during Ramadan on parameters of the haematological and steroidal modules of the athletes biological passport - a pilot study. Drug Test Anal 2015; 7:1017-24. [DOI: 10.1002/dta.1917] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/08/2015] [Accepted: 10/08/2015] [Indexed: 11/09/2022]
Affiliation(s)
- K. Alsaadi
- Anti-Doping Lab Qatar; Doping Analysis Lab; Doha Qatar
| | - S.C. Voss
- Anti-Doping Lab Qatar; Doping Analysis Lab; Doha Qatar
| | - S. Kraiem
- Anti-Doping Lab Qatar; Doping Analysis Lab; Doha Qatar
| | - A. Alwahaibi
- Anti-Doping Lab Qatar; Doping Analysis Lab; Doha Qatar
| | - S. Alyazedi
- Anti-Doping Lab Qatar; Doping Analysis Lab; Doha Qatar
| | - N. Dbes
- Anti-Doping Lab Qatar; Doping Analysis Lab; Doha Qatar
| | - R. Goebel
- Qatar University; Sport Science Department; Doha Qatar
| | - V. Mohamed-Ali
- Anti-Doping Lab Qatar; Life Science Research Division; Doha Qatar
| | - S. Alsowaidi
- Anti-Doping Lab Qatar; Life Science Research Division; Doha Qatar
| | - A.M. Seyam
- Anti-Doping Lab Qatar; Life Science Research Division; Doha Qatar
| | - A.S. Bashraheel
- Anti-Doping Lab Qatar; Life Science Research Division; Doha Qatar
| | - M. Alsayrafi
- Anti-Doping Lab Qatar; Doping Analysis Lab; Doha Qatar
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Thurman-Newell JA, Petzing JN, Williams DJ. Quantification of biological variation in blood-based therapy--a summary of a meta-analysis to inform manufacturing in the clinic. Vox Sang 2015; 109:394-402. [PMID: 26174339 PMCID: PMC5016773 DOI: 10.1111/vox.12288] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 02/18/2015] [Accepted: 03/27/2015] [Indexed: 11/28/2022]
Abstract
Background and Objectives Biological raw materials, the basis for cellular therapies such as stem cells, have a significantly greater degree of complexity than their traditional pharmaceutical counterparts. This can be attributed to the inherent variation of its source – human beings. Currently, cell therapies are made in small, ad hoc batches, but larger scale production is a prerequisite to meeting future demand and will require a quality‐by‐design approach to manufacturing that will be designed around, or be robust to this variation. Quantification of variation will require understanding of the current baseline and stratification of its sources. Materials and Methods Haematopoietic stem cell therapy was chosen as a case study to explore this variation, and a PRISMA‐guided (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) systematic meta‐analysis was carried out for a number of predetermined cell measurements. Results From this data set, it appears that the extent of variation in therapeutic dose (in terms of transplanted total nucleated cells and CD34+ cells per kilogram) for HSCT is between one and four orders of magnitude of the median. Conclusions This is tolerated under the practice of medicine but would be unmanageable from a biomanufacturing perspective and raises concerns about comparable levels of efficacy and treatment. A number of sources that will contribute towards this variation are also reported, as is the direction of travel for 4 greater clarity of the scale of this challenge.
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Affiliation(s)
- J A Thurman-Newell
- Healthcare Engineering Group, Centre for Biological Engineering, Loughborough University, Loughborough, UK
| | - J N Petzing
- Healthcare Engineering Group, Centre for Biological Engineering, Loughborough University, Loughborough, UK
| | - D J Williams
- Healthcare Engineering Group, Centre for Biological Engineering, Loughborough University, Loughborough, UK
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Salomo L, Poulsen SK, Rix M, Kamper AL, Larsen TM, Astrup A. The New Nordic Diet: phosphorus content and absorption. Eur J Nutr 2015; 55:991-6. [DOI: 10.1007/s00394-015-0913-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 04/25/2015] [Indexed: 01/03/2023]
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Jones MP, Arheart KL, Cray C. Reference intervals, longitudinal analyses, and index of individuality of commonly measured laboratory variables in captive bald eagles (Haliaeetus leucocephalus). J Avian Med Surg 2014; 28:118-26. [PMID: 25115040 DOI: 10.1647/2013-001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The objectives of this study were to determine reference intervals, perform longitudinal analyses, and determine the index of individuality (IoI) of 8 hematologic, and 13 biochemical and electrophoretic variables for a group of captive bald eagles (Haliaeetus leucocephalus). Reference intervals were determined from blood samples collected during annual wellness examinations for 41 eagles (23 male and 18 female) with ages ranging between 6 and 43 years (18.7 +/- 7.4, mean +/- SD) at the time of sample collection. Longitudinal analyses and IoI were determined for measured hematologic, biochemical, and protein electrophoretic variables, both individually and as a group, for a subset of 16 eagles (10 male and 6 female) during a 12-year period. This smaller group of eagles ranged in age between 2 and 20 years at the start of the study period, and between 14 and 32 years (21.9 +/- 5.0, mean +/- SD) at the end of the study period. Significant increases with age within the group of 16 eagles were observed only for red blood cells, percent heterophils, total protein, and beta-globulin protein fraction, while albumin:globulin decreased significantly with age. A low IoI (> or = 1.4) was determined for all hematologic and biochemical variables except gamma globulins, which had high IoI (< or = 0.6) for 3 individuals within the subset of 16.
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Abstract
It is known that the oral cavity is a production site for mouth-exhaled NH3. However, the mechanism of NH3 production in the oral cavity has been unclear. Since bacterial urease in the oral cavity has been found to produce ammonia from oral fluid urea, we hypothesize that oral fluid urea is the origin of mouth-exhaled NH3. Our results show that under certain conditions a strong correlation exists between oral fluid urea and oral fluid ammonia (NH4(+)+NH3) (rs = 0.77, p < 0.001). We also observe a strong correlation between oral fluid NH3 and mouth-exhaled NH3 (rs = 0.81, p < 0.001). We conclude that three main factors affect the mouth-exhaled NH3 concentration: urea concentration, urease activity and oral fluid pH. Bacterial urease catalyses the hydrolysis of oral fluid urea to ammonia (NH4(+)+NH3). Oral fluid ammonia (NH4(+)+NH3) and pH determine the concentration of oral fluid NH3, which evaporates from oral fluid into gas phase and turns to mouth-exhaled NH3.
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Affiliation(s)
- W Chen
- Laboratory of Physical Chemistry, Department of Chemistry, PO Box 55 (A. I. Virtasen aukio 1), FI-00014 University of Helsinki, Finland
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Abstract
The emergence of fibroblast growth factor 23 as a potentially modifiable risk factor in CKD has led to growing interest in its measurement as a tool to assess patient risk and target therapy. This review discusses the analytical and clinical challenges faced in translating fibroblast growth factor 23 testing into routine practice. As for other bone mineral markers, agreement between commercial fibroblast growth factor 23 assays is poor, mainly because of differences in calibration, but also, these differences reflect the variable detection of hormone fragments. Direct comparison of readout from different assays is consequently limited and likely hampers setting uniform fibroblast growth factor 23-directed targets. Efforts are needed to standardize assay output to enhance clinical use. Fibroblast growth factor 23 is robustly associated with cardiovascular and renal outcomes in patients with CKD and adds value to risk assessments based on conventional risk factors. Compared with most other mineral markers, fibroblast growth factor 23 shows better intraindividual temporal stability, with minimal diurnal and week-to-week variability, but substantial interindividual variation, maximizing discriminative power for risk stratification. Conventional therapeutic interventions for the CKD-mineral bone disorder, such as dietary phosphate restriction and use of oral phosphate binders or calcimimetics, are associated with variable efficacy at modulating circulating fibroblast growth factor 23 concentrations, like they are for other mineral metabolites. Dual therapy with dietary phosphate restriction and noncalcium-based binder use achieves the most consistent fibroblast growth factor 23-lowering effect and seems best monitored using an intact assay. Additional studies are needed to evaluate whether strategies aimed at reducing levels or antagonizing its action have beneficial effects on clinical outcomes in CKD patients. Moreover, a better understanding of the mechanisms driving fibroblast growth factor 23 elevations in CKD is needed to inform the use of therapeutic interventions targeting fibroblast growth factor 23 excess. This evidence must be forthcoming to support the use of fibroblast growth factor 23 measurement and fibroblast growth factor 23-directed therapy in the clinic.
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Affiliation(s)
- Edward R Smith
- Department of Nephrology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Bone mineral metabolism parameters and urinary albumin excretion in a representative US population sample. PLoS One 2014; 9:e88388. [PMID: 24505486 PMCID: PMC3914974 DOI: 10.1371/journal.pone.0088388] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 01/12/2014] [Indexed: 01/14/2023] Open
Abstract
Background and Hypothesis Even within accepted normal ranges, higher serum phosphorus, dietary phosphorus density, parathyroid hormone (PTH) and alkaline phosphatase (ALP) are independent predictors of cardiovascular mortality. Lower serum 25-hydroxy vitamin D (25(OH)D) also predicts adverse cardiovascular outcomes. We hypothesized that vascular dysfunction accompanying subtle disturbances of these bone metabolism parameters would result in associations with increased low grade albuminuria. Study Population and Measures We examined participants in the National Health and Nutrition Examination Surveys 1999–2010 (N = 19,383) with estimated glomerular filtration rate (eGFR) ≥60 ml/min/1.73 m2 and without severe albuminuria (urine albumin:creatinine ratio (ACR) <300 mg/g). Albuminuria was quantified as ACR and fractional albumin excretion (FEalb). Results Increasing quintiles of dietary phosphorus density, serum phosphorus and ALP were not associated with higher ACR or FEalb. The lowest versus highest quintile of 25(OH)D was associated with greater albuminuria, but not after adjustment for other covariates including cardiovascular risk factors. An association between the highest versus lowest quintile of bone-specific ALP and greater ACR persisted after covariate adjustment, but was not accompanied by an independent association with FEalb. Increasing quintiles of PTH demonstrated associations with both higher ACR and FEalb that were not abolished by adjusting for covariates including age, gender, race, body mass index, diabetes, blood pressure, history of cardiovascular disease, smoking, eGFR, 25(OH)D, season of measurement, lipids, hemoglobin and C-reactive protein. Adjusted increases in ACR and FEalb associated with the highest versus lowest quintile of PTH were 19% (95% confidence interval 7–28% p<0.001) and 17% (8–31% p = 0.001) respectively. Conclusion In this population, of the bone mineral parameters associated with cardiovascular outcomes, only PTH is independently associated with ACR and FEalb.
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Hepburn D, Roberts H, Zouwail S. Impact of reduced frequency of phosphate testing on detected phosphate levels and phosphate prescription in critical care. Crit Care 2014. [PMCID: PMC4069453 DOI: 10.1186/cc13622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Plumelle D, Lombard E, Nicolay A, Portugal H. Influence of diet and sample collection time on 77 laboratory tests on healthy adults. Clin Biochem 2013; 47:31-7. [PMID: 24240063 DOI: 10.1016/j.clinbiochem.2013.11.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 11/05/2013] [Accepted: 11/06/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We studied the effect of a standardized breakfast or lunch before blood sampling on 77 analytes. DESIGN AND METHODS The mean difference between assays from 20 healthy adults was calculated on blood samples taken before and after food intake. Significant differences were tested using two-tailed Student t-test and compared to the acceptable limits derived from analytical and intraindividual biological variation. RESULTS Most of the analytes investigated were not significantly affected by food intake. Six of them were influenced by breakfast or lunch: triglycerides, glucose, creatinine, C-peptide and insulin were significantly upregulated, whereas testosterone was downregulated. Fourteen parameters were more influenced by time of sampling than by meals: nine decreased during the day (total bilirubin, BNP, myoglobin, cortisol, TSH, C-telopeptide, prolactin, ACTH, uric acid) and two increased (white blood cells, neutrophils). Three parameters showed levels that were similar at 9:00 am and 5:00 pm but their lowest level at 12:30 pm (inorganic phosphorus, osteocalcin, PTH). CONCLUSIONS Fasting is necessary for some laboratory tests. Clinicians should be aware of variations due to sampling time before ordering non-fasting tests, and in the subsequent interpretation of results.
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Affiliation(s)
- Dorian Plumelle
- Clinical Laboratory, Hospital La Conception, Marseille, France
| | - Elise Lombard
- Clinical Laboratory, Hospital La Conception, Marseille, France; Aix Marseille Université, Faculté de Pharmacie, Marseille, France.
| | - Alain Nicolay
- Clinical Laboratory, Hospital La Conception, Marseille, France; Aix Marseille Université, Faculté de Pharmacie, Marseille, France
| | - Henri Portugal
- Clinical Laboratory, Hospital La Conception, Marseille, France; Aix Marseille Université, Faculté de Pharmacie, Marseille, France
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Tanaka M, Budhathoki S, Hirata A, Morita M, Kono S, Adachi M, Kawate H, Ohnaka K, Takayanagi R. Behavioral and clinical correlates of serum bilirubin concentrations in Japanese men and women. BMC Endocr Disord 2013; 13:39. [PMID: 24090309 PMCID: PMC3852517 DOI: 10.1186/1472-6823-13-39] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 09/26/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A considerable interest has been drawn to potential protective effects of bilirubin against oxidative stress-related diseases. Smoking is known to be associated with lower concentrations of serum bilirubin, but other behavioral correlates of serum bilirubin have not been well studied. In this cross-sectional study, we examined the associations of behavioral and clinical factors with serum total bilirubin in Japanese men and women. METHOD The study subjects comprised of 4802 men and 6414 women aged 49-76 years who participated in the baseline survey of an ongoing cohort study on lifestyle-related diseases in Fukuoka, Japan. With consideration to time of the day of blood sampling and fasting hours, the associations with smoking, alcohol intake, body mass index, physical activity, coffee, tea, blood pressure, glycated hemoglobin (HbA1c), HDL cholesterol and non-HDL cholesterol with serum bilirubin were evaluated by analysis of covariance and multiple linear regression analysis. RESULTS While smoking was negatively associated with serum bilirubin, alcohol consumption was positively associated with serum bilirubin in both men and women. Coffee consumption was associated with lower bilirubin concentrations in both sexes. In the multiple linear regression analysis, HDL cholesterol was positively and HbA1c was negatively associated with bilirubin in both men and women, and the associations were more evident in women. CONCLUSION Smoking, alcohol use and coffee consumption were important behavioral correlates of serum bilirubin in Japanese men and women. Serum HDL cholesterol was a measurable clinical correlate of bilirubin in women.
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Affiliation(s)
- Maya Tanaka
- Department of Preventive Medicine, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Sanjeev Budhathoki
- Department of Preventive Medicine, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Akie Hirata
- Department of Preventive Medicine, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Makiko Morita
- Department of Preventive Medicine, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Suminori Kono
- Department of Preventive Medicine, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Masahiro Adachi
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hisaya Kawate
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keizo Ohnaka
- Department of Geriatric Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryoichi Takayanagi
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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McGovern AP, de Lusignan S, van Vlymen J, Liyanage H, Tomson CR, Gallagher H, Rafiq M, Jones S. Serum phosphate as a risk factor for cardiovascular events in people with and without chronic kidney disease: a large community based cohort study. PLoS One 2013; 8:e74996. [PMID: 24040373 PMCID: PMC3769279 DOI: 10.1371/journal.pone.0074996] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 08/09/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Serum phosphate is a known risk factor for cardiovascular events and mortality in people with chronic kidney disease (CKD), however data on the association of these outcomes with serum phosphate in the general population are scarce. We investigate this relationship in people with and without CKD in a large community-based population. METHODS Three groups from an adult cohort of the Quality Improvement in Chronic Kidney Disease (QICKD) cluster randomised trial (ISRCTN56023731) were followed over a period of 2.5 years: people with normal renal function (N = 24,184), people with CKD stages 1-2 (N = 20,356), and people with CKD stages 3-5 (N = 13,292). We used a multilevel logistic regression model to determine the association between serum phosphate, in these groups, and a composite outcome of all-cause mortality, cardiovascular events, and advanced coronary artery disease. We adjusted for known cardiovascular risk factors. FINDINGS Higher phosphate levels were found to correlate with increased cardiovascular risk. In people with normal renal function and CKD stages 1-2, Phosphate levels between 1.25 and 1.50 mmol/l were associated with increased cardiovascular events; odds ratio (OR) 1.36 (95% CI 1.06-1.74; p = 0.016) in people with normal renal function and OR 1.40 (95% CI 1.09-1.81; p = 0.010) in people with CKD stages 1-2. Hypophosphatemia (<0.75 mmol/l) was associated with fewer cardiovascular events in people with normal renal function; OR 0.59 (95% CI 0.36-0.97; p = 0.049). In people with CKD stages 3-5, hyperphosphatemia (>1.50 mmol/l) was associated with increased cardiovascular risk; OR 2.34 (95% CI 1.64-3.32; p<0.001). Other phosphate ranges were not found to have a significant impact on cardiovascular events in people with CKD stages 3-5. CONCLUSIONS Serum phosphate is associated with cardiovascular events in people with and without CKD. Further research is required to determine the mechanisms underlying these associations.
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Affiliation(s)
- Andrew Peter McGovern
- Department of Health Care Management and Policy, University of Surrey, Guildford, United Kingdom
| | - Simon de Lusignan
- Department of Health Care Management and Policy, University of Surrey, Guildford, United Kingdom
- Division of Population Health Sciences and Education, St. George's – University of London, London, United Kingdom
| | - Jeremy van Vlymen
- Department of Health Care Management and Policy, University of Surrey, Guildford, United Kingdom
| | - Harshana Liyanage
- Department of Health Care Management and Policy, University of Surrey, Guildford, United Kingdom
| | - Charles Richard Tomson
- Department of Renal Medicine, Southmead Hospital – North Bristol NHS Trust, Bristol, United Kingdom
| | - Hugh Gallagher
- Division of Population Health Sciences and Education, St. George's – University of London, London, United Kingdom
- South West Thames Renal and Transplantation Unit, St. Helier Hospital, Carshalton, United Kingdom
| | - Meena Rafiq
- Department of Health Care Management and Policy, University of Surrey, Guildford, United Kingdom
| | - Simon Jones
- Department of Health Care Management and Policy, University of Surrey, Guildford, United Kingdom
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Factors affecting hemoglobin measurement. J Clin Monit Comput 2013; 27:499-508. [PMID: 23529342 DOI: 10.1007/s10877-013-9456-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 03/20/2013] [Indexed: 12/18/2022]
Abstract
A review of the literature shows that current "standard" laboratory measurements for hemoglobin are subject to numerous factors that affect both accuracy and reliability. In addition, total hemoglobin concentration measurements are subject to numerous factors that affect the "true" hemoglobin value. This article discusses both the physiologic factors that influence hemoglobin levels and the technical aspects and variability among the different measurement methodologies currently available.
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Rekić D, Röshammar D, Bergstrand M, Tarning J, Calcagno A, D'Avolio A, Ormaasen V, Vigan M, Barrail-Tran A, Ashton M, Gisslén M, Äbelö A. External validation of the bilirubin-atazanavir nomogram for assessment of atazanavir plasma exposure in HIV-1-infected patients. AAPS JOURNAL 2012; 15:308-15. [PMID: 23224752 PMCID: PMC3618856 DOI: 10.1208/s12248-012-9440-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 11/02/2012] [Indexed: 11/30/2022]
Abstract
Atazanavir increases plasma bilirubin levels in a concentration-dependent manner. Due to less costly and readily available assays, bilirubin has been proposed as a marker of atazanavir exposure. In this work, a previously developed nomogram for detection of suboptimal atazanavir exposure is validated against external patient populations. The bilirubin nomogram was validated against 311 matching bilirubin and atazanavir samples from 166 HIV-1-infected Norwegian, French, and Italian patients on a ritonavir-boosted regimen. In addition, the nomogram was evaluated in 56 Italian patients on an unboosted regimen. The predictive properties of the nomogram were validated against observed atazanavir plasma concentrations. The use of the nomogram to detect non-adherence was also investigated by simulation. The bilirubin nomogram predicted suboptimal exposure in the patient populations on a ritonavir-boosted regimen with a negative predictive value of 97% (95% CI 95–100). The bilirubin nomogram and monitoring of atazanavir concentrations had similar predictive properties for detecting non-adherence based on simulations. Although both methods performed adequately during a period of non-adherence, they had lower predictive power to detect past non-adherence episodes. Using the bilirubin nomogram for detection of suboptimal atazanavir exposure in patients on a ritonavir-boosted regimen is a rapid and cost-effective alternative to routine measurements of the actual atazanavir exposure in plasma. Its application may be useful in clinical settings if atazanavir concentrations are not available.
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Affiliation(s)
- Dinko Rekić
- Unit for Pharmacokinetics and Drug Metabolism, Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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A multicenter blinded analysis indicates no association between chronic fatigue syndrome/myalgic encephalomyelitis and either xenotropic murine leukemia virus-related virus or polytropic murine leukemia virus. mBio 2012; 3:mBio.00266-12. [PMID: 22991430 PMCID: PMC3448165 DOI: 10.1128/mbio.00266-12] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The disabling disorder known as chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) has been linked in two independent studies to infection with xenotropic murine leukemia virus-related virus (XMRV) and polytropic murine leukemia virus (pMLV). Although the associations were not confirmed in subsequent studies by other investigators, patients continue to question the consensus of the scientific community in rejecting the validity of the association. Here we report blinded analysis of peripheral blood from a rigorously characterized, geographically diverse population of 147 patients with CFS/ME and 146 healthy subjects by the investigators describing the original association. This analysis reveals no evidence of either XMRV or pMLV infection. Chronic fatigue syndrome/myalgic encephalomyelitis has an estimated prevalence of 42/10,000 in the United States, with annual direct medical costs of $7 billion. Here, the original investigators who found XMRV and pMLV (polytropic murine leukemia virus) in blood of subjects with this disorder report that this association is not confirmed in a blinded analysis of samples from rigorously characterized subjects. The increasing frequency with which molecular methods are used for pathogen discovery poses new challenges to public health and support of science. It is imperative that strategies be developed to rapidly and coherently address discoveries so that they can be carried forward for translation to clinical medicine or abandoned to focus resource investment more productively. Our study provides a paradigm for pathogen dediscovery that may be helpful to others working in this field.
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Schumacher YO, Klodt F, Nonis D, Pottgiesser T, Alsayrafi M, Bourdon PC, Voss SC. The impact of long-haul air travel on variables of the athlete's biological passport. Int J Lab Hematol 2012; 34:641-7. [DOI: 10.1111/j.1751-553x.2012.01450.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 05/03/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Y. O. Schumacher
- Department of Sports Medicine; University of Freiburg; Freiburg Germany
| | - F. Klodt
- Department of Sports Medicine; University of Freiburg; Freiburg Germany
| | - D. Nonis
- Department of Sports Medicine; University of Freiburg; Freiburg Germany
| | - T. Pottgiesser
- Department of Sports Medicine; University of Freiburg; Freiburg Germany
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Sennels HP, Jørgensen HL, Goetze JP, Fahrenkrug J. Rhythmic 24-hour variations of frequently used clinical biochemical parameters in healthy young males – The Bispebjerg study of diurnal variations. Scandinavian Journal of Clinical and Laboratory Investigation 2012; 72:287-95. [DOI: 10.3109/00365513.2012.662281] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sennels HP, Jørgensen HL, Hansen ALS, Goetze JP, Fahrenkrug J. Diurnal variation of hematology parameters in healthy young males: the Bispebjerg study of diurnal variations. Scandinavian Journal of Clinical and Laboratory Investigation 2012; 71:532-41. [PMID: 21988588 DOI: 10.3109/00365513.2011.602422] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the influence of time of day on the circulating concentrations of 21 hematology parameters. MATERIALS AND METHODS Venous blood samples were obtained under standardized circumstances from 24 healthy young men every third hour through 24 hours, nine time points in total. At each time point, the level of melatonin, iron, transferrin, transferrin saturation, ferritin, cobalamin, folate, red blood cells and white blood cells was measured. The data were analysed by rhythmometric statistical methods. The biological variations were calculated. RESULTS Significant oscillation of melatonin (p < 0.0001) with an amplitude (amp) of 19.84 pg/ml and a peak level at 03:34 h confirmed the normal 24-hour rhythms of the participants. Erythrocytes (p < 0.0001, amp = 0.15 × 10(12)/L), hemoglobin (p < 0.0001, amp = 0.29 mmol/L), hematocrit (p < 0.0001, amp = 0.01), iron (p < 0.0001, amp = 4.00μmol/L), transferrin (p = 0.03, amp = 1.41μmol/L), transferrin saturation (p < 0.0001, amp = 6.37%) and folate (p < 0.0001, amp = 1.55nmol/L) oscillated significantly, with gradually falling mean levels through the day to nadir around midnight. Leukocyte count (p < 0.0001, amp = 0.78 × 10(9)/L), neutrophils (p = 0.001, 0.31 × 10(9)/L), eosinophils (p < 0.0001, amp = 0.04 × 10(9)/L), monocytes (p = 0.0009, amp = 0.06 × 10(9)/L), lymphocytes (p < 0.0001, amp = 0.49 × 10(9)/L) oscillated significantly with gradually increasing mean levels through the day peaking at midnight. Iron, leukocytes and hemoglobin had the highest 24 hour oscillations in proportion to the reference intervals of the parameters for healthy young men. CONCLUSIONS Biochemical screenings are biased by diurnal variations, which must be considered when blood concentrations of these parameters are interpreted in the clinical setting.
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Affiliation(s)
- Henriette P Sennels
- Department of Clinical Biochemistry, Faculty of Health Sciences, Bispebjerg Hospital, Copenhagen, Denmark.
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Rekić D, Clewe O, Röshammar D, Flamholc L, Sönnerborg A, Ormaasen V, Gisslén M, Abelö A, Ashton M. Bilirubin-a potential marker of drug exposure in atazanavir-based antiretroviral therapy. AAPS JOURNAL 2011; 13:598-605. [PMID: 21913053 DOI: 10.1208/s12248-011-9299-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 08/24/2011] [Indexed: 01/11/2023]
Abstract
The objective of this work was to examine the atazanavir-bilirubin relationship using a population-based approach and to assess the possible application of bilirubin as a readily available marker of atazanavir exposure. A model of atazanavir exposure and its concentration-dependent effect on bilirubin levels was developed based on 200 atazanavir and 361 bilirubin samples from 82 patients receiving atazanavir in the NORTHIV trial. The pharmacokinetics was adequately described by a one-compartment model with first-order absorption and lag-time. The maximum inhibition of bilirubin elimination rate constant (I(max)) was estimated at 91% (95% CI, 87-94) and the atazanavir concentration resulting in half of I(max) (IC50) was 0.30 μmol/L (95% CI, 0.24-0.37). At an atazanavir/ritonavir dose of 300/100 mg given once daily, the bilirubin half-life was on average increased from 1.6 to 8.1 h. A nomogram, which can be used to indicate suboptimal atazanavir exposure and non-adherence, was constructed based on model simulations.
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Affiliation(s)
- Dinko Rekić
- Unit for Pharmacokinetics and Drug Metabolism, Department of Pharmacology, Sahlgrenska Academy at University of Gothenburg, Sweden.
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Sithranga Boopathy N, Kathiresan K, Jeon YJ. Effect of mangrove black tea extract from Ceriops decandra (Griff.) on hematology and biochemical changes in dimethyl benz[a]anthracene-induced hamster buccal pouch carcinogenesis. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2011; 32:193-200. [PMID: 21843799 DOI: 10.1016/j.etap.2011.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Revised: 04/04/2011] [Accepted: 05/18/2011] [Indexed: 05/31/2023]
Abstract
Effect of the black tea extracted from a mangrove plant species, Ceriops decandra (Griff.) was studied on dimethyl benz[a]anthracene (DMBA)-induced changes in blood hematology and plasma non-enzymatic antioxidants in male hamsters. Hamsters were painted with 0.5% solution of DMBA in liquid paraffin on the right buccal pouch three times in a week up to 14 weeks. Each application treated with 0.4mg of DMBA. The mangrove black tea extract (MBTE) was administrated orally with 5mgkg(-1) twice a day and then with DMBA on alternate days. Results showed that the DMBA caused a significant (P<0.05) decline in the levels of reduced glutathione (GSH), vitamin-C, -E, red blood cells, hemoglobin, mean corpuscular volume and hematocrit; and increase in the levels of WBC, platelets, lymphocytes and neutrophils. The MBTE prevented the DMBA-induced adverse changes significantly in blood and biochemical parameters of the male hamsters. This work concluded that the black tea extracted from the coastal mangrove species C. decandra prevented the DMBA-induced buccal pouch carcinogenesis in hamsters.
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Affiliation(s)
- N Sithranga Boopathy
- Center of Advanced Study in Marine Biology, Faculty of Marine Sciences, Annamalai University, Parangipettai 608 502, India
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Impact of time since last caloric intake on blood glucose levels. Eur J Epidemiol 2011; 26:719-28. [PMID: 21822717 PMCID: PMC3186886 DOI: 10.1007/s10654-011-9608-z] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Accepted: 07/12/2011] [Indexed: 12/02/2022]
Abstract
Blood glucose (BG) is usually measured after a caloric restriction of at least 8 h; however evidence-based recommendations for the duration of a fasting status are missing. Here we analyze the effect of fasting duration on levels of BG to determine the minimal fasting duration to achieve comparable BG levels to conventional fasting measurements. We used data of a cross-sectional study on primary care patients, performed in October 2005. We included 28,024 individuals (age-range 18–99 years; 63% women) without known diabetes mellitus and without missing data for BG and fasting status. We computed general linear models, adjusting for age, sex, time of blood withdrawal, systolic blood pressure, waist circumference, total- and HDL-cholesterol, physical activity, smoking, intake of beta-blocker and alcohol. We tested the intra-individual variability with respect to fasting status. Overall, the mean BG differed only slightly between individuals fasting ≥8 h and those fasting <8 h (men: 5.1 ± 0.8 mmol/L versus 5.2 ± 1.2 mmol/L; women: 4.9 ± 0.7 mmol/L, 5.0 ± 1.0 mmol/L). After 3 h of fasting differences of BG diminished in men to −0.08 mmol/L (95%-CI: −0.15; −0.01 mmol/L), in women to −0.07 mmol/L (−0.12; −0.03 mmol/L) compared to individuals fasting ≥8 h. Noteworthy, age, time of day of blood withdrawal, physical activity, and intake of hard liquor influenced BG levels considerably. Our data challenge the necessity for a fasting duration of ≥8 h when measuring blood glucose, suggesting a random sampling or a fasting duration of 3 h as sufficient. Rather, our study indicates that essentially more effort on the assessment of additional external/internal factors on BG levels is necessary.
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Sundvall J, Leiviskä J, Laatikainen T, Peltonen M, Salomaa V, Vanhala M, Korpi-Hyövälti E, Lauronen J, Alfthan G. The use of fasting vs. non-fasting triglyceride concentration for estimating the prevalence of high LDL-cholesterol and metabolic syndrome in population surveys. BMC Med Res Methodol 2011; 11:63. [PMID: 21569280 PMCID: PMC3112195 DOI: 10.1186/1471-2288-11-63] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 05/10/2011] [Indexed: 02/01/2023] Open
Abstract
Background For practical reasons it is not easy to obtain fasting samples in large population health surveys. Non-fasting triglyceride (Tg) values are difficult to interpret. The authors compared the accuracy of statistically corrected non-fasting Tg values with true fasting values and estimated the misclassification of subjects with high low-density lipoprotein cholesterol (LDL-C) and the metabolic syndrome. Methods Non-fasting blood was obtained from a population-based sample of 4282 individuals aged 24-75 years in the National FINRISK 2007 Study. Fasting blood samples were drawn from the same persons 3 months later. Non-fasting serum Tg values were converted into fasting values using previously published formula. LDL-C was calculated and classification of the metabolic syndrome was carried out according to three different latest guidelines. Results The median (25th, 75th percentile) non-fasting serum Tg concentration was 1.18 (0.87, 1.72) mmol/L and after postprandial correction 1.06 (0.78, 1.52) mmol/L. The true-fasting serum Tg concentration was 1.00 (0.75, 1.38) mmol/L (P < 0.001) vs. non-fasting and corrected value. Bias of the corrected value was +5.9% compared with the true-fasting Tg. Of the true fasting subjects, 56.4% had LDL-C ≥3.00 mmol/L. When calculated using non-fasting serum Tg, the prevalence of high LDL-C was 51.3% and using statistically corrected Tg it was 54.8%. The prevalence of metabolic syndrome was 35.5% among fully fasted persons and among non-fasting subjects 39.7%, which after statistical correction of Tg decreased to 37.6% (P < 0.001 for all comparisons). Conclusions Correction of non-fasting serum Tg to fasting values plays a minor role in population studies but nevertheless reduces misclassification of calculated high LDL-C from 5.1 to 1.6% and the metabolic syndrome from 4.2 to 2.1%.
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Affiliation(s)
- Jouko Sundvall
- National Institute for Health and Welfare, Department of Chronic Disease Prevention, Helsinki, Finland.
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Ohnaka K, Kono S. Bilirubin, cardiovascular diseases and cancer: epidemiological perspectives. Expert Rev Endocrinol Metab 2010; 5:891-904. [PMID: 30780834 DOI: 10.1586/eem.10.65] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Owing to a potent antioxidant property of bilirubin, a growing interest has been drawn to the potential protective effects of bilirubin against oxidative stress-related diseases. This article evaluates associations of bilirubin with atherosclerotic diseases and cancer. Serum bilirubin has consistently been shown to be inversely associated with diverse atherosclerotic diseases, mostly among men in different populations. A limited number of prospective studies have shown a U-shaped or reversed J-shaped relationship between bilirubin and coronary heart disease in men and no evident association in women. Few studies have provided evidence supportive of a protective association between bilirubin and cancer risk. The findings on bilirubin-related genetic polymorphisms are inconsistent in relation to coronary heart disease and cancer.
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Affiliation(s)
- Keizo Ohnaka
- a Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka 812-8582, Japan
| | - Suminori Kono
- a Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka 812-8582, Japan
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Genizi J, Lewy H, Ashkenazi Y, Antonelli J, Horowitz Y, Miron D. Time patterns in young infants' blood count. BIOL RHYTHM RES 2010. [DOI: 10.1080/09291010903215687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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