1
|
Krarup KB, Krarup HB, Mørk M, Lundbye-Christensen S, Handberg A, Nguyen HTT, Pedersen IS, Kristensen SR. Are Gamers Prone to eThrombosis during Long Gaming Sessions? Life (Basel) 2024; 14:525. [PMID: 38672795 PMCID: PMC11051545 DOI: 10.3390/life14040525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
During the last two decades, several cases of venous thrombosis (VTE) after a prolonged period at a computer have been described, denominated as "eThrombosis". Video gaming on a computer has become very popular and can be a social activity where several players gather to play against each other or in a virtual environment for several days ("LAN (i.e., Local Area Network) parties") where the participants are sedentary and consuming calorie-rich food items. The aim of this study was to investigate potential coagulation activation during a 42 h LAN party. Nine male gamers volunteered for the LAN party. Citrated blood was sampled before and every 6 h, and plasma was analyzed for thrombin generation, thrombin-antithrombin complexes (TAT), prothrombin fragment 1 + 2 (F1 + 2), and D-dimer. Thrombin generation increased slightly but not significantly during the LAN party, whereas the coagulation activation markers were unchanged. These results do not indicate that the coagulation system is activated significantly during 42 h of gaming with minimal physical activity. Although increased activity cannot be excluded, it does not directly indicate a risk of VTE in general.
Collapse
Affiliation(s)
- Kasper B. Krarup
- Department of Geriatrics, Aalborg University Hospital, 9000 Aalborg, Denmark;
- Sports Medicine Center, Region Hospital North Jutland, 9900 Frederikshavn, Denmark
| | - Henrik B. Krarup
- Department of Molecular Diagnostics, Aalborg University Hospital, 9000 Aalborg, Denmark; (H.B.K.); (H.T.T.N.); (I.S.P.)
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark; (S.L.-C.)
| | - Morten Mørk
- Department of Clinical Biochemistry, Aalborg University Hospital, 9000 Aalborg, Denmark;
| | | | - Aase Handberg
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark; (S.L.-C.)
- Department of Clinical Biochemistry, Aalborg University Hospital, 9000 Aalborg, Denmark;
| | - Hien T. T. Nguyen
- Department of Molecular Diagnostics, Aalborg University Hospital, 9000 Aalborg, Denmark; (H.B.K.); (H.T.T.N.); (I.S.P.)
| | - Inge S. Pedersen
- Department of Molecular Diagnostics, Aalborg University Hospital, 9000 Aalborg, Denmark; (H.B.K.); (H.T.T.N.); (I.S.P.)
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark; (S.L.-C.)
| | - Søren R. Kristensen
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark; (S.L.-C.)
- Department of Clinical Biochemistry, Aalborg University Hospital, 9000 Aalborg, Denmark;
| |
Collapse
|
2
|
Jakobsen SS, Frøkjaer JB, Fisker RV, Kristensen SR, Thorlacius-Ussing O, Larsen AC. Monocyte recruitment in venous pulmonary embolism at time of cancer diagnosis in upper gastrointestinal cancer patients. J Thromb Thrombolysis 2024; 57:11-20. [PMID: 37792208 PMCID: PMC10830795 DOI: 10.1007/s11239-023-02897-5] [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] [Accepted: 09/12/2023] [Indexed: 10/05/2023]
Abstract
Upper gastrointestinal cancer is frequently complicated by venous thromboembolisms (VTE), especially pulmonary embolisms (PE) increase the mortality rate. Monocytes are a part of the innate immune system and up-regulation may indicate an ongoing inflammatory response or infectious disease and has lately been associated with a moderate risk of suffering from VTE. This prospectively study aims to compare the incidence of pulmonary embolism with markers of coagulation and compare it to the absolute monocyte count. A consecutive cohort of 250 patients with biopsy proven upper gastrointestinal cancer (i.e. pancreas, biliary tract, esophagus and gastric cancer) where included at the time of cancer diagnosis and before treatment. All patients underwent bilateral compression ultrasonography for detection of deep vein thrombosis (DVT). Of these 143 had an additionally pulmonary angiografi (CTPA) with the staging computer tomography. 13 of 250 patients (5.2%) had a DVT and 11 of 143 (7.7%) had CTPA proven PE. PE was significantly more common among patients with elevated D-dimer (OR 11.62, 95%CI: 1.13-119, P = 0.039) and elevated absolute monocyte count (OR 7.59, 95%CI: 1.37-41.98, P = 0.020). Only patients with pancreatic cancer had a significantly higher risk of DVT (OR 11.03, 95%CI: 1.25-97.43, P = 0.031). The sensitivity of absolute monocyte count was 63.6 (95%CI: 30.8-89.1) and specificity 80.3 (95%CI: 72.5-86.7), with a negative predictive value of 96.4 (95%CI: 91-99) in PE. An increased absolute monocyte count was detected in patients suffering from PE but not DVT, suggesting a possible interaction with the innate immune system.
Collapse
Affiliation(s)
- Sarah S Jakobsen
- Department of Gastrointestinal Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
- Clinical Cancer Research Center, Aalborg University Hospital, 9000, Aalborg, Denmark
| | - Jens B Frøkjaer
- Department of Radiology, Aalborg University Hospital, 9000, Aalborg, Denmark
- Clinical Cancer Research Center, Aalborg University Hospital, 9000, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000, Aalborg, Denmark
| | - Rune V Fisker
- Department of Radiology, Aalborg University Hospital, 9000, Aalborg, Denmark
- Department of Nuclear Medicine, Aalborg University Hospital, 9000, Aalborg, Denmark
- Clinical Cancer Research Center, Aalborg University Hospital, 9000, Aalborg, Denmark
| | - Søren R Kristensen
- Department of Biochemistry, Aalborg University Hospital, 9000, Aalborg, Denmark
- Cardiovascular Research Center, Aalborg University, 9000, Aalborg, Denmark
| | - Ole Thorlacius-Ussing
- Department of Gastrointestinal Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
- Clinical Cancer Research Center, Aalborg University Hospital, 9000, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000, Aalborg, Denmark
| | - Anders C Larsen
- Department of Gastrointestinal Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.
- Clinical Cancer Research Center, Aalborg University Hospital, 9000, Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, 9000, Aalborg, Denmark.
| |
Collapse
|
3
|
Crobach MJ, Anijs RJ, Brækkan SK, Severinsen MT, Hammerstrøm J, Skille H, Kristensen SR, Paulsen B, Tjønneland A, Versteeg HH, Overvad K, Hansen JB, Næss IA, Cannegieter SC. Survival after Cancer-related Venous Thrombosis: the Scandinavian Thrombosis and Cancer Study. Blood Adv 2023:495177. [PMID: 37013958 PMCID: PMC10388725 DOI: 10.1182/bloodadvances.2022009577] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 04/05/2023] Open
Abstract
Cancer patients have an increased risk of developing venous thromboembolism (VTE) and this combination is reported to result in poorer survival compared to cancer alone. The aim of this study was to investigate the impact of VTE on survival of cancer patients in a general population. The Scandinavian Thrombosis and Cancer (STAC) cohort, a population-based cohort including 144,952 subjects without previous VTE or cancer was used. During follow-up, cancer and VTE incidences were registered. 'Cancer-related VTE' was defined as VTE diagnosed in patients with overt or occult cancer. Survival of subjects without cancer and/or VTE ('disease-free') was compared with survival of subjects with cancer and cancer-related VTE. Cox-regression models with cancer and VTE as time-varying exposures were performed to calculate hazard ratios for death. Sub-analyses were performed across cancer types and stages and VTE type (deep vein thrombosis or pulmonary embolism). During follow-up (mean 11.7 years) 14,621 subjects developed cancer and 2,444 developed VTE, of which 1241 where cancer-related. The mortality rates (per 100 person-years) for disease-free subjects, VTE only, cancer only and cancer-related VTE were 0.63 (95%CI 0.62-0.65), 5.0 (4.6-5.5), 9.2 (9.0-9.5) and 45.3 (41.1-50.0), respectively. Compared with cancer only patients, the risk of death for cancer-related VTE patients was increased 3.4-fold (95%CI 3.1-3.8). Within all cancer types, the occurrence of VTE increased the mortality risk 2.8 to 14.7-fold. In a general population, cancer patients with VTE had a 3.4-fold higher mortality risk than cancer patients without VTE, independent of cancer type.
Collapse
Affiliation(s)
| | | | - Sigrid K Brækkan
- K.G. Jebsen Thrombosis Research and Expertise Center (TREC), Tromsø, Norway
| | | | - Jens Hammerstrøm
- Norwegian University of Science and Technology, Trondheim, Torgarden, Norway
| | | | | | | | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen Diet, Genes and Environment (DGE), Copenhagen, Denmark
| | | | | | | | - Inger A Næss
- Trondheim University Hospital, Trondheim, Norway
| | | |
Collapse
|
4
|
Francetic I, Meacock R, Elliott J, Kristensen SR, Britteon P, Lugo-Palacios DG, Wilson P, Sutton M. Framework for identification and measurement of spillover effects in policy implementation: intended non-intended targeted non-targeted spillovers (INTENTS). Implement Sci Commun 2022; 3:30. [PMID: 35287757 PMCID: PMC8919154 DOI: 10.1186/s43058-022-00280-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is increasing awareness among researchers and policymakers of the potential for healthcare interventions to have consequences beyond those initially intended. These unintended consequences or "spillover effects" result from the complex features of healthcare organisation and delivery and can either increase or decrease overall effectiveness. Their potential influence has important consequences for the design and evaluation of implementation strategies and for decision-making. However, consideration of spillovers remains partial and unsystematic. We develop a comprehensive framework for the identification and measurement of spillover effects resulting from changes to the way in which healthcare services are organised and delivered. METHODS We conducted a scoping review to map the existing literature on spillover effects in health and healthcare interventions and used the findings of this review to develop a comprehensive framework to identify and measure spillover effects. RESULTS The scoping review identified a wide range of different spillover effects, either experienced by agents not intentionally targeted by an intervention or representing unintended effects for targeted agents. Our scoping review revealed that spillover effects tend to be discussed in papers only when they are found to be statistically significant or might account for unexpected findings, rather than as a pre-specified feature of evaluation studies. This hinders the ability to assess all potential implications of a given policy or intervention. We propose a taxonomy of spillover effects, classified based on the outcome and the unit experiencing the effect: within-unit, between-unit, and diagonal spillover effects. We then present the INTENTS framework: Intended Non-intended TargEted Non-Targeted Spillovers. The INTENTS framework considers the units and outcomes which may be affected by an intervention and the mechanisms by which spillover effects are generated. CONCLUSIONS The INTENTS framework provides a structured guide for researchers and policymakers when considering the potential effects that implementation strategies may generate, and the steps to take when designing and evaluating such interventions. Application of the INTENTS framework will enable spillover effects to be addressed appropriately in future evaluations and decision-making, ensuring that the full range of costs and benefits of interventions are correctly identified.
Collapse
Affiliation(s)
- Igor Francetic
- Health Organization, Policy and Economics (HOPE) Research Group, Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK.
| | - Rachel Meacock
- Health Organization, Policy and Economics (HOPE) Research Group, Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK
| | - Jack Elliott
- Health Organization, Policy and Economics (HOPE) Research Group, Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK
| | - Søren R Kristensen
- Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Phillip Britteon
- Health Organization, Policy and Economics (HOPE) Research Group, Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK
| | - David G Lugo-Palacios
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Paul Wilson
- Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK
| | - Matt Sutton
- Health Organization, Policy and Economics (HOPE) Research Group, Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK
- Melbourne Institute: Applied Economic and Social Research, University of Melbourne, Melbourne, Australia
| |
Collapse
|
5
|
Riahi E, Adelborg K, Pedersen L, Kristensen SR, Hansen AT, Sørensen H. Atrial fibrillation, liver cirrhosis, thrombosis, and bleeding: A Danish population‐based cohort study. Res Pract Thromb Haemost 2022; 6:e12668. [PMID: 35229067 PMCID: PMC8867136 DOI: 10.1002/rth2.12668] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 12/28/2021] [Accepted: 01/05/2022] [Indexed: 12/04/2022] Open
Abstract
Objectives We examined the impact of liver cirrhosis on the risk of thromboembolic events and bleeding complications in patients with atrial fibrillation or flutter (AFF). Methods This population‐based cohort study used data from Danish health registries. We identified all patients with a first‐time diagnosis of AFF during 1995 to 2015, and followed them from their AFF diagnosis until the end of 2016. Patients were categorized according to the presence or absence of liver cirrhosis. We computed incidence rates per 1000 person‐years and hazard ratios (HRs) with 95% confidence intervals (CIs) based on Cox regression analyses, adjusting for age, CHA2DS2VASc score, and Charlson Comorbidity Index score. Results We identified 273 225 patients with AFF. Of these, 1463 (0.54%) had liver cirrhosis. During 0 to 5 years of follow‐up, compared to patients without liver cirrhosis, patients with liver cirrhosis had higher incidence rates and hazards of ischemic stroke (29.7 vs 21.6; HR, 1.3; 95% CI, 1.1‐1.6), venous thromboembolism (9.2 vs 5.5; HR, 1.5; 95% CI, 1.2‐2.3), but not myocardial infarction (10.2 vs 11.2; HR, 0.9; 95% CI, 0.7–1.2). Patients with liver cirrhosis also had higher rates of hemorrhagic stroke (5.8 vs 3.3; HR, 1.7; 95% CI, 1.1‐2.6), subdural hemorrhage (5.3 vs 1.6; HR, 3.2; 95% CI, 2.1‐4.9), hemorrhage of the lung or urinary tract (24.6 vs 15.2; HR, 1.6; 95% CI, 1.3–2.0), and gastrointestinal hemorrhage (34.5 vs 10.4; HR, 3.3; 95% CI, 2.7–3.9). Conclusion In patients with AFF, liver cirrhosis was associated with an elevated risk of ischemic stroke, venous thromboembolism, and all evaluated bleeding complications.
Collapse
Affiliation(s)
- Emil Riahi
- Department of Clinical Epidemiology Aarhus University Hospital and Aarhus University Aarhus Denmark
- Department of Surgery Randers Regional Hospital Randers Denmark
| | - Kasper Adelborg
- Department of Clinical Epidemiology Aarhus University Hospital and Aarhus University Aarhus Denmark
- Department of Clinical Biochemistry Aarhus University Hospital Aarhus Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology Aarhus University Hospital and Aarhus University Aarhus Denmark
| | - Søren R. Kristensen
- The Atrial Fibrillation Study Group Aalborg University Hospital Aalborg Denmark
- Department of Clinical Biochemistry Aalborg University Hospital Aalborg Denmark
| | - Anette T. Hansen
- Department of Clinical Epidemiology Aarhus University Hospital and Aarhus University Aarhus Denmark
| | - Henrik T. Sørensen
- Department of Clinical Epidemiology Aarhus University Hospital and Aarhus University Aarhus Denmark
| |
Collapse
|
6
|
Kovacs R, Brown GW, Kadungure A, Kristensen SR, Gwati G, Anselmi L, Midzi N, Borghi J. Who is Paid in Pay-For-Performance? Inequalities in the Distribution of Financial Bonuses Amongst Health Centres in Zimbabwe. Health Policy Plan 2022; 37:429-439. [PMID: 35090018 PMCID: PMC9006063 DOI: 10.1093/heapol/czab154] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/08/2021] [Accepted: 01/28/2022] [Indexed: 11/25/2022] Open
Abstract
Although pay-for-performance (P4P) schemes have been implemented across low- and middle-income countries (LMICs), little is known about their distributional consequences. A key concern is that financial bonuses are primarily captured by providers who are already better able to perform (for example, those in wealthier areas), P4P could exacerbate existing inequalities within the health system. We examine inequalities in the distribution of pay-outs in Zimbabwe’s national P4P scheme (2014–2016) using quantitative data on bonus payments and facility characteristics and findings from a thematic policy review and 28 semi-structured interviews with stakeholders at all system levels. We found that in Zimbabwe, facilities with better baseline access to guidelines, more staff, higher consultation volumes and wealthier and less remote target populations earned significantly higher P4P bonuses throughout the programme. For instance, facilities that were 1 SD above the mean in terms of access to guidelines, earned 90 USD more per quarter than those that were 1 SD below the mean. Differences in bonus pay-outs for facilities that were 1 SD above and below the mean in terms of the number of staff and consultation volumes are even more pronounced at 348 USD and 445 USD per quarter. Similarly, facilities with villages in the poorest wealth quintile in their vicinity earned less than all others—and 752 USD less per quarter than those serving villages in the richest quintile. Qualitative data confirm these findings. Respondents identified facility baseline structural quality, leadership, catchment population size and remoteness as affecting performance in the scheme. Unequal distribution of P4P pay-outs was identified as having negative consequences on staff retention, absenteeism and motivation. Based on our findings and previous work, we provide some guidance to policymakers on how to design more equitable P4P schemes.
Collapse
Affiliation(s)
- Roxanne Kovacs
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Garrett W Brown
- School of Politics and International Studies (POLIS), University of Leeds, Woodhouse Leeds LS2 9JT, UK
| | | | - Søren R Kristensen
- Danish Centre for Health Economics University of Southern Denmark, 5000 Odense C Denmark & Imperial College London, Faculty of Medicine, Institute of Global Health Innovation, London SW7 2AZ, UK
| | - Gwati Gwati
- Ministry of Health and Child Care, Harare, Zimbabwe
| | - Laura Anselmi
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, M13 9NT, UK
| | - Nicholas Midzi
- National Institute of Health Research, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Josephine Borghi
- *Corresponding author. Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK. E-mail:
| |
Collapse
|
7
|
Paulsen B, Gran OV, Severinsen MT, Hammerstrøm J, Kristensen SR, Cannegieter SC, Skille H, Tjønneland A, Rosendaal FR, Overvad K, Næss IA, Hansen JB, Brækkan SK. Association of smoking and cancer with the risk of venous thromboembolism: the Scandinavian Thrombosis and Cancer cohort. Sci Rep 2021; 11:18752. [PMID: 34548519 PMCID: PMC8455552 DOI: 10.1038/s41598-021-98062-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 08/31/2021] [Indexed: 12/21/2022] Open
Abstract
Smoking is a well-established risk factor for cancer, and cancer patients have a high risk of venous thromboembolism (VTE). Conflicting results have been reported on the association between smoking and risk of VTE, and the effect of smoking on VTE-risk in subjects with cancer is scarcely studied. We aimed to investigate the association between smoking and VTE in subjects with and without cancer in a large population-based cohort. The Scandinavian Thrombosis and Cancer (STAC) cohort included 144,952 participants followed from 1993-1997 to 2008-2012. Information on smoking habits was derived from self-administered questionnaires. Active cancer was defined as the first two years following the date of cancer diagnosis. Former smokers (n = 35,890) and those with missing information on smoking status (n = 3680) at baseline were excluded. During a mean follow up of 11 years, 10,181 participants were diagnosed with cancer, and 1611 developed incident VTE, of which 214 were cancer-related. Smoking was associated with a 50% increased risk of VTE (HR 1.49, 95% CI 1.12-1.98) in cancer patients, whereas no association was found in cancer-free subjects (HR 1.07, 95% CI 0.96-1.20). In cancer patients, the risk of VTE among smokers remained unchanged after adjustment for cancer site and metastasis. Stratified analyses showed that smoking was a risk factor for VTE among those with smoking-related and advanced cancers. In conclusion, smoking was associated with increased VTE risk in subjects with active cancer, but not in those without cancer. Our findings imply a biological interaction between cancer and smoking on the risk of VTE.
Collapse
Affiliation(s)
- Benedikte Paulsen
- Thrombosis Research Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsö, Norway
| | - Olga V Gran
- Thrombosis Research Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsö, Norway
| | - Marianne T Severinsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | - Jens Hammerstrøm
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Søren R Kristensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Suzanne C Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hanne Skille
- Thrombosis Research Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsö, Norway
| | - Anne Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Kim Overvad
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Inger Anne Næss
- Department of Public Health and General Practice, HUNT Research Centre, Norwegian University of Science and Technology, Levanger, Norway
| | - John-Bjarne Hansen
- Thrombosis Research Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsö, Norway.,Division of Internal Medicine, University Hospital of North Norway, Tromsö, Norway
| | - Sigrid K Brækkan
- Thrombosis Research Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsö, Norway. .,Division of Internal Medicine, University Hospital of North Norway, Tromsö, Norway.
| |
Collapse
|
8
|
Skille H, Paulsen B, Hveem K, Severinsen MT, Gabrielsen ME, Kristensen SR, Næss IA, Hindberg K, Tjønneland A, Brækkan SK, Hansen JB. Prothrombotic genotypes and risk of venous thromboembolism in occult cancer. Thromb Res 2021; 205:17-23. [PMID: 34237679 DOI: 10.1016/j.thromres.2021.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/24/2021] [Accepted: 06/26/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Studies have reported that the combination of some prothrombotic genotypes and overt cancer yields a synergistic effect on VTE risk. Whether individual prothrombotic genotypes or number of risk alleles in a genetic risk score (GRS) affect VTE risk in occult cancer have not been addressed. The aim of this study was to investigate the joint effect of five prothrombotic genotypes and occult cancer on VTE risk. METHODS Cases with incident VTE (n = 1566) and a subcohort (n = 14,537) were sampled from the Scandinavian Thrombosis and Cancer Cohort (1993-2012). Five single nucleotide polymorphisms previously reported in a GRS were genotyped: ABO (rs8176719), F5 (rs6025), F2 (rs1799963), FGG (rs2066865) and F11 (rs2036914). Hazard ratios (HRs) for VTE by individual SNPs and GRS were estimated according to non-cancer and occult cancer (one year preceding a cancer diagnosis) exposure. RESULTS Occult cancer occurred in 1817 subjects, and of these, 93 experienced a VTE. The VTE risk was 4-fold higher (HR 4.05, 95% CI 3.28-5.00) in subjects with occult cancer compared with those without cancer. Among subjects with occult cancer, those with VTE had a higher proportion of prothrombotic and advanced cancers than those without VTE. The VTE risk increased according to individual prothrombotic genotypes and GRS in cancer-free subjects, while no such effect was observed in subjects with occult cancer (HR for ≥4 versus ≤1 risk alleles in GRS: 1.14, 95% CI 0.61-2.11). CONCLUSIONS Five well-established prothrombotic genotypes, individually or combined, were not associated with increased risk of VTE in individuals with occult cancer.
Collapse
Affiliation(s)
- Hanne Skille
- Thrombosis Research Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Benedikte Paulsen
- Thrombosis Research Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Kristian Hveem
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; HUNT Research Centre, Department of Public Health and Nursing, Norwegian University of Science and Technology, Levanger, Norway
| | - Marianne T Severinsen
- Department of Clinical Medicine, Aalborg University, Denmark; Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | - Maiken E Gabrielsen
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; HUNT Research Centre, Department of Public Health and Nursing, Norwegian University of Science and Technology, Levanger, Norway
| | - Søren R Kristensen
- Department of Clinical Medicine, Aalborg University, Denmark; Department of Clinical Biochemistry, Aalborg University hospital, Aalborg, Denmark
| | - Inger Anne Næss
- Department of Rheumatology, Trondheim University Hospital, Trondheim, Norway
| | - Kristian Hindberg
- Thrombosis Research Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Anne Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Sigrid K Brækkan
- Thrombosis Research Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway; Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway.
| | - John-Bjarne Hansen
- Thrombosis Research Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway; Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| |
Collapse
|
9
|
Gade IL, Kold S, Severinsen MT, Kragholm KH, Torp‐Pedersen C, Kristensen SR, Riddersholm SJ. Venous thromboembolism after lower extremity orthopedic surgery: A population-based nationwide cohort study. Res Pract Thromb Haemost 2021; 5:148-158. [PMID: 33537539 PMCID: PMC7845063 DOI: 10.1002/rth2.12449] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/07/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) causes morbidity and mortality in the general population. Several events occur after lower limb orthopedic surgery, but the contribution from various types of lower limb surgery is not well known. OBJECTIVE To investigate the postoperative incidence of VTE for all types of lower extremity orthopedic surgery compared with the background population. METHODS Individual-level linkage of Danish nationwide register data for all Danish residents with first-time orthopedic surgery of the lower limb (1996-2017) and, for each of these, four controls from the general population matched on age, sex, and history of VTE. Adjusted hazard ratios (HR) compared the postoperative risk of VTE to the matched controls. RESULTS In total 7203 of the 1 012 823 patients with a first orthopedic procedure had a VTE within 180 days after surgery, corresponding to a postoperative cumulative incidence of 0.71% (95% confidence interval [CI], 0.70-0.73). The cumulative incidence of VTE among controls was 0.11% (95% CI, 0.11-0.12). The HR of VTE within the first 30 days after surgery below knee level was 20.5 (95% CI, 17.9-23.5) compared with matched controls. The HRs of VTE after minor distal procedures (eg, meniscectomy and arthroscopies) were 2.9 (95% CI, 1.9-4.4) to 7.1 (95% CI, 6.4-8.0). CONCLUSION All types of lower limb orthopedic surgery including minor distal procedures were associated with higher rates of VTE compared with matched controls, in particular within the first 30 days after surgery.
Collapse
Affiliation(s)
- Inger Lise Gade
- Department of Hematology and Clinical Cancer Research CenterAalborg University HospitalAalborgDenmark
- Department of Clinical BiochemistryAalborg University HospitalAalborgDenmark
| | - Søren Kold
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
- Department of Orthopedic SurgeryAalborg University HospitalAalborgDenmark
| | - Marianne T. Severinsen
- Department of Hematology and Clinical Cancer Research CenterAalborg University HospitalAalborgDenmark
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
| | - Kristian H. Kragholm
- Department of CardiologyNorth Denmark Regional HospitalHjørringDenmark
- Unit of Clinical BiostatisticsAalborg University HospitalAalborgDenmark
| | - Christian Torp‐Pedersen
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
- Unit of Clinical BiostatisticsAalborg University HospitalAalborgDenmark
- Department of Cardiology and Clinical InvestigationNorth Zealand HospitalHillerødDenmark
| | - Søren R. Kristensen
- Department of Clinical BiochemistryAalborg University HospitalAalborgDenmark
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
| | | |
Collapse
|
10
|
Kovacs RJ, Powell-Jackson T, Kristensen SR, Singh N, Borghi J. How are pay-for-performance schemes in healthcare designed in low- and middle-income countries? Typology and systematic literature review. BMC Health Serv Res 2020; 20:291. [PMID: 32264888 PMCID: PMC7137308 DOI: 10.1186/s12913-020-05075-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pay for performance (P4P) schemes provide financial incentives to health workers or facilities based on the achievement of pre-specified performance targets and have been widely implemented in health systems across low and middle-income countries (LMICs). The growing evidence base on P4P highlights that (i) there is substantial variation in the effect of P4P schemes on outcomes and (ii) there appears to be heterogeneity in incentive design. Even though scheme design is likely a key determinant of scheme effectiveness, we currently lack systematic evidence on how P4P schemes are designed in LMICs. METHODS We develop a typology to classify the design of P4P schemes in LMICs, which highlights different design features that are a priori likely to affect the behaviour of incentivised actors. We then use results from a systematic literature review to classify and describe the design of P4P schemes that have been evaluated in LMICs. To capture academic publications, Medline, Embase, and EconLit databases were searched. To include relevant grey literature, Google Scholar, Emerald Insight, and websites of the World Bank, WHO, Cordaid, Norad, DfID, USAID and PEPFAR were searched. RESULTS We identify 41 different P4P schemes implemented in 29 LMICs. We find that there is substantial heterogeneity in the design of P4P schemes in LMICs and pinpoint precisely how scheme design varies across settings. Our results also highlight that incentive design is not adequately being reported on in the literature - with many studies failing to report key design features. CONCLUSIONS We encourage authors to make a greater effort to report information on P4P scheme design in the future and suggest using the typology laid out in this paper as a starting point.
Collapse
Affiliation(s)
- Roxanne J Kovacs
- London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK.
| | - Timothy Powell-Jackson
- London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
| | - Søren R Kristensen
- Imperial College London, Faculty of Medicine, Institute of Global Health Innovation, London, UK
| | - Neha Singh
- London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
| | - Josephine Borghi
- London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
| |
Collapse
|
11
|
Blix K, Gran OV, Severinsen MT, Cannegieter SC, Jensvoll H, Overvad K, Hammerstrøm J, Tjønneland A, Naess IA, Braekkan SK, Rosendaal FR, Kristensen SR, Hansen JB. Impact of time since diagnosis and mortality rate on cancer-associated venous thromboembolism: the Scandinavian Thrombosis and Cancer (STAC) cohort. J Thromb Haemost 2018; 16:1327-1335. [PMID: 29691978 DOI: 10.1111/jth.14130] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 10/24/2017] [Indexed: 12/13/2022]
Abstract
Essentials Competing risk by death may lead to overestimation of venous thromboembolism (VTE) risk in cancers. We assessed the risk of VTE in cancer with and without accounting for competing risk by death. The risk of VTE was influenced by the mortality rate and the time since cancer diagnosis. Competing risk by death should be taken into account when exploring VTE risk in cancer. SUMMARY Background Venous thromboembolism (VTE) is a common complication in cancer, and studies have suggested that aggressive cancers create the highest risk of VTE. However, competing risk by death may result in overestimation of VTE risk in patients with cancers associated with high mortality. Therefore, we estimated the risk of VTE by cancer site, accounting for the differential mortality between cancers. Methods The Scandinavian Thrombosis and Cancer cohort included 144 952 participants followed from 1993-1997 to 2008-2012. Incidence rates, cause-specific hazard ratios (HRs) and subdistribution HRs (SHRs) were assessed for overall cancer and by cancer site according to time intervals since cancer diagnosis. Results During follow-up, 14 272 subjects developed cancer, and 567 had cancer-related VTE. In cause-specific analyses, the VTE risk was highest in the first 6 months after cancer diagnosis (HR 17.5, 95% confidence interval [CI] 15.1-20.3), and declined rapidly thereafter. However, when mortality was taken into account, the risk was similar in the periods 6 months before (SHR 4.8, 95% CI 3.6-6.4) and 6 months after (SHR 4.6, 95% CI 3.9-5.4) cancer diagnosis. The range of the 2-year cumulative VTE incidence rates was substantially narrowed for all cancer sites after competing risk by death was taken into account (from 1-10% to 1-4%). Conclusion VTE risk by cancer site was influenced by the mortality rate and the time since cancer diagnosis. Our findings suggest that the cancer itself is a major contributor to VTE risk, and that competing risk by death should be taken into account when VTE risk in cancer is explored.
Collapse
Affiliation(s)
- K Blix
- K. G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT - the Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - O V Gran
- K. G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT - the Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - M T Severinsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | - S C Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - H Jensvoll
- K. G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT - the Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - K Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - J Hammerstrøm
- Department of Hematology, Trondheim University Hospital, Trondheim, Norway
| | - A Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - I A Naess
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - S K Braekkan
- K. G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT - the Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - F R Rosendaal
- K. G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT - the Arctic University of Norway, Tromsø, Norway
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - S R Kristensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - J-B Hansen
- K. G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT - the Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| |
Collapse
|
12
|
Munkholm SB, Krøgholt T, Ebbesen F, Szecsi PB, Kristensen SR. The smartphone camera as a potential method for transcutaneous bilirubin measurement. PLoS One 2018; 13:e0197938. [PMID: 29856793 PMCID: PMC5983497 DOI: 10.1371/journal.pone.0197938] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 04/01/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Hyperbilirubinemia is a common problem in neonates that can progress into kernicterus. Suspected neonatal hyperbilirubinemia is a common reason for contact with the healthcare system. The severity and management of jaundice are determined based on estimated bilirubin levels. However, no easy and accessible tool for self-assessing neonatal jaundice is currently available. Smartphones could potentially be transformed into a medical device that could be used by both patients and practitioners. OBJECTIVE To investigate whether a digital image produced by a camera embedded on a smartphone can be a used as a screening tool for neonatal hyperbilirubinemia. STUDY DESIGN A total of 64 randomly selected newborns were enrolled. The inclusion criteria were healthy Caucasians, gestational age >35 weeks, age >24 hours and ≤14 days old, and parental informed consent. The exclusion criteria were facial skin lesions and light treatment. Images of the glabella were obtained with an iPhone 6 via i) directly applied pressure, ii) a dermatoscope, or iii) a dermatoscope equipped with a Wratten No. 11 filter. The red, green and blue colour intensities of each image were compared to bilirubin levels. RESULTS Only the dermatoscope-acquired intensities of the green and blue channels were significantly correlated (p < 0.001) with bilirubin measurements (Pearson's r: 0.59 and 0.48, respectively). For the green and blue channels, discrimination limits of 212 and 190, respectively, revealed a sensitivity and specificity of 100% and 62.5%, respectively, for green and 90.9% and 60%, respectively, for blue for a plasma bilirubin above 205 μmol/L. CONCLUSIONS The results of this study indicate that a smartphone equipped with a consistent light source in the form of a dermatoscope may be a simple screening tool for neonatal hyperbilirubinemia. However, the method requires some improvement before clinical application.
Collapse
Affiliation(s)
- Sarah B. Munkholm
- Department of Acute Medicine, Randers Regional Hospital, Randers, Denmark
| | | | - Finn Ebbesen
- Department of Paediatrics, Aalborg University Hospital, Aalborg, Denmark
| | - Pal B. Szecsi
- Department of Clinical Biochemistry, Copenhagen University Hospital Holbæk, Holbæk, Denmark
| | - Søren R. Kristensen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
13
|
Mørk M, Nielsen MH, Bæk R, Jørgensen MM, Pedersen S, Kristensen SR. Postprandial Increase in Blood Plasma Levels of Tissue Factor-Bearing (and Other) Microvesicles Measured by Flow Cytometry: Fact or Artifact? TH Open 2018; 2:e147-e157. [PMID: 31249938 PMCID: PMC6524869 DOI: 10.1055/s-0038-1642021] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 03/01/2018] [Indexed: 11/23/2022] Open
Abstract
Tissue factor (TF)–bearing microvesicles (MVs) and exosomes may play a role in hemostasis and thrombosis. MVs may be quantified by flow cytometry (FC)–based detection of phosphatidylserine (PS)-positive submicron particles carrying specific antigens, although interference from lipoproteins complicates this approach. In this study, we evaluated the effect of food intake on blood levels of TF-bearing particles measured by FC and small extracellular vesicles (EVs) measured by a protein microarray–based test termed EV Array. Platelet-free plasma (PFP) was obtained from 20 healthy persons in the fasting state and 75 minutes after consumption of a meal. Postprandial changes in the concentration of PS-positive particles, including subgroups binding labeled antibodies against TF, CD41, CD146, and CD62E, respectively (FC), small EVs (EV Array), and TF antigen and procoagulant phospholipids (PPLs) were measured. Furthermore, we tested the effect on FC results of in vitro addition of lipoproteins to fasting PFP. We found significantly increased plasma concentrations of PS-positive particles and all examined subgroups postprandially, while no changes in small EVs, PPL, or TF antigen levels were found. Levels of all types of particles measured by FC were also elevated by lipoprotein spiking. In conclusion, meal consumption as well as in vitro addition of lipoproteins to fasting plasma induces increased levels of PS-positive particles as measured by FC, including TF-positive subtypes and subtypes exposing other antigens. While the observed postprandial increase may to some extent reflect elevated MV levels, our results indicate a substantial interference from lipoproteins.
Collapse
Affiliation(s)
- Morten Mørk
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark.,Aalborg AF Study Group, Aalborg University Hospital, Aalborg, Denmark.,EVsearch.dk, Aalborg, Denmark
| | - Morten H Nielsen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark.,EVsearch.dk, Aalborg, Denmark
| | - Rikke Bæk
- EVsearch.dk, Aalborg, Denmark.,Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Malene M Jørgensen
- EVsearch.dk, Aalborg, Denmark.,Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Shona Pedersen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark.,EVsearch.dk, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Søren R Kristensen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark.,Aalborg AF Study Group, Aalborg University Hospital, Aalborg, Denmark.,EVsearch.dk, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
14
|
Gade IL, Brækkan SK, Næss IA, Hansen JB, Cannegieter SC, Rosendaal FR, Overvad K, Hindberg K, Hammerstrøm J, Gran OV, Tjønneland A, Severinsen MT, Kristensen SR. Long-Term Incidence of Venous Thromboembolism in Cancer: The Scandinavian Thrombosis and Cancer Cohort. TH Open 2018; 2:e131-e138. [PMID: 31249936 PMCID: PMC6524868 DOI: 10.1055/s-0038-1641678] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 02/19/2018] [Indexed: 12/21/2022] Open
Abstract
The risk of venous thromboembolism (VTE) in patients who survive the first years after a cancer diagnosis after the acute effects of disease and treatment in comparison to a similar background population has been sparsely investigated. The aim of the study was to investigate if incidence rates (IRs) of VTE differed in patients who were alive at least 2 years after a cancer diagnosis without VTE compared with cancer-free references in a population-based cohort study. The study entry was 2 years after a first cancer diagnosis. For each cancer-exposed subject, five reference subjects were identified within the cohort. The IRs were calculated as number of VTEs per 1,000 person years (×10 -3 p-y) in total and in distinct cancer types and corresponding reference subjects. Incidence rate ratios (IRRs) were calculated by Poisson's regression. During a mean follow-up of 5.3 years, 110 VTEs occurred among the 7,288 cancer-exposed subjects and 321 VTEs occurred among the 36,297 identified reference subjects. The IR of VTE was higher for cancer-exposed subjects compared with reference subjects, IRs 3.7 × 10 -3 p-y, 95% CI: 3.1 to 4.5 and 1.9 × 10 -3 p-y, 95% CI: 1.7 to 2.2, respectively. IRs of VTE in most solid cancer types declined to almost the same level as in the reference subjects 2 years after cancer diagnosis, but remained higher in hematological cancers, IRR 4.0, 95% CI: 2.0 to 7.8.
Collapse
Affiliation(s)
- Inger Lise Gade
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Sigrid K Brækkan
- Department of Clinical Medicine, K.G Jebsen Thrombosis Research and Expertise Centre (TREC), University of Tromsø-The Arctic University of Norway, Tromsø, Norway.,Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Inger Anne Næss
- Department of Haematology, Trondheim University Hospital, Trondheim, Norway
| | - John-Bjarne Hansen
- Department of Clinical Medicine, K.G Jebsen Thrombosis Research and Expertise Centre (TREC), University of Tromsø-The Arctic University of Norway, Tromsø, Norway.,Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Suzanne C Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Kim Overvad
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Kristian Hindberg
- Department of Clinical Medicine, K.G Jebsen Thrombosis Research and Expertise Centre (TREC), University of Tromsø-The Arctic University of Norway, Tromsø, Norway
| | - Jens Hammerstrøm
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Olga V Gran
- Department of Clinical Medicine, K.G Jebsen Thrombosis Research and Expertise Centre (TREC), University of Tromsø-The Arctic University of Norway, Tromsø, Norway
| | - Anne Tjønneland
- Department of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Marianne T Severinsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
| | - Søren R Kristensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
15
|
Kristensen AF, Kristensen SR, Falkmer U, Münster AMB, Pedersen S. Analytical and between-subject variation of thrombin generation measured by calibrated automated thrombography on plasma samples. Scand J Clin Lab Invest 2018; 78:175-179. [PMID: 29336181 DOI: 10.1080/00365513.2018.1427280] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The Calibrated Automated Thrombography (CAT) is an in vitro thrombin generation (TG) assay that holds promise as a valuable tool within clinical diagnostics. However, the technique has a considerable analytical variation, and we therefore, investigated the analytical and between-subject variation of CAT systematically. Moreover, we assess the application of an internal standard for normalization to diminish variation. METHODS 20 healthy volunteers donated one blood sample which was subsequently centrifuged, aliquoted and stored at -80 °C prior to analysis. The analytical variation was determined on eight runs, where plasma from the same seven volunteers was processed in triplicates, and for the between-subject variation, TG analysis was performed on plasma from all 20 volunteers. The trigger reagents used for the TG assays included both PPP reagent containing 5 pM tissue factor (TF) and PPPlow with 1 pM TF. Plasma, drawn from a single donor, was applied to all plates as an internal standard for each TG analysis, which subsequently was used for normalization. RESULTS The total analytical variation for TG analysis performed with PPPlow reagent is 3-14% and 9-13% for PPP reagent. This variation can be minimally reduced by using an internal standard but mainly for ETP (endogenous thrombin potential). The between-subject variation is higher when using PPPlow than PPP and this variation is considerable higher than the analytical variation. CONCLUSION TG has a rather high inherent analytical variation but considerable lower than the between-subject variation when using PPPlow as reagent.
Collapse
Affiliation(s)
- Anne F Kristensen
- a Department of Clinical Biochemistry , Aalborg University Hospital , Aalborg , Denmark.,b Department of Clinical Medicine , Aalborg University , Aalborg , Denmark
| | - Søren R Kristensen
- a Department of Clinical Biochemistry , Aalborg University Hospital , Aalborg , Denmark.,b Department of Clinical Medicine , Aalborg University , Aalborg , Denmark
| | - Ursula Falkmer
- b Department of Clinical Medicine , Aalborg University , Aalborg , Denmark.,c Department of Oncology , Aalborg University Hospital , Aalborg , Denmark
| | - Anna-Marie B Münster
- d Department of Clinical Biochemistry , Hospital Unit West , Holstebro , Denmark
| | - Shona Pedersen
- a Department of Clinical Biochemistry , Aalborg University Hospital , Aalborg , Denmark.,b Department of Clinical Medicine , Aalborg University , Aalborg , Denmark
| |
Collapse
|
16
|
Han L, Meacock R, Anselmi L, Kristensen SR, Sutton M, Doran T, Clough S, Power M. Variations in mortality across the week following emergency admission to hospital: linked retrospective observational analyses of hospital episode data in England, 2004/5 to 2013/14. Health Serv Deliv Res 2017. [DOI: 10.3310/hsdr05300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Patients admitted to hospital outside normal working hours suffer higher complication and mortality rates than patients admitted at times when the hospital is fully operational. This ‘weekend effect’ is well described but poorly understood. It is not clear whether or not the effect extends to other out-of-hours periods, or how far excess mortality for out-of-hours admissions reflects a different presenting population with higher severity of illness and how much is explained by poorer availability and quality of services.
Objectives
We aimed to assess (1) the costs and benefits of introducing 7-day services, (2) whether or not mortality rates are elevated during all out-of-hours periods, (3) whether or not selection of more severely ill patients for admission out of hours explains elevated mortality rates and (4) whether or not mortality rates out of hours are related to staffing levels.
Methods
We conducted a series of retrospective observational analyses of hospital episode data in England, using both national data and data from a single, large acute NHS trust. For the national studies, we analysed emergency admissions to all 140 non-specialist acute hospital trusts in England between April 2013 and February 2014 (over 12 million accident and emergency attendances and 4.5 million emergency admissions). For the single trust, we analysed emergency admissions between April 2004 and March 2014 (240,000 admissions). Deaths within 30 days of attendance or admission were compared for normal working hours and out-of-hours periods.
Results
We found that, in addition to elevated mortality for weekend admissions, mortality rates are also elevated for patients admitted during night-time periods. Elevated mortality was reduced for stroke patients in a large acute trust when more – and more experienced – nursing staff were present during the first hour of admission. Nationally, we found that excess mortality out of hours was largely explained by a sicker population of patients being selected for admission. However, mortality rates were still elevated on Sunday daytimes when we accounted for severity of patient illness. We also found that the estimated cost of implementing 7-day services exceeds the maximum amount that the National Institute for Health and Care Excellence would recommend the NHS should spend on eradicating excess mortality at weekends.
Limitations
Our results depend on the accuracy and completeness of data recording by hospital staff. If accuracy of recording is related to time of patient admission, our results may be biased. Results based on data from a single trust should be treated as indicative.
Conclusions
In addressing variations in patient outcomes across the week, a more nuanced approach, extending services for key specialties over critical periods – rather than implementing whole-system changes – is likely to be the most cost-effective.
Future work
Future research should aim to develop and use appropriate measures of severity of illness to facilitate meaningful analysis of variations in patient outcomes, and to identify candidate specialties and critical periods for which extending services is likely to be cost-effective.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Lu Han
- Department of Health Sciences, University of York, York, UK
| | - Rachel Meacock
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Laura Anselmi
- Centre for Health Economics, University of Manchester, Manchester, UK
| | | | - Matt Sutton
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Tim Doran
- Department of Health Sciences, University of York, York, UK
| | - Stuart Clough
- Haelo, Salford Royal NHS Foundation Trust, Salford, UK
| | - Maxine Power
- Haelo, Salford Royal NHS Foundation Trust, Salford, UK
| |
Collapse
|
17
|
Gade IL, Braekkan SK, Naess IA, Hansen JB, Cannegieter SC, Overvad K, Jensvoll H, Hammerstrøm J, Blix K, Tjønneland A, Kristensen SR, Severinsen MT. The impact of initial cancer stage on the incidence of venous thromboembolism: the Scandinavian Thrombosis and Cancer (STAC) Cohort. J Thromb Haemost 2017; 15:1567-1575. [PMID: 28585779 DOI: 10.1111/jth.13752] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Indexed: 12/13/2022]
Abstract
Essentials Impact of cancer stage on venous thromboembolism (VTE) risk is not well-known in all cancers. The Scandinavian Thrombosis and Cancer Cohort provides person-time data and validated VTEs. Impact of cancer stage on VTE incidence tended to vary with cancer type. Cancer stage may not per se be a risk factor for VTE in all cancer types. SUMMARY Background Absolute measures of the impact of cancer stage on the incidence of venous thromboembolism (VTE) in patients with distinct cancer types have not been investigated in a large population-based cohort study. Objectives To investigate differences in the incidence rates of objectively confirmed VTE according to the development of cancer in a large population-based cohort study. Cancer type and stage at the time of diagnosis were taken into account. Patients and Methods The Scandinavian Thrombosis and Cancer Cohort includes data regarding cancer types, stages and objectively confirmed VTE diagnoses among 144 952 participants followed from 1993 to 2012. We studied stage-specific incidence rates of VTE, and calculated incidence rate differences (IRDs) for VTE according to stages in patients with 10 types of solid cancer. Results During the entire follow-up, 335 VTEs occurred, of which 293 occurred within 5 years. The IRD of VTE in patients with distant metastasis as compared with those with localized disease indicated large variation depending on cancer type. The highest IRD was observed for pancreatic cancer (IRD of 187.0 × 10-3 person-years [p-y]; 95% confidence interval [CI] - 6.7 to 380.8), and the lowest IRD was observed for prostate cancer (IRD of 3.7 × 10-3 p-y; 95% CI - 7 to 15.2). Regional spread as compared with localized disease also indicated large variation depending on cancer type; the highest IRD was observed for uterine cancer (IRD of 37.6 × 10-3 p-y; 95% CI - 23.7 to 99), and the IRDs for breast and prostate cancer were close to zero. Conclusion More advanced cancer at the time of diagnosis was associated with a higher risk of VTE, but the strength of the associations differed substantially between cancer types.
Collapse
Affiliation(s)
- I L Gade
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - S K Braekkan
- Department of Clinical Medicine, K. G. Jebsen Thrombosis Research and Expertise Center (TREC), UiT The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - I A Naess
- Department of Hematology, Trondheim University Hospital, Trondheim, Norway
| | - J-B Hansen
- Department of Clinical Medicine, K. G. Jebsen Thrombosis Research and Expertise Center (TREC), UiT The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - S C Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - K Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - H Jensvoll
- Department of Clinical Medicine, K. G. Jebsen Thrombosis Research and Expertise Center (TREC), UiT The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - J Hammerstrøm
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - K Blix
- Department of Clinical Medicine, K. G. Jebsen Thrombosis Research and Expertise Center (TREC), UiT The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - A Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - S R Kristensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - M T Severinsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
18
|
Mørk M, Handberg A, Pedersen S, Jørgensen MM, Bæk R, Nielsen MK, Kristensen SR. Prospects and limitations of antibody-mediated clearing of lipoproteins from blood plasma prior to nanoparticle tracking analysis of extracellular vesicles. J Extracell Vesicles 2017; 6:1308779. [PMID: 28473885 PMCID: PMC5405563 DOI: 10.1080/20013078.2017.1308779] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/31/2017] [Indexed: 01/12/2023] Open
Abstract
Introduction: Nanoparticle tracking analysis (NTA) enables measurement of extracellular vesicles (EVs) but lacks the ability to distinct between EVs and lipoproteins which are abundantly present in blood plasma. Limitations in ultracentrifugation and size exclusion chromatography applied for EV isolation may result in inadequate EV purification and preservation. In this proof of concept study, we aimed to evaluate the potential of antibody-mediated removal of lipoproteins from plasma prior to extracellular vesicle (EV) analysis by nanoparticle tracking analysis (NTA). Methods: Ten platelet-free plasma (PFP) samples from healthy fasting subjects were incubated with magnetic beads coated with antibodies against apolipoprotein B-48 and B-100 (ApoB). Plasma samples were analysed with NTA before and after application of the bead procedure. Four fasting PFP samples were analysed with an ELISA specific for human ApoB to estimate the degree of removal of lipoproteins and EV array analysis was used for identification of possible EV loss. Results: The magnetic bead separation procedure resulted in a median reduction of the particle concentration in plasma by 62% (interquartile range 32-72%). The mean size of the remaining particles generally increased. ApoB concentration was reduced to a level close to the background signal, whereas a median reduction of the EV content by 21% (range 8-43%) was observed. Conclusion: Anti-ApoB antibody coated magnetic beads may hold potential for removal of lipoproteins from human PFP prior to EV measurement by NTA but some artefactual effect and EV loss may have to be endured.
Collapse
Affiliation(s)
- Morten Mørk
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark.,AF Study Group, Aalborg University Hospital, Aalborg, Denmark
| | - Aase Handberg
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Shona Pedersen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark.,AF Study Group, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Malene M Jørgensen
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark, part of EVsearch.dk
| | - Rikke Bæk
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark, part of EVsearch.dk
| | - Morten K Nielsen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Søren R Kristensen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark.,AF Study Group, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
19
|
Vogel R, Coumans FAW, Maltesen RG, Böing AN, Bonnington KE, Broekman ML, Broom MF, Buzás EI, Christiansen G, Hajji N, Kristensen SR, Kuehn MJ, Lund SM, Maas SLN, Nieuwland R, Osteikoetxea X, Schnoor R, Scicluna BJ, Shambrook M, de Vrij J, Mann SI, Hill AF, Pedersen S. A standardized method to determine the concentration of extracellular vesicles using tunable resistive pulse sensing. J Extracell Vesicles 2016; 5:31242. [PMID: 27680301 PMCID: PMC5040823 DOI: 10.3402/jev.v5.31242] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [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] [Received: 02/08/2016] [Revised: 08/11/2016] [Accepted: 08/25/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Understanding the pathogenic role of extracellular vesicles (EVs) in disease and their potential diagnostic and therapeutic utility is extremely reliant on in-depth quantification, measurement and identification of EV sub-populations. Quantification of EVs has presented several challenges, predominantly due to the small size of vesicles such as exosomes and the availability of various technologies to measure nanosized particles, each technology having its own limitations. MATERIALS AND METHODS A standardized methodology to measure the concentration of extracellular vesicles (EVs) has been developed and tested. The method is based on measuring the EV concentration as a function of a defined size range. Blood plasma EVs are isolated and purified using size exclusion columns (qEV) and consecutively measured with tunable resistive pulse sensing (TRPS). Six independent research groups measured liposome and EV samples with the aim to evaluate the developed methodology. Each group measured identical samples using up to 5 nanopores with 3 repeat measurements per pore. Descriptive statistics and unsupervised multivariate data analysis with principal component analysis (PCA) were used to evaluate reproducibility across the groups and to explore and visualise possible patterns and outliers in EV and liposome data sets. RESULTS PCA revealed good reproducibility within and between laboratories, with few minor outlying samples. Measured mean liposome (not filtered with qEV) and EV (filtered with qEV) concentrations had coefficients of variance of 23.9% and 52.5%, respectively. The increased variance of the EV concentration measurements could be attributed to the use of qEVs and the polydisperse nature of EVs. CONCLUSION The results of this study demonstrate the feasibility of this standardized methodology to facilitate comparable and reproducible EV concentration measurements.
Collapse
Affiliation(s)
- Robert Vogel
- School of Mathematics and Physics, The University of Queensland, St Lucia, QLD, Australia.,Izon Science Ltd., Burnside, Christchurch, New Zealand
| | - Frank A W Coumans
- Laboratory of Experimental Clinical Chemistry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Raluca G Maltesen
- Department of Clinical Biochemistry and Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Anita N Böing
- Laboratory of Experimental Clinical Chemistry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Marike L Broekman
- Department of Neurosurgery and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Edit I Buzás
- Department of Genetics, Cell and Immunobiology, Semmelweis University, Budapest, Hungary
| | | | - Najat Hajji
- Laboratory of Experimental Clinical Chemistry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Søren R Kristensen
- Department of Clinical Biochemistry and Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Meta J Kuehn
- Department of Biochemistry, Duke University, Medical Centre, Durham, NC, USA
| | - Sigrid M Lund
- Department of Clinical Biochemistry and Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Sybren L N Maas
- Department of Neurosurgery and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rienk Nieuwland
- Laboratory of Experimental Clinical Chemistry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Xabier Osteikoetxea
- Department of Genetics, Cell and Immunobiology, Semmelweis University, Budapest, Hungary
| | - Rosalie Schnoor
- Department of Neurosurgery and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Benjamin J Scicluna
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Parkville, VIC, Australia.,Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Bundoora, VIC, Australia
| | - Mitch Shambrook
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Bundoora, VIC, Australia
| | - Jeroen de Vrij
- Department of Neurosurgery and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Andrew F Hill
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Parkville, VIC, Australia.,Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Bundoora, VIC, Australia
| | - Shona Pedersen
- Department of Clinical Biochemistry and Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark;
| |
Collapse
|
20
|
Navarro-Fernández J, de la Morena-Barrio ME, Padilla J, Miñano A, Bohdan N, Águila S, Martínez-Martínez I, Sevivas TS, de Cos C, Fernández-Mosteirín N, Llamas P, Asenjo S, Medina P, Souto JC, Overvad K, Kristensen SR, Corral J, Vicente V. Antithrombin Dublin (p.Val30Glu): a relatively common variant with moderate thrombosis risk of causing transient antithrombin deficiency. Thromb Haemost 2016; 116:146-54. [PMID: 27098529 DOI: 10.1160/th15-11-0871] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 03/02/2016] [Indexed: 12/24/2022]
Abstract
The key haemostatic role of antithrombin and the risk of thrombosis associated with its deficiency support that the low incidence of antithrombin deficiency among patients with thrombosis might be explained by underestimation of this disorder. It was our aim to identify mutations in SERPINC1 causing transient antithrombin deficiency. SERPINC1 was sequenced in 214 cases with a positive test for antithrombin deficiency, including 67 with no deficiency in the sample delivered to our laboratory. The p.Val30Glu mutation (Antithrombin Dublin) was identified in five out of these 67 cases, as well as in three out of 127 cases with other SERPINC1 mutations. Genotyping in 1593 patients with venous thrombosis and 2592 controls from two populations, revealed a low prevalent polymorphism (0.3 %) that moderately increased the risk of venous thrombosis (OR: 2.9; 95 % CI: 1.07-8.09; p= 0.03) and identified one homozygous patient with an early thrombotic event. Carriers had normal anti-FXa activity, and plasma antithrombin was not sensitive to heat stress or proteolytic cleavage. Analysis of one sample with transient deficit revealed a type I deficiency, without aberrant or increased latent forms. The recombinant variant, which lacked the two amino-terminal residues, had reduced secretion from HEK-EBNA cells, formed hyperstable disulphide-linked polymers, and had negligible activity. In conclusion, p.Val30Glu by affecting the cleavage of antithrombin's signal peptide, results in a mature protein lacking the N-terminal dipeptide with no functional consequences in normal conditions, but that increases the sensitivity to be folded intracellularly into polymers, facilitating transient antithrombin deficiency and the subsequent risk of thrombosis.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Javier Corral
- Dr. Javier Corral, University of Murcia, Centro Regional de Hemodonación, Calle Ronda de Garay s/n, Murcia 30003, Spain, Tel.: +34968341990, Fax: +34968261914, E-mail:
| | | |
Collapse
|
21
|
Jepsen ST, Jørgensen TM, Zong W, Trydal T, Kristensen SR, Sørensen HS. Evaluation of back scatter interferometry, a method for detecting protein binding in solution. Analyst 2015; 140:895-901. [PMID: 25503796 DOI: 10.1039/c4an01129e] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Back Scatter Interferometry (BSI) has been proposed to be a highly sensitive and versatile refractive index sensor usable for analytical detection of biomarker and protein interactions in solution. However the existing literature on BSI lacks a physical explanation of why protein interactions in general should contribute to the BSI signal. We have established a BSI system to investigate this subject in further detail. We contribute with a thorough analysis of the robustness of the sensor including unwanted contributions to the interferometric signal caused by temperature variation and dissolved gasses. We report a limit of the effective minimum detectability of refractive index at the 10(-7) level. Long term stability was examined by simultaneously monitoring the temperature inside the capillary revealing an average drift of 2.0 × 10(-7) per hour. Finally we show that measurements on protein A incubated with immunoglobulin G do not result in a signal that can be attributed to binding affinities as otherwise claimed in literature.
Collapse
Affiliation(s)
- S T Jepsen
- Dept. of Clinical Biochemistry, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | | | | | | | | | | |
Collapse
|
22
|
Jensvoll H, Severinsen MT, Hammerstrøm J, Brækkan SK, Kristensen SR, Cannegieter SC, Blix K, Tjønneland A, Rosendaal FR, Dziewiecka O, Overvad K, Næss IA, Hansen JB. Existing data sources in clinical epidemiology: the Scandinavian Thrombosis and Cancer Cohort. Clin Epidemiol 2015; 7:401-10. [PMID: 26396546 PMCID: PMC4577261 DOI: 10.2147/clep.s84279] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Although venous thromboembolism (VTE) is a known common complication in cancer patients, there is limited knowledge on patient-related and cancer-specific risk factors in the general population. The Scandinavian Thrombosis and Cancer (STAC) Cohort was established by merging individual data from three large Scandinavian cohorts (The Tromsø Study, the second Nord-Trøndelag Health Study, and the Danish Diet, Cancer and Health Study). Here, we present the profile of the STAC cohort and provide age-specific incidence rates of VTE and cancer. Methods The STAC cohort includes 144,952 subjects aged 19–101 years without previous VTE or cancer. Baseline information collected in 1993–1997 included physical examination, self-administered questionnaires, and blood samples. Validated VTE events and cancer diagnoses were registered up to 2007–2012. Results There were 2,444 VTE events (1.4 per 1,000 person-years [PY]) during follow-up, and the incidence increased exponentially from 0.3 per 1,000 PY in subjects aged 20–29 years to 6.4 per 1,000 PY in subjects aged 80+. Overall, 51% of the VTE events were provoked, and cancer was the most common provoking factor (19%), followed by immobilization and surgery (both 15%). In total, 19,757 subjects developed cancer during follow-up (9.8 per 1,000 PY), and the 5-year age-specific incidence rates of cancer were coherent with corresponding rates from the Norwegian Cancer Registry. Conclusion The STAC cohort will provide a unique opportunity to explore the epidemiology and impact of genetic and environmental patient-related and cancer-specific risk factors for VTE in the general population.
Collapse
Affiliation(s)
- Hilde Jensvoll
- Department of Clinical Medicine, KG Jebsen - Thrombosis Research and Expertise Center (TREC), UiT - The Arctic University of Norway ; Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Marianne T Severinsen
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark ; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jens Hammerstrøm
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sigrid K Brækkan
- Department of Clinical Medicine, KG Jebsen - Thrombosis Research and Expertise Center (TREC), UiT - The Arctic University of Norway ; Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Søren R Kristensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark ; Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Suzanne C Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Kristine Blix
- Department of Clinical Medicine, KG Jebsen - Thrombosis Research and Expertise Center (TREC), UiT - The Arctic University of Norway ; Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Anne Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Frits R Rosendaal
- Department of Clinical Medicine, KG Jebsen - Thrombosis Research and Expertise Center (TREC), UiT - The Arctic University of Norway ; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands ; Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Olga Dziewiecka
- Department of Clinical Medicine, KG Jebsen - Thrombosis Research and Expertise Center (TREC), UiT - The Arctic University of Norway
| | - Kim Overvad
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark ; Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Inger Anne Næss
- Department of Hematology, Trondheim University Hospital, Trondheim, Norway
| | - John-Bjarne Hansen
- Department of Clinical Medicine, KG Jebsen - Thrombosis Research and Expertise Center (TREC), UiT - The Arctic University of Norway ; Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| |
Collapse
|
23
|
Larsen AC, Brøndum Frøkjaer J, Wishwanath Iyer V, Vincents Fisker R, Sall M, Yilmaz MK, Kuno Møller B, Kristensen SR, Thorlacius-Ussing O. Venous thrombosis in pancreaticobiliary tract cancer: outcome and prognostic factors. J Thromb Haemost 2015; 13:555-62. [PMID: 25594256 DOI: 10.1111/jth.12843] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 07/07/2014] [Accepted: 01/08/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND The differences in outcome among cancer patients with incidental vs. symptomatic venous thromboembolism (VTE) are unknown. In this study, patients with extrahepatic pancreaticobiliary tract cancer (PBC) were selected for a prospective cohort study between February 2008 and February 2011. METHODS At the time of cancer diagnosis, all patients were examined for deep vein thrombosis with bilateral compression ultrasonography (biCUS). Computed tomography pulmonary angiography was also performed to diagnose pulmonary embolisms. After inclusion, the patients were followed up with clinical examinations, blood collections, and biCUS. RESULTS A total of 121 PBC patients were enrolled. At the time of cancer diagnosis, 15 patients had experienced a VTE (12.4%, 95% confidence interval [CI] 7.1-19.6), including six symptomatic and nine incidental cases. A total of 25 first-time VTE events were identified (20.7%; 95% CI 13.8-29.0). Patients with a VTE had reduced survival, with a median overall survival (OS) of 4.4 months (95% CI 2.2-11.5). The median OS of the patients with incidental VTE was 3.0 months (95% CI 0.1-15.0), which was not different from the median OS of the patients with symptomatic VTE (5.0 months; 95% CI 2.1-14.5). The median OS was 11.9 months (95% CI 8.1-14.7) in the PBC patients with no VTEs. CONCLUSION The occurrence of a VTE event in a PBC patient within the first months of the disease is associated with significantly increased mortality.
Collapse
Affiliation(s)
- A C Larsen
- Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark; Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Larsen AC, Dabrowski T, Frøkjær JB, Fisker RV, Iyer VV, Møller BK, Kristensen SR, Thorlacius-Ussing O. Prevalence of venous thromboembolism at diagnosis of upper gastrointestinal cancer. Br J Surg 2014; 101:246-53. [PMID: 24446107 DOI: 10.1002/bjs.9353] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2013] [Indexed: 01/27/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) in patients with upper gastrointestinal (GI) cancer increases morbidity and mortality. This study aimed to determine the prevalence of VTE at diagnosis of upper GI cancer. METHODS Patients admitted between February 2008 and February 2011 with upper GI cancer (pancreatic, extrahepatic biliary, lower oesophageal, gastro-oesophageal junction or gastric cancer) were investigated in a cross-sectional cohort study. At cancer diagnosis, all patients were examined for deep vein thrombosis (DVT) by means of bilateral compression ultrasonography. From February 2009 and onwards, computed tomographic pulmonary angiography (CTPA) was also performed for the diagnosis of pulmonary embolism (PE). RESULTS Some 250 patients had ultrasonography; CTPA was performed in 143 patients on admission. DVT was detected in 13 (5·2 per cent) of the 250 patients, eight (3·2 per cent) of whom were asymptomatic. DVT was correlated with tumour location in the pancreaticobiliary tract (odds ratio (OR) 6·27, 95 per cent confidence interval 1·18 to 33·38; P = 0·031) and tumour stage IV (OR 19·34, 2·33 to 160·70; P = 0·006). PE was detected in 11 (7·7 per cent) of 143 patients, eight (5·6 per cent) of whom were asymptomatic. PE embolism was also significantly more common in patients with pancreaticobiliary tract cancer (OR 7·81, 1·28 to 47·62; P = 0·026) and in those with stage IV disease (OR 17·19, 1·83 to 161·50; P = 0·013). CONCLUSION The prevalence of VTE at cancer diagnosis was significantly higher in patients with pancreaticobiliary tract cancer than in those with other forms of upper GI cancer, and in patients with advanced cancer stage.
Collapse
Affiliation(s)
- A C Larsen
- Department of Gastrointestinal Surgery, Aarhus University Hospital, Aalborg, Denmark
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Jørgensen M, Bæk R, Pedersen S, Søndergaard EKL, Kristensen SR, Varming K. Extracellular Vesicle (EV) Array: microarray capturing of exosomes and other extracellular vesicles for multiplexed phenotyping. J Extracell Vesicles 2013; 2:20920. [PMID: 24009888 PMCID: PMC3760630 DOI: 10.3402/jev.v2i0.20920] [Citation(s) in RCA: 174] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 05/21/2013] [Accepted: 05/22/2013] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Exosomes are one of the several types of cell-derived vesicles with a diameter of 30-100 nm. These extracellular vesicles are recognized as potential markers of human diseases such as cancer. However, their use in diagnostic tests requires an objective and high-throughput method to define their phenotype and determine their concentration in biological fluids. To identify circulating as well as cell culture-derived vesicles, the current standard is immunoblotting or a flow cytometrical analysis for specific proteins, both of which requires large amounts of purified vesicles. METHODS Based on the technology of protein microarray, we hereby present a highly sensitive Extracellular Vesicle (EV) Array capable of detecting and phenotyping exosomes and other extracellular vesicles from unpurified starting material in a high-throughput manner. To only detect the exosomes captured on the EV Array, a cocktail of antibodies against the tetraspanins CD9, CD63 and CD81 was used. These antibodies were selected to ensure that all exosomes captured are detected, and concomitantly excluding the detection of other types of microvesicles. RESULTS The limit of detection (LOD) was determined on exosomes derived from the colon cancer cell line LS180. It clarified that supernatant from only approximately 10(4) cells was needed to obtain signals or that only 2.5×10(4) exosomes were required for each microarray spot (~1 nL). Phenotyping was performed on plasma (1-10 µL) from 7 healthy donors, which were applied to the EV Array with a panel of antibodies against 21 different cellular surface antigens and cancer antigens. For each donor, there was considerable heterogeneity in the expression levels of individual markers. The protein profiles of the exosomes (defined as positive for CD9, CD63 and CD81) revealed that only the expression level of CD9 and CD81 was approximately equal in the 7 donors. This implies questioning the use of CD63 as a standard exosomal marker since the expression level of this tetraspanin was considerably lower.
Collapse
Affiliation(s)
- Malene Jørgensen
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | | | | | | | | | | |
Collapse
|
26
|
Christensen AL, Dethlefsen C, Severinsen MT, Kristensen SR. Seasonal variation of venous thrombosis: a consecutive case series within studies from Leiden, Milan and Tromsø: a rebuttal. J Thromb Haemost 2013; 11:568-70. [PMID: 23279121 DOI: 10.1111/jth.12110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 12/18/2012] [Indexed: 11/29/2022]
|
27
|
El-Galaly TC, Severinsen MT, Overvad K, Steffensen R, Vistisen AK, Tjønneland A, Kristensen SR. Single nucleotide polymorphisms and the risk of venous thrombosis: results from a Danish case-cohort study. Br J Haematol 2012; 160:838-41. [DOI: 10.1111/bjh.12132] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 10/01/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Tarec C. El-Galaly
- Department of Haematology; Aalborg Hospital; Aarhus University Hospital; Aalborg Denmark
| | - Marianne T. Severinsen
- Department of Haematology; Aalborg Hospital; Aarhus University Hospital; Aalborg Denmark
| | - Kim Overvad
- Department of Cardiology; Centre for Cardiovascular Research; Aalborg Hospital; Aarhus University Hospital; Aalborg Denmark
- Department of Epidemiology; School of Public Health; Aarhus University; Aarhus Denmark
| | - Rudi Steffensen
- Department of Clinical Immunology; Aalborg Hospital; Aarhus University Hospital; Aalborg Denmark
| | - Anders K. Vistisen
- Department of Haematology; Aalborg Hospital; Aarhus University Hospital; Aalborg Denmark
| | - Anne Tjønneland
- Institute of Cancer Epidemiology; Danish Cancer Society; Copenhagen Denmark
| | - Søren R. Kristensen
- Department of Clinical Biochemistry; Centre for Cardiovascular Research; Aalborg Hospital; Aarhus University Hospital; Aalborg Denmark
| |
Collapse
|
28
|
El-Galaly TC, Kristensen SR, Overvad K, Steffensen R, Tjønneland A, Severinsen MT. Interaction between blood type, smoking and factor V Leiden mutation and risk of venous thromboembolism: a Danish case-cohort study. J Thromb Haemost 2012; 10:2191-3. [PMID: 22577971 DOI: 10.1111/j.1538-7836.2012.04772.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
29
|
Rees SE, Rychwicka-Kielek BA, Andersen BF, Bibi R, Pedersen JF, Weinreich UM, Birket-Smith LB, Kristensen SR. Calculating acid-base and oxygenation status during COPD exacerbation using mathematically arterialised venous blood. Clin Chem Lab Med 2012; 50:2149-54. [DOI: 10.1515/cclm-2012-0233] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 06/22/2012] [Indexed: 11/15/2022]
|
30
|
Tuckuviene R, Christensen AL, Helgestad J, Johnsen SP, Kristensen SR. Paediatric arterial ischaemic stroke and cerebral sinovenous thrombosis in Denmark 1994-2006: a nationwide population-based study. Acta Paediatr 2011; 100:543-9. [PMID: 21114523 DOI: 10.1111/j.1651-2227.2010.02100.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIM To assess the incidence rates (IR), clinical characteristics, risk factors, treatment and outcomes of paediatric arterial ischaemic stroke (AIS) and cerebral sinovenous thrombosis (CSVT). METHODS Using population-based, nationwide medical registries, we identified all patients aged 0-18 years at the time of hospitalization with first-ever AIS and/or CSVT in Denmark between 1994 and 2006. Medical records were retrieved and reviewed. RESULTS We identified 211 patients with AIS and 40 patients with CSVT corresponding to IRs of 1.33 (95% CI 1.16-1.52) and 0.25 (95% CI 0.19-0.34) per 100,000 person-years, respectively. The IRs peaked in infancy (<1 year) for both AIS and CSVT with an additional peak among adolescents (15-18 years) for CSVT. The IR of AIS increased 3.9% per year (p=0.036), whereas no changes were found for CSVT. In total, 48.2% of the patients received antithrombotic treatment; no major complications were observed. All-cause and thrombosis-related 30-day case fatality ratios were 3.6% and 2.4%, respectively; neurological sequelae were found in 56.2% of patients. CONCLUSION The IR of AIS was highest in infants and had increased with 3.9% annually during the observation period. The IR of CSVT had an additional peak in adolescence and remained unchanged over time.
Collapse
Affiliation(s)
- R Tuckuviene
- Department of Clinical Biochemistry, Centre of Cardiovascular Research, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark.
| | | | | | | | | |
Collapse
|
31
|
Severinsen MT, Overvad K, Johnsen SP, Dethlefsen C, Madsen PH, Tjønneland A, Kristensen SR. Genetic susceptibility, smoking, obesity and risk of venous thromboembolism. Br J Haematol 2010; 149:273-9. [PMID: 20148880 DOI: 10.1111/j.1365-2141.2010.08086.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The F5 G1691A (Factor V Leiden) and F2 G20210A (prothrombin) mutations are linked to an increase in the incidence rate of venous thromboembolism (VTE), but their effects are highly variable. We investigated whether the effects of smoking and obesity might explain this variability. In a case-cohort study including the participants of the Danish Diet, Cancer and Health study, we computed incidence rates and Cox proportional hazard ratios for VTE in individuals with and without the mutations, categorized by weight and tobacco consumption. The sole effect of heavy smoking was 128 extra VTE events per 100,000 person years in individuals with the F5 G1691A mutation versus 59 in individuals without. The sole effect of obesity was 222 extra VTE events per 100,000 person years in individuals with the F5 G1691A mutation, versus 103 in individuals without this mutation; and 705 extra VTE events per 100,000 person years in individuals with the F2 G20210A mutation versus 107 in individuals without this mutation. The F5 G1691A and F2 G20210A mutations conferred increased susceptibility to the unfavourable effects of smoking and obesity on the risk for VTE. Thus, individuals with genetic risk factors for VTE might benefit from maintaining a healthy lifestyle.
Collapse
|
32
|
Martínez-Martínez I, Ordóñez A, Guerrero JA, Pedersen S, Miñano A, Teruel R, Velázquez L, Kristensen SR, Vicente V, Corral J. Effects of acrolein, a natural occurring aldehyde, on the anticoagulant serpin antithrombin. FEBS Lett 2009; 583:3165-70. [PMID: 19729010 DOI: 10.1016/j.febslet.2009.07.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Revised: 07/16/2009] [Accepted: 07/20/2009] [Indexed: 11/29/2022]
Abstract
We studied the effect of acrolein, an alpha,beta-unsaturated aldehyde that causes adduct-modification of lysine, cysteine, and histidine residues, on antithrombin, a key anticoagulant serpin. Intrinsic fluorescence, functionality (anti-FXa and anti-IIa activity), heparin affinity and conformational features of plasma and purified antithrombin were evaluated. In vivo experiments were carried out in mice. Intrinsic fluorescence showed a two-step conformational change. Acrolein, even at low dose, impaired the anticoagulant function of purified antithrombin by affecting its heparin affinity. However, higher concentrations of acrolein and long incubations are required to cause mild functional effects on plasma antithrombin and mice.
Collapse
Affiliation(s)
- I Martínez-Martínez
- Centro Regional de Hemodonación, Universidad de Murcia, Ronda de Garay S/N, Murcia 30003, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Abstract
BACKGROUND Large-scale prospective studies are needed to assess whether smoking is associated with venous thromboembolism (VTE) (i.e. deep venous thrombosis and pulmonary embolism) independently of established risk factors. OBJECTIVE To investigate the association between smoking and the risk of VTE among middle-aged men and women. METHODS From 1993 to 1997, 27,178 men and 29,875 women, aged 50-64 years and born in Denmark, were recruited into the Danish prospective study 'Diet, Cancer and Health'. During follow-up, VTE cases were identified in the Danish National Patient Registry. Medical records were reviewed and only verified VTE cases were included in the study. Baseline data on smoking and potential confounders were included in gender stratified Cox proportional hazard models to asses the association between smoking and the risk of VTE. The analyses were adjusted for alcohol intake, body mass index, physical activity, and in women also for use of hormone replacement therapy. RESULTS During follow-up, 641 incident cases of VTE were verified. We found a positive association between current smoking and VTE, with a hazard ratio of 1.52 (95% CI, 1.15-2.00) for smoking women and 1.32 (95% CI, 1.00-1.74) for smoking men, and a positive dose-response relationship. Former smokers had the same hazard as never smokers. CONCLUSIONS Smoking was an independent risk factor for VTE among middle-aged men and women. Former smokers have the same risk of VTE as never smokers, indicating acute effects of smoking, and underscoring the potential benefits of smoking cessation.
Collapse
Affiliation(s)
- M T Severinsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aalborg, Denmark.
| | | | | | | | | | | |
Collapse
|
34
|
Jensen JK, Atar D, Kristensen SR, Mickley H, Januzzi JL. Usefulness of natriuretic peptide testing for long-term risk assessment following acute ischemic stroke. Am J Cardiol 2009; 104:287-91. [PMID: 19576362 DOI: 10.1016/j.amjcard.2009.03.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 03/12/2009] [Accepted: 03/12/2009] [Indexed: 11/17/2022]
Abstract
Acute-phase levels of B-type natriuretic peptide (BNP) and the N-terminal fragment of the BNP prohormone (NT-pro-BNP) have been associated with mortality when measured in patients with an acute ischemic stroke; however, data regarding the longer-term value of NT-pro-BNP for long-term prognostication after ischemic stroke are limited. Two hundred sixteen patients (mean age 67 +/- 13 years) with acute ischemic stroke were seen 6 months after index admission at which time a structured evaluation including measurement of plasma NT-pro-BNP was performed. Patients were followed for 45 months, with all-cause mortality as the clinical end point. Median NT-pro-BNP concentration for the entire group was 147 pg/ml (10th to 90th percentiles 37 to 869). At follow-up 45 patients (21%) had died. NT-pro-BNP concentrations were significantly higher in decedents (308 pg/ml, 10th to 90th percentiles 74 to 2,279) than in the 171 survivors (132 pg/ml, 10th to 90th percentiles 35 to 570, p <0.001). Patients with NT-pro-BNP < or =147 pg/ml had a significantly improved survival rate on univariate analysis (p <0.001). In multivariate analysis after adjustment for age, stroke severity, heart and renal failures, levels of NT-pro-BNP were an independent predictor of mortality >6 months after stroke (adjusted hazard ratio 1.5, 95% confidence interval 1.1 to 1.9, p = 0.005). In conclusion, NT-pro-BNP concentrations measured during the stable phase after acute ischemic stroke are strongly predictive of long-term mortality.
Collapse
Affiliation(s)
- Jesper K Jensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark.
| | | | | | | | | |
Collapse
|
35
|
Jensen JK, Korsholm L, Høilund-Carlsen PF, Atar D, Kristensen SR, Mickley H. The relation between electrocardiographic ST-T changes and NT-proBNP in patients with acute ischemic stroke. SCAND CARDIOVASC J 2009; 41:294-8. [PMID: 17886116 DOI: 10.1080/14017430701601644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND ST-segment depression and T-wave inversion (ST-T changes) in the electrocardiogram (ECG) and raised levels of natriuretic peptide have been observed in acute ischemic stroke patients. It is unknown whether any relation between ST-T changes and raised levels of natriuretic peptides in patients with an acute ischemic stroke exists. METHODS Serial measurements of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) and 12-lead ECGs were obtained in 192 consecutive patients with an acute ischemic stroke without ischemic heart disease, atrial fibrillation, heart- or renal failure. RESULTS ST-T changes suggestive of myocardial ischemia were observed in the 12 lead ECG of 47 patients (24%). In uni- and multivariate regression analysis after adjustment for age, stroke severity, female sex, systolic blood pressure, diabetes mellitus, and levels of troponin T > 0.03 microg/L, ST-T changes in the ECG remained associated with increased levels of NT-proBNP (beta=76.5, p=0.011). CONCLUSIONS ST-T changes suggestive of myocardial ischemia are independently associated with the levels of NT-proBNP in patients with acute ischemic stroke. The clinical importance of this observation remains to be defined.
Collapse
Affiliation(s)
- Jesper K Jensen
- Department of Cardiology, Odense University Hospital, Denmark.
| | | | | | | | | | | |
Collapse
|
36
|
Madsen EH, Schmidt EB, Maurer-Spurej E, Kristensen SR. Effects of aspirin and clopidogrel in healthy men measured by platelet aggregation and PFA-100. Platelets 2008; 19:335-41. [PMID: 18791939 DOI: 10.1080/09537100801989857] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
There are no generally accepted definitions for low-response (frequently called resistance) to the platelet inhibitors, aspirin and clopidogrel. Low-response may increase the risk of cardiovascular events in atherosclerotic patients. We aimed to define the normal drug responses in healthy men. Platelet function was measured in 20 healthy men during 11 days of aspirin or clopidogrel intake, using light transmission aggregometry (LTA) and the Platelet Function Analyzer 100 (PFA-100). The lower limits for LTA at baseline were 64% and 61%, using arachidonic acid and ADP as agonists, respectively. During aspirin intake the LTA results were stable from day to day, and an upper limit of 9% arachidonic acid stimulated aggregation was found. Clopidogrel intake was best shown by ADP induced aggregation. However, two out of 20 individuals exhibited low-response to clopidogrel. In the remaining 18 volunteers an upper limit of 48% aggregation was found. We found an upper limit for collagen-epinephrine stimulated PFA-100 results of 166 s at baseline. During aspirin intake, these results varied considerably from day to day in nine out of 20 men, resulting in an overlap between the reference ranges at baseline and during therapy. In conclusion, platelet inhibition by aspirin and clopidogrel assessed by aggregometry was stable during 11 days of treatment and reference ranges were established. The PFA-100 results varied greatly and low-response was not precisely defined by this method.
Collapse
Affiliation(s)
- Esben H Madsen
- Department of Clinical Biochemistry, Centre for Cardiovascular Research, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark.
| | | | | | | |
Collapse
|
37
|
Madsen EH, Schmidt EB, Gehr N, Johannesen NL, Kristensen SR. Testing aspirin resistance using the Platelet Function Analyzer-100: some methodological caveats and considerations. J Thromb Haemost 2008; 6:386-8. [PMID: 18036189 DOI: 10.1111/j.1538-7836.2008.02850.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
|
38
|
Abstract
Anaemia is a negative prognostic factor for patients with heart failure and impaired renal function, but its role in stroke patients is unknown. Furthermore, anaemia has been shown to influence the level of N-terminal pro-brain natriuretic peptide (NT-proBNP), but this is only investigated in patients with heart failure, not in stroke patients. Two-hundred-and-fifty consecutive, well-defined ischemic stroke patients were investigated. Mortality was recorded at 6 months follow-up. Anaemia was diagnosed in 37 patients (15%) in whom stroke severity was worse than in the non-anaemic group, whilst the prevalence of renal affection, smoking and heart failure was lower. At 6 months follow-up, 23 patients were dead, and anaemia had an odds ratio of 4.7 when adjusted for age, Scandinavian Stroke Scale and a combined variable of heart and/or renal failure and/or elevation of troponin T using logistic regression. The median NT-proBNP level in the anaemic group was significantly higher than in the non-anaemic group, and in a multivariate linear regression model, anaemia remained an independent predictor of NT-proBNP. Conclusively, anaemia was found to be a negative prognostic factor for ischemic stroke patients. Furthermore, anaemia influenced the NT-proBNP level in ischemic stroke patients, an important aspect when interpreting NT-proBNP in these patients.
Collapse
Affiliation(s)
- M Nybo
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | | | | | | |
Collapse
|
39
|
Kristensen SR, Rasmussen B, Pedersen S, Bathum L. Detecting antithrombin deficiency may be a difficult task--more than one test is necessary. J Thromb Haemost 2007; 5:617-8. [PMID: 17229050 DOI: 10.1111/j.1538-7836.2007.02395.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
40
|
Otzen DE, Giehm L, Baptista RP, Kristensen SR, Melo EP, Pedersen S. Aggregation as the basis for complex behaviour of cutinase in different denaturants. Biochimica et Biophysica Acta (BBA) - Proteins and Proteomics 2007; 1774:323-33. [PMID: 17208524 DOI: 10.1016/j.bbapap.2006.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Revised: 11/12/2006] [Accepted: 11/27/2006] [Indexed: 11/17/2022]
Abstract
We have previously described the complexity of the folding of the lipolytic enzyme cutinase from F. solani pisi in guanidinium chloride. Here we extend the refolding analysis by refolding from the pH-denatured state and analyze the folding behaviour in the presence of the weaker denaturant urea and the stronger denaturant guanidinium thiocyanate. In urea there is excellent consistency between equilibrium and kinetic data, and the intermediate accumulating at low denaturant concentrations is off-pathway. However, in GdmCl, refolding rates, and consequently the stability of the native state, vary significantly depending on whether refolding takes place from the pH- or GdmCl-denatured state, possibly due to transient formation of aggregates during folding from the GdmCl-denatured state. In GdmSCN, stability is reduced by several kcal/mol with significant aggregation in the unfolding transition region. The basis for the large variation in folding behaviour may be the denaturants' differential ability to support formation of exposed hydrophobic regions and consequent changes in aggregative properties during refolding.
Collapse
Affiliation(s)
- Daniel E Otzen
- Department of Life Sciences, Aalborg University, Sohngaardsholmsvej 49, Aalborg DK- 9000, Denmark.
| | | | | | | | | | | |
Collapse
|
41
|
Jensen JK, Kristensen SR, Bak S, Atar D, Høilund-Carlsen PF, Mickley H. Frequency and significance of troponin T elevation in acute ischemic stroke. Am J Cardiol 2007; 99:108-12. [PMID: 17196472 DOI: 10.1016/j.amjcard.2006.07.071] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Revised: 07/13/2006] [Accepted: 07/23/2006] [Indexed: 01/28/2023]
Abstract
Elevated levels of troponin have been reported in patients with acute ischemic stroke. In this prospective study, the prevalence and characteristics of troponin elevation were examined in 244 patients with acute ischemic stroke but without overt ischemic heart disease. Troponin T (TnT) and creatine kinase-MB (CK-MB) concentrations were measured and 12-lead electrocardiograms obtained daily during the first 5 days of admission. Myocardial perfusion scintigraphy was performed in patients with TnT levels of 0.10 micro g/L and in comparable controls without elevation of TnT. Patients were followed for a mean of 19 +/- 7 months, with all-cause mortality as the clinical end point. Elevated levels of TnT (>0.03 micro g/L) and creatine kinase-MB (> or =10 micro g/L) were observed in 10% and 9% of patients, respectively. Patients with elevated TnT had higher frequencies of heart and/or renal failure. Perfusion abnormalities on myocardial perfusion scintigraphy at rest were not more frequent or pronounced in patients with TnT levels of > or =0.10 micro g/L than in the control group. Only 7 patients (3%) had elevations of TnT or creatine kinase-MB and electrocardiographic changes suggesting acute myocardial infarctions. According to univariate and multivariate analyses, elevation of TnT was significantly associated with mortality. In conclusion, elevated levels of TnT are rare in patients presenting with ischemic stroke but without overt ischemic heart disease. Heart and renal failure rather than myocardial infarction are the most likely causes. When present, elevation of TnT seems to be useful in identifying patients who are at increased risk of dying within the following 2 years.
Collapse
Affiliation(s)
- Jesper K Jensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark.
| | | | | | | | | | | |
Collapse
|
42
|
Jensen JK, Mickley H, Bak S, Korsholm L, Kristensen SR. Serial Measurements of N-Terminal pro-Brain Natriuretic Peptide after Acute Ischemic Stroke. Cerebrovasc Dis 2006; 22:439-44. [PMID: 16912478 DOI: 10.1159/000094997] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Accepted: 05/26/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The exact time-course of N-terminal pro-brain natriuretic peptide (NT-proBNP) and the prognostic importance in the immediate phase of ischemic stroke have not been established. METHODS NT-proBNP was measured daily from admission to day 5 and again at 6-month follow-up in 250 consecutive patients with acute ischemic stroke. RESULTS NT-proBNP peaked the day after onset of symptoms (p = 0.007) followed by a decrease until day 5 (p = 0.001, ANOVA). At 6-month follow-up the difference in the level of NT-proBNP was unchanged compared to day 5 (p = 0.42). NT-proBNP levels > or =615 pg/ml at day 2 after onset of symptoms was associated with 6-month mortality. CONCLUSION NT-proBNP peaks the day after onset of symptoms in patients with acute ischemic stroke. A single measurement of NT-proBNP appears to be an indicator of 6-month mortality.
Collapse
Affiliation(s)
- J K Jensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark.
| | | | | | | | | |
Collapse
|
43
|
Kristensen SR, Abrahamsen B, Madsen JS, Gram J, Rejnmark L, Rud B, Jespersen J. Venous thrombosis is not increased in younger women on genuine oestrogen postmenopausal hormonal replacement therapy: results from the Danish Osteoporosis Prevention Study (DOPS). Thromb Haemost 2006; 95:915-6. [PMID: 16676096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
|
44
|
Pedersen S, Nesgaard L, Baptista RP, Melo EP, Kristensen SR, Otzen DE. pH-dependent aggregation of cutinase is efficiently suppressed by 1,8-ANS. Biopolymers 2006; 83:619-29. [PMID: 16964599 DOI: 10.1002/bip.20598] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We have studied the thermal stability of the triglyceride-hydrolyzing enzyme cutinase from F. solani pisi at pH values straddling the pI (pH 8.0). At the pI, increasing the protein concentration from 5 to 80 microM decreases the apparent melting temperature by 19 degrees C. This effect vanishes at pH values more than one unit away from pI. In contrast to additives such as detergents and osmolytes, the hydrophobic fluorophore 1,8-ANS completely and saturably suppresses this effect, restoring 70% of enzymatic activity upon cooling. ANS binds strongly to native cutinase as a noncompetitive inhibitor with up to 5 ANS per cutinase molecule. Only the first ANS molecule stabilizes cutinase; however, the last 4 ANS molecules decrease Tm by up to 7 degrees C. Similar pI-dependent aggregation and suppression by ANS is observed for T. lanuginosus lipase, but not for lysozyme or porcine alpha-amylase, suggesting that this behavior is most prevalent for proteins with affinity for hydrophobic substrates and consequent exposure of hydrophobic patches. Aggregation may be promoted by a fluctuating ensemble of native-like states associating via intermolecular beta-sheet rich structures unless blocked by ANS. Our data highlight the chaperone activity of small molecules with affinity for hydrophobic surfaces and their potential application as stabilizers at appropriate stoichiometries.
Collapse
Affiliation(s)
- Shona Pedersen
- Department of Life Sciences, Aalborg University, DK-9000 Aalborg, Denmark
| | | | | | | | | | | |
Collapse
|
45
|
Madsen JS, Kristensen SR, Gram J, Bladbjerg EM, Henriksen FL, Gram J, Christensen K, Jespersen J. Positive impact of hormone replacement therapy on the fibrinolytic system: a long-term randomized controlled study in healthy postmenopausal women. J Thromb Haemost 2003; 1:1984-91. [PMID: 12941041 DOI: 10.1046/j.1538-7836.2003.00362.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The mechanisms by which postmenopausal hormone replacement therapy (HRT) may influence risk of cardiovascular disease are still unclear. Impaired fibrinolytic function is associated with an enhanced risk of cardiovascular disease and therefore the effect of HRT on fibrinolysis may be of importance. OBJECTIVES To investigate the prolonged effect of HRT on the fibrinolytic system and to determine whether two common polymorphisms in the plasminogen activator inhibitor-1 (PAI-1) and tissue-type plasminogen activator (t-PA) genes modulate this effect. METHODS Healthy postmenopausal women (n = 248) were randomized to HRT (n = 122) or no substitution (n = 126) 5 years prior to investigation. RESULTS Significantly higher values of t-PA activity and lower values of PAI-1 activity and PAI-1 antigen were found in the HRT group compared with the control group. This effect was independent of smoking and without influence from the two common polymorphisms PAI-1 -675(4G/5G) and t-PA intron8ins311. Furthermore, no difference between opposed estrogen (with norethisterone acetate as the gestagen component) and unopposed estrogen therapy was found. Both an intention-to-treat and a per-protocol analysis were performed and similar results were obtained. CONCLUSIONS Long-term treatment with HRT in healthy postmenopausal women was found to be associated with a beneficial fibrinolytic profile. This effect was found independent of smoking status, opposed and unopposed estrogen therapy had equal effect, and no influence of the two common polymorphisms PAI-1-675(4G/5G) and t-PA intron8ins311 was found. This effect of HRT on fibrinolytic capacity may be one of the beneficial effects of HRT in relation to cardiovascular diseases.
Collapse
Affiliation(s)
- J S Madsen
- Departments of Clinical Biochemistry and Endocrinology, Odense University Hospital, Odense, Denmark.
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Bladbjerg EM, Madsen JS, Kristensen SR, Abrahamsen B, Brixen K, Mosekilde L, Jespersen J. Effect of long-term hormone replacement therapy on tissue factor pathway inhibitor and thrombin activatable fibrinolysis inhibitor in healthy postmenopausal women: a randomized controlled study. J Thromb Haemost 2003; 1:1208-14. [PMID: 12871321 DOI: 10.1046/j.1538-7836.2003.00281.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
It was recently reported from the Women's Health Initiative that healthy women using combined hormone replacement therapy (HRT) for 5 years have an increased cardiovascular risk. We hypothesize that the increased risk is confined to subgroups of atherosclerotic women. Such women may have higher arterial tissue factor expression and higher thrombin formation, and changes in tissue factor pathway coagulation inhibitor (TFPI) and thrombin activatable fibrinolysis inhibitor (TAFI) may be deleterious. Healthy postmenopausal women (n = 719) were randomized to hormone therapy [n = 357; opposed (n = 290) and unopposed (n = 67)] or no treatment (n = 362). Plasma TFPI and TAFI and the TFPI -287T/C and TAFI -438G/A polymorphisms were measured 5-6 years after randomization. Concentrations of TFPI were significantly lower in the hormone group than in the control group (P < 0.001) and in all genotypes of the TFPI polymorphism. Overall, concentrations of TAFI did not differ between the two groups but were reduced by hormone therapy in homozygotes for the rare TAFI -438 A allele (P < 0.05). The hormone effects on TFPI and TAFI were similar in smokers and non-smokers and in women using unopposed and opposed therapy. The observed decrease in TFPI may contribute to the increased cardiovascular risk associated with HRT.
Collapse
Affiliation(s)
- E M Bladbjerg
- Department for Thrombosis Research, University of Southern Denmark, Ribe County Hospital, Finsensgade 35, DK-6700 Esbjerg, Denmark.
| | | | | | | | | | | | | |
Collapse
|
47
|
Madsen JS, Kristensen SR, Klitgaard NA, Bladbjerg EM, Abrahamsen B, Stilgren L, Jespersen J. Effect of long-term hormone replacement therapy on plasma homocysteine in postmenopausal women: a randomized controlled study. Am J Obstet Gynecol 2002; 187:33-9. [PMID: 12114885 DOI: 10.1067/mob.2002.123030] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the long-term effect of hormone replacement therapy on total homocysteine and to study whether there was any difference in effect between opposed and unopposed hormone replacement therapy or whether the methylenetetrahydrofolate reductase C677T polymorphism was associated with the effect of hormone replacement therapy on total homocysteine. STUDY DESIGN Two hundred nine healthy postmenopausal women were randomized to hormone replacement therapy (n = 103) or no substitution (n = 106) 5 to 7 years earlier. RESULTS Women who received hormone replacement therapy had significantly lower total homocysteine concentrations than women in the control group; median total homocysteine values were 8.6 micromol/L and 9.7 micromol/L, respectively, in a per-protocol analysis (P =.02). The effect was comparable in all methylenetetrahydrofolate reductase genotypes, and no difference between unopposed and opposed hormone replacement therapy could be demonstrated. Similar results were obtained when an intention-to-treat analysis was performed. CONCLUSION Long-term hormone replacement therapy results in lower total homocysteine concentrations in all methylenetetrahydrofolate reductase genotypes without demonstrable difference in effect between unopposed and opposed hormone replacement therapy.
Collapse
Affiliation(s)
- Jonna S Madsen
- Department of Clinical Biochemistry, Odense University Hospital, Denmark.
| | | | | | | | | | | | | |
Collapse
|
48
|
Abstract
The aim of this study was to select an effective and stable protocol for the differentiation of human satellite cells (Sc) and to identify the optimal time period for the experimental use of differentiated human Sc-cultures. In order to identify the differentiation conditions which give a good survival of myotubes and a high grade of differentiation, Sc-cultures were induced to differentiate in media supplemented with either 2% fetal calf serum (FCS) 2% horse serum (HS) or 10% HS. Based on higher CK-activities in cultures differentiating in FCS-supplemented media compared to horse sera, fetal calf serum was chosen to induce differentiation. The ATP, DNA and protein content increased during the first 4 days after induction of differentiation and was followed by a period with minor changes. The maximal differences of ATP, DNA and protein between days 4-10 were evaluated and the differences in the three components were found to be less than 20% of the average value with a certainity of more than 0.9. Day 8-myotubes were investigated morphologically and were found immunoreactive for fast myosin, and expressed areas with clear cross striation. We recommend the use of differentiated Sc-cultures in the period from day 4 to 8 after induction of differentiation as only minor differentation-related changes will take place in the cells during this period of time.
Collapse
Affiliation(s)
- M Gaster
- Department of Endocrinology, Odense University Hospital, Denmark.
| | | | | | | |
Collapse
|
49
|
Haastrup B, Gill S, Kristensen SR, Jørgensen PJ, Glatz JF, Haghfelt T, Hørder M. Biochemical markers of ischaemia for the early identification of acute myocardial infarction without St segment elevation. Cardiology 2001; 94:254-61. [PMID: 11326147 DOI: 10.1159/000047326] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Blood was collected on admission and after 1-2 h in 130 consecutive patients admitted with typical chest pain in order to assess the capacity of myoglobin, fatty-acid-binding protein (FABP), CK-MB mass, and troponin I (TnI) in the early identification of acute myocardial infarction (AMI) without ST elevation. Using the maximum value within 6 h of onset of symptoms, AMI was detected with a 90-95% sensitivity and a 81-94% specificity by FABP at a cut-off level 8-12 midrog/l, or 81-86% and 89-93%, respectively, by myoglobin at a cut-off level 70-90 microg/l. CK-MB mass and TnI had low sensitivity, albeit very high specificity. As almost all AMI patients were identified within 6 h, serial measurements of FABP or myoglobin ruled out AMI with a very high degree of certainty. Due to the low prevalence of AMI (16%), the positive predictive values were modest (47-73%), yet increasing the probability of AMI by a factor 3-4. Myoglobin and FABP are very useful markers in the early triage of chest pain patients.
Collapse
Affiliation(s)
- B Haastrup
- Department of Cardiology, Odense University Hospital, Odense C, Denmark.
| | | | | | | | | | | | | |
Collapse
|
50
|
Laursen RV, Kristensen SR, Angelo-Nielsen K. [Macro creatine kinase as a pitfall in diagnosis of acute myocardial infarction]. Ugeskr Laeger 2000; 162:5930-1. [PMID: 11094555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Measurement of creatine kinase and the more heart-specific creatine kinase B has been a mainstay in the diagnosis of acute myocardial infarction in Denmark since the 1970's. However, an elevated creatine kinase B may reflect other conditions than myocardial damage, for example the presence of other isoenzymes or macro creatine kinase. A case is presented with a review of the literature.
Collapse
|