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Gregersen H, Sun D, Field F, Combs W, Christensen P, Mousa H, Moawad FJ, Eisenstein S, Kassab GS. Fecobionics in proctology: review and perspectives. Surg Open Dig Adv 2023; 12:100117. [PMID: 38313319 PMCID: PMC10838111 DOI: 10.1016/j.soda.2023.100117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Fecobionics is a novel integrated technology for assessment of anorectal function. It is a defecatory test with simultaneous measurements of pressures, orientation, and device angle (a proxy of the anorectal angle). Furthermore, the latest Fecobionics prototypes measure diameters (shape) using impedance planimetry during evacuation of the device. The simultaneous measurement of multiple variables in the integrated test allows new metrics to be developed including more advanced novel defecation indices, enabling mechanistic insight in the defecation process at an unprecedented level in patients with anorectal disorders including patients suffering from obstructed defecation, fecal incontinence, and low anterior resection syndrome. The device has the consistency and shape of a normal stool (type 3-4 on the Bristol Stool Form Scale). Fecobionics has been validated on the bench and in animal studies and used in clinical trials to study defecation phenotypes in normal human subjects and patients with obstructed defecation, fecal incontinence, and low anterior resection syndrome after rectal cancer surgery. Subtypes have been defined, especially of patients with obstructed defecation. Furthermore, Fecobionics has been used to monitor biofeedback therapy in patients with fecal incontinence to predict the outcome of the therapy (responder versus non-responder). Most Fecobionics studies showed a closer correlation to symptoms as compared to current technologies for anorectal assessment. The present article outlines previous and ongoing work, and perspectives for future studies in proctology, including in physiological assessment of function, diagnostics, monitoring of therapy, and as a tool for biofeedback therapy.
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Affiliation(s)
- H Gregersen
- California Medical Innovations Institute, San Diego, California, USA
| | - D Sun
- School of Microelectronics and Communication Engineering, Chongqing University, Chongqing, China
| | - F Field
- S3DT Holdings, San Diego, California, USA
| | - W Combs
- S3DT Holdings, San Diego, California, USA
| | - P Christensen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - H Mousa
- CHOP, University of Pennsylvania, Philadelphia, Pennsylvania
| | - F J Moawad
- Scripps Clinic, Division of Gastroenterology, La Jolla, California, USA
| | - S Eisenstein
- Department of Surgery, University of California San Diego, La Jolla, California, USA
| | - G S Kassab
- California Medical Innovations Institute, San Diego, California, USA
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Qvist N, Hansen UD, Christensen P, Rijkhoff NMJ, Klarskov N, Duelund-Jakobsen J. Electrical stimulation of the dorsal clitoral nerve in the treatment of idiopathic defecatory urgency. A pilot study. Tech Coloproctol 2023; 27:459-463. [PMID: 36648602 PMCID: PMC10169878 DOI: 10.1007/s10151-023-02752-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023]
Abstract
PURPOSE To investigate the effect of dorsal clitoral nerve stimulation (DCNS) on bothersome urgency to defecate with or without fecal incontinence and the patient-reported discomfort or adverse effect with the method. METHODS For dorsal clitoral nerve stimulation, a battery powered, handheld stimulator was used, set to a pulse width of 200 µs and a frequency of 20 Hz. One electrode was placed at the preputium of the clitoris and acted as cathode while an anode electrode was placed on the belly. Prior to stimulation the patients were asked to complete a bowel habit diary throughout 14 consecutive days before and during stimulation. RESULTS Fourteen out of the 16 patients included completed the study. A decrease in the number of episodes (per day) with strong urgency declined in eight patients but increased in four cases during the stimulation period. An increase in episodes with moderate or mild urgency was observed in 11 and 6 cases, respectively, and a decrease in defecation without the feeling of urgency or passive incontinence decreased in two thirds of the patients. Two patients discontinued the study prematurely, on due to worsening in symptoms and one due to pelvic pain. CONCLUSION Although the results may be promising, much still must be learned about the method including mode and duration of stimulation, better electrodes and more patient friendly equipment together with the development of better questionnaires to assess the patient burden of urgency.
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Affiliation(s)
- N Qvist
- Research Unit for Surgery, Odense University Hospital Odense, Odense, Denmark.
- University of Southern Denmark, Odense, Denmark.
| | - U D Hansen
- University of Southern Denmark, Odense, Denmark
- Research Unit for Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - P Christensen
- Department of Surgery, Pelvic Floor Clinic, Aarhus University Hospital, Aarhus, Denmark
| | - N M J Rijkhoff
- Research Unit for Surgery, Odense University Hospital Odense, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - N Klarskov
- Department of Gynecology and Obstetrics, Herlev Hospital, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - J Duelund-Jakobsen
- Department of Surgery, Pelvic Floor Clinic, Aarhus University Hospital, Aarhus, Denmark
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Amiri HES, Brain D, Sharaf O, Withnell P, McGrath M, Alloghani M, Al Awadhi M, Al Dhafri S, Al Hamadi O, Al Matroushi H, Al Shamsi Z, Al Shehhi O, Chaffin M, Deighan J, Edwards C, Ferrington N, Harter B, Holsclaw G, Kelly M, Kubitschek D, Landin B, Lillis R, Packard M, Parker J, Pilinski E, Pramman B, Reed H, Ryan S, Sanders C, Smith M, Tomso C, Wrigley R, Al Mazmi H, Al Mheiri N, Al Shamsi M, Al Tunaiji E, Badri K, Christensen P, England S, Fillingim M, Forget F, Jain S, Jakosky BM, Jones A, Lootah F, Luhmann JG, Osterloo M, Wolff M, Yousuf M. The Emirates Mars Mission. Space Sci Rev 2022; 218:4. [PMID: 35194256 PMCID: PMC8830993 DOI: 10.1007/s11214-021-00868-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 11/22/2021] [Indexed: 06/14/2023]
Abstract
The Emirates Mars Mission (EMM) was launched to Mars in the summer of 2020, and is the first interplanetary spacecraft mission undertaken by the United Arab Emirates (UAE). The mission has multiple programmatic and scientific objectives, including the return of scientifically useful information about Mars. Three science instruments on the mission's Hope Probe will make global remote sensing measurements of the Martian atmosphere from a large low-inclination orbit that will advance our understanding of atmospheric variability on daily and seasonal timescales, as well as vertical atmospheric transport and escape. The mission was conceived and developed rapidly starting in 2014, and had aggressive schedule and cost constraints that drove the design and implementation of a new spacecraft bus. A team of Emirati and American engineers worked across two continents to complete a fully functional and tested spacecraft and bring it to the launchpad in the middle of a global pandemic. EMM is being operated from the UAE and the United States (U.S.), and will make its data freely available.
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Affiliation(s)
- H. E. S. Amiri
- UAE Ministry of Industry and Advanced Technology, Abu Dhabi, United Arab Emirates
| | - D. Brain
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - O. Sharaf
- Mohammed Bin Rashid Space Centre, Dubai, United Arab Emirates
| | - P. Withnell
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - M. McGrath
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - M. Alloghani
- Mohammed Bin Rashid Space Centre, Dubai, United Arab Emirates
| | - M. Al Awadhi
- Mohammed Bin Rashid Space Centre, Dubai, United Arab Emirates
| | - S. Al Dhafri
- Mohammed Bin Rashid Space Centre, Dubai, United Arab Emirates
| | - O. Al Hamadi
- Mohammed Bin Rashid Space Centre, Dubai, United Arab Emirates
| | - H. Al Matroushi
- Mohammed Bin Rashid Space Centre, Dubai, United Arab Emirates
| | - Z. Al Shamsi
- Mohammed Bin Rashid Space Centre, Dubai, United Arab Emirates
| | - O. Al Shehhi
- Mohammed Bin Rashid Space Centre, Dubai, United Arab Emirates
| | - M. Chaffin
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - J. Deighan
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - C. Edwards
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
- Northern Arizona University, Flagstaff, AZ USA
| | - N. Ferrington
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - B. Harter
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - G. Holsclaw
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - M. Kelly
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - D. Kubitschek
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - B. Landin
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - R. Lillis
- Space Sciences Lab, University of California, Berkeley, USA
| | - M. Packard
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | | | - E. Pilinski
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - B. Pramman
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - H. Reed
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - S. Ryan
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - C. Sanders
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - M. Smith
- NASA Goddard Space Flight Center, Greenbelt, MD USA
| | - C. Tomso
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - R. Wrigley
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - H. Al Mazmi
- UAE Space Agency, Abu Dhabi, United Arab Emirates
| | - N. Al Mheiri
- Mohammed Bin Rashid Space Centre, Dubai, United Arab Emirates
| | - M. Al Shamsi
- Mohammed Bin Rashid Space Centre, Dubai, United Arab Emirates
| | - E. Al Tunaiji
- Mohammed Bin Rashid Space Centre, Dubai, United Arab Emirates
| | - K. Badri
- Mohammed Bin Rashid Space Centre, Dubai, United Arab Emirates
| | | | - S. England
- Virgina Tech University, Blacksburg, VA USA
| | - M. Fillingim
- Space Sciences Lab, University of California, Berkeley, USA
| | - F. Forget
- Laboratoire de Météorologie Dynamique, Paris, France
| | - S. Jain
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - B. M. Jakosky
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - A. Jones
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - F. Lootah
- Mohammed Bin Rashid Space Centre, Dubai, United Arab Emirates
| | - J. G. Luhmann
- Space Sciences Lab, University of California, Berkeley, USA
| | - M. Osterloo
- Space Science International, Boulder, CO USA
| | - M. Wolff
- Space Science International, Boulder, CO USA
| | - M. Yousuf
- Mohammed Bin Rashid Space Centre, Dubai, United Arab Emirates
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Borre M, Fassov J, Juul T, Laurberg S, Christensen P, Drewes A, Faaborg P, Krogh K, Bräuner A, Ussing OT, Lauritsen MB. Diet and bowel symptoms among colon cancer survivors. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Affiliation(s)
- P Christensen
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.
| | - N S Fearnhead
- Department of Colorectal Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - J Martellucci
- General, Emergency and Mini-Invasive Surgery, Careggi University Hospital, Florence, Italy
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6
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Kristensen HØ, Krogsgaard M, Christensen P, Thomsen T. Validation of the colostomy impact score in patients ostomized for a benign condition. Colorectal Dis 2020; 22:2270-2277. [PMID: 32741098 DOI: 10.1111/codi.15290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/17/2020] [Indexed: 02/08/2023]
Abstract
AIM The colostomy impact (CI) score is a patient-reported outcome measure assessing reduction in health-related quality of life (HRQL) due to a stoma. The score was originally developed and validated in a cohort of rectal cancer survivors with a permanent colostomy. For the CI score to be applied to patients with a colostomy after surgery for a benign condition it must be validated in this patient group. The aim of this study was to assess construct validity and known groups validity of the CI score in patients with a colostomy after surgery for a benign condition. METHOD In a cross-sectional survey among ostomates in the Capital Region of Denmark, patients completed the CI score and the SF-36 v2 questionnaires. Construct validity was assessed by Pearson's correlation coefficients and known groups validity was assessed by t-test when dividing patients into groups of minor or major CI. RESULTS The CI score showed a moderate negative correlation with the Physical Component Summary (PCS) of -0.41 and a weak negative correlation with the Mental Component Summary (MCS) of -0.39. The strength of the correlation depended on the underlying condition leading to stoma formation. Differences were significant between the minor and major CI groups in mean PSC and MCS with t-values of 5.32 and 3.86, respectively. CONCLUSION The CI score is a valid instrument for assessing stoma-related impact on HRQL regardless of the underlying condition leading to stoma formation, and the CI score discriminates meaningfully between groups with known differences in stoma-related reduced HRQL.
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Affiliation(s)
- H Ø Kristensen
- Research Unit, Department of Surgery, Aarhus University Hospital, Aarhus N, Denmark
| | - M Krogsgaard
- Department of Surgical Gastroenterology, Clinic C, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Gastroenterology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - P Christensen
- Department of Surgery, Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects after Cancer in the Pelvic Organs, Aarhus University Hospital, Aarhus N, Denmark
| | - T Thomsen
- Department of Anaesthesiology, Herlev and Gentofte Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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7
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Haas S, Faaborg PM, Gram M, Lundby L, Brock C, Drewes AM, Laurberg S, Krogh K, Christensen P. Cortical processing to anorectal stimuli after rectal resection with and without radiotherapy. Tech Coloproctol 2020; 24:721-730. [PMID: 32323098 DOI: 10.1007/s10151-020-02210-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/06/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Bowel dysfunction is common after surgery for rectal cancer, especially when neoadjuvant radiotherapy is used. The role of sensory function in the pathogenesis remains obscure, and the aim of the present study was to characterize the sensory pathways of the brain-gut axis in rectal cancer patients treated with resection ± radiotherapy compared with healthy volunteers. METHODS Sensory evaluation by (neo)rectal distensions was performed and sensory evoked potentials (SEPs) were recorded during rapid balloon distensions of the (neo)rectum and anal canal in resected patients with (n = 8) or without (n = 12) radiotherapy. Twenty healthy volunteers were included for comparison. (Neo)rectal latencies and amplitudes of SEPs were compared and spectral band analysis from (neo)rectal and anal distensions was used as a proxy of neuronal processing. RESULTS Neorectal sensation thresholds were significantly increased in both patient categories (all p < 0.008). There were no differences in (neo)rectal SEP latencies and amplitudes between groups. However, spectral analysis of (neo)rectal SEPs showed significant differences between all groups in all bands (all p < 0.01). On the other hand, anal SEP analyses only showed significant differences between the delta (0-4 Hz), theta (4-8 Hz) and, gamma 32-50 Hz) bands (all p < 0.02) between the subgroup of patients that also received radiotherapy and healthy volunteers. CONCLUSIONS Surgery for rectal cancer leads to abnormal cortical processing of neorectal sensation. Additional radiotherapy leads to a different pattern of central sensory processing of neorectal and anal sensations. This may play a role in the functional outcome of these patients.
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Affiliation(s)
- S Haas
- Department of Surgery, Aarhus University Hospital, Palle Juul-Jensens Blvd 99, 8200, Århus N, Denmark. .,Danish Cancer Society Centre for Research and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus and Aalborg University Hospitals, Aalborg, Denmark.
| | - P M Faaborg
- Department of Surgery, Vejle Hospital, Vejle, Denmark.,Danish Cancer Society Centre for Research and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus and Aalborg University Hospitals, Aalborg, Denmark
| | - M Gram
- Mech-Sense, Department of Gastroenterology and Hepatology, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
| | - L Lundby
- Department of Surgery, Aarhus University Hospital, Palle Juul-Jensens Blvd 99, 8200, Århus N, Denmark.,Danish Cancer Society Centre for Research and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus and Aalborg University Hospitals, Aalborg, Denmark
| | - C Brock
- Mech-Sense, Department of Gastroenterology and Hepatology, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
| | - A M Drewes
- Mech-Sense, Department of Gastroenterology and Hepatology, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark.,Danish Cancer Society Centre for Research and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus and Aalborg University Hospitals, Aalborg, Denmark
| | - S Laurberg
- Department of Surgery, Aarhus University Hospital, Palle Juul-Jensens Blvd 99, 8200, Århus N, Denmark.,Danish Cancer Society Centre for Research and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus and Aalborg University Hospitals, Aalborg, Denmark
| | - K Krogh
- Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aalborg, Denmark.,Danish Cancer Society Centre for Research and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus and Aalborg University Hospitals, Aalborg, Denmark
| | - P Christensen
- Department of Surgery, Aarhus University Hospital, Palle Juul-Jensens Blvd 99, 8200, Århus N, Denmark.,Danish Cancer Society Centre for Research and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus and Aalborg University Hospitals, Aalborg, Denmark
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8
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Bjørsum-Meyer T, Christensen P, Jakobsen MS, Baatrup G, Qvist N. Correlation of anorectal manometry measures to severity of fecal incontinence in patients with anorectal malformations - a cross-sectional study. Sci Rep 2020; 10:6016. [PMID: 32265467 PMCID: PMC7138810 DOI: 10.1038/s41598-020-62908-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 05/24/2019] [Accepted: 03/16/2020] [Indexed: 12/15/2022] Open
Abstract
Anorectal malformations (ARM) are a spectrum of anomalies of the rectum and anal canal affecting 1 in 2500 to 5000 live births. Functional problems are common and related to the type of ARM and associated malformations. We aimed to evaluate the results of Three-dimensional High Resolution Anorectal Manometry (3D-HRAM) in long-term follow-up after surgical correction of ARM with special reference to fecal incontinence. Twenty-one patients with anorectal malformations and primary repair at our center consented to participate in the study. Pressures of the anal sphincter muscles and defects were addressed by 3D-HRAM. Fecal incontinence and disease-specific quality of life were evaluated by the Fecal Incontinence Quality of Life score and Wexner incontinence score respectively. The study was approved by the Committee in Health Research Ethics and the Danish Data Protection Agency. Median age was 22(12–31) years and 13(67%) participants were females. Sphincter defect was present in 48% (N = 10) of participants. Participants with sphincter defects had significant higher Wexner score and size of sphincter defects and mean anal squeeze pressure were correlated to Wexner score. Participants with or without sphincter defects did not differ on manometry parameters including resting anal and squeeze pressure or disease-specific quality of life. In a study of the long-term outcome after repair of anorectal malformations we found a higher Wexner incontinence score in the presence of an anal sphincter defect and the size of the defect and mean anal squeeze pressure were correlated to the Wexner incontinence score.
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Affiliation(s)
- T Bjørsum-Meyer
- Department of Surgery, Odense University Hospital, Odense C, 5000, Denmark. .,University of Southern Denmark, Faculty of Health Science, Department of Clinical research, Odense C, 5000, Denmark.
| | - P Christensen
- Department of Surgery, Aarhus University Hospital, Odense, 9000, Denmark
| | - M S Jakobsen
- Department of Pediatrics, Odense University Hospital, Odense, 5000, Denmark
| | - G Baatrup
- Department of Surgery, Odense University Hospital, Odense C, 5000, Denmark.,University of Southern Denmark, Faculty of Health Science, Department of Clinical research, Odense C, 5000, Denmark
| | - N Qvist
- Department of Surgery, Odense University Hospital, Odense C, 5000, Denmark.,University of Southern Denmark, Faculty of Health Science, Department of Clinical research, Odense C, 5000, Denmark
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Keane C, Fearnhead NS, Bordeianou L, Christensen P, Espin Basany E, Laurberg S, Mellgren A, Messick C, Orangio GR, Verjee A, Wing K, Bissett I. International consensus definition of low anterior resection syndrome. Colorectal Dis 2020; 22:331-341. [PMID: 32037685 DOI: 10.1111/codi.14957] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 08/23/2019] [Indexed: 12/13/2022]
Abstract
AIM Low anterior resection syndrome (LARS) is pragmatically defined as disordered bowel function after rectal resection leading to a detriment in quality of life. This broad characterization does not allow for precise estimates of prevalence. The LARS score was designed as a simple tool for clinical evaluation of LARS. Although the LARS score has good clinical utility, it may not capture all important aspects that patients may experience. The aim of this collaboration was to develop an international consensus definition of LARS that encompasses all aspects of the condition and is informed by all stakeholders. METHOD This international patient-provider initiative used an online Delphi survey, regional patient consultation meetings, and an international consensus meeting. Three expert groups participated: patients, surgeons and other health professionals from five regions (Australasia, Denmark, Spain, Great Britain and Ireland, and North America) and in three languages (English, Spanish, and Danish). The primary outcome measured was the priorities for the definition of LARS. RESULTS Three hundred twenty-five participants (156 patients) registered. The response rates for successive rounds of the Delphi survey were 86%, 96% and 99%. Eighteen priorities emerged from the Delphi survey. Patient consultation and consensus meetings refined these priorities to eight symptoms and eight consequences that capture essential aspects of the syndrome. Sampling bias may have been present, in particular, in the patient panel because social media was used extensively in recruitment. There was also dominance of the surgical panel at the final consensus meeting despite attempts to mitigate this. CONCLUSION This is the first definition of LARS developed with direct input from a large international patient panel. The involvement of patients in all phases has ensured that the definition presented encompasses the vital aspects of the patient experience of LARS. The novel separation of symptoms and consequences may enable greater sensitivity to detect changes in LARS over time and with intervention.
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Affiliation(s)
- C Keane
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - N S Fearnhead
- Department of Colorectal Surgery, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - L Bordeianou
- Colorectal Surgery Centre/Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - P Christensen
- Danish Cancer Society National Research Centre for Survivorship and Late Side Effect to Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - E Espin Basany
- Colon and Recto Unit, Department of General Surgery, Vall de Hebron Hospital, Universitat Autonoma de Barcelona, Spain
| | - S Laurberg
- Danish Cancer Society National Research Centre for Survivorship and Late Side Effect to Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - A Mellgren
- Division of Colon and Rectal Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - C Messick
- Department of Surgical Oncology, Section of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - G R Orangio
- Department of Surgery/School of Medicine, Louisiana State University, New Orleans, Louisiana, USA
| | - A Verjee
- Bowel Disease Research Foundation, London, UK
| | - K Wing
- Otago Community Hospice, Dunedin, New Zealand
| | - I Bissett
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
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10
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Barbosa M, Glavind-Kristensen M, Moller Soerensen M, Christensen P. Secondary sphincter repair for anal incontinence following obstetric sphincter injury: functional outcome and quality of life at 18 years of follow-up. Colorectal Dis 2020; 22:71-79. [PMID: 31347749 DOI: 10.1111/codi.14792] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/07/2019] [Indexed: 12/12/2022]
Abstract
AIM Secondary sphincter repair has been the conventional management of anal incontinence (AI) when a structural defect in the sphincter is recognized. However, disappointing long-term results have contributed to a tendency towards an increasing use of alternative treatment methods. This study aimed to assess the long-term functional outcomes following a secondary sphincter repair in women with AI after obstetric sphincter injury. METHOD This is a questionnaire study of women who underwent a secondary sphincter repair in Denmark between January 1990 and December 2005. Patients were identified through the Danish National Patient Registry. Functional outcomes were assessed by a self-administered questionnaire in 2010 and 2018. Primary outcomes were Wexner and St. Mark's scores. Impact on quality of life was assessed using the Fecal Incontinence Quality of Life Scale. RESULTS Functional outcome was assessed in 370 women in 2010 and 255 women in 2018. At 18.3 [interquartile range (IQR 15.0-22.0)] years of follow-up, the mean ± SD Wexner score was 8.8 ± 4.8 and the mean St. Mark's score was 11.7 ± 5.0. Flatus incontinence was the most frequent symptom, reported by 97%. Incontinence for liquid and solid stools was reported by 75% and 54%, respectively. There were no significant changes in incontinence frequencies over time. Women with a Wexner score of ≥ 9 had a significantly lower quality of life score in all domains than did women with a Wexner score of < 9 (P < 0.001). CONCLUSION At long-term follow-up, few patients are fully continent following a secondary sphincter repair. However, it appears that the functional results remain stable at very long-term follow-up.
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Affiliation(s)
- M Barbosa
- Pelvic Floor Unit, Department of Surgery, Aarhus University Hospital, Aarhus N, Denmark
| | - M Glavind-Kristensen
- Pelvic Floor Unit, Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus N, Denmark
| | - M Moller Soerensen
- Pelvic Floor Unit, Department of Surgery, Aarhus University Hospital, Aarhus N, Denmark
| | - P Christensen
- Pelvic Floor Unit, Department of Surgery, Aarhus University Hospital, Aarhus N, Denmark
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11
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Sanderson DCW, Carmichael LA, Fisk S, Christensen P, Delincée H, Hammerton K, Nootenboom H, Pfordt J, Pinnioja S, Schreiber GA, Toyoda M. Thermoluminescence Detection of Irradiated Fruits and Vegetables: International Interlaboratory Trial. J AOAC Int 2019. [DOI: 10.1093/jaoac/86.5.971] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
An international interlaboratory trial was conducted to validate thermoluminescence methods for detecting irradiated fruits and vegetables. Five products were used in this study. This paper presents the results from prestudy material, homogeneity testing, details of sample preparation, and participants' results. Prestudy results provided a basis for cross comparison of instruments in different laboratories. A wide range of sensitivities, reproducibilities, and signal-to-background ratios were observed. Homogeneity testing showed that the method can distinguish between nonirradiated and irradiated products, including those bleached with 100 J/cm2 artificial daylight, provided that sensitivity rejection criteria are rigorously applied. Blind results were returned by 9 participants in the form of first and second glow integrals and glow ratios for all samples and a qualitative classification for each product. Of the 387 results reported, 327 valid results were obtained from participants. Where valid data were obtained, correct qualitative identifications were made by participants in all cases. Participants' results and homogeneity testing both confirm the validity of the thermoluminescence method for detecting irradiated fruits and vegetables.
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Affiliation(s)
- David C W Sanderson
- Scottish Universities Research and Reactor Centre (SURRC), Scottish Enterprise Technology Park, Rankine Ave, East Kilbride, G75 OQF, UK
| | - Lorna A Carmichael
- Scottish Universities Research and Reactor Centre (SURRC), Scottish Enterprise Technology Park, Rankine Ave, East Kilbride, G75 OQF, UK
| | - Saffron Fisk
- Scottish Universities Research and Reactor Centre (SURRC), Scottish Enterprise Technology Park, Rankine Ave, East Kilbride, G75 OQF, UK
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12
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Sanderson DCW, Carmichael LA, Fisk S, Christensen P, Delincée H, Nootenboom H, Pfordt J, Pinnioja S, Schreiber GA, Wagner U. Thermoluminescence Detection of Irradiated Shellfish: International Interlaboratory Trial. J AOAC Int 2019. [DOI: 10.1093/jaoac/86.5.976] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
An international interlaboratory trial was conducted using thermoluminescence for the detection of irradiated shellfish, aimed at validating the method for routine use. Nephrops norvegicus, mussels, brown shrimps, black tiger prawns, and king scallops were presented as nonirradiated and irradiated to 0.5 and 2.5 kGy. The protocol called for the use of 3 preparation methods: extraction of silicates from whole shellfish by acid hydrolysis and physical separation, and of carbonates from powdered shells. Homogeneity was tested on each product and each treatment. Results verified that all methods were able to distinguish between nonirradiated and irradiated samples regardless of dose. Silicate methods produced better discrimination than powdered shell, and acid hydrolysis showed some evidence of better separation between the 2 doses than the physical method. Participants received each product in each treatment category for blind analysis. Six participants returned results for acid hydrolysis, 7 for physical separation, and 5 for the powdered shell method. Their results confirmed the homogeneity testing. Qualitative results gave 100% correct classification for both silicate methods and 85.3% for powdered shell. Silicate methods are therefore preferable unless only shell is available. Overall, the results confirmed the case for validation.
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Affiliation(s)
- David C W Sanderson
- Scottish Universities Research and Reactor Centre (SURRC), Scottish Enterprise Technology Park, Rankine Ave, East Kilbride, G75 OQF, UK
| | - Lorna A Carmichael
- Scottish Universities Research and Reactor Centre (SURRC), Scottish Enterprise Technology Park, Rankine Ave, East Kilbride, G75 OQF, UK
| | - Saffron Fisk
- Scottish Universities Research and Reactor Centre (SURRC), Scottish Enterprise Technology Park, Rankine Ave, East Kilbride, G75 OQF, UK
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13
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Kronborg C, Serup-Hansen E, Wind K, Christensen P, Spindler K. Patient-reported outcomes including LARS score and quality of life one year after chemoradiotherapy for anal cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.221] [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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14
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Elfeki H, Duelund-Jakobsen J, Christensen P. Chait trapdoor cecostomy catheter for treatment of intractable constipation - a video vignette. Colorectal Dis 2019; 21:733. [PMID: 30951241 DOI: 10.1111/codi.14634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 03/16/2019] [Indexed: 02/08/2023]
Affiliation(s)
- H Elfeki
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Surgery, Mansoura University Hospital, Mansoura, Egypt
| | | | - P Christensen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
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15
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Prodhan U, Milan A, Silvestre M, Christensen P, Raben A, Fogelholm M, Poppitt S, Cameron-Smith D. Differential Trajectories in Altered Insulin Sensitivity Following Weight Loss and Their Impact on Circulatory Amino Acids: Results from the PREVIEW: New Zealand Sub-study (OR27-07-19). Curr Dev Nutr 2019. [DOI: 10.1093/cdn/nzz046.or27-07-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
Metabolite profiling studies have consistently identified altered circulatory concentrations of amino acids (AAs) in individuals with heightened risk of type 2 diabetes and cardiovascular diseases. Of the changes reported to date, the branched-chain amino acids (BCAA) may be a reliable biomarker of disease risk and have been reported to be elevated many years prior to the onset of diabetes. We hypothesised that energy restriction-associated weight loss in pre-diabetes individuals would result in altered profile of circulatory AAs, including BCAA, with the changes correlating with the improvement in insulin sensitivity.
Methods
Pre-diabetic individuals (confirmed using the American Diabetes Association criteria) aged 25–70 years with BMI > 25 kg/m2 recruited into the New Zealand arm of the PREVIEW diabetes prevention trial, participated in an 8-week weight reduction program, with a requirement to lose ≥ 8% initial body weight using a commercial low-calorie diet (LCD, Cambridge Diet, UKTM). Among those who succeeded, current analysis based on available samples (n = 168) from baseline (week-0) and end of weight loss (week-8). Serum free AA concentrations measured by ultra-high pressure liquid chromatography (UPLC) and all other metabolites measured using standard assays.
Results
Significant weight loss (11.1 ± 0.2% from baseline) accompanied improved insulin sensitivity and lipid profile. BCAA concentration positively correlated with insulin resistance measured at week 0 and 8, correspondingly (P < 0.05). Although the concentration of some AAs reduced significantly from week 0 to 8 (P < 0.05), reduction in fasting BCAA concentration was not significant (P > 0.05). However, regression analysis demonstrated that independent of weight loss, every 1.0 standard deviation (SD) reduction in BCAA concentration was associated with improvement in insulin sensitivity by 1.9 SD (P < 0.05).
Conclusions
As expected, dietary energy restriction-associated weight loss in individuals with pre-diabetes contributes towards normalisation of insulin sensitivity. Further, the responsiveness of AA and BCAA profiles to weight loss may be beneficial for monitoring and overseeing disease risk and improvement.
Funding Sources
This research was funded by the EU 7th Framework Programme; the New Zealand Health Research Council; the Food and Health Programme Seed Funding, University of Auckland; and AgResearch Limited (the Strategic Science Investment Fund). Cambridge Weight Plan, Ltd, UKTM provided the commercial LCD.
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Affiliation(s)
- Utpal Prodhan
- Liggins Institute, University of Auckland, New Zealand
| | - Amber Milan
- Liggins Institute, University of Auckland, New Zealand
| | | | - Pia Christensen
- Department of Nutrition, Exercise and Sports, faculty of Science, University of Copenhagen, Denmark
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, faculty of Science, University of Copenhagen, Denmark
| | - Mikael Fogelholm
- Department of Food and Nutrition, University of Helsinki, Finland
| | - Sally Poppitt
- Human Nutrition Unit, University of Auckland, New Zealand
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16
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Huttunen-Lenz M, Hansen S, Larsen TM, Christensen P, Drummen M, Adam T, Taylor MA, Simpson E, Martinez JA, Navas-Carretero S, Handjieva-Darlenska T, Poppitt SD, Silvestre MP, Fogelholm M, Jalo E, Muirhead R, Brodie S, Raben A, Schlicht W. The PREVIEW Study. European Journal of Health Psychology 2019. [DOI: 10.1027/2512-8442/a000026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Individuals at risk of Type 2 Diabetes are advised to change health habits. This study investigated how the PREMIT behavior modification intervention and its association with socio-economic variables influenced weight maintenance and habit strength in the PREVIEW study. Overweight adults with pre-diabetes were enrolled ( n = 2,224) in a multi-center RCT including a 2-month weight-loss phase and a 34-month weight-maintenance phase for those who lost ≥ 8% body weight. Initial stages of the PREMIT covered the end of weight-loss and the beginning of weight-maintenance phase (18 weeks). Cross-sectional and longitudinal data were explored. Frequent PREMIT sessions attendance, being female, and lower habit strength for poor diet were associated with lower weight re-gain. Being older and not in employment were associated with lower habit strength for physical inactivity. The PREMIT appeared to support weight loss maintenance. Younger participants, males, and those in employment appeared to struggle more with inactivity habit change and weight maintenance.
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Affiliation(s)
- Maija Huttunen-Lenz
- Department of Exercise and Health Sciences, University of Stuttgart, Germany
| | - Sylvia Hansen
- Department of Exercise and Health Sciences, University of Stuttgart, Germany
| | | | - Pia Christensen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Mathijs Drummen
- Department of Nutrition and Movement Sciences, Maastricht University, The Netherlands
| | - Tanja Adam
- Department of Nutrition and Movement Sciences, Maastricht University, The Netherlands
| | - Moira A. Taylor
- School of Life Sciences, University of Nottingham, United Kingdom
| | | | - Jose A. Martinez
- Centre for Nutrition Research, University of Navarra, Pamplona, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Santiago Navas-Carretero
- Centre for Nutrition Research, University of Navarra, Pamplona, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Sally D. Poppitt
- School of Biological Sciences, University of Auckland, Human Nutrition Unit, New Zealand
| | - Marta P. Silvestre
- School of Biological Sciences, University of Auckland, Human Nutrition Unit, New Zealand
| | - Mikael Fogelholm
- Department of Food and Nutrition, University of Helsinki, Finland
| | - Elli Jalo
- Department of Food and Nutrition, University of Helsinki, Finland
| | - Roslyn Muirhead
- Charles Perkins Centre and School of Life and Environmental Biosciences, University of Sydney, Australia
| | - Shannon Brodie
- Charles Perkins Centre and School of Life and Environmental Biosciences, University of Sydney, Australia
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Wolfgang Schlicht
- Department of Exercise and Health Sciences, University of Stuttgart, Germany
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17
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Elfeki H, Larsen HM, Emmertsen KJ, Christensen P, Youssef M, Khafagy W, Omar W, Laurberg S. Bowel dysfunction after sigmoid resection for cancer and its impact on quality of life. Br J Surg 2019; 106:805. [DOI: 10.1002/bjs.11174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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18
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Kronborg C, Christensen P, Pedersen B, Spindler K. EP-1469 Radiation dose to pelvic floor muscles and functional outcome after treatment for anal cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31889-4] [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: 10/26/2022]
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19
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Christensen P, Meinert Larsen T, Westerterp‐Plantenga M, Macdonald I, Martinez JA, Handjiev S, Poppitt S, Hansen S, Ritz C, Astrup A, Pastor‐Sanz L, Sandø‐Pedersen F, Pietiläinen KH, Sundvall J, Drummen M, Taylor MA, Navas‐Carretero S, Handjieva‐Darlenska T, Brodie S, Silvestre MP, Huttunen‐Lenz M, Brand‐Miller J, Fogelholm M, Raben A. Men and women respond differently to rapid weight loss: Metabolic outcomes of a multi-centre intervention study after a low-energy diet in 2500 overweight, individuals with pre-diabetes (PREVIEW). Diabetes Obes Metab 2018; 20:2840-2851. [PMID: 30088336 PMCID: PMC6282840 DOI: 10.1111/dom.13466] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/28/2018] [Accepted: 07/06/2018] [Indexed: 12/12/2022]
Abstract
AIMS The PREVIEW lifestyle intervention study (ClinicalTrials.gov Identifier: NCT01777893) is, to date, the largest, multinational study concerning prevention of type-2 diabetes. We hypothesized that the initial, fixed low-energy diet (LED) would induce different metabolic outcomes in men vs women. MATERIALS AND METHODS All participants followed a LED (3.4 MJ/810 kcal/daily) for 8 weeks (Cambridge Weight Plan). Participants were recruited from 8 sites in Europe, Australia and New Zealand. Those eligible for inclusion were overweight (BMI ≥ 25 kg/m2 ) individuals with pre-diabetes according to ADA-criteria. Outcomes of interest included changes in insulin resistance, fat mass (FM), fat-free mass (FFM) and metabolic syndrome Z-score. RESULTS In total, 2224 individuals (1504 women, 720 men) attended the baseline visit and 2020 (90.8%) completed the follow-up visit. Following the LED, weight loss was 16% greater in men than in women (11.8% vs 10.3%, respectively) but improvements in insulin resistance were similar. HOMA-IR decreased by 1.50 ± 0.15 in men and by 1.35 ± 0.15 in women (ns). After adjusting for differences in weight loss, men had larger reductions in metabolic syndrome Z-score, C-peptide, FM and heart rate, while women had larger reductions in HDL cholesterol, FFM, hip circumference and pulse pressure. Following the LED, 35% of participants of both genders had reverted to normo-glycaemia. CONCLUSIONS An 8-week LED induced different effects in women than in men. These findings are clinically important and suggest gender-specific changes after weight loss. It is important to investigate whether the greater decreases in FFM, hip circumference and HDL cholesterol in women after rapid weight loss compromise weight loss maintenance and future cardiovascular health.
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Affiliation(s)
- Pia Christensen
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenCopenhagenDenmark
| | - Thomas Meinert Larsen
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenCopenhagenDenmark
| | | | - Ian Macdonald
- MRC/ARUK Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research CentreSchool of Life SciencesUniversity of Nottingham, NottinghamNG7 2UH, UK
| | - J. Alfredo Martinez
- Department of Nutrition, Food Science and Physiology, Center for Nutrition ResearchUniversity of NavarraPamplonaSpain
- CIBERObn, Obesity and NutritionInstituto de Salud Carlos IIIMadridSpain
- IMDEA AlimentaciónMadridSpain
| | - Svetoslav Handjiev
- Department of Pharmacology and ToxicologyMedical University of SofiaSofiaBulgaria
| | - Sally Poppitt
- Human Nutrition Unit, School of Biological SciencesUniversity of AucklandAucklandNew Zealand
| | - Sylvia Hansen
- Department of Exercise and Health SciencesUniversity of StuttgartStuttgartGermany
| | - Christian Ritz
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenCopenhagenDenmark
| | - Arne Astrup
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenCopenhagenDenmark
| | - Laura Pastor‐Sanz
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenCopenhagenDenmark
| | - Finn Sandø‐Pedersen
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenCopenhagenDenmark
| | - Kirsi H. Pietiläinen
- Obesity Research Unit, Research Program Unit, Diabetes and ObesityUniversity of HelsinkiHelsinkiFinland
- Obesity Center, Abdominal Center, EndocrinologyHelsinki University Hospital, University of HelsinkiHelsinkiFinland
| | - Jouko Sundvall
- National Institute for Health and Welfare THLHelsinkiFinland
| | - Mathijs Drummen
- Department of Nutrition and Movement Sciences, School for Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
| | | | - Santiago Navas‐Carretero
- Department of Nutrition, Food Science and Physiology, Center for Nutrition ResearchUniversity of NavarraPamplonaSpain
- CIBERObn, Obesity and NutritionInstituto de Salud Carlos IIIMadridSpain
| | | | - Shannon Brodie
- Charles Perkins Centre and School of Life and Environmental BiosciencesUniversity of SydneySydneyAustralia
| | - Marta P. Silvestre
- Human Nutrition Unit, School of Biological SciencesUniversity of AucklandAucklandNew Zealand
| | - Maija Huttunen‐Lenz
- Department of Exercise and Health SciencesUniversity of StuttgartStuttgartGermany
| | - Jennie Brand‐Miller
- Charles Perkins Centre and School of Life and Environmental BiosciencesUniversity of SydneySydneyAustralia
| | - Mikael Fogelholm
- Department of Food and NutritionUniversity of HelsinkiHelsinkiFinland
| | - Anne Raben
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenCopenhagenDenmark
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20
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Elfeki H, Larsen HM, Emmertsen KJ, Christensen P, Youssef M, Khafagy W, Omar W, Laurberg S. Bowel dysfunction after sigmoid resection for cancer and its impact on quality of life. Br J Surg 2018; 106:142-151. [PMID: 30211443 DOI: 10.1002/bjs.10979] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/12/2018] [Accepted: 07/13/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Several studies have explored functional outcomes after rectal cancer surgery, but bowel dysfunction after sigmoid resection for cancer has hardly been considered. The aim of this study was to identify the prevalence and pattern of bowel dysfunction after resection for sigmoid cancer, and the impact of bowel function on quality of life (QoL) by comparison with patients who had polypectomy for cancer. METHODS This was a national cross-sectional study. Data were collected from the Danish Colorectal Cancer Group database, and a questionnaire regarding bowel function and European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 QoL questionnaire was sent to all Danish colonic cancer survivors treated with sigmoid resection or polypectomy between 2001 and 2014. RESULTS A total of 3295 patients (3061 sigmoid resection, 234 polypectomy) responded to the questionnaire (response rate 63·8 per cent). Twelve bowel symptoms were more prevalent after sigmoid resection, including: excessive straining, fragmentation, bloating, nocturnal defaecation, bowel false alarm, liquid stool incontinence, incomplete evacuation and sense of outlet obstruction. QoL impairment owing to bowel symptoms was reported in 16·6 per cent of patients in the resection group and 10·1 per cent after polypectomy (P = 0·008). Obstructed defaecation symptoms (ODS) were encountered significantly more often after sigmoid resection than following polypectomy (17·9 versus 7·3 per cent; P < 0·001). In the resection group, patients with ODS had substantial impairment on most aspects of QoL assessed by the EORTC QLQ-C30. CONCLUSION Sigmoid resection for cancer is associated with an increased risk of long-term bowel dysfunction; obstructed defaecation is prevalent and associated with substantial impairment of QoL.
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Affiliation(s)
- H Elfeki
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus University Hospital, Aarhus, Denmark.,Colorectal Surgery Unit, Department of Surgery, Mansoura University Hospital, Mansoura, Egypt
| | - H M Larsen
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus University Hospital, Aarhus, Denmark
| | - K J Emmertsen
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus University Hospital, Aarhus, Denmark.,Department of Surgery, Regional Hospital Randers, Randers, Denmark
| | - P Christensen
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus University Hospital, Aarhus, Denmark
| | - M Youssef
- Colorectal Surgery Unit, Department of Surgery, Mansoura University Hospital, Mansoura, Egypt
| | - W Khafagy
- Colorectal Surgery Unit, Department of Surgery, Mansoura University Hospital, Mansoura, Egypt
| | - W Omar
- Colorectal Surgery Unit, Department of Surgery, Mansoura University Hospital, Mansoura, Egypt
| | - S Laurberg
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus University Hospital, Aarhus, Denmark
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Huttunen-Lenz M, Hansen S, Christensen P, Meinert Larsen T, Sandø-Pedersen F, Drummen M, Adam TC, Macdonald IA, Taylor MA, Martinez JA, Navas-Carretero S, Handjiev S, Poppitt SD, Silvestre MP, Fogelholm M, Pietiläinen KH, Brand-Miller J, Berendsen AA, Raben A, Schlicht W. PREVIEW study-influence of a behavior modification intervention (PREMIT) in over 2300 people with pre-diabetes: intention, self-efficacy and outcome expectancies during the early phase of a lifestyle intervention. Psychol Res Behav Manag 2018; 11:383-394. [PMID: 30254498 PMCID: PMC6143124 DOI: 10.2147/prbm.s160355] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Onset of type 2 diabetes (T2D) is often gradual and preceded by impaired glucose homeostasis. Lifestyle interventions including weight loss and physical activity may reduce the risk of developing T2D, but adherence to a lifestyle change is challenging. As part of an international T2D prevention trial (PREVIEW), a behavior change intervention supported participants in achieving a healthier diet and physically active lifestyle. Here, our aim was to explore the influence of this behavioral program (PREMIT) on social-cognitive variables during an 8-week weight loss phase. METHODS PREVIEW consisted of an initial weight loss, Phase I, followed by a weight- maintenance, Phase II, for those achieving the 8-week weight loss target of ≥ 8% from initial bodyweight. Overweight and obese (BMI ≥25 kg/m2) individuals aged 25 to 70 years with confirmed pre-diabetes were enrolled. Uni- and multivariate statistical methods were deployed to explore differences in intentions, self-efficacy, and outcome expectancies between those who achieved the target weight loss ("achievers") and those who did not ("non-achievers"). RESULTS At the beginning of Phase I, no significant differences in intentions, self-efficacy and outcome expectancies between "achievers" (1,857) and "non-achievers" (163) were found. "Non-achievers" tended to be younger, live with child/ren, and attended the PREMIT sessions less frequently. At the end of Phase I, "achievers" reported higher intentions (healthy eating χ2(1)=2.57; P <0.008, exercising χ2(1)=0.66; P <0.008), self-efficacy (F(2; 1970)=10.27, P <0.005), and were more positive about the expected outcomes (F(4; 1968)=11.22, P <0.005). CONCLUSION Although statistically significant, effect sizes observed between the two groups were small. Behavior change, however, is multi-determined. Over a period of time, even small differences may make a cumulative effect. Being successful in behavior change requires that the "new" behavior is implemented time after time until it becomes a habit. Therefore, having even slightly higher self-efficacy, positive outcome expectancies and intentions may over time result in considerably improved chances to achieve long-term lifestyle changes.
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Affiliation(s)
- Maija Huttunen-Lenz
- Department of Exercise and Health Sciences, University of Stuttgart, Stuttgart, Germany,
| | - Sylvia Hansen
- Department of Exercise and Health Sciences, University of Stuttgart, Stuttgart, Germany,
| | - Pia Christensen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Meinert Larsen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Finn Sandø-Pedersen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Mathijs Drummen
- Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands
| | - Tanja C Adam
- Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands
| | - Ian A Macdonald
- MRC/ARUK Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, School of Life Sciences, University of Nottingham, Nottingham, UK
- School of Life Sciences, University of Nottingham Medical School, Nottingham, UK
| | - Moira A Taylor
- School of Life Sciences, University of Nottingham Medical School, Nottingham, UK
| | - J Alfredo Martinez
- Center for Nutrition Research at the University of Navarra, Pamplona, Spain
- Madrid Institute of Advanced Studies (IMDEA Food), Madrid, Spain
- Biomedical Research Centre Network in Physiopathology of Obesity and Nutrition (CIBERobn), Carlos III Institute, Madrid, Spain
| | - Santiago Navas-Carretero
- Center for Nutrition Research at the University of Navarra, Pamplona, Spain
- Madrid Institute of Advanced Studies (IMDEA Food), Madrid, Spain
- Biomedical Research Centre Network in Physiopathology of Obesity and Nutrition (CIBERobn), Carlos III Institute, Madrid, Spain
| | - Svetoslav Handjiev
- Department of Pharmacology and Toxicology, Medical University - Sofia, Sofia, Bulgaria
| | - Sally D Poppitt
- Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - Marta P Silvestre
- Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - Mikael Fogelholm
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Kirsi H Pietiläinen
- Obesity Research Unit, Research Program Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
- Abdominal Center, Endocrinology, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
| | - Jennie Brand-Miller
- Charles Perkins Centre and School of Life and Environmental Biosciences, University of Sydney, Camperdown, NSW, Australia
| | - Agnes Am Berendsen
- Division of Human Nutrition & Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Wolfgang Schlicht
- Department of Exercise and Health Sciences, University of Stuttgart, Stuttgart, Germany,
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Affiliation(s)
- P. Christensen
- Department of Anatomy and Physiology Royal Veterinary and Agricultural University, Copenhagen, Denmark
| | - J.M. Parlevliet
- Department of Herd Health and Reproduction Veterinary School, Utrecht University, The Netherlands
| | - A. Van Buiten
- Department of Herd Health and Reproduction Veterinary School, Utrecht University, The Netherlands
| | - P. Hyttel
- Department of Anatomy and Physiology Royal Veterinary and Agricultural University, Copenhagen, Denmark
| | - B. Colenbrander
- Department of Herd Health and Reproduction Veterinary School, Utrecht University, The Netherlands
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Elfeki H, Thyø A, Nepogodiev D, Pinkney TD, White M, Laurberg S, Christensen P. Patient and healthcare professional perceptions of colostomy-related problems and their impact on quality of life following rectal cancer surgery. BJS Open 2018; 2:336-344. [PMID: 30263985 PMCID: PMC6156164 DOI: 10.1002/bjs5.69] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 12/30/2017] [Revised: 02/11/2018] [Accepted: 03/16/2018] [Indexed: 01/01/2023] Open
Abstract
Background The perception of colostomy‐related problems and their impact on health‐related quality of life (QoL) may differ between patients and healthcare professionals. The aim of this study was to investigate this using the Colostomy Impact Score (CIS) tool. Methods Healthcare professionals including consultant colorectal surgeons, stoma nurses, ward nurses, trainees and medical students were recruited. An online survey was designed. From the 17 items used to develop the CIS, participants chose the seven factors they thought to confer the strongest negative impact on the QoL of patients with a colostomy. They were then asked to rank the 12 responses made by patients to the final seven factors contained in the CIS. Results were compared with the original patient rankings at the time of development of the CIS. Results A total of 156 healthcare professionals (50·4 per cent of the pooled professionals) from 17 countries completed the survey. Of the original seven items in the CIS, six were above the threshold for random selection. Ranking the responses, a poor match between participants and the original score was detected for 49·7 per cent of the professionals. The most under‐rated item originally present in the CIS was stool consistency, reported by 47 of the 156 professionals (30·1 per cent), whereas frequency of changing the stoma bag was the item not included in the CIS that was chosen most often by professionals (124, 79·5 per cent). Significant differences were not observed between different groups of professionals. Conclusion The perspective of colostomy‐related problems differs between patients with a colostomy and healthcare professionals.
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Affiliation(s)
- H Elfeki
- Colorectal Surgical Unit, Department of Surgery Aarhus University Hospital Aarhus Denmark.,Colorectal Surgical Unit, Department of Surgery Mansoura University Hospital Mansoura Egypt
| | - A Thyø
- Colorectal Surgical Unit, Department of Surgery Aarhus University Hospital Aarhus Denmark
| | - D Nepogodiev
- Academic Department of Surgery, University of Birmingham Birmingham UK
| | - T D Pinkney
- Academic Department of Surgery, University of Birmingham Birmingham UK
| | - M White
- Colorectal Surgery Department, Queen Elizabeth Hospital University Hospitals Birmingham NHS Foundation Trust Birmingham UK
| | - S Laurberg
- Colorectal Surgical Unit, Department of Surgery Aarhus University Hospital Aarhus Denmark
| | - P Christensen
- Colorectal Surgical Unit, Department of Surgery Aarhus University Hospital Aarhus Denmark
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Andriessen C, Christensen P, Vestergaard Nielsen L, Ritz C, Astrup A, Meinert Larsen T, Martinez JA, Saris WHM, van Baak MA, Papadaki A, Kunesova M, Jebb S, Blundell J, Lawton C, Raben A. Weight loss decreases self-reported appetite and alters food preferences in overweight and obese adults: Observational data from the DiOGenes study. Appetite 2018; 125:314-322. [PMID: 29471068 DOI: 10.1016/j.appet.2018.02.016] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 02/09/2018] [Accepted: 02/15/2018] [Indexed: 12/27/2022]
Abstract
People with obesity often struggle to maintain their weight loss after a weight loss period. Furthermore, the effect of weight loss on appetite and food preferences remains unclear. Hence this study investigated the effect of weight loss on subjective appetite and food preferences in healthy, overweight and obese volunteers. A subgroup of adult participants (n = 123) from the Diet Obesity and Genes (DiOGenes) study (subgroup A) was recruited from across six European countries. Participants lost ≥8% of initial body weight during an 8-week low calorie diet (LCD). Subjective appetite and food preferences were measured before and after the LCD, in response to a standardized meal test, using visual analogue rating scales (VAS) and the Leeds Food Choice Questionnaire (FCQ). After the LCD, participants reported increased fullness (p < 0.05), decreased desire to eat (p < 0.05) and decreased prospective consumption (p < 0.05) after consuming the test meal. An interaction effect (visit x time) was found for hunger ratings (p < 0.05). Area under the curve (AUC) for hunger, desire to eat and prospective consumption was decreased by 18.1%, 20.2% and 21.1% respectively whereas AUC for fullness increased by 13.9%. Preference for low-energy products measured by the Food Preference Checklist (FPC) decreased by 1.9% before the test meal and by 13.5% after the test meal (p < 0.05). High-carbohydrate and high-fat preference decreased by 11.4% and 16.2% before the test meal and by 17.4% and 22.7% after the meal (p < 0.05). No other effects were observed. These results suggest that LCD induced weight loss decreases the appetite perceptions of overweight volunteers whilst decreasing their preference for high-fat-, high-carbohydrate-, and low-energy products.
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Affiliation(s)
- Charlotte Andriessen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark; Department of Human Nutrition, Wageningen University, The Netherlands.
| | - Pia Christensen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark.
| | | | - Christian Ritz
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark.
| | - Arne Astrup
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark.
| | | | - J Alfredo Martinez
- Center for Nutrition Research, University of Navarra, Pamplona, CIBERobn, Fisiopatología de la Obesidady Nutrición, Madrid, Spain.
| | - Wim H M Saris
- Department of Human Biology and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, The Netherlands.
| | - Marleen A van Baak
- Department of Human Biology and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, The Netherlands.
| | - Angeliki Papadaki
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom; Department of Social Medicine, Preventive Medicine & Nutrition Clinic, University of Crete, Heraklion, Crete, Greece.
| | - Marie Kunesova
- Institute of Endocrinology, Obesity Management Centre, Prague, Czech Republic.
| | - Susan Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
| | - John Blundell
- School of Psychology, University of Leeds, Leeds, United Kingdom.
| | - Clare Lawton
- School of Psychology, University of Leeds, Leeds, United Kingdom.
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark.
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25
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Møller G, Rikardt Andersen J, Ritz C, P Silvestre M, Navas-Carretero S, Jalo E, Christensen P, Simpson E, Taylor M, Martinez JA, Macdonald I, Swindell N, Mackintosh KA, Stratton G, Fogelholm M, Larsen TM, Poppitt SD, Dragsted LO, Raben A. Higher Protein Intake Is Not Associated with Decreased Kidney Function in Pre-Diabetic Older Adults Following a One-Year Intervention-A Preview Sub-Study. Nutrients 2018; 10:nu10010054. [PMID: 29315212 PMCID: PMC5793282 DOI: 10.3390/nu10010054] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 12/27/2017] [Accepted: 01/03/2018] [Indexed: 12/28/2022] Open
Abstract
Concerns about detrimental renal effects of a high-protein intake have been raised due to an induced glomerular hyperfiltration, since this may accelerate the progression of kidney disease. The aim of this sub-study was to assess the effect of a higher intake of protein on kidney function in pre-diabetic men and women, aged 55 years and older. Analyses were based on baseline and one-year data in a sub-group of 310 participants included in the PREVIEW project (PREVention of diabetes through lifestyle Intervention and population studies in Europe and around the World). Protein intake was estimated from four-day dietary records and 24-hour urinary urea excretion. We used linear regression to assess the association between protein intake after one year of intervention and kidney function markers: creatinine clearance, estimated glomerular filtration rate (eGFR), urinary albumin/creatinine ratio (ACR), urinary urea/creatinine ratio (UCR), serum creatinine, and serum urea before and after adjustments for potential confounders. A higher protein intake was associated with a significant increase in UCR (p = 0.03) and serum urea (p = 0.05) after one year. There were no associations between increased protein intake and creatinine clearance, eGFR, ACR, or serum creatinine. We found no indication of impaired kidney function after one year with a higher protein intake in pre-diabetic older adults.
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Affiliation(s)
- Grith Møller
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, 1958 Copenhagen, Denmark.
| | - Jens Rikardt Andersen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, 1958 Copenhagen, Denmark.
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, 1958 Copenhagen, Denmark.
| | - Marta P Silvestre
- Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland 1010, New Zealand.
| | - Santiago Navas-Carretero
- Centre for Nutrition Research, University of Navarra, Calle Lrunlrrea 1, 31008 Pamplona, Navarra, Spain.
- CIBERobn, Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, 28029 Madrid, Spain.
| | - Elli Jalo
- Department of Food and Environmental Sciences, University of Helsinki, 00014 Helsinki, Finland.
| | - Pia Christensen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, 1958 Copenhagen, Denmark.
| | - Elizabeth Simpson
- School of Life Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, University Park, Nottingham NG7 2RD, UK.
| | - Moira Taylor
- School of Life Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, University Park, Nottingham NG7 2RD, UK.
| | - J Alfredo Martinez
- Centre for Nutrition Research, University of Navarra, Calle Lrunlrrea 1, 31008 Pamplona, Navarra, Spain.
- CIBERobn, Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, 28029 Madrid, Spain.
- Institute IMDEA Food, Crta. De Canto Blanco 8, 28029 Madrid, Spain.
| | - Ian Macdonald
- School of Life Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, University Park, Nottingham NG7 2RD, UK.
| | - Nils Swindell
- School of Sport and Exercise Sciences, A-STEM Research Centre, Swansea University, Singleton Park SA2 8PP, UK.
| | - Kelly A Mackintosh
- School of Sport and Exercise Sciences, A-STEM Research Centre, Swansea University, Singleton Park SA2 8PP, UK.
| | - Gareth Stratton
- School of Sport and Exercise Sciences, A-STEM Research Centre, Swansea University, Singleton Park SA2 8PP, UK.
| | - Mikael Fogelholm
- Department of Food and Environmental Sciences, University of Helsinki, 00014 Helsinki, Finland.
| | - Thomas M Larsen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, 1958 Copenhagen, Denmark.
| | - Sally D Poppitt
- Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland 1010, New Zealand.
| | - Lars O Dragsted
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, 1958 Copenhagen, Denmark.
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, 1958 Copenhagen, Denmark.
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26
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Christensen P, Henriksen M, Bartels EM, Leeds AR, Meinert Larsen T, Gudbergsen H, Riecke BF, Astrup A, Heitmann BL, Boesen M, Christensen R, Bliddal H. Long-term weight-loss maintenance in obese patients with knee osteoarthritis: a randomized trial. Am J Clin Nutr 2017; 106:755-763. [PMID: 28747328 DOI: 10.3945/ajcn.117.158543] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 06/21/2017] [Indexed: 01/29/2023] Open
Abstract
Background: A formula low-energy diet (LED) reduces weight effectively in obese patients with knee osteoarthritis, but the role of LED in long-term weight-loss maintenance is unclear.Objective: We aimed to determine the effect of intermittent LED compared with daily meal replacements on weight-loss maintenance and number of knee replacements over 3 y.Design: The design was a randomized trial with participants aged >50 y who had knee osteoarthritis and a body mass index [BMI (in kg/m2)] ≥30. Participants were recruited from the osteoarthritis outpatient clinic at Copenhagen University Hospital in Frederiksberg, Denmark; they had previously completed a 68-wk lifestyle intervention trial and achieved an average weight loss of 10.5 kg (10% of initial body weight). Participants were randomly assigned to either the intermittent treatment (IN) group with LED for 5 wk every 4 mo for 3 y or to daily meal replacements of 1-2 meals for 3 y [regular (RE) group]. Attention by dietitians and the amount of formula products were similar. Primary outcomes were changes in body weight and proportion of participants receiving knee replacements. Outcomes were analyzed on the intention-to-treat-population with the use of baseline-carried-forward imputation for missing data.Results: A total of 153 participants (means ± SDs: BMI: 33.3 ± 4.6; age: 63.8 ± 6.3 y; 83% women) were recruited between June and December 2009 and randomly assigned to the IN (n = 76) or RE (n = 77) group. A total of 53 and 56 participants, respectively, completed the trial. Weight increased by 0.68 and 1.75 kg in the IN and RE groups, respectively (mean difference: -1.06 kg; 95% CI: -2.75, 0.63 kg; P = 0.22). Alloplasty rates were low and did not differ (IN group: 8 of 76 participants; RE group: 12 of 77 participants; P = 0.35).Conclusions: After a mean 10% weight-loss and 1-y maintenance, additional use of daily meal replacements or intermittent LED resulted in weight-loss maintenance for 3 y. These results challenge the commonly held assumption that weight regain in the long term is inevitable. This trial was registered at clinicaltrials.gov as NCT00938808.
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Affiliation(s)
- Pia Christensen
- The Parker Institute and Departments of.,Departments of Nutrition, Exercise and Sports, Faculty of Science and
| | - Marius Henriksen
- The Parker Institute and Departments of.,Physical and Occupational Therapy and
| | | | - Anthony R Leeds
- The Parker Institute and Departments of.,Departments of Nutrition, Exercise and Sports, Faculty of Science and.,North London Obesity Surgery Service, Whittington and Central Middlesex Hospitals, London, United Kingdom
| | | | | | | | - Arne Astrup
- Departments of Nutrition, Exercise and Sports, Faculty of Science and
| | - Berit L Heitmann
- The Parker Institute and Departments of.,Public Health, Section for General Practice, University of Copenhagen, Copenhagen, Denmark; and
| | - Mikael Boesen
- The Parker Institute and Departments of.,Radiology, Copenhagen University Hospital at Bispebjerg and Frederiksberg, Copenhagen, Denmark
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27
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Mortensen AR, Grossmann I, Rosenkilde M, Wara P, Laurberg S, Christensen P. Double-blind randomized controlled trial of collagen mesh for the prevention of abdominal incisional hernia in patients having a vertical rectus abdominis myocutaneus flap during surgery for advanced pelvic malignancy. Colorectal Dis 2017; 19:491-500. [PMID: 27805791 DOI: 10.1111/codi.13552] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 07/18/2016] [Indexed: 02/08/2023]
Abstract
AIM The study investigated the effect of collagen mesh-assisted closure at the donor site in preventing the formation of incisional hernia following construction of a vertical rectus abdominis myocutaneus (VRAM) flap as part of pelvic surgery for recurrent colorectal cancer. METHOD The study was a double-blinded randomized controlled superiority trial that was designed and performed according to the Consolidated Standards of Reporting Trials (CONSORT) Statement. Eligible patients undergoing surgery that included a VRAM flap for advanced colorectal pelvic malignancy were prospectively randomized to conventional abdominal wound closure or collagen mesh-assisted closure. The primary end-point was incisional herniation at 1 year confirmed by CT. Secondary end-points were CT-verified incisional herniation at 3 and 36 months, clinically recognizable incisional herniation, donor-site and reconstructive-site complications, surgical mortality, postoperative morbidity, postoperative recovery and survival. RESULTS In total, 58 (29 conventional closure; 29 mesh-assisted closure) patients were included. At 1 year, incisional herniation on the CT scan was found in 12 (50%) of 24 patients in the conventional closure group, and in 8 (33%) of 24 in the mesh-assisted closure group (P = 0.38). No significant difference between the groups was found in surgical mortality, early or late complications or survival. Donor-site morbidity was comparable between the two groups. CONCLUSION No preventative effect of collagen mesh-assisted closure was observed following VRAM flap reconstruction.
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Affiliation(s)
- A R Mortensen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - I Grossmann
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - M Rosenkilde
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - P Wara
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - S Laurberg
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - P Christensen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
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28
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Thyø A, Emmertsen KJ, Pinkney TD, Christensen P, Laurberg S. The colostomy impact score: development and validation of a patient reported outcome measure for rectal cancer patients with a permanent colostomy. A population-based study. Colorectal Dis 2017; 19:O25-O33. [PMID: 27883253 DOI: 10.1111/codi.13566] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 09/29/2016] [Indexed: 12/12/2022]
Abstract
AIM The aim was to develop and validate a simple scoring system evaluating the impact of colostomy dysfunction on quality of life (QOL) in patients with a permanent stoma after rectal cancer treatment. METHOD In this population-based study, 610 patients with a permanent colostomy after previous rectal cancer treatment during the period 2001-2007 completed two questionnaires: (i) the basic stoma questionnaire consisting of 22 items about stoma function with one anchor question addressing the overall stoma impact on QOL and (ii) the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) C30. Answers from half of the cohort were used to develop the score and subsequently validated on the remaining half. Logistic regression analyses identified and selected items for the score and multivariate analysis established the score value allocated to each item. RESULTS The colostomy impact score includes seven items with a total range from 0 to 38 points. A score of ≥ 10 indicates major colostomy impact (Major CI). The score has a sensitivity of 85.7% for detecting patients with significant stoma impact on QOL. Using the EORTC QLQ scales, patients with Major CI experienced significant impairment in their QOL compared to the Minor CI group. CONCLUSION This new scoring system appears valid for the assessment of the impact on QOL from having a permanent colostomy in a Danish rectal cancer population. It requires validation in non-Danish populations prior to its acceptance as a valuable patient-reported outcome measure for patients internationally.
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Affiliation(s)
- A Thyø
- Colorectal Surgical Unit, Aarhus University Hospital, Aarhus, Denmark
| | - K J Emmertsen
- Colorectal Surgical Unit, Aarhus University Hospital, Aarhus, Denmark
| | - T D Pinkney
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - P Christensen
- Colorectal Surgical Unit, Aarhus University Hospital, Aarhus, Denmark
| | - S Laurberg
- Colorectal Surgical Unit, Aarhus University Hospital, Aarhus, Denmark
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29
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Christensen P. From misbelieve to proofs in transanal irrigation for functional bowel problems. Tech Coloproctol 2016; 20:609-10. [DOI: 10.1007/s10151-016-1510-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 07/19/2016] [Indexed: 11/28/2022]
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30
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Nielsen SD, Faaborg PM, Christensen P, Krogh K, Finnerup NB. Chronic abdominal pain in long-term spinal cord injury: a follow-up study. Spinal Cord 2016; 55:290-293. [DOI: 10.1038/sc.2016.124] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 11/09/2022]
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31
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Tankisi H, Pugdahl K, Rasmussen MM, Clemmensen D, Rawashdeh YF, Christensen P, Krogh K, Fuglsang-Frederiksen A. Pelvic floor electrophysiology in spinal cord injury. Clin Neurophysiol 2016; 127:2319-24. [PMID: 26975618 DOI: 10.1016/j.clinph.2015.12.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/08/2015] [Accepted: 12/20/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The study aimed to investigate sacral peripheral nerve function and continuity of pudendal nerve in patients with chronic spinal cord injury (SCI) using pelvic floor electrophysiological tests. METHODS Twelve patients with low cervical or thoracic SCI were prospectively included. Quantitative external anal sphincter (EAS) muscle electromyography (EMG), pudendal nerve terminal motor latency (PNTML) testing, bulbocavernosus reflex (BCR) testing and pudendal short-latency somatosensory-evoked potential (SEP) measurement were performed. RESULTS In EAS muscle EMG, two patients had abnormal increased spontaneous activity and seven prolonged motor unit potential duration. PNTML was normal in 10 patients. BCR was present with normal latency in 11 patients and with prolonged latency in one. The second component of BCR could be recorded in four patients. SEPs showed absent cortical responses in 11 patients and normal latency in one. CONCLUSIONS Pudendal nerve and sacral lower motor neuron involvement are significantly associated with chronic SCI, most prominently in EAS muscle EMG. The frequent finding of normal PNTML latencies supports earlier concerns on the utility of this test; however, BCR and pudendal SEPs may have clinical relevance. SIGNIFICANCE As intact peripheral nerves including pudendal nerve are essential for efficient supportive therapies, pelvic floor electrophysiological testing prior to these interventions is highly recommended.
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Affiliation(s)
- H Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.
| | - K Pugdahl
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - M M Rasmussen
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark; Pelvic Floor Unit, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - D Clemmensen
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
| | - Y F Rawashdeh
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - P Christensen
- Pelvic Floor Unit, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - K Krogh
- Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
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32
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Juul T, Battersby NJ, Christensen P, Janjua AZ, Branagan G, Laurberg S, Emmertsen KJ, Moran B. Validation of the English translation of the low anterior resection syndrome score. Colorectal Dis 2015; 17:908-16. [PMID: 25807963 DOI: 10.1111/codi.12952] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 01/25/2015] [Indexed: 02/08/2023]
Abstract
AIM Many patients having anterior resection for rectal cancer suffer from severe long-term bowel dysfunction, known as low anterior resection syndrome (LARS). The LARS score was developed in Denmark, and Swedish, Spanish and German versions have been validated. The aim of this study was to validate the English translation of the LARS score in British rectal cancer patients. METHOD Rectal cancer patients who underwent an anterior resection in 12 UK centres received the LARS score questionnaire, the EORTC QLQ-C30 and a single ad hoc quality of life question. A subgroup of patients received the LARS score questionnaire twice. RESULTS The response rate was 80% and 451 patients were included in the analyses. A strong association between LARS score and quality of life (convergent validity) was found (P < 0.01), discriminative validity was good (P < 0.02) and the test-retest reliability was high (intraclass correlation coefficient 0.83). CONCLUSION The English translation of the LARS score has shown good psychometric properties comparable with recently published results from an international multicentre study. Thus, the English translation of the LARS score can be considered a valid and reliable tool for measuring LARS.
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Affiliation(s)
- T Juul
- Department of Surgery - Section for Colorectal Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - N J Battersby
- The Pelican Cancer Foundation, The Ark, Basingstoke, UK.,Department of Colorectal Surgery, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - P Christensen
- Department of Surgery - Section for Colorectal Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - A Z Janjua
- The Pelican Cancer Foundation, The Ark, Basingstoke, UK.,Department of Colorectal Surgery, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - G Branagan
- Colorectal Surgery, Salisbury NHS Foundation Trust, Basingstoke, UK
| | - S Laurberg
- Department of Surgery - Section for Colorectal Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - K J Emmertsen
- Department of Surgery - Section for Colorectal Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - B Moran
- The Pelican Cancer Foundation, The Ark, Basingstoke, UK.,Department of Colorectal Surgery, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
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Tylén K, Christensen P, Roepstorff A, Lund T, Østergaard S, Donald M. Brains striving for coherence: Long-term cumulative plot formation in the default mode network. Neuroimage 2015. [PMID: 26216276 DOI: 10.1016/j.neuroimage.2015.07.047] [Citation(s) in RCA: 21] [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] [Indexed: 11/15/2022] Open
Abstract
Many everyday activities, such as engaging in conversation or listening to a story, require us to sustain attention over a prolonged period of time while integrating and synthesizing complex episodic content into a coherent mental model. Humans are remarkably capable of navigating and keeping track of all the parallel social activities of everyday life even when confronted with interruptions or changes in the environment. However, the underlying cognitive and neurocognitive mechanisms of such long-term integration and profiling of information remain a challenge to neuroscience. While brain activity is generally traceable within the short time frame of working memory (milliseconds to seconds), these integrative processes last for minutes, hours or even days. Here we report two experiments on story comprehension. Experiment I establishes a cognitive dissociation between our comprehension of plot and incidental facts in narratives: when episodic material allows for long-term integration in a coherent plot, we recall fewer factual details. However, when plot formation is challenged, we pay more attention to incidental facts. Experiment II investigates the neural underpinnings of plot formation. Results suggest a central role for the brain's default mode network related to comprehension of coherent narratives while incoherent episodes rather activate the frontoparietal control network. Moreover, an analysis of cortical activity as a function of the cumulative integration of narrative material into a coherent story reveals to linear modulations of right hemisphere posterior temporal and parietal regions. Together these findings point to key neural mechanisms involved in the fundamental human capacity for cumulative plot formation.
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Affiliation(s)
- K Tylén
- Center for Semiotics, Department for Aesthetics and Communication, Aarhus University, Jens Chr. Skous Vej 2, 8000 Aarhus C, Denmark; Center for Functionally Integrative Neuroscience, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark; The Interacting Minds Center, Department of Culture and Society, Aarhus University, Jens Chr. Skous Vej 4, 8000 Aarhus C, Denmark.
| | - P Christensen
- The Interacting Minds Center, Department of Culture and Society, Aarhus University, Jens Chr. Skous Vej 4, 8000 Aarhus C, Denmark; Centre for Languages and Literature, Lund University, Helgonabacken 12, 221 00 Lund, Sweden
| | - A Roepstorff
- Center for Functionally Integrative Neuroscience, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark; The Interacting Minds Center, Department of Culture and Society, Aarhus University, Jens Chr. Skous Vej 4, 8000 Aarhus C, Denmark
| | - T Lund
- Center for Functionally Integrative Neuroscience, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - S Østergaard
- Center for Semiotics, Department for Aesthetics and Communication, Aarhus University, Jens Chr. Skous Vej 2, 8000 Aarhus C, Denmark
| | - M Donald
- Department of Psychology, Hunphrey Hall, 62 Arch St., Queens University, Kingston, Ontario K7L3N6, Canada
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Christensen R, Henriksen M, Leeds AR, Gudbergsen H, Christensen P, Sørensen TJ, Bartels EM, Riecke BF, Aaboe J, Frederiksen R, Boesen M, Lohmander LS, Astrup A, Bliddal H. Effect of weight maintenance on symptoms of knee osteoarthritis in obese patients: a twelve-month randomized controlled trial. Arthritis Care Res (Hoboken) 2015; 67:640-50. [PMID: 25370359 PMCID: PMC4657487 DOI: 10.1002/acr.22504] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [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: 04/04/2014] [Revised: 08/27/2014] [Accepted: 10/21/2014] [Indexed: 12/21/2022]
Abstract
Objective To compare results of obese patients with knee osteoarthritis (OA) who, after an intensive weight loss regimen, received 1 year of either dietary support (D), a knee-exercise program (E), or “no attention” (C; control group). Methods We conducted a randomized, 2-phase, parallel-group trial. A total of 192 obese participants with knee OA were enrolled; the mean age was 62.5 years and 81% were women with a mean entry weight of 103.2 kg. In phase 1, all participants were randomly assigned to 1 of 3 groups and began a dietary regimen of 400–810 and 1,250 kcal/day for 16 weeks (2 8-week phases) to achieve a major weight loss. Phase 2 consisted of 52 weeks' maintenance in either group D, E, or C. Outcomes were changes from randomization in pain on a 100-mm visual analog scale, weight, and response according to the Outcome Measures in Rheumatology-Osteoarthritis Research Society International criteria. Results Mean weight loss for phase 1 was 12.8 kg. After 1 year on maintenance therapy, the D group sustained a lower weight (11.0 kg, 95% confidence interval [95% CI] 9.0, 12.8 kg) than those in the E (6.2, 95% CI 4.4, 8.1 kg) and C (8.2, 95% CI 6.4, 10.1 kg) groups (P = 0.002 by analysis of covariance [ANCOVA]). Adherence was low in the E group. All groups had statistically significant pain reduction (D: 6.1; E: 5.6; and C: 5.5 mm) with no difference between groups (P = 0.98 by ANCOVA). In each group 32 (50%), 26 (41%), and 33 (52%) participants responded to treatment in the D, E, and C groups, respectively, with no statistically significant difference in the number of responders (P = 0.41). Conclusion A significant weight reduction with a 1-year maintenance program improves knee OA symptoms irrespective of maintenance program.
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Affiliation(s)
- Robin Christensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region of Copenhagen, Denmark
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Rasmussen MM, Krogh K, Clemmensen D, Tankisi H, Fuglsang-Frederiksen A, Rawashdeh Y, Bluhme H, Christensen P. The artificial somato-autonomic reflex arch does not improve bowel function in subjects with spinal cord injury. Spinal Cord 2015; 53:705-10. [DOI: 10.1038/sc.2015.75] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 03/28/2015] [Accepted: 04/01/2015] [Indexed: 11/10/2022]
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Christensen KK, Christensen P, Seger RA. Intravenous administration of human IgG to newborn infants: changes in serum antibody levels to GBS. Antibiot Chemother (1971) 2015; 35:247-53. [PMID: 3901901 DOI: 10.1159/000410378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Christensen KK, Christensen P. Chlorhexidine for prevention of neonatal colonization with GBS. Antibiot Chemother (1971) 2015; 35:296-302. [PMID: 3901906 DOI: 10.1159/000410383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Christensen KK, Christensen P. Immunological characterization of mothers of infants with neonatal GBS infection: definition of a risk group. Antibiot Chemother (1971) 2015; 35:190-3. [PMID: 3901895 DOI: 10.1159/000410372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Bartels EM, Christensen R, Christensen P, Henriksen M, Bennett A, Gudbergsen H, Boesen M, Bliddal H. Effect of a 16 weeks weight loss program on osteoarthritis biomarkers in obese patients with knee osteoarthritis: a prospective cohort study. Osteoarthritis Cartilage 2014; 22:1817-25. [PMID: 25106676 DOI: 10.1016/j.joca.2014.07.027] [Citation(s) in RCA: 23] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 06/26/2014] [Accepted: 07/29/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Changes in biomarkers for bone and cartilage in knee osteoarthritis (KOA) may reflect changes in tissue turnover induced by interventions. The aim of this study was to assess the effect on osteoarthritis biomarkers of an intensive weight loss intervention in obese KOA patients. METHODS 192 obese KOA patients followed a 16 weeks weight loss intervention (ClinicalTrials.gov: NCT00655941). Serum Cartilage Oligomeric Matrix Protein (sCOMP), Urine C-terminal telopeptide of collagen type II (uCTX-II) and type I (uCTX-I) were determined by enzyme-linked immunoassay (ELISA) at baseline and after 16 weeks. Patient-reported symptoms were assessed by the Knee Injury and Osteoarthritis Outcome Score (KOOS) Questionnaire without the sports and recreation score (KOOS-4). Change from baseline was analyzed using Analysis of CoVariance (ANCOVA) adjusting for sex, age, and body mass index (BMI). Bivariate associations were analyzed using Spearman's test of rank correlation. RESULTS 175 patients completed the treatment and lost mean 13.4 (95% CI: 12.5-14.4) kg. sCOMP concentration decreased on average 1.1 (95% CI: -1.5 to -0.8) U/L with a correlation to weight loss (r = -0.17, P = 0.028), but not to change in KOOS-4 (r = -0.13, P = 0.091). uCTX-II increased significantly, mean 69 (95% CI: 31-106) ng/mmol creatinine, with no relation to weight loss (P = 0.14). Change in uCTX-II was reversely related to change in KOOS-4 (r = -0.28, P = 0.0003). uCTX-I increased, mean 67 (95% CI: 47-87) μg/mmol creatinine, and correlated to weight loss (r = 0.22, P = 0.0007), while not to KOOS-4 (P = 0.93). CONCLUSION A rapid substantial weight loss in obese KOA patients was weakly, while significantly associated with a reduction in sCOMP, and increases in both uCTX-II and uCTX-I.
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Affiliation(s)
- E M Bartels
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark.
| | - R Christensen
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark; Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.
| | - P Christensen
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark; Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark.
| | - M Henriksen
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark.
| | - A Bennett
- Immunodiagnostic Systems Limited (IDS), UK.
| | - H Gudbergsen
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark; Knowledgecentre for Telemedicine, The Capital Region of Denmark, Denmark; Department of Rheumatology, Copenhagen University Hospitals, Glostrup, Frederiksberg and Bispebjerg, Denmark.
| | - M Boesen
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark; Department of Radiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark.
| | - H Bliddal
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark; Faculty of Health Science, University of Copenhagen, Denmark; SMI, Aalborg University, Denmark.
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Hughes AT, Milan AM, Christensen P, Ross G, Davison AS, Gallagher JA, Dutton JJ, Ranganath LR. Urine homogentisic acid and tyrosine: simultaneous analysis by liquid chromatography tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2014; 963:106-12. [PMID: 24952314 DOI: 10.1016/j.jchromb.2014.06.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 05/28/2014] [Accepted: 06/01/2014] [Indexed: 11/17/2022]
Abstract
Alkaptonuria (AKU) is a rare debilitating autosomal recessive disorder of tyrosine metabolism. Deficiency of homogentisate 1,2-dioxygenase results in increased homogentisic acid (HGA) which although excreted in gram quantities in the urine, is deposited as an ochronotic pigment in connective tissues, especially cartilage. Ochronosis leads to a severe, early-onset form of osteoarthritis, increased renal and prostatic stone formation and hardening of heart vessels. Treatment with the orphan drug, Nitisinone, an inhibitor of the enzyme 4-hydroxyphenylpyruvate dioxygenase has been shown to reduce urinary excretion of HGA, resulting in accumulation of the upstream pre-cursor, tyrosine. Using reverse phase LC-MS/MS, a method has been developed to simultaneously quantify urinary HGA and tyrosine. Using matrix-matched calibration standards, two product ion transitions were identified for each compound and their appropriate isotopically labelled internal standards. Validation was performed across the AKU and post-treatment concentrations expected. Intrabatch accuracy for acidified urine was 96-109% for tyrosine and 94-107% for HGA; interbatch accuracy (n=20 across ten assays) was 95-110% for tyrosine and 91-109% for HGA. Precision, both intra- and interbatch was <10% for tyrosine and <5% for HGA. Matrix effects observed with acidified urine (12% decrease, CV 5.6%) were normalised by the internal standard. Tyrosine and HGA were proved stable under various storage conditions and no carryover, was observed. Overall the method developed and validated shows good precision, accuracy and linearity appropriate for the monitoring of patients with AKU, pre and post-nitisinone therapy.
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Affiliation(s)
- A T Hughes
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool and Broadgreen University Hospital Trust, Duncan Building, Liverpool L7 8XP, United Kingdom; Bone and Joint Research Group, Musculoskeletal Biology, Sherrington Building, University of Liverpool, Liverpool L69 3GE, United Kingdom
| | - A M Milan
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool and Broadgreen University Hospital Trust, Duncan Building, Liverpool L7 8XP, United Kingdom; Bone and Joint Research Group, Musculoskeletal Biology, Sherrington Building, University of Liverpool, Liverpool L69 3GE, United Kingdom.
| | - P Christensen
- Agilent Technologies, 5500 Lakeside, Cheadle Royal Business Park, Cheadle, Stockport SK8 3GR, United Kingdom
| | - G Ross
- Agilent Technologies, 5500 Lakeside, Cheadle Royal Business Park, Cheadle, Stockport SK8 3GR, United Kingdom
| | - A S Davison
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool and Broadgreen University Hospital Trust, Duncan Building, Liverpool L7 8XP, United Kingdom
| | - J A Gallagher
- Bone and Joint Research Group, Musculoskeletal Biology, Sherrington Building, University of Liverpool, Liverpool L69 3GE, United Kingdom
| | - J J Dutton
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool and Broadgreen University Hospital Trust, Duncan Building, Liverpool L7 8XP, United Kingdom
| | - L R Ranganath
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool and Broadgreen University Hospital Trust, Duncan Building, Liverpool L7 8XP, United Kingdom; Bone and Joint Research Group, Musculoskeletal Biology, Sherrington Building, University of Liverpool, Liverpool L69 3GE, United Kingdom
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Tankisi H, Rasmussen M, Pugdahl K, Clemmensen D, Rawashdeh Y, Christensen P, Krogh K, Fuglsang-Frederiksen A. P875: Pelvic floor electrophysiology in spinal cord injury. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50907-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bliddal H, Christensen P, Bartels E, Leeds A, Astrup A, Christensen R. AB0778 Long-Term Intervention with Weight Loss in Patients with Concomitant Obesity and Knee Osteoarthritis: A Randomised Trial (The Light Study). Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5634] [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: 11/04/2022]
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Faaborg PM, Christensen P, Krassioukov A, Laurberg S, Frandsen E, Krogh K. Autonomic dysreflexia during bowel evacuation procedures and bladder filling in subjects with spinal cord injury. Spinal Cord 2014; 52:494-8. [PMID: 24777164 DOI: 10.1038/sc.2014.45] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 01/27/2014] [Accepted: 02/03/2014] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Randomized, controlled clinical trial. OBJECTIVES Bladder and bowel management may cause serious autonomic dysreflexia (AD) in subjects with high spinal cord injury (SCI). We aimed at investigating autonomic responses to digital rectal evacuation (DE), transanal irrigation (TAI) with 500 ml and filling cystometry (FC) in SCI. SETTING Aarhus University Hospital, Denmark. METHODS Eight subjects with SCI (AIS A) at or above T6 (high SCI) and a previous history of AD were compared with three subjects with SCI (AIS A) between T10 and L2 (low SCI). In randomized order, DE, TAI and FC were performed. AD was defined as an acute rise in systolic blood pressure (sBP) of ⩾30 mm Hg above baseline. Blood levels of norepinephrine and epinephrine were determined before and shortly after the procedures. RESULTS During all three procedures, AD occurred in all patients with high SCI but not in those with low SCI. In high SCI subjects, DE increased median sBP from 127 (range: 86-154) to 188 (range: 140-206) mm Hg (P<0.02), TAI from 126 (range: 91-146) to 163 (range: 130-188) mm Hg (P<0.02) and FC from 125 (range: 106-149) to 200 (range: 179-220) mm Hg (P<0.01). The sBP increase was lower during TAI than during DE (P<0.05) or FC (P<0.02). In high SCI subjects, the blood levels of norepinephrine, but not those of epinephrine, increased significantly during all three stimuli (all P<0.05). CONCLUSION Bowel and bladder management caused AD in high SCI. The response is less severe during TAI than during FC or DE.
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Affiliation(s)
- P M Faaborg
- 1] Pelvic Floor Unit, Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark [2] Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - P Christensen
- Pelvic Floor Unit, Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark
| | - A Krassioukov
- Division of Physical Medicine and Rehabilitation, ICORD, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - S Laurberg
- Pelvic Floor Unit, Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark
| | - E Frandsen
- Department of Clinical Physiology and Nuclear Medicine, Glostrup University Hospital, Copenhagen, Denmark
| | - K Krogh
- Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
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Lykke K, Christensen P, Reventlow S. GPs' strategies in exploring the preschool child's wellbeing in the paediatric consultation. BMC Fam Pract 2013; 14:177. [PMID: 24261344 PMCID: PMC3870995 DOI: 10.1186/1471-2296-14-177] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 11/15/2013] [Indexed: 11/24/2022]
Abstract
Background Although General Practitioners (GPs) are uniquely placed to identify children with emotional, social, and behavioural problems, they succeed in identifying only a small number of them. The aim of this article is to explore the strategies, methods, and tools employed by GPs in the assessment of the preschool child’s emotional, mental, social, and behavioural health. We look at how GPs address parental care of the child in general and in situations where GPs have a particular awareness of the child. Method Twenty-eight Danish GPs were purposively selected to take part in a qualitative study which combined focus-group discussions, observation of child consultations, and individual interviews with GPs. Results Analysis of the data suggests that GPs have developed a set of methods, and strategies to assess the preschool child and parental care of the child. They look beyond paying narrow attention to the physical health of the child and they have expanded their practice to include the relations and interactions in the consultation room. The physical examination of the child continues to play a central role in doctor-child communication. Conclusion The participating GPs’ strategies helped them to assess the wellbeing of the preschool child but they often find it difficult to share their impressions with parents.
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Affiliation(s)
- Kirsten Lykke
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Postboks 2099, Copenhagen K, 1014, Denmark.
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Christensen P, Frederiksen R, Bliddal H, Riecke BF, Bartels EM, Henriksen M, Juul-S Rensen T, Gudbergsen H, Winther K, Astrup A, Christensen R. Comparison of three weight maintenance programs on cardiovascular risk, bone and vitamins in sedentary older adults. Obesity (Silver Spring) 2013; 21:1982-90. [PMID: 23512743 DOI: 10.1002/oby.20413] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 01/24/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Obese patients with knee osteoarthritis (OA) are encouraged to lose weight to obtain symptomatic relief. Risk of vascular events is higher in people with OA compared to people without arthritis. Our aim in this randomized trial was to compare changes in cardiovascular disease (CVD) risk-factors, nutritional health, and body composition after 1-year weight-loss maintenance achieved by [D]diet, [E]knee-exercise, or [C]control, following weight loss by low-energy-diet. DESIGN AND METHODS Obese individuals (n = 192, >50 years) with knee OA, 63 years (SD 6), weight 103.2 kg (15.0), body-mass index 37.3 kg/m(2) (4.8), were enrolled into a 68-week weight-loss trial. RESULTS Mean changes in weight, in D, E, and C were -11.0, -6.3, and -8.3 kg (P = 0.002). Reduction in waist circumference in D, E, and C were -8.4, -4.6, and -7.0 cm (P = 0.007). D reduced waist circumference significantly more than E: -3.8 cm (95%CI -6.2 to -1.4; P = 0.0024). There was no difference between the groups in changes in CVD risk factors; blood pressure, triglycerides, and cholesterol. Nutritional health was improved in all groups. For markers of bone, no statistical difference was found between the groups. CONCLUSIONS Dietary support, or control, maintained improvements in cardiovascular risk factors to the same extent and none of the interventions had a detrimental effect on bone.
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Affiliation(s)
- Pia Christensen
- The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen F, Denmark; Department of Human Nutrition, Faculty of Life Sciences, University of Copenhagen, Frederiksberg, Denmark
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Fernandes L, Hagen KB, Bijlsma JWJ, Andreassen O, Christensen P, Conaghan PG, Doherty M, Geenen R, Hammond A, Kjeken I, Lohmander LS, Lund H, Mallen CD, Nava T, Oliver S, Pavelka K, Pitsillidou I, da Silva JA, de la Torre J, Zanoli G, Vliet Vlieland TPM. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann Rheum Dis 2013; 72:1125-35. [PMID: 23595142 DOI: 10.1136/annrheumdis-2012-202745] [Citation(s) in RCA: 845] [Impact Index Per Article: 76.8] [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] [Indexed: 02/06/2023]
Abstract
The objective was to develop evidence -based recommendations and a research and educational agenda for the non-pharmacological management of hip and knee osteoarthritis (OA). The multidisciplinary task force comprised 21 experts: nurses, occupational therapists, physiotherapists, rheumatologists, orthopaedic surgeons, general practitioner, psychologist, dietician, clinical epidemiologist and patient representatives. After a preliminary literature review, a first task force meeting and five Delphi rounds, provisional recommendations were formulated in order to perform a systematic review. A literature search of Medline and eight other databases was performed up to February 2012. Evidence was graded in categories I-IV and agreement with the recommendations was determined through scores from 0 (total disagreement) to 10 (total agreement). Eleven evidence-based recommendations for the non-pharmacological core management of hip and knee OA were developed, concerning the following nine topics: assessment, general approach, patient information and education, lifestyle changes, exercise, weight loss, assistive technology and adaptations, footwear and work. The average level of agreement ranged between 8.0 and 9.1. The proposed research agenda included an overall need for more research into non-pharmacological interventions for hip OA, moderators to optimise individualised treatment, healthy lifestyle with economic evaluation and long-term follow-up, and the prevention and reduction of work disability. Proposed educational activities included the required skills to teach, initiate and establish lifestyle changes. The 11 recommendations provide guidance on the delivery of non-pharmacological interventions to people with hip or knee OA. More research and educational activities are needed, particularly in the area of lifestyle changes.
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Affiliation(s)
- Linda Fernandes
- National Resource Center for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
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Rasmussen MM, Krogh K, Clemmensen D, Bluhme H, Rawashdeh Y, Christensen P. Colorectal transport during defecation in subjects with supraconal spinal cord injury. Spinal Cord 2013; 51:683-7. [PMID: 23774126 DOI: 10.1038/sc.2013.58] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 04/17/2013] [Accepted: 05/08/2013] [Indexed: 01/07/2023]
Abstract
STUDY DESIGN Clinical study. OBJECTIVES To explore how supraconal spinal cord injury (SCI) affects colorectal emptying at defecation. Further, to relate findings to subject symptomatology expressed by bowel function scores and gastrointestinal transit time (GITT). SETTING Aarhus University Hospital, Denmark. METHODS Colorectal contents were marked by oral intake of (111)In-coated resin pellets. Movement of stools at defecation was assessed by comparing scintigrams performed before and just after defecation. Results from 15 subjects with SCI (14 males, median age=47 years (range: 22-74 years), SCI level: C5-Th9) were compared with those from 16 healthy volunteers (12 males, median age=31 years (range: 24-42 years)). Bowel symptoms were described from standard symptom scores, and GITT was assessed by radiopaque markers. RESULTS Median emptying at defecation was 31% of the rectosigmoid (range: 0% to complete emptying of the rectosigmoid and 49% of the descending colon) in subjects with SCI and 89% of the rectosigmoid (range: 53% to complete emptying of the rectosigmoid and the descending colon, and 3% of the transverse colon) in the control group (P<0.01). Colorectal emptying at defecation was associated with the St Mark's fecal incontinence score (P=0.02) but not with the Cleveland constipation score (P=0.17), the neurogenic bowel dysfunction score (P=0.12) or GITT (P=0.99). CONCLUSION Supraconal SCI results in significantly reduced emptying of stools at defecation. This is independent of changes in GITT.
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Affiliation(s)
- M M Rasmussen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.
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Mao W, Huang C, Kearney V, Song K, Christensen P, Sun X, Hao Y, Solberg T. WE-E-108-01: BEST IN PHYSICS (THERAPY) - Radiotherapy Enhancement with a Novel Class of Hollow Nanoconstructs. Med Phys 2013. [DOI: 10.1118/1.4815579] [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: 11/07/2022] Open
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