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Nielsen RL, Bornaes O, Storgaard IK, Kallemose T, Jørgensen LM, Jawad BN, Altintas I, Juul-Larsen HG, Tavenier J, Durhuus JA, Bengaard AKP, Holst JJ, Kolko M, Sonne DP, Breindahl T, Damgaard M, Porrini E, Hornum M, Andersen O, Pedersen MM, Rasmussen HH, Munk T, Lund TM, Jensen PS, Andersen AL, Houlind MB. Appetite stimulation with cannabis-based medicine and methods for assessment of glomerular filtration in older patients with medical illness: A study protocol. Basic Clin Pharmacol Toxicol 2023; 133:237-253. [PMID: 37314893 DOI: 10.1111/bcpt.13914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/05/2023] [Accepted: 06/07/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND AIM Malnutrition in older patients is linked to poor appetite. Cannabis-based medicine may have orexigenic properties in older patients, but this has to our knowledge never been investigated. In older patients, uncertainty applies to the accuracy of estimated glomerular filtration rate (eGFR) based on creatinine, which is crucial for medication prescribing. In older patients with poor appetite, the study aims (1) to assess the efficacy of Sativex® (8.1-mg delta-9-tetrahydrocannabinol [THC] and 7.5-mg cannabidiol [CBD]) to stimulate appetite and (2) to compare the performance of various GFR-estimates and measured-GFR (mGFR) for determining gentamicin clearance utilizing population pharmacokinetic (popPK) modelling methods. METHODS AND OBJECTIVES This study is composed of two substudies. Substudy 1 is an investigator-initiated single-center, double-blinded, randomized, placebo-controlled, superiority, cross-over study. Substudy 1 will recruit 17 older patients with poor appetite, who will also be invited to substudy 2. Substudy 2 is a single-dose pharmacokinetics study and will recruit 55 patients. Participants will receive Sativex® and placebo in substudy 1 and gentamicin with simultaneous measurements of GFR in substudy 2. The primary endpoints are as follows: Substudy 1-the difference in energy intake between Sativex® and placebo conditions; substudy 2- the accuracy of different eGFR equations compared to mGFR. The secondary endpoints include safety parameters, changes in the appetite hormones, total ghrelin and GLP-1 and subjective appetite sensations, and the creation of popPK models of THC, CBD, and gentamicin.
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Affiliation(s)
- R L Nielsen
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - O Bornaes
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - I K Storgaard
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - T Kallemose
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - L M Jørgensen
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - B N Jawad
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - I Altintas
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - H G Juul-Larsen
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - J Tavenier
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - J A Durhuus
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Cellular and Molecular Medicine, Center for Healthy Aging, Copenhagen, Denmark
| | - A K P Bengaard
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - J J Holst
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - M Kolko
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - D P Sonne
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - T Breindahl
- Department of Clinical Biochemistry, North Denmark Regional Hospital, Hjørring, Denmark
| | - M Damgaard
- Department of Clinical Physiology and Nuclear Medicine, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - E Porrini
- Laboratory of Renal Function (LFR), Faculty of Medicine, University of La Laguna, La Laguna, Spain
| | - M Hornum
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Nephrology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - O Andersen
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - M M Pedersen
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - H H Rasmussen
- Center for Nutrition and Intestinal Failure, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - T Munk
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - T M Lund
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - P S Jensen
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Orthopeadic Surgery, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - A L Andersen
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - M B Houlind
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
- The Hospital Pharmacy, Herlev, Denmark
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2
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Biström M, Jons D, Engdahl E, Gustafsson R, Huang J, Brenner N, Butt J, Alonso-Magdalena L, Gunnarsson M, Vrethem M, Bender N, Waterboer T, Granåsen G, Olsson T, Kockum I, Andersen O, Fogdell-Hahn A, Sundström P. Epstein-Barr virus infection after adolescence and human herpesvirus 6A as risk factors for multiple sclerosis. Eur J Neurol 2020; 28:579-586. [PMID: 33065762 PMCID: PMC7839468 DOI: 10.1111/ene.14597] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/06/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Infections with human herpesvirus 6A (HHV-6A) and Epstein-Barr virus (EBV) have been linked to multiple sclerosis (MS) development. For EBV, late infection has been proposed as a risk factor, but serological support is lacking. The objective of this study was to investigate how age affects the EBV and HHV-6A associated risks of developing MS. METHODS In this nested case-control study, Swedish biobanks were accessed to find pre-symptomatically collected blood samples from 670 individuals who later developed relapsing MS and 670 matched controls. A bead-based multiplex assay was used to determine serological response against EBV and HHV-6A. Conditional logistic regression was used to calculate odds ratios and 95% confidence intervals. RESULTS Seropositivity against EBV exhibited a pattern where associations switched from a decreased risk of developing MS in the group below 20 years of age to an increased risk amongst individuals aged 20-29 and 30-39 years (p for trend 0.020). The age of transition was estimated to be 18.8 years. In contrast, HHV-6A was associated with increased MS risk in all age groups (total cohort odds ratio 2.1, 95% confidence interval 1.6-2.7). CONCLUSIONS This study suggests EBV infection after adolescence and age independent HHV-6A infection as risk factors for MS.
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Affiliation(s)
- M Biström
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - D Jons
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - E Engdahl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Center for Molecular Medicine, Stockholm, Sweden
| | - R Gustafsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Center for Molecular Medicine, Stockholm, Sweden
| | - J Huang
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Center for Molecular Medicine, Stockholm, Sweden
| | - N Brenner
- Infections and Cancer Epidemiology, German Cancer Research Center (Deutsches Krebsforschungszentrum), Heidelberg, Germany
| | - J Butt
- Infections and Cancer Epidemiology, German Cancer Research Center (Deutsches Krebsforschungszentrum), Heidelberg, Germany
| | - L Alonso-Magdalena
- Department of Neurology, Skåne University Hospital in Malmö/Lund and Institution of Clinical Sciences, Neurology, Lund University, Lund, Sweden
| | - M Gunnarsson
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - M Vrethem
- Department of Neurology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - N Bender
- Infections and Cancer Epidemiology, German Cancer Research Center (Deutsches Krebsforschungszentrum), Heidelberg, Germany
| | - T Waterboer
- Infections and Cancer Epidemiology, German Cancer Research Center (Deutsches Krebsforschungszentrum), Heidelberg, Germany
| | - G Granåsen
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - T Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Center for Molecular Medicine, Stockholm, Sweden
| | - I Kockum
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Center for Molecular Medicine, Stockholm, Sweden
| | - O Andersen
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - A Fogdell-Hahn
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Center for Molecular Medicine, Stockholm, Sweden
| | - Peter Sundström
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
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Khan F, Inoue K, Remme E, Andersen O, Gude E, Skulstad H, Chetrit M, Garcia-Izquierdo Jaen E, Ha J, Klein A, Kikuchi S, Ohte N, Nagueh S, Smiseth O. Assessment of left ventricular filling pressure: left atrial reservoir strain is an excellent replacement for missing tricuspid regurgitation velocity. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0049] [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: 11/12/2022] Open
Abstract
Abstract
Background
When evaluating left ventricular filling pressure (LVFP) according to current guidelines, tricuspid regurgitation (TR) velocity is often not available.
Purpose
In the present study we investigate if left atrial (LA) reservoir strain may be used instead of TR velocity for evaluation of LVFP.
Methods
We performed a prospective, multicenter, multinational and multivendor study in an all comer population of 322 patients with suspected heart failure or other cardiovascular disease where LVFP was measured by right- or left heart catheterization, as pulmonary capillary wedge pressure or pre-A LV diastolic pressure, respectively. Echocardiography was performed within 1 day of catheterization.
101 patients classified as special populations in the 2016 ASE/EACVI recommendations (i.e. non-cardiac pulmonary hypertension, atrial fibrillation, hypertrophic and restrictive cardiomyopathies) were excluded. Of the remaining 221 patients, 118 patients had EF ≥50% and 103 patients had EF <50%. Regression analysis was performed for LA reservoir strain and TR velocity against LVFP. LA reservoir strain at a cut-off value of <18% was applied instead of TR velocity in the 2016 ASE/EACVI algorithm and compared with the current algorithm.
Results
LA reservoir strain correlated better with LVFP than TR velocity, r=0.62 vs 0.40 (p<0.01) (Figure 1). When replacing TR velocity with LA reservoir strain, the feasibility of the ASE/EACVI 2016 algorithm increased from 91.8% to 98.1%. The accuracy of the algorithm was not significantly altered (80% vs 79%).
An accuracy of 80% for the algorithm is lower than what has been reported in earlier publications, this may be due to inclusion of patients without suspected heart failure and no assessment of clinical data, which in turn may have influenced the accuracy of the algorithm.
Conclusion
LA reservoir strain has better correlation to LVFP than TR velocity, and can be used in the ASE/EACVI 2016 algorithm for estimation of LVFP as a replacement when TR velocity is missing.
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): South-Eastern Norway Regional Health Authority
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Affiliation(s)
- F Khan
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - K Inoue
- Ehime University Graduate School of Medicine, Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime, Japan
| | - E.W Remme
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - O.S Andersen
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - E Gude
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - H Skulstad
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - M Chetrit
- Cleveland Clinic, Cleveland, United States of America
| | | | - J.W Ha
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - A.L Klein
- Cleveland Clinic, Cleveland, United States of America
| | - S Kikuchi
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - N Ohte
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - S.F Nagueh
- The Methodist Hospital, Houston, United States of America
| | - O.A Smiseth
- Oslo University Hospital Rikshospitalet, Oslo, Norway
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4
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Khan F, Inoue K, Remme E, Andersen O, Gude E, Skulstad H, Chetrit M, Garcia-Izquierdo Jaen E, Ha J, Klein A, Kikuchi S, Ohte N, Nagueh S, Smiseth O. Which single echo parameter is the best marker of left ventricular filling pressure? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0050] [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
Estimation of left ventricular filling pressure (LVFP) is highly relevant in clinical practice. Invasive pressure remains the gold standard, but a number of echocardiographic parameters that correlate with LVFP are used as non-invasive markers of pressure.
Purpose
We investigated how different echocardiographic parameters correlated with invasively measured LVFP, and how accurately those parameters could differentiate between normal or elevated LVFP.
Method
We performed a prospective, multicenter, multinational and multivendor study in an all comer population of 322 patients with suspected heart failure or other cardiovascular disease. 194 patients had EF ≥50% and 129 had EF <50%. LVFP was measured by right- or left heart catheterization, as pulmonary capillary wedge pressure or pre-A LV diastolic pressure, respectively.
When excluding all special patient populations defined in the 2016 recommendations for echocardiographic evaluation of LV diastolic function, 213 patients remained. Of these 135 had EF ≥50% and 74 had EF <50%.
Echocardiography was performed within 1 day of catheterization. Previously recommended cut-off values for established parameters were used to determine the accuracy of classifying LVFP as normal or elevated. For left atrial (LA) reservoir strain, based on ROC analysis, a cut-off value of <18% was used as marker of elevated LVFP.
Results
LA reservoir strain and the ratio of peak mitral early flow velocity (E) and LA reservoir strain (E/LA strain) showed the best correlations to LVFP (Table 1, Figure 1). They also had the highest accuracy, 75% for both, in classifying LVFP as normal or elevated in the whole patient population. E/LA reservoir strain provided no additional diagnostic value to using LA reservoir strain alone.
In HFpEF patients accuracy was essentially similar for LA strain, E/LA strain and E/e', whereas in HFrEF patients the two former tended to be better than E/e'.
Conclusion
Parameters containing LA reservoir strain showed the best correlation to LVFP. This indicates that LA reservoir strain may have a role in evaluation of LVFP.
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): South-Eastern Norway Regional Health Authority
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Affiliation(s)
- F Khan
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - K Inoue
- Ehime University Graduate School of Medicine, Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime, Japan
| | - E.W Remme
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - O.S Andersen
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - E Gude
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - H Skulstad
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - M Chetrit
- Cleveland Clinic, Cleveland, United States of America
| | | | - J.W Ha
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - A.L Klein
- Cleveland Clinic, Cleveland, United States of America
| | - S Kikuchi
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - N Ohte
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - S.F Nagueh
- The Methodist Hospital, Houston, United States of America
| | - O.A Smiseth
- Oslo University Hospital Rikshospitalet, Oslo, Norway
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5
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Lindstroem MB, Andersen O, Kallemose T, Rasmussen LJH, Rosthoej S, Jervelund SS. The effect of the employment of consultants in the Emergency Department on quality of care and equity. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.502] [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: 11/15/2022] Open
Abstract
Abstract
Background
Hospitals struggle with increasing acute admissions and crowding in Emergency Departments (EDs) negatively affect length of hospitalisation, in-hospital mortality, patient safety and flow. In response to this, the Danish Health Authorities have recommended the presence of consultants in the ED to expedite the clinical decision-making process. In 2016, consultant-led triage and continuous presence of consultants was introduced at the ED at Hvidovre Hospital, Denmark. However, little is known on the effect of consultants in the ED, and how it affects care for patients of varying socioeconomic status. This study investigated whether the employment of consultants in a Danish ED affected the quality of care for acutely admitted medical patients in terms of length of admission, readmission, and mortality, and how this effect was distributed across socioeconomic status in patients.
Methods
Admission data was collected during two 7-month periods, one prior to and one after the organisational intervention, with 9,869 adult medical patients admitted for up to 48 hours in the ED. Linear regression and Cox proportional hazards regression analyses adjusted for age, sex, comorbidities, level of education and employment status were applied.
Results
Following the employment of consultants, an overall 11% increase in index-admissions was observed, and 90% of patients were discharged by a consultant with a reduced mean length of admission by 1.4 hours (95% CI: 1.0 - 1.9). No significant change was found in in-hospital mortality, readmission, or mortality within 90 days after discharge. No difference was found in quality of care across socioeconomic status.
Conclusions
Consultants in the ED was found to reduce length of admission without a negative effect on the quality of care for ED admitted medical patients in general, or for patients with lower socioeconomic status. To reduce readmission and mortality among acutely admitted patients, other means must be initiated.
Key messages
Consultants in the ED may reduce length of admission without a negative effect on the quality of care. To reduce readmission and mortality among acutely admitted patients, other means must be initiated.
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Affiliation(s)
- M B Lindstroem
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - O Andersen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Acute Medical Department, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - T Kallemose
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - L J H Rasmussen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
| | - S Rosthoej
- Section of Biostatistics, University of Copenhagen, Department of Public Health, Copenhagen, Denmark
| | - S S Jervelund
- Section for Health Services Research, University of Copenhagen, Department of Public Health, Copenhagen, Denmark
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6
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Skoog B, Link J, Tedeholm H, Longfils M, Nerman O, Fagius J, Andersen O. Short-term prediction of secondary progression in a sliding window: A test of a predicting algorithm in a validation cohort. Mult Scler J Exp Transl Clin 2019; 5:2055217319875466. [PMID: 35145727 PMCID: PMC8822449 DOI: 10.1177/2055217319875466] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 08/14/2019] [Accepted: 08/19/2019] [Indexed: 12/03/2022] Open
Abstract
Introduction The Multiple Sclerosis Prediction Score (MSPS, www.msprediction.com) estimates, for any month during the course of relapsing–remitting multiple sclerosis (MS), the individual risk of transition to secondary progression (SP) during the following year. Objective Internal verification of the MSPS algorithm in a derivation cohort, the Gothenburg Incidence Cohort (GIC, n = 144) and external verification in the Uppsala MS cohort (UMS, n = 145). Methods Starting from their second relapse, patients were included and followed for 25 years. A matrix of MSPS values was created. From this matrix, a goodness-of-fit test and suitable diagnostic plots were derived to compare MSPS-calculated and observed outcomes (i.e. transition to SP). Results The median time to SP was slightly longer in the UMS than in the GIC, 15 vs. 11.5 years (p = 0.19). The MSPS was calibrated with multiplicative factors: 0.599 for the UMS and 0.829 for the GIC; the calibrated MSPS provided a good fit between expected and observed outcomes (chi-square p = 0.61 for the UMS), which indicated the model was not rejected. Conclusion The results suggest that the MSPS has clinically relevant generalizability in new cohorts, provided that the MSPS was calibrated to the actual overall SP incidence in the cohort.
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Affiliation(s)
- B Skoog
- University of Gothenburg, the Sahlgrenska Academy, Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation, Sweden
| | - J Link
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - H Tedeholm
- University of Gothenburg, the Sahlgrenska Academy, Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation, Sweden
| | - M Longfils
- Department of Mathematical Sciences, Chalmers University of Technology, Sweden
| | - O Nerman
- Department of Mathematical Sciences, Chalmers University of Technology, Sweden
| | - J Fagius
- Neurology, Department of Neuroscience, Uppsala University, Sweden
| | - O Andersen
- University of Gothenburg, the Sahlgrenska Academy, Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation, Sweden
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7
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Pedersen MM, Kirk JW, Petersen J, Bandholm TQ, Tjørnhøj-Thomsen T, Nilsen P, Andersen O. INCREASING 24 HOUR MOBILITY IN OLDER MEDICAL PATIENTS: THE WALK-COPENHAGEN PROJECT. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M M Pedersen
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark, Hvidovre, Hovedstaden, Denmark
| | - J W Kirk
- Optimed, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - J Petersen
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark; Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - T Q Bandholm
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark; Physical Medicine Research-Copenhagen (PMR-C), Copenhagen University Hospital, Hvidovre, Denmark; Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - T Tjørnhøj-Thomsen
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Denmark
| | - P Nilsen
- Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Sweden
| | - O Andersen
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
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8
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Axelsson M, Sjögren M, Andersen O, Blennow K, Zetterberg H, Lycke J. Neurofilament light protein levels in cerebrospinal fluid predict long-term disability of Guillain-Barré syndrome: A pilot study. Acta Neurol Scand 2018; 138:143-150. [PMID: 29624650 DOI: 10.1111/ane.12927] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Although the recovery from Guillain-Barré syndrome (GBS) is good in most patients, some develop permanent severe disability or even die. Early predictors would increase the likelihood to identify patients at risk for poor outcome at the acute stage, allowing them intensified therapeutic intervention. MATERIALS AND METHOD Eighteen patients with a history of GBS 9-17 years ago were reassessed with scoring of neurological disability and quality of life assessment (QoL). Their previous diagnostic work-up included clinical examination with scoring of disability, neurophysiological investigation, a battery of serology tests for infections, and cerebrospinal fluid (CSF) examination. Aliquots of CSF were frozen, stored for 20-28 years, and analyzed by ELISA for determination of neurofilament light protein (NFL) and glial fibrillary acidic protein (GFAP). RESULTS Patients with poor outcome (n = 3) had significantly higher NFL and GFAP levels at GBS nadir than those with good outcome (n = 15, P < .01 and P < .05, respectively). High NFL correlated with more prominent disability and worse QoL at long-term follow-up (r = .694, P < .001, and SF 36 dimension physical component summary (PCS) (r =-.65, P < .05), respectively, whereas GFAP did not correlate with clinical outcome or QoL. CONCLUSION High NFL in CSF at the acute stage of GBS seems to predict long-term outcome and might, together with neurophysiological and clinical measures, be useful in treatment decisions and clinical care of GBS.
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Affiliation(s)
- M. Axelsson
- Department of Clinical Neuroscience; Institute of Neuroscience and Physiology; The Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - M. Sjögren
- Department of Clinical Neuroscience; Institute of Neuroscience and Physiology; The Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - O. Andersen
- Department of Clinical Neuroscience; Institute of Neuroscience and Physiology; The Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - K. Blennow
- Department of Psychiatry and Neurochemistry; Institute of Neuroscience and Physiology; The Sahlgrenska Academy; The University of Gothenburg; Mölndal Sweden
- Clinical Neurochemistry Laboratory; Sahlgrenska University Hospital; Mölndal Sweden
| | - H. Zetterberg
- Department of Psychiatry and Neurochemistry; Institute of Neuroscience and Physiology; The Sahlgrenska Academy; The University of Gothenburg; Mölndal Sweden
- Clinical Neurochemistry Laboratory; Sahlgrenska University Hospital; Mölndal Sweden
- Department of Molecular Neuroscience; UCL Institute of Neurology; London UK
- UK Dementia Research Institute; London UK
| | - J. Lycke
- Department of Clinical Neuroscience; Institute of Neuroscience and Physiology; The Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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9
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Westin O, Rasmussen LJH, Andersen O, Eugen-Olsen J, Friberg J. P1898Soluble urokinase plasminogen activator receptor (suPAR) is an independent risk factor for stroke in patients with atrial fibrillation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1898] [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: 11/12/2022] Open
Affiliation(s)
- O Westin
- Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Department of Cardiology, Copenhagen, Denmark
| | - L J H Rasmussen
- Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Copenhagen, Denmark
| | - O Andersen
- Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Copenhagen, Denmark
| | - J Eugen-Olsen
- Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Copenhagen, Denmark
| | - J Friberg
- Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Department of Cardiology, Copenhagen, Denmark
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10
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Andersen O, Hildeman A, Longfils M, Tedeholm H, Skoog B, Tian W, Zhong J, Ekholm S, Novakova L, Runmarker B, Nerman O, Maier SE. Diffusion tensor imaging in multiple sclerosis at different final outcomes. Acta Neurol Scand 2018; 137:165-173. [PMID: 28741711 DOI: 10.1111/ane.12797] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Methods to evaluate the relative contributions of demyelination vs axonal degeneration over the long-term course of MS are urgently needed. We used magnetic resonance diffusion tensor imaging (DTI) to estimate degrees of demyelination and axonal degeneration in the corpus callosum (CC) in cases of MS with different final outcomes. MATERIALS AND METHODS We determined DTI measures mean diffusivity (MD), fractional anisotropy (FA), and axial (AD) and radial (RD) diffusivities in the CC of 31 MS patients, of whom 13 presented a secondary progressive course, 11 a non-progressive course, and seven a monophasic course. The study participants were survivors from an incidence cohort of 254 attack-onset MS patients with 50 years of longitudinal follow-up. As reference, we included five healthy individuals without significant morbidity. RESULTS In patients with secondary progression, compared to all other groups, the corpus callosum showed increased RD and reduced FA, but no change in AD. None of the parameters exhibited differences among non-progressive and monophasic course groups and controls. CONCLUSION Increased RD was observed in secondary progressive MS, indicating significant myelin loss. Normal RD values observed in the clinically isolated syndrome and non-progressive groups confirm their benign nature. AD was not a characterizing parameter for long-term outcome. Demyelination revealed by increased RD is a distinguishing trait for secondary progression.
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Affiliation(s)
- O. Andersen
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - A. Hildeman
- Department of Mathematical Sciences Chalmers University of Technology and University of Gothenburg Gothenburg Sweden
| | - M. Longfils
- Department of Mathematical Sciences Chalmers University of Technology and University of Gothenburg Gothenburg Sweden
| | - H. Tedeholm
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - B. Skoog
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - W. Tian
- Department of Imaging Sciences Medical Center University of Rochester Rochester NY USA
| | - J. Zhong
- Department of Imaging Sciences Medical Center University of Rochester Rochester NY USA
| | - S. Ekholm
- Department of Imaging Sciences Medical Center University of Rochester Rochester NY USA
- Department of Radiology Sahlgrenska University Hospital Gothenburg Sweden
| | - L. Novakova
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - B. Runmarker
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - O. Nerman
- Department of Mathematical Sciences Chalmers University of Technology and University of Gothenburg Gothenburg Sweden
| | - S. E. Maier
- Department of Radiology Sahlgrenska University Hospital Gothenburg Sweden
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11
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Andersen O. MS and infections-Abandoned and surviving hypotheses. Acta Neurol Scand 2017; 136 Suppl 201:4-9. [PMID: 29068491 DOI: 10.1111/ane.12846] [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] [Accepted: 08/31/2017] [Indexed: 11/29/2022]
Abstract
In this introduction, we follow the ups and downs of infections in MS pathogenesis. Our arguments focus on specific agents and events, not referring to general MS epidemiology. The historical approach continues on to contemporary data and a critical analysis.
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Affiliation(s)
- O. Andersen
- Institution of Neuroscience and Physiology; University of Gothenburg Neurology; Sahlgrenska University Hospital; Göteborg Sweden
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12
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Celius EG, Andersen O, Fredriksen JL. Preface. Acta Neurol Scand 2017; 136 Suppl 201:3. [PMID: 29068489 DOI: 10.1111/ane.12842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2017] [Indexed: 11/27/2022]
Affiliation(s)
- E. G. Celius
- Department of Neurology; Oslo University Hospital; Ullevål and Institute of Health and Society; Faculty of Medicine; University of Oslo; Oslo Norway
| | - O. Andersen
- Institute of Neuroscience and Physiology; The Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - J. L. Fredriksen
- Department of Neurology; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis; Rigshospitalet Glostrup; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
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13
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Houlind M, Treldal C, Aakjær M, Palm H, Malmquist B, Andersen O, Christrup L, Petersen K. Renal function estimations and dose recommendations for Gabapentin, Ibuprofen and Morphine in acute hip fracture patients. Scand J Pain 2017. [DOI: 10.1016/j.sjpain.2017.04.031] [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
Aims
Optimization of pain management is essential for fasttrack surgery and safety in acute hip fracture (AHF) patients. Kidney function determines the doses of several postoperative painkillers, but previous studies have shown the standard Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation overestimate glomerular filtration rate (GFR) in elderly and underweight patients. The optimized Cockcroft Gault (CGop) equation might be more accurate in this patient group. The study aims to (1) investigate the differences in estimated GFR (eGFR) based on CKD-EPI and CGop and (2) to simulate this impact on recommended dosing of standard painkillers in AHF patients.
Methods
Patients admitted with AHF from January to April 2015 were included. eGFR was calculated for each patient by CKD-EPI and CGop based on the lowest measured serum creatinine between 1 and 4 days postoperatively. CKD-classification (1–5) was performed based on both eGFR values. If patients were classified differently based on the two eGFR values, then drug dosages were simulated for Morphine, Ibuprofen and Gabapentin according to prescribing recommendations in Renbase®.Two-sided Mann–Whitney test was used to compare median values between groups.
Results
176 patients (62% women) with a median age of 76 years were included. CKD-EPI (78.0mL/min/m2) estimated eGFR significantly higher compared with GGop (58.9, P < 0.001). Depending on the equation used to estimate GFR, CKD ≥ 3 (eGFR < 60 mL/min/m2) occurred in 23–53% all patients. Using CGop to estimate GFR resulted in CKD re-classification for 63% of all patients. Using CKD-EPI to estimate GFR resulted in significantly higher doses of Morphine, Ibuprofen and Gabapentin (P < 0.0001) in re-classified patients.
Conclusions
GFR estimates are significantly higher when calculated by CKD-EPI compared to CGop, and this difference results in significantly higher recommended doses of painkillers in AHF patients. Future studies should include a gold standard for measuring GFR and maybe alternative biomarkers for the renal function.
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Affiliation(s)
- M.B. Houlind
- Optimed, Clinical Research Center, Hvidovre Hospital , The Capital Region of Denmark , Copenhagen , Denmark
- The Hospital Pharmacy , Copenhagen University Hospital , The Capital Region of Denmark , Copenhagen , Denmark
- Department of Pharmacology and Pharmacotherapy, Faculty of Pharmaceutical Sciences , University of Copenhagen , Copenhagen , Denmark
| | - C. Treldal
- Optimed, Clinical Research Center, Hvidovre Hospital , The Capital Region of Denmark , Copenhagen , Denmark
- The Hospital Pharmacy , Copenhagen University Hospital , The Capital Region of Denmark , Copenhagen , Denmark
| | - M. Aakjær
- Optimed, Clinical Research Center, Hvidovre Hospital , The Capital Region of Denmark , Copenhagen , Denmark
- The Hospital Pharmacy , Copenhagen University Hospital , The Capital Region of Denmark , Copenhagen , Denmark
- Department of Pharmacology and Pharmacotherapy, Faculty of Pharmaceutical Sciences , University of Copenhagen , Copenhagen , Denmark
| | - H. Palm
- Department of Orthopaedic Surgery, Hvidovre Hospital , The Capital Region of Denmark , Hvidovre , Denmark
| | - B. Malmquist
- Department of Orthopaedic Surgery, Hvidovre Hospital , The Capital Region of Denmark , Hvidovre , Denmark
| | - O. Andersen
- Optimed, Clinical Research Center, Hvidovre Hospital , The Capital Region of Denmark , Copenhagen , Denmark
| | - L.L. Christrup
- Department of Orthopaedic Surgery, Hvidovre Hospital , The Capital Region of Denmark , Hvidovre , Denmark
| | - K.K. Petersen
- SMI, Department of Health Science and Technology , Aalborg University , Aalborg , Denmark
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14
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Pedersen M, Petersen J, Beyer N, Damkjær L, Juul-Larsen H, Bodilsen A, Andersen O, Bandholm T. MOBILITY DURING AND AFTER HOSPITALIZATION IN OLDER MEDICAL PATIENTS: THE STAND-CPH TRIAL. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M.M. Pedersen
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark,
- Physical Medicine Research-Copenhagen (PMR-C), Department of Physiotherapy, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark
| | - J. Petersen
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark,
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark,
| | - N.A. Beyer
- Musculoskeletal Rehabilitation Research Unit, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Copenhagen, Denmark,
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,
| | - L. Damkjær
- Department of Rehabilitation, Copenhagen Municipality Health Administration, Copenhagen, Denmark,
| | - H.G. Juul-Larsen
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark,
| | - A.C. Bodilsen
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark,
- Physical Medicine Research-Copenhagen (PMR-C), Department of Physiotherapy, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark
| | - O. Andersen
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark,
| | - T.Q. Bandholm
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark,
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark,
- Physical Medicine Research-Copenhagen (PMR-C), Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark,
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15
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Abdullah OB, Grand J, Sijapati A, Nimskov P, Nielsen FE, Schmidt JC, Pérez N, Kirkegaard T, Fløjstrup M, Brabrand M, Galthen-Sørensen M, Ramoskiene R, Arshad A, Lassen A, Teglbjærg LS, Andersen O, Jørgensen LM, Sivertsen DM, Kirk JW, Petersen J, Klausen HH, Bodilsen AC, Petersen J, Bandholm T, Haupt T, Sivertsen DM, Andersen O, Hansen CS, Pottegård A, Ekelund U, Forberg JL, Jensen HK, Lassen AT, Madsen JLB, Graumann O, Posth S, Pietersen PI, Konge L, Laursen CB, Madsen JLB, Hansen SN, Jensen KM, Brabrand M, Hasselbalch RB, Pries-Heje M, Ravn L, Lind M, Rasmussen LS, Jensen BN, Havshøj U, Henriksen DP, Brabrand M, Lassen AT, Nygaard HH, Maschmann C, Skjøt-Arkil H, Mogensen CB, Hansen LH, Wittenhoff L, Mogensen CB, Skjøt-Arkil H, Duvald I, Duvald I, Rasmussen LJH, Ladelund S, Haupt TH, Ellekilde G, Eugen-Olsen J, Andersen O, Betzer M, Lyngby R, Elkjær M, Jørgensen C, Brabrand M, Gram B, Pries-Heje MM, Hasselbalch RB, Ravn L, Lind MN, Boel T, Ulriksen PS, Jensen NH, Jensen KM, Mølleskov E, Fog IØ, Kristensen MR, Jensen E. Meeting abstracts from the 7th Danish Emergency Medicine Conference. Scand J Trauma Resusc Emerg Med 2017. [PMCID: PMC5374601 DOI: 10.1186/s13049-017-0364-2] [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: 11/10/2022] Open
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16
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Sundal C, Vedeler C, Miletic H, Andersen O. Morvan syndrome with Caspr2 antibodies. Clinical and autopsy report. J Neurol Sci 2016; 372:453-455. [PMID: 27802867 DOI: 10.1016/j.jns.2016.10.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/24/2016] [Accepted: 10/26/2016] [Indexed: 12/01/2022]
Affiliation(s)
- C Sundal
- Section of Clinical Neuroscience, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, University of Gothenburg, Sweden
| | - C Vedeler
- Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - H Miletic
- Department of Pathology, Haukeland University Hospital, Bergen, Norway; Department of Biomedicine, University of Bergen, Bergen, Norway
| | - O Andersen
- Section of Clinical Neuroscience, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, University of Gothenburg, Sweden.
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17
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Tavenier J, Haupt T, Andersen A, Buhl S, Langkilde A, Andersen J, Jensen JE, Pedersen M, Petersen J, Andersen O. MON-P041: Nutritional Support During Hospitalization is Associated with an Earlier Decrease in Inflammation in Acutely Ill Older Medical Patients with SIRS. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30675-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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18
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Celius EG, Rocca M, Andersen O. Preface. Acta Neurol Scand 2016; 134 Suppl 200:3. [PMID: 27580898 DOI: 10.1111/ane.12653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 11/28/2022]
Affiliation(s)
- E G Celius
- Department of Neurology, Oslo University Hospital and Institute of Health and Society, University of Oslo, Oslo, Norway
| | - M Rocca
- Division of Neuroscience, Institute of Experimental Neurology, Hospital San Raffaele, University of Milan, Milan, Italy
| | - O Andersen
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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19
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Callander M, Haghighi S, Landtblom AM, Ahlgren CE, Nilsson SI, Rydberg L, Al Khoury H, Rosegren L, Andersen O. Multiple sclerosis immunopathic trait and HLA-DR(2)15 as independent risk factors in multiple sclerosis. Mult Scler 2016; 13:441-5. [PMID: 17463066 DOI: 10.1177/1352458506070264] [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: 11/15/2022]
Abstract
We analysed HLA haplotypes in pairs of 78 sporadic multiple sclerosis (MS) patients and 78 healthy siblings. The presence of 2 oligoclonal IgG bands, detected by immunoblotting of the cerebrospinal fluid in healthy siblings, has previously been defined as MS immunopathic trait (MSIT), based on a cut-off derived from healthy unrelated volunteers. The frequency of MSIT was 17.9% (n=14/78 siblings). The HLA-DR(15)2 allelle was present in 21.4% (n=3/14) of the siblings with MSIT, in 40.6% (n =26/64) of the siblings without MSIT, and in 59% (n =46/78) of the patients with clinically-definite (CD) MS. The distribution of zero, one or two HLA-DR(2)15 alleles was significantly skewed towards a lower allelle count in the siblings with MSIT compared with the group of unrelated siblings with MS (P=0.002), and also lower than their related siblings with MS (P=0.1). These results suggest that the MS susceptibility gene, HLA-DR(2)15 type, does not induce MSIT, and conceivably these are two separate risk factors in the development of MS. The effect of HLA-DR(2)15 and MSIT in sporadic MS appears to be synergistic. Multiple Sclerosis 2007; 13: 441-445. http://msj.sagepub.com
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Affiliation(s)
- M Callander
- Department of Neurology, University Hospital, Linköping, Sweden.
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20
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Haghighi S, Andersen O, Nilsson S, Rydberg L, Wahlström J. A linkage study in two families with multiple sclerosis and healthy members with oligoclonal CSF immunopathy. Mult Scler 2016; 12:723-30. [PMID: 17262999 DOI: 10.1177/1352458506070972] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 01/15/2023]
Abstract
We studied two extended families in which not only multiple sclerosis (MS) segregates, but also approximately 18% of the cerebrospinal fluid (CSF) investigated blood relatives have ‘MS immunopathic trait’, an oligoclonal CSF immunopathy similar to that seen in MS, but with no neurological symptoms. Both families fit a genetic model for autosomal dominant inheritance for MS immunopathic trait, although with reduced penetrance in family A. In order to identify genetic factors of importance for the development of MS immunopathic trait, we performed a genome scan using the CHLC/Weber Screening Set (ver 6A), with 285 successful markers, to test the hypothesis that a single gene is causing the MS immunopathic trait in these families. Using a parametric method, we identified regions with suggestive linkage at chromosome 6q12 with a LOD-score of 2.4, putative linkage with LOD-score 1.5 at chromosome 6p21 (HLA region), putative linkage at chromosome 12q24 with a LOD-score of 1.7 and suggestive linkage at chromosome 19q13.2 with a LOD-score of 1.8. The LOD-score at chromosome 19q13.2 increased to 2.2 when only family A was analysed. In family A, all MS patients and two of five individuals with MS immunopathic trait had HLA DRB1*(15) and in family B, all blood relatives had the rare HLA type DRB1*0103, which is associated with other autoimmune diseases. We suggest that DRB1*0103 is a necessary but not sufficient condition for the susceptibility for MS immunopathic trait in this family.
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Affiliation(s)
- S Haghighi
- Institute of Clinical Neuroscience, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
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21
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Granberg T, Hashim F, Andersen O, Sundal C, Karrenbauer VD. Hereditary diffuse leukoencephalopathy with spheroids - a volumetric and radiological comparison with multiple sclerosis patients and healthy controls. Eur J Neurol 2016; 23:817-22. [DOI: 10.1111/ene.12948] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 11/13/2015] [Indexed: 02/02/2023]
Affiliation(s)
- T. Granberg
- Division of Medical Imaging and Technology; Department of Clinical Science; Intervention and Technology; Karolinska Institutet; Stockholm Sweden
- Department of Radiology; Karolinska University Hospital; Stockholm Sweden
| | - F. Hashim
- Division of Medical Imaging and Technology; Department of Clinical Science; Intervention and Technology; Karolinska Institutet; Stockholm Sweden
- Department of Radiology; Karolinska University Hospital; Stockholm Sweden
| | - O. Andersen
- The Sahlgrenska Academy; Department of Neuroscience and Physiology; Section of Clinical Neuroscience and Rehabilitation; University of Gothenburg; Gothenburg Sweden
| | - C. Sundal
- The Sahlgrenska Academy; Department of Neuroscience and Physiology; Section of Clinical Neuroscience and Rehabilitation; University of Gothenburg; Gothenburg Sweden
- Department of Neurology; Haukeland University Hospital; Bergen Norway
| | - V. D. Karrenbauer
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
- Department of Neurology; Karolinska University Hospital; Stockholm Sweden
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22
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Treldal C, Jacobsen CB, Mogensen S, Rasmussen M, Jacobsen J, Petersen J, Lynge Pedersen AM, Andersen O. Effect of a local anesthetic lozenge in relief of symptoms in burning mouth syndrome. Oral Dis 2016; 22:123-31. [DOI: 10.1111/odi.12386] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 09/26/2015] [Accepted: 10/23/2015] [Indexed: 11/28/2022]
Affiliation(s)
- C Treldal
- Clinical Research Centre; Copenhagen University Hospital; Hvidovre Denmark
| | - CB Jacobsen
- Clinical Research Centre; Copenhagen University Hospital; Hvidovre Denmark
| | - S Mogensen
- Clinical Research Centre; Copenhagen University Hospital; Hvidovre Denmark
| | - M Rasmussen
- Clinical Research Centre; Copenhagen University Hospital; Hvidovre Denmark
| | - J Jacobsen
- Section for Pharmaceutical Design and Drug Delivery; Department of Pharmacy; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - J Petersen
- Clinical Research Centre; Copenhagen University Hospital; Hvidovre Denmark
| | - AM Lynge Pedersen
- Section for Oral Medicine, Clinical Oral Physiology, Oral Pathology and Anatomy; Department of Odontology; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - O Andersen
- Clinical Research Centre; Copenhagen University Hospital; Hvidovre Denmark
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Andersen O. Nordic MS Epidemiology. Introduction. Acta Neurol Scand 2015; 132:1-3. [PMID: 26046551 DOI: 10.1111/ane.12423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- O. Andersen
- Section of Clinical Neuroscience and Rehabilitation; Institute of Neuroscience and Physiology; The Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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Andersen O. Conclusion: National incidence and risk factor assessments may become a basis for the evaluation of prevention trials – prospects from the Third Nordic MS Symposium. Acta Neurol Scand 2015; 132:71-5. [PMID: 26046562 DOI: 10.1111/ane.12434] [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] [Accepted: 04/10/2015] [Indexed: 11/29/2022]
Abstract
This symposium started with an overview of recent incidence and prevalence data from the Scandinavian national registers and continued with a critical analysis of several alleged risk factors for MS. These risk factors are constantly changing and therefore might explain current incidence changes. In addition, they may be the subject of preventive measures.
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Affiliation(s)
- O. Andersen
- Section of Clinical Neuroscience and Rehabilitation; Institute of Neuroscience and Physiology; The Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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25
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Andersen O. Stone Walls as a Means of Understanding the Different Types of Reindeer Herding: A Study from the Lule Sami Area on the Norwegian Side of the Border. Arctic Anthropology 2015. [DOI: 10.3368/aa.51.2.23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Mogensen S, Sveindottir K, Treldal C, Nygaard A, Mohammad A, Kristensen C, Petersen J, Andersen O. PO-124: New local anesthetic lozenge induces no risk of aspiration in healthy subjects and head/neck cancer patients. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)34884-2] [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: 10/23/2022]
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27
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Jons D, Sundström P, Andersen O. Targeting Epstein-Barr virus infection as an intervention against multiple sclerosis. Acta Neurol Scand 2015; 131:69-79. [PMID: 25208981 DOI: 10.1111/ane.12294] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2014] [Indexed: 12/25/2022]
Abstract
We here review contemporary data on genetic and environmental risk factors, particularly Epstein-Barr virus infection, for multiple sclerosis. There is an important immunogenetic etiological factor for multiple sclerosis. However, a general assumption is that immune defense genes are activated by the environment, basically by infections. We contend that the relationship between infectious mononucleosis and multiple sclerosis cannot be completely explained by genetics and inverse causality. Epstein-Barr infection as indicated by positive serology is an obligatory precondition for multiple sclerosis, which is a stronger attribute than a risk factor only. Data on events in the early pathogenesis of multiple sclerosis are cumulating from bio-banks with presymptomatic specimens, but there is only little information from the critical age when Epstein-Barr infection including infectious mononucleosis is acquired, nor on the detailed immunological consequences of this infection in individuals with and without multiple sclerosis. We discuss how focused bio-banking may elaborate a rationale for the development of treatment or vaccination against Epstein-Barr virus infection. A cohort in which intervention against Epstein-Barr infections was performed should be the object of neurological follow-up.
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Affiliation(s)
- D. Jons
- Section of Clinical Neuroscience and Rehabilitation; Institution of Neuroscience and Physiology; the Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - P. Sundström
- Section of Neurology; Department of Pharmacology and Clinical Neuroscience; University of Umeå; Umeå Sweden
| | - O. Andersen
- Section of Clinical Neuroscience and Rehabilitation; Institution of Neuroscience and Physiology; the Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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Andersen O, Gasda SE, Nilsen HM. Vertically Averaged Equations with Variable Density for $$\hbox {CO}_2$$ CO 2 Flow in Porous Media. Transp Porous Media 2014. [DOI: 10.1007/s11242-014-0427-z] [Citation(s) in RCA: 10] [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] [Indexed: 10/24/2022]
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Press R, Askmark H, Svenningsson A, Andersen O, Axelson HW, Strömberg U, Wahlin A, Isaksson C, Johansson JEJ, Hägglund H. Autologous haematopoietic stem cell transplantation: a viable treatment option for CIDP. J Neurol Neurosurg Psychiatry 2014; 85:618-24. [PMID: 24262917 DOI: 10.1136/jnnp-2013-306014] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [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] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Only 70-80% of patients with chronic inflammatory demyelinating polyneuropathy (CIDP) respond satisfactorily to the established first-line immunomodulatory treatments. Autologous haematopoietic stem cell transplantation (AHSCT) has been performed as a last treatment resort in a few therapy-refractory cases with CIDP. We describe the results of AHSCT in 11 consecutive Swedish patients with therapy-refractory CIDP with a median follow-up time of 28 months. METHOD Case data were gathered retrospectively for AHSCT treatments in 11 patients with CIDP refractory to the first-line immunomodulatory treatments, intravenous high-dose immunoglobulin, corticosteroids and plasma exchange and to one or more second-line treatments used in 10 of the 11 patients. RESULTS The median Inflammatory Neuropathy Cause and Treatment (INCAT) score within 1 month prior to AHSCT was 6 and the Rankin score 4. Total INCAT and Rankin scores improved significantly within 2-6 months after AHSCT and continued to do so at last follow-up. The motor action potential amplitudes (CMAP) improved already within 4 months (median) after AHSCT. Three of the 11 patients relapsed during the follow-up period, requiring retransplantation with AHSCT in one. Eight of the 11 patients maintained drug-free remission upon last follow-up. AHSCT was safe but on the short term associated with a risk of cytomegalovirus (CMV) and Epstein-Barr virus reactivation, CMV disease, haemorrhagic cystitis and pancreatitis. CONCLUSIONS Our results though hampered by the limited number of patients and the lack of a control group suggest AHSCT to be efficacious in therapy-refractory CIDP, with a manageable complication profile. Confirmation of these results is necessary through randomised controlled trials.
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Affiliation(s)
- R Press
- Department of Neurology, Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital Huddinge, , Stockholm, Huddinge, Sweden
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Bobe K, Willbold E, Morgenthal I, Andersen O, Studnitzky T, Nellesen J, Tillmann W, Vogt C, Vano K, Witte F. In vitro and in vivo evaluation of biodegradable, open-porous scaffolds made of sintered magnesium W4 short fibres. Acta Biomater 2013; 9:8611-23. [PMID: 23542554 DOI: 10.1016/j.actbio.2013.03.035] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 02/23/2013] [Accepted: 03/22/2013] [Indexed: 11/27/2022]
Abstract
A cytocompatible and biocompatible, degradable, open-porous, mechanically adaptable metal scaffold made of magnesium alloy W4 melt-extracted short fibres was fabricated by liquid phase sintering. Cylindrical samples (3×5 mm) of sintered W4 short fibres were evaluated under in vitro (L929, HOB, eudiometer, weight loss) and in vivo conditions (rabbits: 6 and 12 weeks). The in vitro corrosion environment (e.g., temperature, flow, composition of corrosion solution, exposure time) significantly influenced the corrosion rates of W4 scaffolds compared with corrosion in vivo. Corrosion rates under cell culture conditions for 72 h varied from 1.05 to 3.43 mm y(-1) depending on the media composition. Corrosion rates measured in eudiometric systems for 24 h were ~24-27 times higher (3.88-4.43 mm y(-1)) than corrosion in vivo after 6 weeks (0.16 mm y(-1)). Moreover, it was found that the cell culture media composition significantly influences the ionic composition of the extract by selectively dissolving ions from W4 samples or their corrosion products. A pilot in vivo study for 6 and 12 weeks demonstrated active bone remodelling, no foreign body reaction and no clinical observation of gas formation during W4 scaffold implantation. Long-term in vivo studies need to be conducted to prove complete degradation of the W4 scaffold and total replacement by the host tissue.
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Herasimtschuk AA, Hansen BR, Langkilde A, Moyle GJ, Andersen O, Imami N. Low-dose growth hormone for 40 weeks induces HIV-1-specific T cell responses in patients on effective combination anti-retroviral therapy. Clin Exp Immunol 2013; 173:444-53. [PMID: 23701177 DOI: 10.1111/cei.12141] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2013] [Indexed: 12/22/2022] Open
Abstract
Recombinant human growth hormone (rhGH) administered to combination anti-retroviral therapy (cART)-treated human immunodeficiency virus-1 (HIV-1)-infected individuals has been found to reverse thymic involution, increase total and naive CD4 T cell counts and reduce the expression of activation and apoptosis markers. To date, such studies have used high, pharmacological doses of rhGH. In this substudy, samples from treated HIV-1(+) subjects, randomized to receive either a physiological dose (0·7 mg) of rhGH (n = 21) or placebo (n = 15) daily for 40 weeks, were assessed. Peptide-based enzyme-linked immunospot (ELISPOT) assays were used to enumerate HIV-1-specific interferon (IFN)-γ-producing T cells at baseline and week 40. Individuals who received rhGH demonstrated increased responses to HIV-1 Gag overlapping 20mer and Gag 9mer peptide pools at week 40 compared to baseline, whereas subjects who received placebo showed no functional changes. Subjects with the most robust responses in the ELISPOT assays had improved thymic function following rhGH administration, as determined using CD4(+) T cell receptor rearrangement excision circle (TREC ) and thymic density data from the original study. T cells from these robust responders were characterized further phenotypically, and showed decreased expression of activation and apoptosis markers at week 40 compared to baseline. Furthermore, CD4 and CD8 T cell populations were found to be shifted towards an effector and central memory phenotype, respectively. Here we report that administration of low-dose rhGH over 40 weeks with effective cART resulted in greater improvement of T lymphocyte function than observed with cART alone, and provide further evidence that such an approach could also reduce levels of immune activation.
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Andersen O. Carcinoma of the Fifth Toe: Report of Two Cases. Acta Radiol 2013. [DOI: 10.1177/028418515504400109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Novakova L, Skoog B, Runmarker B, Ekholm S, Winblad S, Lisovskaja V, Andersen O. Clinically isolated syndromes with no further disease activity suggestive of multiple sclerosis at the age of population life expectancy. Mult Scler 2013; 20:496-500. [PMID: 23868138 DOI: 10.1177/1352458513496345] [Citation(s) in RCA: 11] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The proportion of patients with clinically isolated syndrome (CIS) reported to convert to clinically definite multiple sclerosis varied between 30 and 75%. We studied the lifetime probability of remaining in the "CIS only" condition. The study was based on the longitudinally followed Gothenburg 1950-1964 incidence cohort (n = 306). Survival analysis revealed that 17.8% of 236 attack onset patients remained "CIS only". Patients with afferent (optic and sensory) symptoms had a better prognosis with approximately 30% of these patients remaining "CIS only". Patients who had experienced no relapse during the first 25 years remained "CIS only" for the subsequent 25 years of follow-up.
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Affiliation(s)
- L Novakova
- Section of Clinical Neuroscience and Rehabilitation, University of Gothenburg, Sweden
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Haghighi S, Lekman A, Nilsson S, Blomqvist M, Andersen O. Increased CSF sulfatide levels and serum glycosphingolipid antibody levels in healthy siblings of multiple sclerosis patients. J Neurol Sci 2013; 326:35-9. [DOI: 10.1016/j.jns.2013.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Revised: 12/17/2012] [Accepted: 01/04/2013] [Indexed: 01/21/2023]
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Abstract
An overview of prevalence and incidence studies performed in Swedish centres is provided, showing improving coverage and methodology, notably the development in Gothenburg of the representative incidence cohort design. A common database for major Swedish centres was established in 1995, implementing the terminology of predictors from the Gothenburg cohort. By 2001, these databases were merged into the web-based national multiple sclerosis (MS) registry, which has had an ever-increasing coverage, although with still moderate data density. The registry now contains records on 13,000 Swedish patients with MS. It has the status of a national quality registry and exerts nation-wide pharmacological surveillance. In addition, it has been, and is being, used in nearly 100 scientific studies, including large epidemiological and genetic projects.
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Affiliation(s)
- O. Andersen
- Institution of Neuroscience and Physiology; University of Gothenburg; Gothenburg; Sweden
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Klausen H, Petersen J, Lindhardt T, Bandholm T, Hendriksen C, Kehlet H, Vestbo J, Andersen O. Outcomes in elderly Danish citizens admitted with community-acquired pneumonia. Regional differencties, in a public healthcare system. Respir Med 2012; 106:1778-87. [DOI: 10.1016/j.rmed.2012.08.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 08/07/2012] [Accepted: 08/14/2012] [Indexed: 02/06/2023]
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Tedeholm H, Lycke J, Skoog B, Lisovskaja V, Hillert J, Dahle C, Fagius J, Fredrikson S, Landtblom AM, Malmeström C, Martin C, Piehl F, Runmarker B, Stawiarz L, Vrethem M, Nerman O, Andersen O. Time to secondary progression in patients with multiple sclerosis who were treated with first generation immunomodulating drugs. Mult Scler 2012; 19:765-74. [PMID: 23124789 PMCID: PMC3652599 DOI: 10.1177/1352458512463764] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [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: 11/16/2022]
Abstract
BACKGROUND It is currently unknown whether early immunomodulatory treatment in relapsing-remitting MS (RRMS) can delay the transition to secondary progression (SP). OBJECTIVE To compare the time interval from onset to SP in patients with RRMS between a contemporary cohort, treated with first generation disease modifying drugs (DMDs), and a historical control cohort. METHODS We included a cohort of contemporary RRMS patients treated with DMDs, obtained from the Swedish National MS Registry (disease onset between 1995-2004, n = 730) and a historical population-based incidence cohort (onset 1950-64, n = 186). We retrospectively analyzed the difference in time to SP, termed the "period effect" within a 12-year survival analysis, using Kaplan-Meier and Cox regression analysis. RESULTS We found that the "period" affected the entire severity spectrum. After adjusting for onset features, which were weaker in the contemporary material, as well as the therapy initiation time, the DMD-treated patients still exhibited a longer time to SP than the controls (hazard ratios: men, 0.32; women, 0.53). CONCLUSION Our results showed there was a longer time to SP in the contemporary subjects given DMD. Our analyses suggested that this effect was not solely driven by the inclusion of benign cases, and it was at least partly due to the long-term immunomodulating therapy given.
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Affiliation(s)
- H Tedeholm
- Sahlgrenska University Hospital, Gothenburg, Sweden
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Pedersen MM, Bodilsen AC, Petersen J, Beyer N, Andersen O, Lawson-Smith L, Kehlet H, Bandholm T. Twenty-Four-Hour Mobility During Acute Hospitalization in Older Medical Patients. J Gerontol A Biol Sci Med Sci 2012; 68:331-7. [DOI: 10.1093/gerona/gls165] [Citation(s) in RCA: 152] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mossberg N, Nordin M, Movitz C, Nilsson S, Hellstrand K, Bergström T, Andersson B, Andersen O. The recurrent Guillain-Barré syndrome: a long-term population-based study. Acta Neurol Scand 2012; 126:154-61. [PMID: 22507178 DOI: 10.1111/j.1600-0404.2012.01667.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe a population-based material of patients with recurrent Guillain-Barré syndrome (RGBS), examine the long time course, and search for factors predisposing to recurrence. MATERIALS AND METHODS We performed a follow-up study of the neurology and neurophysiology and a systematic study of the acute microbial serology of patients with RGBS. These parameters were compared with the results of a previous study of monophasic GBS. RESULTS The patients with RGBS (n = 15) were retrieved from admissions of 229 patients with GBS during a 17-year period. They had 2-7 (median 3) episodes occurring at irregular intervals over decades. Of the 11 patients who accepted a follow-up examination, six were in full remission, and five had moderate sequelae. Nine had a demyelinating subtype, one had an axonal motor variant, and one patient with incomplete Miller Fisher syndrome had associated arachnoiditis. Two patients showed ultimate transition to a course similar to chronic inflammatory demyelinating polyneuropathy. Episodes were generally shorter in RGBS than in GBS, and an initial episode duration <45 days was predictive of recurrence and related to a younger onset age (univariate P = 0.005-0.009). Triggering infections occurred in all patients, in 32 of 41 episodes (78%) with few examples of etiological promiscuity. Serological findings did not differ from those in GBS. CONCLUSIONS Episodes in RGBS were shorter than in monophasic GBS. We were unable to identify further immunological predisposing factors for recurrence beyond the previously demonstrated relationship to a weaker respiratory burst. We observed no obvious tendency for the recurrence frequency to wane.
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Affiliation(s)
- N. Mossberg
- Department of Neuroscience and Physiology; University of Gothenburg; Gothenburg; Sweden
| | - M. Nordin
- Department of Neuroscience and Physiology; University of Gothenburg; Gothenburg; Sweden
| | - C. Movitz
- Department of Infectious Diseases; University of Gothenburg; Gothenburg; Sweden
| | - S. Nilsson
- Department of Mathematical Statistics; Chalmers University of Technology; Gothenburg; Sweden
| | - K. Hellstrand
- Department of Infectious Diseases; University of Gothenburg; Gothenburg; Sweden
| | - T. Bergström
- Department of Infectious Diseases; University of Gothenburg; Gothenburg; Sweden
| | - B. Andersson
- Department of Infectious Diseases; University of Gothenburg; Gothenburg; Sweden
| | - O. Andersen
- Department of Neuroscience and Physiology; University of Gothenburg; Gothenburg; Sweden
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Sundal C, Ekholm S, Nordborg C, Jönsson L, Börjesson-Hanson A, Lindén T, Zetterberg H, Viitanen M, Andersen O. Update of the original HDLS kindred: divergent clinical courses. Acta Neurol Scand 2012; 126:67-75. [PMID: 22098561 DOI: 10.1111/j.1600-0404.2011.01624.x] [Citation(s) in RCA: 7] [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: 11/30/2022]
Abstract
BACKGROUND Hereditary diffuse leukoencephalopathy with spheroids (HDLS) was first identified among a Swedish kindred with 17 cases. The average age of onset was 36 years. Autopsy in four cases revealed the presence of axonal spheroids. The causative gene is unknown. METHODS We performed genealogical and longitudinal observations of the original kindred. Forty members were examined, five telephone-interviewed, and one of the original HDLS cases from 1984 was neuropathologically examined. The clinical course was documented. The cerebrospinal fluid (CSF) findings of two recently affected cases were examined, and one of those autopsied. RESULTS Of those examined, two developed HDLS during our survey and 38 were healthy. Those interviewed by telephone were healthy. One had symptoms suggestive of HDLS in 1984, but autopsy during our survey showed no spheroids. This patient, two relatives healthy at our examination and one without symptoms at telephone interview had HDLS diagnoses in the 1984 report. Thus, four HDLS diagnoses were unconfirmed. The number of identified patients amounts to 15 among 75 individuals in four generations, including two recent cases who demonstrated a subacute multisystem encephalopathy in Case 1 and an insidious course in Case 2. CSF showed signs of neurodegeneration without inflammation, and autopsy verified HDLS in Case 1. CONCLUSIONS Some HDLS cases were misdiagnosed with unspecified psychiatric diagnoses in affected relatives from the original 1984 publication. However, HDLS is an encephalopathy dominated by a frontal lobe syndrome with an inexorably progressive and fatal course, where the different symptomatology in two recent cases confirmed the existence of acute and chronic variants.
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Affiliation(s)
- C Sundal
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Skoog B, Runmarker B, Oden A, Andersen O. Multiple Sclerosis: A Method To Identify High Risk for Secondary Progression (P05.089). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p05.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Andersen O, Borjesson-Hanson A, Linden T, Zetterberg H, Nordborg C, Roeber S, Sundal C. Update of the Original HDLS Kindred: Divergent Clinical Courses (P05.032). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Haugaard SB, Andersen O, Hansen TW, Eugen-Olsen J, Linneberg A, Madsbad S, Olsen MH, Jørgensen T, Borch-Johnsen K, Jeppesen J. The immune marker soluble urokinase plasminogen activator receptor is associated with new-onset diabetes in non-smoking women and men. Diabet Med 2012; 29:479-87. [PMID: 22050462 DOI: 10.1111/j.1464-5491.2011.03513.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM To explore the putative association of new-onset diabetes and the soluble urokinase plasminogen activator receptor (suPAR), which is a new and stable plasma marker of immune function and low-grade inflammation. This association has been previously suggested by using the less sensitive International Classification of Disease system to detect incident diabetes in the Danish MONICA 10 cohort. METHODS The Danish National Diabetes Register enabled more accurate identification of incident diabetes during a median follow-up of 13.8 years in the Danish MONICA 10 cohort (n = 2353 generally healthy individuals). The soluble urokinase plasminogen activator receptor was measured by the ELISA method. To fulfil model assumptions, outcome analyses were stratified by age, and further by smoking, owing to the interaction between the soluble urokinase plasminogen activator receptor and smoking on new-onset diabetes (P < 0.0001). RESULTS New-onset diabetes (n = 182) was associated with increased soluble urokinase plasminogen activator receptor levels (P = 0.013). Among 699 middle-aged (41 and 51 years) and 564 older (61 and 71 years) non-smokers, participants in the upper soluble urokinase plasminogen activator receptor quartile had a sex- and age-adjusted relative risk of 6.01 (95% CI 2.17-16.6, P < 0.0006) and relative risk of 3.25 (95% CI 1.51-6.98, P = 0.0025), respectively, for new-onset diabetes compared with participants in the lowest quartile. This relationship remained significant after additional adjustments for C-reactive protein and leukocytes or fasting glucose and insulin or BMI (P < 0.05). The soluble urokinase plasminogen activator receptor was not related to incident diabetes among smokers (P ≥ 0.85). CONCLUSIONS In these explorative analyses, the soluble urokinase plasminogen activator receptor associated independently with incident diabetes in non-smokers, supporting an immune origin of Type 2 diabetes. Competing disease risk may explain lack of association among smokers.
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Affiliation(s)
- S B Haugaard
- Clinical Research Centre, Copenhagen University, Denmark.
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Abstract
OBJECTIVES Patients with multiple sclerosis were reported to harbour antibodies not only against proteins and glycoproteins but also against glycolipids, including sulfatide and galactosylceramide (GalCer), the two major glycosphingolipids of myelin. However, previous results were inconsistent concerning glycosphingolipid levels, antibody type, dominance of serum or Cerebrospinal fluid compartments and relationship to the multiple sclerosis (MS) course. RESULTS We hereby report that the cerebrospinal fluid levels of sulfatide were increased in patients with MS (n = 46) compared with controls (n = 50, P < 0.001). In addition, patients had higher serum IgM anti-glycosphingolipid titres than controls (P = 0.03 for sulfatide, <0.001 for GalCer), while the anti-glycosphingolipid IgM antibodies in the cerebrospinal fluid were essentially normal. However, in seven of 46 patients cerebrospinal fluid IgG antibodies against GalCer (P = 0.004) could be detected, which was not found in any of the control individuals, and this finding might mirror the occurrence of more specific B-cell clones behind the blood-brain barrier. CONCLUSIONS The IgM immunoreactivity in serum did not show any relationship to the type of course or severity of MS, arguing against a phenomenon secondary to myelin damage. Thus, the IgM antibody findings are compatible with an early antigen challenge or autoimmunity associated with natural antibodies.
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Affiliation(s)
- S Haghighi
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden
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Sundal C, Ekholm S, Andersen O. Adult-onset leukoencephalopathies. Acta Neurol Scand 2011. [DOI: 10.1111/j.1600-0404.2010.01439.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Andersen O. Reply: Reply to Oluf Anderson's Reply: Predicting a window of therapeutic opportunity in multiple sclerosis. Brain 2011. [DOI: 10.1093/brain/awq339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sehestedt T, Lyngbæk S, Eugen-Olsen J, Jeppesen J, Andersen O, Hansen TW, Linneberg A, Jørgensen T, Haugaard SB, Olsen MH. Soluble urokinase plasminogen activator receptor is associated with subclinical organ damage and cardiovascular events. Atherosclerosis 2011; 216:237-43. [PMID: 21354571 DOI: 10.1016/j.atherosclerosis.2011.01.049] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [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] [Received: 10/01/2010] [Revised: 01/27/2011] [Accepted: 01/27/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The soluble urokinase plasminogen activator receptor (suPAR) is a plasma marker of low grade inflammation and has been associated with cardiovascular risk. We wanted to investigate whether suPAR was associated with markers of subclinical organ damage. METHODS In a population sample of 2038 individuals, aged 41, 51, 61 and 71 years, without diabetes, prior stroke or myocardial infarction, not receiving any cardiovascular, anti-diabetic or lipid-lowering medications, we measured urine albumin/creatinine ratio (UACR), carotid atherosclerotic plaques and carotid/femoral pulse wave-velocity (PWV) together with traditional cardiovascular risk factors and high sensitivity C-reactive protein (hsCRP). RESULTS suPAR was significantly associated with the presence of plaques (P = 0.003) and UACR (P < 0.001), but not PWV (P = 0.17) when adjusting for age, gender, systolic blood pressure, cholesterol, plasma glucose, waist/hip ratio, smoking and hsCRP. However, suPAR explained only a small part of the variation in the markers of subclinical organ damage (R(2) 0.02-0.04). During a median follow-up of 12.7 years (5th-95th percentile 5.1-13.4 years) a total of 174 composite endpoints (CEP) of cardiovascular death, non-fatal myocardial infarction and stroke occurred. suPAR was associated with CEP independent of plaques, PWV, UACR, and hsCRP as well as age, gender, systolic blood pressure, cholesterol, plasma glucose, waist/hip ratio and smoking with a standardized hazard ratio of 1.16 (95% confidence interval 1.04-1.28, P = 0.006). CONCLUSION suPAR was associated with subclinical organ damage, but predicted cardiovascular events independent of subclinical organ damage, traditional risk factors and hsCRP. Further studies must investigate whether suPAR plays an independent role in the pathogenesis of cardiovascular disease.
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Affiliation(s)
- T Sehestedt
- Cardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital, Nordre Ringvej 57, 2600 Glostrup, Denmark.
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Eugen-Olsen J, Andersen O, Linneberg A, Ladelund S, Hansen TW, Langkilde A, Petersen J, Pielak T, Møller LN, Jeppesen J, Lyngbaek S, Fenger M, Olsen MH, Hildebrandt PR, Borch-Johnsen K, Jørgensen T, Haugaard SB. Circulating soluble urokinase plasminogen activator receptor predicts cancer, cardiovascular disease, diabetes and mortality in the general population. J Intern Med 2010; 268:296-308. [PMID: 20561148 DOI: 10.1111/j.1365-2796.2010.02252.x] [Citation(s) in RCA: 298] [Impact Index Per Article: 21.3] [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: 12/27/2022]
Abstract
BACKGROUND Low-grade inflammation is thought to contribute to the development of cardiovascular disease (CVD), type-2 diabetes mellitus (T2D), cancer and mortality. Biomarkers of inflammation may aid in risk prediction and enable early intervention and prevention of disease. OBJECTIVE The aim of this study was to investigate whether plasma levels of the inflammatory biomarker soluble urokinase plasminogen activator receptor (suPAR) are predictive of disease and mortality in the general population. DESIGN This was an observational prospective cohort study. Cohort participants were included from June 1993 to December 1994 and followed until the end of 2006. SETTING General adult Caucasian population. PARTICIPANTS The MONICA10 study, a population-based cohort recruited from Copenhagen, Denmark, included 2602 individuals aged 41, 51, 61 or 71 years. MEASUREMENTS Blood samples were analysed for suPAR levels using a commercially available enzyme-linked immunosorbent assay. Risk of cancer (n = 308), CVD (n = 301), T2D (n = 59) and mortality (n = 411) was assessed with a multivariate proportional hazards model using Cox regression. RESULTS Elevated baseline suPAR level was associated with an increased risk of cancer, CVD, T2D and mortality during follow-up. suPAR was more strongly associated with cancer, CVD and mortality in men than in women, and in younger compared with older individuals. suPAR remained significantly associated with the risk of negative outcome after adjustment for a number of relevant risk factors including C-reactive protein levels. LIMITATION Further validation in ethnic populations other than Caucasians is needed. CONCLUSION The stable plasma protein suPAR may be a promising biomarker because of its independent association with incident cancer, CVD, T2D and mortality in the general population.
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Affiliation(s)
- J Eugen-Olsen
- Clinical Research Centre, Copenhagen University, Hvidovre Hospital, Hvidovre, Denmark.
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Abstract
The health effects documented in recent epidemiological studies of nickel-exposed workers relate to past exposures, mostly of unknown magnitude and unknown nickel speciation. Major studies have been carried out at nickel smelters and refineries. Although each study suffers from some deficiencies, as is common in such retrospective studies, the findings in concert strongly indicate that nickel emitted from the calcining and sintering operations is a potent carcinogen resulting in nasal and pulmonary cancers. Some risk appears to be present in other refinery operations, such as Orford furnace, copper and nickel sulfate, and crushing departments, and one study has suggested a risk associated with soluble nickel compounds in the electrolysis department, although this finding has not been confirmed. Only one study demonstrated an exposure-response relationship, which, however, was not statistically significant. Other studies showed a relationship between increased exposure time and augmented cancer risk. In nickel-using industries, no excess cancer related to nickel exposures has been demonstrated beyond doubt; concurrent exposures to other potential carcinogens constitute a confounding variable that makes interpretation difficult. However, the studies have not excluded that a cancer hazard may be present outside the nickel-producing facilities. Further, case-referent studies of respiratory cancers suggest that a nickel-related etiology may well exist in the nickel-using industries. As the exact identity of the carcinogenic form or forms of nickel remains unknown, exposure to all nickel compounds should be kept as low as reasonably achievable.
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Affiliation(s)
- P Grandjean
- Department of Environmental Medicine, Odense University, Denmark
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