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Roumeliotis S, Neofytou IE, Maassen C, Lux P, Kantartzi K, Papachristou E, Schurgers LJ, Liakopoulos V. Association of Red Blood Cell Distribution Width and Neutrophil-to-Lymphocyte Ratio with Calcification and Cardiovascular Markers in Chronic Kidney Disease. Metabolites 2023; 13:metabo13020303. [PMID: 36837922 PMCID: PMC9966770 DOI: 10.3390/metabo13020303] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
We aimed to investigate the association between Red Blood Cell Distribution Width (RDW) and Neutrophil-to-Lymphocyte Ratio (NLR), simple, rapidly assessed markers from the complete blood count with vascular calcification (VC)/stiffness and cardiovascular disease (CVD) in chronic kidney disease (CKD). Dephosphorylated, uncarboxylated matrix Gla-protein (dp-ucMGP), and central/peripheral hemodynamics' parameters were measured in 158 CKD patients, including Hemodialysis and Peritoneal Dialysis. Spearman's rho analysis showed that RDW correlated with C-reactive protein (CRP) (r = 0.29, p < 0.001), dp-ucMGP (r = 0.43, p = < 0.0001), central diastolic blood pressure (DBP) (r = -0.19, p = 0.02), and albuminuria (r = -0.17, p = 0.03). NLR correlated with the duration of CVD (r = 0.32, p < 0.001), CRP (r = 0.27, p = 0.01), dp-ucMGP (r = 0.43, p < 0.0001), central DBP (r = -0.32, p < 0.0001) and eGFR (r = -0.25, p = 0.04). In multiple regression models, circulating dp-ucMGP was an independent predictor of RDW (β = 0.001, p = 0.001) and NLR (β = 0.002, p = 0.002). In CKD patients, RDW and NLR are associated with traditional and novel markers of VC and CVD.
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Affiliation(s)
- Stefanos Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
- Correspondence: ; Tel./Fax: +30-2310994694
| | - Ioannis E. Neofytou
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Cecile Maassen
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands
| | - Petra Lux
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands
| | - Konstantia Kantartzi
- Department of Nephrology, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Evangelos Papachristou
- Department of Nephrology and Renal Transplantation, Patras University Hospital, 26504 Patras, Greece
| | - Leon J. Schurgers
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands
| | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
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Clarke P, Shearer MJ, Card DJ, Nichols A, Ponnusamy V, Mahaveer A, Voong K, Dockery K, Holland N, Mulla S, Hall LJ, Maassen C, Lux P, Schurgers LJ, Harrington DJ. Exclusively breastmilk-fed preterm infants are at high risk of developing subclinical vitamin K deficiency despite intramuscular prophylaxis at birth. J Thromb Haemost 2022; 20:2773-2785. [PMID: 36087073 PMCID: PMC9828794 DOI: 10.1111/jth.15874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 07/25/2022] [Accepted: 08/25/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND There is near-global consensus that all newborns be given parenteral vitamin K1 (VK1 ) at birth as prophylaxis against VK deficiency bleeding (VKDB). Breastmilk has a low VK content and cases of late VKDB are reported in exclusively breastmilk-fed preterm infants despite VK prophylaxis at birth. OBJECTIVES To assess the prevalence of functional VK insufficiency in preterm infants based on elevated under-γ-carboxylated (Glu) species of Gla proteins, factor II (PIVKA-II), and osteocalcin (GluOC), synthesized by liver and bone, respectively. PATIENTS/METHODS Prospective, multicenter, observational study in preterm infants born <33 weeks' gestation. Blood samples and dietary history were collected before hospital discharge, and after discharge at 2-3 months' corrected age. Outcome measures were serum VK1 , PIVKA-II, and %GluOC (GluOC as a percentage of the sum of GluOC plus GlaOC) compared between exclusively breastmilk-fed and formula/mixed-fed infants after discharge. RESULTS After discharge, breastmilk-fed babies had significantly lower serum VK1 (0.15 vs. 1.81 μg/L), higher PIVKA-II (0.10 vs. 0.02 AU/ml) and higher %GluOC (63.6% vs. 8.1%) than those receiving a formula/mixed-feed diet. Pre-discharge (based on elevated PIVKA-II), only one (2%) of 45 breastmilk-fed infants was VK insufficient. After discharge, eight (67%) of 12 exclusively breastmilk-fed babies were VK insufficient versus only one (4%) of 25 formula/mixed-fed babies. CONCLUSIONS Preterm infants who remain exclusively or predominantly human breastmilk-fed after neonatal unit discharge are at high risk of developing subclinical VK deficiency in early infancy. Routine postdischarge VK1 supplementation of breastfed infants to provide intakes comparable to those from formula milks should prevent this deficiency.
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Affiliation(s)
- Paul Clarke
- Neonatal Intensive Care UnitNorfolk and Norwich University Hospitals NHS Foundation TrustNorwichUK
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | - Martin J. Shearer
- Centre for Haemostasis and ThrombosisGuy's and St Thomas's NHS Foundation TrustLondonUK
| | - David J. Card
- Nutristasis Unit, Viapath, Guy's and St Thomas's NHS Foundation TrustLondonUK
| | - Amy Nichols
- Neonatal Intensive Care UnitNorfolk and Norwich University Hospitals NHS Foundation TrustNorwichUK
| | - Vennila Ponnusamy
- Neonatal Intensive Care UnitAshford and St Peter's Hospitals NHS Foundation TrustChertseyUK
| | - Ajit Mahaveer
- Neonatal Intensive Care Unit, St Mary's HospitalManchester University NHS Foundation TrustManchesterUK
| | - Kieran Voong
- Centre for Haemostasis and ThrombosisGuy's and St Thomas's NHS Foundation TrustLondonUK
| | - Karen Dockery
- Neonatal Intensive Care Unit, St Mary's HospitalManchester University NHS Foundation TrustManchesterUK
| | - Nicky Holland
- Neonatal Intensive Care UnitAshford and St Peter's Hospitals NHS Foundation TrustChertseyUK
| | - Shaveta Mulla
- Neonatal Intensive Care UnitNorfolk and Norwich University Hospitals NHS Foundation TrustNorwichUK
| | - Lindsay J. Hall
- Gut Microbes & HealthQuadram Institute BioscienceNorwichUK
- ZIEL – Institute for Food & HealthTechnical University of MunichFreisingGermany
| | - Cecile Maassen
- Department of BiochemistryCardiovascular Research Institute MaastrichtMaastricht UniversityMaastrichtThe Netherlands
| | - Petra Lux
- Department of BiochemistryCardiovascular Research Institute MaastrichtMaastricht UniversityMaastrichtThe Netherlands
| | - Leon J. Schurgers
- Department of BiochemistryCardiovascular Research Institute MaastrichtMaastricht UniversityMaastrichtThe Netherlands
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Dofferhoff ASM, Piscaer I, Schurgers LJ, Visser MPJ, van den Ouweland JMW, de Jong PA, Gosens R, Hackeng TM, van Daal H, Lux P, Maassen C, Karssemeijer EGA, Vermeer C, Wouters EFM, Kistemaker LEM, Walk J, Janssen R. Reduced vitamin K status as a potentially modifiable risk factor of severe COVID-19. Clin Infect Dis 2020; 73:e4039-e4046. [PMID: 32852539 PMCID: PMC7499546 DOI: 10.1093/cid/ciaa1258] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/25/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Respiratory failure and thromboembolism are frequent in SARS-CoV-2-infected patients. Vitamin K activates both hepatic coagulation factors and extrahepatic endothelial anticoagulant protein S, required for thrombosis prevention. In times of vitamin K insufficiency, hepatic procoagulant factors are preferentially activated over extrahepatic proteins. Vitamin K also activates matrix Gla protein (MGP), which protects against pulmonary and vascular elastic fiber damage. We hypothesized that vitamin K may be implicated in coronavirus disease 2019 (COVID-19), linking pulmonary and thromboembolic disease. METHODS 135 hospitalized COVID-19 patients were compared with 184 historical controls. Poor outcome was defined as invasive ventilation and/or death. Inactive vitamin K-dependent MGP (dp-ucMGP) and prothrombin (PIVKA-II) were measured, inversely related to extrahepatic and hepatic vitamin K status, respectively. Desmosine was measured to quantify the rate of elastic fiber degradation. Arterial calcification severity was assessed by computed tomography. RESULTS Dp-ucMGP was elevated in COVID-19 patients compared to controls (p<0.001), with even higher dp-ucMGP in patients with poor outcomes (p<0.001). PIVKA-II was normal in 82.1% of patients. Dp-ucMGP was correlated with desmosine (p<0.001), and coronary artery (p=0.002) and thoracic aortic (p<0.001) calcification scores. CONCLUSIONS Dp-ucMGP was severely increased in COVID-19 patients, indicating extrahepatic vitamin K insufficiency, which was related to poor outcome while hepatic procoagulant factor II remained unaffected. These data suggest a mechanism of pneumonia-induced extrahepatic vitamin K depletion leading to accelerated elastic fiber damage and thrombosis in severe COVID-19 due to impaired activation of MGP and endothelial protein S, respectively. A clinical trial could assess whether vitamin K administration improves COVID-19 outcomes.
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Affiliation(s)
- Anton S M Dofferhoff
- Department of Internal Medicine, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Ianthe Piscaer
- Department of Respiratory Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Leon J Schurgers
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Margot P J Visser
- Department of Pulmonary Medicine, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht and Utrecht University, The Netherlands
| | - Reinoud Gosens
- Department of Molecular Pharmacology, University of Groningen, Groningen, The Netherlands
| | - Tilman M Hackeng
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Henny van Daal
- Department of Clinical Chemistry, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Petra Lux
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Cecile Maassen
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | | | - Cees Vermeer
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Emiel F M Wouters
- Department of Respiratory Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.,Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | | | - Jona Walk
- Department of Internal Medicine, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Rob Janssen
- Department of Pulmonary Medicine, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
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Gerhardy HJ, Weber R, Lux P, Klein RM, Winter J. [Autopneumonectomie. A Forgotten Disease]. Pneumologie 2020; 74:371-373. [PMID: 32557508 DOI: 10.1055/a-1148-8770] [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: 10/24/2022]
Abstract
HISTORY An 80-year old female was referred to our hospital with left internal carotid artery stenosis and a childhood history of hemoptysis. INVESTIGATIONS AND DIAGNOSIS The ECG showed 2nd degree Mobitz atrio-ventricular block. The chest x-ray and computerized tomography identified a shift of the mediastinum and the heart to the left. The left lung was completely destroyed whilst the right lung was enlarged and crossed the midline. Pulmonary function tests revealed a moderate restrictive ventilation disorder. The diagnosis of autopneumonectomy was based on patient history together with radiological findings. TREATMENT AND COURSE A pacemaker was implanted with two stimulation electrodes via a left cephalic venous cutdown. A carotid endarterectomy was also performed without any complication. CONCLUSION After autopneumonectomy, postpneumonectomy like syndrome may occur in very rare cases, whereupon operative treatment is mandatory. Any respiratory infections should be treated with antibiotics. Pacemaker electrode placement via the subclavian vein is contraindicated due to the risk of a catastrophic pneumothorax.
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Affiliation(s)
- H J Gerhardy
- Abteilung für Kardiologie, Rhythmologie und konservative Intensivmedizin, Augusta-Krankenhaus Düsseldorf, Akademisches Lehrkrankenhaus der Heinrich-Heine-Universität Düsseldorf
| | - R Weber
- Abteilung für Kardiologie, Rhythmologie und konservative Intensivmedizin, Augusta-Krankenhaus Düsseldorf, Akademisches Lehrkrankenhaus der Heinrich-Heine-Universität Düsseldorf
| | - P Lux
- Röntgeninstitut Düsseldorf
| | - R M Klein
- Abteilung für Kardiologie, Rhythmologie und konservative Intensivmedizin, Augusta-Krankenhaus Düsseldorf, Akademisches Lehrkrankenhaus der Heinrich-Heine-Universität Düsseldorf.,Lehrstuhl: Universität Witten/Herdecke
| | - J Winter
- Abteilung für Kardiologie, Rhythmologie und konservative Intensivmedizin, Augusta-Krankenhaus Düsseldorf, Akademisches Lehrkrankenhaus der Heinrich-Heine-Universität Düsseldorf
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Eersels K, Diliën H, Lowdon JW, Steen Redeker E, Rogosic R, Heidt B, Peeters M, Cornelis P, Lux P, Reutelingsperger CP, Schurgers LJ, Cleij TJ, van Grinsven B. A Novel Biomimetic Tool for Assessing Vitamin K Status Based on Molecularly Imprinted Polymers. Nutrients 2018; 10:E751. [PMID: 29891757 PMCID: PMC6024727 DOI: 10.3390/nu10060751] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 04/24/2018] [Accepted: 06/08/2018] [Indexed: 11/18/2022] Open
Abstract
Vitamin K was originally discovered as a cofactor required to activate clotting factors and has recently been shown to play a key role in the regulation of soft tissue calcification. This property of vitamin K has led to an increased interest in novel methods for accurate vitamin K detection. Molecularly Imprinted Polymers (MIPs) could offer a solution, as they have been used as synthetic receptors in a large variety of biomimetic sensors for the detection of similar molecules over the past few decades, because of their robust nature and remarkable selectivity. In this article, the authors introduce a novel imprinting approach to create a MIP that is able to selectively rebind vitamin K₁. As the native structure of the vitamin does not allow for imprinting, an alternative imprinting strategy was developed, using the synthetic compound menadione (vitamin K₃) as a template. Target rebinding was analyzed by means of UV-visible (UV-VIS) spectroscopy and two custom-made thermal readout techniques. This analysis reveals that the MIP-based sensor reacts to an increasing concentration of both menadione and vitamin K₁. The Limit of Detection (LoD) for both compounds was established at 700 nM for the Heat Transfer Method (HTM), while the optimized readout approach, Thermal Wave Transport Analysis (TWTA), displayed an increased sensitivity with a LoD of 200 nM. The sensor seems to react to a lesser extent to Vitamin E, the analogue under study. To further demonstrate its potential application in biochemical research, the sensor was used to measure the absorption of vitamin K in blood serum after taking vitamin K supplements. By employing a gradual enrichment strategy, the sensor was able to detect the difference between baseline and peak absorption samples and was able to quantify the vitamin K concentration in good agreement with a validation experiment using High-Performance Liquid Chromatography (HPLC). In this way, the authors provide a first proof of principle for a low-cost, straightforward, and label-free vitamin K sensor.
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Affiliation(s)
- Kasper Eersels
- Maastricht Science Programme, Faculty of Science and Engineering, Maastricht University P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Hanne Diliën
- Maastricht Science Programme, Faculty of Science and Engineering, Maastricht University P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Joseph W Lowdon
- Maastricht Science Programme, Faculty of Science and Engineering, Maastricht University P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Erik Steen Redeker
- Maastricht Science Programme, Faculty of Science and Engineering, Maastricht University P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Renato Rogosic
- Maastricht Science Programme, Faculty of Science and Engineering, Maastricht University P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Benjamin Heidt
- Maastricht Science Programme, Faculty of Science and Engineering, Maastricht University P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Marloes Peeters
- Division of Chemistry and Environmental Science, School of Science and the Environment, Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, Manchester M1 5GD, UK.
| | - Peter Cornelis
- Soft-Matter Physics and Biophysics Section, Department of Physics and Astronomy, KU Leuven, Celestijnenlaan 200 D, B-3001 Leuven, Belgium.
| | - Petra Lux
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, 6200 MD Maastricht, The Netherlands.
| | - Chris P Reutelingsperger
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, 6200 MD Maastricht, The Netherlands.
| | - Leon J Schurgers
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, 6200 MD Maastricht, The Netherlands.
| | - Thomas J Cleij
- Maastricht Science Programme, Faculty of Science and Engineering, Maastricht University P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Bart van Grinsven
- Maastricht Science Programme, Faculty of Science and Engineering, Maastricht University P.O. Box 616, 6200 MD Maastricht, The Netherlands.
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Geiger H, Klepper J, Lux P, Heidland A. Biochemical Assessment and Clinical Evaluation of a Bilirubin Adsorbent Column (Br-350) in Critically ILL Patients with Intractable Jaundice. Int J Artif Organs 2018. [DOI: 10.1177/039139889201500107] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We investigated the efficacy of an anion-exchange adsorbent column (ASAHI BR-350, DIAMED) for removal of bilirubin and bile acids in five patients with intractable jaundice of various origin. Four litres of plasma were separated by membrane plasma separation (Plasmaflow OP-05) at a rate of 22.5 ml/min. The plasma was then perfused through an anion exchange adsorbent and returned to the venous blood line of the plasma separator. In some of the patients this procedure was combined with regular hemodialysis treatment. The concentration of total bilirubin was cut by 31 to 60%; total bile acids were reduced by 20 to 74%. Three patients recovered and had a favourable outcome. Two patients died despite the bilirubin adsorption treatment. The effects of the adsorbent column on specific blood parameters, including the coagulation system, were measured. Our data suggest that bilirubin adsorption should be examined further as a treatment for critically ill patients with intractable jaundice.
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Affiliation(s)
- H. Geiger
- IV Medical Clinic, University of Erlangen-Nürnberg, Erlangen
| | - J. Klepper
- Department of Nephrology, University of Würzburg, Würzburg - Germany
| | - P. Lux
- Department of Nephrology, University of Würzburg, Würzburg - Germany
| | - A. Heidland
- Department of Nephrology, University of Würzburg, Würzburg - Germany
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Neradova A, Schumacher SP, Hubeek I, Lux P, Schurgers LJ, Vervloet MG. Phosphate binders affect vitamin K concentration by undesired binding, an in vitro study. BMC Nephrol 2017; 18:149. [PMID: 28464802 PMCID: PMC5414218 DOI: 10.1186/s12882-017-0560-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [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: 07/26/2016] [Accepted: 04/19/2017] [Indexed: 12/02/2022] Open
Abstract
Background Vascular calcification is a major contributing factor to mortality in end stage renal disease (ESRD). Despite the efficacy of phosphate binders to improve hyperphosphatemia, data on vascular calcification are less clear. There seems to be a difference in attenuation or delay in progression between different binders. In this in vitro experiment we tested whether phosphate binders could limit bioavailability of vitamin K2 by undesired binding. Vitamin K-deficiency limits activation of the vascular tissue mineralization inhibitor matrix γ-carboxyglutamate (Gla) protein (MGP) thereby exacerbating vascular calcification. Methods In this experiment vitamin K2 (menaquinone-7; MK-7) binding was assessed by adding 1 mg of vitamin K2 to a medium with pH 6 containing 67 mg phosphate binder with either 7 mg of phosphate or no phosphate. Five different phosphate binders were tested. After five and a half hours vitamin K was analyzed by HPLC. All experiments were performed in triplicate. Results Sucroferric-oxyhydroxide and sevelamer carbonate did not significantly bind vitamin K2, both in solution only containing vitamin K2 or in combination with phosphate. Calcium acetate/magnesium carbonate binds vitamin K2 strongly both in absence (p = 0.001) and presence of phosphate (p = 0.003). Lanthanum carbonate significantly binds vitamin K2 in solution containing only vitamin K2 (p = 0.005) whereas no significant binding of vitamin K2 was observed in the solution containing vitamin K2 and phosphate (p = 0.462). Calcium carbonate binds vitamin K2 significantly in a solution with vitamin K2 and phosphate (p = 0.009) whereas without phosphate no significant binding of vitamin K2 was observed (p = 0.123). Conclusions Sucroferric-oxyhydroxide and sevelamer carbonate were the only binders of the five binders studied that did not bind vitamin K2 in vitro. The presence or absence of phosphate significantly interferes with vitamin K2 binding so phosphate binders could potentially limit bioavailability vitamin K2.
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Affiliation(s)
- A Neradova
- Department of Nephrology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - S P Schumacher
- Department of cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - I Hubeek
- Clinical chemistry laboratory, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - P Lux
- Department of Biochemistry, Cardiovascular Research institute Maastricht, University Maastricht, Maastricht, The Netherlands
| | - L J Schurgers
- Department of Biochemistry, Cardiovascular Research institute Maastricht, University Maastricht, Maastricht, The Netherlands
| | - M G Vervloet
- Department of Nephrology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. .,Institute for Cardiovascular Research VU, ICaR-VU, Amsterdam, The Netherlands.
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9
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Abstract
The current S3 guidelines on the surgical treatment of colorectal cancer note that with a suitable patient selection and expertise of the surgeon the same oncological results can be achieved laparoscopically as with the open procedure. This requires that the same quality requirements have to be provided for both methods. The most important quality parameters of right sided (extended) hemicolectomy are central ligation of the supplying arteries (ileocolic artery, right branch of the middle colic artery and middle colic artery) flush to the central origin of the vessel (superior mesenteric artery or middle colic artery) and the sharp dissection of the mesocolon without any preparation tears. The photographic documentation of the fresh surgical specimens for categorizing the preparation quality as well as to determine the pedicle of the vessel can capture this quality well and is also currently the best surrogate parameter to evaluate the oncological quality of the operation. At present, there are still considerable widespread deficits not only with the laparoscopic approach but also in open surgery which must be urgently fixed.
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Affiliation(s)
- P Lux
- Kinderchirurgische Abteilung, Universitätsklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland,
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Pox C, Aretz S, Bischoff SC, Graeven U, Hass M, Heußner P, Hohenberger W, Holstege A, Hübner J, Kolligs F, Kreis M, Lux P, Ockenga J, Porschen R, Post S, Rahner N, Reinacher-Schick A, Riemann JF, Sauer R, Sieg A, Scheppach W, Schmitt W, Schmoll HJ, Schulmann K, Tannapfel A, Schmiegel W. [S3-guideline colorectal cancer version 1.0]. Z Gastroenterol 2013; 51:753-854. [PMID: 23955142 DOI: 10.1055/s-0033-1350264] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- C Pox
- Medizinische Klinik, Knappschaftskrankenhaus GmbH Bochum, Ruhr-Universität Bochum, Bochum
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Vogl TJ, Schmiegel W, Pox C, Pereira PL, Brambs HJ, Lux P, Fischer S. [S3 guideline--Diagnosis and treatment of colorectal carcinoma: relevance for radiologic imaging and interventions]. ROFO-FORTSCHR RONTG 2013; 185:699-708. [PMID: 23804154 DOI: 10.1055/s-0033-1335818] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The new German S3 guideline "Colorectal Carcinoma" was created as part of the German Guideline Program in Oncology of the Association of the Scientific Medical Societies in Germany, the German Cancer Society and the German Cancer Aid under the auspices of the German Society for Digestive and Metabolic Diseases and replaces the guideline from 2008. With its evidence-based treatment recommendations, the guideline contains numerous updates and detailed definitions regarding the diagnosis and treatment of colon and rectal cancer. In particular, consensus-based recommendations regarding early detection, preoperative diagnostic method selection, and the use of interventional radiological treatment methods are detailed. The guideline also includes quality indicators so that standardized quality assurance methods can be used to optimize patient-related processes.The present article discusses the significance of the current recommendations for radiological diagnosis and treatment and is intended to enhance the quality of patient information and care by increasing distribution.
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Affiliation(s)
- T J Vogl
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt.
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Weber K, Göhl J, Lux P, Merkel S, Hohenberger W. [Principles and technique of lymph node dissection in colorectal carcinoma]. Chirurg 2012; 83:487-98; quiz 499-500. [PMID: 22573253 DOI: 10.1007/s00104-011-2238-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Colorectal carcinoma is a common malignant tumor which shows a standard behavior for lymphogenic metastasis. Depending on the localization of the primary tumor the corresponding lymphatic area also has to be removed because lymph node metastases can already be present by every tumor even if there is no obvious intraoperative evidence. Lymphatic drainage is essentially oriented to the supplying arteries of the corresponding intestinal segment. The anatomy of arterial supply is individually variable and often deviates from the usual textbook presentation. In this review the oncological requirements of an adequate lymph node dissection in colorectal carcinoma are described with emphasis on the technical aspects to obtain an optimal specimen.
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Affiliation(s)
- K Weber
- Chirurgische Klinik, Universitätsklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland
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Affiliation(s)
- P. Lux
- a Philips GmbH Forschungslaboratorium Hamburg, 2000 Hamburg 54, BRD
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Kröpil P, Lanzman RS, Lux P, Winter J, Blondin D, Miese FR, Mödder U, Scherer A, Fürst G. Interdisziplinäre Bergung von Schrittmachersonden und Rekanalisation okkludierter Venen – der Radiologe im kardiochirurgischen Operationssaal. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0029-1248001] [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: 10/20/2022]
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Abstract
AIM The efficacy of sacral nerve stimulation (SNS) to treat faecal incontinence has been demonstrated in the short- and mid-term. We analysed SNS outcome in the first patients with a permanent neurostimulator in whom follow-up ranges up to 14 years. METHOD Of 12 patients who underwent SNS from 1994 to 1999, 9 were eligible for long-term analysis (defined as a minimum of 7 years). In 3 the device had to be removed because of pain or neurological disease. Functional outcome was monitored prospectively by standardized questionnaire. For efficacy, the recorded frequency of incontinent episodes over 2-week periods and the Wexner Score were obtained yearly after implant. Quality of life measures (FIQL scale [QoL]) were introduced in 1998. Stimulation parameter adjustments, battery longevity, and complications were documented. RESULTS Mean follow-up in the nine patients was 9.8 years (range 7-14), over which time efficacy persisted. Clinical improvement was significant (baseline vs last follow-up): median percentage of incontinent bowel movements/week 40% (range 9-100) vs 0% (0-60%; P = 0.008), median number of incontinent episodes/week, 9 (range 2-58) vs 0 (0-29; P = 0.012); median Cleveland Clinic Score, 17 (range 12-19) vs 10 (3-14; P < 0.007); QoL improved in all categories. Pulse generator exchange was required in eight of the nine patients after a mean of 7.4 years for battery fatigue (mean 2.1 V). Complications occurred in five of the original 12 and were therapy-related, but not technique-related, in four patients. CONCLUSION Sacral nerve stimulation is an effective and safe long-term treatment for faecal incontinence. Clinical outcome is stable over time.
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Affiliation(s)
- K E Matzel
- Chirurgische Klinik der Universität Erlangen, Erlangen, Germany.
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Schellhammer F, Heinen W, Lux P, Mödder U. Interventionelle Therapie – stripping – von Fibrinscheiden zentralvenöser Katheter. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221770] [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: 10/20/2022]
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van Genderen H, Kenis H, Lux P, Ungeth L, Maassen C, Deckers N, Narula J, Hofstra L, Reutelingsperger C. In vitro measurement of cell death with the annexin A5 affinity assay. Nat Protoc 2007; 1:363-7. [PMID: 17406257 DOI: 10.1038/nprot.2006.55] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [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: 11/09/2022]
Abstract
One of the hallmarks of cell death is the cell surface-expression of phosphatidylserine. Expression of phosphatidylserine at the cell surface can be measured in vitro with the phosphatidylserine-binding protein annexin A5 conjugated to fluorochromes. This measurement can be made by flow cytometry or by confocal scanning-laser microscopy. The annexin A5 affinity assay comprises the incubation of cells stimulated to execute cell death with fluorescence-labeled annexin A5 and propidium iodide. Living cells are annexin A5-negative and propidium iodide negative, cells in the early phases of cell death are annexin A5 positive-and propidium iodide-negative, and secondary necrotic cells are annexin A5-positive and propidium iodide-positive. The entire procedure takes about 30 minutes for flow cytometry and 45 minutes for confocal scanning-laser microscopy. Various precautions and considerations are discussed further in the protocol described here.
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Affiliation(s)
- Hugo van Genderen
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, University of Maastricht, PO Box 616, 6200 MD, Maastricht, The Netherlands
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Hammer F, Subtil S, Sanning P, Filko D, Lux P, Allolio B, Arlt W. Lack of hepatic conversion of dehydroepiandrosterone sulfate (DHEAS) to DHEA. Endocr Res 2004; 30:759-60. [PMID: 15666822 DOI: 10.1081/erc-200044027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- F Hammer
- Department of Medicine, University of Würzburg, Würzburg, Germany
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Hammer F, Subtil S, Lux P, Filko D, Sanning P, Allolio B, Arlt W. No evidence for hepatic conversion of dehydroepiandrosterone sulfate (DHEAS) to DHEA – in vivo and in vitro studies. Exp Clin Endocrinol Diabetes 2004. [DOI: 10.1055/s-2004-819094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Van Heerde WL, Reutelingsperger CPM, Maassen C, Lux P, Derksen RHWM, De Groot PG. The presence of antiphospholipid antibodies is not related to increased levels of annexin A5 in plasma. J Thromb Haemost 2003; 1:532-6. [PMID: 12871462 DOI: 10.1046/j.1538-7836.2003.00106.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Annexin A5 has been proposed to be important for shielding of negatively charged phospholipids from blood, thereby preventing the binding of clotting factors. It has been suggested that antiphospholipid antibodies can disrupt the binding of annexin A5 from negatively phospholipid-containing surfaces, resulting in uncontrolled coagulation. If this hypothesis is correct, than the plasma levels of annexin A5 will be increased in patients with antiphospholipid antibodies. Therefore, we have measured plasma levels of annexin A5 of 175 patients with systemic lupus erythematosus (SLE), of which 104 had antiphospholipid antibodies and 23 patients had primary antiphospholipid syndrome. The annexin A5 levels were compared with the annexin A5 plasma levels measured in 23 patients with diabetes mellitus type 2 and 35 healthy volunteers. We found a significant increase of annexin A5 plasma levels in patients with SLE (median 6.7 ng mL(-1)) and primary antiphospholipid syndrome (median 7.1 ng mL(-1)) as compared to patients with diabetes mellitus type 2 (median 3.3 ng mL(-1)) and healthy volunteers (median 3.9 ng mL(-1)). However, no correlation was found with the presence of antiphospholipid antibodies or with a history of thromboembolic complications. Based on these observations, we conclude that displacement of annexin A5 from cellular surfaces by antiphospholipid antibodies is not a common mechanism in patients with antiphospholipid antibodies.
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Affiliation(s)
- W L Van Heerde
- Central Hematology Laboratory, University Medical Center St. Radboud Nijmegen, Nijmegen, The Netherlands.
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Geiger H, Klepper J, Lux P, Heidland A. Biochemical assessment and clinical evaluation of a bilirubin adsorbent column (BR-350) in critically ill patients with intractable jaundice. Int J Artif Organs 1992; 15:35-9. [PMID: 1551726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We investigated the efficacy of an anion-exchange adsorbent column (ASAHI BR-350, DIAMED) for removal of bilirubin and bile acids in five patients with intractable jaundice of various origin. Four litres of plasma were separated by membrane plasma separation (Plasmaflow OP-05) at a rate of 22.5 ml/min. The plasma was then perfused through an anion exchange adsorbent and returned to the venous blood line of the plasma separation. In some of the patients this procedure was combined with regular hemodialysis treatment. The concentration of total bilirubin was cut by 31 to 60%; total bile acids were reduced by 20 to 74%. Three patients recovered and had a favourable outcome. Two patients died despite the bilirubin adsorption treatment. The effects of the adsorbent column on specific blood parameters, including the coagulation system, were measured. Our data suggest that bilirubin adsorption should be examined further as a treatment for critically ill patients with intractable jaundice.
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Affiliation(s)
- H Geiger
- IV Medical Clinic, University of Erlangen-Nürnberg, Germany
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Abstract
A series of mono- and geminal difluorinated analogues of spermidine (4-azaoctane-1,8-diamine) have been tested as potential substrates of partially purified rat hepatoma (HTC) cell or pure bovine spleen spermine synthase (EC 2.5.1.22). Substitution of the hydrogen atoms of the methylene group at position 7 by one or two fluorine atoms decreases 8-fold and 160-fold the apparent Km values for the HTC cell enzyme respectively. Similarly, the Km values of 7-monofluoro and 7,7-difluorospermidine for the pure bovine enzyme are reduced 8-fold and 100-fold respectively, in comparison with spermidine. Di-, but not monofluoro substitution, in the 6-position causes a 5-fold reduction in the affinity for the HTC cell enzyme. Gem-fluorine substitution in the 2-position abolishes substrate capability. In addition to their high affinity for spermine synthase, 7-monofluorospermidine and 7,7-difluorospermidine cause substrate inhibition. This phenomenon, which is more pronounced in the case of the difluorinated analogues is pH-dependent. These enzymatic findings are discussed with regard to the protonation sites of the spermidine analogues, determined by potentiometric titration, which vary as a function of the number and position of the fluorine substituents relative to the basic amino groups.
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Affiliation(s)
- J G Baillon
- Merrell Dow Research Institute, Strasbourg, France
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Lux P, Breidenbach W, Firrell J. Determination of temporal changes in blood flow in vascularized and nonvascularized nerve grafts in the dog. Plast Reconstr Surg 1988; 82:133-44. [PMID: 3380903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The time course of revascularization of nonvascularized and vascularized nerve grafts was followed histologically and quantitatively using microspheres in the saphenous nerve of dogs. Nonvascularized and vascularized nerve grafts were created in opposite hindlimbs of each dog. The intravascular presence of India ink was not observed until the third day postoperatively in the nonvascularized grafts, while it was demonstrated in vascularized grafts on the first postoperative day. Control blood flow in undisturbed nerves ranged from 0.06 to 0.16 ml/min/gm dry weight. On postoperative day 1, flow was not detectable in any of the nonvascularized grafts, while vascularized grafts all had increased flow with a mean of 0.73 ml/min/gm dry weight. By day 3, two of six dogs had some measurable flow in the nonvascularized grafts, while flow in vascularized grafts had reached a mean of 1.88 ml/min/gm dry weight. By day 6, blood flow rate had increased to 7.63 and 4.72 ml/min/gm dry weight for nonvascularized and vascularized grafts, respectively. By this avoidance of up to 3 days of warm ischemia, there may be some advantage to vascularized nerve grafts even in a well-vascularized bed.
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Affiliation(s)
- P Lux
- Louisville Institute for Hand and Microsurgery, Jewish Hospital, Ky
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