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Strong TV, Miller JL, McCandless SE, Gevers E, Yanovski JA, Matesevac L, Bohonowych J, Ballal S, Yen K, Hirano P, Cowen NM, Bhatnagar A. Behavioral changes in patients with Prader-Willi syndrome receiving diazoxide choline extended-release tablets compared to the PATH for PWS natural history study. J Neurodev Disord 2024; 16:22. [PMID: 38671361 PMCID: PMC11046911 DOI: 10.1186/s11689-024-09536-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Prader-Willi syndrome (PWS) is a rare neurobehavioral-metabolic disease caused by the lack of paternally expressed genes in the chromosome 15q11-q13 region, characterized by hypotonia, neurocognitive problems, behavioral difficulties, endocrinopathies, and hyperphagia resulting in severe obesity if energy intake is not controlled. Diazoxide choline extended-release (DCCR) tablets have previously been evaluated for their effects on hyperphagia and other behavioral complications of people with PWS in a Phase 3 placebo-controlled study of participants with PWS, age 4 and older with hyperphagia (C601) and in an open label extension study, C602. METHODS To better understand the longer-term impact of DCCR, a cohort from PATH for PWS, a natural history study that enrolled participants with PWS age 5 and older, who met the C601 age, weight and baseline hyperphagia inclusion criteria and had 2 hyperphagia assessments ≥ 6 months apart, were compared to the C601/C602 cohort. Hyperphagia was measured using the Hyperphagia Questionnaire for Clinical Trials (HQ-CT, range 0-36). The primary analysis used observed values with no explicit imputation of missing data. A sensitivity analysis was conducted in which all missing HQ-CT assessments in the C601/C602 cohort were assigned the highest possible value (36), representing the worst-case scenario. Other behavioral changes were assessed using the Prader-Willi Syndrome Profile questionnaire (PWSP). RESULTS Relative to the PATH for PWS natural history study cohort, the DCCR-treated C601/C602 cohort showed significant improvements in HQ-CT score at 26 weeks (LSmean [SE] -8.3 [0.75] vs. -2.5 [0.43], p < 0.001) and 52 weeks (LSmean [SE] -9.2 [0.77] vs. -3.4 [0.47], p < 0.001). The comparison between the cohorts remained significant in the worst-case imputation sensitivity analysis. There were also significant improvements in all domains of the PWSP at 26 weeks (all p < 0.001) and 52 weeks (all p ≤ 0.003) for C601/C602 participants compared to the PATH for PWS participants. CONCLUSION Long-term administration of DCCR to people with PWS resulted in changes in hyperphagia and other behavioral complications of PWS that are distinct from the natural history of the syndrome as exemplified by the cohort from PATH for PWS. The combined effects of administration of DCCR should reduce the burden of the syndrome on the patient, caregivers and their families, and thereby may benefit people with PWS and their families. TRIAL REGISTRATION Clinical study C601 was originally registered on ClinicalTrials.gov on February 22, 2018 (NCT03440814). Clinical study C602 was originally registered on ClinicalTrials.gov on October 22, 2018 (NCT03714373). PATH for PWS was originally registered on ClinicalTrials.gov on October 24, 2018 (NCT03718416).
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Affiliation(s)
| | - Jennifer L Miller
- University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Shawn E McCandless
- University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, 80045, USA
| | - Evelien Gevers
- Queen Mary University of London and Barts Health NHS Trust - Royal London Children's Hospital, London, E1 1FR, UK
| | - Jack A Yanovski
- US Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Health, Bethesda, MD, 20847, USA
| | - Lisa Matesevac
- Foundation for Prader-Willi Research, Covina, CA, 91723, USA
| | | | | | - Kristen Yen
- Soleno Therapeutics, Redwood City, CA, 94065, USA
| | | | - Neil M Cowen
- Soleno Therapeutics, Redwood City, CA, 94065, USA
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Miller JL, Gevers E, Bridges N, Yanovski JA, Salehi P, Obrynba KS, Felner EI, Bird LM, Shoemaker AH, Angulo M, Butler MG, Stevenson D, Goldstone AP, Wilding J, Lah M, Shaikh MG, Littlejohn E, Abuzzahab MJ, Fleischman A, Hirano P, Yen K, Cowen NM, Bhatnagar A. Diazoxide choline extended-release tablet in people with Prader-Willi syndrome: results from long-term open-label study. Obesity (Silver Spring) 2024; 32:252-261. [PMID: 37919617 DOI: 10.1002/oby.23928] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE This study assessed the effect of 1-year administration of diazoxide choline extended-release tablet (DCCR) on hyperphagia and other complications of Prader-Willi syndrome (PWS). METHODS The authors studied 125 participants with PWS, age ≥ 4 years, who were enrolled in the DESTINY PWS Phase 3 study and who received DCCR for up to 52 weeks in DESTINY PWS and/or its open-label extension. The primary efficacy endpoint was Hyperphagia Questionnaire for Clinical Trials (HQ-CT) score. Other endpoints included behavioral assessments, body composition, hormonal measures, and safety. RESULTS DCCR administration resulted in significant improvements in HQ-CT (mean [SE] -9.9 [0.77], p < 0.0001) and greater improvements in those with more severe baseline hyperphagia (HQ-CT > 22). Improvements were seen in aggression, anxiety, and compulsivity (all p < 0.0001). There were reductions in leptin, insulin, and insulin resistance, as well as a significant increase in adiponectin (all p < 0.004). Lean body mass was increased (p < 0.0001). Disease severity was reduced as assessed by clinician and caregiver (both p < 0.0001). Common treatment-emergent adverse events included hypertrichosis, peripheral edema, and hyperglycemia. Adverse events infrequently resulted in discontinuation (7.2%). CONCLUSIONS DCCR administration to people with PWS was well tolerated and associated with broad-ranging improvements in the syndrome. Sustained administration of DCCR has the potential to reduce disease severity and the burden of care for families.
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Affiliation(s)
- Jennifer L Miller
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Evelien Gevers
- Queen Mary University of London, Barts Health NHS Trust-Royal London Children's Hospital, London, UK
| | | | - Jack A Yanovski
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Parisa Salehi
- Seattle Children's Hospital, Seattle, Washington, USA
| | | | - Eric I Felner
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lynne M Bird
- University of California, San Diego/Rady Children's Hospital, San Diego, California, USA
| | | | - Moris Angulo
- New York University Langone Health, Mineola, New York, USA
| | - Merlin G Butler
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Anthony P Goldstone
- Department of Endocrinology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - John Wilding
- University of Liverpool, Clinical Sciences Centre, Aintree University Hospital, Liverpool, UK
| | - Melissa Lah
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - M Guftar Shaikh
- Royal Hospital for Children, University of Glasgow, Glasgow, UK
| | | | | | | | | | - Kristen Yen
- Soleno Therapeutics, Redwood City, California, USA
| | - Neil M Cowen
- Soleno Therapeutics, Redwood City, California, USA
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Jacobs A, Cifelli P, Delbeck D, Elbarbary N, Gevers E, Sumnik Z, Amaratunga S, Pundziute-Lyckå A, Casteels K. Pigmented hypertrichosis with insulin-dependent diabetes mellitus syndrome: A case series. Horm Res Paediatr 2024:000536019. [PMID: 38163427 DOI: 10.1159/000536019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION Pigmented hypertrichosis with insulin-dependent diabetes mellitus (PHID) syndrome is a rare disease, and part of the cluster Histiocytosis-lymphadenopathy plus syndrome (H syndrome), which is associated with mutations in the SLC29A3 gene. Patients with PHID show clinical features of H syndrome, but also have insulin-dependent diabetes mellitus. The PHID associated diabetes has previously been described as predominantly in absence of pancreatic autoantibodies. Case Series Presentation: Through an open call in two international diabetes registers, clinical and genetic characteristics of 7 PHID patients in 6 treatment centres were collected after informed consent. All of them had consanguinity in their families, and their origins were located in North-African and Middle Eastern regions. 4 out of 7 patients had at least one positive pancreatic autoantibody. DISCUSSION AND CONCLUSION Our case series reveals that PHID exhibits a wide range of clinical symptoms and signs. When consanguinity is present in a patient with newly diagnosed diabetes, and/or if other atypical symptoms such as dysmorphic features, skin lesions, haematological abnormalities and developmental delay are present; threshold for genetic analysis should be low. Moreover, the presence of autoantibodies should not withhold genetic testing, as our case series contradicts the previous observation of predominant auto-antibody absence in PHID.
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Lawrence NR, Bacila I, Dawson J, Mahdi S, Alvi S, Cheetham TD, Crowne E, Das U, Dattani MT, Davies JH, Gevers E, Krone RE, Patel L, Randell T, Ryan FJ, Keevil B, Ahmed SF, Krone NP. Quality of Life in Children and Young People With Congenital Adrenal Hyperplasia-UK Nationwide Multicenter Assessment. J Clin Endocrinol Metab 2023; 109:e336-e346. [PMID: 37439248 DOI: 10.1210/clinem/dgad405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/26/2023] [Accepted: 07/11/2023] [Indexed: 07/14/2023]
Abstract
CONTEXT Quality of life (QoL) has been inconsistently reported in children and young people (CYP) with congenital adrenal hyperplasia (CAH). OBJECTIVE Assess QoL in CYP with CAH in the UK alongside biometric and androgen profiles. DESIGN To define the evidence base for health care delivery, we conducted a cross-sectional study in CYP with CAH in the UK. Questionnaire results were compared with normative data and between groups, and modelled for association with sex, height, weight, body mass index, or steroid biomarkers of CAH control. SETTING Tertiary care in 14 UK centers. PATIENTS Results from 104 patients, 55% female, mean age 12.7 years (SD 3.0), paired responses from parents. INTERVENTIONS Strengths and Difficulties questionnaire (SDQ) and pediatric QoL questionnaire. MAIN OUTCOME MEASURE Total QoL scores as assessed by SDQ and a pediatric QoL questionnaire in comparison to normative data. RESULTS Total scores were worse in parents than normative data, but similar in patients. Patient QoL was rated better in social functioning but worse in emotional, school, and peer domains by patients, and worse in total scores and domains of peer problems, and psychosocial, emotional, and school functioning by parents. Parents consistently scored QoL of their children lower than their child. Larger height-SD score and lower weight-SD score were associated with better QoL. Girls with lower steroid biomarkers had worse SDQ scores. CONCLUSIONS In CYP with CAH, reduced height, increased weight, and hormonal biomarkers consistent with overtreatment were associated with worse QoL; addressing these problems should be prioritized in clinical management.Clinical Trials Registration Number: SCH/15/088.
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Affiliation(s)
| | - Irina Bacila
- Department of Oncology & Metabolism, University of Sheffield, Sheffield S10 2RX, UK
| | - Jeremy Dawson
- Department of Oncology & Metabolism, University of Sheffield, Sheffield S10 2RX, UK
| | - Sundus Mahdi
- Department of Oncology & Metabolism, University of Sheffield, Sheffield S10 2RX, UK
| | - Sabah Alvi
- Department of Paediatric Endocrinology and Diabetes, Leeds Children's Hospital, Leeds LS2 3AX, UK
| | - Timothy D Cheetham
- Department of Paediatric Endocrinology, Great North Children's Hospital, University of Newcastle, Newcastle NE1 4LP, UK
| | - Elizabeth Crowne
- Department of Paediatric Endocrinology & Diabetes, Bristol Royal Hospital for Children, University Hospitals Bristol Foundation Trust, Bristol BS2 8BJ, UK
| | - Urmi Das
- Department of Paediatric Endocrinology, Alder Hey Children's Hospital, Liverpool L14 5AB, UK
| | - Mehul Tulsidas Dattani
- Department of Paediatric Endocrinology and Diabetes, Great Ormond Street Hospital, London WC1N 1LE, UK
| | - Justin H Davies
- Department of Paediatric Endocrinology, University Hospital Southampton, Southampton SO16 6YD, UK
- Department of Human Development & Health, University of Southampton, Southampton SO17 1BJ, UK
| | - Evelien Gevers
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University London, London and Barts Health NHS Trust-The Royal London Hospital, London E1 1BB, UK
| | - Ruth E Krone
- Department of Paediatric Endocrinology, Birmingham Women's & Children's Hospital, Birmingham B4 6NH, UK
| | - Leena Patel
- Paediatric Endocrine Service, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - Tabitha Randell
- Department of Paediatric Diabetes and Endocrinology, Nottingham Children's Hospital, Nottingham NG7 2UH, UK
| | - Fiona J Ryan
- Department of Paediatric Endocrinology and Diabetes, Oxford Children's Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Brian Keevil
- Department of Biochemistry, Manchester University NHS Foundation Trust, Manchester M13 9PL, UK
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow G12 8QQ, UK
| | - Nils P Krone
- Department of Oncology & Metabolism, University of Sheffield, Sheffield S10 2RX, UK
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Fou L, Agwu JC, Aswani N, Bakhai C, Gevers E. Glucose monitoring and glucose lowering agents for children and young people with type 2 diabetes: summary of updated NICE guidance. BMJ 2023; 382:1686. [PMID: 37699608 DOI: 10.1136/bmj.p1686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Affiliation(s)
- Linyun Fou
- National Institute for Health and Care Excellence (NICE), Manchester, UK
| | | | - Nivedita Aswani
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield
| | | | - Evelien Gevers
- Barts Health NHS Trust, Royal London Children's Hospital, London
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University of London, London
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Miller JL, Gevers E, Bridges N, Yanovski JA, Salehi P, Obrynba KS, Felner EI, Bird LM, Shoemaker AH, Angulo M, Butler MG, Stevenson D, Abuzzahab J, Barrett T, Lah M, Littlejohn E, Mathew V, Cowen NM, Bhatnagar A. Diazoxide Choline Extended-Release Tablet in People With Prader-Willi Syndrome: A Double-Blind, Placebo-Controlled Trial. J Clin Endocrinol Metab 2023; 108:1676-1685. [PMID: 36639249 PMCID: PMC10271219 DOI: 10.1210/clinem/dgad014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
CONTEXT Prader-Willi syndrome (PWS) is a rare neurobehavioral-metabolic disease caused by the lack of paternally expressed genes in the chromosome 15q11-q13 region, characterized by hypotonia, neurocognitive problems, behavioral difficulties, endocrinopathies, and hyperphagia resulting in severe obesity if not controlled. OBJECTIVE The primary end point was change from baseline in hyperphagia using the Hyperphagia Questionnaire for Clinical Trials (HQ-CT). Other end points included Global Impression Scores, and changes in body composition, behaviors, and hormones. METHODS In DESTINY PWS, a 13-week, randomized, double-blind, placebo-controlled, phase 3 trial, 127 participants with PWS aged 4 years and older with hyperphagia were randomly assigned 2:1 to diazoxide choline extended-release tablet (DCCR) or placebo. RESULTS DCCR did not significantly improve hyperphagia (HQ-CT least-square mean (LSmean) [SE] -5.94 [0.879] vs -4.27 [1.145]; P = .198), but did so in participants with severe hyperphagia (LSmean [SE] -9.67 [1.429] vs -4.26 [1.896]; P = .012). Two of 3 secondary end points were improved (Clinical Global Impression of Improvement [CGI-I]; P = .029; fat mass; P = .023). In an analysis of results generated pre-COVID, the primary (HQ-CT; P = .037) and secondary end points were all improved (CGI-I; P = .015; Caregiver Global Impression of Change; P = .031; fat mass; P = .003). In general, DCCR was well tolerated with 83.3% in the DCCR group experiencing a treatment-emergent adverse event and 73.8% in the placebo group (not significant). CONCLUSION DCCR did not significantly improve hyperphagia in the primary analysis but did in participants with severe baseline hyperphagia and in the pre-COVID analysis. DCCR treatment was associated with significant improvements in body composition and clinician-reported outcomes.
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Affiliation(s)
- Jennifer L Miller
- Department of Pediatric Endocrinology, University of Florida College of Medicine, Gainesville, Florida 32608, USA
| | - Evelien Gevers
- Queen Mary University London, London E1 4NS, UK; Barts Health NHS Trust-Royal London Children's Hospital, London E1 1FR, UK
| | | | - Jack A Yanovski
- US Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Parisa Salehi
- Endocrinology, Seattle Children's Hospital, Seattle, Washington 98105, USA
| | - Kathryn S Obrynba
- Endocrinology, Nationwide Children's Hospital, Columbus, Ohio 43205, USA
| | - Eric I Felner
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia 30322, USA
| | - Lynne M Bird
- University of California, San Diego/Rady's Children's Hospital, San Diego, California 92123, USA
| | | | - Moris Angulo
- NYU Langone Health, Mineola, New York 11501, USA
| | - Merlin G Butler
- University of Kansas Medical Center, Kansas City, Kansas 66160, USA
| | | | | | - Timothy Barrett
- Birmingham Women's and Children's Hospital, Birmingham B15 2TG, UK
| | - Melissa Lah
- Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
| | | | - Verghese Mathew
- Hull and East Yorkshire Hospitals NHS Trust, Hull HU3 2JZ, UK
| | - Neil M Cowen
- Soleno Therapeutics, Redwood City, California 94065, USA
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Abuzzahab J, Angulo M, Bird L, Butler M, Cowen N, Gevers E, Goldstone A, Hirano P, Konczal L, Lah M, Mathew V, Mejia Corletto J, Miller J, Obrynba K, Salehi P, Shaikh MG, Shoemaker A, Stevenson D, Viskochil D, Wilding J, Woloschak M, Yanovski J, Felner E. OR10-2 Hormonal and Cardiometabolic Changes Associated with Diazoxide Choline Extended-Release (DCCR) Tablets in Patients with Prader-Willi Syndrome. J Endocr Soc 2022. [PMCID: PMC9626988 DOI: 10.1210/jendso/bvac150.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Prader-Willi syndrome (PWS) is a rare genetic neurodevelopmental condition, characterized by hyperphagia, obesity, hormone deficiencies and behavioral/psychological manifestations. DCCR is under investigation as a treatment for hyperphagia in PWS through its actions on hypothalamic circuits involved in appetite regulation including NPY neurons and central inhibition of DMV neurons to improve insulin sensitivity. In addition to these effects, DCCR acts on pancreatic beta cells, to reduce glucose stimulated insulin secretion, which might have additional effects to reduce fat deposition in adipocytes, serum leptin concentrations and insulin resistance. Objectives and methods This analysis characterized changes in hormonal and cardiometabolic parameters in patients with PWS receiving oral daily DCCR. 125 participants with genetically-confirmed PWS ≥4 years old with hyperphagia were treated with DCCR in multi-center studies conducted at 29 sites in the US and the UK: a 13-week, Phase 3, double-blind, placebo-controlled study (DESTINY PWS) and its long-term, open-label extension study (analysis at 52 weeks). The target DCCR dose for these studies was ≥3.3 mg/kg with an optimal dose of 4.2 - 5.8 mg/kg. Overall, 103 patients received DCCR (100-525 mg/day) for 52 weeks. For all parameters, the baseline measurement was defined as (immediately prior to) start of DCCR treatment. Results Serum leptin, insulin, and HOMA-IR were significantly reduced following 52 weeks of DCCR administration. Results are expressed as Least square (LS) mean change from baseline [Standard Error (SE)]. There were significant decreases in: Leptin (ng/mL) = -11.08[1.26], p<0.001; Insulin (μIU/mL) = -2.5[0.69], p<0.001; and HOMA-IR = -0.5 [0.17], p=0.003. Serum adiponectin (µg/mL) was significantly increased: 1.82[0.41], p < 0.001. Fat mass measured by DXA was stable at 52 weeks. Conclusions The reductions in fasting leptin, insulin and HOMA-IR, and the increase in adiponectin with prolonged DCCR treatment in the absence of reductions in total body fat are consistent with improved insulin sensitivity that may also reflect improvement in leptin sensitivity and healthier body fat distribution, such as reduced visceral adiposity. This could result from both direct pancreatic and hypothalamus-to-periphery actions of DCCR. It remains to be determined if such beneficial metabolic changes also result in reduced systemic inflammation and cardiovascular health. DCCR administration was associated with significant reductions in leptin, insulin, and HOMA-IR, increases in adiponectin and stabilization of body fat. These and other changes in cardiometabolic parameters suggest that DCCR may have long term health benefit in patients with PWS. Presentation: Sunday, June 12, 2022 11:15 a.m. - 11:30 a.m.
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Bacila I, Lawrence NR, Mahdi S, Alvi S, Cheetham TD, Crowne E, Das U, Dattani MT, Davies JH, Gevers E, Krone RE, Kyriakou A, Patel L, Randell T, Ryan FJ, Keevil B, Ahmed SF, Krone NP. Health status of children and young persons with congenital adrenal hyperplasia in the UK (CAH-UK): a cross-sectional multi-centre study. Eur J Endocrinol 2022; 187:543-553. [PMID: 36001026 PMCID: PMC9513639 DOI: 10.1530/eje-21-1109] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 08/24/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE There is limited knowledge on the onset of comorbidities in congenital adrenal hyperplasia (CAH) during childhood. We aimed to establish the health status of children with CAH in the UK. DESIGN AND METHODS This cross-sectional multicentre study involved 14 tertiary endocrine UK units, recruiting 101 patients aged 8-18 years with classic 21-hydroxylase deficiency and 83 controls. We analysed demographic, clinical and metabolic data, as well as psychological questionnaires (Strengths and Difficulties (SDQ), Paediatric Quality of Life (PedsQL)). RESULTS Patient height SDS in relation to mid-parental height decreased with age, indicating the discrepancy between height achieved and genetic potential height. Bone age was advanced in 40.5% patients, with a mean difference from the chronological age of 1.8 (±2.3) years. Patients were more frequently overweight (27%) or obese (22%) compared to controls (10.8% and 10.8%, respectively, P < 0.001). No consistent relationship between glucocorticoid dose and anthropometric measurements or hormonal biomarkers was detected. A small number of patients had raised total cholesterol (3.0%), low HDL (3.0%), raised LDL (7.0%) and triglycerides (5.0%). SDQ scores were within the 'high' and 'very high' categories of concern for 16.3% of patients. 'School functioning' was the lowest PedsQL scoring dimension with a median (interquartile range) of 70 (55-80), followed by 'emotional functioning' with a median of 75 (65-85). CONCLUSIONS Our results show an increased prevalence of problems with growth and weight gain in CAH children and suggest reduced quality of life. This highlights the urgent need to optimise management and monitoring strategies to improve long-term health outcomes.
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Affiliation(s)
- Irina Bacila
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | | - Sundus Mahdi
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | | | | - Elizabeth Crowne
- Bristol Royal Hospital for Children, University Hospitals Bristol Foundation Trust, Bristol, UK
| | - Urmi Das
- Alder Hey Children’s Hospital, Liverpool, UK
| | | | - Justin H Davies
- University Hospital Southampton, Southampton, UK
- Southampton, United Kingdom University of UK
| | - Evelien Gevers
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University London, London and Barts Health NHS Trust – The Royal London Hospital, London, UK
| | - Ruth E Krone
- Birmingham Women’s & Children’s Hospital, Birmingham, UK
| | - Andreas Kyriakou
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
| | - Leena Patel
- Paediatric Endocrine Service, Royal Manchester Children’s Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Fiona J Ryan
- Oxford Children’s Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Brian Keevil
- Department of Biochemistry, Manchester University NHS Foundation Trust, Manchester, UK
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
| | - Nils P Krone
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Correspondence should be addressed to N P Krone;
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Bunyan DJ, Gevers E, Hobbs JI, Duncan-Flavell PJ, Howarth RJ, Holder-Espinasse M, Klee P, Van-Heurk R, Lemmens L, Carminho-Rodrigues MT, Mohamed Z, Goturu A, Hughes CR, Ajzensztejn M, Thomas NS. Rare dosage abnormalities flanking the SHOX gene. Egypt J Med Hum Genet 2021. [DOI: 10.1186/s43042-021-00209-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Transcriptional regulation of the SHOX gene is highly complex. Much of our understanding has come from the study of copy number changes of conserved non-coding sequences both upstream and downstream of the gene. Downstream deletions have been frequently reported in patients with Leri–Weill dyschondrosteosis or idiopathic short stature. In contrast, there are only four cases in the literature of upstream deletions that remove regulatory elements. Although duplications flanking the SHOX gene have also been reported, their pathogenicity is more difficult to establish. To further evaluate the role of flanking copy number variants in SHOX-related disorders, we describe nine additional patients from a large SHOX diagnostic cohort.
Results
The nine cases presented here include five with duplications (two upstream of SHOX and three downstream), one with a downstream triplication and three with upstream deletions. Two of the deletions remove a single conserved non-coding element (CNE-3) while the third does not remove any known regulatory element but is just 4 kb upstream of SHOX, and the deleted region may be important in limb bud development. We also describe six families with novel sequence gains flanking SHOX. Three families had increased dosage of a proposed regulatory element approximately 380 kb downstream of SHOX (X:970,000), including one family with the first ever reported triplication of this region. One family had two in cis downstream duplications co-segregating with LWD, and the two others had a duplication of just the upstream SHOX regulatory element CNE-5.
Conclusions
This study further extends our knowledge of the range of variants that may potentially cause SHOX-related phenotypes and may aid in determining the clinical significance of similar variants.
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Shankar A, Kurzawinski T, Ross E, Stoneham S, Beale T, Proctor I, Hulse T, Simpson K, Gaze MN, Cattaneo E, Gevers E, Marshall L, Hubbard JG, Brain C. Treatment outcome with a selective RET tyrosine kinase inhibitor selpercatinib in children with multiple endocrine neoplasia type 2 and advanced medullary thyroid carcinoma. Eur J Cancer 2021; 158:38-46. [PMID: 34649088 DOI: 10.1016/j.ejca.2021.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/04/2021] [Revised: 09/03/2021] [Accepted: 09/11/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Medullary thyroid carcinoma (MTC) in the context of multiple endocrine neoplasia type 2 (MEN2) is caused by mutations in the RET proto-oncogene. Therefore, in children with MEN2 and advanced MTC, the RET tyrosine kinase (TK) pathway is a target for treatment with selpercatinib, a selective RET TK inhibitor. PATIENTS AND METHODS A retrospective review of the clinical, genetic, biochemical (calcitonin and carcinoembryonic antigen [CEA]) and imaging data of six medically untreated children with MEN2 and recurrent and or progressive MTC. The main parameters were safety and objective treatment response to selpercatinib. RESULTS Six children (three males and three females, aged 3-12 years), four with MEN2B and two MEN2A, are reported. All had initial total thyroidectomy and extensive neck dissections but subsequently developed recurrent and progressive disease. All experienced an improvement in clinical symptoms with a concomitant biochemical response evidenced by significant fall in serum calcitonin and CEA concentrations. The fall in serum calcitonin was evident within 2 weeks of the start of selpercatinib, and responses were ongoing at a median follow-up of 13 months (range, 11-22 months). Four children with measurable radiological disease had good volume reduction. The most common adverse effects were transient but reversible grade 1 or 2 increase in alanine aminotransferase, serum bilirubin and constipation. No child required a dose modification or had to discontinue selpercatinib because of a drug-related adverse event. CONCLUSION Selpercatinib has shown excellent therapeutic efficacy with minimal toxicity in children with MEN2 and progressive metastatic RET-mutated MTC.
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Affiliation(s)
- Ananth Shankar
- Children and Young People's Cancer Services, University College London Hospitals NHS Foundation Trust, London, UK.
| | - Tom Kurzawinski
- Department of Endocrine Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Emma Ross
- Department of Paediatric Oncology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sara Stoneham
- Children and Young People's Cancer Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tim Beale
- Department of Head and Neck Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ian Proctor
- Department of Cellular Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tony Hulse
- Department of Paediatric Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kate Simpson
- Department of Pharmacy, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mark N Gaze
- Department of Oncology, University College London Hospitals NHS Foundation Trust, National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK
| | - Elene Cattaneo
- Children's and Adolescent Services, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Evelien Gevers
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University of London and Department of Paediatric Endocrinology, Barts Health NHS Trust, London, UK
| | - Lynley Marshall
- Department of Paediatric and Adolescent Oncology, The Royal Marsden NHS Foundation Trust, Sutton and The Institute of Cancer Research, London, UK
| | | | - Caroline Brain
- Department of Paediatric Endocrinology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Hebenstreit D, Ahmed SF, Krone N, Krall C, Bryce J, Alvi S, Ortolano R, Lima M, Birkebaek N, Bonfig W, Claahsen van der Grinten H, Costa EC, Poyrazoglu S, de Vries L, Flück CE, Guran T, Bugrul F, Güven A, Iotova V, Koehler B, Schröder JT, Konrad D, Gevers E, Krone R, Milenkovic T, Vieites A, Ross R, Tadokoro Cuccaro R, Hughes I, Acerini C, Springer A. Surgical Practice in Girls with Congenital Adrenal Hyperplasia: An International Registry Study. Sex Dev 2021; 15:229-235. [PMID: 34350892 DOI: 10.1159/000517055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/29/2021] [Indexed: 11/19/2022] Open
Abstract
In this article international trends in surgical practice in girls with congenital adrenal hyperplasia (CAH) are evaluated. All cases that had been classified in the I-CAH/I-DSD registry as 46,XX CAH and who were born prior to 2017 were identified. Centers were approached to obtain information on surgical decision making. Of the 330 included participants, 208 (63.0%) presented within the first month of life, and 326 (98.8%) cases were assigned female. Genital surgery had been performed in 250 (75.8%). A total of 64.3, 89.2, and 96.8% of cases residing in Europe, South America and Asia, respectively, had at least one surgery. In a logistic regression model for the probability of surgery before the second birthday (early surgery) over time an increase of probability for early vaginal surgery could be identified, but not for clitoral surgery or both surgeries combined. Genitoplasty in girls with CAH remains controversial. This large international study provides a snapshot of current practice and reveals geographical and temporal differences. Fewer surgeries were reported for Europe, and there seems to be a significant trend towards aiming for vaginal surgery within the first 2 years of life.
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Affiliation(s)
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, United Kingdom
| | - Nils Krone
- University of Sheffield, Sheffield, United Kingdom
| | - Christoph Krall
- Center for Medical Statistics, Informatics, and Intelligent Systems, Section for Medical Statistics, Medical University of Vienna, Vienna, Austria
| | - Jillian Bryce
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, United Kingdom
| | - Sabah Alvi
- Paediatric Endocrinology, Leeds Children's Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Rita Ortolano
- Department of Medical and Surgical Sciences, Pediatric Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Mario Lima
- Department of Medical and Surgical Sciences, Pediatric Surgery Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Niels Birkebaek
- Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Walter Bonfig
- Department of Pediatrics TU Munich, Munich, Germany
- Klinikum Wels-Grieskirchen, Wels-Grieskirchen, Austria
| | - Hedi Claahsen van der Grinten
- Department of Paediatric Endocrinology, Radboud University Amalia Childers Hospital Medical Centre, Nijmegen, The Netherlands
| | - Eduardo Correa Costa
- Pediatric Surgery Service, Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, Brazil
| | - Sukran Poyrazoglu
- Istanbul Faculty of Medicine, Department of Paediatrics, Paediatric Endocrinology Unit, Istanbul University, Istanbul, Turkey
| | - Liat de Vries
- The Jesse and Sara Lea Shafer Institute of Endocrinology and Diabetes, Schneider Tel Aviv Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Christa E Flück
- Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics and Department of BioMedical Research, Bern University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Tulay Guran
- Marmara University, Department of Pediatric Endocrinology and Diabetes, Pendik, Istanbul, Turkey
| | - Fuat Bugrul
- Marmara University, Department of Pediatric Endocrinology and Diabetes, Pendik, Istanbul, Turkey
| | - Ayla Güven
- Saglik Bilimleri University Medical Faculty, Zeynep Kamil Women and Children Hospital, Pediatric Endocrinology Clinic, Istanbul, Turkey
| | - Violeta Iotova
- Department of Paediatrics, Medical University-Varna, UMHAT "Sv. Marina", Varna, Bulgaria
| | - Birgit Koehler
- Klinik für Pädiatrische Endokrinologie und Diabetologie, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jennyver-Tabea Schröder
- Klinik für Pädiatrische Endokrinologie und Diabetologie, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Daniel Konrad
- Division of Paediatric Endocrinology and Diabetology, University Children's Hospital, Zurich, Switzerland
| | - Evelien Gevers
- Department of Paediatric Endocrinology, Barts Health NHS Trust, Royal London Hospital, London, United Kingdom
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University London, London, United Kingdom
| | - Ruth Krone
- Birmingham Women's & Children's Hospital, Department for Endocrinology & Diabetes, Birmingham, United Kingdom
| | - Tatjana Milenkovic
- Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Čupić", Belgrade, Serbia
| | - Ana Vieites
- Centro de Investigaciones Endocrinológicas, División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Richard Ross
- University of Sheffield, Sheffield, United Kingdom
| | | | - Ieuan Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Carlo Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Alexander Springer
- Department of Paediatric Surgery, Medical University Vienna, Vienna, Austria
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12
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Bacila I, Freeman N, Daniel E, Sandrk M, Bryce J, Ali SR, Yavas Abali Z, Atapattu N, Bachega TA, Balsamo A, Birkebæk N, Blankenstein O, Bonfig W, Cools M, Costa EC, Darendeliler F, Einaudi S, Elsedfy HH, Finken M, Gevers E, Claahsen-van der Grinten HL, Guran T, Güven A, Hannema SE, Higham CE, Iotova V, van der Kamp HJ, Korbonits M, Krone RE, Lichiardopol C, Luczay A, Mendonca BB, Milenkovic T, Miranda MC, Mohnike K, Neumann U, Ortolano R, Poyrazoglu S, Thankamony A, Tomlinson JW, Vieites A, de Vries L, Ahmed SF, Ross RJ, Krone NP. International practice of corticosteroid replacement therapy in congenital adrenal hyperplasia: data from the I-CAH registry. Eur J Endocrinol 2021; 184:553-563. [PMID: 33460392 DOI: 10.1530/eje-20-1249] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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] [Received: 10/29/2020] [Accepted: 01/15/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Despite published guidelines no unified approach to hormone replacement in congenital adrenal hyperplasia (CAH) exists. We aimed to explore geographical and temporal variations in the treatment with glucocorticoids and mineralocorticoids in CAH. DESIGN This retrospective multi-center study, including 31 centers (16 countries), analyzed data from the International-CAH Registry. METHODS Data were collected from 461 patients aged 0-18 years with classic 21-hydroxylase deficiency (54.9% females) under follow-up between 1982 and 2018. Type, dose and timing of glucocorticoid and mineralocorticoid replacement were analyzed from 4174 patient visits. RESULTS The most frequently used glucocorticoid was hydrocortisone (87.6%). Overall, there were significant differences between age groups with regards to daily hydrocortisone-equivalent dose for body surface, with the lowest dose (median with interquartile range) of 12.0 (10.0-14.5) mg/m2/day at age 1-8 years and the highest dose of 14.0 (11.6-17.4) mg/m2/day at age 12-18 years. Glucocorticoid doses decreased after 2010 in patients 0-8 years (P < 0.001) and remained unchanged in patients aged 8-18 years. Fludrocortisone was used in 92% of patients, with relative doses decreasing with age. A wide variation was observed among countries with regards to all aspects of steroid hormone replacement. CONCLUSIONS Data from the I-CAH Registry suggests international variations in hormone replacement therapy, with a tendency to treatment with high doses in children.
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Affiliation(s)
- Irina Bacila
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Nicole Freeman
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Eleni Daniel
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Marija Sandrk
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Jillian Bryce
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
| | - Salma Rashid Ali
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
| | - Zehra Yavas Abali
- Pediatric Endocrinology and Diabetes, Marmara University, Istanbul, Turkey
| | - Navoda Atapattu
- Pediatric Endocrinology, Lady Ridgeway Hospital, Colombo, Sri Lanka
| | - Tania A Bachega
- Department of Internal Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Antonio Balsamo
- Department of Medical and Surgical Sciences, Pediatric Unit, Endo-ERN Center for Rare Endocrine Diseases, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Niels Birkebæk
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Oliver Blankenstein
- Institute for Experimental Pediatric Endocrinology and Center for Chronically Sick Children, Charite - Universitätsmedizin Berlin, Berlin, Germany
| | - Walter Bonfig
- Department of Pediatrics, Technical University Munich, Munich, Germany
- Department of Pediatrics, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Martine Cools
- Pediatric Endocrinology, Internal Medicine and Pediatric Research Unit, University Hospital Ghent, Ghent University, Ghent, Belgium
| | - Eduardo Correa Costa
- Pediatric Surgery Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Feyza Darendeliler
- Paediatric Endocrinology Unit, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Silvia Einaudi
- Department of Paediatric Endocrinology, Regina Margherita Children's Hospital, University of Torino, Torino, Italy
| | | | - Martijn Finken
- Department of Paediatric Endocrinology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Evelien Gevers
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University London, London, UK
- Department of Paediatric Endocrinology, Barts Health NHS Trust - Royal London Hospital, London, UK
| | | | - Tulay Guran
- Pediatric Endocrinology and Diabetes, Marmara University, Istanbul, Turkey
| | - Ayla Güven
- Saglik Bilimleri University, Medical Faculty Zeynep Kamil Maternity and Children Hospital, Pediatric Endocrinology Clinic, Istanbul, Turkey
| | - Sabine E Hannema
- Department of Pediatric Endocrinology, Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, Netherlands
- Department of Paediatrics, Leiden University Medical Centre, Leiden, Netherlands
| | - Claire E Higham
- Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Violeta Iotova
- Department of Paediatrics, Medical University of Varna, Varna, Bulgaria
| | - Hetty J van der Kamp
- Pediatric Endocrinology Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Marta Korbonits
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University London, London, UK
| | - Ruth E Krone
- Department of Endocrinology and Diabetes, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Corina Lichiardopol
- Department of Endocrinology, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | | | | | - Tatjana Milenkovic
- Department of Endocrinology, Institute for Mother and Child Healthcare of Serbia 'Dr Vukan Čupić' Belgrade, Serbia
| | - Mirela C Miranda
- Department of Internal Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Klaus Mohnike
- Department of Pediatrics, Otto-von-Guericke University, Magdeburg, Germany
| | - Uta Neumann
- Institute for Experimental Pediatric Endocrinology and Center for Chronically Sick Children, Charite - Universitätsmedizin Berlin, Berlin, Germany
| | - Rita Ortolano
- Department of Medical and Surgical Sciences, Pediatric Unit, Endo-ERN Center for Rare Endocrine Diseases, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Sukran Poyrazoglu
- Paediatric Endocrinology Unit, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ajay Thankamony
- Department of Pediatrics, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Jeremy W Tomlinson
- Oxford Centre for Diabetes, Endocrinology & Metabolism, NIHR Oxford Biomedical Research Centre, Churchill Hospital, Oxford, UK
| | - Ana Vieites
- Centro de Investigaciones Endocrinológicas (CEDIE-CONICET), Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Liat de Vries
- Institute for Diabetes and Endocrinology, Schneider's Children Medical Center of Israel, Petah-Tikvah, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
| | - Richard J Ross
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Nils P Krone
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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13
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Ali SR, Bryce J, Haghpanahan H, Lewsey JD, Tan LE, Atapattu N, Birkebaek NH, Blankenstein O, Neumann U, Balsamo A, Ortolano R, Bonfig W, Claahsen-van der Grinten HL, Cools M, Costa EC, Darendeliler F, Poyrazoglu S, Elsedfy H, Finken MJJ, Fluck CE, Gevers E, Korbonits M, Guaragna-Filho G, Guran T, Guven A, Hannema SE, Higham C, Hughes IA, Tadokoro-Cuccaro R, Thankamony A, Iotova V, Krone NP, Krone R, Lichiardopol C, Luczay A, Mendonca BB, Bachega TASS, Miranda MC, Milenkovic T, Mohnike K, Nordenstrom A, Einaudi S, van der Kamp H, Vieites A, de Vries L, Ross RJM, Ahmed SF. Real-World Estimates of Adrenal Insufficiency-Related Adverse Events in Children With Congenital Adrenal Hyperplasia. J Clin Endocrinol Metab 2021; 106:e192-e203. [PMID: 32995889 PMCID: PMC7990061 DOI: 10.1210/clinem/dgaa694] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/24/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Although congenital adrenal hyperplasia (CAH) is known to be associated with adrenal crises (AC), its association with patient- or clinician-reported sick day episodes (SDE) is less clear. METHODS Data on children with classic 21-hydroxylase deficiency CAH from 34 centers in 18 countries, of which 7 were Low or Middle Income Countries (LMIC) and 11 were High Income (HIC), were collected from the International CAH Registry and analyzed to examine the clinical factors associated with SDE and AC. RESULTS A total of 518 children-with a median of 11 children (range 1, 53) per center-had 5388 visits evaluated over a total of 2300 patient-years. The median number of AC and SDE per patient-year per center was 0 (0, 3) and 0.4 (0.0, 13.3), respectively. Of the 1544 SDE, an AC was reported in 62 (4%), with no fatalities. Infectious illness was the most frequent precipitating event, reported in 1105 (72%) and 29 (47%) of SDE and AC, respectively. On comparing cases from LMIC and HIC, the median SDE per patient-year was 0.75 (0, 13.3) vs 0.11 (0, 12.0) (P < 0.001), respectively, and the median AC per patient-year was 0 (0, 2.2) vs 0 (0, 3.0) (P = 0.43), respectively. CONCLUSIONS The real-world data that are collected within the I-CAH Registry show wide variability in the reported occurrence of adrenal insufficiency-related adverse events. As these data become increasingly used as a clinical benchmark in CAH care, there is a need for further research to improve and standardize the definition of SDE.
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Affiliation(s)
- Salma R Ali
- Developmental Endocrinology Research Group, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
- Office for Rare Conditions, Royal Hospital for Children & Queen Elizabeth University Hospital, Glasgow, UK
| | - Jillian Bryce
- Office for Rare Conditions, Royal Hospital for Children & Queen Elizabeth University Hospital, Glasgow, UK
| | - Houra Haghpanahan
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - James D Lewsey
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Li En Tan
- Developmental Endocrinology Research Group, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | | | - Niels H Birkebaek
- Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Oliver Blankenstein
- Centre for Chronic Sick Children, Institute for Experimental Paediatric Endocrinology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Uta Neumann
- Centre for Chronic Sick Children, Institute for Experimental Paediatric Endocrinology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Antonio Balsamo
- Department of Medical and Surgical Sciences, Pediatric Unit, Center for Rare Endocrine Conditions (Endo-ERN), S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Rita Ortolano
- Department of Medical and Surgical Sciences, Pediatric Unit, Center for Rare Endocrine Conditions (Endo-ERN), S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Walter Bonfig
- Department of Paediatrics, Technical University München, Munich, Germany
- Department of Paediatrics, Klinikum Wels-Grieskirchen, Wels, Austria
| | | | - Martine Cools
- University Hospital Ghent, Ghent University, Ghent, Belgium
| | - Eduardo Correa Costa
- Pediatric Surgery Service, Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, Brazil
| | - Feyza Darendeliler
- Istanbul Faculty of Medicine, Department of Paediatrics, Paediatric Endocrinology Unit, Istanbul University, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Istanbul Faculty of Medicine, Department of Paediatrics, Paediatric Endocrinology Unit, Istanbul University, Istanbul, Turkey
| | - Heba Elsedfy
- Department of Pediatrics, Ain Shams University, Cairo, Egypt
| | - Martijn J J Finken
- Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Endocrinology, Amsterdam, The Netherlands
| | - Christa E Fluck
- Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics and Department of BioMedical Research, Bern University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Evelien Gevers
- Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - Márta Korbonits
- Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - Guilherme Guaragna-Filho
- Department of Pediatrics, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Tulay Guran
- Marmara University, Department of Pediatric Endocrinology and Diabetes, Pendik, Istanbul, Turkey
| | - Ayla Guven
- Health Science University, Medical Faculty, Zeynep Kamil Women and Children Hospital, Pediatric Endocrinology Clinic, Istanbul, Turkey
| | - Sabine E Hannema
- Department of Paediatric Endocrinology, Sophia Children’s Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Claire Higham
- Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, University Of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | | | - Ajay Thankamony
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Violeta Iotova
- Department of Paediatrics, Medical University-Varna, UMHAT “Sv. Marina,” Varna, Bulgaria
| | - Nils P Krone
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Ruth Krone
- Birmingham Women’s & Children’s Hospital, Department for Endocrinology & Diabetes, Birmingham, UK
| | - Corina Lichiardopol
- Department of Endocrinology, University of Medicine and Pharmacy Craiova, University Emergency Hospital, Craiova, Romania
| | - Andrea Luczay
- Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Berenice B Mendonca
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Disciplina de Endocrinologia, Hospital Das Clinicas, Faculdade De Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Tania A S S Bachega
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Disciplina de Endocrinologia, Hospital Das Clinicas, Faculdade De Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Mirela C Miranda
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Disciplina de Endocrinologia, Hospital Das Clinicas, Faculdade De Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Tatjana Milenkovic
- Department of Endocrinology, Mother and Child Health Care Institute of Serbia “Dr Vukan Čupić,” Belgrade, Serbia
| | | | | | - Silvia Einaudi
- Pediatric Endocrinology Regina Margherita Children’s Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Hetty van der Kamp
- Wilhelmina Kinderziekenhuis, Division of Pediatric Endocrinology, Utrecht, Netherlands
| | - Ana Vieites
- Centro de Investigaciones Endocrinológicas, División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Liat de Vries
- The Jesse and Sara Lea Shafer Institute of Endocrinology and Diabetes, Schneider Children’s Medical Center of Israel, Petah Tikvah, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Richard J M Ross
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
- Office for Rare Conditions, Royal Hospital for Children & Queen Elizabeth University Hospital, Glasgow, UK
- Correspondence and Reprint Requests: Professor S. Faisal Ahmed, MD FRCPCH, Developmental Endocrinology Research Group, School of Medicine, Dentistry & Nursing, University of Glasgow, Royal Hospital for Children, Office Block, 1345 Govan Road, Glasgow G51 4TF, UK. E-mail:
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14
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Bacila I, Adaway J, Hawley J, Mahdi S, Krone R, Patel L, Alvi S, Randell T, Gevers E, Dattani M, Cheetham T, Kyriakou A, Schiffer L, Ryan F, Crowne E, Davies JH, Ahmed SF, Keevil B, Krone N. Measurement of Salivary Adrenal-Specific Androgens as Biomarkers of Therapy Control in 21-Hydroxylase Deficiency. J Clin Endocrinol Metab 2019; 104:6417-6429. [PMID: 31361321 DOI: 10.1210/jc.2019-00031] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 01/06/2019] [Accepted: 07/22/2019] [Indexed: 02/12/2023]
Abstract
BACKGROUND Monitoring of hormonal control represents a key part of the management of congenital adrenal hyperplasia (CAH). Monitoring strategies remain suboptimal because they rely on frequent blood tests and are not specific for adrenal-derived hormones. Recent evidence suggests the crucial role of adrenal-specific 11-oxygenated-C19 androgens in the pathogenesis of CAH. OBJECTIVE To establish a correlation between plasma and salivary adrenal-specific androgens in CAH as a noninvasive monitoring strategy. DESIGN This prospective cross-sectional study recruited patients between 2015 and 2018. SETTING Multicenter study including 13 tertiary centers in the United Kingdom. PARTICIPANTS Seventy-eight children with CAH and 62 matched healthy controls. METHODS Using liquid chromatography-tandem mass spectrometry, plasma and salivary concentrations of five steroids were measured: 17-hydroxyprogesterone (17OHP), androstenedione (A4), testosterone (T), 11-hydroxyandrostenedione (11OHA4), and 11-ketotestosterone (11KT). The correlation between plasma and salivary steroids was analyzed to assess their use in clinical practice. RESULTS Strong correlations between plasma and salivary steroid concentrations in patients with CAH were detected: 17OHP (rs = 0.871; P < 0.001), A4 (rs = 0.931; P < 0.001), T (rs = 0.867; P < 0.001), 11OH4A (rs = 0.876; P < 0.001), and 11KT (rs = 0.944; P < 0.001). These results were consistent for patient subgroups based on sex and age. Analysis of patient subgroups based on 17OHP concentrations established clear correlations between plasma and salivary concentrations of the adrenal-specific androgen 11KT. CONCLUSIONS The current study identified tight correlations between plasma and saliva for the adrenal-derived 11-oxygenated C19 androgen 11KT, as well as 17OHP and A4, which are widely used for monitoring treatment in CAH. This combination of steroid hormones will serve as an improved noninvasive salivary test for disease monitoring in patients with CAH.
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Affiliation(s)
- Irina Bacila
- Academic Unit of Child Health, Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Jo Adaway
- Department of Biochemistry, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - James Hawley
- Department of Biochemistry, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Sundus Mahdi
- Academic Unit of Child Health, Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Ruth Krone
- Birmingham Women's & Children's Hospital, Birmingham, United Kingdom
| | - Leena Patel
- University of Manchester, Manchester, United Kingdom
| | - Sabah Alvi
- Leeds General Infirmary, Leeds, United Kingdom
| | | | - Evelien Gevers
- Queen Mary University London and Barts Health NHS Trust, The Royal London Hospital, London, United Kingdom
| | - Mehul Dattani
- Great Ormond Street Hospital, London, United Kingdom
| | - Timothy Cheetham
- Great North Children's Hospital, University of Newcastle, Newcastle, United Kingdom
| | - Andreas Kyriakou
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, United Kingdom
| | - Lina Schiffer
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - Fiona Ryan
- Oxford Children's Hospital, Oxford, United Kingdom
| | - Elizabeth Crowne
- Bristol Royal Hospital for Children, University Hospitals Bristol Foundation Trust, Bristol, United Kingdom
| | - Justin H Davies
- University Hospital Southampton, Southampton, United Kingdom
| | - Syed Faisal Ahmed
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, United Kingdom
| | - Brian Keevil
- Department of Clinical Biochemistry, Wythenshawe Hospital, Manchester, United Kingdom
| | - Nils Krone
- Academic Unit of Child Health, Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
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15
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Jones S, Khanolkar AR, Gevers E, Stephenson T, Amin R. Cardiovascular risk factors from diagnosis in children with type 1 diabetes mellitus: a longitudinal cohort study. BMJ Open Diabetes Res Care 2019; 7:e000625. [PMID: 31641519 PMCID: PMC6777407 DOI: 10.1136/bmjdrc-2018-000625] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 07/04/2019] [Accepted: 08/02/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND For childhood onset type 1 diabetes (T1D), the pathogenesis of atherosclerosis is greatly accelerated and results in early cardiovascular disease (CVD) and increased mortality. However, cardioprotective interventions in this age group are not routinely undertaken. AIMS To document prevalence of cardiovascular risk factors from diagnosis of childhood T1D and their relationship with disease duration and ethnicity. METHODS Routinely collected clinical records for 565 children with T1D were retrospectively analyzed. Data were collected from diagnosis and at routine check-ups at pediatric diabetes clinics across Barts Health National Health Service Trust. Age at diagnosis was 8.5 years (0.9-19.4). Mean follow-up 4.3 years (0-10.8). 48% were boys and 60% were non-white. Linear longitudinal mixed effects models were used to evaluate relationships between risk factors and diabetes duration. RESULTS CVD risk factors were present at first screening; 33.8% of children were overweight or obese, 20.5% were hypertensive (elevated diastolic blood pressure (BP)) and total cholesterol, low-density lipoprotein-cholesterol and high-density lipoprotein-cholesterol were abnormal in 63.5%, 34.2% and 22.0%, respectively. Significant associations between diabetes duration and annual increases of body mass index (0.6 kg/m2), BP (0.1 SD score) and lipids (0.02-0.06 mmol/L) were noted. Annual increases were significantly higher in black children for BP and Bangladeshi children for lipids. Bangladeshi children also had greatest baseline levels. CONCLUSIONS CVD risk factors are present in up to 60% of children at diagnosis of T1D and increase in prevalence during the early years of the disease. Commencing screening in younger children and prioritizing appropriate advice and attention to ethnic variation when calculating risk should be considered.
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Affiliation(s)
| | - Amal R Khanolkar
- GOS Institute of Child Health, UCL, London, UK
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Evelien Gevers
- Department of Paediatric Endocrinology, Barts Health NHS Trust, Royal London Children's Hospital, London, UK
- Centre for Endocrinology, Queen Mary University of London, London, UK
| | | | - Rakesh Amin
- GOS Institute of Child Health, UCL, London, UK
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16
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Jones S, Khanolkar A, Matyka K, Gevers E, Stephenson T, Amin R. 7.1-O1Ethnic differences in the development of cardiovascular disease risk factors in children and young people with type 1 diabetes – a prospective longitudinal study in the UK. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.231] [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: 11/14/2022] Open
Affiliation(s)
- S Jones
- GOS Institute of Child Health, University College London, United Kingdom
| | - A Khanolkar
- GOS Institute of Child Health, University College London, United Kingdom
| | - K Matyka
- Warwick Medical School, Warwick University, United Kingdom
| | - E Gevers
- Queen Mary University of London and The Royal London Hospital, BARTS Health, United Kingdom
| | - T Stephenson
- GOS Institute of Child Health, University College London, United Kingdom
| | - R Amin
- GOS Institute of Child Health, University College London, United Kingdom
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17
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Harris P, Brennan J, Martin J, Gould D, Bakran A, Gilling-Smith G, Buth J, Gevers E, White D. Longitudinal Aneurysm Shrinkage following Endovascular Aortic Aneurysm Repair: A Source of Intermediate and Late Complications. J Endovasc Ther 2016; 6:11-6. [PMID: 10088886 DOI: 10.1177/152660289900600104] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To report the incidence of delayed complications following endovascular abdominal aortic aneurysm (AAA) repair and the relationship of these sequelae to morphological changes in the sac and endograft. Methods: Twenty-six AAA patients treated with Vanguard endografts had completed ≥1-year follow-up. Postoperative angiograms and spiral computed tomographic (CT) scans with 3-dimensional reconstruction were compared to the 1-year images to determine morphological changes in the aneurysm sac and the endograft. These changes were then related to complications occurring between 1 and 12 months postoperatively in the study group. Results: Comparison of angiograms uncovered endograft buckling in 18 (69%) patients and acutely angled or kinked endografts in 10 (38%). Measurements from the CT scans found that undistorted endografts had a mean change in sac length of +6.6 mm. Mean sac length change in buckled endografts was −3.1 mm, while kinked endografts displayed a mean change of −6.2 mm (p < 0.002, Student's t-test). Five (19%) patients, all with distorted endografts, demonstrated late (1 to 12 months) complications (4 endoleaks and 1 graft limb thrombosis) owing to component separation, distal stent migration, and acute angulation. No movement in the proximal stent was observed. Elongation of the endograft (flow line measurement) was observed in one tube graft only. Conclusions: In this study, longitudinal shrinkage of the sac following endovascular aortic aneurysm repair led to buckling or kinking of the endograft within 1 year in 69% of patients. This appears to be an important source of delayed complications.
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Affiliation(s)
- P Harris
- Regional Vascular Unit, Royal Liverpool University Hospital, United Kingdom.
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18
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Schoenmakers E, Carlson B, Agostini M, Moran C, Rajanayagam O, Bochukova E, Tobe R, Peat R, Gevers E, Muntoni F, Guicheney P, Schoenmakers N, Farooqi S, Lyons G, Hatfield D, Chatterjee K. Mutation in human selenocysteine transfer RNA selectively disrupts selenoprotein synthesis. J Clin Invest 2016; 126:992-6. [PMID: 26854926 DOI: 10.1172/jci84747] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 12/18/2015] [Indexed: 11/17/2022] Open
Abstract
Selenium is a trace element that is essential for human health and is incorporated into more than 25 human selenocysteine-containing (Sec-containing) proteins via unique Sec-insertion machinery that includes a specific, nuclear genome-encoded, transfer RNA (tRNA[Ser]Sec). Here, we have identified a human tRNA[Ser]Sec mutation in a proband who presented with a variety of symptoms, including abdominal pain, fatigue, muscle weakness, and low plasma levels of selenium. This mutation resulted in a marked reduction in expression of stress-related, but not housekeeping, selenoproteins. Evaluation of primary cells from the homozygous proband and a heterozygous parent indicated that the observed deficit in stress-related selenoprotein production is likely mediated by reduced expression and diminished 2'-O-methylribosylation at uridine 34 in mutant tRNA[Ser]Sec. Moreover, this methylribosylation defect was restored by cellular complementation with normal tRNA[Ser]Sec. This study identifies a tRNA mutation that selectively impairs synthesis of stress-related selenoproteins and demonstrates the importance of tRNA modification for normal selenoprotein synthesis.
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McLean M, Lambert C, Gevers E, Cowlard J, Chaudry R, Nwokoro C. 179 12 years too late? Rethinking CFRD screening. J Cyst Fibros 2015. [DOI: 10.1016/s1569-1993(15)30356-8] [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: 11/25/2022]
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20
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Bochukova E, Schoenmakers N, Agostini M, Schoenmakers E, Rajanayagam O, Keogh JM, Henning E, Reinemund J, Gevers E, Sarri M, Downes K, Offiah A, Albanese A, Halsall D, Schwabe JWR, Bain M, Lindley K, Muntoni F, Vargha-Khadem F, Dattani M, Farooqi IS, Gurnell M, Chatterjee K. A mutation in the thyroid hormone receptor alpha gene. N Engl J Med 2012; 366:243-9. [PMID: 22168587 DOI: 10.1056/nejmoa1110296] [Citation(s) in RCA: 250] [Impact Index Per Article: 20.8] [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: 11/19/2022]
Abstract
Thyroid hormones exert their effects through alpha (TRα1) and beta (TRβ1 and TRβ2) receptors. Here we describe a child with classic features of hypothyroidism (growth retardation, developmental retardation, skeletal dysplasia, and severe constipation) but only borderline-abnormal thyroid hormone levels. Using whole-exome sequencing, we identified a de novo heterozygous nonsense mutation in a gene encoding thyroid hormone receptor alpha (THRA) and generating a mutant protein that inhibits wild-type receptor action in a dominant negative manner. Our observations are consistent with defective human TRα-mediated thyroid hormone resistance and substantiate the concept of hormone action through distinct receptor subtypes in different target tissues.
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Affiliation(s)
- Elena Bochukova
- University of Cambridge Metabolic Research Laboratories and National Institute for Health Research Cambridge Biomedical Research Centre, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, United Kingdom
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21
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Cuypers P, Buth J, Harris PL, Gevers E, Lahey R. Reprinted article "Realistic expectations for patients with stent-graft treatment of abdominal aortic aneurysms. Results of a European multicentre registry". Eur J Vasc Endovasc Surg 2011; 42 Suppl 1:S63-71. [PMID: 21855026 DOI: 10.1016/j.ejvs.2011.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/1999] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The outcomes for patients after endovascular treatment of abdominal aortic aneurysm (AAA) are determined primarily by the endpoints of death and endoleaks, the latter representing continued risk of rupture. The data of a multicentre registry were analysed with regard to the early outcome of stent-graft procedures for AAA and the complications associated with this treatment. In addition, the results during follow-up were analysed by determining mortality and endoleak development as separate endpoints and as a combined endpoint defined as endoleak-free survival. SETTING 38 European institutions of Vascular Surgery collaborating in a multicentre registry project. PATIENTS AND METHODS 899 patients with AAA underwent between May 1994 and March 1998 elective endovascular repair (818 men and 81 women; mean age 69 years). 80 (8.9%) of the patients had medical conditions that excluded them from open repair. 818 (91%) of patients had a bifurcated device, 63 (7%) had a straight tube graft, and only 18 (2%) had an aorto-uni-iliac device. Clinical examination and contrast-enhanced computed tomography was performed at fixed follow-up intervals to assess increase or decrease of the maximum transverse diameter (MTD). Endoleaks observed at follow-up were discriminated into persistent endoleak and temporary endoleak. The latter is defined as single time observed endoleaks or with two or more negative imaging studies between observed endoleaks. Life-table analyses were used to calculate the rates of freedom-from-endoleak (no endoleak at any time), freedom-from-persistent endoleak (no persistent endoleak), patient survival, and persistent-endoleak-free-survival. RESULTS The median follow-up of this patient series was 6.2 months. The ratio between observed and expected follow-up data was 82% for the overall follow-up period. However, at 18 months of follow-up this rate was only 45%. The number of patients followed during this period was sufficient to allow statistically meaningful assessment. The MTD in patients with temporary endoleaks demonstrated a significant decrease at 6 to 12 months compared to preoperative values (mean 57 and 53 respectively, p = 0.004). In patients with persistent endoleaks there was no change between the preoperative and 6-month MTD (mean 57 and 60 mm respectively). At 6 and 18 months freedom-from-endoleak was 83% and 74% and freedom-from-persistent endoleak was 93% and 90%, respectively. The 18-month cumulative patient survival was 88% and the main outcome measure, the persistent endoleak-free-survival was 79%. CONCLUSIONS The MTD decreases in patients with temporary endoleak, but not in patients with persistent endoleak. Therefore, the use of the rate of freedom-from-persistent endoleak, reflecting absence of persisting endoleaks to estimate the prognosis with regard to the AAA, is justified. Determining persistent endoleak-free survival appears a rational approach to provide a realistic outlook for patients with stent-grafted AAA. The observed 18-month endoleak-free survival reflects a satisfactory mid-term result.
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Affiliation(s)
- Ph Cuypers
- EUROSTAR Data Registry Centre, Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands
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22
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Koek HL, de Bruin A, Gast A, Gevers E, Kardaun JWPF, Reitsma JB, Grobbee DE, Bots ML. Incidence of first acute myocardial infarction in the Netherlands. Neth J Med 2007; 65:434-441. [PMID: 18079566] [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: 05/25/2023]
Abstract
OBJECTIVES To study the incidence of first acute myocardial infarction (AMi) in the Netherlands. BACKGROUND We recently showed that AMi patients can be followed longitudinally within dutch national medical registrations in a valid way. This makes it possible to provide nationwide incidence estimates of first AMi in the Netherlands. METHODS New cases of first AMi in the dutch population in 2000 were identified through linkage of the national hospital discharge register, the population register and the cause of death statistics and included hospitalised first Ami patients and out-of-hospital deaths from first AMi. RESULTS 31,777 patients with a first AMi were identified. The incidence (per 100,000 persons per year) increased from 2 in men aged <30 years to 2996 in men aged > or = 90 years. Corresponding figures for women ranged from 1 to 2226. The incidence was higher in men than in women in all age groups, but the male-to-female ratio decreased after the age of 50-59 year. Of all first AMI patients, 40% died before being admitted to a hospital. The proportion of non-hospitalised AMI patients increased with age in men after the age of 50-59 years. Within the age groups the proportion of out-of-hospital deaths was similar for men and women. CONCLUSION Our study provides the first nationwide incidence estimates of first AMI in the Netherlands. Expected differences in incidence with regard to age and gender were shown. The large proportion of out-of-hospital deaths reinforces the importance of primary prevention AMI.
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Affiliation(s)
- H L Koek
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
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23
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Koek HL, Kardaun JWPF, Gevers E, de Bruin A, Reitsma JB, Grobbee DE, Bots ML. Acute myocardial infarction incidence and hospital mortality: routinely collected national data versus linkage of national registers. Eur J Epidemiol 2007; 22:755-62. [PMID: 17828438 PMCID: PMC2071965 DOI: 10.1007/s10654-007-9174-6] [Citation(s) in RCA: 11] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Accepted: 07/26/2007] [Indexed: 11/26/2022]
Abstract
Background and Objective To compare levels of and trends in incidence and hospital mortality of first acute myocardial infarction (AMI) based on routinely collected hospital morbidity data and on linked registers. Cases taken from routine hospital data are a mix of patients with recurrent and first events, and double counting occurs when cases are admitted for an event several times during 1 year. By linkage of registers, recurrent events and double counts can be excluded. Study Design and Setting In 1995 and 2000, 28,733 and 25,864 admissions for AMI were registered in the Dutch national hospital discharge register. Linkage with the population register yielded 21,565 patients with a first AMI in 1995 and 20,414 in 2000. Results In 1995 and 2000, the incidence based on the hospital register was higher than based on the linked registers in men (22% and 23% higher) and women (18% and 20% higher). In both years, hospital mortality based on the hospital register and on linked registers was similar. The decline in incidence between 1995 and 2000 was comparable whether based on standard hospital register data or linked data (18% and 20% in men, 15% and 17% in women). Similarly, the decline in hospital mortality was comparable using either approach (11% and 9% in both men and women). Conclusion Although the incidence based on routine hospital data overestimates the actual incidence of first AMI based on linked registers, hospital mortality and trends in incidence and hospital mortality are not changed by excluding recurrent events and double counts. Since trends in incidence and hospital mortality of AMI are often based on national routinely collected data, it is reassuring that our results indicate that findings from such studies are indeed valid and not biased because of recurrent events and double counts. Electronic supplementary material The online version of this article (doi:10.1007/s10654-007-9174-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Huberdina L. Koek
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, HPN Str. 06.131, P.O. Box 85.060, 3508 AB Utrecht, The Netherlands
| | | | | | | | - Joannes B. Reitsma
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands
| | - Diederick E. Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, HPN Str. 06.131, P.O. Box 85.060, 3508 AB Utrecht, The Netherlands
| | - Michiel L. Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, HPN Str. 06.131, P.O. Box 85.060, 3508 AB Utrecht, The Netherlands
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Koek HL, de Bruin A, Gast F, Gevers E, Kardaun JWPF, Reitsma JB, Grobbee DE, Bots ML. Short- and long-term prognosis after acute myocardial infarction in men versus women. Am J Cardiol 2006; 98:993-9. [PMID: 17027558 DOI: 10.1016/j.amjcard.2006.05.016] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [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: 01/22/2006] [Revised: 05/08/2006] [Accepted: 05/08/2006] [Indexed: 10/24/2022]
Abstract
The prevailing view is that women have a higher early mortality after acute myocardial infarction (AMI) than men, but several studies have shown no differences. Further, long-term differences have not been addressed widely. The present study examined gender differences in short- and long-term prognoses after AMI in The Netherlands. A nationwide cohort of 21,565 patients with a first hospitalized AMI in 1995 was identified through linkage of the National Hospital Discharge Register and the population register. Crude short- and long-term mortalities were significantly higher in women than in men (28-day hazard ratio [HR] 1.70, 95% confidence interval [CI] 1.58 to 1.82; 5-year HR 1.52, 95% CI 1.46 to 1.59). After adjustment for age, the risk difference was attenuated at 28 days and even reversed at 5 years in favor of women (28-day HR 1.11, 95% CI 1.03 to 1.20; 5-year HR 0.94, 95% CI 0.90 to 0.99). When differences in other covariates were also taken into account, the risk differences remained virtually the same. To account for differences in reperfusion procedures, we repeated the analyses in 1,176 patients who underwent acute reperfusion therapy (angioplasty/thrombolysis). Comparable, but not statistically significant, gender differences were observed (28-day HR 1.06, 95% CI 0.65 to 1.74; 5-year HR 0.82, 95% CI 0.62 to 1.08). In conclusion, our findings in an unselected cohort covering a complete nation indicate that the worse short- and long-term prognoses after an AMI in women compared with men may largely be explained by differences in age, whereas differences in co-morbidity, origin, infarct location, and reperfusion therapy seem to contribute little.
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Affiliation(s)
- Huiberdina L Koek
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
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25
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Koek HL, de Bruin A, Gast A, Gevers E, Kardaun JWPF, Reitsma JB, Grobbee DE, Bots ML. Decline in incidence of hospitalisation for acute myocardial infarction in the Netherlands from 1995 to 2000. Heart 2005; 92:162-5. [PMID: 15863523 PMCID: PMC1860752 DOI: 10.1136/hrt.2004.054486] [Citation(s) in RCA: 11] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To study the change in incidence of hospitalisation for a first acute myocardial infarction (AMI) in the Netherlands from 1995 to 2000. METHODS Patients hospitalised with their first AMI in the Netherlands in 1995 and 2000 were identified through linkage of the national hospital discharge register and the population register. RESULTS 21,565 patients hospitalised for their first AMI in 1995 and 19,058 patients hospitalised for their first AMI in 2000 were identified. In both years, the age specific incidence of hospitalisation for a first AMI was higher in men than in women and increased with age (up to 90 years). In both men and women, the age standardised incidence was lower in 2000 than in 1995, a decline of 19% (95% confidence interval 17% to 21%) and 17% (95% confidence interval 14% to 19%), respectively. CONCLUSIONS Our study provides the first nationwide incidence estimates of first AMI in the Netherlands. From 1995 to 2000, the risk of AMI declined considerably.
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Affiliation(s)
- H L Koek
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
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Abstract
OBJECTIVES We describe educational inequalities in the incidence of injuries resulting in hospital admission and explore the contribution of exposure variables and chronic diseases, alcohol consumption, and sedative use to the observed inequalities. STUDY DESIGN AND SETTING Data from the Dutch prospective GLOBE study were linked to the National Hospital Discharge Register after 7 years of follow-up. RESULTS Significantly higher hazard ratios (HRs) of traffic injuries in lower compared with higher educational groups were substantially reduced after adjustment for differences in the use of cars and mopeds between these groups. Significantly increased HRs in occupational, home, and sports (OHS) injuries in lower compared with higher educational groups were reduced after adjustment for higher prevalence rates of chronic diseases, very excessive alcohol consumption, and sedative use in lower educational groups. CONCLUSION Exposure variables, chronic diseases, alcohol consumption, and sedative use contribute to educational inequalities in traffic and OHS injuries resulting in hospital admission.
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Affiliation(s)
- Frank J van Lenthe
- Department of Public Health, Erasmus Medical Centre, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.
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Reitsma JB, Kardaun JW, Gevers E, de Bruin A, van der Wal J, Bonsel GJ. [Possibilities for anonymous follow-up studies of patients in Dutch national medical registrations using the Municipal Population Register: a pilot study]. Ned Tijdschr Geneeskd 2003; 147:2286-90. [PMID: 14655296] [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] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
OBJECTIVE To examine the feasibility of using information from the Dutch Municipal Population Register (Dutch acronym: GBA) to anonymously track groups of patients. DESIGN Exploratory. METHOD Using a random sample from the Dutch National Medical Register (Dutch acronym: LMR), hospital admission with discharge in January 1996, it was determined to what extent the admission records could be linked to the GBA. The following variables were used in the linking process: date of birth, gender and the numerical part (4 digits) of the postal code. Once a record had been linked to a single record in the GBA, the pattern of moving and mortality over the next two years was investigated. RESULTS Of the 124,598 different hospitalisation records in the LMR cohort, 84% could be linked with a single record in the GBA. In 11% of the patients no unique link was possible: one hospital record could be linked to several records in the GBA. No matching record could be found for 5% of the patients; some of these were foreign citizens resident in the Netherlands. Two years after discharge, the cumulative mortality was 44% for cancer patients, 28% for patients with acute myocardial infarction, 57% for patients with heart failure and 20% for patients with respiratory diseases. Eleven percent of the patients moved within the two-year period following discharge. This would have caused a considerable bias in the aforementioned mortality rates, if the patients' migration had meant that they could no longer be followed. CONCLUSION The introduction of the GBA has significantly increased the possibilities for following patients within and between registries. A prerequisite for this is a unique and correct identification of an individual within the GBA.
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Affiliation(s)
- J B Reitsma
- Academisch Medisch Centrum, afd. Klinische Epidemiologie en Biostatistiek, Postbus 22.660, 1100 DD Amsterdam.
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Van Lenthe FJ, Gevers E, Joung IMA, Bosma H, Mackenbach JP. Material and behavioral factors in the explanation of educational differences in incidence of acute myocardial infarction: the Globe study. Ann Epidemiol 2002; 12:535-42. [PMID: 12495826 DOI: 10.1016/s1047-2797(01)00279-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To quantify the contribution of material and behavioral factors to educational differences in the incidence of acute myocardial infarction (AMI), taking into account their interrelationship. METHODS Self-reported information about educational level, behavioral factors (alcohol, smoking, physical inactivity, and obesity), and material factors (housing conditions, crowding, employment status, financial problems, and an income proxy) was obtained from 45 to 74 year old responders to the baseline measurement of the Dutch prospective GLOBE-study in 1991 (n = 9872). Incidence of AMI in study participants was determined by hospital admissions due to AMI between 1991 and 1998. RESULTS The increased hazard ratio of AMI in the lowest compared to the highest educational group [hazard ratio (HR) = 1.85, 95% confidence interval (CI): 1.19; 2.88] decreased by 60% after adjustment for all four behavioral factors. Similarly, adjustment for housing conditions, employment status and the income proxy reduced the hazard ratio by 76%. Thirty-six percent of the contribution of behavioral factors to educational differences in AMI in the lowest compared to the highest educational group was the result of more often living in worse material circumstances in the first group. CONCLUSIONS Material factors contribute more to educational differences in incidence of AMI than behavioral factors. Improving material circumstances in lower educational groups may form an important strategy in the reduction of inequalities in AMI, partly because of its influence on unhealthy behavior.
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Affiliation(s)
- Frank J Van Lenthe
- Department of Public Health, Erasmus University Medical School, Rotterdam, The Netherlands
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Cuypers P, Buth J, Harris PL, Gevers E, Lahey R. Realistic expectations for patients with stent-graft treatment of abdominal aortic aneurysms. Results of a European multicentre registry. Eur J Vasc Endovasc Surg 1999; 17:507-16. [PMID: 10377023 DOI: 10.1053/ejvs.1999.0836] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE the outcomes for patients after endovascular treatment of abdominal aortic aneurysm (AAA) are determined primarily by the endpoints of death and endoleaks, the latter representing continued risk of rupture. The data of a multicentre registry were analysed with regard to the early outcome of stent-graft procedures for AAA and the complications associated with this treatment. In addition, the results during follow-up were analysed by determining mortality and endoleak development as separate endpoints and as a combined endpoint defined as endoleak-free survival. SETTING 38 European institutions of Vascular Surgery collaborating in a multicentre registry project. PATIENTS AND METHODS 899 patients with AAA underwent between May 1994 and March 1998 elective endovascular repair (818 men and 81 women; mean age 69 years). 80 (8.9%) of the patients had medical conditions that excluded them from open repair. 818 (91%) of patients had a bifurcated device, 63 (7%) had a straight tube graft, and only 18 (2%) had an aorto-uni-iliac device. Clinical examination and contrast-enhanced computed tomography was performed at fixed follow-up intervals to assess increase or decrease of the maximum transverse diameter (MTD). Endoleaks observed at follow-up were discriminated into persistent endoleak and temporary endoleak. The latter is defined as single time observed endoleaks or with two or more negative imaging studies between observed endoleaks. Life-table analyses were used to calculate the rates of freedom-from-endoleak (no endoleak at any time), freedom-from-persistent endoleak (no persistent endoleak), patient survival, and persistent-endoleak-free-survival. RESULTS the median follow-up of this patient series was 6.2 months. The ratio between observed and expected follow-up data was 82% for the overall follow-up period. However, at 18 months of follow-up this rate was only 45%. The number of patients followed during this period was sufficient to allow statistically meaningful assessment. The MTD in patients with temporary endoleaks demonstrated a significant decrease at 6 to 12 months compared to preoperative values (mean 57 and 53 respectively, p =0.004). In patients with persistent endoleaks there was no change between the preoperative and 6-month MTD (mean 57 and 60 mm respectively). At 6 and 18 months freedom-from-endoleak was 83% and 74% and freedom-from-persistent endoleak was 93% and 90%, respectively. The 18-month cumulative patient survival was 88% and the main outcome measure, the persistent endoleak-free-survival was 79%. CONCLUSIONS the MTD decreases in patients with temporary endoleak, but not in patients with persistent endoleak. Therefore, the use of the rate of freedom-from-persistent endoleak, reflecting absence of persisting endoleaks to estimate the prognosis with regard to the AAA, is justified. Determining persistent endoleak-free survival appears a rational approach to provide a realistic outlook for patients with stent-grafted AAA. The observed 18-month endoleak-free survival reflects a satisfactory mid-term result.
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Affiliation(s)
- P Cuypers
- EUROSTAR Data Registry Centre, Department of Vascular Surgery, Eindhoven, The Netherlands
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Harris P, Brennan J, Martin J, Gould D, Bakran A, Gilling-Smith G, Buth J, Gevers E, White D. Longitudinal aneurysm shrinkage following endovascular aortic aneurysm repair: a source of intermediate and late complications. J Endovasc Surg 1999. [PMID: 10088886 DOI: 10.1583/1074-6218(1999)006<0011:lasfea>2.0.co;2] [Citation(s) in RCA: 120] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To report the incidence of delayed complications following endovascular abdominal aortic aneurysm (AAA) repair and the relationship of these sequelae to morphological changes in the sac and endograft. METHODS Twenty-six AAA patients treated with Vanguard endografts had completed > or = 1-year follow-up. Postoperative angiograms and spiral computed tomographic (CT) scans with 3-dimensional reconstruction were compared to the 1-year images to determine morphological changes in the aneurysm sac and the endograft. These changes were then related to complications occurring between 1 and 12 months postoperatively in the study group. RESULTS Comparison of angiograms uncovered endograft buckling in 18 (69%) patients and acutely angled or kinked endografts in 10 (38%). Measurements from the CT scans found that undistorted endografts had a mean change in sac length of +6.6 mm. Mean sac length change in buckled endografts was -3.1 mm, while kinked endografts displayed a mean change of -6.2 mm (p < 0.002, Student's t-test). Five (19%) patients, all with distorted endografts, demonstrated late (1 to 12 months) complications (4 endoleaks and 1 graft limb thrombosis) owing to component separation, distal stent migration, and acute angulation. No movement in the proximal stent was observed. Elongation of the endograft (flow line measurement) was observed in one tube graft only. CONCLUSIONS In this study, longitudinal shrinkage of the sac following endovascular aortic aneurysm repair led to buckling or kinking of the endograft within 1 year in 69% of patients. This appears to be an important source of delayed complications.
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Affiliation(s)
- P Harris
- Regional Vascular Unit, Royal Liverpool University Hospital, United Kingdom.
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Abstract
Male- and female-specific modes of episodic growth hormone (GH) release are presumptively imposed by sex steroid hormones, and, although typically evident visually, are vividly distinguished quantitatively via a regularity statistic, approximate entropy (ApEn), in both the rat and human. GH secretory patterns may determine GH-stimulated growth and specific hepatic and muscle gene expression in the rat. Consequently, it is important to discern mechanisms that underlie their regulation. Here we have examined the impact of prepubertal gonadal suppression (at 4 wk of age) via surgical or pharmacological [gonadotropin-releasing hormone (GnRH) agonist] intervention on the regularity (ApEn) of GH release in male and female rats (at 10-11 wk of age) sampled at 10-min intervals for 10 h (n = 60 points) during a lights-out (dark) period. We observed a graded hierarchy of mean disorderliness of GH release that was quantifiable by ApEn measures, with maximal to minimal disorderliness in the following rank order: intact female, GnRH agonist-treated female, ovariectomized female, orchidectomized male, GnRH agonist-treated male, and intact male. These observations suggest a continuum of sex steroid actions on the regularity of GH secretion and, by inference, on the interplay among GH-releasing hormone, somatostatin, and GH/insulin-like growth factor I negative feedback.
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Affiliation(s)
- E Gevers
- Department of Pediatric Endocrinology, University Hospital Leiden, The Netherlands
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