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Zedan AH, Osther PJS, Assenholt J, Madsen JS, Hansen TF. Circulating miR-141 and miR-375 are associated with treatment outcome in metastatic castration resistant prostate cancer. Sci Rep 2020; 10:227. [PMID: 31937854 PMCID: PMC6959345 DOI: 10.1038/s41598-019-57101-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 12/20/2019] [Indexed: 12/31/2022] Open
Abstract
Metastatic castration resistant prostate cancer (mCRPC) is associated with high mortality, where monitoring of disease activity is still a major clinical challenge. The role of microRNAs (miRs) has been widely investigated in prostate cancer with both diagnostic and prognostic potential. The aim of this study was to investigate the relationship between circulating miRs and treatment outcome in mCRPC patients. The relative expression of five miRs (miR-93-5p, -125b-1-5p, -141-3p, -221-3p, and miR-375-3p) was investigated in plasma samples from 84 mCRPC patients; 40 patients were treated with docetaxel (DOC cohort) and 44 patients with abiraterone (ABI cohort). Blood was sampled at baseline before treatment start and at radiological progression. The plasma levels of four miRs; miR-93-5p, -141-3p, -221-3p, and miR-375-3p decreased significantly after treatment initiation in patients receiving docetaxel, and for miR-141-3p and miR-375-3p the level increased again at the time of radiological progression. In the patients treated with abiraterone, the plasma level of miR-221-3p likewise decreased significantly after the first treatment cycle. High baseline levels of both miR-141-3p and miR-375-3p were significantly associated with a shorter time to radiological progression in both cohorts. Additionally, high baseline levels of miR-141-3p and miR-221-3p were significantly associated with a shorter overall survival (OS) in the ABI cohort, while high levels of miR-141-3p and miR-375-3p were significantly associated with shorter OS in the DOC cohort. Plasma levels of miR-141-3p and miR-375-3p may predict time to progression in mCRPC patients treated with docetaxel or abiraterone. The clinical impact of these findings is dependent on validation in larger cohorts.
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Affiliation(s)
- A H Zedan
- Urological Research Centre, Department of Urology, Vejle Hospital, Vejle, Denmark. .,Department of Oncology, Vejle Hospital, Vejle, Denmark. .,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - P J S Osther
- Urological Research Centre, Department of Urology, Vejle Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - J Assenholt
- Department of Biochemistry and Clinical Immunology, Vejle Hospital, Vejle, Denmark
| | - J S Madsen
- Department of Biochemistry and Clinical Immunology, Vejle Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - T F Hansen
- Department of Oncology, Vejle Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Olesen MN, Soelberg K, Debrabant B, Nilsson AC, Lillevang ST, Grauslund J, Brandslund I, Madsen JS, Paul F, Smith TJ, Jarius S, Asgari N. Cerebrospinal fluid biomarkers for predicting development of multiple sclerosis in acute optic neuritis: a population-based prospective cohort study. J Neuroinflammation 2019; 16:59. [PMID: 30857557 PMCID: PMC6410527 DOI: 10.1186/s12974-019-1440-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 02/22/2019] [Indexed: 12/02/2022] Open
Abstract
Background Long-term outcome in multiple sclerosis (MS) depends on early treatment. In patients with acute optic neuritis (ON), an early inflammatory event, we investigated markers in cerebrospinal fluid (CSF), which may predict a diagnosis of MS. Methods Forty patients with acute ON were recruited in a prospective population-based cohort with median 29 months (range 19–41) of follow-up. Paired CSF and serum samples were taken within 14 days (range 2–38), prior to treatment. Prospectively, 16/40 patients were by a uniform algorithm diagnosed with MS (MS-ON) and 24 patients continued to manifest isolated ON (ION) during follow-up. Levels of cytokines and neurofilament light chain (NF-L) were measured at the onset of acute ON and compared to healthy controls (HC). Significance levels were corrected for multiple comparisons (“q”). The predictive value of biomarkers was determined with multivariable prediction models using nomograms. Results CSF TNF-α, IL-10, and CXCL13 levels were increased in MS-ON compared to those in ION patients (q = 0.021, 0.004, and 0.0006, respectively). MS-ON patients had increased CSF pleocytosis, IgG indices, and oligoclonal bands (OCBs) compared to ION (q = 0.0007, q = 0.0058, and q = 0.0021, respectively). CSF levels of IL-10, TNF-a, IL-17A, and CXCL13 in MS-ON patients correlated with leukocyte counts (r > 0.69 and p < 0.002) and IgG index (r > 0.55, p < 0.037). CSF NF-L levels were increased in ON patients compared to those in HC (q = 0.0077). In MS-ON, a progressive increase in NF-L levels was observed at 7 to 14 days after disease onset (r = 0.73, p < 0.0065). Receiver-operating characteristic (ROC) curves for two multivariable prediction models were generated, with IL-10, CXCL13, and NF-L in one (“candidate”) and IgG index, OCB, and leukocytes in another (“routine”). Area under the curve was 0.89 [95% CI 0.77–1] and 0.86 [0.74–0.98], respectively. Predictions of the risk of MS diagnosis were illustrated by two nomograms. Conclusions CSF TNF-α, IL-10, CXCL13, and NF-L levels were associated with the development of MS, suggesting that the inflammatory and neurodegenerative processes occurred early. Based on subsequent diagnosis, we observed a high predictive value of routine and candidate biomarkers in CSF for the development of MS in acute ON. The nomogram predictions may be useful in the diagnostic work-up of MS. Electronic supplementary material The online version of this article (10.1186/s12974-019-1440-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M N Olesen
- Department of Neurology, Slagelse Hospital, Slagelse, Denmark.,Department of Clinical Immunology and Biochemistry, Lillebælt Hospital, Vejle, Denmark.,Institutes of Regional Health Research and Molecular Medicine, University of Southern Denmark, Winsloewsvej 25.2, 5000, Odense C, Denmark
| | - K Soelberg
- Department of Internal Medicine, Slagelse Hospital, Slagelse, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - B Debrabant
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - A C Nilsson
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - S T Lillevang
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - J Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - I Brandslund
- Department of Clinical Immunology and Biochemistry, Lillebælt Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - J S Madsen
- Department of Clinical Immunology and Biochemistry, Lillebælt Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - F Paul
- Clinical and Experimental Multiple Sclerosis Research Center and NeuroCure Clinical Research Center, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - T J Smith
- Departments of Ophthalmology and Visual Sciences and Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - S Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - N Asgari
- Department of Neurology, Slagelse Hospital, Slagelse, Denmark. .,Institutes of Regional Health Research and Molecular Medicine, University of Southern Denmark, Winsloewsvej 25.2, 5000, Odense C, Denmark. .,Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark.
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Abstract
SummaryPresently, the diagnosis of hip dysplasia is based on a single pelvic radiographic examination of the dog at the age of 12 to 24 months. However, by this method, only a static appearance of the coxofemoral joint is evaluated. The purpose of our study was to diagnose hip dysplasia in young dogs and consequently, we included a radiographic evaluation of the dynamic appearance of the coxofemoral joint.A stress-radiographic examination was applied to 23 German Shepherd Dogs at the age of six and 12 months to obtain maximal reduction and maximal dislocation of the coxofemoral joint. Finally, at the age of 12 months, the hips were examined radiographically using the conventional criteria for hip dysplasia.At the age of six months, dogs with hip dysplasia showed significantly greater joint laxity and lateral dislocation of the femoral head than normal dogs. However, some predysplastic dogs, with lateral dislocation of the femoral head, developed normal hips and would be approved for breeding. Based on these findings, we conclude that stress-radiographic examinations of young dogs provide important, hitherto unrecognized, information of relevance in the future screening programmes to reduce the incidence of hip dysplasia.A stress-radiographic examination of young dogs provides important, hitherto unrecognized, information of relevance in the future screening programmes to reduce the incidence of hip dysplasia.
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Soelberg K, Jarius S, Skejoe H, Engberg H, Mehlsen JJ, Nilsson AC, Madsen JS, Reindl M, Wildemann B, Grauslund J, Kyvik KO, Smith TJ, Lillevang ST, Paul F, Weinshenker BG, Asgari N. A population-based prospective study of optic neuritis. Mult Scler 2017; 23:1893-1901. [PMID: 28980518 DOI: 10.1177/1352458517734070] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Optic neuritis (ON) is often associated with multiple sclerosis (MS). Early diagnosis is critical to optimal patient management. OBJECTIVE To estimate the incidence of acute ON and the rates of conversion to MS and antibody-mediated ON. METHOD Population-based prospective study was performed in patients with ON from three ophthalmological departments and 44 practicing ophthalmologists from 2014 to 2016. Ophthalmological and neurological examination, magnetic resonance imaging (MRI), determination of aquaporin-4(AQP4)-IgG and myelin-oligodendrocyte glycoprotein (MOG)-IgG were investigated blindly. RESULTS In all, 63 patients were evaluated and 51 fulfilled the criteria for ON. All were Caucasian, with female:male ratio of 2.2:1 and a median age of 38 years (16-66); 44 (86%) had a single episode of ON (four bilateral), while 7/51 (14%) had recurrent ON. The overall age-specific incidence was 3.28 (2.44-4.31) per 100,000 person years, 2.02 for men and 4.57 for women. At follow-up, 20 patients met the diagnostic criteria for MS, MRI lesions disseminated in space and time in 17/20 patients. AQP4-IgG was detected in none, MOG-IgG was detected in two patients. CONCLUSION The prospective incidence of ON was estimated. MRI enabled a diagnosis of MS in a subgroup of patients. Antibody-mediated ON with specificity for MOG was detected in 4% of cases.
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Affiliation(s)
- K Soelberg
- Departments of Regional Health Research and Molecular Medicine, University of Southern Denmark, Odense, Denmark/Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark/Department of Neurology, Slagelse Hospital, Slagelse, Denmark/Department of Neurology, Lillebaelt Hospital, Vejle, Denmark/Department of Ophthalmology, Odense University Hospital, Odense, Denmark
| | - S Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Hpb Skejoe
- Department of Radiology, Aleris-Hamlet Hospital, Copenhagen, Denmark
| | - H Engberg
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark/Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - J J Mehlsen
- Department of Ophthalmology, Lillebaelt Hospital, Vejle, Denmark
| | - A C Nilsson
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - J S Madsen
- Department of Clinical Immunology and Biochemistry, Lillebaelt Hospital, Vejle, Denmark
| | - M Reindl
- Clinical Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - B Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - J Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark/Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - K O Kyvik
- Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark/Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - T J Smith
- Departments of Ophthalmology & Visual Sciences and Internal Medicine, Medical School, University of Michigan, Ann Arbor, MI, USA
| | - S T Lillevang
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - F Paul
- Clinical and Experimental Multiple Sclerosis Research Center and NeuroCure Clinical Research Center, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany/Experimental and Clinical Research Center (ECRC), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - N Asgari
- Department of Neurology, Slagelse Hospital, Slagelse, Denmark/Departments of Regional Health Research, Neurobiology and Molecular Medicine, University of Southern Denmark, Odense, Denmark/Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
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Kreiner-Møller E, Chawes BLK, Vissing NH, Koppelman GH, Postma DS, Madsen JS, Olsen DA, Baty F, Vonk JM, Kerkhof M, Sleiman P, Hakonarsson H, Mortensen LJ, Poorisrisak P, Bisgaard H, Bønnelykke K. VEGFA variants are associated with pre-school lung function, but not neonatal lung function. Clin Exp Allergy 2014; 43:1236-45. [PMID: 24152156 DOI: 10.1111/cea.12188] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 06/10/2013] [Accepted: 07/14/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Vascular endothelial growth factor (VEGF) is implicated in airway remodelling and asthma development. We studied VEGFA gene variants and plasma levels and the development of lung function, bronchial hyperresponsiveness and asthma in childhood. METHODS We analysed 13 SNPs in the VEGFA gene in 411 children from the COPSAC2000 high-risk birth cohort. Asthma was diagnosed prospectively, and lung function measurements were obtained at birth and 6 years of age. Plasma VEGF levels were measured at 18 months of age. We used a Bonferroni adjusted significance level. Findings were replicated in the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) birth cohort at age 8. RESULTS At age six, three SNPs from the same linkage block were associated with FEV1 (rs699947, P = 1.31E-05), independent of asthma, and there were suggestive associations between FEV1/FVC ratio and rs833052 and maximal mid-expiratory flow and rs6900017. Replication in the PIAMA cohort showed borderline association between FEV1 and rs699947 and significant meta-analysis result. SNPs upstream and nearby rs699947 were nominally associated with VEGF plasma levels. VEGF levels were not associated with asthmatic symptoms or lung function measures. CONCLUSIONS AND CLINICAL RELEVANCE VEGF gene variants are associated with lung function at school age, but not at birth, suggesting a role of VEGF in post-natal lung function development.
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Affiliation(s)
- E Kreiner-Møller
- COPSAC: Copenhagen Prospective Studies on Asthma in Childhood, Copenhagen University Hospital, Gentofte, Denmark; The Danish Pediatric Asthma Center, Copenhagen University Hospital, Gentofte, Denmark
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6
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Kindberg Boysen A, Madsen JS, Jørgensen PE. Procalcitonin as a marker of postoperative complications. Scandinavian Journal of Clinical and Laboratory Investigation 2009; 65:387-94. [PMID: 16081361 DOI: 10.1080/00365510510025755] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Procalcitonin (PCT) is a 116 amino acid peptide that functions as a pro-hormone for calcitonin in the C cells of the thyroid gland. Large quantities of intact PCT are present in the blood of patients with sepsis, particularly when organ dysfunction occurs. PCT has been proposed as an early marker of postoperative complications. The aim of this study was to examine the diagnostic accuracy of PCT as a marker of postoperative complications by systematically reviewing the existing literature. MATERIAL AND METHODS The databases PubMed, Embase and the Cochrane Library were searched to find studies on the diagnostic accuracy of PCT in the postoperative phase. Primary studies were retrieved using specific inclusion and exclusion criteria. RESULTS A total of nine studies were included. These studies were heterogeneous regarding the spectrum of patients, complications, design and methodological quality according to QUADAS (quality assessment of studies of diagnostic accuracy). This could explain the marked variation in diagnostic accuracy. Considering all types of complications the sensitivity ranged from 37% to 100% and the specificity from 70% to 100%. On examining the infectious complications separately, it was found that the sensitivity ranged from 70% to 86% and the specificity from 45% to 98%. CONCLUSIONS Owing to a pronounced heterogeneity among the existing studies, the diagnostic accuracy of PCT as a marker for postoperative complications is not yet sufficiently clarified.
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Affiliation(s)
- A Kindberg Boysen
- Department of Clinical Biochemistry, Odense University Hospital, Denmark.
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Nissen N, Madsen JS, Bladbjerg EM, Beck Jensen JE, Jørgensen NR, Langdahl B, Abrahamsen B, Brixen K. No association between hip geometry and four common polymorphisms associated with fracture: the Danish osteoporosis prevention study. Calcif Tissue Int 2009; 84:276-85. [PMID: 19225709 DOI: 10.1007/s00223-009-9219-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [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: 06/22/2008] [Accepted: 01/16/2009] [Indexed: 10/21/2022]
Abstract
Both osteoporosis and hip geometry are independently associated with fracture risk. There is a significant genetic contribution to the risk of osteoporosis, and evidence provided by twin studies has suggested that hip geometry may also in part be genetically programmed. Polymorphisms in a number of genes, including those coding for methylene-tetrahydrofolate reductase (MTHFR c.677C > T), the purinergic P2X(7) receptor (Glu496Ala and Ile568Asn), and the low-density lipoprotein receptor-related protein 5 (LRP5 exon 9 [c.266A > G]), have been associated with an increased fracture incidence and/or reduced bone mineral density (BMD). The aim of the present study was to test whether these polymorphisms influence hip structural geometry in perimenopausal women. The four polymorphisms were genotyped in 800 healthy recently perimenopausal women never using hormone replacement therapy. BMD of the femoral neck was measured using a Hologic QDR-2000 densitometer and femoral neck axis length, neck width, neck shaft angle, and femoral head diameter were measured from the screen images. Genotype frequencies were compatible with Hardy-Weinberg equilibrium. No significant differences between homozygotes for the minor allele and carriers of the common allele regarding parameters of hip geometry were demonstrated. According to the anthropometric characteristics of the subjects, only body height in the MTHFR TT genotype group was significantly different from the combined CT/CC genotype group (P < 0.05). The geometric dimensions of the proximal femur in perimenopausal women are not associated with the MTHFR c.677C > T, P2X(7) (Glu496Ala), P2X(7) (Ile568Asn), and LRP5 exon 9 (c.266A > G) polymorphisms.
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Affiliation(s)
- N Nissen
- Department of Endocrinology, Odense University Hospital, University of Southern Denmark, Odense, 5000, Odense C, Denmark.
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Aspegren K, Bastholt L, Bested KM, Bonnesen T, Ejlersen E, Fog I, Hertel T, Kodal T, Lund J, Madsen JS, Malchow-Møller A, Petersen M, Sørensen B, Wermuth L. Validation of the PHEEM instrument in a Danish hospital setting. Med Teach 2007; 29:498-500. [PMID: 17885982 DOI: 10.1080/01421590701477357] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The Postgraduate Hospital Educational Environment Measure (PHEEM) has been translated into Danish and then validated with good internal consistency by 342 Danish junior and senior hospital doctors. Four of the 40 items are culturally dependent in the Danish hospital setting. Factor analysis demonstrated that seven items are interconnected. This information can be used to shorten the instrument by perhaps another three items.
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Affiliation(s)
- K Aspegren
- The Postgraduate Deanery and Office of Medical Education, Faculty of Medicine, Odense, Denmark.
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Madsen JS, Kristensen SR, Gram J, Bladbjerg EM, Henriksen FL, Gram J, Christensen K, Jespersen J. Positive impact of hormone replacement therapy on the fibrinolytic system: a long-term randomized controlled study in healthy postmenopausal women. J Thromb Haemost 2003; 1:1984-91. [PMID: 12941041 DOI: 10.1046/j.1538-7836.2003.00362.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [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: 11/20/2022]
Abstract
BACKGROUND The mechanisms by which postmenopausal hormone replacement therapy (HRT) may influence risk of cardiovascular disease are still unclear. Impaired fibrinolytic function is associated with an enhanced risk of cardiovascular disease and therefore the effect of HRT on fibrinolysis may be of importance. OBJECTIVES To investigate the prolonged effect of HRT on the fibrinolytic system and to determine whether two common polymorphisms in the plasminogen activator inhibitor-1 (PAI-1) and tissue-type plasminogen activator (t-PA) genes modulate this effect. METHODS Healthy postmenopausal women (n = 248) were randomized to HRT (n = 122) or no substitution (n = 126) 5 years prior to investigation. RESULTS Significantly higher values of t-PA activity and lower values of PAI-1 activity and PAI-1 antigen were found in the HRT group compared with the control group. This effect was independent of smoking and without influence from the two common polymorphisms PAI-1 -675(4G/5G) and t-PA intron8ins311. Furthermore, no difference between opposed estrogen (with norethisterone acetate as the gestagen component) and unopposed estrogen therapy was found. Both an intention-to-treat and a per-protocol analysis were performed and similar results were obtained. CONCLUSIONS Long-term treatment with HRT in healthy postmenopausal women was found to be associated with a beneficial fibrinolytic profile. This effect was found independent of smoking status, opposed and unopposed estrogen therapy had equal effect, and no influence of the two common polymorphisms PAI-1-675(4G/5G) and t-PA intron8ins311 was found. This effect of HRT on fibrinolytic capacity may be one of the beneficial effects of HRT in relation to cardiovascular diseases.
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Affiliation(s)
- J S Madsen
- Departments of Clinical Biochemistry and Endocrinology, Odense University Hospital, Odense, Denmark.
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10
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Bladbjerg EM, Madsen JS, Kristensen SR, Abrahamsen B, Brixen K, Mosekilde L, Jespersen J. Effect of long-term hormone replacement therapy on tissue factor pathway inhibitor and thrombin activatable fibrinolysis inhibitor in healthy postmenopausal women: a randomized controlled study. J Thromb Haemost 2003; 1:1208-14. [PMID: 12871321 DOI: 10.1046/j.1538-7836.2003.00281.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [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: 11/20/2022]
Abstract
It was recently reported from the Women's Health Initiative that healthy women using combined hormone replacement therapy (HRT) for 5 years have an increased cardiovascular risk. We hypothesize that the increased risk is confined to subgroups of atherosclerotic women. Such women may have higher arterial tissue factor expression and higher thrombin formation, and changes in tissue factor pathway coagulation inhibitor (TFPI) and thrombin activatable fibrinolysis inhibitor (TAFI) may be deleterious. Healthy postmenopausal women (n = 719) were randomized to hormone therapy [n = 357; opposed (n = 290) and unopposed (n = 67)] or no treatment (n = 362). Plasma TFPI and TAFI and the TFPI -287T/C and TAFI -438G/A polymorphisms were measured 5-6 years after randomization. Concentrations of TFPI were significantly lower in the hormone group than in the control group (P < 0.001) and in all genotypes of the TFPI polymorphism. Overall, concentrations of TAFI did not differ between the two groups but were reduced by hormone therapy in homozygotes for the rare TAFI -438 A allele (P < 0.05). The hormone effects on TFPI and TAFI were similar in smokers and non-smokers and in women using unopposed and opposed therapy. The observed decrease in TFPI may contribute to the increased cardiovascular risk associated with HRT.
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Affiliation(s)
- E M Bladbjerg
- Department for Thrombosis Research, University of Southern Denmark, Ribe County Hospital, Finsensgade 35, DK-6700 Esbjerg, Denmark.
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Samson MA, Dillingham MF, Fanton GS, Madsen JS. Arthroscopic treatment of shoulder instability: current concepts and techniques. Surg Technol Int 2002; 8:253-7. [PMID: 12451539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
The incidence of glenohumeral joint instability is estimated to effect between 2 and 8% of the population. It represents at least one third of all shoulder related emergency room visits. When one considers the spectrum of shoulder instability, including transient subluxation, the true incidence of glenohumeral instability is probably grossly under-reported. Although any age group can be affected, shoulder instability is primarily a disease of the young. The occurrence of instability is inversely proportional to the age of the patient and the time of original injury. A patient who dislocates for the first time as a teen can expect a redislocation rate approaching 90% in his or her lifetime. Therefore, many authors recommend early surgical treatment to repair the lesion.
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12
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Jørgensen HL, Madsen JS, Madsen B, Saleh MMA, Abrahamsen B, Fenger M, Lauritzen JB. Association of a common allelic polymorphism (C677T) in the methylene tetrahydrofolate reductase gene with a reduced risk of osteoporotic fractures. A case control study in Danish postmenopausal women. Calcif Tissue Int 2002; 71:386-92. [PMID: 12232679 DOI: 10.1007/s00223-001-2126-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [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: 11/19/2001] [Accepted: 03/29/2002] [Indexed: 11/26/2022]
Abstract
Twin studies indicate a substantial genetic component in the development of osteoporosis. One of the latest studied candidate genes is the one coding for methylene tetrahydrofolate reductase (MTHFR) (C677T) in which a point mutation gives rise to a thermolabile variant of MTHFR. The aim of this study was to investigate the influence of this mutation on peripheral measures of bone density and on the odds ratios (OR) for hip and lower forearm fracture in a case control study of Danish postmenopausal women. A total of 74 women with lower forearm fracture, 41 women with hip fracture, and 207 age-matched controls were included. All had broadband ultrasound attenuation (BUA) and speed of sound (SOS) measured at the heel as well as bone mineral density (BMD) measured by dual X-ray absorptiometry at the distal forearm. The MTHFR (C677T) genotypes were determined using polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP). Only 2 of 21 individuals with the TT genotype had sustained a fracture as opposed to 46 of 142 with the CT genotype and 67 of 159 with the CC genotype (P = 0.007). Using logistic regression, the following odds ratios were found when comparing the individuals homozygotic for the C-allele with those homozygotic for the T-allele: lower forearm fracture OR = 3.93 (1.25; 12.40, P = 0.02), hip fracture OR = 6.99 (l.35; 36.92, P = 0.02) and the fractures combined OR = 4.33 (1.73; 10.81, P = 0.002). In this study, the MTHFR (C677T) genotypes were not significantly associated with BMD at the lower forearm or with ultrasound parameters measured at the calcaneus. However, a significant increase in the odds ratio of fracture was found for the wild-type C-allele.
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Affiliation(s)
- H L Jørgensen
- Department of Clinical Biochemistry, Hvidovre University Hospital, Kettegaard Allé 30, 2650 Hvidovre, Denmark.
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Jørgensen PE, Madsen JS, Larsen TB, Hilden J, Magid E. [Evidence-based use of clinical biochemistry]. Ugeskr Laeger 2001; 163:5815-9. [PMID: 11685853] [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: 02/22/2023]
Abstract
Evidence-based use of clinical biochemistry integrates into clinical decision-making the best research evidence with the clinical expertise of the physician and the expectations and concerns of the patient. The best research evidence for the clinical use of a biochemical test should be appraised in close collaboration between clinicians and specialists in clinical biochemistry, as familiarity with both the clinical problem and the analytical performance of the test is necessary. At present, it is difficult to ensure an evidence-based use of biochemical tests. More and methodologically better studies of the clinical value of biochemical tests are needed, and methods should be developed that make it possible to assess the results of such studies by systematic reviews and meta-analyses. Clinical biochemistry is an interdisciplinary specialty, and papers on the clinical value of biochemical tests are published in a vast number of journals of different clinical specialties as well as those of clinical biochemistry. It is thus almost impossible to keep abreast of the subject. The establishment of a system for literature surveillance focusing on methodologically sound studies of the clinical value of biochemical tests would be advantageous. Lastly, training and education on how to find and assess the existing evidence for the clinical use of biochemical tests are needed.
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Affiliation(s)
- P E Jørgensen
- Viborg-Kjellerup Sygehus, klinisk biokemisk afdeling, Odense Universitetshospital, afdeling KKA, klinisk biokemi
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Madsen JS, Wallstedt B, Brandt CJ, Hørder M. [Questions as evident key to knowledge: teaching medical students evidence-based medicine]. Ugeskr Laeger 2001; 163:3609-13. [PMID: 11445979] [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: 02/20/2023]
Abstract
INTRODUCTION In Denmark, as in other countries, there is an increasing focus on evidence-based medicine (EBM) as a necessary tool for using modern sources of information, but until now EBM training has not been incorporated in our undergraduate curriculum. MATERIAL AND METHODS This course is given in the ninth semester (out of 13) and the subject matter is clinical biochemistry. The course consists of seven (one-hour) lectures over three weeks. First, the EBM method is introduced, then the students split up into small groups, choose their own diagnostic problem, and carry out a structured search. The search leads to the choice of a scientific article, which is subsequently presented to and discussed by all the students. We asked about their opinion of the course by questionnaire. RESULTS The answers to the questionnaire confirmed that the students have improved their ability to read and assess scientific articles and to seek information, and it has stimulated them to understand concepts instead of memorising details. DISCUSSION Although the assessment of this course was positive, it can no doubt be improved and further developed. In our opinion the use of EBM should not be confined to one course. The medical students should be introduced to EBM at an early stage, thereby abling them to practice it throughout their training.
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Affiliation(s)
- J S Madsen
- Syddansk Universitet, Det Sundhedsvidenskabelige Fakultet, Klinisk Institut, Afdeling for Klinisk Biokemi, Genetik og Farmakologi og Enheden for Uddannelsesudvikling.
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Affiliation(s)
- E Bindseil
- Laboratory-of Veterinary Pathology, Small Animal Hospital, Royal Veterinary and Agricultural University, Frederiksberg, Denmark
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Madsen JS. The joint capsule and joint laxity in dogs with hip dysplasia. J Am Vet Med Assoc 1997; 210:1463-5. [PMID: 9154198] [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: 02/04/2023]
Abstract
Present knowledge of the complexity of joint diseases makes it difficult to investigate the causes and early pathogenesis of canine hip dysplasia. Clinical signs of canine hip dysplasia including joint laxity may be a result of primary or secondary alterations of the joint. We already know that joint laxity is related to effusive synovitis (ie, accumulation of synovial fluid) and to other primary collagenous diseases. Canine hip dysplasia may be a third collagenous disease associated with joint laxity. This paper summarizes some of the studies that investigated the relationship between joint laxity and a defect in collagen metabolism and the influence that alterations in transsynovial flow have on joint laxity.
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Affiliation(s)
- J S Madsen
- Small Animal Hospital, Department of Clinical Studies, Royal Veterinary and Agricultural University, Frederiksberg C., Denmark
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Abstract
Angiotensin converting enzyme (ACE) inhibitors are generally well tolerated. Worldwide, only few reports have been published associating pancreatitis with ACE inhibitor therapy. We report a case in whom there was no other likely explanation for the acute pancreatitis than enalapril therapy, which was temporally associated with the symptoms. Possible mechanisms underlying the induction of pancreatitis by ACE inhibitors are discussed. With the increasing use of ACE inhibitors, the incidence of rare adverse effects such as potentially lethal pancreatitis is likely to increase. Clinicians need to be aware of this association.
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Affiliation(s)
- J S Madsen
- Department of Internal Medicine C, Odense University Hospital, Denmark
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Madsen JS, Svalastoga E. Serum concentrations of procollagen type III aminoterminal peptide in growing dogs with hip dysplasia. Acta Vet Scand 1995; 36:157-60. [PMID: 7572455 PMCID: PMC8095420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The aim of the present study was to investigate the use of procollagen type III aminoterminal peptide (PIIINP) measurements in serum as an indicator of progress of fibrosis of coxofemoral joint capsules in hip dysplasia in immature dogs. High serum concentrations of PIIINP may indicate ongoing fibrosis with enhanced synthesis and deposition of fibrillar type III collagen, or an alteration in degradation and elimination of circulating PIIINP (Hørslev-Petersen et al. 1988a). Therefore, high concentrations of PIIINP in serum was expected in dogs with hip dysplasia, which is a developmental condition with capsular fibrosis and osteoarthritis (Gay et al. 1986).
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Affiliation(s)
- J S Madsen
- Department of Clinical Studies, Small Animal Hospital, Royal Veterinary and Agricultural University, Frederiksberg C, Denmark
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Abstract
Femoral neck angles were measured radiographically in 41 dogs examined for hip dysplasia. Steep femoral neck inclination was found to be a phenomenon of hip dysplasia and coxofemoral joint laxity. The altered biomechanics of a steep femoral neck inclination may be a factor in the pathogenesis of hip dysplasia and secondary osteoarthritis.
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Madsen JS, Svalastoga E. Inclination and anteversion of collum femoris in hip dysplasia and coxarthritis. Acta Vet Scand 1994; 35:115-9. [PMID: 7942375 PMCID: PMC8101367] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Femoral neck angles were measured radiographically in 41 dogs examined for hip dysplasia. Steep femoral neck inclination was found to be a phenomenon of hip dysplasia and coxofemoral joint laxity. The altered biomechanics of a steep femoral neck inclination may be a factor in the pathogenesis of hip dysplasia and secondary osteoarthritis.
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Affiliation(s)
- J S Madsen
- Department of Clinical Studies, Small Animal Hospital, Royal Veterinary and Agricultural University, Frederiksberg, Denmark
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Madsen JS, Jensen LT, Strøm H, Hørslev-Petersen K, Svalastoga E. Procollagen type-III aminoterminal peptide in serum and synovial fluid of dogs with hip dysplasia and coxarthrosis. Am J Vet Res 1990; 51:1544-6. [PMID: 2240774] [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: 12/30/2022]
Abstract
Hip dysplasia is an affection of the coxofemoral joint that progresses until stabilization is caused by fibrosis and osteoarthritic changes. This stabilization process can be examined by clinical and radiographic methods. The capability of evaluating the procollagen concentrations in liquids, such as serum and synovial fluid, has further offered the basis for an objective biochemical evaluation of the stabilization process. Our study was performed to evaluate whether determination of procollagen concentrations was suitable for the use in practice. The procollagen type-III aminoterminal peptide (P-III-NP) concentration was measured in serum and in synovial fluid from coxofemoral joints in 20 dogs. Dogs were grouped on the basis of evidence of dysplasia and osteoarthritic changes of the hip: (1) a control group of 6 dogs without clinical or radiographic signs of hip dysplasia, and (2) dysplastic group of 14 dogs, which was further grouped with respect to the coxofemoral joint laxity, as determined by the Ortolani test. Synovial fluid concentration of P-III-NP was significantly (P less than 0.05) higher in fluid from dysplastic joints than in fluid from normal joints. Serum concentrations of P-III-NP were significantly (P less than 0.05) higher in dogs in which results of the Ortolani test were positive.
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Affiliation(s)
- J S Madsen
- Department of Small Animal Diseases and Clinical Practice, Royal Veterinary and Agricultural University of Copenhagen, Frederiksberg, Denmark
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