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Schwandt A, Best F, Biester T, Grünerbel A, Kopp F, Krakow D, Laimer M, Wagner C, Holl RW. Both the frequency of HbA 1c testing and the frequency of self-monitoring of blood glucose predict metabolic control: A multicentre analysis of 15 199 adult type 1 diabetes patients from Germany and Austria. Diabetes Metab Res Rev 2017; 33. [PMID: 28544457 DOI: 10.1002/dmrr.2908] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 04/10/2017] [Accepted: 05/02/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND The objective of this study was to examine the association between metabolic control and frequency of haemoglobin A1c (HbA1c ) measurements and of self-monitoring of blood glucose, as well as the interaction of both. METHODS Data of 15 199 adult type 1 diabetes patients registered in a standardized electronic health record (DPV) were included. To model the association between metabolic control and frequency of HbA1c testing or of self-monitoring of blood glucose, multiple hierarchic regression models with adjustment for confounders were fitted. Tukey-Kramer test was used to adjust P values for multiple comparisons. Vuong test was used to compare non-nested models. RESULTS The baseline variables of the study population were median age 19.9 [Q1; Q3: 18.4; 32.2] years and diabetes duration 10.4 [6.8; 15.7] years. Haemoglobin A1c was 60.4 [51.5; 72.5] mmol/mol. Frequency of HbA1c testing was 8.0 [5.0; 9.0] within 2 years, and daily self-monitoring of blood glucose frequency was 5.0 [4.0; 6.0]. After adjustment, a U-shaped association between metabolic control and frequency of HbA1c testing was observed with lowest HbA1c levels in the 3-monthly HbA1c testing group. There was an inverse relationship between self-monitoring of blood glucose and HbA1c with lower HbA1c associated with highest frequency of testing (>6 daily measurements). Quarterly HbA1c testing and frequent self-monitoring of blood glucose were associated with best metabolic control. The adjusted Vuong Z statistic suggests that metabolic control might be better explained by HbA1c testing compared to self-monitoring of blood glucose (P < .0001). CONCLUSION This research reveals the importance of quarterly clinical HbA1c monitoring together with frequent self-monitoring of blood glucose in diabetes management to reach and maintain target HbA1c .
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Affiliation(s)
- A Schwandt
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - F Best
- Outpatient Diabetes Center, Essen, Germany
| | - T Biester
- AUF DER BULT, Diabetes Centre for Children and Adolescents, Hannover, Germany
| | - A Grünerbel
- Outpatient Diabetes Center Munich South, Munich, Germany
| | - F Kopp
- Department of Internal Medicine, Diabetes Center, Clinical Center Augsburg, Augsburg, Germany
| | - D Krakow
- Diabetes Center Forchheim, Forchheim, Germany
| | - M Laimer
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Bern, Bern, Switzerland
| | - C Wagner
- Outpatient Diabetes Center, Surheim, Germany
| | - R W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
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2
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Hartmann B, Groß F, Bramlage P, Lanzinger S, Danne T, Wagner S, Krakow D, Zimmermann A, Malcharzik C, Holl R. Lean diabetes: A joint analysis of the German DIVE and DPV registries. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- B Hartmann
- Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - F Groß
- Praxis Dr. Groß, Murnau, Germany
| | - P Bramlage
- Institut für Pharmakologie und Präventive Medizin, Mahlow, Germany
| | - S Lanzinger
- Institut für Epidemiologie und medizinische Biometrie, ZIBMT, Universität Ulm, Ulm, Germany
| | - T Danne
- Kinderkrankenhaus 'Auf der Bult', Diabeteszentrum für Kinder und Jugendliche, Hannover, Germany
| | - S Wagner
- DONAUISAR Klinikum, Deggendorf, Germany
| | - D Krakow
- Diabeteszentrum Forchheim, Forchheim, Germany
| | - A Zimmermann
- Praxis Dr. Zimmermann, Diabeteszentrum Bad Aibling, Bad Aibling, Germany
| | | | - R Holl
- Institut für Epidemiologie und medizinische Biometrie, ZIBMT, Universität Ulm, Ulm, Germany
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3
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Badiner N, Taylor SP, Forlenza K, Lachman RS, Bamshad M, Nickerson D, Cohn DH, Krakow D. Mutations in DYNC2H1, the cytoplasmic dynein 2, heavy chain 1 motor protein gene, cause short-rib polydactyly type I, Saldino-Noonan type. Clin Genet 2017; 92:158-165. [PMID: 27925158 DOI: 10.1111/cge.12947] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 10/31/2016] [Accepted: 11/27/2016] [Indexed: 01/16/2023]
Abstract
The short-rib polydactyly syndromes (SRPS) are autosomal recessively inherited, genetically heterogeneous skeletal ciliopathies. SRPS phenotypes were historically categorized as types I-IV, with type I first delineated by Saldino and Noonan in 1972. Characteristic findings among all forms of SRP include short horizontal ribs, short limbs and polydactyly. The SRP type I phenotype is characterized by a very small thorax, extreme micromelia, very short, poorly mineralized long bones, and multiple organ system anomalies. To date, the molecular basis of this most severe type of SRP, also known as Saldino-Noonan syndrome, has not been determined. We identified three SRP cases that fit the original phenotypic description of SRP type I. In all three cases, exome sequence analysis revealed compound heterozygosity for mutations in DYNC2H1, which encodes the main component of the retrograde IFT A motor, cytoplasmic dynein 2 heavy chain 1. Thus SRP type I, II, III and asphyxiating thoracic dystrophy (ATD), which also result from DYNC2H1 mutations. Herein we describe the phenotypic features, radiographic findings, and molecular basis of SRP type I.
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Affiliation(s)
- N Badiner
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - S P Taylor
- Department of Human Genetics, Los Angeles, CA, USA
| | - K Forlenza
- Department of Orthopaedic Surgery, Los Angeles, CA, USA
| | - R S Lachman
- International Skeletal Dysplasia Registry at UCLA, Los Angeles, CA, USA
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- University of Washington Center for Mendelian Genomics, Seattle, WA, USA
| | - M Bamshad
- University of Washington Center for Mendelian Genomics, Seattle, WA, USA.,Department of Genome Sciences, Seattle, WA, USA.,Department of Pediatrics, University of Washington, Seattle, WA, USA.,Division of Genetic Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - D Nickerson
- University of Washington Center for Mendelian Genomics, Seattle, WA, USA.,Department of Genome Sciences, Seattle, WA, USA
| | - D H Cohn
- Department of Orthopaedic Surgery, Los Angeles, CA, USA.,International Skeletal Dysplasia Registry at UCLA, Los Angeles, CA, USA.,Department of Developmental Cell and Molecular Biology, University of California at Los Angeles, Los Angeles, CA, USA
| | - D Krakow
- Department of Human Genetics, Los Angeles, CA, USA.,Department of Orthopaedic Surgery, Los Angeles, CA, USA.,International Skeletal Dysplasia Registry at UCLA, Los Angeles, CA, USA.,Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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4
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Schwandt A, Best F, Biester T, Grünerbel A, Kopp F, Krakow D, Laimer M, Wagner C, Holl RW. Die Häufigkeit der HbA1c-Messungen und die Häufigkeit der Blutzuckerselbstmessungen beeinflussen die Stoffwechseleinstellung! Ergebnisse einer multizentrischen Studie mit 15.199 erwachsenen Typ-1-Diabetes Patienten aus der DPV-Datenbank. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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5
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Bellur S, Jain M, Cuthbertson D, Krakow D, Shapiro JR, Steiner RD, Smith PA, Bober MB, Hart T, Krischer J, Mullins M, Byers PH, Pepin M, Durigova M, Glorieux FH, Rauch F, Sutton VR, Lee B, Nagamani SC. Cesarean delivery is not associated with decreased at-birth fracture rates in osteogenesis imperfecta. Genet Med 2015; 18:570-6. [PMID: 26426884 PMCID: PMC4818203 DOI: 10.1038/gim.2015.131] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 08/14/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose Osteogenesis imperfecta (OI) predisposes to recurrent fractures. The moderate-to-severe forms of OI present with antenatal fractures and the mode of delivery that would be safest for the fetus is not known. Methods We conducted systematic analyses on the largest cohort of individuals (n=540) with OI enrolled to-date in the OI Linked Clinical Research Centers. Self-reported at-birth fracture rates were compared in individuals with OI types I, III, and IV. Multivariate analyses utilizing backward-elimination logistic regression model building were performed to assess the effect of multiple covariates including method of delivery on fracture-related outcomes. Results When accounting for other covariates, at-birth fracture rates did not differ based on whether delivery was by vaginal route or by cesarean section (CS). Increased birth weight conferred higher risk for fractures irrespective of the delivery method. In utero fracture, maternal history of OI, and breech presentation were strong predictors for choosing CS for delivery. Conclusion Our study, the largest to analyze the effect of various factors on at-birth fracture rates in OI shows that delivery by CS is not associated with decreased fracture rate. With the limitation that the fracture data were self-reported in this cohort, these results suggest that CS should be performed only for other maternal or fetal indications, but not for the sole purpose of fracture prevention in OI.
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Affiliation(s)
- S Bellur
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - M Jain
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - D Cuthbertson
- College of Medicine, University of South Florida, Tampa, Florida, USA
| | - D Krakow
- Department of Orthopedic Surgery, University of California, Los Angeles, California, USA.,Department of Human Genetics, University of California, Los Angeles, California, USA.,Department of Obstetrics and Gynecology, University of California, Los Angeles, California, USA
| | - J R Shapiro
- Department of Bone and Osteogenesis Imperfecta, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - R D Steiner
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA.,Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, Oregon, USA.,Marshfield Clinic Research Foundation and University of Wisconsin, Marshfield and Madison, Wisconsin, USA
| | - P A Smith
- Shriners Hospitals for Children, Chicago, Illinois, USA
| | - M B Bober
- Division of Medical Genetics, Alfred I. DuPont Hospital for Children, Wilmington, Delaware, USA
| | - T Hart
- Osteogenesis Imperfecta Foundation, Gaithersburg, Maryland, USA
| | - J Krischer
- College of Medicine, University of South Florida, Tampa, Florida, USA
| | - M Mullins
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - P H Byers
- Department of Medicine, Division of Medical Genetics, University of Washington, Seattle, Washington, USA.,Department of Pathology, Division of Medical Genetics, University of Washington, Seattle, Washington, USA
| | - M Pepin
- Department of Medicine, Division of Medical Genetics, University of Washington, Seattle, Washington, USA.,Department of Pathology, Division of Medical Genetics, University of Washington, Seattle, Washington, USA
| | - M Durigova
- Department of Orthopedic Surgery, Shriners Hospital for Children and McGill University, Montreal, Québec, Canada
| | - F H Glorieux
- Department of Orthopedic Surgery, Shriners Hospital for Children and McGill University, Montreal, Québec, Canada
| | - F Rauch
- Department of Orthopedic Surgery, Shriners Hospital for Children and McGill University, Montreal, Québec, Canada
| | - V R Sutton
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA.,Texas Children's Hospital, Houston, Texas, USA
| | - B Lee
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA.,Texas Children's Hospital, Houston, Texas, USA
| | | | - S C Nagamani
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA.,Texas Children's Hospital, Houston, Texas, USA
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Duran I, Csukasi F, Taylor S, Krakow D, Becerra J, Bombarely A, Marí-Beffa M. Collagen duplicate genes of bone and cartilage participate during regeneration of zebrafish fin skeleton. Gene Expr Patterns 2015; 19:60-9. [DOI: 10.1016/j.gep.2015.07.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 07/14/2015] [Accepted: 07/31/2015] [Indexed: 11/17/2022]
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7
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Krakow D, Feulner-Krakow G. LINDA: the diabetes self-management training programme for people with type 1 or type 2 diabetes. ACTA ACUST UNITED AC 2015. [DOI: 10.1002/edn.90] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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8
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Hermann G, Herbst A, Schütt M, Kempe HP, Krakow D, Müller-Korbsch M, Holl RW. Association of physical activity with glycaemic control and cardiovascular risk profile in 65 666 people with type 2 diabetes from Germany and Austria. Diabet Med 2014; 31:905-12. [PMID: 24646320 DOI: 10.1111/dme.12438] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 12/18/2013] [Accepted: 03/10/2014] [Indexed: 11/27/2022]
Abstract
AIMS To provide representative data from routine diabetes care concerning the physical activity levels of people with type 2 diabetes, and to show the association of activity level with cardio-metabolic risk profile in a gender-specific analysis. METHODS The anonymized data from 65 666 subjects with type 2 diabetes, who have been receiving treatment in specialized diabetes institutions, were analysed using a large multi-centre database. The population was categorized as physically inactive (PA0), active 1-2 times per week (PA1), active >2 times per week (PA2), and then stratified by age (20-59 and 60-80 years). BMI, glycaemic control (measured by HbA(1c) levels), blood pressure, lipid profile and therapeutic regimen were adjusted for age, gender and diabetes duration. RESULTS Most subjects were inactive (PA0: 90%; PA1: 6%, PA2: 4%). BMI, HbA(1c) and lipid profiles were better in older subjects and hypertension rates were lower in younger subjects. In both age groups, BMI, HbA(1c) (both P < 0.0001) and triglycerides (P < 0.002) were lower in the most active group PA2 compared with the inactive group PA0. HDL was higher in elderly (P < 0.0001) and pulse pressure (P = 0.03) lower in younger most active subjects only. Insulin therapy was used more frequently by the physically inactive and by older people. CONCLUSIONS This survey indicates that glycaemic control and cardio-metabolic risk profiles in people with type 2 diabetes are positively related to physical activity. The effects of physical activity were beneficial in younger as well as in older people. The high number of inactive people with diabetes underlines the need to promote physical activity and sport.
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Affiliation(s)
- G Hermann
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
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9
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Bohn B, Scheuing N, Jehle PM, Laubner K, Born B, Merger S, Hummel M, Krakow D, Voll A, Zimmermann A, Zimny S, Holl RW. Are insulin analogues detemir or glulisine used preferentially in overweight/obese subjects? A German multicentre analysis of 38560 type 2 diabetic patients from the DPV registry. Exp Clin Endocrinol Diabetes 2014; 122:602-7. [PMID: 25054308 DOI: 10.1055/s-0034-1383646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Several studies suggest benefits of insulin analogues detemir or glulisine in overweight and obese patients with type 2 diabetes. The present multicentre study therefore examines, whether these insulin analogues are used more frequently in patients with increased body mass index. METHODS Data of 38 560 adult type 2 diabetic patients using insulin analogues, from 150 centres in Germany, registered in a standardized, prospective, computer-based documentation program (DPV), were included. Patients were classified into body mass index categories according to World Health Organization. Analysis was stratified by 3 time periods. To adjust for confounding effects, multivariable logistic regression models were created. RESULTS Detemir was preferentially used in overweight (OR 1.36, 95%-CI 1.20-1.53) and obese patients (OR 2.06, 95%-CI 1.84-2.31) compared to normal-weight patients. These effects remained significant after adjusting for sex, age, new/old federal state of Germany, size of centre, treatment in university clinic and clinic/specialized private practice. Models were additionally adjusted for time period and interaction of BMI category with age or sex. For glulisine, a minor effect was present when comparing obese to normal-weight patients (OR 1.26, 95%-CI 1.06-1.50). After adjustment, this finding was no longer significant. Stratified by obesity grade, class III obese patients more frequently used detemir or glulisine compared to class I obese patients. Comparing time periods, odds ratios did not differ, neither for detemir nor for glulisine. CONCLUSION Detemir is used more often in overweight and obese patients compared to normal-weight patients. For glulisine, the relationship is less pronounced.
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Affiliation(s)
- B Bohn
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | - N Scheuing
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | - P M Jehle
- Department of Internal Medicine, Academic Hospital Paul Gerhardt Stift, Lutherstadt Wittenberg, Martin- Luther-University Halle-Wittenberg, Germany
| | - K Laubner
- Division of Endocrinology and Diabetology, Department of Internal Medicine II, University Hospital of Freiburg, Freiburg, Germany
| | - B Born
- Department of Diabetology and Infectiology, Medical Clinic I, Reutlingen, Germany
| | - S Merger
- Division of Endocrinology, Diabetes and Metabolism, Graduate School of Molecular Diabetology and Endocrinology, Ulm University, Ulm, Germany
| | - M Hummel
- Specialized Diabetes Practice, Rosenheim, Germany
| | - D Krakow
- Diabetes Centre Forchheim, Germany
| | - A Voll
- Specialized Diabetes Practice, Traunstein, Germany
| | - A Zimmermann
- Specialized Diabetes Practice, Bad Aibling, Germany
| | - S Zimny
- Department for General Internal Medicine, Endocrinology and Diabetes, HELIOS Kliniken Schwerin, Schwerin, Germany
| | - R W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
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Scheuing N, Best F, Dapp A, Dreyhaupt I, Filz HP, Krakow D, Lang W, Siegel E, Zeyfang A, Holl RW. DPV-Analyse von 183.219 erwachsenen Typ 2 Diabetespatienten zeigt bei Patienten mit komorbider Parkinsonerkrankung eine bessere metabolische Kontrolle trotz erhöhten Raten für Hypertonie, Schlaganfall, Demenz und wiederholter stationärer Aufnahme. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1341923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Taylor P, Wu S, Nelson SF, Cohn DH, Krakow D. Exome sequencing for disease gene discovery in Jeune’s Asphyxiating Thoracic Dystrophy. Cilia 2012. [PMCID: PMC3555716 DOI: 10.1186/2046-2530-1-s1-p105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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12
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Awa WL, Fach E, Krakow D, Welp R, Kunder J, Voll A, Zeyfang A, Wagner C, Schütt M, Boehm B, de Souza M, Holl RW. Type 2 diabetes from pediatric to geriatric age: analysis of gender and obesity among 120,183 patients from the German/Austrian DPV database. Eur J Endocrinol 2012; 167:245-54. [PMID: 22645200 DOI: 10.1530/eje-12-0143] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIM To characterize the clinical phenotype of type 2 diabetes mellitus (T2DM) with respect to age, gender, and BMI. METHOD Anonymized data of 120,183 people with T2DM from the German/Austrian multicenter Diabetes Patienten Verlaufsdokumentation database were analyzed based on chronological age or age at diagnosis (0-19, 20-39, 40-59, 60-79, and ≥80 years). Age, gender, and BMI comparisons with clinical phenotype were made using χ(2) and Kruskal-Wallis tests (SAS V9.2). RESULTS Of all the patients, 51.3% were male, average age was 67.112.7 years, and average disease duration was 9.99.1 years. More girls than boys were diagnosed during adolescence and more men than women during adulthood (2060 years). No gender differences existed when age at diagnosis was 60 years. Patients were obese on average (BMI: 30.5±6.1 kg/m(2)) and had significantly higher BMI values than German population peers. The BMI gap was widest in the younger age categories and closed with increasing age. Adult women were significantly more obese than men. Obese patients more often had elevated HbA1c (≥7.5%), hypertension or dyslipidemia (irrespective of age), microalbuminuria (adults), or retinopathy (elderly) than nonobese patients. More men than women (20-60 years) had hypertension, dyslipidemia, or microalbuminuria while more women than men (≥60 years) had hypertension or dyslipidemia. CONCLUSION During puberty, more girls than boys were diagnosed with T2DM while during adulthood males predominated. T2DM manifested at comparatively lower BMI in males, and younger patients were more obese at diagnosis. Age, gender, and BMI were also associated with poor metabolic control and cardiovascular disease comorbidities/complications.
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Affiliation(s)
- Wendy L Awa
- Institute of Epidemiology and Medical Biometry, University of Ulm, Albert-Einstein-Allee 41, 89081 Ulm, Germany
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13
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Weber D, Faber-Heinemann G, Hess G, Hess E, Kaltheuner M, Krakow D, Lederle M, Molinski M, Reuter HM, Scheper N, Simonsohn M, Heinemann L. Klinische Wirksamkeit von DPP-4-Hemmern und GLP-1-Analoga bei 907 Patienten mit Typ 2 Diabetes mellitus in diabetologischen Schwerpunktpraxen. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1314474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Molz K, Marg W, Lange K, Bartus B, Herwig J, Vogel C, Krakow D, Nellen-Hellmuth N, Holl RW. Wie häufig werden Patienten im Durchschnitt pro Behandlungsjahr geschult? Darstellung der Schulungshäufigkeit bezüglich Alter, Diabetesdauer und Migrationshintergrund bei 26994 Patienten unterschiedlicher Altersgruppen mit Typ 1-Diabetes mellitus aus der DPV-Datenbank. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1314617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Klaassens M, Reinstein E, Hilhorst-Hofstee Y, Schrander JJP, Malfait F, Staal H, ten Have LC, Blaauw J, Roggeveen HCJ, Krakow D, De Paepe A, van Steensel MAM, Pals G, Graham JM, Schrander-Stumpel CTRM. Ehlers-Danlos arthrochalasia type (VIIA-B)--expanding the phenotype: from prenatal life through adulthood. Clin Genet 2011; 82:121-30. [PMID: 21801164 DOI: 10.1111/j.1399-0004.2011.01758.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The Ehlers-Danlos syndromes (EDS) form a clinically and genetically heterogeneous group of inherited connective-tissue disorders characterized by joint hypermobility, tissue fragility and skin abnormalities. Six subtypes have been well characterized based on clinical features and molecular genetic abnormalities. The arthrochalasia type EDS (formerly types VIIA and B) is characterized by severe generalized joint hypermobility with multiple dislocations including congenital bilateral dislocation of the hips, muscular hypotonia and distinct dysmorphic features. The diagnosis of the arthrochalasia type EDS is of importance in the neonatal period because of consequences of physical disability in later life. However, the differential diagnosis may be difficult because of overlap with other hypermobility syndromes. In addition, the significant hypotonia may direct the physician toward various neuromuscular diagnoses. As patients become older, the hypotonia decreases and facial features become less distinct. In this report, we describe seven patients at different ages. Timing of diagnosis varied from prenatal life to adult age. The diagnosis of EDS type VII was confirmed by biochemical studies or mutation analysis showing characteristic mutations in COL1A1 and COL1A2. These mutations result in skipping of exon 6, which leads to defective collagen synthesis. For physicians treating patients with EDS type VII, achieving mobility for the patient is the greatest challenge and it may be impossible because of recurrent dislocations of nearly all joints in severe cases.
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Affiliation(s)
- M Klaassens
- Department of Pediatrics, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands.
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Awa WL, Fach EM, Welp R, Voll AM, Zeyfang A, Krakow D, Wagner C, Kunder J, Schütt M, de Souza M, Holl RW. Typ-2-Diabetes von der Pädiatrie bis zur Geriatrie: Demografie, Anthropologie, Immunologie und antidiabetische Therapie bei 120183 Typ-2-Patienten aus 298 DPV Zentren. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Weber D, Kaltheuner M, Scheper C, Hübbenet JV, Heckermann S, Reichert D, Hess E, Hess G, Krakow D, Lederle M, Molinski M, Nitzsche G, Reuter HM, Simonsohn M, Heinemann L, Faber-Heinemann G. Evaluierung der Morbiditäten und Co-Morbiditäten von Patienten mit Diabetes, die in diabetologischen Schwerpunkt-Praxen behandelt werden. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Hess G, Hess E, Weber D, Scheper C, Kaltheuner M, Molinski M, Krakow D, Reuter HM, Nitzsche G, Simonsohn M, Lederle M, Hübbenet JV, Faber-Heinemann G, Heinemann L. Charakteristika von 833 Patienten, die neu mit GLP-1-Analoga oder DPP-IV Inhibitoren in 38 Diabetes-Schwerpunktpraxen therapiert werden. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hübbenet JV, Weber D, Kaltheuner M, Krakow D, Molinski M, Scheper N, Simonsohn M, Faber-Heinemann G, Heinemann L. Umfang der Kommunikation bei der Schnittstelle Hausarzt – Diabetologische Schwerpunktpraxis: Vergleich von DMP-Patienten vs. Nicht-DMP-Patienten. DIABETOL STOFFWECHS 2010. [DOI: 10.1055/s-0030-1253939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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20
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Winer N, Kyndt F, Paumier A, David A, Isidor B, Quentin M, Jouitteau B, Sanyas P, Philippe HJ, Hernandez A, Krakow D, Le Caignec C. Prenatal diagnosis of Larsen syndrome caused by a mutation in the filamin B gene. Prenat Diagn 2009; 29:172-4. [PMID: 19085972 DOI: 10.1002/pd.2164] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- N Winer
- CHU de Nantes, Service de Gynécologie Obstétrique, Nantes, France
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Bicknell LS, Morgan T, Bonafé L, Wessels MW, Bialer MG, Willems PJ, Cohn DH, Krakow D, Robertson SP. Mutations in FLNB cause boomerang dysplasia. J Med Genet 2006; 42:e43. [PMID: 15994868 PMCID: PMC1736093 DOI: 10.1136/jmg.2004.029967] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Boomerang dysplasia (BD) is a perinatal lethal osteochondrodysplasia, characterised by absence or underossification of the limb bones and vertebrae. The BD phenotype is similar to a group of disorders including atelosteogenesis I, atelosteogenesis III, and dominantly inherited Larsen syndrome that we have recently shown to be associated with mutations in FLNB, the gene encoding the actin binding cytoskeletal protein, filamin B. We report the identification of mutations in FLNB in two unrelated individuals with boomerang dysplasia. The resultant substitutions, L171R and S235P, lie within the calponin homology 2 region of the actin binding domain of filamin B and occur at sites that are evolutionarily well conserved. These findings expand the phenotypic spectrum resulting from mutations in FLNB and underline the central role this protein plays during skeletogenesis in humans.
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Steiner C, Ehtesham N, Taylor KD, Sebald E, Cantor R, King LM, Guo X, Hang T, Hu MS, Cui JR, Friedman B, Norato D, Allanson J, Honeywell C, Mettler G, Field F, Lachman R, Cohn DH, Krakow D. A locus for spondylocarpotarsal synostosis syndrome at chromosome 3p14. J Med Genet 2004; 41:266-9. [PMID: 15060099 PMCID: PMC1735744 DOI: 10.1136/jmg.2003.012252] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Spondylocarpotarsal synostosis syndrome is a rare autosomal recessive disorder characterised by vertebral fusions, frequently manifesting as an unsegmented vertebral bar, as well as fusions of the carpal and tarsal bones. In a study of three consanguineous families and one non-consanguineous family, linkage analysis was used to establish the chromosomal location of the disease gene. Linkage analysis localised the disease gene to chromosome 3p14. A maximum lod score of 6.49 (q = 0) was obtained for the marker at locus D3S3532 on chromosome 3p. Recombination mapping narrowed the linked region to the 5.7 cM genetic interval between the markers at loci D3S3724 and D3S1300. A common region of homozygosity was found between the markers at loci D3S3724 and D3S1300, defining a physical interval of approximately 4 million base pairs likely to contain the disease gene. Identification of the gene responsible for this disorder will provide insight into the genes that play a role in the formation of the vertebral column and joints.
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Affiliation(s)
- C Steiner
- Medical Genetics Department, Medical Sciences School, State University of Campinas, Campinas, São Paulo, Brazil
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23
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Earl D, Kreutzman J, Field F, Krakow D, Wilcox W, Rimoin D, Lachman R, Graham J. 123 LARSEN SYNDROME CLINICAL AND RADIOGRAPHIC DELINEATION. J Investig Med 2004. [DOI: 10.1136/jim-52-suppl1-123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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24
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Krakow D, Williams J, Poehl M, Rimoin DL, Platt LD. Use of three-dimensional ultrasound imaging in the diagnosis of prenatal-onset skeletal dysplasias. Ultrasound Obstet Gynecol 2003; 21:467-472. [PMID: 12768559 DOI: 10.1002/uog.111] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Recognition of prenatal-onset skeletal dysplasias has improved with advances in ultrasound imaging. Skeletal abnormalities can be recognized by two-dimensional (2D) ultrasound, but generating a precise diagnosis can be challenging. We aimed to determine whether three-dimensional (3D) imaging conferred any advantages over 2D imaging in these cases. METHODS We studied five women with fetuses of 16-28 gestational weeks referred for abnormal ultrasound skeletal findings. First 2D and then 3D sonography was performed and the results compared. RESULTS The pregnancies resulted in the following skeletal dysplasias: thanatophoric dysplasia, achondrogenesis II/hypochondrogenesis, achondroplasia, chondrodysplasia punctata (rhizomelic form) and Apert's syndrome. For all five fetuses, the correct diagnosis was made in the prenatal period by analysis of the 2D images. In each case the 3D images confirmed the preliminary diagnosis and for many findings it improved the visualization of the abnormalities. CONCLUSION The 3D imaging had advantages over the 2D imaging when it came to evaluation of facial dysmorphism, relative proportion of the appendicular skeletal elements and the hands and feet. Most importantly, the patient and referring physician appreciated the 3D images of the abnormal findings more readily which aided in counseling and management of the pregnancy.
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Affiliation(s)
- D Krakow
- Department of Obstetrics and Gynecology, Ahmanson Department of Pediatrics, Burns and Allen Cedars-Sinai Research Institute, Los Angeles, California, USA.
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25
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Abstract
We report the isolation, genomic structure, chromosomal location, and expression pattern of the FEM1A gene, the human ortholog of the Caenorhabditis elegans fem-1 and mouse Fem1a genes. The coding sequence is 1851 bp and encodes a 617 amino acid protein. The human FEM1A protein has 65% identity with the mouse Fem1a protein and 34% identity with the C. elegans fem-1 protein, indicating conservation of this protein. The N-terminal region of the encoded protein contains six ankyrin repeat elements, a motif found in signaling and transcriptional regulatory molecules such as Notch and glp1. The gene was highly expressed in human kidney and cardiac tissue, and was expressed at lower levels in multiple tissues, including cartilage. FEM1A was localized to chromosome 5q23.1, a region of conserved synteny with a portion of mouse chromosome 17 that contains Fem1a. In C. elegans, fem-1 is involved in a pathway necessary for sex determination. The identification of a human homolog of this conserved gene suggests a potential role for this sex-determining molecule in humans.
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MESH Headings
- Amino Acid Sequence
- Animals
- Blotting, Northern
- Caenorhabditis elegans/genetics
- Caenorhabditis elegans Proteins
- Cell Cycle Proteins/genetics
- Chromosome Mapping
- Chromosomes, Human, Pair 5/genetics
- DNA, Complementary/chemistry
- DNA, Complementary/genetics
- DNA, Complementary/isolation & purification
- Exons
- Female
- Gene Expression
- Genes/genetics
- Humans
- Introns
- Mice
- Molecular Sequence Data
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Radiation Hybrid Mapping
- Sequence Alignment
- Sequence Analysis, DNA
- Sequence Homology, Amino Acid
- Tissue Distribution
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Affiliation(s)
- D Krakow
- Department of Obstetrics and Gynecology, Burns and Allen Cedars-Sinai Research Institute, Los Angeles, CA, USA.
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26
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Unger S, Korkko J, Krakow D, Lachman RS, Rimoin DL, Cohn DH. Double heterozygosity for pseudoachondroplasia and spondyloepiphyseal dysplasia congenita. Am J Med Genet 2001; 104:140-6. [PMID: 11746045 DOI: 10.1002/ajmg.10062] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Pseudoachondroplasia (PSACH) and spondyloepiphyseal dysplasia congenita (SEDC) are autosomal dominant forms of short-limb short stature caused by mutations in genes that encode structural components of the cartilage extracellular matrix. PSACH results from mutations in the cartilage oligomeric matrix protein (COMP) gene, while SEDC is caused by mutations in the gene for type II procollagen (COL2A1). We report a child with a distinct skeletal dysplasia due to the combined phenotypes of PSACH and SEDC. The proband's mother had PSACH and his father had SEDC. The child was suspected of having both phenotypes on the basis of the severity of his clinical and radiographic findings, and this was confirmed by molecular analysis. The COMP gene mutation (C348R), while not previously published, is typical of those in PSACH patients, whereas the COL2A1 mutation (T1370M) is somewhat atypical, as it predicts an amino acid change within the carboxyl-terminal region of the protein. Both mutations segregated with their respective phenotypes within this family. The description and natural history of the double heterozygote phenotype may be useful in counseling families regarding risk and prognosis.
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Affiliation(s)
- S Unger
- Ahmanson Department of Pediatrics, Cedars-Sinai Research Institute, Los Angeles, California 90048, USA
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27
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Krakow D, Santulli T, Platt LD. Use of three-dimensional ultrasonography in differentiating craniosynostosis from severe fetal molding. J Ultrasound Med 2001; 20:427-431. [PMID: 11316322 DOI: 10.7863/jum.2001.20.4.427] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- D Krakow
- Department of Obstetrics and Gynecology and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
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28
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Graham JM, Krakow D, Tolo VT, Smith AK, Lachman RS. Radiographic findings and Gs-alpha bioactivity studies and mutation screening in acrodysostosis indicate a different etiology from pseudohypoparathyroidism. Pediatr Radiol 2001; 31:2-9. [PMID: 11200992 DOI: 10.1007/s002470000355] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Acrodysostosis is an uncommon skeletal dysplasia associated with nasal hypoplasia, midface deficiency, severe brachydactyly, and varying degrees of hearing loss and mental retardation. Previous publications have suggested that it may be difficult to distinguish acrodystostosis from pseudohypoparathyroidism on clinical grounds, but acrodysostosis does appear to have distinct clinical and radiologic findings. Spinal stenosis is an underappreciated risk in acrodysostosis, despite the reported loss of normal caudal widening of the lumbar interpediculate distance on AP spine radiographs in the original report of this disorder by Robinow et al., with confirmation of these radiographic findings by Butler et al. We report two sporadic cases of acrodysostosis, one of which required decompressive laminectomy for symptomatic spinal stenosis, and review 11 cases of acrodysostosis from 9 families that were submitted to the International Skeletal Dysplasia Registry. The objective of this report is to determine the frequency and severity of spinal stenosis in patients with acrodysostosis and to summarize the clinical and radiographic findings of acrodysostosis in an effort to distinguish acrodysostosis clearly from pseudohypoparathyroidism. The pattern of brachydactyly differs between these two conditions, and varying degrees of spinal stenosis are characteristic of acrodysostosis. Both our index patients with acrodysostosis had normal bioactivity of the alpha subunit of the Gs protein, therefore indicating that acrodysostosis has a different pathogenesis from pseudohypoparathyroidism. Furthermore, single-strand confirmational polymorphism (SSCP) analysis failed to demonstrate any confirmational alterations in the coding exons of the Gs alpha gene. These radiographic and laboratory findings substantiate that acrodysostosis is clinically different from pseudohypoparathyroidism and that it is necessary to follow patients with acrodysostosis for signs of spinal stenosis.
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Affiliation(s)
- J M Graham
- Division of Clinical Genetics Birth Defects Center, Medical Genetics Birth Defects Center, International Skeletal Dysplasia Registry, UCLA School of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Krakow D, Salazar D, Wilcox WR, Rimoin DL, Cohn DH. Exclusion of the Ellis-van Creveld region on chromosome 4p16 in some families with asphyxiating thoracic dystrophy and short-rib polydactyly syndromes. Eur J Hum Genet 2000; 8:645-8. [PMID: 10951528 DOI: 10.1038/sj.ejhg.5200507] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Ellis-van Creveld syndrome (EVC) is a relatively rare, usually non-lethal, autosomal recessive skeletal dysplasia characterized by short stature, polydactyly, cardiac and renal anomalies. Linkage analysis has localized the disease gene to chromosome 4p16, with the markers at loci D4S827 and D4S3135 defining the centromeric and telomeric limits of the linked interval, respectively. There has been long-term speculation that asphyxiating thoracic dystrophy (ATD) and the short-rib polydactyly syndromes (SRP) represent the severe end of the EVC disease spectrum. We performed linkage analysis using markers from the EVC region in seven families manifesting either ATD or SRP type III. In two of the families, one segregating ATD and one SRP kindred, linkage of the phenotype to the EVC region was excluded. In the other five families linkage of the phenotype to the EVC region could not be excluded, but the families were too small for linkage to the region to be established. The exclusion of the EVC region in ATD and SRP III families suggests that locus heterogeneity exists within the short-rib dysplasia (with and without polydactyly) group of disorders.
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Affiliation(s)
- D Krakow
- Ahmanson Department of Pediatrics, Steven Spielberg Pediatric Research Center, Los Angeles, CA, USA.
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Snijders RJ, Platt LD, Greene N, Carlson D, Krakow D, Gregory K, Bradley K. Femur length and trisomy 21: impact of gestational age on screening efficiency. Ultrasound Obstet Gynecol 2000; 16:142-145. [PMID: 11117083 DOI: 10.1046/j.1469-0705.2000.00198.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE This study assesses two methods used to define relatively short femur in screening for trisomy 21 and examines changes in performance of screening with gestational age. DESIGN Retrospective analysis of data on menstrual age, femur length (FL) and biparietal diameter (BPD) in 49 trisomy 21 pregnancies and 6069 normal controls. Reference ranges were derived for BPD/FL versus menstrual age and for FL versus BPD. Two methods of defining short femur (BPD/FL and observed-to-expected FL ratio) were examined for false-positive rates and detection rates for trisomy 21 at different gestational ages. RESULTS In the control group the BPD/FL ratio and its standard deviation decreased with menstrual age. Trisomy 21 was associated with a significantly higher BPD/FL ratio (P < 0.001) and the deviation increased significantly with menstrual age (P < 0.05). Eleven percent of 28 fetuses examined at 15-17 weeks had a BPD/FL above the 95th centile compared with 24% of 21 fetuses examined at 18-20 weeks (P = 0.40). The median observed-to-expected FL ratio in the control group was 1.0 throughout the gestational age range but the standard deviation decreased significantly with menstrual age (P < 0.01). Trisomy 21 was associated with a significantly reduced observed-to-expected FL ratio (P < 0.001) and the deviation increased significantly with menstrual age (P < 0.05). A fixed cut-off of 0.91 for observed-to-expected FL ratio provided a false-positive rate of 12% at 15-17 weeks compared with 6% at 18-20 weeks of gestation (P < 0.001) with detection rates of 29 and 38%, respectively (P = 0.73). CONCLUSION Irrespective of the definition used to define the condition, relatively short femur is a poor marker for trisomy 21 particularly when the assessment takes place before 18 weeks of gestation.
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Affiliation(s)
- R J Snijders
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Cedars-Sinai Medical Center Burns & Allen Research Institute, UCLA School of Medicine, Los Angeles, CA, USA
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31
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Abstract
The COL2A1 gene was assayed for mutations in genomic DNA from 12 patients with achondrogenesis type II/hypochondrogenesis. The exons and flanking sequences of the 54 exons in the COL2A1 gene were amplified by a series of specific primers using PCR. The PCR products were scanned for mutations by conformation sensitive gel electrophoresis, and PCR products that generated heteroduplex bands were then sequenced. Mutations in the COL2A1 gene were found in all 12 patients. Ten of the mutations were single base substitutions that converted a codon for an obligate glycine to a codon for an amino acid with a bulkier side chain. One of the mutations was a change in a consensus RNA splice site. Another was an 18-base pair deletion of coding sequences. The results confirmed previous indications that conformation sensitive gel electrophoresis is highly sensitive for detection of mutations in large and complex genes. They also demonstrate that most, if not all, patients with achondrogenesis type II/hypochondrogenesis have mutations in the COL2A1 gene.
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Affiliation(s)
- J Körkkö
- Center for Gene Therapy, MCP Hahnemann University, Philadelphia, Pennsylvania, USA
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32
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Colige A, Sieron AL, Li SW, Schwarze U, Petty E, Wertelecki W, Wilcox W, Krakow D, Cohn DH, Reardon W, Byers PH, Lapière CM, Prockop DJ, Nusgens BV. Human Ehlers-Danlos syndrome type VII C and bovine dermatosparaxis are caused by mutations in the procollagen I N-proteinase gene. Am J Hum Genet 1999; 65:308-17. [PMID: 10417273 PMCID: PMC1377929 DOI: 10.1086/302504] [Citation(s) in RCA: 292] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Ehlers-Danlos syndrome (EDS) type VIIC is a recessively inherited connective-tissue disorder, characterized by extreme skin fragility, characteristic facies, joint laxity, droopy skin, umbilical hernia, and blue sclera. Like the animal model dermatosparaxis, EDS type VIIC results from the absence of activity of procollagen I N-proteinase (pNPI), the enzyme that excises the N-propeptide of type I and type II procollagens. The pNPI enzyme is a metalloproteinase containing properdin repeats and a cysteine-rich domain with similarities to the disintegrin domain of reprolysins. We used bovine cDNA to isolate human pNPI. The human enzyme exists in two forms: a long version similar to the bovine enzyme and a short version that contains the Zn++-binding catalytic site but lacks the entire C-terminal domain in which the properdin repeats are located. We have identified the mutations that cause EDS type VIIC in the six known affected human individuals and also in one strain of dermatosparactic calf. Five of the individuals with EDS type VIIC were homozygous for a C-->T transition that results in a premature termination codon, Q225X. Four of these five patients were homozygous at three downstream polymorphic sites. The sixth patient was homozygous for a different transition that results in a premature termination codon, W795X. In the dermatosparactic calf, the mutation is a 17-bp deletion that changes the reading frame of the message. These data provide direct evidence that EDS type VIIC and dermatosparaxis result from mutations in the pNPI gene.
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Affiliation(s)
- A Colige
- Laboratory of Connective Tissues Biology, University of Liège, Liège, Belgium
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Gong Y, Krakow D, Marcelino J, Wilkin D, Chitayat D, Babul-Hirji R, Hudgins L, Cremers CW, Cremers FP, Brunner HG, Reinker K, Rimoin DL, Cohn DH, Goodman FR, Reardon W, Patton M, Francomano CA, Warman ML. Heterozygous mutations in the gene encoding noggin affect human joint morphogenesis. Nat Genet 1999; 21:302-4. [PMID: 10080184 DOI: 10.1038/6821] [Citation(s) in RCA: 230] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The secreted polypeptide noggin (encoded by the Nog gene) binds and inactivates members of the transforming growth factor beta superfamily of signalling proteins (TGFbeta-FMs), such as BMP4 (ref. 1). By diffusing through extracellular matrices more efficiently than TGFbeta-FMs, noggin may have a principal role in creating morphogenic gradients. During mouse embryogenesis, Nog is expressed at multiple sites, including developing bones. Nog-/- mice die at birth from multiple defects that include bony fusion of the appendicular skeleton. We have identified five dominant human NOG mutations in unrelated families segregating proximal symphalangism (SYM1; OMIM 185800) and a de novo mutation in a patient with unaffected parents. We also found a dominant NOG mutation in a family segregating multiple synostoses syndrome (SYNS1; OMIM 186500); both SYM1 and SYNS1 have multiple joint fusion as their principal feature. All seven NOG mutations alter evolutionarily conserved amino acid residues. The findings reported here confirm that NOG is essential for joint formation and suggest that NOG requirements during skeletogenesis differ between species and between specific skeletal elements within species.
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Affiliation(s)
- Y Gong
- Department of Genetics and Center for Human Genetics, Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Ohio, USA
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Faiyaz ul Haque M, King LM, Krakow D, Cantor RM, Rusiniak ME, Swank RT, Superti-Furga A, Haque S, Abbas H, Ahmad W, Ahmad M, Cohn DH. Mutations in orthologous genes in human spondyloepimetaphyseal dysplasia and the brachymorphic mouse. Nat Genet 1998; 20:157-62. [PMID: 9771708 DOI: 10.1038/2458] [Citation(s) in RCA: 154] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The osteochondrodysplasias are a genetically heterogeneous group of disorders affecting skeletal development, linear growth and the maintenance of cartilage and bone. We have studied a large inbred Pakistani family with a distinct form of recessively inherited spondyloepimetaphyseal dysplasia (SEMD) and mapped a gene associated with this dwarfing condition to chromosome 10q23-24, a region syntenic with the locus for the brachymorphic mutation on mouse chromosome 19. We identified two orthologous genes, ATPSK2 and Atpsk2, encoding novel ATP sulfurylase/APS kinase orthologues in the respective regions of the human and mouse genomes. We characterized a nonsense mutation in ATPSK2 in the SEMD family and a missense mutation in the region of Atpsk2 encoding the APS kinase activity in the brachymorphic mouse. ATP sulfurylase/APS kinase catalyses the metabolic activation of inorganic sulfate to PAPS, the universal donor for post-translational protein sulfation in all cell types. The cartilage-specificity of the human and mouse phenotypes provides further evidence of the critical role of sulfate activation in the maturation of cartilage extracellular matrix molecules and the effect of defects in this process on the architecture of cartilage and skeletogenesis.
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Affiliation(s)
- M Faiyaz ul Haque
- Ahmanson Department of Pediatrics, Steven Spielberg Pediatric Research Center, Cedars-Sinai Research Institute, Los Angeles, California 90048, USA
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35
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Ahmad M, Faiyaz Ul Haque M, Ahmad W, Abbas H, Haque S, Krakow D, Rimoin DL, Lachman RS, Cohn DH. Distinct, autosomal recessive form of spondyloepimetaphyseal dysplasia segregating in an inbred Pakistani kindred. Am J Med Genet 1998; 78:468-73. [PMID: 9714015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We describe a large inbred kindred from a remote area of Pakistan, comprising eight generations, with a distinct form of spondyloepimetaphyseal dysplasia (SEMD). We evaluated 16 affected individuals: 11 males and 5 females. Analysis of the pedigree strongly suggests autosomal recessive inheritance, and consanguineous loops could account for all the affected individuals being homozygous for the abnormal allele. The clinical findings included short stature evident at birth, short bowed lower limbs, mild brachydactyly, kyphoscoliosis, an abnormal gait, enlarged knee joints, precocious osteoarthropathy, and normal intelligence. Radiographs demonstrated delayed epiphyseal ossification at the hips and knees, platyspondyly with irregular end plates and narrowed joint spaces, diffuse, early osteoarthritic changes, primarily in the spine and hands, and mild brachydactyly. Mild metaphyseal abnormalities were seen predominantly at hips and knees. This distinctive phenotype is distinct from other autosomal recessive forms of SEMD because of the mild degree of metaphyseal involvement, the type of brachydactyly, and the absence of loose joints or other clinical findings.
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Affiliation(s)
- M Ahmad
- Department of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
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Wilcox WR, Tavormina PL, Krakow D, Kitoh H, Lachman RS, Wasmuth JJ, Thompson LM, Rimoin DL. Molecular, radiologic, and histopathologic correlations in thanatophoric dysplasia. Am J Med Genet 1998; 78:274-81. [PMID: 9677066 DOI: 10.1002/(sici)1096-8628(19980707)78:3<274::aid-ajmg14>3.0.co;2-c] [Citation(s) in RCA: 115] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Various mutations in the fibroblast growth factor receptor 3 (FGFR3) gene have recently been reported in thanatophoric dysplasia (TD). We examined the clinical, radiographic, and histologic findings in 91 cases from the International Skeletal Dysplasia Registry and correlated them with the specific FGFR3 mutation. Every case of TD examined had an identifiable FGFR3 mutation. Radiographically, all of the cases with the Lys650Glu substitution demonstrated straight femora with craniosynostosis, and frequently a cloverleaf skull (CS) was demonstrated. In all other cases, the femora were curved, and CS was infrequently present but was occasionally as severe as TD with the Lys650Glu substitution. Histopathologically, all of the cases shared similar abnormalities, but cases with the Lys650Glu substitution had better preservation of the growth plate. Cases with the Tyr373Cys substitution tended to have more severe radiographic manifestations than the Arg248Cys cases, but there was overlap in the phenotypic spectrum between them. One common classification of TD distinguishes affected infants based on the presence or absence of CS. In contrast, and as originally proposed by Langer et al. [1987: Am J Med Genet 3: 167-179], our data suggest that TD can be divided into at least two groups (TD1 and TD2) based on the presence of straight or curved femora. The variable presence of CS and severity of the radiologic and histologic findings in the other substitutions may be due to other genetic, environmental, or stochastic factors.
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Affiliation(s)
- W R Wilcox
- Medical Genetics Birth Defects Center, Steven Spielberg Pediatrics Research Center, Cedars-Sinai Burns and Allen Research Institute, Los Angeles, California 90048, USA.
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Krakow D, Reinker K, Powell B, Cantor R, Priore MA, Garber A, Lachman RS, Rimoin DL, Cohn DH. Localization of a multiple synostoses-syndrome disease gene to chromosome 17q21-22. Am J Hum Genet 1998; 63:120-4. [PMID: 9634519 PMCID: PMC1377242 DOI: 10.1086/301921] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Multiple synostoses syndrome is an autosomal dominant disorder characterized by premature onset of joint fusions, which initially affect the interphalangeal joints, by characteristic facies, and by deafness. We performed linkage analysis on a large Hawaiian family with multiple synostoses syndrome. Because another autosomal dominant disorder, proximal symphalangism, shares some clinical symptoms with multiple synostoses syndrome and has been linked to markers at loci at chromosome 17q21-22, we tested the hypothesis that multiple synostoses syndrome is linked to the same chromosomal region. Using polymorphic markers from the proximal symphalangism interval, we conducted linkage analysis and showed that the multiple synostoses-syndrome phenotype is linked to the same chromosomal region. A maximum LOD score of 3.98 at recombination fraction of .00 was achieved for the marker at locus D17S787. Further genetic analysis identified individuals with recombinant genotypes, allowing localization of the disease gene within the interval D17S931-D17S792, a 16-cM region. These data provide evidence that multiple synostoses syndrome and proximal symphalangism may be allelic disorders.
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Affiliation(s)
- D Krakow
- Ahmanson Department of Pediatrics, University of California Los Angeles, School of Medicine, Los Angeles, CA, USA
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Krakow D, Greenspoon JS, Firestein GS. Relapsing polychondritis and pregnancy: normal fetal outcome despite maternal flares. J Clin Rheumatol 1996; 2:118. [PMID: 19078043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Abstract
A case of a pregnant woman with membranous glomerulonephropathy requiring hemodialysis is described. During hemodialysis the patient underwent Doppler flow studies of the uterine and umbilical arteries. In spite of avoidance of hypotension and major fluid shifts, hemodialysis was accompanied by a significant increase in the systolic/diastolic ratio of the proximal uterine artery. There was no significant change in the umbilical artery systolic/diastolic ratio.
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Affiliation(s)
- D Krakow
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA 90048
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Abstract
Ovarian cancer continues to be the foremost cause of mortality because of gynecologic malignancies. Surgical and chemotherapeutic advances have been made, yet the cause of ovarian oncogenesis is poorly understood. Recognition of the familial clustering has focused investigators in the direction of isolating genetic susceptibility loci for ovarian cancer. Research on cytogenetic abnormalities have led to the identification of oncogenes and tumor suppressor genes, which have contributed to a multistep model of molecular oncogenesis. This review discusses how the familial clustering of breast and ovarian cancers, as well as the chromosomal alterations and oncogenes identified, have all contributed to our understanding of the genetic factors involved in the development of ovarian cancer.
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Affiliation(s)
- B Y Karlan
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
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Allen R, Castro L, Arora C, Krakow D, Huang S, Platt L. Endothelium-derived relaxing factor inhibition and the pressor response to norepinephrine in the pregnant rat. Obstet Gynecol 1994; 83:92-6. [PMID: 8272316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To determine whether endothelium-derived relaxing factor (EDRF) plays a role in the blunted pressor response to norepinephrine that is characteristic of normal pregnancy. METHODS Eleven pregnant (mean +/- standard error of the mean 18 +/- 1 days of gestation) and 11 virgin conscious, unrestrained Sprague-Dawley rats with long-term indwelling vascular catheters were studied. Mean arterial pressure (MAP) and heart rate were measured in response to continuous infusions of either vehicle (5% dextrose) or increasing concentrations of norepinephrine (25, 100, and 200 ng/kg/minute) before and after administration of NG-monomethyl-L-arginine (LNMMA), a specific inhibitor of EDRF synthesis. RESULTS Baseline MAP was lower in pregnant than in virgin rats (96 +/- 3 versus 105 +/- 3 mmHg; P < .05). Before LNMMA administration, the pregnant rats exhibited a significantly blunted pressor response to increasing concentrations of norepinephrine compared to that of virgin rats (P < .005). Given alone, LNMMA produced a greater increase in baseline MAP in virgin rats than in pregnant rats (rise in MAP of 44 +/- 2 versus 31 +/- 2 mmHg; P < .001). However, LNMMA abolished the blunted pressor response to norepinephrine in the pregnant animals and did not significantly affect the pressor response to norepinephrine in virgin rats. Heart rate responses to increasing concentrations of norepinephrine in the presence and absence of LNMMA were not significantly different in the two groups of animals. CONCLUSION Stimulated EDRF production may contribute to the blunted pressor response to norepinephrine characteristic of pregnancy in the rat.
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Affiliation(s)
- R Allen
- Department of Obstetrics and Gynecology, Cedars-Sinai Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
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Binstock M, Krakow D, Stamler J, Reiff J, Persky V, Liu K, Moss D. Coffee and pancreatic cancer: an analysis of international mortality data. Am J Epidemiol 1983; 118:630-40. [PMID: 6637990 DOI: 10.1093/oxfordjournals.aje.a113674] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
This study assessed the relationship of per capita coffee imports and consumption, total dietary fat, saturated fat, cholesterol, tobacco, cigarettes, and national income for 1957-1965 to age-adjusted pancreatic cancer death rates of men and women from 22 countries in 1971-1974. With simple correlation analysis, coffee, total dietary fat, saturated fat, and national income were each significantly correlated with both male and female pancreatic cancer mortality. Bivariate partial correlation coefficients of coffee with pancreatic cancer mortality were significant (one-tailed) in 11 of 12 analyses and borderline significant in two-way analyses of variance (ANOVA) (two-tailed) controlling for each of the other variables. Saturated fat and pancreatic cancer were also significantly related in univariate analyses, and in 11 of 12 bivariate partial correlation analyses; in ANOVA, significance was borderline in 10 of 12 analyses. Total fat and pancreatic mortality were also significantly associated in most of the univariate and bivariate correlation analyses, but not in the two-way analyses of variance. The findings of this study are consistent with the hypothesis that coffee and dietary lipid are involved in the etiology of pancreatic cancer.
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