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Grabowski D, Johansen LB, Nannsen AØ, Andersen A, Kristensen K, Iken MK, Hangaard S, Madsen M, Schou AJ, Toubroe SM, Pilgaard KA, DeCosta P. Diabetes Management Support in Preschool and Primary School: A Qualitative Ideation Study Presenting Recommendations for Improved Communicative Practice. Healthcare (Basel) 2024; 12:225. [PMID: 38255112 PMCID: PMC10815472 DOI: 10.3390/healthcare12020225] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
Diabetes care in institutional settings is a significant challenge that affects the whole family as well as care workers and teachers. The present study is the ideation part of a rigorous development process in the KIds with Diabetes in School (KIDS) project. We have previously conducted a thorough three-part needs assessment in which we explored the problem area from the viewpoints of (1) municipal administrative staff, (2) preschool and school staff and (3) families. Based on the identified needs and to a great extent on the contents and shortcomings of existing guidelines, the objective of the present study is to explore and develop possible solutions and recommendations for addressing the challenges and problems. To meet this objective, we held comprehensive multistakeholder participatory workshops in each of the five Danish regions. Five main themes with multiple subthemes were identified as areas to be addressed: (1) training and knowledge, (2) communication and collaboration, (3) the designated contact/support person, (4) national guidelines, and (5) the Diabetes Coordinator. Our findings demonstrate that communicative structures and dynamics are at the very heart of the identified problems and challenges and that the possible solutions should revolve around improving existing structures and highlighting the importance of constantly working on understanding and developing communication strategies. We propose a set of recommendations for practice based on these communicative needs.
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Affiliation(s)
- Dan Grabowski
- Steno Diabetes Center Copenhagen (SDCC), Copenhagen University Hospital, 2730 Herlev, Denmark
| | - Lise Bro Johansen
- Steno Diabetes Center Copenhagen (SDCC), Copenhagen University Hospital, 2730 Herlev, Denmark
| | | | - Anette Andersen
- Steno Diabetes Center Aarhus (SDCA), Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Kurt Kristensen
- Steno Diabetes Center Aarhus (SDCA), Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Pediatrics, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | | | - Stine Hangaard
- Steno Diabetes Center North Denmark (SDCN), 9000 Aalborg, Denmark
| | - Mette Madsen
- Steno Diabetes Center North Denmark (SDCN), 9000 Aalborg, Denmark
- Department of Pediatrics and Adolescent Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Anders Jørgen Schou
- Steno Diabetes Center Odense (SDCO), 5000 Odense, Denmark
- Pediatric Research Unit, Odense University Hospital, 5000 Odense, Denmark
| | | | - Kasper Ascanius Pilgaard
- Steno Diabetes Center Copenhagen (SDCC), Copenhagen University Hospital, 2730 Herlev, Denmark
- Department of Pediatrics, Copenhagen University Hospital, 2730 Herlev, Denmark
| | - Patricia DeCosta
- Steno Diabetes Center Copenhagen (SDCC), Copenhagen University Hospital, 2730 Herlev, Denmark
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Rasmussen VF, Thrysøe M, Randel Nyengaard J, Tankisi H, Karlsson P, Hansen J, Krogh K, Brock C, Kamperis K, Madsen M, Singer W, Vestergaard ET, Kristensen K, Terkelsen AJ. Corrigendum to "Neuropathy in adolescents with type 1 diabetes: Confirmatory diagnostic tests, bedside tests, and risk factors" [Diab. Res. Clin. Pract. 201 (2023) 110736]. Diabetes Res Clin Pract 2023; 205:110950. [PMID: 37852855 DOI: 10.1016/j.diabres.2023.110950] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Affiliation(s)
- Vinni Faber Rasmussen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark; Department of Pediatrics and Adolescent Medicine, Randers Regional Hospital, Randers, Denmark.
| | - Mathilde Thrysøe
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jens Randel Nyengaard
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark; Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Hatice Tankisi
- Department of Neurophysiology, Department of Clinical Medicine, Aarhus University, Denmark
| | - Páll Karlsson
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - John Hansen
- Institute of Health Science and Technology, Aalborg University, Denmark
| | - Klaus Krogh
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Christina Brock
- Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Konstantinos Kamperis
- Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Denmark
| | - Mette Madsen
- Department of Pediatric and Adolescent Medicine, Aalborg University Hospital, Denmark; Steno Diabetes Center North Denmark, Aalborg, Denmark
| | | | - Esben Thyssen Vestergaard
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark; Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Denmark
| | - Kurt Kristensen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark
| | - Astrid Juhl Terkelsen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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3
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Rasmussen VF, Thrysøe M, Nyengaard JR, Tankisi H, Karlsson P, Hansen J, Krogh K, Brock C, Kamperis K, Madsen M, Singer W, Vestergaard ET, Kristensen K, Terkelsen AJ. Neuropathy in adolescents with type 1 diabetes: Confirmatory diagnostic tests, bedside tests, and risk factors. Diabetes Res Clin Pract 2023; 201:110736. [PMID: 37276985 DOI: 10.1016/j.diabres.2023.110736] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/17/2023] [Accepted: 05/26/2023] [Indexed: 06/07/2023]
Abstract
AIMS To estimate the prevalence of large fiber (LFN), small fiber (SFN), and autonomic neuropathy in adolescents with type 1 diabetes using confirmatory tests known from adults and to identify risk factors and bedside methods for neuropathy. METHODS Sixty adolescents with type 1 diabetes (diabetes duration > five years) and 23 control subjects underwent neurological examination and confirmatory diagnostic tests for neuropathy, including nerve conduction studies, skin biopsies determining intraepidermal nerve fiber density, quantitative sudomotor axon reflex test (QSART), cardiovascular reflex tests (CARTs), and tilt table test. Possible risk factors were analyzed. Bedside tests (biothesiometry, DPNCheck®, Sudoscan, and Vagus®device) were compared with the confirmatory tests using ROC analysis. RESULTS The prevalence of neuropathies in the adolescents with diabetes (mean HbA1c 7.6% (60 mmol/mol)) was as follows: 14% confirmed/26% subclinical LFN, 2% confirmed/25% subclinical SFN, 20% abnormal QSART, 8% abnormal CARTs, and 14% orthostatic hypotension. Higher age, higher insulin dose, previous smoking, and higher triglycerides level were found to increase the relative risk for neuropathy. The bedside tests showed poor to acceptable concordance with the confirmatory tests (all, AUC ≤ 0.75). CONCLUSIONS The diagnostic tests confirmed the presence of neuropathy in adolescents with diabetes and underscore the importance of prevention and screening.
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Affiliation(s)
- Vinni Faber Rasmussen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark; Department of Pediatrics and Adolescent Medicine, Randers Regional Hospital, Randers, Denmark.
| | - Mathilde Thrysøe
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jens Randel Nyengaard
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark; Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Hatice Tankisi
- Department of Neurophysiology, Department of Clinical Medicine, Aarhus University, Denmark
| | - Páll Karlsson
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - John Hansen
- Institute of Health Science and Technology, Aalborg University, Denmark
| | - Klaus Krogh
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Christina Brock
- Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Konstantinos Kamperis
- Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Denmark
| | - Mette Madsen
- Department of Pediatric and Adolescent Medicine, Aalborg University Hospital, Denmark; Steno Diabetes Center North Denmark, Aalborg, Denmark
| | | | - Esben Thyssen Vestergaard
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark; Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Denmark
| | - Kurt Kristensen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark
| | - Astrid Juhl Terkelsen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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Rasmussen MQ, Tindbæk G, Nielsen MM, Merrild C, Steiniche T, Pedersen JS, Moestrup SK, Degn SE, Madsen M. Epigenetic Silencing of LRP2 Is Associated with Dedifferentiation and Poor Survival in Multiple Solid Tumor Types. Cancers (Basel) 2023; 15:cancers15061830. [PMID: 36980716 PMCID: PMC10046670 DOI: 10.3390/cancers15061830] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/30/2023] Open
Abstract
More than 80% of human cancers originate in epithelial tissues. Loss of epithelial cell characteristics are hallmarks of tumor development. Receptor-mediated endocytosis is a key function of absorptive epithelial cells with importance for cellular and organismal homeostasis. LRP2 (megalin) is the largest known endocytic membrane receptor and is essential for endocytosis of various ligands in specialized epithelia, including the proximal tubules of the kidney, the thyroid gland, and breast glandular epithelium. However, the role and regulation of LRP2 in cancers that arise from these tissues has not been delineated. Here, we examined the expression of LRP2 across 33 cancer types in The Cancer Genome Atlas. As expected, the highest levels of LRP2 were found in cancer types that arise from LRP2-expressing absorptive epithelial cells. However, in a subset of tumors from these cancer types, we observed epigenetic silencing of LRP2. LRP2 expression showed a strong inverse correlation to methylation of a specific CpG site (cg02361027) in the first intron of the LRP2 gene. Interestingly, low expression of LRP2 was associated with poor patient outcome in clear cell renal cell carcinoma, papillary renal cell carcinoma, mesothelioma, papillary thyroid carcinoma, and invasive breast carcinoma. Furthermore, loss of LRP2 expression was associated with dedifferentiated histological and molecular subtypes of these cancers. These observations now motivate further studies on the functional role of LRP2 in tumors of epithelial origin and the potential use of LRP2 as a cancer biomarker.
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Affiliation(s)
| | - Gitte Tindbæk
- Department of Biomedicine, Aarhus University, 8000 Aarhus, Denmark
- Department of Clinical Biochemistry, Horsens Regional Hospital, 8700 Horsens, Denmark
| | - Morten Muhlig Nielsen
- Department of Molecular Medicine (MOMA), Aarhus University Hospital, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
| | - Camilla Merrild
- Department of Biomedicine, Aarhus University, 8000 Aarhus, Denmark
| | - Torben Steiniche
- Department of Pathology, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Jakob Skou Pedersen
- Department of Molecular Medicine (MOMA), Aarhus University Hospital, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
- Bioinformatics Research Center (BiRC), Aarhus University, 8000 Aarhus, Denmark
| | - Søren K Moestrup
- Department of Biomedicine, Aarhus University, 8000 Aarhus, Denmark
- Department of Cancer and Inflammation Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Søren E Degn
- Department of Biomedicine, Aarhus University, 8000 Aarhus, Denmark
| | - Mette Madsen
- Department of Biomedicine, Aarhus University, 8000 Aarhus, Denmark
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5
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Nannsen AØ, Kristensen K, Johansen LB, Iken MK, Madsen M, Pilgaard KA, Grabowski D, Hangaard S, Schou AJ, Andersen A. Management of Diabetes during School Hours: A Cross-Sectional Questionnaire Study in Denmark. Healthcare (Basel) 2023; 11:healthcare11020251. [PMID: 36673619 PMCID: PMC9859616 DOI: 10.3390/healthcare11020251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
Managing diabetes is complicated for many children. It often requires support from an adult during the school day. In Denmark, most children spend 30-35 h a week at school. Nevertheless, diabetes management in schools remains largely uninvestigated. This study aimed to examine the characteristics and organization of diabetes management in Danish primary schools from the personnel's perspective. All primary schools in Denmark were invited to participate in the study (n = 2129), and 525 schools were included. A questionnaire was constructed and sent by email. Questionnaire data are presented in the descriptive statistics and compared with the ISPAD guidelines. According to 77.2% of respondents, school personnel had received training in diabetes management, and 78.5% of the schools had at least one person available for diabetes support every day. Respondents felt prepared to help the students with counting carbohydrates (38.9%), dosing insulin (39.1%), and helping the students during high (52.1%) or low (60.3%) blood sugar levels, insulin chock (35.2%), or during activities (36.3%). Yet, diabetes management was a challenging task. Only 61.7% had an action plan for diabetes management, 37.4% had face-to-face information meetings with the parents, and 55.1% of respondents reported having sufficient time to cooperate with the parents.
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Affiliation(s)
- Anne Østergaard Nannsen
- Steno Diabetes Center Aarhus (SDCA), Aarhus University Hospital, 8200 Aarhus N, Denmark
- Correspondence:
| | - Kurt Kristensen
- Steno Diabetes Center Aarhus (SDCA), Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Pediatrics, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Lise Bro Johansen
- Steno Diabetes Center Copenhagen (SDCC), Department of Research, Copenhagen University Hospital, 2730 Herlev, Denmark
| | | | - Mette Madsen
- Steno Diabetes Center North Denmark (SDCN), 9000 Aalborg, Denmark
- Department of Pediatrics and Adolescent Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Kasper Ascanius Pilgaard
- Steno Diabetes Center Copenhagen (SDCC), Department of Research, Copenhagen University Hospital, 2730 Herlev, Denmark
- Department of Pediatrics, Copenhagen University Hospital, 2730 Herlev, Denmark
| | - Dan Grabowski
- Steno Diabetes Center Copenhagen (SDCC), Department of Research, Copenhagen University Hospital, 2730 Herlev, Denmark
| | - Stine Hangaard
- Steno Diabetes Center North Denmark (SDCN), 9000 Aalborg, Denmark
| | - Anders Jørgen Schou
- Steno Diabetes Center Odense (SDCO), 5000 Odense, Denmark
- Pediatric Research Unit, Odense University Hospital, 5000 Odense, Denmark
| | - Anette Andersen
- Steno Diabetes Center Aarhus (SDCA), Aarhus University Hospital, 8200 Aarhus N, Denmark
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6
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Jarman M, Shen Y, Yuan Y, Madsen M, Robson PJ, Bell RC. Applying suggested new terminology and definitions for human milk feeding in the Alberta Pregnancy Outcomes and Nutrition (APrON) longitudinal pregnancy cohort. Appl Physiol Nutr Metab 2023; 48:17-26. [PMID: 36137297 DOI: 10.1139/apnm-2021-0658] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The complexity of human milk-feeding behaviours may not be captured using simpler definitions of "exclusive" and "non-exclusive" breastfeeding. New definitions have been suggested to describe variation in these behaviours more fully but have not been widely applied. We applied the new definitions to data derived from 3-day human milk-feeding diaries. Participants (n = 1091) recorded the number, beginning/end time, and modes of feeding of infants aged 3 months. Data were used to create six exclusive groups according to feeding mode(s): (1) human milk at-breast only; (2) human milk at-breast and human milk in a bottle; (3) human milk at-breast and infant formula in a bottle; (4) human milk at-breast and human milk and infant formula mixed in the same bottle; (5) human milk at-breast, human milk in a bottle, and infant formula in a bottle (not mixed); and (6) a bottle that sometimes contained human milk and sometimes infant formula (not mixed), never at-breast. Differences in maternal and infant characteristics were examined among groups. Fifty-seven percent fed at-breast only (Group 1). Those in Group 1 spent a similar amount of time feeding directly at-breast (median 132 (IQR 98-172) min/day) as those in Groups 2 (124 (95-158)), 3 (143 (100-190)), and 5 (114 (84-142)) (p > 0.05), indicating that adding bottle feeding did not always reduce the time infants were fed at-breast. Applying new suggested definitions to describe human milk-feeding behaviours from the mothers' perspective highlights the complexity of patterns used and warrants further application and research to explore impacts on health outcomes.
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Affiliation(s)
- Megan Jarman
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, AB, Canada.,School of Psychology, College of Health and Life Science, Aston University, Birmingham, UK
| | - Ye Shen
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Yan Yuan
- School of Public Health, University of Alberta, Edmonton AB, Canada
| | - Mette Madsen
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Paula J Robson
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, AB, Canada.,School of Public Health, University of Alberta, Edmonton AB, Canada.,Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Edmonton, AB T5J 3H1, Canada
| | - Rhonda C Bell
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, AB, Canada
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7
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Petersen MH, Willert CW, Andersen JV, Madsen M, Waagepetersen HS, Skotte NH, Nørremølle A. Progressive Mitochondrial Dysfunction of Striatal Synapses in R6/2 Mouse Model of Huntington's Disease. J Huntingtons Dis 2022; 11:121-140. [PMID: 35311711 DOI: 10.3233/jhd-210518] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 01/14/2023]
Abstract
BACKGROUND Huntington's disease (HD) is a neurodegenerative disorder characterized by synaptic dysfunction and loss of white matter volume especially in the striatum of the basal ganglia and to a lesser extent in the cerebral cortex. Studies investigating heterogeneity between synaptic and non-synaptic mitochondria have revealed a pronounced vulnerability of synaptic mitochondria, which may lead to synaptic dysfunction and loss. OBJECTIVE As mitochondrial dysfunction is a hallmark of HD pathogenesis, we investigated synaptic mitochondrial function from striatum and cortex of the transgenic R6/2 mouse model of HD. METHODS We assessed mitochondrial volume, ROS production, and antioxidant levels as well as mitochondrial respiration at different pathological stages. RESULTS Our results reveal that striatal synaptic mitochondria are more severely affected by HD pathology than those of the cortex. Striatal synaptosomes of R6/2 mice displayed a reduction in mitochondrial mass coinciding with increased ROS production and antioxidants levels indicating prolonged oxidative stress. Furthermore, synaptosomal oxygen consumption rates were significantly increased during depolarizing conditions, which was accompanied by a marked increase in mitochondrial proton leak of the striatal synaptosomes, indicating synaptic mitochondrial stress. CONCLUSION Overall, our study provides new insight into the gradual changes of synaptic mitochondrial function in HD and suggests compensatory mitochondrial actions to maintain energy production in the HD brain, thereby supporting that mitochondrial dysfunction do indeed play a central role in early disease progression of HD.
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Affiliation(s)
- Maria Hvidberg Petersen
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Jens Velde Andersen
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Mette Madsen
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Niels Henning Skotte
- Proteomics Program, The Novo Nordisk Foundation Centre for Protein Research, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Nørremølle
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
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8
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Andersen SL, Frederiksen AL, Rasmussen AB, Madsen M, Christensen AMR. Homozygous missense variant of PTH (c.166C>T, p.(Arg56Cys)) as the cause of familial isolated hypoparathyroidism in a three-year-old child. J Pediatr Endocrinol Metab 2022; 35:691-694. [PMID: 35120289 DOI: 10.1515/jpem-2021-0752] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/17/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Hypoparathyroidism is a rare disorder which is predominantly of idiopathic or genetic origin in children. The diagnosis is made from the biochemical measurement of parathyroid hormone (PTH), and the key findings include a low PTH in combination with hypocalcemia and hyperphosphatemia. However, the level of PTH encountered in patients with hypoparathyroidism may be dependent on the underlying genetic cause of the disorder as well as the biochemical assay used for assessment of PTH. CASE PRESENTATION A three-year-old child with asymptomatic primary hypoparathyroidism was identified with a homozygous missense variant of PTH. A sudden unexpected high PTH result after a shift from 2nd to 3rd generation PTH assay in the routine laboratory provided a clue on the underlying genetic etiology. CONCLUSIONS Pathogenic variants of PTH as a cause of hypoparathyroidism are rarely described. In this case, the child was asymptomatic, and discordant PTH results were seen with different assays.
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Affiliation(s)
- Stine Linding Andersen
- Department of Clinical Biochemistry, Aalborg University Hospital , Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University , Aalborg, Denmark
| | - Anja Lisbeth Frederiksen
- Department of Clinical Medicine, Aalborg University , Aalborg, Denmark.,Department of Clinical Genetics, Aalborg University Hospital , Aalborg, Denmark
| | | | - Mette Madsen
- Department of Pediatrics, Aalborg University Hospital , Aalborg, Denmark.,Steno Diabetes Center North Jutland, Aalborg University Hospital , Aalborg, Denmark
| | - Ann-Margrethe Rønholt Christensen
- Department of Pediatrics, Aalborg University Hospital , Aalborg, Denmark.,Steno Diabetes Center North Jutland, Aalborg University Hospital , Aalborg, Denmark
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9
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Bryniarski MA, Zhao B, Chaves LD, Mikkelsen JH, Yee BM, Yacoub R, Shen S, Madsen M, Morris ME. Immunoglobulin G Is a Novel Substrate for the Endocytic Protein Megalin. AAPS J 2021; 23:40. [PMID: 33677748 DOI: 10.1208/s12248-021-00557-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/07/2021] [Indexed: 11/30/2022]
Abstract
Therapeutic immunoglobulin G (IgG) antibodies comprise the largest class of protein therapeutics. Several factors that influence their overall disposition have been well-characterized, including target-mediated mechanics and convective flow. What remains poorly defined is the potential for non-targeted entry into various tissues or cell types by means of uptake via cell surface receptors at those sites. Megalin and cubilin are large endocytic receptors whose cooperative function plays important physiological roles at the tissues in which they are expressed. One such example is the kidney, where loss of either results in significant declines in proximal tubule protein reabsorption. Due to their diverse ligand profile and broad tissue expression, megalin and cubilin represent potential candidates for receptor-mediated uptake of IgG into various epithelia. Therefore, the objective of the current work was to determine if IgG was a novel ligand of megalin and/or cubilin. Direct binding was measured for human IgG with both megalin and the cubilin/amnionless complex. Additional work focusing on the megalin-IgG interaction was then conducted to build upon these findings. Cell uptake studies using megalin ligands for competitive inhibition or proximal tubule cells stably transduced with megalin-targeted shRNA constructs supported a role for megalin in the endocytosis of human IgG. Furthermore, a pharmacokinetic study using transgenic mice with a kidney-specific mosaic knockout of megalin demonstrated increased urinary excretion of human IgG in megalin knockout mice when compared to wild-type controls. These findings indicate that megalin is capable of binding and internalizing IgG via a high affinity interaction.
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Affiliation(s)
- Mark A Bryniarski
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, 445 Pharmacy Building, Buffalo, New York, 14214-8033, USA
| | - Bei Zhao
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, 445 Pharmacy Building, Buffalo, New York, 14214-8033, USA
| | - Lee D Chaves
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, 445 Pharmacy Building, Buffalo, New York, 14214-8033, USA.,Department of Internal Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | | | - Benjamin M Yee
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, 445 Pharmacy Building, Buffalo, New York, 14214-8033, USA
| | - Rabi Yacoub
- Department of Internal Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Shichen Shen
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, 445 Pharmacy Building, Buffalo, New York, 14214-8033, USA
| | - Mette Madsen
- Department of Biomedicine, Aarhus University, 8000, Aarhus C., Denmark
| | - Marilyn E Morris
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, 445 Pharmacy Building, Buffalo, New York, 14214-8033, USA.
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10
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Ibfelt EH, Vistisen D, Falberg Rønn P, Pørksen S, Madsen M, Kremke B, Svensson J. Association between glycaemic outcome and BMI in Danish children with type 1 diabetes in 2000-2018: a nationwide population-based study. Diabet Med 2021; 38:e14401. [PMID: 32918312 DOI: 10.1111/dme.14401] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/19/2020] [Accepted: 09/03/2020] [Indexed: 10/23/2022]
Abstract
AIM To describe the development of HbA1c and BMI over time in Danish children with type 1 diabetes; and to investigate the association between HbA1c and BMI including influence of age, gender, diabetes duration, severe hypoglycaemia and treatment method. METHODS We used the nationwide Danish Registry of Childhood and Adolescent Diabetes, DanDiabKids, including annual registrations of all children with diabetes treated at Danish hospitals. With linear mixed-effects models and splines we analyzed the HbA1c and BMI development over time as well as the association between HbA1c and BMI including effects of gender, age, disease duration, hypoglycaemia and treatment method. BMI z-scores were calculated for these analyses. RESULTS For the period from 2000 to 2018, 6097 children with type 1 diabetes were identified from the DanDiabKids database. The median (interquartile range) HbA1c level was 65 (57-74) mmol/mol (8.1%) and the median BMI z-score was 0.85 in girls and 0.67 in boys. A non-linear association was found between HbA1c and BMI z-score, with the highest BMI z-score observed for HbA1c values in the range of approximately 60-70 mmol/mol (7.6-6.8%). The association was modified by gender, age and diabetes duration. Severe hypoglycaemia and insulin pump treatment had a small positive impact on BMI z-score. CONCLUSION The association between HbA1c and BMI z-score was non-linear, with the highest BMI z-score being observed for intermediate HbA1c levels; however, specific patterns depended on gender, age and diabetes duration.
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Affiliation(s)
- E H Ibfelt
- Steno Diabetes Centre Copenhagen, Gentofte, Denmark
| | - D Vistisen
- Steno Diabetes Centre Copenhagen, Gentofte, Denmark
| | | | - S Pørksen
- Zealand University Hospital, Roskilde, Denmark
- Steno Diabetes Centre Sjaelland, Holbaek, Denmark
| | - M Madsen
- Aalborg University Hospital, Aalborg, Denmark
| | - B Kremke
- Randers Regional Hospital, Randers, Denmark
| | - J Svensson
- Herlev and Gentofte Hospital, Herlev, Denmark
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11
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Gyldenkerne C, Olesen K, Thrane P, Madsen M, Thim T, Wurtz M, Jensen L, Raungaard B, Poulsen P, Boetker H, Maeng M. Diabetes is not a risk factor for myocardial infarction in patients without coronary artery disease. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Diabetes is considered a risk factor for myocardial infarction (MI). However, we have previously found that diabetes was not a short-term risk factor for MI in the absence of obstructive coronary artery disease (CAD).
Purpose
As long-term data are not available, we aimed to assess adverse cardiac events in patients with and without diabetes stratified by CAD up to 11 years after coronary angiography.
Methods
We conducted a cohort study of patients undergoing coronary angiography from 2003 to 2012 and followed them by cross-linking Danish health registries. Patients were stratified according to the presence/absence of CAD and diabetes. Outcomes included MI, cardiac death, all-cause death, and coronary revascularization.
Results
A total of 86,202 patients were included (diabetes: n=12,652). Median follow-up was 8.8 years. Using patients with neither CAD nor diabetes as reference (cumulative MI incidence 2.6%), the risk of MI was similar for patients with diabetes alone (3.2%; hazard ratio 1.202, 95% CI: 0.996–1.451), was increased for patients with CAD alone (9.3%; hazard ratio 2.75, 95% CI: 2.52–3.01), and was highest for patients with both CAD and diabetes (12.3%; hazard ratio 3.79, 95% CI: 3.43–4.20), see Figure. Similar associations were observed for cardiac death and coronary revascularization.
Conclusions
Diabetes patients without CAD by coronary angiography have a similar risk of MI compared to patients with neither CAD nor diabetes. In the presence of CAD, however, diabetes increases the risk of MI.
Figure 1
Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): The Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
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Affiliation(s)
- C Gyldenkerne
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - K.K.W Olesen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - P.G Thrane
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - M Madsen
- Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus, Denmark
| | - T Thim
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - M Wurtz
- Region Hospital Herning, Department of Cardiology, Herning, Denmark
| | - L.O Jensen
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - B Raungaard
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - P.L Poulsen
- Aarhus University Hospital, Steno Diabetes Center, Aarhus, Denmark
| | - H.E Boetker
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - M Maeng
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
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12
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Olesen K, Madsen M, Gyldenkerne C, Thrane P, Thim T, Jensen L, Botker H, Sorensen H, Maeng M. Ten-year cardiovascular risk in diabetes patients without of coronary artery disease – a Danish cohort study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients with diabetes without obstructive coronary artery disease (CAD) by coronary angiography (CAG) have a risk of myocardial infarction (MI) similar to that of non-diabetes patients without CAD. Their cardiovascular risk compared to the general population is unknown.
Purpose
We examined the 10-year risks of myocardial infarction (MI), ischemic stroke, and death in diabetes patients without CAD after CAG compared to the general population.
Methods
We included all diabetes patients without obstructive CAD examined by CAG from 2003–2016 in Western Denmark and an age and sex matched comparison group, sampled from the general population in Western Denmark without previous history of coronary heart disease. Outcomes were MI, ischemic stroke, and death. The 10-year cumulative incidences were estimated. Adjusted hazard ratios (HRs) were estimated by stratified Cox regression using the general population as the reference group.
Results
We identified 5,760 diabetes patients without obstructive CAD and 29,139 individuals from the general population. Median follow-up was 7 years with 25% of participants followed for up to 10 years. Diabetes patients without obstructive CAD had an almost similar 10-year risk of MI (3.2% vs 2.9%, adjusted HR 0.91, 95% CI 0.70–1.17, Figure) compared to the general population cohort. Diabetes patients had an increased risk of ischemic stroke (5.2% vs 2.2%, adjusted HR 1.88, 95% CI 1.48–2.39), and death (29.7% vs 17.9%, adjusted HR 1.41, 95% CI 1.29–1.54). The duration of diabetes was associated with increased cardiovascular risk.
Conclusions
Absence of obstructive CAD by CAG in patients with diabetes ensures a low MI risk similar to the general population, but diabetes patients still have an increased risk of ischemic stroke and all-cause death despite absence of CAD.
Figure 1
Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Department of Cardiology, Aarhus University Hospital
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Affiliation(s)
- K.K.W Olesen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - M Madsen
- Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus, Denmark
| | - C Gyldenkerne
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - P.G Thrane
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - T Thim
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - L.O Jensen
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - H.E Botker
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - H.T Sorensen
- Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus, Denmark
| | - M Maeng
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
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13
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Pilgaard KA, Breinegaard N, Johannesen J, Pörksen S, Fredheim S, Madsen M, Kristensen K, Svensson J, Birkebaek NH. Episodes of severe hypoglycemia is associated with a progressive increase in hemoglobin A1c in children and adolescents with type 1 diabetes. Pediatr Diabetes 2020; 21:808-813. [PMID: 32304129 DOI: 10.1111/pedi.13020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/01/2020] [Accepted: 04/02/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To investigate the trajectory in glycemic control following episodes of severe hypoglycemia (SH) among children and adolescents with type 1 diabetes (T1D). METHODS A Danish national population-based study comprising data from 2008-17. SH was defined according to the 2014 ISPAD guidelines. A mixed model was applied with HbA1c as outcome and SH episodes and time since first episode as explanatory variables. Data were adjusted for age, gender and diabetes duration. RESULTS A total of 4244 children (51.6% boys) with 18 793 annual outpatient visits were included. Mean (SD) age at diabetes onset was 9.0 (4.1) years. Median diabetes duration at inclusion in the study was 1.2 (Q1 = 0.9, Q3 = 3.0) years, and median diabetes duration at last visit was 5.0 (Q1 = 2.7, Q3 = 8.1) years. A total of 506 children experienced at least one episode of SH during the nine-year follow-up; 294 children experienced one episode, 115 two episodes and 97 three or more episodes of SH. HbA1c increased with episodes of SH and in the years following the first episode. The glycemic trajectory peaked 2 to 3 years after an SH episode. The accumulated deterioration in glycemic control was in the range of 5% in patients with two or more episodes equivalent to an increase in HbA1c of 4 mmol/mol (HbA1c ~0.4%). CONCLUSION SH was followed by a progressive and lasting increase in HbA1c among Danish children and adolescents with T1D. Thus, in addition to the known risk of new episodes of hypoglycemia and cognitive impairment, SH contributes to long-term diabetes complications.
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Affiliation(s)
- Kasper A Pilgaard
- Department of Paediatrics, Nordsjaellands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Nina Breinegaard
- Department of Biostatistics, University of Copenhagen, Kobenhavn, Denmark
| | - Jesper Johannesen
- Department of Paediatrics, Herlev University Hospital, Herlev, Denmark
| | - Sven Pörksen
- Department of Paediatrics, Roskilde University Hospital, Roskilde, Denmark.,Steno Diabetes Center Region of Zealand, Roskilde, Denmark
| | - Siri Fredheim
- Steno Diabetes Center Region of Zealand, Roskilde, Denmark.,Department of Paediatrics, Sjaellands University Hospital, Roskilde, Denmark
| | - Mette Madsen
- Department of Paediatrics, Aalborg University Hospital, Aalborg, Denmark
| | - Kurt Kristensen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Jannet Svensson
- Department of Paediatrics, Herlev University Hospital, Herlev, Denmark
| | - Niels H Birkebaek
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.,Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
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14
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Topperzer MK, Larsen HB, Hoffmann M, Schmiegelow K, Lausen B, Madsen M, Roland P, Sørensen JL. Response to: Patient-centred medical education: A proposed definition. Med Teach 2020; 42:360-361. [PMID: 31185784 DOI: 10.1080/0142159x.2019.1625315] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Martha Krogh Topperzer
- Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen (UCPH), Copenhagen, Denmark
| | - Hanne Bækgaard Larsen
- Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen (UCPH), Copenhagen, Denmark
| | - M Hoffmann
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, UCPH, Copenhagen, Denmark
| | - K Schmiegelow
- Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen (UCPH), Copenhagen, Denmark
| | - B Lausen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, UCPH, Copenhagen, Denmark
| | - M Madsen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, UCPH, Copenhagen, Denmark
| | - P Roland
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, UCPH, Copenhagen, Denmark
| | - J L Sørensen
- Juliane Marie Centre, Rigshospitalet, UCPH, Denmark
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15
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Herskin CW, Olsen BS, Madsen M, Kjaersgaard P, Fredheim S, Johansen A, Kristensen K, Birkebaek NH, Svensson J, Pilgaard KA, Johannesen J. Screening for retinopathy in children with type 1 diabetes in Denmark. Pediatr Diabetes 2020; 21:106-111. [PMID: 31618523 DOI: 10.1111/pedi.12936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/09/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND/OBJECTIVE Children with type 1 diabetes (T1D) are screened regularly for retinopathy with fundus photography to prevent visual impairment. According to Danish national guidelines, screening should take place at age 12, 15, and 18 years after minimum 3 years of diabetes. As glycemic control has improved, prevalence of retinopathy is expected to be decreased. The aim of this study is to investigate the prevalence, degree, and progression of retinopathy in children with T1D and to explore if screening at 12 years is currently indicated in Denmark. METHODS Data on all Danish children with onset of T1D from 2003 to 2013 (n = 2943) were collected from the "DanDiabKids" registry. For children with registered screenings (n = 2382), prevalence of retinopathy at 12, 15, and 18 years was determined. In children with retinopathy, subsequent screenings were studied to reveal if retinopathy was persistent or temporary. RESULTS Prevalence of retinopathy at 12, 15, and 18 years was 0.9%, 2.3%, and 3.1%, respectively. Minimal background retinopathy was seen in over 90% and 100% at 12 years. In available re-screenings, retinopathy resolved spontaneously in 87.5% of all cases and 100% of cases at 12 years. CONCLUSIONS The prevalence of retinopathy in Danish children with T1D was low. At 12 years, prevalence was 0.9% and exclusively minimal background retinopathy with 100% remission in re-screenings. Thus, screening at this age does not seem to have significant clinical relevance. We propose more individualized screening selection before the age of 15.
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Affiliation(s)
- Camilla W Herskin
- Department of Paediatrics, Herlev University Hospital, Herlev, Denmark
| | - Birthe S Olsen
- Department of Paediatrics, Herlev University Hospital, Herlev, Denmark
| | - Mette Madsen
- Department of Paediatrics, Aalborg University Hospital, Aalborg, Denmark
| | - Per Kjaersgaard
- Department of Paediatrics, Herning Hospital, Herning, Denmark
| | - Siri Fredheim
- Department of Paediatrics, Herlev University Hospital, Herlev, Denmark
| | - Anders Johansen
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark
| | - Kurt Kristensen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Niels H Birkebaek
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Jannet Svensson
- Department of Paediatrics, Herlev University Hospital, Herlev, Denmark
| | - Kasper A Pilgaard
- Pediatric and Adolescent Department, Nordsjaellands Hospital, Hillerød, Denmark
| | - Jesper Johannesen
- Department of Paediatrics, Herlev University Hospital, Herlev, Denmark
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16
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Johnsen S, Madsen M, Linder M, Sulo G, Ghanima W, Gislason G, Halvorsen S, Hohnloser SH, Jenkins A, Al-Khalili F, Tell GS, Ehrenstein V. P3470Comparative effectiveness and safety of non-vitamin K oral anticoagulants and warfarin in non-valvular atrial fibrillation - a cohort study in 3 Nordic countries. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Non-vitamin K oral anticoagulants (NOACs) are an alternative to warfarin in the prevention of stroke in non-valvular atrial fibrillation (NVAF). Nordic countries have high quality of warfarin treatment, making them an especially suitable setting for assessing effectiveness and safety of NOACs against warfarin.
Purpose
The BEYOND Pooled (BEnefit of NOACs studY of nOn-valvular AF patieNts in NorDic countries) study compared risks of ischaemic or haemorrhagic stroke/systemic embolism (S/SE), and risk of bleeding with acute hospitalisation with an overnight stay (bleeding) in NVAF patients treated with apixaban, dabigatran or rivaroxaban, each compared with warfarin treatment.
Methods
A cohort study of treatment-naïve adult NVAF patients dispensed apixaban, dabigatran, rivaroxaban or warfarin was identified from 01 Jan 2013 to 31 Dec 2016. The population and study variables were identified from national registries in Denmark, Norway and Sweden. After 1:1 propensity score (PS) matching for each NOAC-warfarin comparison, individual-level data were pooled across the countries. Cox proportional-hazards regression was used to estimate adjusted hazard ratios (aHRs) of the endpoints.
Results
PS matched NOAC cohort sizes were: apixaban (55,696) dabigatran (28,526) and rivaroxaban (30,701), and the total follow-up in the PS-matched population was 291,171 years (mean 1.3 years). During the follow-up, 35,450 oral anticoagulation (OAC) patients had a S/SE and 38,620 OAC patients had bleeding. Adjusted HRs for the two endpoints are presented in the table. PH assumption has not been formally tested but cum incidence curves did not indicate substantial differences in the effects over time.
Table 1. Adjusted hazard ratios (aHR) of stroke/systemic embolism and bleeding for non-vitamin K oral anticoagulants versus warfarin Endpoint Apixaban vs Warfarin: aHR (95% CI) Dabigatran vs Warfarin: aHR (95% CI) Rivaroxaban vs Warfarin: aHR (95% CI) Stroke/SE 0.93 (0.85–1.03) 0.89 (0.80–1.00) 0.97 (0.88–1.08) Bleeding 0.72 (0.67–0.77) 0.87 (0.80–0.95) 1.12 (1.04–1.20)
Conclusions
Relative to warfarin, apixaban and dabigatran were associated with lower rates of bleeding whereas rivaroxaban was associated with a higher rate. The three NOACs had comparable rates of stroke and systemic embolism relative to warfarin.
Acknowledgement/Funding
This study was funded by the Pfizer/Bristol-Myers Squibb Alliance.
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Affiliation(s)
- S Johnsen
- Aalborg University, Department of Clinical Medicine, Aalborg, Denmark
| | - M Madsen
- Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus, Denmark
| | - M Linder
- Karolinska Institute, Centre for Pharmacoepidemiology, Stockholm, Sweden
| | - G Sulo
- Norwegian Institute of Public Health, Centre for Disease Burden, Bergen, Norway
| | - W Ghanima
- Oestfold Hospital Trust, Department of Hematology, Fredrikstad, Norway
| | - G Gislason
- Gentofte Hospital - Copenhagen University Hospital, Department of Cardiology, Hellerup, Denmark
| | - S Halvorsen
- Ulleval University Hospital, Department of Cardiology, Oslo, Norway
| | - S H Hohnloser
- JW Goethe University, Department of Cardiology, Frankfurt am Main, Germany
| | - A Jenkins
- Pfizer Ltd, Tadworth, United Kingdom
| | - F Al-Khalili
- Sophiahemmets Hospital, Heart, Lung and Allergy Clinic, Stockholm, Sweden
| | - G S Tell
- University of Bergen, Department of Global Public Health and Primary Care, Bergen, Norway
| | - V Ehrenstein
- Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus, Denmark
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17
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Olesen KKW, Madsen M, Gyldenkerne C, Thrane PG, Wurtz M, Thim T, Jensen LO, Eikelboom JW, Botker HE, Sorensen HT, Maeng M. 287Diabetes mellitus is a risk factor for ischemic stroke in patients with and without coronary artery disease after coronary angiography. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Diabetes (DM) and non-DM patients without coronary artery disease (CAD) by coronary angiography (CAG) have the same low risk of myocardial infarction.
Purpose
To study whether DM patients without CAD have the same risk of ischemic stroke as patients with neither DM nor CAD.
Methods
We conducted a cohort study of patients, who underwent CAG between 2004 and 2012 in the Western Denmark Heart Registry. Patients previously diagnosed with ischemic stroke or atrial fibrillation (AF) and those treated with an oral anticoagulant were excluded. Patients were stratified according to presence of DM and CAD. Follow-up started 30 days after CAG. We computed event rates and adjusted incidence rate ratios (IRRs) using patients with neither DM nor CAD as reference.
Results
A total of 68,829 patients were included. Median follow-up was 4.0 years. Patients with both DM and CAD were at the highest risk of ischemic stroke (1.25 events per 100 person-years; adjusted IRR 2.10, 95% CI 1.77–2.48) (Figure 1). Patients with CAD alone (0.70 events per 100 person-years; adjusted IRR 1.29, 95% CI 1.12–1.48) or DM alone (0.84 events per 100 person-years; adjusted IRR 1.79, 95% CI 1.41–2.26) were at intermediate risk while patients with neither DM nor CAD (0.46 events per 100 person-years) were at lowest risk. Among DM patients, extent of CAD was further predictive of risk (ptrend<0.001).
Figure 1
Conclusions
Not only CAD but also DM independently predict the risk of ischemic stroke after CAG. Their combination further increases the risk of ischemic stroke depending on the extent of CAD.
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Affiliation(s)
- K K W Olesen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - M Madsen
- Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus, Denmark
| | - C Gyldenkerne
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - P G Thrane
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - M Wurtz
- Region Hospital Herning, Department of Cardiology, Herning, Denmark
| | - T Thim
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - L O Jensen
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - J W Eikelboom
- Mcmaster University, Population Health Research Institute, Hamilton, Canada
| | - H E Botker
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - H T Sorensen
- Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus, Denmark
| | - M Maeng
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
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18
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Ahlborn LB, Madsen M, Jonson L, Nielsen FC, Lassen U, Yde CW, Mau-Sorensen M. Concordance of Mutation Detection in Circulating Tumor DNA in Early Clinical Trials Using Different Blood Collection Protocols. Clin Lab 2019; 63:1755-1759. [PMID: 29035458 DOI: 10.7754/clin.lab.2017.170516] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Small fragments of tumor DNA can be found in the circulation of cancer patients, providing a noninvasive access to tumor material (liquid biopsy). Analysis of circulating tumor DNA (ctDNA) has been used for diagnosis, treatment decisions, and detection of therapy resistance, including in patients with tumors inaccessible for biopsy, making ctDNA an important alternative source of tumor material. Immediate separation of plasma is widely used in standard isolation of cell-free DNA to ensure high quality plasma DNA. However, these procedures are labor intensive and logistically challenging in a clinical setting. Here we investigate the concordance between standard blood collection for molecular analysis using immediate separation of plasma, compared to the use of collection tubes allowing for delayed processing. METHODS In this study, we measured the fractional abundance of tumor specific mutations (BRAF p.V600E and PIK3CA p.H1047R) in ctDNA isolated from blood samples collected in either cell-stabilizing Cell-Free DNA BCT tubes (delayed processing within 72 hours) or standard K3EDTA tubes (immediate processing within 15 minutes). Twenty-five blood sample pairs (EDTA/BCT) were collected from patients with advanced solid cancers enrolled in early clinical trials. RESULTS Concordance in the fractional abundance of mutations in ctDNA isolated from blood collected in either K3EDTA or BCT tubes from patients with different solid cancers was observed. CONCLUSIONS This study indicates that BCT tubes are preferable for collection of circulating DNA in a clinical setting due to the favorable storage and shipping conditions.
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19
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Madsen M, Takemi M, Kesselheim J, Tashiro S, Siebner H. Focal TACS of the primary motor hand area at individual mu and beta rhythm – effects on cortical excitability. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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20
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Affiliation(s)
- S. A. Tolouee
- Department of Urology, Zealand University Hospital, Roskilde, Denmark
| | - M. Madsen
- Department of Urology, Zealand University Hospital, Roskilde, Denmark
| | - K. D. Berg
- Department of Urology, Zealand University Hospital, Roskilde, Denmark
| | - C. Dahl
- Department of Urology, Zealand University Hospital, Roskilde, Denmark
| | - M. Fode
- Department of Urology, Zealand University Hospital, Roskilde, Denmark
| | - N. H. Azawi
- Department of Urology, Zealand University Hospital, Roskilde, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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21
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Steensig K, Olesen KKW, Madsen M, Thim T, Jensen LO, Raungaard B, Kristensen SD, Boetker HE, Lip GYH, Eikelboom JW, Maeng M. 6152A novel model for prediction of ischemic stroke in patients without atrial fibrillation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.6152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Steensig
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - K K W Olesen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - M Madsen
- Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus, Denmark
| | - T Thim
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - L O Jensen
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - B Raungaard
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - S D Kristensen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - H E Boetker
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - G Y H Lip
- University of Birmingham, Institute of Cardiovascular Sciences, Birmingham, United Kingdom
| | - J W Eikelboom
- McMaster University, Department of Medicine, Hamilton, Canada
| | - M Maeng
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
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Hansen KW, Sorensen R, Madsen M, Jensen JS, Mortensen PE, Lange T, Gislason GH, Galatius S. P1230Association between early invasive management, secondary preventive medical therapy and long-term outcomes after acute coronary syndromes. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1230] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K W Hansen
- Bispebjerg University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - R Sorensen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M Madsen
- University of Copenhagen - Departmen of Public Health, Copenhagen, Denmark
| | - J S Jensen
- Copenhagen University Hospital Gentofte - Department. of Cardiology, Copenhagen, Denmark
| | - P E Mortensen
- Odense University Hospital, Department of Thoracic Surgery, Odense, Denmark
| | - T Lange
- University of Copenhagen - Departmen of Public Health, Copenhagen, Denmark
| | - G H Gislason
- Copenhagen University Hospital Gentofte - Department. of Cardiology, Copenhagen, Denmark
| | - S Galatius
- Bispebjerg University Hospital, Department of Cardiology, Copenhagen, Denmark
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Pareek M, Jensen LO, Christiansen EH, Aaroe J, Jensen JS, Kristensen SD, Lassen JF, Thuesen L, Madsen M, Boetker HE, Maeng M. 146210-year outcomes from a randomized comparison of zotarolimus-eluting and sirolimus-eluting stents: the SORT OUT III study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1462] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Pareek
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - L O Jensen
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - E H Christiansen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - J Aaroe
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - J S Jensen
- Gentofte University Hospital, Department of Cardiology, Gentofte, Denmark
| | - S D Kristensen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - J F Lassen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - L Thuesen
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - M Madsen
- Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus, Denmark
| | - H E Boetker
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - M Maeng
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
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Steensig K, Olesen KKW, Thim T, Nielsen JC, Madsen M, Jensen SE, Jensen LO, Kristensen SD, Boetker HE, Lip GYH, Maeng M. 2162Coronary artery disease is an independent risk factor for ischemic stroke among patients with atrial fibrillation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2162] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Steensig
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - K K W Olesen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - T Thim
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - J C Nielsen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - M Madsen
- Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus, Denmark
| | - S E Jensen
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - L O Jensen
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - S D Kristensen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - H E Boetker
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - G Y H Lip
- University of Birmingham, Institute of Cardiovascular Sciences, Birmingham, United Kingdom
| | - M Maeng
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
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Azawi NH, Tolouee SA, Madsen M, Berg KD, Dahl C, Fode M. Core needle biopsy clarify the histology of the small renal masses and may prevent overtreatment. Int Urol Nephrol 2018; 50:1205-1209. [DOI: 10.1007/s11255-018-1885-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 04/30/2018] [Indexed: 10/16/2022]
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26
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Christensen G, Osler M, Madsen M, McGue M, Mortensen E, Christensen K. The influence of familial factors on the intelligence-mortality association – A twin approach. Intelligence 2017. [DOI: 10.1016/j.intell.2017.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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27
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Mortensen SP, Egginton S, Madsen M, Hansen JB, Munch GDW, Iepsen UW, Åkerström T, Pedersen BK, Hellsten Y. Alpha adrenergic receptor blockade increases capillarization and fractional O 2 extraction and lowers blood flow in contracting human skeletal muscle. Acta Physiol (Oxf) 2017; 221:32-43. [PMID: 28199786 DOI: 10.1111/apha.12857] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 12/09/2016] [Revised: 01/17/2017] [Accepted: 02/10/2017] [Indexed: 12/28/2022]
Abstract
AIM To assess the effect of elevated basal shear stress on angiogenesis in humans and the role of enhanced skeletal muscle capillarization on blood flow and O2 extraction. METHODS Limb haemodynamics and O2 extraction were measured at rest and during one-leg knee-extensor exercise (12 and 24 W) in 10 healthy untrained young men before and after 4-week treatment with an α1 receptor-antagonist (Terazosin, 1-2 mg day-1 ). Corresponding biopsies were taken from the m. vastus lateralis. RESULTS Resting leg blood flow was increased by 57% 6 h following Terazosin treatment (P < 0.05), while basal capillary-to-fibre ratio was 1.69 ± 0.08 and increased to 1.90 ± 0.08 after treatment (P < 0.05). Leg O2 extraction during knee-extensor exercise was higher (4-5%; P < 0.05), leg blood flow and venous lactate levels lower (6-7%; P < 0.05), while leg VO2 was not different after Terazosin treatment. CONCLUSIONS These results demonstrate that daily treatment with an α-adrenergic receptor blocker induces capillary growth in human skeletal muscle, likely due to increased shear stress. The increase in capillarization resulted in an increased fractional O2 extraction, a lower blood flow and venous lactate levels in the exercising leg. The increase in capillarization, and concomitant functional readouts in the exercising leg, may provide a basis for novel angiotherapy.
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Affiliation(s)
- S. P. Mortensen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
- Department of Cardiovascular and Renal Research; Institute of Molecular Medicine; University of Southern Denmark; Odense Denmark
| | - S. Egginton
- School of Biomedical Sciences; University of Leeds; Leeds UK
| | - M. Madsen
- Department of Nutrition, Exercise and Sport; University of Copenhagen; Copenhagen Denmark
| | - J. B. Hansen
- Department of Nutrition, Exercise and Sport; University of Copenhagen; Copenhagen Denmark
| | - G. D. W. Munch
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - U. W. Iepsen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - T. Åkerström
- Department of Nutrition, Exercise and Sport; University of Copenhagen; Copenhagen Denmark
| | - B. K. Pedersen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - Y. Hellsten
- Department of Nutrition, Exercise and Sport; University of Copenhagen; Copenhagen Denmark
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Maeng M, Christiansen E, Raungaard B, Kristensen S, Terkelsen C, Jensen S, Ravkilde J, Junker A, Veien K, Madsen M, Boetker H, Jensen L. P1376Landmark analysis of clinical outcome following first-generation vs newer-generation coronary drug-eluting stent implantation: a pooled analysis of SORT OUT III-V studies. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1376] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Norderud K, Egholm G, Thim T, Olesen K, Madsen M, Jensen S, Jensen L, Boetker H, Kristensen S, Maeng M. P1549Validation of the European Society of Cardiology non-cardiac surgery risk score in patients with ischemic heart disease. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1549] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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30
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Thim T, Egholm G, Olesen K, Madsen M, Jensen S, Jensen L, Botker H, Kristensen S, Maeng M. P6482Stent implantation procedure characteristics and risk of adverse cardiac events among patients undergoing non-cardiac surgery within 12 months after coronary drug-eluting stent implantation. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6482] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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31
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Maeng M, Christiansen E, Raungaard B, Kristensen S, Terkelsen C, Jensen S, Ravkilde J, Junker A, Veien K, Madsen M, Boetker H, Jensen L. 2199Rate of very late stent thrombosis differs between drug-eluting stents: a 5-year pooled landmark analysis of the SORT OUT III, IV, and V trials. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.2199] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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32
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Olesen K, Madsen M, Egholm G, Thim T, Jensen L, Raungaard B, Boetker H, Soerensen H, Maeng M. P6464Association between anti-diabetic treatment strategy and cardiovascular risk in diabetic patients with and without coronary artery disease. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6464] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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33
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Maeng M, Christiansen E, Raungaard B, Kristensen S, Terkelsen C, Jensen S, Ravkilde J, Junker A, Veien K, Madsen M, Boetker H, Jensen L. 31245-year clinical outcome following first-generation vs newer-generation coronary drug-eluting stent implantation: A pooled analysis of SORT OUT III, IV, and V studies. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.3124] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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34
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Jensen L, Maeng M, Ravkilde J, Terkelsen C, Hansen H, Kristensen S, Madsen M, Hansen K, Boetker H, Christiansen E. 2926Long term outcomes of first and second generation drug-eluting stents in patients with diabetes: a pooled analysis of individual patient data from SORT OUT III, IV and V trials. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.2926] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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35
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Egholm G, Thim T, Olesen K, Madsen M, Jensen S, Jensen L, Boetker H, Kristensen S, Maeng M. P2330Risk of adverse cardiac events in patients undergoing surgery after coronary drug-eluting stent implantation for acute coronary syndrome and stable angina pectoris. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2330] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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36
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Kristensen H, Madsen M, Jensen P, Pawlak W. Evaluation of the benefits from the introduction meeting for patients with chronic non-malignant pain and their relatives in interdisciplinary pain center. Scand J Pain 2017. [DOI: 10.1016/j.sjpain.2017.04.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Background
Treatment of patients with chronic nonmalignant pain (CNMP) is challenging and requires a multidisciplinary effort. In a multidisciplinary pain center, patients are treated by a team of doctor, nurse, physiotherapist, psychologist and social worker. Especially in the beginning of treatment patients receive much information. Many patients and their relatives have problems with comprehending it.
Objective
This is an action research study aimed to find the optimal mode for to introduce patients with CNMP and their relatives to the multidisciplinary pain treatment.
Method
In the fall of 2016, we began to invite patients and their relatives to the introduction meeting (IM), which takes place in groups of up to 20 people, has duration of 1 hour and is led by the physiotherapist and nurse, but the physician is also present. Invited patients are able to understand written and oral Danish and are not suffering from social phobias. During IM facts about the center, treatment course and pain physiology are presenter. Immediately after IM, participants are anonymously asked about their experiences.
Results
Up to date (February 2017) 254 patients were invited. Invitation was rejected by 63 patients (24,8%). Question about understanding of chronic pain was answered by 108 participants (both patients and their relatives), and 103 participants declared better understanding of chronic pain after IM end before. 69 participants answered question about understanding of treatment course in the center. All but 2 participants declared after IM at their understanding was better end before. In fact, 31 (44,9%) participants estimated changes in understanding of treatment course as much significant.
Conclusion
The IM at the beginning of multidisciplinary therapy seems to be a promising activity for patients with CNMP referred to the multidisciplinary pain center, as well as for their relatives. Study is ongoing and updated results will be presented at the conference.
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Affiliation(s)
- H.L.A. Kristensen
- Multidisciplinary Pain Centre, Department of Anaesthesia, Næstved Hospital , Næstved , Denmark
| | - M. Madsen
- Multidisciplinary Pain Centre, Department of Anaesthesia, Næstved Hospital , Næstved , Denmark
| | - P.B.F. Jensen
- Multidisciplinary Pain Centre, Department of Anaesthesia, Næstved Hospital , Næstved , Denmark
| | - W.Z. Pawlak
- Multidisciplinary Pain Centre, Department of Anaesthesia, Næstved Hospital , Næstved , Denmark
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Mathiesen JS, Kroustrup JP, Vestergaard P, Madsen M, Stochholm K, Poulsen PL, Krogh Rasmussen Å, Feldt-Rasmussen U, Schytte S, Pedersen HB, Hahn CH, Bentzen J, Gaustadnes M, Ørntoft TF, Hansen TVO, Nielsen FC, Brixen K, Frederiksen AL, Godballe C. Incidence and prevalence of multiple endocrine neoplasia 2B in Denmark: a nationwide study. Endocr Relat Cancer 2017; 24:L39-L42. [PMID: 28438782 DOI: 10.1530/erc-17-0122] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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] [Received: 04/19/2017] [Accepted: 04/24/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Jes Sloth Mathiesen
- Department of ORL Head & Neck SurgeryOdense University Hospital, Odense, Denmark
- Institute of Clinical ResearchUniversity of Southern Denmark, Odense, Denmark
| | - Jens Peter Kroustrup
- Department of Clinical Medicine and EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Peter Vestergaard
- Department of Clinical Medicine and EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Mette Madsen
- Department of PediatricsAalborg University Hospital, Aalborg, Denmark
| | - Kirstine Stochholm
- Department of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, Denmark
| | - Per Løgstrup Poulsen
- Department of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, Denmark
| | - Åse Krogh Rasmussen
- Department of Medical EndocrinologyCopenhagen University Hospital, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical EndocrinologyCopenhagen University Hospital, Copenhagen, Denmark
| | - Sten Schytte
- Department of ORL Head & Neck SurgeryAarhus University Hospital, Aarhus, Denmark
| | | | - Christoffer Holst Hahn
- Department of ORL Head & Neck SurgeryCopenhagen University Hospital, Copenhagen, Denmark
| | - Jens Bentzen
- Department of OncologyHerlev Hospital, Herlev, Denmark
| | - Mette Gaustadnes
- Department of Molecular MedicineAarhus University Hospital, Aarhus, Denmark
| | | | | | - Finn Cilius Nielsen
- Center for Genomic MedicineCopenhagen University Hospital, Copenhagen, Denmark
| | - Kim Brixen
- Institute of Clinical ResearchUniversity of Southern Denmark, Odense, Denmark
| | - Anja Lisbeth Frederiksen
- Institute of Clinical ResearchUniversity of Southern Denmark, Odense, Denmark
- Department of Clinical GeneticsOdense University Hospital, Odense, Denmark
| | - Christian Godballe
- Department of ORL Head & Neck SurgeryOdense University Hospital, Odense, Denmark
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Svensson J, Cerqueira C, Kjærsgaard P, Lyngsøe L, Hertel NT, Madsen M, Mortensen HB, Johannesen J. Danish Registry of Childhood and Adolescent Diabetes. Clin Epidemiol 2016; 8:679-683. [PMID: 27822115 PMCID: PMC5094642 DOI: 10.2147/clep.s99469] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [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] [Indexed: 12/31/2022] Open
Abstract
AIM The aims of the Danish Registry of Childhood and Adolescent Diabetes (DanDiabKids) are to monitor and improve the quality of care for children and adolescents with diabetes in Denmark and to follow the incidence and prevalence of diabetes. STUDY POPULATION The study population consists of all children diagnosed with diabetes before the age of 15 years since 1996. Since 2015, every child followed up at a pediatric center (<18 years of age) will be included. MAIN VARIABLES The variables in the registry are the quality indicators, demographic variables, associated conditions, diabetes classification, family history of diabetes, growth parameters, self-care, and treatment variables. The quality indicators are selected based on international consensus of measures of good clinical practice. The indicators are metabolic control as assessed by HbA1c, blood pressure, albuminuria, retinopathy, neuropathy, number of severe hypoglycemic events, and hospitalization with ketoacidosis. DESCRIPTIVE DATA The number of children diagnosed with diabetes is increasing with ∼3% per year mainly for type 1 diabetes (ie, 296 new patients <15 years of age were diagnosed in 2014). The disease management has changed dramatically with more children treated intensively with multiple daily injections, insulin pumps, and increased number of self-monitored blood glucose values per day. These initiatives have resulted in a significant improvement in HbA1c over the years and a decrease in the number of children experiencing severe hypoglycemia, diabetic nephropathy, and retinopathy. CONCLUSION The systematic collection of data in DanDiabKids documents improved quality of care over the last 12 years, despite a substantial increase in the number of patients cared for by pediatric departments in Denmark, fulfilling the purpose of the registry.
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Affiliation(s)
- Jannet Svensson
- Pediatric and Adolescent Department, Copenhagen University Hospital, Herlev and Gentofte, Herlev
| | - Charlotte Cerqueira
- Registry Support Centre (East) - Epidemiology and Biostatistics, Research Centre for Prevention and Health, Capital Region of Denmark, Glostrup
| | | | - Lene Lyngsøe
- Pediatric and Adolescent Department, Nordsjællands Hospital, Hillerød
| | | | - Mette Madsen
- Pediatric Department, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik B Mortensen
- Pediatric and Adolescent Department, Copenhagen University Hospital, Herlev and Gentofte, Herlev
| | - Jesper Johannesen
- Pediatric and Adolescent Department, Copenhagen University Hospital, Herlev and Gentofte, Herlev
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Storm T, Christensen EI, Christensen JN, Kjaergaard T, Uldbjerg N, Larsen A, Honoré B, Madsen M. Megalin Is Predominantly Observed in Vesicular Structures in First and Third Trimester Cytotrophoblasts of the Human Placenta. J Histochem Cytochem 2016; 64:769-784. [PMID: 27798286 DOI: 10.1369/0022155416672210] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 06/15/2016] [Accepted: 08/30/2016] [Indexed: 12/31/2022] Open
Abstract
The membrane receptor megalin is crucial for normal fetal development. Besides its expression in the developing fetus, megalin is also expressed in the human placenta. Similar to its established function in the kidney proximal tubules, placental megalin has been proposed to mediate uptake of vital nutrients. However, details of megalin expression, subcellular localization, and function in the human placenta remain to be established. By immunohistochemical analyses of first trimester and term human placenta, we showed that megalin is predominantly expressed in cytotrophoblasts, the highly proliferative cells in placenta. Only limited amounts of megalin could be detected in syncytiotrophoblasts and least in term placenta syncytiotrophoblasts. Immunocytochemical analyses furthermore showed that placental megalin associates with structures of the endolysosomal apparatus. Combined, our results clearly place placental megalin in the context of endocytosis and trafficking of ligands. However, due to the limited expression of megalin in syncytiotrophoblasts, especially in term placenta, it appears that the main role for placental megalin is not to mediate uptake of nutrients from the maternal bloodstream, as previously proposed. In contrast, our results point toward novel and complex functions for megalin in the cytotrophoblasts. Thus, we propose that the perception of placental megalin localization and function should be revised.
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Affiliation(s)
- Tina Storm
- Department of Biomedicine, Aarhus University, Aarhus C, Denmark (TS, EIC, JNC, TK, AL, BH, MM)
| | - Erik I Christensen
- Department of Biomedicine, Aarhus University, Aarhus C, Denmark (TS, EIC, JNC, TK, AL, BH, MM)
| | - Julie Nelly Christensen
- Department of Biomedicine, Aarhus University, Aarhus C, Denmark (TS, EIC, JNC, TK, AL, BH, MM)
| | - Tine Kjaergaard
- Department of Biomedicine, Aarhus University, Aarhus C, Denmark (TS, EIC, JNC, TK, AL, BH, MM)
| | - Niels Uldbjerg
- Department of Clinical Medicine-Obstetrics and Gynaecology, Aarhus University Hospital, Skejby, Denmark (NU)
| | - Agnete Larsen
- Department of Biomedicine, Aarhus University, Aarhus C, Denmark (TS, EIC, JNC, TK, AL, BH, MM)
| | - Bent Honoré
- Department of Biomedicine, Aarhus University, Aarhus C, Denmark (TS, EIC, JNC, TK, AL, BH, MM)
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Abstract
This study examined inequalities in infant mortality in Denmark in relation to maternal educational level, and compared the inequalities to those observed in a similar study 10 years earlier. It was a register-based study of all singleton births in Denmark 1991-92, a study population of 113,814 births. When adjusted for mother's age, parity, and smoking, the stillbirth rate was independent of mother's educational level, but a clear social gradient in infant mortality was observed. Compared with a similar study in 1982-83, infant mortality has decreased most in the highest educational group and has increased in the lowest educational group. In conclusion, social inequality in infant mortality in Denmark is pronounced and cannot be explained by differences in smoking habits. The social gap between different educational groups has widened during the last decade, but may partly be explained by the decreasing number of women in the lowest educational group.
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Affiliation(s)
- Ole Olsen
- Danish Institute for Clinical Epidemiology, Copenhagen, Denmark
| | - Mette Madsen
- Danish Institute for Clinical Epidemiology, Copenhagen, Denmark
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41
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Osler M, Jørgensen T, Gerdes LU, Davidsen M, Brønnum-Hansen H, Madsen M, Schroll M. Changes in community and individual level psychosocial coronary risk factors in the Danish MONICA population, 1982-92. Scand J Public Health 2016. [DOI: 10.1177/14034948020300010901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim: Myocardial infarction incidence declined by 3-5% per year from 1982-92 in the Danish study population of the WHO MONICA project. This study examined whether psychosocial coronary risk factors changed in the population during this period. Methods : Cross-sectional data from 6,695 Danish men and women aged 30, 40, 50, and 60 years, were examined in 1982-84, 1986-87, and 1991-92. Data from Social Registers were used to analyse trends in community social structure. Results: From 1982 to 1992 an increase in individuals' school education and social class followed an increase in the general welfare of the study area. At the same time type A behaviours increased in both men and women, while there were no changes in reported personal problems. The proportion of women living alone increased, while the proportion of emotionally distressed decreased. In men there were no changes in cohabitation status or emotional distress. The changes in the psychosocial factors were the same in different educational groups. Conclusion: The socioeconomic position of the population improved at the individual and the community level during the study period. This was concurrent with the declining incidence of myocardial infarction.
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Affiliation(s)
| | - Torben Jørgensen
- Copenhagen County Centre of Preventive Medicine, Copenhagen, Denmark
| | | | - Michael Davidsen
- National Institute of Public Health, Copenhagen County Centre of Preventive Medicine, Copenhagen, Denmark
| | | | | | - Marianne Schroll
- Copenhagen County Centre of Preventive Medicine, Copenhagen, Denmark
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Osler M, Jørgensen T, Davidsen M, Grønbaek M, Brønnum-Hansen H, Madsen M, Gerdes U, Schroll M. Socioeconomic status and trends in alcohol drinking in the Danish MONICA population, 1982- 92. Scand J Public Health 2016; 29:40-3. [PMID: 11355715 DOI: 10.1177/14034948010290010901] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 11/16/2022]
Abstract
Aims: To examine trends in alcohol drinking in different educational groups. Methods: Data from three cross-sectional WHO MONICA surveys conducted in 1982-84, 1987, and 1991-92 were analysed to estimate trends in abstention, moderate, heavy, and sporadic heavy alcohol use in relation to level of education, age and smoking. In total, 6,695 Danish men and women aged 30, 40, 50, and 60 years were included. Results: Alcohol drinking decreased in both men and women during the study period, but changes were only significant among the highest educated. In the highest educated men the prevalence of moderate alcohol use increased from 77 to 82%, while heavy alcohol use declined from 19 to 12%. In the highest educated women the prevalence of abstention increased from 15 to 22%, while moderate alcohol use declined from 78 to 68%. Conclusion: During the 1980s, alcohol drinking decreased among the highest educated men and women and an educational gradient in alcohol drinking widened in men and attenuated in women.
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Affiliation(s)
- M Osler
- Institute of Public Health, University of Copenhagen, Denmark.
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Boas Soja AM, Zwisler ADO, Melchior T, Hommel E, Torp-Pedersen C, Madsen M. Prevalence and characteristics of impaired glucose metabolism in patients referred to comprehensive cardiac rehabilitation: the DANSUK study. ACTA ACUST UNITED AC 2016; 13:784-90. [PMID: 17001219 DOI: 10.1097/01.hjr.0000238391.12223.d0] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Lifestyle and pharmacological interventions can delay the progression of impaired glucose tolerance (IGT) to type 2 diabetes (T2DM), and there is growing evidence that earlier detection of T2DM and intensified risk factor management may result in improved cardiovascular morbidity and mortality. We studied the prevalence of impaired glucose metabolism (T2DM, IGT and impaired fasting glucose; IFG) in patients referred to cardiac rehabilitation, and further studied whether we could identify groups in which an oral glucose tolerance test (OGTT) need not be performed. METHODS As part of a cardiac rehabilitation trial, 201 patients participated. Patients without a diagnosis of T2DM (N=159) underwent an OGTT 3 months after inclusion. RESULTS Forty-two patients (21%) had known T2DM at enrolment. Based on the OGTT, 26 patients (13%) had unrecognized T2DM, 36 (18%) had IGT and 19 (9%) were diagnosed with isolated IFG according to the World Health Organization definition. Using fasting plasma glucose alone, 19% of the patients with unrecognized T2DM and two-thirds of patients with IGT would be misclassified. Using IFG as a means to detect IGT showed a sensitivity of only 33% and a positive predictive value of 39%. CONCLUSION More than 60% of the patients (123/201) referred to cardiac rehabilitation had impaired glucose metabolism and 18% of the screened patients (29/159) would be misclassified if an OGTT was omitted. IFG and IGT did not identify the same patients or the same cardiovascular risk profile. An OGTT test should therefore be considered a constituent part of routine care management in cardiac rehabilitation settings.
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Affiliation(s)
- Anne Merete Boas Soja
- Bispebjerg University Hospital, Department of Cardiology, Copenhagen bNational Institute of Public Health, Copenhagen, Denmark.
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Albrecht SM, Higginbotham AP, Madsen M, Kuemmeth F, Jespersen TS, Nygård J, Krogstrup P, Marcus CM. Exponential protection of zero modes in Majorana islands. Nature 2016; 531:206-9. [DOI: 10.1038/nature17162] [Citation(s) in RCA: 770] [Impact Index Per Article: 96.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 01/18/2016] [Indexed: 11/09/2022]
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Madsen M, Russell L, Stensballe J, Bonde J, Perner A. Transfusions in patients with leukaemia admitted to an intensive care unit. Intensive Care Med Exp 2015. [PMCID: PMC4798093 DOI: 10.1186/2197-425x-3-s1-a248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Russell L, Madsen M, Bonde J, Perner A. Bleeding and thrombosis in leukaemia patients admittet to an intensive care unit. Intensive Care Med Exp 2015. [PMCID: PMC4797408 DOI: 10.1186/2197-425x-3-s1-a252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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47
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Hansen KW, Sorensen R, Madsen M, Madsen JK, Jensen JS, von Kappelgaard LM, Mortensen PE, Lange T, Galatius S. Effectiveness of an early versus a conservative invasive treatment strategy in acute coronary syndromes: a nationwide cohort study. Ann Intern Med 2015; 163:737-46. [PMID: 26502223 DOI: 10.7326/m15-0303] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Randomized clinical trials have found that early invasive strategies reduce mortality, myocardial infarction (MI), and rehospitalization compared with a conservative invasive approach in acute coronary syndromes (ACSs), but the effectiveness of such strategies in real-world settings is unknown. OBJECTIVE To investigate adverse cardiovascular outcomes of an early versus a conservative invasive strategy in a national cohort of patients with ACSs. DESIGN Retrospective cohort study. SETTING Administrative health care data on hospitalizations, procedures, and outcomes abstracted from the Danish national registries and covering all acute invasive procedures in patients presenting with an ACS. PATIENTS 19 704 propensity score-matched patients hospitalized with a first ACS between 1 January 2005 and 31 December 2011. MEASUREMENTS Risk for cardiac death or rehospitalization for MI within 60 days of hospitalization. RESULTS Compared with a conservative approach, early invasive strategies were associated with a lower risk for cardiac death (cumulative incidence, 5.9% vs. 7.6%; adjusted hazard ratio [HR], 0.75 [95% CI, 0.66 to 0.84]; P < 0.001). Similar results were found for rehospitalization for MI (cumulative incidence, 3.4% vs. 5.0%; adjusted odds ratio, 0.67 [CI, 0.58 to 0.77]; P < 0.001) and all-cause death (cumulative incidence, 7.3% vs. 10.6%; adjusted HR, 0.65 [CI, 0.59 to 0.72]; P < 0.001). LIMITATION Potential residual confounding due to lack of core clinical variables. CONCLUSION In this real-world cohort of patients with a first hospitalization for an ACS, the use of an early invasive treatment strategy was associated with a lower risk for cardiac death and rehospitalization for MI compared with a conservative invasive approach. PRIMARY FUNDING SOURCE Department of Cardiology, University Hospital Gentofte.
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Affiliation(s)
- Kim Wadt Hansen
- From University Hospital Bispebjerg, University of Copenhagen, and University of Southern Denmark, Copenhagen; University Hospital Gentofte, Hellerup; University Hospital Holbæk, Holbæk; and Odense University Hospital, Odense, Denmark
| | - Rikke Sorensen
- From University Hospital Bispebjerg, University of Copenhagen, and University of Southern Denmark, Copenhagen; University Hospital Gentofte, Hellerup; University Hospital Holbæk, Holbæk; and Odense University Hospital, Odense, Denmark
| | - Mette Madsen
- From University Hospital Bispebjerg, University of Copenhagen, and University of Southern Denmark, Copenhagen; University Hospital Gentofte, Hellerup; University Hospital Holbæk, Holbæk; and Odense University Hospital, Odense, Denmark
| | - Jan Kyst Madsen
- From University Hospital Bispebjerg, University of Copenhagen, and University of Southern Denmark, Copenhagen; University Hospital Gentofte, Hellerup; University Hospital Holbæk, Holbæk; and Odense University Hospital, Odense, Denmark
| | - Jan Skov Jensen
- From University Hospital Bispebjerg, University of Copenhagen, and University of Southern Denmark, Copenhagen; University Hospital Gentofte, Hellerup; University Hospital Holbæk, Holbæk; and Odense University Hospital, Odense, Denmark
| | - Lene Mia von Kappelgaard
- From University Hospital Bispebjerg, University of Copenhagen, and University of Southern Denmark, Copenhagen; University Hospital Gentofte, Hellerup; University Hospital Holbæk, Holbæk; and Odense University Hospital, Odense, Denmark
| | - Poul Erik Mortensen
- From University Hospital Bispebjerg, University of Copenhagen, and University of Southern Denmark, Copenhagen; University Hospital Gentofte, Hellerup; University Hospital Holbæk, Holbæk; and Odense University Hospital, Odense, Denmark
| | - Theis Lange
- From University Hospital Bispebjerg, University of Copenhagen, and University of Southern Denmark, Copenhagen; University Hospital Gentofte, Hellerup; University Hospital Holbæk, Holbæk; and Odense University Hospital, Odense, Denmark
| | - Soren Galatius
- From University Hospital Bispebjerg, University of Copenhagen, and University of Southern Denmark, Copenhagen; University Hospital Gentofte, Hellerup; University Hospital Holbæk, Holbæk; and Odense University Hospital, Odense, Denmark
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Michelsen SI, Flachs EM, Madsen M, Uldall P. Parental social consequences of having a child with cerebral palsy in Denmark. Dev Med Child Neurol 2015; 57:768-75. [PMID: 26154654 DOI: 10.1111/dmcn.12719] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2015] [Indexed: 11/28/2022]
Abstract
AIM To analyse the social situation of parents who have a child with cerebral palsy (CP). METHOD This was a population-based longitudinal study with linkage to public registries. Parents of children with CP (n=3671) identified in the Danish CP Registry were compared with 17,983 parents of children without CP. Employment, income, cohabitation status, and presence of additional children were factors analysed during a follow-up period of 28 years. We followed parents from before their child was born and up to the age of 43 years of the child. RESULTS Mothers of children with CP under the age of 10 were less often employed: odds ratio [OR] of employment at age 5y 0.45 (95% confidence interval [CI] 0.36-0.57), but only 11% left the labour market. Mothers of children without CP had higher incomes: ratio full-time working 1.11 (95% CI 1.07-1.15). The risk of not living together was not increased among parents of children with CP: at age 5 years OR 1.04 (95% CI 0.84-1.28). Parents of children with CP as the first born postponed or more seldom had subsequent children: hazard ratio [HR] 0.75 (95% CI 0.68-0.83). INTERPRETATION The Danish welfare system seems to have succeeded in keeping parents in the labour market and living together with their child. Special attention needs to be paid to the financial situation of families with children with CP under 10 years of age.
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Affiliation(s)
- Susan I Michelsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Esben M Flachs
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Mette Madsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Peter Uldall
- Copenhagen University Hospital, Pediatric Clinic 1, Copenhagen, Denmark
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Hansen KW, Soerensen R, Madsen M, Madsen JK, Jensen JS, von Kappelgaard LM, Mortensen PE, Galatius S. Developments in the invasive diagnostic-therapeutic cascade of women and men with acute coronary syndromes from 2005 to 2011: a nationwide cohort study. BMJ Open 2015; 5:e007785. [PMID: 26063568 PMCID: PMC4466619 DOI: 10.1136/bmjopen-2015-007785] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To investigate for trends in sex-related differences in the invasive diagnostic-therapeutic cascade in a population of patients with acute coronary syndromes (ACS). DESIGN A nationwide cohort study. SETTING Administrative and clinical registries covering all hospitalisations, invasive cardiac procedures and deaths in the Danish population of 5.6 million inhabitants. PARTICIPANTS We included 52,565 patients aged 30-90 years who were hospitalised with a first ACS from January 2005 to November 2011. Follow-up was 60 days from the day of index admission. MAIN OUTCOME MEASURES Diagnostic coronary angiography, percutaneous coronary intervention or coronary artery bypass within 60 days of index admission. RESULTS Women constituted 36%, were older, had more comorbidity and were less likely to be admitted to a hospital with cardiac catheterisation facilities than men. Mortality rates were similar for both sexes. Diagnostic coronary angiography was performed less frequently on women compared with men, both within 1 day (31% vs 42%; p<0.001) and within 60 days (67% vs 80%; p<0.001), yielding adjusted female-male HRs of 0.83 (0.79-0.87) and 0.86 (0.84-0.89), respectively.Among the 39,677 patients undergoing coronary angiography, non-obstructive coronary artery disease was more frequent among women than men (22% vs 9%; p<0.001). Women were less likely to undergo percutaneous coronary intervention (58% vs 72%; p<0.001) and coronary artery bypass (6% vs 11%, p<0.001) within 60 days than men, yielding adjusted HRs of 0.96 (0.92-0.99) and 0.81 (0.74-0.89), respectively. The sex-related differences were not attenuated over time for any of the invasive cardiac procedures (p values for trend >0.05). CONCLUSIONS In this nationwide study, men were more likely to undergo an invasive approach than women when hospitalised with a first ACS--a difference persisting from 2005 to 2011. Future studies should focus on the potential mechanisms behind this differential treatment.
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Affiliation(s)
- Kim Wadt Hansen
- Department of Cardiology, University Hospital Bispebjerg, Bispebjerg, Denmark
| | - R Soerensen
- Department of Cardiology, University Hospital Gentofte, Hellerup, Denmark
| | - M Madsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - J K Madsen
- Emergency Department, Holbaek University Hospital, Holbaek, Denmark
| | - J S Jensen
- Department of Cardiology, University Hospital Gentofte, Hellerup, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - L M von Kappelgaard
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- The Danish Heart Registry, Denmark
| | - P E Mortensen
- The Danish Heart Registry, Denmark
- Department of Thoracic Surgery, Odense University Hospital, Denmark
| | - S Galatius
- Department of Cardiology, University Hospital Bispebjerg, Bispebjerg, Denmark
- The Danish Heart Registry, Denmark
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Andersen RK, Hammer K, Hager H, Christensen JN, Ludvigsen M, Honoré B, Thomsen MBH, Madsen M. Melanoma tumors frequently acquire LRP2/megalin expression, which modulates melanoma cell proliferation and survival rates. Pigment Cell Melanoma Res 2015; 28:267-80. [PMID: 25585665 DOI: 10.1111/pcmr.12352] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 01/12/2015] [Indexed: 12/13/2022]
Abstract
We show that the multiligand receptor megalin, known to mediate uptake and trafficking of nutrients and signaling molecules, is frequently expressed in malignant melanoma samples. Expression of megalin-encoding mRNA was investigated in 65 samples of nevi, melanomas, and melanoma metastases and was observed in more than 60% of the malignant samples, while only in 20% of the benign counterparts. Megalin expression in nevus and melanoma samples was additionally investigated by immunohistochemistry, which confirmed our mRNA-based observations. We furthermore show that a panel of tumor-derived melanoma cell lines express LRP2/megalin endogenously. In these cells, megalin is internalized from the cell surface and localizes extensively to intracellular vesicles, confirming receptor activity and pointing toward association with the endocytic apparatus. Groundbreaking, our results indicate that sustained megalin expression in melanoma cells is crucial for cell maintenance, as siRNA-mediated reduction in melanoma cell expression of LRP2/megalin significantly decreases melanoma cell proliferation and survival rates.
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Affiliation(s)
- Rikke K Andersen
- Department of Biomedicine, University of Aarhus, Aarhus, Denmark
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