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Helman J, Wahlgren H, Andersson L, Morelle J, Öberg CM. Quantifying Ultrafiltration in Peritoneal Dialysis Using the Sodium Dip. Kidney360 2024; 5:195-204. [PMID: 38236202 PMCID: PMC10914194 DOI: 10.34067/kid.0000000000000358] [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] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/10/2024] [Indexed: 01/19/2024]
Abstract
Key Points Ultrafiltration (UF) is a key component of clinical peritoneal dialysis prescription, but the traditional method to assess UF is hampered by large inaccuracies. Here we propose a novel method, based on a computational model and on a single dialysate sodium measurement, to accurately estimate UF and osmotic conductance to glucose in patients on peritoneal dialysis. Background Volume overload is highly prevalent among patients treated with peritoneal dialysis (PD), contributes to hypertension, and is associated with an increased risk of cardiovascular events and death in this population. As a result, optimizing peritoneal ultrafiltration (UF) is a key component of high-quality dialysis prescription. Osmotic conductance to glucose (OCG) reflects the water transport properties of the peritoneum, but measuring it requires an accurate quantification of UF, which is often difficult to obtain because of variability in catheter patency and peritoneal residual volume. Methods In this study, we derived a new mathematical model for estimating UF during PD, on the basis of sodium sieving, using a single measure of dialysate sodium concentration. The model was validated experimentally in a rat model of PD, using dialysis fluid with two different sodium concentrations (125 and 134 mmol/L) and three glucose strengths (1.5%, 2.3%, and 4.25%). Then, the same model was tested in a cohort of PD patients to predict UF. Results In experimental and clinical conditions, the sodium-based estimation of UF rate correlated with UF rate measurements on the basis of volumetry and albumin dilution, with a R 2 =0.35 and R 2 =0.76, respectively. UF on the basis of sodium sieving was also successfully used to calculate OCG in the clinical cohort, with a Pearson r of 0.77. Conclusions Using the novel mathematical models in this study, the sodium dip can be used to accurately estimate OCG, and therefore, it is a promising measurement method for future clinical use.
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Affiliation(s)
- Jakob Helman
- Department of Clinical Sciences Lund, Skåne University Hospital, Lund, Sweden
| | - Hedda Wahlgren
- Department of Clinical Sciences Lund, Skåne University Hospital, Lund, Sweden
| | - Linn Andersson
- Department of Clinical Sciences Lund, Skåne University Hospital, Lund, Sweden
| | - Johann Morelle
- Division of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium
- UCLouvain School of Medicine, Université catholique de Louvain, Brussels, Belgium
| | - Carl M. Öberg
- Department of Clinical Sciences Lund, Skåne University Hospital, Lund, Sweden
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Nordlund D, Lav T, Jablonowski R, Khoshnood A, Ekelund U, Atar D, Erlinge D, Engblom H, Arheden H. Contractility, ventriculoarterial coupling, and stroke work after acute myocardial infarction using CMR-derived pressure-volume loop data. Clin Cardiol 2024; 47:e24216. [PMID: 38269628 PMCID: PMC10790509 DOI: 10.1002/clc.24216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Noninvasive left ventricular (LV) pressure-volume (PV) loops derived by cardiac magnetic resonance (CMR) have recently been shown to enable characterization of cardiac hemodynamics. Thus, such PV loops could potentially provide additional diagnostic information such as contractility, arterial elastance (Ea ) and stroke work (SW) currently not available in clinical routine. This study sought to investigate to what extent PV-loop variables derived with a novel noninvasive method can provide incremental physiological information over cardiac dimensions and blood pressure in patients with acute myocardial infarction (MI). METHODS A total of 100 patients with acute MI and 75 controls were included in the study. All patients underwent CMR 2-6 days after MI including assessment of myocardium at risk (MaR) and infarct size (IS). Noninvasive PV loops were generated from CMR derived LV volumes and brachial blood pressure measurements. The following variables were quantified: Maximal elastance (Emax ) reflecting contractility, Ea , ventriculoarterial coupling (Ea /Emax ), SW, potential energy, external power, energy per ejected volume, and efficiency. RESULTS All PV-loop variables were significantly different in MI patients compared to healthy volunteers, including contractility (Emax : 1.34 ± 0.48 versus 1.50 ± 0.41 mmHg/mL, p = .024), ventriculoarterial coupling (Ea /Emax : 1.27 ± 0.61 versus 0.73 ± 0.17, p < .001) and SW (0.96 ± 0.32 versus 1.38 ± 0.32 J, p < .001). These variables correlated to both MaR and IS (Emax : r2 = 0.25 and r2 = 0.29; Ea /Emax : r2 = 0.36 and r2 = 0.41; SW: r2 = 0.21 and r2 = 0.25). CONCLUSIONS Noninvasive PV-loops provide physiological information beyond conventional diagnostic variables, such as ejection fraction, early after MI, including measures of contractility, ventriculoarterial coupling, and SW.
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Affiliation(s)
- David Nordlund
- Department of Clinical Sciences Lund, Clinical PhysiologyLund University and Skane University HospitalLundSweden
| | - Theodor Lav
- Department of Clinical Sciences Lund, Clinical PhysiologyLund University and Skane University HospitalLundSweden
| | - Robert Jablonowski
- Department of Clinical Sciences Lund, Clinical PhysiologyLund University and Skane University HospitalLundSweden
| | - Ardavan Khoshnood
- Department of Clinical Sciences Malmö, Emergency Medicine, Lund UniversitySkane University HospitalMalmöSweden
| | - Ulf Ekelund
- Department of Clinical Sciences Lund, Emergency MedicineLund University and Skane University HospitalLundSweden
| | - Dan Atar
- Dept. of CardiologyOslo University Hospital UllevalOsloNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - David Erlinge
- Cardiology, Department of Clinical Sciences LundLund University and Skane University HospitalLundSweden
| | - Henrik Engblom
- Department of Clinical Sciences Lund, Clinical PhysiologyLund University and Skane University HospitalLundSweden
| | - Håkan Arheden
- Department of Clinical Sciences Lund, Clinical PhysiologyLund University and Skane University HospitalLundSweden
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3
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Reumann D, Krauditsch C, Novatchkova M, Sozzi E, Wong SN, Zabolocki M, Priouret M, Doleschall B, Ritzau-Reid KI, Piber M, Morassut I, Fieseler C, Fiorenzano A, Stevens MM, Zimmer M, Bardy C, Parmar M, Knoblich JA. In vitro modeling of the human dopaminergic system using spatially arranged ventral midbrain-striatum-cortex assembloids. Nat Methods 2023; 20:2034-2047. [PMID: 38052989 PMCID: PMC10703680 DOI: 10.1038/s41592-023-02080-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 10/10/2023] [Indexed: 12/07/2023]
Abstract
Ventral midbrain dopaminergic neurons project to the striatum as well as the cortex and are involved in movement control and reward-related cognition. In Parkinson's disease, nigrostriatal midbrain dopaminergic neurons degenerate and cause typical Parkinson's disease motor-related impairments, while the dysfunction of mesocorticolimbic midbrain dopaminergic neurons is implicated in addiction and neuropsychiatric disorders. Study of the development and selective neurodegeneration of the human dopaminergic system, however, has been limited due to the lack of an appropriate model and access to human material. Here, we have developed a human in vitro model that recapitulates key aspects of dopaminergic innervation of the striatum and cortex. These spatially arranged ventral midbrain-striatum-cortical organoids (MISCOs) can be used to study dopaminergic neuron maturation, innervation and function with implications for cell therapy and addiction research. We detail protocols for growing ventral midbrain, striatal and cortical organoids and describe how they fuse in a linear manner when placed in custom embedding molds. We report the formation of functional long-range dopaminergic connections to striatal and cortical tissues in MISCOs, and show that injected, ventral midbrain-patterned progenitors can mature and innervate the tissue. Using these assembloids, we examine dopaminergic circuit perturbations and show that chronic cocaine treatment causes long-lasting morphological, functional and transcriptional changes that persist upon drug withdrawal. Thus, our method opens new avenues to investigate human dopaminergic cell transplantation and circuitry reconstruction as well as the effect of drugs on the human dopaminergic system.
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Affiliation(s)
- Daniel Reumann
- Institute of Molecular Biotechnology (IMBA) of the Austrian Academy of Sciences, Vienna BioCenter, Vienna, Austria
- Vienna BioCenter, Doctoral School of the University of Vienna and Medical University of Vienna, Vienna, Austria
| | - Christian Krauditsch
- Institute of Molecular Biotechnology (IMBA) of the Austrian Academy of Sciences, Vienna BioCenter, Vienna, Austria
| | - Maria Novatchkova
- Institute of Molecular Biotechnology (IMBA) of the Austrian Academy of Sciences, Vienna BioCenter, Vienna, Austria
| | - Edoardo Sozzi
- Department of Experimental Medical Science, Developmental and Regenerative Neurobiology, Wallenberg Neuroscience Center, Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Sakurako Nagumo Wong
- Institute of Molecular Biotechnology (IMBA) of the Austrian Academy of Sciences, Vienna BioCenter, Vienna, Austria
- Vienna BioCenter, Doctoral School of the University of Vienna and Medical University of Vienna, Vienna, Austria
| | - Michael Zabolocki
- Laboratory for Human Neurophysiology and Genetics, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Marthe Priouret
- Institute of Molecular Biotechnology (IMBA) of the Austrian Academy of Sciences, Vienna BioCenter, Vienna, Austria
| | - Balint Doleschall
- Institute of Molecular Biotechnology (IMBA) of the Austrian Academy of Sciences, Vienna BioCenter, Vienna, Austria
- Vienna BioCenter, Doctoral School of the University of Vienna and Medical University of Vienna, Vienna, Austria
| | - Kaja I Ritzau-Reid
- Department of Materials, Department of Bioengineering, Institute of Biomedical Engineering, Imperial College London, London, UK
| | - Marielle Piber
- Institute of Molecular Biotechnology (IMBA) of the Austrian Academy of Sciences, Vienna BioCenter, Vienna, Austria
- Zebrafish Neurogenetics Unit, Institut Pasteur, Paris, France
| | - Ilaria Morassut
- Institute of Molecular Biotechnology (IMBA) of the Austrian Academy of Sciences, Vienna BioCenter, Vienna, Austria
- Department of Basic Neurosciences, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Charles Fieseler
- Department of Neuroscience and Developmental Biology, University of Vienna, Vienna, Austria
| | - Alessandro Fiorenzano
- Department of Experimental Medical Science, Developmental and Regenerative Neurobiology, Wallenberg Neuroscience Center, Lund Stem Cell Center, Lund University, Lund, Sweden
- Stem Cell Fate Laboratory, Institute of Genetics and Biophysics 'Adriano Buzzati Traverso' (IGB), CNR, Naples, Italy
| | - Molly M Stevens
- Department of Materials, Department of Bioengineering, Institute of Biomedical Engineering, Imperial College London, London, UK
| | - Manuel Zimmer
- Department of Neuroscience and Developmental Biology, University of Vienna, Vienna, Austria
| | - Cedric Bardy
- Laboratory for Human Neurophysiology and Genetics, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Malin Parmar
- Department of Experimental Medical Science, Developmental and Regenerative Neurobiology, Wallenberg Neuroscience Center, Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Jürgen A Knoblich
- Institute of Molecular Biotechnology (IMBA) of the Austrian Academy of Sciences, Vienna BioCenter, Vienna, Austria.
- Department of Neurology, Medical University of Vienna, Vienna, Austria.
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Öberg CM, Sternby J, Nilsson A, Storr M, Flieg R, Harenski K, Roos V, Källquist L, Hobro S. Experimental hemodialysis in diet-induced ketosis and the potential use of dialysis as an adjuvant cancer treatment. Sci Rep 2023; 13:19476. [PMID: 37945638 PMCID: PMC10636042 DOI: 10.1038/s41598-023-46715-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 11/03/2023] [Indexed: 11/12/2023] Open
Abstract
Numerous in vivo studies on the ketogenic diet, a diet that can induce metabolic conditions resembling those following extended starvation, demonstrate strong outcomes on cancer survival, particularly when combined with chemo-, radio- or immunological treatments. However, the therapeutic application of ketogenic diets requires strict dietary adherence from well-informed and motivated patients, and it has recently been proposed that hemodialysis might be utilized to boost ketosis and further destabilize the environment for cancer cells. Yet, plasma ketones may be lost in the dialysate-lowering blood ketone levels. Here we performed a single 180-min experimental hemodialysis (HD) session in six anesthetized Sprague-Dawley rats given ketogenic diet for five days. Median blood ketone levels pre-dialysis were 3.5 mmol/L (IQR 2.2 to 5.6) and 3.8 mmol/L (IQR 2.2 to 5.1) after 180 min HD, p = 0.54 (95% CI - 0.6 to 1.2). Plasma glucose levels were reduced by 36% (- 4.5 mmol/L), p < 0.05 (95% CI - 6.7 to - 2.5). Standard base excess was increased from - 3.5 mmol/L (IQR - 4 to - 2) to 0.5 mmol/L (IQR - 1 to 3), p < 0.01 (95% CI 2.0 to 5.0). A theoretical model was applied confirming that intra-dialytic glucose levels decrease, and ketone levels slightly increase since hepatic ketone production far exceeds dialytic removal. Our experimental data and in-silico modeling indicate that elevated blood ketone levels during ketosis are maintained during hemodialysis despite dialytic removal.
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Affiliation(s)
- Carl M Öberg
- Department of Clinical Sciences Lund, Skåne University Hospital, Njurmottagningen SUS Lund, Barngatan 2a, 221 85, Lund, Sweden.
| | - Jan Sternby
- Baxter International Inc., Magistratsvägen 10, 22643, Lund, Sweden
| | - Anders Nilsson
- Baxter International Inc., Magistratsvägen 10, 22643, Lund, Sweden
| | - Markus Storr
- Baxter International Inc., 72379, Hechingen, Germany
| | - Ralf Flieg
- Baxter International Inc., 72379, Hechingen, Germany
| | - Kai Harenski
- Baxter Deutschland GmbH., 85 716, Unterschleissheim, Germany
| | - Viktoria Roos
- Baxter International Inc., Magistratsvägen 10, 22643, Lund, Sweden.
| | - Linda Källquist
- Baxter International Inc., Magistratsvägen 10, 22643, Lund, Sweden
| | - Sture Hobro
- Baxter International Inc., Magistratsvägen 10, 22643, Lund, Sweden
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Niemeyer Hultstrand J, Törnroos E, Tydén T, Larsson M, Makenzius M, Gemzell‐Danielsson K, Sundström‐Poromaa I, Ekstrand Ragnar M. Contraceptive use among women seeking an early induced abortion in Sweden. Acta Obstet Gynecol Scand 2023; 102:1496-1504. [PMID: 37493190 PMCID: PMC10577618 DOI: 10.1111/aogs.14630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/23/2023] [Accepted: 06/20/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION In spite of societal efforts to strengthen women's sexual and reproductive health in Sweden, many women have unmet contraceptive needs and the abortion rate remains high. The aim of this study was to investigate contraceptive use among abortion-seeking women. MATERIAL AND METHODS Swedish-speaking women seeking an induced abortion up to the end of gestational week 12 at seven hospitals filled out an anonymous paper questionnaire between January and June 2021. Data were analyzed using frequencies and cross-tabulations, and the Chi-square test was used to compare age-groups. Valid percentages are presented. RESULTS In total, 623 women participated. Median age was 29 years and 13% were born outside the Nordic countries. In the year preceding the abortion, condoms (37%, n = 228) were the most commonly used contraceptive method, followed by short-acting reversible contraception (SARC) (35%, n = 213) and withdrawal (25%, n = 152). Around one in five (n = 113) had not used any method in the year preceding the abortion. Sixteen percent (n = 96) had changed contraceptive method in the last year. At the time around conception, 15% (n = 90) reported use of SARC and 2% (n = 12) of long-acting reversible contraception (LARC). Four out of 10 women (n = 268) reported non-use of contraception at the time around conception, with a higher proportion among adolescents (70%, n = 30, P = 0.001). Among the women who responded to why they had not used any method (n = 387), the main reasons were that they did not believe they could become pregnant at that time (37%, n = 144) or had negative experiences from using contraceptives (32%, n = 123). A majority (88%, n = 527) planned to use contraception after the abortion. Of the women who had decided on method, 55% (n = 271) planned to use LARC, and 38% (n = 188) planned to use SARC. CONCLUSION The unmet need for contraception appears to be high among abortion-seeking women in Sweden. Many had discontinued contraception use during the last year, and the main reasons for avoidance were beliefs that one could not become pregnant and negative experiences of contraceptives. The underestimation of pregnancy risk indicates limited fertility awareness, thus our recommendation would be to strengthen the sexual and reproductive knowledge among this group.
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Affiliation(s)
| | - Elin Törnroos
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
| | - Tanja Tydén
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
| | - Margareta Larsson
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
| | - Marlene Makenzius
- Department of Global Public HealthKarolinska InstitutetStockholmSweden
- Department of Health SciencesMid Sweden UniversityÖstersundSweden
- Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | - Kristina Gemzell‐Danielsson
- Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
- WHO CenterKarolinska University HospitalStockholmSweden
| | | | - Maria Ekstrand Ragnar
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
- Department of Health SciencesLund UniversityLundSweden
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Tärnhäll A, Björk J, Wallinius M, Gustafsson P, Billstedt E, Hofvander B. Healthcare utilization and psychiatric morbidity in violent offenders: findings from a prospective cohort study. Soc Psychiatry Psychiatr Epidemiol 2023; 58:617-628. [PMID: 36574014 PMCID: PMC10066109 DOI: 10.1007/s00127-022-02408-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 12/12/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE Although persistent offenders with histories of imprisonment and violence have disproportionate high rates of psychiatric disorders, little is known of their psychiatric healthcare utilization (HCU) and HCU-associated factors. This study aimed to explore psychiatric HCU, psychiatric morbidity, and psychotropic prescription drugs in violent offenders with a history of incarceration. METHODS Male offenders aged 18-25 (n = 266) imprisoned for violent and/or physical sexual offenses were clinically assessed in 2010-2012 and prospectively followed in Swedish national registries through 2017. Register-based information regarding HCU, psychiatric morbidity, and psychotropic drugs was tracked and compared with a general population group (n = 10,000) and across offending trajectory groups. Baseline risk factors were used to explain prospective psychiatric HCU in violent offenders. RESULTS Violent offenders used less general healthcare and psychiatric outpatient care, but more psychiatric inpatient care and were more often given psychiatric diagnoses and psychotropic drugs than the general population. Participants previously assigned to persisting offending trajectory groups had higher rates of psychiatric HCU than those assigned to a desisting trajectory. In multivariable regression models, psychiatric HCU was associated with anxiety disorders, prior psychiatric contact, placement in a foster home, psychopathic traits, low intellectual functioning, and persistent offending. CONCLUSIONS Violent offenders are burdened by extensive and serious psychiatric morbidity and typically interact with psychiatric healthcare as inpatients rather than outpatients. Knowledge about their backgrounds, criminal behaviors, and psychiatric statuses can aid the planning of psychiatric services for this troublesome group.
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Affiliation(s)
- André Tärnhäll
- Lund Clinical Research on Externalizing and Developmental Psychopathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
- Department of Forensic Psychiatry, Region Skåne, Malmö, Sweden.
- Centre of Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden.
| | - Jonas Björk
- Department of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Märta Wallinius
- Lund Clinical Research on Externalizing and Developmental Psychopathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Centre of Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden
- Research Department, Regional Forensic Psychiatric Clinic, Växjö, Sweden
| | - Peik Gustafsson
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Eva Billstedt
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Björn Hofvander
- Lund Clinical Research on Externalizing and Developmental Psychopathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Forensic Psychiatry, Region Skåne, Malmö, Sweden
- Centre of Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden
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Söderlund Z, Ibáñez-Fonseca A, Hajizadeh S, Rodríguez-Cabello JC, Liu J, Ye L, Tykesson E, Elowsson L, Westergren-Thorsson G. Controlled release of growth factors using synthetic glycosaminoglycans in a modular macroporous scaffold for tissue regeneration. Commun Biol 2022; 5:1349. [PMID: 36482075 PMCID: PMC9732287 DOI: 10.1038/s42003-022-04305-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
Healthy regeneration of tissue relies on a well-orchestrated release of growth factors. Herein, we show the use of synthetic glycosaminoglycans for controlled binding and release of growth factors to induce a desired cellular response. First, we screened glycosaminoglycans with growth factors of interest to determine kon (association rate constant), koff (dissociation rate constant), and Kd (equilibrium rate constant). As proof-of-concept, we functionalized an elastin-like recombinamer (ELR) hydrogel with a synthetic glycosaminoglycan and immobilized fibroblast growth factor 2 (FGF2), demonstrating that human umbilical vein endothelial cells cultured on top of ELR hydrogel differentiated into tube-like structures. Taking this concept further, we developed a tunable macroporous ELR cryogel material, containing a synthetic glycosaminoglycan and FGF2 that showed increased blood vessel formation and reduced immune response compared to control when implanted in a subcutaneous mouse model. These results demonstrated the possibility for specific release of desired growth factors in/from a modular 3D scaffold in vitro and in vivo.
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Affiliation(s)
- Z Söderlund
- Lung Biology, Department of Experimental Medical Science, Lund University, Lund, Sweden.
| | - A Ibáñez-Fonseca
- Lung Biology, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - S Hajizadeh
- Division Pure and Applied Biochemistry, Lund University, Lund, Sweden
| | | | - J Liu
- Division of Chemical Biology and Medicinal Chemistry, Eshelman School of Phamarcy, University of North Carolina, Chapel Hill, NC, USA
| | - L Ye
- Division Pure and Applied Biochemistry, Lund University, Lund, Sweden
| | - E Tykesson
- Lung Biology, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - L Elowsson
- Lung Biology, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - G Westergren-Thorsson
- Lung Biology, Department of Experimental Medical Science, Lund University, Lund, Sweden
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Rosberg HE, Dahlin LB, Carlsson IK. A qualitative study of the long-term consequences and adaptation in daily life after replantation surgery at a young age. Hand Ther 2022; 27:112-122. [PMID: 37904897 PMCID: PMC10584065 DOI: 10.1177/17589983221118399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 07/19/2022] [Indexed: 11/01/2023]
Abstract
Introduction Impaired functioning is seen in patients following replantation surgery to the thumb or fingers. Our aim was to explore long-term consequences and adaptation in daily life after a thumb and/or multiple finger amputation followed by replantation surgery during young age. Methods Semi-structured interviews were conducted with nine recruited individuals and analysed using content analysis. The participants were asked to describe their hand function, pain, appearance, emotional consequences, impact on daily life and strategies for overcoming daily challenges. Results The interviews revealed five main categories: memories of the injury and concerns for the future; hand function, pain and cold sensitivity; feelings about having a visibly different hand; adaptation to impairments and challenges in daily life; and key messages to healthcare professions and advice to future patients.The circumstances of the injury were well remembered. Pain at rest was rare but occurred when grasping. Cold sensitivity was a major issue. Appearance-related concerns varied from none to a major problem. Despite impaired hand function, solutions were found to challenges in daily life. Compensatory strategies, personal resources and support from others were important in this adaptation process. Conclusions Patients with replantation surgery after an amputation during young age adapt to challenges in daily life over time. Healthcare professionals should offer adequate support to enable emotional processing of trauma experience. Appearance-related concerns should be addressed to prevent distress. Information about alleviating strategies to overcome long-term problems with cold sensitivity should be emphasized.
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Affiliation(s)
- Hans-Eric Rosberg
- Department of Translational Medicine – Hand Surgery, Lund University, Malmö, Sweden
| | - Lars B Dahlin
- Department of Translational Medicine – Hand Surgery, Lund University, Malmö, Sweden
| | - Ingela K Carlsson
- Department of Translational Medicine – Hand Surgery, Lund University, Malmö, Sweden
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9
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Bergling K, Martus G, Öberg CM. Phloretin Improves Ultrafiltration and Reduces Glucose Absorption during Peritoneal Dialysis in Rats. J Am Soc Nephrol 2022; 33:1857-1863. [PMID: 35985816 PMCID: PMC9528341 DOI: 10.1681/asn.2022040474] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/14/2022] [Accepted: 07/24/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Harmful glucose exposure and absorption remain major limitations of peritoneal dialysis (PD). We previously showed that inhibition of sodium glucose cotransporter 2 did not affect glucose transport during PD in rats. However, more recently, we found that phlorizin, a dual blocker of sodium glucose cotransporters 1 and 2, reduces glucose diffusion in PD. Therefore, either inhibiting sodium glucose cotransporter 1 or blocking facilitative glucose channels by phlorizin metabolite phloretin would reduce glucose transport in PD. METHODS We tested a selective blocker of sodium glucose cotransporter 1, mizagliflozin, as well as phloretin, a nonselective blocker of facilitative glucose channels, in an anesthetized Sprague-Dawley rat model of PD. RESULTS Intraperitoneal phloretin treatment reduced glucose absorption by >30% and resulted in a >50% higher ultrafiltration rate compared with control animals. Sodium removal and sodium clearances were similarly improved, whereas the amount of ultrafiltration per millimole of sodium removed did not differ. Mizagliflozin did not influence glucose transport or osmotic water transport. CONCLUSIONS Taken together, our results and previous results indicate that blockers of facilitative glucose channels may be a promising target for reducing glucose absorption and improving ultrafiltration efficiency in PD.
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Affiliation(s)
- Karin Bergling
- Division of Nephrology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
| | - Giedre Martus
- Division of Nephrology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
| | - Carl M. Öberg
- Division of Nephrology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
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Acosta S, Fatemi S, Melander O, Engström G, Gottsäter A. Prospective Comparison of Plasma Biomarker and Traditional Risk Factor Profiles for Incident Isolated Atherosclerotic Disease and Incident Isolated Abdominal Aortic Aneurysm. Front Cardiovasc Med 2022; 8:818656. [PMID: 35097031 PMCID: PMC8790118 DOI: 10.3389/fcvm.2021.818656] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 12/13/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Traditional risk factors for atherosclerotic disease (AD) are well-known, of which some are relevant also for abdominal aortic aneurysms (AAA). The present study compares the importance of plasma biomarkers and traditional risk factor profiles for incident AD without concomitant AAA (isolated AD) and AAA without concomitant AD (isolated AAA) during long-term follow-up. Methods: In the Malmö Diet and Cancer Study—cardiovascular cohort, 5,381 participants were free from atrial fibrillation or flutter, AD (coronary artery disease, atherothrombotic ischemic stroke, carotid artery disease, or peripheral artery disease), and AAA underwent blood sampling under standardized fasting conditions between 1991 and 1994. Cox proportional hazards regression analysis was used to calculate hazard ratios (HR) with 95% CIs. Results: During a median follow-up of 23.1 years, 1,152 participants developed isolated AD, and 44 developed isolated AAA. Adjusted HR for lipoprotein-associated phospholipase A2 (mass) (HR 1.53, 95% CI 1.14–2.04 vs. HR 1.05, 95% CI.99–1.12) was higher for incident isolated AAA compared to incident isolated AD, respectively. Mid-regional pro-adrenomedullin (MR-proADM) was associated with incident isolated AD (HR 1.17, 95% CI 1.1–1.25) and incident isolated AAA (HR 1.47, 95% CI 1.15–1.88). MR-proADM was correlated (r = 0.32; p < 0.001) to body mass index (BMI), and BMI was associated with increased risk of incident isolated AAA (HR 1.43, 95% CI 1.02–2). No participant with diabetes mellitus (DM) at baseline developed isolated AAA (0/44), whereas DM was associated with an increased risk of isolated AD (HR 2.57, 95% CI 2.08–3.18). Adjusted HR for male sex (HR 4.8, 95% CI 2.42–9.48, vs. HR 1.76, 95% CI 1.56–1.98) and current smoking (HR 4.79, 95% CI 2.42–9.47 vs. HR 1.97, 95% CI 1.73–2.23) were higher in the incident isolated AAA group compared to the incident isolated AD group, respectively. Conclusions: The data supports the view that components of vascular inflammation and cardiovascular stress drives AAA development, whereas glycated cross-links in abdominal aortic wall tissue may have a plausible role in reducing AAA risk in individuals with DM.
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Affiliation(s)
- Stefan Acosta
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Malmö, Sweden
- *Correspondence: Stefan Acosta
| | - Shahab Fatemi
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Malmö, Sweden
| | - Olle Melander
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Internal Medicine and Emergency Medicine, Malmö, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Anders Gottsäter
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Internal Medicine and Emergency Medicine, Malmö, Sweden
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Willén D, Mastio R, Söderlund Z, Manner S, Westergren-Thorsson G, Tykesson E, Ellervik U. Azide-Functionalized Naphthoxyloside as a Tool for Glycosaminoglycan Investigations. Bioconjug Chem 2021; 32:2507-2515. [PMID: 34784477 PMCID: PMC8678990 DOI: 10.1021/acs.bioconjchem.1c00473] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/03/2021] [Indexed: 11/28/2022]
Abstract
We present a xylosylated naphthoxyloside carrying a terminal azide functionality that can be used for conjugation using click chemistry. We show that this naphthoxyloside serves as a substrate for β4GalT7 and induces the formation of soluble glycosaminoglycan (GAG) chains with physiologically relevant lengths and sulfation patterns. Finally, we demonstrate its usefulness by conjugation to the Alexa Fluor 647 and TAMRA fluorophores and coupling to a surface plasmon resonance chip for interaction studies with the hepatocyte growth factor known to interact with the GAG heparan sulfate.
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Affiliation(s)
- Daniel Willén
- Centre
for Analysis and Synthesis, Centre for Chemistry and Chemical Engineering, Lund University, P.O. Box 124, SE-221 00 Lund, Sweden
| | - Roberto Mastio
- Centre
for Analysis and Synthesis, Centre for Chemistry and Chemical Engineering, Lund University, P.O. Box 124, SE-221 00 Lund, Sweden
| | - Zackarias Söderlund
- Department
of Experimental Medical Science, Lund University, P.O. Box 117, SE-221 00 Lund, Sweden
| | - Sophie Manner
- Centre
for Analysis and Synthesis, Centre for Chemistry and Chemical Engineering, Lund University, P.O. Box 124, SE-221 00 Lund, Sweden
| | | | - Emil Tykesson
- Department
of Experimental Medical Science, Lund University, P.O. Box 117, SE-221 00 Lund, Sweden
| | - Ulf Ellervik
- Centre
for Analysis and Synthesis, Centre for Chemistry and Chemical Engineering, Lund University, P.O. Box 124, SE-221 00 Lund, Sweden
- Department
of Experimental Medical Science, Lund University, P.O. Box 117, SE-221 00 Lund, Sweden
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12
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Ahrén B, Pacini G. Glucose effectiveness: Lessons from studies on insulin-independent glucose clearance in mice. J Diabetes Investig 2021; 12:675-685. [PMID: 33098240 PMCID: PMC8088998 DOI: 10.1111/jdi.13446] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/15/2020] [Accepted: 10/19/2020] [Indexed: 01/07/2023] Open
Abstract
Besides insulin-mediated transport of glucose into the cells, an important role is also played by the non-insulin-mediated transport. This latter process is called glucose effectiveness (acronym SG ), which is estimated by modeling of glucose and insulin data after an intravenous glucose administration, and accounts for ≈70% of glucose disposal. This review summarizes studies on SG , mainly in humans and rodents with focus on results achieved in model experiments in mice. In humans, SG is reduced in type 2 diabetes, in obesity, in liver cirrhosis and in some elderly populations. In model experiments in mice, SG is independent from glucose levels, but increases when insulin secretion is stimulated, such as after administration of the incretin hormones, glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide. SG is reduced in insulin resistance induced by high-fat feeding and by exogenous administration of glucagon. Glucose-dependent (insulin-independent) glucose disposal is therefore important for glucose elimination, and it is also well regulated. It might be of pathophysiological relevance for the development of type 2 diabetes, in particular during insulin resistance, and might also be a target for glucose-reducing therapy. Measuring SG is essentially important when carrying out metabolic studies to understand glucose homeostasis.
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Affiliation(s)
- Bo Ahrén
- Department of Clinical Sciences LundLund UniversityLundSweden
| | - Giovanni Pacini
- Metabolic UnitInstitute of Neurosciences (IN‐CNR)PadovaItaly
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13
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Bennet L, Udumyan R, Östgren CJ, Rolandsson O, Jansson SPO, Wändell P. Mortality in first- and second-generation immigrants to Sweden diagnosed with type 2 diabetes: a 10 year nationwide cohort study. Diabetologia 2021; 64:95-108. [PMID: 32979073 PMCID: PMC7716891 DOI: 10.1007/s00125-020-05279-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 08/11/2020] [Indexed: 12/23/2022]
Abstract
AIMS/HYPOTHESIS Non-Western immigrants to Europe are at high risk for type 2 diabetes. In this nationwide study including incident cases of type 2 diabetes, the aim was to compare all-cause mortality (ACM) and cause-specific mortality (CSM) rates in first- and second-generation immigrants with native Swedes. METHODS People living in Sweden diagnosed with new-onset pharmacologically treated type 2 diabetes between 2006 and 2012 were identified through the Swedish Prescribed Drug Register. They were followed until 31 December 2016 for ACM and until 31 December 2012 for CSM. Analyses were adjusted for age at diagnosis, sex, socioeconomic status, education, treatment and region. Associations were assessed using Cox regression analysis. RESULTS In total, 138,085 individuals were diagnosed with type 2 diabetes between 2006 and 2012 and fulfilled inclusion criteria. Of these, 102,163 (74.0%) were native Swedes, 28,819 (20.9%) were first-generation immigrants and 7103 (5.1%) were second-generation immigrants with either one or both parents born outside Sweden. First-generation immigrants had lower ACM rate (HR 0.80 [95% CI 0.76, 0.84]) compared with native Swedes. The mortality rates were particularly low in people born in non-Western regions (0.46 [0.42, 0.50]; the Middle East, 0.41 [0.36, 0.47]; Asia, 0.53 [0.43, 0.66]; Africa, 0.47 [0.38, 0.59]; and Latin America, 0.53 [0.42, 0.68]). ACM rates decreased with older age at migration and shorter stay in Sweden. Compared with native Swedes, first-generation immigrants with ≤ 24 years in Sweden (0.55 [0.51, 0.60]) displayed lower ACM rates than those spending >24 years in Sweden (0.92 [0.87, 0.97]). Second-generation immigrants did not have better survival rates than native Swedes but rather displayed higher ACM rates for people with both parents born abroad (1.28 [1.05, 1.56]). CONCLUSIONS/INTERPRETATION In people with type 2 diabetes, the lower mortality rate in first-generation non-Western immigrants compared with native Swedes was reduced over time and was equalised in second-generation immigrants. These findings suggest that acculturation to Western culture may impact ACM and CSM in immigrants with type 2 diabetes but further investigation is needed. Graphical abstract.
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Affiliation(s)
- Louise Bennet
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden.
- Department of Family Medicine, Lund University, Malmö, Sweden.
| | - Ruzan Udumyan
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Carl Johan Östgren
- Department of Health, Medicine and Caring Sciences, General Practice, Linköping University, Linköping, Sweden
| | - Olov Rolandsson
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Stefan P O Jansson
- Institution of Medical Sciences, University Health Care Research Center, Örebro University, Örebro, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Per Wändell
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
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Abstract
BACKGROUND AND OBJECTIVES Continuous glucose monitoring (CGM) could be a valuable instrument for measurement of glucose concentration in preterm neonate. We undertook a systematic review and meta-analysis to compare the diagnostic accuracy of CGM devices to intermittent blood glucose evaluation methods for the detection of hypoglycaemic or hypoglycaemic events in preterm infants. DATA SOURCES A structured electronic database search was performed for studies that assessed the accuracy of CGM against any intermittent blood glucose testing methods in detecting episodes of altered glycaemia in preterm infants. No restrictions were used. Three review authors screened records and included studies. DATA EXTRACTION Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. From individual patient data (IPD), sensitivity and specificity were determined using predefined thresholds. The mean absolute relative difference (MARD) of the studied CGM devices was assessed and if those satisfied the accuracy requirements (EN ISO 15197). IPD datasets were meta-analysed using a logistic mixed-effects model. A bivariate model was used to estimate the summary receiver operating characteristic curve (ROC) curve and extract the area under the curve (AUC). The overall level of certainty of the evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation. RESULTS Among 4481 records, 11 were included. IPD datasets were obtained for five studies. Only two of the studies showed an MARD lower than 10%, with none of the five CGM devices studied satisfying the European Union (EU) ISO 15197 requirements. Pooled sensitivity and specificity of CGM devices for hypoglycaemia were 0.39 and 0.99, whereas for hyperglycaemia were 0.87 and 0.99, respectively. The AUC was 0.70 and 0.86, respectively. The certainty of the evidence was considered as low to moderate. Limitations primarily related to the lack of representative population, reference standard and CGM device. CONCLUSIONS CGM devices demonstrated low sensitivity for detecting hypoglycaemia in preterm infants, however, provided high accuracy for detection of hyperglycaemia. PROSPERO REGISTRATION NUMBER CRD42020152248.
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Affiliation(s)
- Chiara Nava
- Neonatal Intensive Care Unit, Ospedale Alessandro Manzoni, Lecco, Lecco, Italy
| | | | - Franciszek Borys
- Poznan University of Medical Sciences, Poznan, Wielkopolskie, Poland
| | - Lotty Hooft
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Matteo Bruschettini
- Department of Clinical Sciences Lund, Paediatrics; Cochrane Sweden, Research and Development, Lund University, Skane University Hospital, Lund, Sweden, Lund, Sweden
| | - Kevin Jenniskens
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
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15
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Peterson M, Pingel R, Rolandsson O, Dahlin LB. Vibrotactile perception on the sole of the foot in an older group of people with normal glucose tolerance and type 2 diabetes. SAGE Open Med 2020; 8:2050312120931640. [PMID: 32587694 PMCID: PMC7294473 DOI: 10.1177/2050312120931640] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 09/27/2019] [Accepted: 05/13/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To evaluate vibrotactile sense in an older group of people with normal glucose tolerance and type 2 diabetes relative to other sensory tests. METHODS Vibration perception thresholds on the sole of the foot (Multifrequency vibrametry and Biothesiometer) were compared to the results from evaluation of touch (monofilament), electrophysiology (sural nerve) and thermal sensation (Thermotest®). RESULTS Vibration perception and temperature thresholds, as well as sural nerve function, differed between normal glucose tolerance and type 2 diabetes. Measuring vibration perception thresholds at lower frequencies with multifrequency vibrametry versus biothesiometer provided correlations similar to sural nerve amplitude. Temperature thresholds correlated with vibration perception thresholds and sural nerve function. Monofilaments revealed pathology in only a few participants with type 2 diabetes. CONCLUSIONS In an older group of people, vibration perception thresholds show a correlation similar to sural nerve amplitude on tactile and non-tactile surfaces. Measuring a vibration perception threshold on a tactile surface in type 2 diabetes provides no clear advantage over measuring it on the medial malleolus. In older type 2 diabetes subjects, both large and small diameter nerve fibers are affected.
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Affiliation(s)
- Magnus Peterson
- Department of Public Health and Caring Sciences, Section of Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
- Academic Primary Healthcare Centre, Stockholm, Sweden
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ronnie Pingel
- Department of Statistics, Uppsala University, Uppsala, Sweden
| | - Olov Rolandsson
- Department of Public Health and Clinical Medicine, Section of Family Medicine, Umeå University, Umeå, Sweden
| | - Lars B Dahlin
- Department of Translational Medicine—Hand Surgery, Lund University and Skåne University Hospital, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
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16
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Olaya-Contreras P, Balcker-Lundgren K, Siddiqui F, Bennet L. Perceptions, experiences and barriers to lifestyle modifications in first-generation Middle Eastern immigrants to Sweden: a qualitative study. BMJ Open 2019; 9:e028076. [PMID: 31630098 PMCID: PMC6803114 DOI: 10.1136/bmjopen-2018-028076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE The prevalence of type 2 diabetes (T2D) among Iraqi immigrants to Sweden is high and partly related to sedentary physical activity and calorie dense food. The aim of the present study was to explore perceptions, experiences and barriers concerning lifestyle modifications (LSM) in Iraqi immigrants to Sweden at risk for T2D. DESIGN A qualitative thematic analysis was conducted on data collected from gender-specific focus group interviews which took place during a culturally adapted randomised controlled intervention study addressing motivation to lifestyle change, self-empowerment, behavioural modifications and sociocultural barriers to LSM. Seven focus groups were held, with an interval of 1-4 weeks between January and May of 2015; each session lasted approximately 1.5 hours. SETTING The city of Malmö, Sweden. PARTICIPANTS Out of 27 women and 23 men assigned to the intervention group, 19 women and 14 men who attended at least one focus group session were included in the study. RESULTS Participants expressed awareness of the content of healthy lifestyle practices. They also expressed numerous social and cultural barriers to LSM connected to irregular meals, overeating, food and drinking preferences and family expectations. Overeating was described as a consequence of social and cultural norms and expectations and of poor mental well-being. Facilitators for reaching successful LSM were connected to family involvement and support. CONCLUSION Our study reports that facilitators for LSM are connected to presence of family support. Preventive actions addressing family involvement may benefit Middle Eastern immigrants at high risk for T2D to consider healthier lifestyles practices. Identification of sociocultural barriers and facilitators for LSM are crucial for successful health promotion in minority populations at risk for T2D. TRIAL REGISTRATION Trial registration number: NCT01420198 for the MEDIM-study; Pre-results.
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Affiliation(s)
- Patricia Olaya-Contreras
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenborg, Sweden
| | | | - Faiza Siddiqui
- Center for Primary Health Care Research, Region Skåne and Lund University, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Louise Bennet
- Center for Primary Health Care Research, Region Skåne and Lund University, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Malmö, Sweden
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17
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Pertesi M, Ekdahl L, Palm A, Johnsson E, Järvstråt L, Wihlborg AK, Nilsson B. Essential genes shape cancer genomes through linear limitation of homozygous deletions. Commun Biol 2019; 2:262. [PMID: 31341961 PMCID: PMC6642121 DOI: 10.1038/s42003-019-0517-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 11/02/2018] [Accepted: 06/26/2019] [Indexed: 12/26/2022] Open
Abstract
The landscape of somatic acquired deletions in cancer cells is shaped by positive and negative selection. Recurrent deletions typically target tumor suppressor, leading to positive selection. Simultaneously, loss of a nearby essential gene can lead to negative selection, and introduce latent vulnerabilities specific to cancer cells. Here we show that, under basic assumptions on positive and negative selection, deletion limitation gives rise to a statistical pattern where the frequency of homozygous deletions decreases approximately linearly between the deletion target gene and the nearest essential genes. Using DNA copy number data from 9,744 human cancer specimens, we demonstrate that linear deletion limitation exists and exposes deletion-limiting genes for seven known deletion targets (CDKN2A, RB1, PTEN, MAP2K4, NF1, SMAD4, and LINC00290). Downstream analysis of pooled CRISPR/Cas9 data provide further evidence of essentiality. Our results provide further insight into how the deletion landscape is shaped and identify potentially targetable vulnerabilities.
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Affiliation(s)
- Maroulio Pertesi
- Hematology and Transfusion Medicine Department of Laboratory Medicine, BMC, SE-221 84 Lund, Sweden
| | - Ludvig Ekdahl
- Hematology and Transfusion Medicine Department of Laboratory Medicine, BMC, SE-221 84 Lund, Sweden
| | - Angelica Palm
- Hematology and Transfusion Medicine Department of Laboratory Medicine, BMC, SE-221 84 Lund, Sweden
| | - Ellinor Johnsson
- Hematology and Transfusion Medicine Department of Laboratory Medicine, BMC, SE-221 84 Lund, Sweden
| | - Linnea Järvstråt
- Hematology and Transfusion Medicine Department of Laboratory Medicine, BMC, SE-221 84 Lund, Sweden
| | - Anna-Karin Wihlborg
- Hematology and Transfusion Medicine Department of Laboratory Medicine, BMC, SE-221 84 Lund, Sweden
| | - Björn Nilsson
- Hematology and Transfusion Medicine Department of Laboratory Medicine, BMC, SE-221 84 Lund, Sweden
- Broad Institute, 415 Main Street, Cambridge, MA 02142 USA
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Borg H, Siesjö P, Kahlon B, Fjalldal S, Erfurth EM. Perioperative serum cortisol levels in ACTH sufficient and ACTH deficient patients during transsphenoidal surgery of pituitary adenoma. Endocrine 2018; 62:83-89. [PMID: 29968225 PMCID: PMC6153577 DOI: 10.1007/s12020-018-1655-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 06/12/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE No previous study has analyzed serum cortisol levels during transsphenoidal endoscopic pituitary surgery in patients with and without hydrocortisone (HC) substitution. METHODS A total of 15 patients undergoing surgery for a pituitary adenoma were studied. Those with normal ACTH function were either not given HC (n = 7) or received 50 mg intravenous HC at the start of surgery (n = 4). Patients with ACTH deficiency received intravenous HC of 100 mg in the morning before surgery (n = 4) with the additional 50 mg for an afternoon operation (n = 2). Propofol and remifentanil were used as anesthetics. Serum cortisol was measured at the start of and every 30 min during surgery. RESULTS Among 7 patients with normal ACTH function without HC substitution, cortisol levels before surgery were 126-244 nmol/L, among the 4 patients undergoing surgery in the morning, whereas the 3 who underwent surgery in the afternoon had lower levels, 38-76 nmol/L. During nose/sinus surgery cortisol levels decreased to 79-139 and 24-54 nmol/L, respectively. At intrasellar manipulation a distinct rise was noted. Also, in the 4 ACTH sufficient patients receiving HC, cortisol levels decreased during nose/sinus surgery, but only with a slight increase during intrasellar surgery. In the 4 ACTH deficient patients cortisol peaked at 1914-2582 nmol/L. CONCLUSIONS Patients with normal ACTH function without HC substitution had very low cortisol levels during the first part of surgery, likely suppressed by the anesthetics. After mechanical impact in the sella, a marked increase in cortisol was noted. Supraphysiological cortisol levels were achieved with our routine HC substitution, advising us to reduce the supplementation.
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Affiliation(s)
- Henrik Borg
- Department of Endocrinology, Skåne University Hospital, Lund, S-221 85, Sweden.
| | - Peter Siesjö
- Department of Neurosurgery, Skåne University Hospital, Lund, S-221 85, Sweden
| | - Babar Kahlon
- Department of Neurosurgery, Skåne University Hospital, Lund, S-221 85, Sweden
| | - Sigridur Fjalldal
- Department of Endocrinology, Skåne University Hospital, Lund, S-221 85, Sweden
| | - Eva Marie Erfurth
- Department of Endocrinology, Skåne University Hospital, Lund, S-221 85, Sweden
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Elmståhl S, Dahlrup B, Ekström H, Nordell E. The association between medical diagnosis and caregiver burden: a cross-sectional study of recipients of informal support and caregivers from the general population study 'Good Aging in Skåne', Sweden. Aging Clin Exp Res 2018; 30:1023-1032. [PMID: 29236217 PMCID: PMC6096871 DOI: 10.1007/s40520-017-0870-0] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 11/27/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Different kinds of chronic diseases might imply different dimensions of caregiver burden, not previously described among the caregivers to recipients from the general elder population. AIM The main objective was to examine differences in burden between the 343 caregivers to persons with different diagnoses. METHODS A group of elderly recipients of informal care (n = 343) from the general population study 'Good Aging in Skåne' (GÅS) Sweden, were divided into five diagnostic groups: dementia (n = 90), heart and lung diseases (n = 48), stroke (n = 62), fractures (n = 66), depression (n = 40) and the group "other", consisting of different diagnoses (n = 37) according to ICD-10. Differences in burden were analyzed using the Caregiver Burden Scale (CBS), a 22-item scale consisting of five dimensions: general strain, isolation, disappointment, emotional involvement and environmental burden. A total burden index comprises the mean of all the 22 items and a higher score indicates a higher burden. RESULTS The most common diagnosis associated to caregiving was dementia and fracture and the median hours weekly for informal support with instrumental ADL for the five diagnostic groups ranged from 7 to 45 h for spouses and from 4 to 7 h for parents. The highest proportion of caregivers scoring high total burden was seen among recipients with dementia (50%) and depression (38%); the OR for high total burden for the dementia group was 4.26 (2.29-7.92) and depression group 2.38 (1.08-5.24) adjusted for covariates like age, gender and ADL and these two groups had higher self-perception of burden in all the dimensions, especially the dimension's emotional burden and strain. CONCLUSION Informal support constitutes a substantial time for instrumental ADL for the diseased elders. Caregivers to persons with dementia and depression experience high burden.
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Affiliation(s)
- Sölve Elmståhl
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, CRC, Skåne University Hospital, Lund University, Jan Waldenströms gata 35, Build. 28 Fl.13, 205 02, Malmo, Sweden.
| | - Beth Dahlrup
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, CRC, Skåne University Hospital, Lund University, Jan Waldenströms gata 35, Build. 28 Fl.13, 205 02, Malmo, Sweden
| | - Henrik Ekström
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, CRC, Skåne University Hospital, Lund University, Jan Waldenströms gata 35, Build. 28 Fl.13, 205 02, Malmo, Sweden
| | - Eva Nordell
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, CRC, Skåne University Hospital, Lund University, Jan Waldenströms gata 35, Build. 28 Fl.13, 205 02, Malmo, Sweden
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Ambite I, Puthia M, Nagy K, Cafaro C, Nadeem A, Butler DSC, Rydström G, Filenko NA, Wullt B, Miethke T, Svanborg C. Molecular Basis of Acute Cystitis Reveals Susceptibility Genes and Immunotherapeutic Targets. PLoS Pathog 2016; 12:e1005848. [PMID: 27732661 PMCID: PMC5061333 DOI: 10.1371/journal.ppat.1005848] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 08/06/2016] [Indexed: 12/19/2022] Open
Abstract
Tissue damage is usually regarded as a necessary price to pay for successful elimination of pathogens by the innate immune defense. Yet, it is possible to distinguish protective from destructive effects of innate immune activation and selectively attenuate molecular nodes that create pathology. Here, we identify acute cystitis as an Interleukin-1 beta (IL-1β)-driven, hyper-inflammatory condition of the infected urinary bladder and IL-1 receptor blockade as a novel therapeutic strategy. Disease severity was controlled by the mechanism of IL-1β processing and mice with intact inflammasome function developed a moderate, self-limiting form of cystitis. The most severe form of acute cystitis was detected in mice lacking the inflammasome constituents ASC or NLRP-3. IL-1β processing was hyperactive in these mice, due to a new, non-canonical mechanism involving the matrix metalloproteinase 7- (MMP-7). ASC and NLRP-3 served as transcriptional repressors of MMP7 and as a result, Mmp7 was markedly overexpressed in the bladder epithelium of Asc-/- and Nlrp3-/- mice. The resulting IL-1β hyper-activation loop included a large number of IL-1β-dependent pro-inflammatory genes and the IL-1 receptor antagonist Anakinra inhibited their expression and rescued susceptible Asc-/- mice from bladder pathology. An MMP inhibitor had a similar therapeutic effect. Finally, elevated levels of IL-1β and MMP-7 were detected in patients with acute cystitis, suggesting a potential role as biomarkers and immunotherapeutic targets. The results reproduce important aspects of human acute cystitis in the murine model and provide a comprehensive molecular framework for the pathogenesis and immunotherapy of acute cystitis, one of the most common infections in man. Infections continue to threaten human health as pathogenic organisms outsmart available therapies with remarkable genetic versatility. Fortunately, microbial versatility is matched by the flexibility of the host immune system which provide a rich source of novel therapeutic concepts. Emerging therapeutic solutions include substances that strengthen the immune system rather than killing the bacteria directly. Selectivity is a concern, however, as boosting of the antibacterial immune response may cause collateral tissue damage. This study addresses how the host response to urinary bladder infection causes acute cystitis and how this response can be attenuated in patients who suffer from this very common condition. We identify the cytokine Interleukin-1 beta (IL-1β) as a key immune response determinant in acute cystitis and successfully treat mice with severe acute cystitis by inhibiting IL-1β or the enzyme MMP-7 that processes IL-1β to its active form. Finally, we detect elevated levels of these molecules in urine samples from patients with cystitis, suggesting clinical relevance and a potential role of IL-1β and MMP-7 both as therapeutic targets and as biomarkers of infection. These findings provide a much needed, molecular framework for the pathogenesis and treatment of acute cystitis.
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Affiliation(s)
- Ines Ambite
- Division of Microbiology, Immunology and Glycobiology, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Manoj Puthia
- Division of Microbiology, Immunology and Glycobiology, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Karoly Nagy
- Division of Microbiology, Immunology and Glycobiology, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Caterina Cafaro
- Division of Microbiology, Immunology and Glycobiology, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Aftab Nadeem
- Division of Microbiology, Immunology and Glycobiology, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Daniel S. C. Butler
- Division of Microbiology, Immunology and Glycobiology, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Gustav Rydström
- Division of Microbiology, Immunology and Glycobiology, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Nina A. Filenko
- Division of Microbiology, Immunology and Glycobiology, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Björn Wullt
- Division of Microbiology, Immunology and Glycobiology, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Thomas Miethke
- Institute of Medical Microbiology and Hygiene, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Catharina Svanborg
- Division of Microbiology, Immunology and Glycobiology, Department of Laboratory Medicine, Lund University, Lund, Sweden
- * E-mail:
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Vieira ML, Naudin C, Mörgelin M, Romero EC, Nascimento ALTO, Herwald H. Modulation of Hemostatic and Inflammatory Responses by Leptospira Spp. PLoS Negl Trop Dis 2016; 10:e0004713. [PMID: 27167223 PMCID: PMC4864083 DOI: 10.1371/journal.pntd.0004713] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 04/24/2016] [Indexed: 12/28/2022] Open
Abstract
Leptospirosis is a worldwide spread zoonotic and neglected infectious disease of human and veterinary concern that is caused by pathogenic Leptospira species. In severe infections, hemostatic impairments such as coagulation/fibrinolysis dysfunction are frequently observed. These complications often occur when the host response is controlled and/or modulated by the bacterial pathogen. In the present investigation, we aimed to analyze the modulation of the hemostatic and inflammatory host responses by the bacterial pathogen Leptospira. The effects of leptospires and their secreted products on stimulation of human intrinsic and extrinsic pathways of coagulation were investigated by means of altered clotting times, assembly and activation of contact system and induction of tissue factor. We show that both extrinsic and intrinsic coagulation cascades are modulated in response to Leptospira or leptospiral secreted proteins. We further find that the pro-inflammatory mediator bradykinin is released following contact activation at the bacterial surface and that pro-coagulant microvesicles are shed from monocytes in response to infection. Also, we show that human leptospirosis patients present higher levels of circulating pro-coagulant microvesicles than healthy individuals. Here we show that both pathways of the coagulation system are modulated by leptospires, possibly leading to altered hemostatic and inflammatory responses during the disease. Our results contribute to the understanding of the leptospirosis pathophysiological mechanisms and may open new routes for the discovery of novel treatments for the severe manifestations of the disease. Leptospirosis is one of the most relevant and spread zoonotic and neglected infectious diseases affecting humans and other mammals, and is caused by pathogenic bacteria of the genus Leptospira. During infectious diseases, when bacterial pathogens control and/or modulate the host response, impaired hemostasis and inflammation are frequently observed. Here we studied the effects of leptospires and their secreted products on stimulation of human intrinsic and extrinsic pathways of coagulation, showing that both coagulation cascades are modulated in response to Leptospira or leptospiral secreted proteins. We further find that activation of the coagulation cascades culminates in the release of the pro-inflammatory mediator bradykinin and noted an induction of pro-coagulant microvesicles. These findings contribute to a better understanding of the local and systemic hemostastic complications during leptospirosis. Collectively, our results show how leptospires can affect host responses, possibly leading to altered host responses during the disease and giving rise to the leptospirosis symptomatology.
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Affiliation(s)
- Mônica L. Vieira
- Department of Clinical Sciences, Lund, Division of Infection Medicine, Lund University, Lund, Sweden
- Centro de Biotecnologia, Instituto Butantan, Sao Paulo, Sao Paulo, Brazil
- * E-mail: ; (MLV); (HH)
| | - Clément Naudin
- Department of Clinical Sciences, Lund, Division of Infection Medicine, Lund University, Lund, Sweden
| | - Matthias Mörgelin
- Department of Clinical Sciences, Lund, Division of Infection Medicine, Lund University, Lund, Sweden
| | - Eliete C. Romero
- Centro de Bacteriologia, Instituto Adolfo Lutz, Sao Paulo, Sao Paulo, Brazil
| | | | - Heiko Herwald
- Department of Clinical Sciences, Lund, Division of Infection Medicine, Lund University, Lund, Sweden
- * E-mail: ; (MLV); (HH)
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