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Christensen B, Zhu C, Niazy M, McCullough T, Ricker N, Huber L. Partial replacement of soybean meal with full-fat black soldier fly larvae meal in plant-based nursery diets did not influence fecal Escherichia coli colony forming units or improve fecal consistency when pigs were weaned into non-disinfected pens. Transl Anim Sci 2023; 7:txad121. [PMID: 37965427 PMCID: PMC10642758 DOI: 10.1093/tas/txad121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 10/18/2023] [Indexed: 11/16/2023] Open
Abstract
At weaning, one hundred pigs (21 d of age; 6.96 ± 0.23 kg BW) were used to determine the effect of partially replacing soybean meal (SBM) in corn- and SBM-based nursery diets on growth performance, fecal scores, Escherichia coli (E. coli) colony forming units (CFU), and cecal mucosal microbial profile when weaned into non-disinfected nursery pens. Pens were randomly assigned to one of four dietary treatments (n = 5): high-complexity (contained highly digestible animal proteins and 10.8% SBM) with and without 3,000 ppm ZnO (HC + and HC-, respectively; representative of commercial diets), low-complexity (corn- and SBM-based; 31.8% SBM; LC), or LC with 30% inclusion of full-fat black soldier fly larvae meal (BSFLM) to partially replace SBM (LCFL; 8.0% SBM). Diets were fed for 14 d (phase I), followed by 4 wk of a common corn-SBM diet (phase II). Fecal E. coli CFU and cecal mucosal microbial 16s rRNA community profiles were assessed 7 d after weaning. During phase I, pigs fed LC and LCFL had lower average daily gains (P < 0.05) than pigs fed HC + and HC-, which were not different. Average daily feed intake was not different for pigs fed LC and LCFL, but lower than for pigs fed HC- (P < 0.001); pigs fed HC + had greater feed intake in phase I vs. all other treatment groups (P < 0.001). Upon nursery exit, only pigs fed LCFL had lower BW than pigs fed HC- (P < 0.05), with intermediate values observed for HC + and LC. Day 3 fecal scores were greater for pigs fed LCFL vs. HC + (P < 0.05) and day 7 E. coli CFU were greater for all treatment groups vs. HC + (P < 0.001). Pigs fed HC- (P < 0.01), LC (P < 0.05), and LCFL (P < 0.05) had lower alpha diversity for cecal mucosal microbiota compared to HC+. At the genus level, pigs fed LC had lower Lactobacillus relative abundance vs. pigs fed HC + (P < 0.01). Therefore, BSFLM can partially replace SBM without sacrificing growth performance vs. nursery pigs fed corn- and SBM-based diets, but both groups had reduced phase I growth performance vs. pigs fed highly digestible diets containing animal proteins when weaned into non-disinfected pens. The BSFLM did not influence fecal E. coli CFU or improve fecal consistency after weaning and therefore, is less effective at minimizing digestive upsets vs. HC + diets.
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Affiliation(s)
- B Christensen
- Department of Animal Biosciences, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - C Zhu
- Department of Animal Biosciences, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - M Niazy
- Department of Pathobiology, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - T McCullough
- Department of Pathobiology, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - N Ricker
- Department of Pathobiology, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - L Huber
- Department of Animal Biosciences, University of Guelph, Guelph, ON N1G 2W1, Canada
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Ebner DK, Evans JM, Christensen B, Breinholt J, Gamez ME, Lester SC, Routman DM, Ma DJ, Price K, Dong H, Park SS, Chintakuntlawar AV, Neben-Wittich MA, McGee LA, Garces Y, Patel SH, Foote RL, Evans JD. Unique T-cell Sub-Population Shifts after SBPT and Nivolumab in Platinum Refractory HNC: Biomarker Correlates from ROR1771. Int J Radiat Oncol Biol Phys 2023; 117:e580. [PMID: 37785763 DOI: 10.1016/j.ijrobp.2023.06.1920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) ROR1771 was a clinical trial investigating the use of stereotactic body proton radiotherapy (SBPT) and nivolumab in recurrent platinum refractory head and neck squamous cell carcinoma (HNSCC). The planned analysis of T-cell subpopulation and biomarker response is herein presented. MATERIALS/METHODS Patients with metastatic histologically confirmed HNSCC from any primary site received 2 cycles of nivolumab followed by SBPT to 1-2 selected target lesion(s) (hilar/lung: 8 of 12 patients), followed by maintenance nivolumab. Peripheral blood mononuclear cells were isolated pre-/post-treatment. Flow cytometry identified T-cell subpopulations. Single Cell 5' Gene Expression (GEX) and V(D)J T Cell Receptor libraries were prepared using Single Cell Immune Profiling. Seurat (v4.1.1) was used to identify cell type clusters, and differential expression post-filtration was evaluated using the Wilcoxon Rank Sum test. RESULTS A total of 12 patients were eligible for analysis, with one alive at time of analysis, 52 months from start of treatment. Median overall survival here was 12.5 months vs. 7.5-months on CheckMate 141. SBPT ranged from 35-50 Gy. Sequential changes in T-cell populations from baseline were noted with initiation of nivolumab, driving decrease in tumor-reactive (TTR; CD11ahighPD1+CD8+), central memory (TCM; CCR7+CD45RA-), and effector T-cells (TEF; CCR7-CD45RA-). TTR and TCM increased following SBPT, with greatest increase (3.5x TTR and 5.2x TCM) in the surviving patient. An average of 68 genes with significant differential expression between timepoints (p<0.0001) demonstrated RNA gene expression changes across all cell subtypes, including ribosomal (RPL and RPS) genes, ACTB, FTL, MALAT1, and others. This averaged 113 genes across all timepoints in the surviving patient, with peak following nivolumab induction. On T-cell receptor (TCR) analysis of this patient, the predominant clonotype diversity changed substantially following nivolumab. Following SBPT, clonotype diversity again changed to include a milieu seen neither at baseline nor with nivolumab alone. These TCRs persisted for approximately 2 weeks following SBPT before returning to resemble the nivolumab-induced TCR diversity alone, coinciding with disease recurrence. CONCLUSION ROR1771 demonstrated overall survival favorably comparable to CheckMate 141. Biomarker analysis of peripheral blood samples demonstrated significant shifts in T-cell subpopulations and underlying gene expression to nivolumab and then to SBPT administration. SBPT to a target lesion changed TCR clonotypes within the peripheral blood beyond those seen with nivolumab administration, with fading of these TCR clonotypes coinciding with recurrence. SBPT in combination with nivolumab may drive systemic immunologic change above that induced by nivolumab alone and warrants further investigation.
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Affiliation(s)
- D K Ebner
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - J M Evans
- Intermountain Precision Genomics, St George, UT
| | | | - J Breinholt
- Intermountain Precision Genomics, St George, UT
| | - M E Gamez
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - S C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - D M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - D J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - K Price
- Department of Medical Oncology, Mayo Clinic, Rochester, MN
| | - H Dong
- Department of Urology and Immunology, Mayo Clinic, Rochester, MN
| | - S S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | | | - L A McGee
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - Y Garces
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - S H Patel
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ
| | - R L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - J D Evans
- Department of Radiation Oncology, Intermountain Healthcare, Murray, UT
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Elford AT, Tye-Din JA, Christensen B. Deteriorating Sprue: A New Frontier for Gastrointestinal Ultrasound. Gastroenterology 2022; 164:876-879. [PMID: 36372222 DOI: 10.1053/j.gastro.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 10/29/2022] [Accepted: 11/01/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Alexander T Elford
- Royal Melbourne Hospital, Parkville, Victoria, Australia; University of Tasmania, Tasmania, Australia.
| | - J A Tye-Din
- Royal Melbourne Hospital, Parkville, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia; Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - B Christensen
- Royal Melbourne Hospital, Parkville, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia
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Lamba M, Tiwari N, Remedios M, Begun J, Christensen B, Bollipo S, Devereaux B. GESA Statement on the timing of elective endoscopic procedures in patients with recent COVID-19 infection. J Gastroenterol Hepatol 2022; 37:1400-1401. [PMID: 35481585 PMCID: PMC9115093 DOI: 10.1111/jgh.15873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 04/18/2022] [Indexed: 12/09/2022]
Affiliation(s)
- M Lamba
- Department of Gastroenterology and HepatologyRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - N Tiwari
- Department of Gastroenterology and HepatologyRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - M Remedios
- Department of Gastroenterology and HepatologyRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia,Gastroenterological Society of AustraliaMelbourneVictoriaAustralia
| | - J Begun
- Gastroenterological Society of AustraliaMelbourneVictoriaAustralia,Mater Young Adult Health CentreMater Misericordiae Brisbane LtdSouth BrisbaneQueenslandAustralia
| | - B Christensen
- Gastroenterological Society of AustraliaMelbourneVictoriaAustralia,Department of GastroenterologyRoyal Melbourne HospitalMelbourneVictoriaAustralia
| | - S Bollipo
- Gastroenterological Society of AustraliaMelbourneVictoriaAustralia,Department of GastroenterologyJohn Hunter HospitalNewcastleNew South WalesAustralia
| | - B Devereaux
- Department of Gastroenterology and HepatologyRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia,Gastroenterological Society of AustraliaMelbourneVictoriaAustralia
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Tveter AT, Blanck T, Nyheim S, Maarnes M, Christensen B, Pedersen SJ, Varsi C, Kjeken I. OP0122-HPR DEVELOPMENT OF A SMARTPHONE APPLICATION FOR TREATMENT OF HAND OSTEOARTHRITIS – HAPPY HANDS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundInternational recommendations state that all patients with hand osteoarthritis (HOA) should receive education and training in ergonomic principles, use of assistive devices and hand exercises as first-line treatment (1). However, research shows that the quality-of-care service in general is sub-optimal for this patient group, with few patients receiving recommended first-line treatment before being referred to specialist healthcare (2).ObjectivesTo make recommended treatment available for patients with HOA by developing a user-friendly self-management application (HAPPY Hands).MethodsThe development process was conducted four phases: 1) information needs analysis and patient interviews; 2) app illustrations and prototype development; 3) heuristic evaluation; and 4) pilot-testing.Two patient research partners were involved in developing the content of the app. Researchers, in collaboration with experienced clinicians, the patient research partners and professional film photographers and animators, developed short informational videos and animations. Illustrations and a prototype of the app was developed in five two-week iterations by the University Center for Information Technology at the University of Oslo (Figure 1). Digital meetings were conducted at the end of each two-week iteration, where illustrations and prototype were discussed with developers, researchers, and patient research partners, informing the next iteration. The HAPPY Hands app will be pilot tested in 70 participants with HOA, simultaneously assessing the feasibility and usability of the app.Figure 1.Illustrations of the Happy Hands smartphone applicationResultsThe prioritized content themes presented by the patient research partners were 1) information about hand OA; 2) goal setting, motivation, and self-efficacy; 3) assistive devices; 4) hand exercises; 5) orthoses; and 6) communication. The app was developed based on a combination of behavioural change techniques informed by Social cognitive theory and the EULAR recommendations on management of HOA. The 12-week intervention consists of 25 short informational videos addressing the prioritized themes. Additionally, the intervention includes a hand exercise program consisting of 8 videos providing instructions on warm up, exercises to improve mobility, strength and coordination, and a stretching exercise. The informational videos and exercise program are delivered in a progressive order over the 12 weeks. When downloading the app, participants are asked to specify when they plan to use the app (three days a week with time points). Thereafter, the patients get a notification on their smartphone with that week’s informational videos and hand exercises at the specified days. After each exercise session the patients are asked to rate their pain and stiffness. Their answers are used to generate graphs that visualise their development over the 12-week intervention period. Each month, patients also answer questions about hand function, which they can use to self-monitor their development. Encouragement and motivational messages are provided each week to enhance continued adherence to the intervention. To date, 60 patients have been included in pilot testing of the app.ConclusionIn this study we successfully implemented a user-centred and iterative approach to develop a e-self-management intervention for treatment of patients with hand OA. The 12-week follow-up in the pilot study will be finished medio May 2022.References[1]Kloppenburg M, Kroon FP, Blanco FJ, Doherty M, Dziedzic KS, Greibrokk E, et al. 2018 update of the EULAR recommendations for the management of hand osteoarthritis. Ann Rheum Dis. 2018:10.1136/annrheumdis-2018-213826[2]Gravås EMH, Tveter AT, Nossum R, Eide REM, Klokkeide Å, Matre KH, et al. Non-pharmacological treatment gap preceding surgical consultation in thumb carpometacarpal osteoarthritis - a cross-sectional study. BMC Musculoskelet Disord. 2019;20(1):180:10.1186/s12891-019-2567-3Disclosure of InterestsNone declared
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Christensen B, Huber L. The effects of creep feed composition and form and nursery diet complexity on small intestinal morphology and jejunal mucosa specific enzyme activities after weaning in pigs. J Anim Sci 2022; 100:6568981. [PMID: 35426433 PMCID: PMC9115911 DOI: 10.1093/jas/skac138] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
Fifty-six litters from first-parity sows standardized to 12 piglets were used to determine the effects of creep feed composition and form and the provision of low- or high-complexity nursery diets on the evolution of small intestinal histomorphology and jejunal mucosa-specific enzyme activities postweaning. At 5 d of age, litters (initial bodyweight [BW] 2.31 ± 0.61 kg) were assigned to one of four creep feeding regimens (n = 14): 1) commercial creep feed (COM), 2) liquid milk replacer (LMR), 3) pelleted milk replacer (PMR), or 4) no creep feed (NO). At weaning (21 d of age), six pigs per litter were provided a HIGH- (contained highly digestible animal proteins) or LOW- (contained corn and soybean meal as main protein sources) complexity nursery diet (n = 7). At 21, 28, and 59 d of age, two pigs per pen (one castrated male and one female) were euthanized, and ileal and jejunal segments for histomorphological measurements and jejunal mucosal scrapings were collected to determine specific mucosa enzyme activities. At weaning, pigs provided COM had a greater ileal absorptive capacity (M) than LMR or NO, which were not different (14.1 vs. 10.4 and 10.5 ± 0.9 μm2; P < 0.05); PMR was intermediate. On days 28 and 59, M was not different among pigs regardless of creep feed treatments. Pigs fed LOW had reduced jejunal villus height (VH; P < 0.001) and M (P < 0.001) on day 28 vs. day 21. The VH and M were not different for pigs fed HIGH or LOW by the end of the nursery period. For all dietary treatments except COM-HIGH and COM-LOW, jejunal mucosal maltase-specific activity was not different between days 21 and 28 of age but greater on day 59 (P < 0.05). For pigs that received COM-HIGH, maltase-specific activity was not different between days 21 and 28 but greater on day 59 than day 28 (P < 0.05). For pigs that received COM-LOW, maltase-specific activity was not different between days 21, 28, and 59. Regardless of creep or nursery treatment, sucrase-specific activity was the greatest on day 59, followed by days 21 and 28 (P < 0.001), and lactase-specific activity was greater on day 21 than on days 28 and 59 (P < 0.001), which were not different. Therefore, pigs that provided LOW diet had greater villus atrophy and reduced M during the first week after weaning vs. pigs that provided HIGH, regardless of creep feeding regimen, but were able to recover by the end of the nursery period. After weaning, the piglet digestive tract must adapt in order to effectively break down and absorb nutrients derived from plant-based ingredients, contributing to the postweaning growth lag. Feeding strategies applied both preweaning and postweaning with the intent to assist in intestinal adaptation have been developed; however, little work has been done examining the interaction between creep and nursery feeding strategies on intestinal histomorphology and jejunal mucosa-specific enzyme activities after weaning. In the current study, piglets that provided creep feed with higher starch content had greater jejunal mucosa maltase-specific enzyme activity and ileal absorptive capacity at weaning. However, these parameters were still negatively affected by weaning, regardless of nursery feeding strategy. Additionally, nursery diets with greater inclusion of soybean meal to replace animal protein sources (low complexity) exacerbated reductions in jejunal absorptive capacity. Conversely, by the end of the nursery period, there were no differences in intestinal histomorphology and jejunal mucosa-specific enzyme activities, regardless of creep or nursery feeding program. Therefore, exposing piglets to starch during creep feeding and reducing the inclusion of soybean meal in nursery diets improved intestinal morphology and mucosa disaccharidase activity directly following weaning, but benefits did not extend to the end of the nursery period.
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Affiliation(s)
- B Christensen
- Department of Animal Biosciences, University of Guelph, Guelph, ON, Canada
| | - L Huber
- Department of Animal Biosciences, University of Guelph, Guelph, ON, Canada
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Christensen B, Karlsen NJ, Jørgensen SDS, Jacobsen LN, Ostenfeld MS, Petersen SV, Müllertz A, Sørensen ES. Milk osteopontin retains integrin-binding activity after in vitro gastrointestinal transit. J Dairy Sci 2019; 103:42-51. [PMID: 31733850 DOI: 10.3168/jds.2019-17212] [Citation(s) in RCA: 15] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/30/2019] [Indexed: 11/19/2022]
Abstract
Osteopontin (OPN) is a multifunctional protein highly expressed in milk, where it is hypothesized to be involved in immunological signaling via the conserved Arg-Gly-Asp (RGD) integrin-binding sequence. Intervention studies have indicated beneficial effects of orally administered OPN in animal and human infants, but the mechanisms underlying these effects are not well described. To induce physiological effects, OPN must resist gastrointestinal transit in a bioactive form. In this study, we subjected bovine milk OPN to in vitro gastrointestinal transit, and characterized the generated fragments using monoclonal antibody and mass spectrometric analyses. We found that the fragment Trp27-Phe151 containing the integrin-binding RGD sequence resisted in vitro gastric digestion. This resistance was dependent on glycosylation of threonine residues near the integrin-binding sequence in both human and bovine milk OPN. Furthermore, the fragment Trp27-Phe151 retained the ability to interact with integrins in an RGD-dependent process. These results suggest a mechanism for how ingested milk OPN can induce physiological effects via integrin signaling in the intestine.
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Affiliation(s)
- B Christensen
- Department of Molecular Biology and Genetics, Aarhus University, DK-8000 Aarhus, Denmark; iFood, Aarhus University Center for Innovative Food Research, DK-8000 Aarhus, Denmark
| | - N J Karlsen
- Department of Molecular Biology and Genetics, Aarhus University, DK-8000 Aarhus, Denmark
| | - S D S Jørgensen
- Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - L N Jacobsen
- Arla Foods Ingredients Group P/S, DK-8260 Viby J, Denmark
| | - M S Ostenfeld
- Arla Foods Ingredients Group P/S, DK-8260 Viby J, Denmark
| | - S V Petersen
- Department of Biomedicine, Aarhus University, DK-8000 Aarhus, Denmark
| | - A Müllertz
- Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - E S Sørensen
- Department of Molecular Biology and Genetics, Aarhus University, DK-8000 Aarhus, Denmark; iFood, Aarhus University Center for Innovative Food Research, DK-8000 Aarhus, Denmark.
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Christensen B, King B, Megison A, Cordell K, Rosebush M. Clinical Diagnostic Accuracy of Oral and Maxillofacial Pathologic Lesions by Dental Specialty. J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.joms.2019.06.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Objectives: Out-of-hours (OOH) services provide access to healthcare outside normal office hours, but the waiting time can sometimes be long. All callers must wait in the telephone queue, even if the health problem is urgent or life-threatening. We tested an emergency access button (EAB), which allowed callers with perceived severe health problems to bypass the queue. We aimed to investigate the severity of the health problems and the relevance of EAB use (assessed by triage professionals). Additionally, we aimed to calculate the number of suspected acute myocardial infarctions (AMI) and ambulance dispatches. Design: Descriptive study of a randomized intervention. Setting: OOH services in two major Danish healthcare regions. Subjects: 217,510 callers participated; 146,355 were randomized to intervention, and 6554 of 6631 (98.8%) questionnaires were completed by OOH triage professionals. Intervention: An EAB allowing randomly selected callers to bypass the telephone queue. Main outcome measures: Severity of contact and relevance of EAB use. Number of suspected AMIs and ambulance dispatches. Results: In both settings, contacts with EAB use concerned significantly more severe health problems than contacts without EAB use (p < 0.001). Triage professionals rated EAB use as "not relevant" in 23% of cases. Significantly more EAB users (10.4%) than EAB non-users (3.3% with EAB option and 1.7% without EAB option, p < 0.001) had a suspected AMI. Conclusions: We found higher proportions of severe health problems, suspected AMIs, and ambulance dispatches among EAB users. Only 23% of EAB use was rated "not relevant". This suggests that the EAB is used as intended. Key points Out-of-hours healthcare is challenged by increasing demand and long triage waiting times. An emergency access button may allow severely ill callers to jump the queue. Callers who bypassed the queue were more severely ill than callers who did not bypass the queue. Only 23% of bypassers presented "not relevant" health problems according to the triage staff.Trial registration: Identifier NCT02572115 registered at Clinicaltrials.gov on 5 October 2015.
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Affiliation(s)
- J. F. Ebert
- Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus C, Denmark;
- CONTACT J. F. Ebert Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000Aarhus C, Denmark
| | - L. Huibers
- Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus C, Denmark;
- Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus C, Denmark;
| | - B. Christensen
- Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus C, Denmark;
| | - F. K. Lippert
- Emergency Medical Services Copenhagen, Capital Region of Denmark, Copenhagen, Denmark
| | - M. B. Christensen
- Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus C, Denmark;
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Ebert JF, Huibers L, Christensen B, Lippert FK, Christensen MB. Giving callers the option to bypass the telephone waiting line in out-of-hours services: a comparative intervention study. Scand J Prim Health Care 2019; 37:120-127. [PMID: 30712448 PMCID: PMC6452808 DOI: 10.1080/02813432.2019.1569427] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE Acute out-of-hours (OOH) healthcare is challenged by potentially long waiting time for callers in acute need of medical aid. OOH callers must usually wait in line, even when contacting for highly urgent or life-threatening conditions. We tested an emergency access button (EAB), which allowed OOH callers to bypass the waiting line if they perceived their health problem as severe. We aimed to investigate EAB use and patient characteristics associated with this use. DESIGN Comparative intervention study. SETTING OOH services in two major Danish healthcare regions. INTERVENTION Giving callers the option to bypass the telephone waiting line by introducing an EAB. PARTICIPANTS OOH service callers contacting during end of October to mid-December 2017. MAIN OUTCOME MEASURES Proportions of EAB use, waiting time and background information on participants in two settings differing on organisation structure, waiting time and triage personnel. RESULTS In total, 97,791 out of 158,784 callers (61.6%) chose to participate. The EAB was used 2905 times out of 97,791 (2.97%, 95%CI 2.86; 3.08). Patient characteristics associated with increased EAB use were male gender, higher age, low education, being retired, and increasing announced estimated waiting time. In one region, immigrants used the EAB more often than native Danish callers. CONCLUSION Only about 3% of all callers chose to bypass the waiting line in the OOH service when given the option. This study suggests that the EAB could serve as a new and simple tool to reduce the waiting time for severely ill patients in an OOH service telephone triage setting. Key Points Acute out-of-hours healthcare is challenged by overcrowding and increasing demand for services. This study shows that only approximately 3% of callers chose to bypass the telephone waiting queue when given the opportunity through an emergency access button. An emergency access button may serve as a new tool to help reduce the triage waiting time for severely ill patients in out-of-hours medical facilities.
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Affiliation(s)
- J. F. Ebert
- Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus C, Denmark;
- Research Unit for General Practice, Aarhus C, Denmark;
- CONTACT Jonas F. Ebert Research Unit for General Practice, Bartholins Allé 2, DK-8000Aarhus C, Denmark
| | - L. Huibers
- Research Unit for General Practice, Aarhus C, Denmark;
| | - B. Christensen
- Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus C, Denmark;
| | - F. K. Lippert
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
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Schulze S, Parsche R, Christensen B. Zervixkarzinom vs. Tuberkulöse Zervizitis – eine klinische Herausforderung (Ein Case Report entsprechend der CARE-Guidelines). Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- S Schulze
- Ruppiner Kliniken, Gynäkologie/Geburtshilfe, Neuruppin, Deutschland
| | - R Parsche
- Ruppiner Kliniken, Radiologie, Neuruppin, Deutschland
| | - B Christensen
- Ruppiner Kliniken, Gynäkologie/Geburtshilfe, Neuruppin, Deutschland
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Pasternak J, Dröge LA, Kommoss S, Harter P, Brucker SY, Mustea A, Strauss A, Christensen B, Weigel M, Ringsdorf U, Jordan J, Sehouli J. Lymphonodektomie in der operativen Behandlung gynäkologischer Sarkome: Auswertung einer Umfrage zur Behandlungspraxis im Rahmen des REGSA Studienregisters. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- J Pasternak
- Universitätsfrauenklinik Tübingen, Tübingen, Deutschland
| | - LA Dröge
- Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie Charité Campus Virchow-Klinikum, Berlin, Deutschland
| | - S Kommoss
- Universitätsfrauenklinik Tübingen, Tübingen, Deutschland
| | - P Harter
- Klinik für Gynäkologie & Gynäkologischer Onkologie, Kliniken Essen-Mitte, Essen, Deutschland
| | - SY Brucker
- Universitätsfrauenklinik Tübingen, Tübingen, Deutschland
| | - A Mustea
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - A Strauss
- Klinik für Gynäkologie und Geburtshilfe, Universität Kiel, Kiel, Deutschland
| | - B Christensen
- Klinik für Gynäkologie und Geburtshilfe, Ruppiner Kliniken, Neuruppin, Deutschland
| | - M Weigel
- Klinik für Frauenheilkunde und Geburtshilfe, Leopoldina Krankenhaus, Schweinfurt, Deutschland
| | - U Ringsdorf
- Gynäkologisches Tumorzentrum Lahn-Dill, Wetzlar, Deutschland
| | - J Jordan
- Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie Charité Campus Virchow-Klinikum, Berlin, Deutschland
| | - J Sehouli
- Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie Charité Campus Virchow-Klinikum, Berlin, Deutschland
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Fangel MV, Nielsen PB, Larsen TB, Christensen B, Overvad TF, Lip GYH, Goldhaber SZ, Jensen MB. P1892Type 1 versus type 2 diabetes and thromboembolic risk in patients with atrial fibrillation: a nationwide cohort study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M V Fangel
- Aalborg University, Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg, Denmark
| | - P B Nielsen
- Aalborg University, Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty og Health, Aalborg, Denmark
| | - T B Larsen
- Aalborg University, Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty og Health, Aalborg, Denmark
| | - B Christensen
- Aarhus University, Department of Public Health, Aarhus, Denmark
| | - T F Overvad
- Aalborg University, Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty og Health, Aalborg, Denmark
| | - G Y H Lip
- University of Birmingham, Institute of Cardiovascular Sciences, Birmingham, United Kingdom
| | - S Z Goldhaber
- Harvard Medical School, Cardiovascular Division, Brigham and Womens Hospital, Boston, United States of America
| | - M B Jensen
- Aalborg University, Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg, Denmark
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Christensen B, Gibson PR, Rubin DT. Letter: vedolizumab for autoimmune liver disease associated inflammatory bowel disease-Authors' reply. Aliment Pharmacol Ther 2018; 47:1423-1424. [PMID: 29676007 DOI: 10.1111/apt.14638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- B Christensen
- Alfred Hospital and Monash University, Melbourne, Australia.,Royal Melbourne Hospital, Melbourne, Australia
| | - P R Gibson
- Alfred Hospital and Monash University, Melbourne, Australia
| | - D T Rubin
- University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL, USA
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Nelson S, Christensen B, King B. Errors in the Management of Odontogenic Infections. J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.joms.2017.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Christensen B, Choi D, McCain J. Utility of Synovial Biopsy for the Diagnosis of Inflammatory Temporomandibular Joint Arthritis. J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.joms.2017.07.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hald K, Nielsen K, Meillier L, Larsen F, Christensen B, Nielsen C, Larsen M. P3433Long term follow-up on socially differentiated cardiac rehabilitation. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ebert JF, Huibers L, Lippert FK, Christensen B, Christensen MB. Development and evaluation of an "emergency access button" in Danish out-of-hours primary care: a study protocol of a randomized controlled trial. BMC Health Serv Res 2017; 17:379. [PMID: 28566087 PMCID: PMC5452428 DOI: 10.1186/s12913-017-2308-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 08/16/2016] [Accepted: 05/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Out-of-hours (OOH) health care for acute medical problems is often challenged by long waiting time for callers in need of advice and triage. Allowing patients to bypass the OOH telephone waiting line may increase patient satisfaction and provide them with a feeling of safety. We aimed to develop an "emergency access button" enabling patients to bypass the normal telephone waiting line in out-of-hours primary care (OOH-PC) if they perceive their condition to be critical and to evaluate the effect of introducing the button in terms of patient satisfaction and their feeling of safety. METHODS All patients calling the OOH-PC in two different Danish health care regions during three months will be included in this randomized controlled trial. Data will be collected through two questionnaires developed for this study: a pop-up questionnaire on the relevance of bypassing the normal waiting line to be completed by triage professionals after patient contact and a paper/electronic questionnaire on perceived safety and satisfaction with the emergency access button to be completed by the callers. These questionnaires were developed and validated using external and internal expert feedback, focus group interviews and a two-week field test. The study will be conducted over three months with an estimated user-rate of the emergency access button of 3%. DISCUSSION We have developed an emergency access button and we now want to investigate whether this new option will influence upon the level of satisfaction and the feeling of safety in the calling patients. Additionally, the study will reveal the assessed relevance of the decision to bypass the line by triage professionals. TRIAL REGISTRATION Registered as NCT02572115 at Clinicaltrials.gov on October 5th 2015.
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Affiliation(s)
- J F Ebert
- Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000, Aarhus C, Denmark. .,Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000, Aarhus C, Denmark.
| | - L Huibers
- Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000, Aarhus C, Denmark.,Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000, Aarhus C, Denmark
| | - F K Lippert
- Emergency Medical Services Copenhagen, The Capital Region of Denmark, Telegrafvej 5, DK-2750, Ballerup, Copenhagen, Denmark
| | - B Christensen
- Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000, Aarhus C, Denmark
| | - M B Christensen
- Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000, Aarhus C, Denmark.,Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000, Aarhus C, Denmark
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Christensen B, Sparrow MP. Editorial: international consensus in clinical trial end-points in ulcerative colitis - clarity or just a step in clearing the fog? Aliment Pharmacol Ther 2017; 45:1274-1275. [PMID: 28370038 DOI: 10.1111/apt.14007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- B Christensen
- Department of Gastroenterology, Alfred Hospital and Monash University, Melbourne, Australia
| | - M P Sparrow
- Department of Gastroenterology, Alfred Hospital and Monash University, Melbourne, Australia
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Christensen B, Sparrow MP. Editorial: adalimumab or infliximab as monotherapy, or in combination with an immunomodulator, in the treatment of Crohn's disease. Aliment Pharmacol Ther 2017; 45:178-179. [PMID: 27910149 DOI: 10.1111/apt.13842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- B Christensen
- Department of Gastroenterology, Alfred Hospital and Monash University, Melbourne, Vic., Australia
| | - M P Sparrow
- Department of Gastroenterology, Alfred Hospital and Monash University, Melbourne, Vic., Australia
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Christensen B, King B. The Effect of Mandibular Fracture Treatment on Nutritional Status. J Oral Maxillofac Surg 2016. [DOI: 10.1016/j.joms.2016.06.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Möbus V, Lück HJ, Forstbauer H, Wachsmann G, Ober A, Schneeweiss A, Christensen B, von Abel E, Grischke EM, Höffkes HG, Klare P, Yon-Dschun K, Schmatloch S, Furlanetto J, Burchardi N, von Minckwitz G, Loibl S. Abstract P1-13-05: GAIN-2: Adjuvant phase III trial to compare intense dose-dense (idd) treatment with EnPC to tailored dose-dense (dt) therapy with dtEC-dtD for patients with high-risk early breast cancer: Results of the second safety interim analyses. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-13-05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: GAIN-2 compares the effectiveness and safety of a predefined intense dose-dense regimen (EnPC) vs. a dose-dense regimen with modification of single doses depending on individual hematological and non-hematological toxicities (dtEC-dtD) (NCT01690702). Moreover, the Trastuzumab substudy compares the subcutaneous administration of the drug to the abdominal wall vs. thigh.
Methods: The primary objective of the GAIN-2 trial is to compare the invasive disease-free survival (iDFS) in patients with high-risk primary breast cancer (luminal A ≥4 N+; luminal B N+; HER2+ and TNBC N0/N+). Patients are randomized between EnPC (epirubicin 150 mg/m2 q2w x 3, nab-Paclitaxel 330 mg/m2 q2w x 3, cyclophosphamide 2000 mg/m2 q2w x 3) or dtEC-dtD (dd/tailored epirubicin/cyclophosphamide q2w x 4 followed by dd/tailored docetaxel q2w x 4) Two safety interim analyses after 200 (Noeding et al. Ann Oncol 2014) and 900 patients who have completed chemotherapy were planned. We present the results of the second safety analysis. In addition to the standard analyses for hematological and non-hematological toxicities, any affections of the cranial nerves as well as the rate of macula degenerations and anaphylactic reactions are of special interest.
Results: Between 09/2012 and 05/2015 a total of 1473 patients have been randomized (EnPC n=734; dtEC-dtD n=739). Among those, 84 patients have been included in the trastuzumab substudy. No safety data are currently available for the substudy. Median age was 52 years and median body-mass-index 26. In terms of hematological adverse events, the rate of febrile neutropenia grade 3-4 (12% vs. 8%) and thrombopenia grade 3-4 (12% vs. 5%) was significantly increased in the EnPC arm. As for non-hematological side effects, there were significantly more patients developing an increase in alkaline phosphatase (59% vs. 40%), ALAT (69% vs. 59%), peripheral sensory neuropathy (83% vs. 68%), arthralgia (63% vs. 49%), myalgia (48% vs. 41%) and bone pain (25% vs. 17%) in the EnPC arm, whereas nosebleed (10% vs. 25%), edema (13% vs. 26%) and hand-foot syndrome (12% vs. 28%) were more common in the dtEC-dtD arm. We observed two treatment related deaths, both in the dtEC-dtD arm (cause of death: acute respiratory distress syndrome and pneumonia). There were no differences between the treatment arms for the toxicities of special interest. In the EnPC arm, overall 30% of the patients required dose-reductions due to hematological toxicities compared with only 10% in the dtEC-dtD arm (p<0.001). The dose could be escalated to the maximum (epirubicin/cyclophosphamide 120/1200 mg/m2 followed by docetaxel 100 mg/m2) in more than one third of the patients receiving dtEC-dtD. In 9% of women a reduction was required in the 4th cycle of docetaxel.
Conclusion: This interim safety analysis from a prospectively randomized trial investigating iddEnPC with predefined doses and a toxicity adapted idd/tailored strategy (dtEC-dtD) showed no additional or unexpected safety signals in the iddEnPC or dtEC-dtD arm. Therefore, no modifications in the conduction of the study are necessary and the study continues as expected.
Citation Format: Möbus V, Lück H-J, Forstbauer H, Wachsmann G, Ober A, Schneeweiss A, Christensen B, von Abel E, Grischke E-M, Höffkes H-G, Klare P, Yon-Dschun K, Schmatloch S, Furlanetto J, Burchardi N, von Minckwitz G, Loibl S. GAIN-2: Adjuvant phase III trial to compare intense dose-dense (idd) treatment with EnPC to tailored dose-dense (dt) therapy with dtEC-dtD for patients with high-risk early breast cancer: Results of the second safety interim analyses. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-13-05.
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Affiliation(s)
- V Möbus
- Klinikum Frankfurt Höchst, Frankfurt, Germany; Gynecologic Oncology Practice Hannover, Hannover, Germany; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf, Germany; Klinikum Sindelfingen-Böblingen, Böblingen, Germany; St. Vincenz-Krankenhaus Limburg, Limburg, Germany; University Hospital Heidelberg, Heidelberg, Germany; Ruppiner Kliniken Neuruppin, Neuruppin, Germany; Klinikum Schwebisch-Gmünd, Schwebisch-Gmünd, Germany; University Hospital Tübingen, Tübingen, Germany; Klinikum Fulda, Fulda, Germany; Praxisklinik Krebsheilkunde, Berlin, Germany; Evangelische Kliniken Bonn, Bonn, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; German Breast Group, Neu-Isenburg, Germany
| | - H-J Lück
- Klinikum Frankfurt Höchst, Frankfurt, Germany; Gynecologic Oncology Practice Hannover, Hannover, Germany; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf, Germany; Klinikum Sindelfingen-Böblingen, Böblingen, Germany; St. Vincenz-Krankenhaus Limburg, Limburg, Germany; University Hospital Heidelberg, Heidelberg, Germany; Ruppiner Kliniken Neuruppin, Neuruppin, Germany; Klinikum Schwebisch-Gmünd, Schwebisch-Gmünd, Germany; University Hospital Tübingen, Tübingen, Germany; Klinikum Fulda, Fulda, Germany; Praxisklinik Krebsheilkunde, Berlin, Germany; Evangelische Kliniken Bonn, Bonn, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; German Breast Group, Neu-Isenburg, Germany
| | - H Forstbauer
- Klinikum Frankfurt Höchst, Frankfurt, Germany; Gynecologic Oncology Practice Hannover, Hannover, Germany; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf, Germany; Klinikum Sindelfingen-Böblingen, Böblingen, Germany; St. Vincenz-Krankenhaus Limburg, Limburg, Germany; University Hospital Heidelberg, Heidelberg, Germany; Ruppiner Kliniken Neuruppin, Neuruppin, Germany; Klinikum Schwebisch-Gmünd, Schwebisch-Gmünd, Germany; University Hospital Tübingen, Tübingen, Germany; Klinikum Fulda, Fulda, Germany; Praxisklinik Krebsheilkunde, Berlin, Germany; Evangelische Kliniken Bonn, Bonn, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; German Breast Group, Neu-Isenburg, Germany
| | - G Wachsmann
- Klinikum Frankfurt Höchst, Frankfurt, Germany; Gynecologic Oncology Practice Hannover, Hannover, Germany; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf, Germany; Klinikum Sindelfingen-Böblingen, Böblingen, Germany; St. Vincenz-Krankenhaus Limburg, Limburg, Germany; University Hospital Heidelberg, Heidelberg, Germany; Ruppiner Kliniken Neuruppin, Neuruppin, Germany; Klinikum Schwebisch-Gmünd, Schwebisch-Gmünd, Germany; University Hospital Tübingen, Tübingen, Germany; Klinikum Fulda, Fulda, Germany; Praxisklinik Krebsheilkunde, Berlin, Germany; Evangelische Kliniken Bonn, Bonn, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; German Breast Group, Neu-Isenburg, Germany
| | - A Ober
- Klinikum Frankfurt Höchst, Frankfurt, Germany; Gynecologic Oncology Practice Hannover, Hannover, Germany; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf, Germany; Klinikum Sindelfingen-Böblingen, Böblingen, Germany; St. Vincenz-Krankenhaus Limburg, Limburg, Germany; University Hospital Heidelberg, Heidelberg, Germany; Ruppiner Kliniken Neuruppin, Neuruppin, Germany; Klinikum Schwebisch-Gmünd, Schwebisch-Gmünd, Germany; University Hospital Tübingen, Tübingen, Germany; Klinikum Fulda, Fulda, Germany; Praxisklinik Krebsheilkunde, Berlin, Germany; Evangelische Kliniken Bonn, Bonn, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; German Breast Group, Neu-Isenburg, Germany
| | - A Schneeweiss
- Klinikum Frankfurt Höchst, Frankfurt, Germany; Gynecologic Oncology Practice Hannover, Hannover, Germany; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf, Germany; Klinikum Sindelfingen-Böblingen, Böblingen, Germany; St. Vincenz-Krankenhaus Limburg, Limburg, Germany; University Hospital Heidelberg, Heidelberg, Germany; Ruppiner Kliniken Neuruppin, Neuruppin, Germany; Klinikum Schwebisch-Gmünd, Schwebisch-Gmünd, Germany; University Hospital Tübingen, Tübingen, Germany; Klinikum Fulda, Fulda, Germany; Praxisklinik Krebsheilkunde, Berlin, Germany; Evangelische Kliniken Bonn, Bonn, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; German Breast Group, Neu-Isenburg, Germany
| | - B Christensen
- Klinikum Frankfurt Höchst, Frankfurt, Germany; Gynecologic Oncology Practice Hannover, Hannover, Germany; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf, Germany; Klinikum Sindelfingen-Böblingen, Böblingen, Germany; St. Vincenz-Krankenhaus Limburg, Limburg, Germany; University Hospital Heidelberg, Heidelberg, Germany; Ruppiner Kliniken Neuruppin, Neuruppin, Germany; Klinikum Schwebisch-Gmünd, Schwebisch-Gmünd, Germany; University Hospital Tübingen, Tübingen, Germany; Klinikum Fulda, Fulda, Germany; Praxisklinik Krebsheilkunde, Berlin, Germany; Evangelische Kliniken Bonn, Bonn, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; German Breast Group, Neu-Isenburg, Germany
| | - E von Abel
- Klinikum Frankfurt Höchst, Frankfurt, Germany; Gynecologic Oncology Practice Hannover, Hannover, Germany; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf, Germany; Klinikum Sindelfingen-Böblingen, Böblingen, Germany; St. Vincenz-Krankenhaus Limburg, Limburg, Germany; University Hospital Heidelberg, Heidelberg, Germany; Ruppiner Kliniken Neuruppin, Neuruppin, Germany; Klinikum Schwebisch-Gmünd, Schwebisch-Gmünd, Germany; University Hospital Tübingen, Tübingen, Germany; Klinikum Fulda, Fulda, Germany; Praxisklinik Krebsheilkunde, Berlin, Germany; Evangelische Kliniken Bonn, Bonn, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; German Breast Group, Neu-Isenburg, Germany
| | - E-M Grischke
- Klinikum Frankfurt Höchst, Frankfurt, Germany; Gynecologic Oncology Practice Hannover, Hannover, Germany; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf, Germany; Klinikum Sindelfingen-Böblingen, Böblingen, Germany; St. Vincenz-Krankenhaus Limburg, Limburg, Germany; University Hospital Heidelberg, Heidelberg, Germany; Ruppiner Kliniken Neuruppin, Neuruppin, Germany; Klinikum Schwebisch-Gmünd, Schwebisch-Gmünd, Germany; University Hospital Tübingen, Tübingen, Germany; Klinikum Fulda, Fulda, Germany; Praxisklinik Krebsheilkunde, Berlin, Germany; Evangelische Kliniken Bonn, Bonn, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; German Breast Group, Neu-Isenburg, Germany
| | - H-G Höffkes
- Klinikum Frankfurt Höchst, Frankfurt, Germany; Gynecologic Oncology Practice Hannover, Hannover, Germany; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf, Germany; Klinikum Sindelfingen-Böblingen, Böblingen, Germany; St. Vincenz-Krankenhaus Limburg, Limburg, Germany; University Hospital Heidelberg, Heidelberg, Germany; Ruppiner Kliniken Neuruppin, Neuruppin, Germany; Klinikum Schwebisch-Gmünd, Schwebisch-Gmünd, Germany; University Hospital Tübingen, Tübingen, Germany; Klinikum Fulda, Fulda, Germany; Praxisklinik Krebsheilkunde, Berlin, Germany; Evangelische Kliniken Bonn, Bonn, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; German Breast Group, Neu-Isenburg, Germany
| | - P Klare
- Klinikum Frankfurt Höchst, Frankfurt, Germany; Gynecologic Oncology Practice Hannover, Hannover, Germany; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf, Germany; Klinikum Sindelfingen-Böblingen, Böblingen, Germany; St. Vincenz-Krankenhaus Limburg, Limburg, Germany; University Hospital Heidelberg, Heidelberg, Germany; Ruppiner Kliniken Neuruppin, Neuruppin, Germany; Klinikum Schwebisch-Gmünd, Schwebisch-Gmünd, Germany; University Hospital Tübingen, Tübingen, Germany; Klinikum Fulda, Fulda, Germany; Praxisklinik Krebsheilkunde, Berlin, Germany; Evangelische Kliniken Bonn, Bonn, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; German Breast Group, Neu-Isenburg, Germany
| | - K Yon-Dschun
- Klinikum Frankfurt Höchst, Frankfurt, Germany; Gynecologic Oncology Practice Hannover, Hannover, Germany; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf, Germany; Klinikum Sindelfingen-Böblingen, Böblingen, Germany; St. Vincenz-Krankenhaus Limburg, Limburg, Germany; University Hospital Heidelberg, Heidelberg, Germany; Ruppiner Kliniken Neuruppin, Neuruppin, Germany; Klinikum Schwebisch-Gmünd, Schwebisch-Gmünd, Germany; University Hospital Tübingen, Tübingen, Germany; Klinikum Fulda, Fulda, Germany; Praxisklinik Krebsheilkunde, Berlin, Germany; Evangelische Kliniken Bonn, Bonn, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; German Breast Group, Neu-Isenburg, Germany
| | - S Schmatloch
- Klinikum Frankfurt Höchst, Frankfurt, Germany; Gynecologic Oncology Practice Hannover, Hannover, Germany; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf, Germany; Klinikum Sindelfingen-Böblingen, Böblingen, Germany; St. Vincenz-Krankenhaus Limburg, Limburg, Germany; University Hospital Heidelberg, Heidelberg, Germany; Ruppiner Kliniken Neuruppin, Neuruppin, Germany; Klinikum Schwebisch-Gmünd, Schwebisch-Gmünd, Germany; University Hospital Tübingen, Tübingen, Germany; Klinikum Fulda, Fulda, Germany; Praxisklinik Krebsheilkunde, Berlin, Germany; Evangelische Kliniken Bonn, Bonn, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; German Breast Group, Neu-Isenburg, Germany
| | - J Furlanetto
- Klinikum Frankfurt Höchst, Frankfurt, Germany; Gynecologic Oncology Practice Hannover, Hannover, Germany; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf, Germany; Klinikum Sindelfingen-Böblingen, Böblingen, Germany; St. Vincenz-Krankenhaus Limburg, Limburg, Germany; University Hospital Heidelberg, Heidelberg, Germany; Ruppiner Kliniken Neuruppin, Neuruppin, Germany; Klinikum Schwebisch-Gmünd, Schwebisch-Gmünd, Germany; University Hospital Tübingen, Tübingen, Germany; Klinikum Fulda, Fulda, Germany; Praxisklinik Krebsheilkunde, Berlin, Germany; Evangelische Kliniken Bonn, Bonn, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; German Breast Group, Neu-Isenburg, Germany
| | - N Burchardi
- Klinikum Frankfurt Höchst, Frankfurt, Germany; Gynecologic Oncology Practice Hannover, Hannover, Germany; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf, Germany; Klinikum Sindelfingen-Böblingen, Böblingen, Germany; St. Vincenz-Krankenhaus Limburg, Limburg, Germany; University Hospital Heidelberg, Heidelberg, Germany; Ruppiner Kliniken Neuruppin, Neuruppin, Germany; Klinikum Schwebisch-Gmünd, Schwebisch-Gmünd, Germany; University Hospital Tübingen, Tübingen, Germany; Klinikum Fulda, Fulda, Germany; Praxisklinik Krebsheilkunde, Berlin, Germany; Evangelische Kliniken Bonn, Bonn, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; German Breast Group, Neu-Isenburg, Germany
| | - G von Minckwitz
- Klinikum Frankfurt Höchst, Frankfurt, Germany; Gynecologic Oncology Practice Hannover, Hannover, Germany; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf, Germany; Klinikum Sindelfingen-Böblingen, Böblingen, Germany; St. Vincenz-Krankenhaus Limburg, Limburg, Germany; University Hospital Heidelberg, Heidelberg, Germany; Ruppiner Kliniken Neuruppin, Neuruppin, Germany; Klinikum Schwebisch-Gmünd, Schwebisch-Gmünd, Germany; University Hospital Tübingen, Tübingen, Germany; Klinikum Fulda, Fulda, Germany; Praxisklinik Krebsheilkunde, Berlin, Germany; Evangelische Kliniken Bonn, Bonn, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; German Breast Group, Neu-Isenburg, Germany
| | - S Loibl
- Klinikum Frankfurt Höchst, Frankfurt, Germany; Gynecologic Oncology Practice Hannover, Hannover, Germany; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf, Germany; Klinikum Sindelfingen-Böblingen, Böblingen, Germany; St. Vincenz-Krankenhaus Limburg, Limburg, Germany; University Hospital Heidelberg, Heidelberg, Germany; Ruppiner Kliniken Neuruppin, Neuruppin, Germany; Klinikum Schwebisch-Gmünd, Schwebisch-Gmünd, Germany; University Hospital Tübingen, Tübingen, Germany; Klinikum Fulda, Fulda, Germany; Praxisklinik Krebsheilkunde, Berlin, Germany; Evangelische Kliniken Bonn, Bonn, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; German Breast Group, Neu-Isenburg, Germany
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Viste A, Horn A, Øvrebø K, Christensen B, Angelsen JH, Hoem D. Bile duct injuries following laparoscopic cholecystectomy. Scand J Surg 2015; 104:233-7. [PMID: 25700851 DOI: 10.1177/1457496915570088] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 12/12/2014] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Bile duct injuries occur rarely but are among the most dreadful complications following cholecystectomies. METHODS Prospective registration of bile duct injuries occurring in the period 1992-2013 at a tertiary referral hospital. RESULTS In total, 67 patients (47 women and 20 men) with a median age of 55 (range 14-86) years had a leak or a lesion of the bile ducts during the study period. Total incidence of postoperative bile leaks or bile duct injuries was 0.9% and for bile duct injuries separately, 0.4%. Median delay from injury to repair was 5 days (range 0-68 days). In 12 patients (18%), the injury was discovered intraoperatively. Bile leak was the major symptom in 59%, and 52% had a leak from the cystic duct or from assumed aberrant ducts in the liver bed of the gall bladder. Following the Clavien-Dindo classification, 39% and 45% were classified as IIIa and IIIb, respectively, 10% as IV, and 6% as V. In all, 31 patients had injuries to the common bile duct or hepatic ducts, and in these patients, 71% were treated with a hepaticojejunostomy. Of patients treated with a hepaticojejunostomy, 56% had an uncomplicated event, whereas 14% later on developed a stricture. Out of 36 patients with injuries to the cystic duct/aberrant ducts, 30 could be treated with stents or sphincterotomies and percutaneous drainage. CONCLUSION Half of injuries following cholecystectomies are related to the cystic duct, and most of these can be treated with endoscopic or percutaneous procedures. A considerable number of patients following hepaticojejunostomy will later on develop a stricture.
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Affiliation(s)
- A Viste
- Department of Acute and Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway Department of Clinical Medicine K1, University of Bergen, Bergen, Norway
| | - A Horn
- Department of Acute and Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway
| | - K Øvrebø
- Department of Acute and Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway
| | - B Christensen
- Department of Acute and Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway
| | - J-H Angelsen
- Department of Acute and Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway
| | - D Hoem
- Department of Acute and Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway
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von Minckwitz G, Loibl S, Untch M, Eidtmann H, Rezai M, Fasching PA, Tesch H, Eggemann H, Schrader I, Kittel K, Hanusch C, Huober J, Solbach C, Jackisch C, Kunz G, Blohmer JU, Hauschild M, Fehm T, Nekljudova V, Gerber B, Gnauert K, Heinrich B, Prätz T, Groh U, Tanzer H, Villena C, Tulusan A, Liedtke B, Blohmer JU, Kittel K, Mau C, Potenberg J, Schilling J, Just M, Weiss E, Bückner U, Wolfgarten M, Lorenz R, Doering G, Feidicker S, Krabisch P, Deichert U, Augustin D, Kunz G, Kast K, von Minckwitz G, Nestle-Krämling C, Rezai M, Höß C, Terhaag J, Fasching P, Staib P, Aktas B, Kühn T, Khandan F, Möbus V, Solbach C, Tesch H, Stickeler E, Heinrich G, Wagner H, Abdallah A, Dewitz T, Emons G, Belau A, Rethwisch V, Lantzsch T, Thomssen C, Mattner U, Nugent A, Müller V, Noesselt T, Holms F, Müller T, Deuker JU, Schrader I, Strumberg D, Uleer C, Solomayer E, Runnebaum I, Link H, Tomé O, Ulmer HU, Conrad B, Feisel-Schwickardi G, Eidtmann H, Schumacher C, Steinmetz T, Bauerfeind I, Kremers S, Langanke D, Kullmer U, Ober A, Fischer D, Kohls A, Weikel W, Bischoff J, Freese K, Schmidt M, Wiest W, Sütterlin M, Dietrich M, Grießhammer M, Burgmann DM, Hanusch C, Rack B, Salat C, Sattler D, Tio J, von Abel E, Christensen B, Burkamp U, Köhne CH, Meinerz W, Graßhoff ST, Decker T, Overkamp F, Thalmann I, Sallmann A, Beck T, Reimer T, Bartzke G, Deryal M, Weigel M, Huober J, Weder P, Steffens CC, Lemster S, Stefek A, Ruhland F, Hofmann M, Schuster J, Simon W, Kronawitter U, Clemens M, Fehm T, Janni W, Latos K, Bauer W, Roßmann A, Bauer L, Lampe D, Heyl V, Hoffmann G, Lorenz-Salehi F, Hackmann J, Schlag R. Survival after neoadjuvant chemotherapy with or without bevacizumab or everolimus for HER2-negative primary breast cancer (GBG 44-GeparQuinto)†. Ann Oncol 2014; 25:2363-2372. [PMID: 25223482 DOI: 10.1093/annonc/mdu455] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The GeparQuinto study showed that adding bevacizumab to 24 weeks of anthracycline-taxane-based neoadjuvant chemotherapy increases pathological complete response (pCR) rates overall and specifically in patients with triple-negative breast cancer (TNBC). No difference in pCR rate was observed for adding everolimus to paclitaxel in nonearly responding patients. Here, we present disease-free (DFS) and overall survival (OS) analyses. PATIENTS AND METHODS Patients (n = 1948) with HER2-negative tumors of a median tumor size of 4 cm were randomly assigned to neoadjuvant treatment with epirubicin/cyclophosphamide followed by docetaxel (EC-T) with or without eight infusions of bevacizumab every 3 weeks before surgery. Patients without clinical response to EC ± Bevacizumab were randomized to 12 weekly cycles paclitaxel with or without everolimus 5 mg/day. To detect a hazard ratio (HR) of 0.75 (α = 0.05, β = 0.8) 379 events had to be observed in the bevacizumab arms. RESULTS With a median follow-up of 3.8 years, 3-year DFS was 80.8% and 3-year OS was 89.7%. Outcome was not different for patients receiving bevacizumab (HR 1.03; P = 0.784 for DFS and HR 0.974; P = 0.842 for OS) compared with patients receiving chemotherapy alone. Patients with TNBC similarly showed no improvement in DFS (HR = 0.99; P = 0.941) and OS (HR = 1.02; P = 0.891) when treated with bevacizumab. No other predefined subgroup (HR+/HER2-; locally advanced (cT4 or cN3) or not; cT1-3 or cT4; pCR or not) showed a significant benefit. No difference in DFS (HR 0.997; P = 0.987) and OS (HR 1.11; P = 0.658) was observed for nonearly responding patients receiving paclitaxel with or without everolimus overall as well as in subgroups. CONCLUSIONS Long-term results, in opposite to the results of pCR, do not support the neoadjuvant use of bevacizumab in addition to an anthracycline-taxane-based chemotherapy or everolimus in addition to paclitaxel for nonearly responding patients. CLINICAL TRIAL NUMBER NCT 00567554, www.clinicaltrials.gov.
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Affiliation(s)
- G von Minckwitz
- Headquarter, German Breast Group, Neu-Isenburg; Department of Gynaecology and Obstetrics, University Hospital, Frankfurt.
| | - S Loibl
- Headquarter, German Breast Group, Neu-Isenburg
| | - M Untch
- Department of Gynaecology and Obstetrics, Klinikum Berlin-Buch, Berlin
| | - H Eidtmann
- Department of Gynaecology and Obstetrics, University Hospital, Kiel
| | - M Rezai
- Breast Center, Luisenkrankenhaus, Düsseldorf
| | - P A Fasching
- Department of Gynaecology and Obstetrics, University Hospital, Erlangen
| | - H Tesch
- Department of Medical Oncology, Chop GmbH, Frankfurt
| | - H Eggemann
- Department of Gynaecology and Obstetrics, University Hospital, Magdeburg
| | - I Schrader
- Department of Gynaecology and Obstetrics, Henriettenstiftung, Hannover
| | - K Kittel
- Department of Gynaecology and Obstetrics, Praxisklinik, Berlin
| | - C Hanusch
- Department of Gynaecology and Obstetrics, Rot-Kreuz-Klinikum, München
| | - J Huober
- Department of Gynaecology and Obstetrics, University Hospital, Ulm
| | - C Solbach
- Department of Gynaecology and Obstetrics, University Hospital, Frankfurt
| | - C Jackisch
- Department of Gynaecology and Obstetrics, Sana-Klinikum, Offenbach
| | - G Kunz
- Department of Gynaecology and Obstetrics, St Johannes Hospital, Dortmund
| | - J U Blohmer
- Department of Gynaecology and Obstetrics, St Gertrauden-Hospital, Berlin
| | - M Hauschild
- Department of Gynaecology and Obstetrics, Hospital, Rheinfelden
| | - T Fehm
- Department of Gynaecology and Obstetrics, University Hospital, Tübingen
| | | | - B Gerber
- Department of Gynaecology and Obstetrics, University Hospital, Rostock, Germany
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Noeding S, Forstbauer H, Wachsmann G, Ober A, Schneeweiss A, Christensen B, von Abel E, Grischke E, Höffkes H, Klare P, Ko Y, Schmatloch S, Burchardi N, Loibl S, von Minckwitz G, Möbus V. Gain2: Adjuvant Phase III Trial Comparing an Intensified Dose-Dense Adjuvant Therapy with Enpc Compared with a Dose-Dense, Dose-Adapted Therapy with Dtec Dtdocetaxel in Patients with Primary Breast Cancer and a High Risk of Recurrence. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu327.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Christensen B, Sørensen E. Osteopontin is highly susceptible to cleavage in bovine milk and the proteolytic fragments bind the αVβ3-integrin receptor. J Dairy Sci 2014; 97:136-46. [DOI: 10.3168/jds.2013-7223] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 10/06/2013] [Indexed: 11/19/2022]
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Christensen B, Han M, Dillon J. The Cost of Odontogenic Infections: a Demographic, Financial, and Outcome Variable Analysis. J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.joms.2013.06.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wark HAC, Sharma R, Mathews KS, Fernandez E, Yoo J, Christensen B, Tresco P, Rieth L, Solzbacher F, Normann RA, Tathireddy P. A new high-density (25 electrodes/mm²) penetrating microelectrode array for recording and stimulating sub-millimeter neuroanatomical structures. J Neural Eng 2013; 10:045003. [PMID: 23723133 DOI: 10.1088/1741-2560/10/4/045003] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Among the currently available neural interface devices, there has been a need for a penetrating electrode array with a high electrode-count and high electrode-density (the number of electrodes/mm(2)) that can be used for electrophysiological studies of sub-millimeter neuroanatomical structures. We have developed such a penetrating microelectrode array with both a high electrode-density (25 electrodes/mm(2)) and high electrode-count (up to 96 electrodes) for small nervous system structures, based on the existing Utah Slanted Electrode Array (USEA). Such high electrode-density arrays are expected to provide greater access to nerve fibers than the conventionally spaced USEA especially in small diameter nerves. APPROACH One concern for such high density microelectrode arrays is that they may cause a nerve crush-type injury upon implantation. We evaluated this possibility during acute (<10 h) in vivo experiments with electrode arrays implanted into small diameter peripheral nerves of anesthetized rats (sciatic nerve) and cats (pudendal nerve). MAIN RESULTS Successful intrafascicular implantation and viable nerve function was demonstrated via microstimulation, single-unit recordings and histological analysis. Measurements of the electrode impedances and quantified electrode dimensions demonstrated fabrication quality. The results of these experiments show that such high density neural interfaces can be implanted acutely into neural tissue without causing a complete nerve crush injury, while mediating intrafascicular access to fibers in small diameter peripheral nerves. SIGNIFICANCE This new penetrating microelectrode array has characteristics un-matched by other neural interface devices currently available for peripheral nervous system neurophysiological research.
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Affiliation(s)
- H A C Wark
- Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
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Choy MCS, Christensen B, Desmond PV. Ileocaecal tuberculosis: re-emergence in developed countries. Intern Med J 2013; 43:342-5. [PMID: 23441665 DOI: 10.1111/imj.12056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 10/01/2012] [Indexed: 11/30/2022]
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Dillon JK, Christensen B, Fairbanks T, Jurkovich G, Moe KS. The emergent surgical airway: cricothyrotomy vs. tracheotomy. Int J Oral Maxillofac Surg 2012; 42:204-8. [PMID: 23265756 DOI: 10.1016/j.ijom.2012.10.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [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: 05/21/2012] [Revised: 08/30/2012] [Accepted: 10/19/2012] [Indexed: 11/19/2022]
Abstract
The American Society of Anesthesiologists difficult airway algorithm identifies two acceptable emergency surgical airways in the 'cannot intubate, cannot ventilate' scenario: cricothyrotomy and tracheotomy. Little has been published regarding the emergency surgical airway practices at different institutions. The authors investigated whether the primary choice of emergency surgical airway at a major level I trauma centre was cricothyrotomy or tracheotomy. A retrospective chart review was conducted of emergency airways performed over 6 years using relevant current procedural terminology codes. The electronic medical records obtained were reviewed to ensure accurate coding and verify the emergent nature of the procedure. Over the study period, there were 4312 documented emergent airways. 3197 (74.1%) were field intubated by paramedics, 1081 (25.1%) were hospital intubated by anaesthesia, 34 (0.008%) required emergency surgical access of which 24 were tracheotomies and 10 cricothyrotomies. Despite the emphasis in resident training and Advanced Trauma Life Support, there was a paucity of cricothyrotomies during the study period. At the authors' institution, tracheotomy is preferentially used as the emergency surgical airway. A multicentre prospective study is recommended to evaluate current practice in emergency surgical airway and to include the emergency open tracheotomy in residency training and continuing education if needed.
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Affiliation(s)
- J K Dillon
- Department of Oral and Maxillofacial Surgery, Harborview Medical Center, University of Washington School of Dentistry, Seattle, WA 98104, USA.
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Schlütter J, Kirkegaard I, Christensen B, Kølvraa S, Uldbjerg N. O606 OVERNIGHT CHANGES IN THE NUMBER OF FETAL CELLS IN MATERNAL BLOOD. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)61036-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Paulsen MS, Andersen M, Munck AP, Larsen PV, Hansen DG, Jacobsen IA, Larsen ML, Christensen B, Sondergaard J. Socio-economic status influences blood pressure control despite equal access to care. Fam Pract 2012; 29:503-10. [PMID: 22234552 DOI: 10.1093/fampra/cmr130] [Citation(s) in RCA: 29] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Denmark has a health care system with free and equal access to care irrespective of age and socio-economic status (SES). We conducted a cross-sectional study to investigate a possible association between SES and blood pressure (BP) control of hypertensive patients treated in general practice. METHODS We enrolled 184 general practices and 5260 hypertensive patients. The general practitioners reported information about BP and diagnosis of diabetes. Information about education, income, antihypertensive drug treatment and other co-morbidity was retrieved from relevant registers from Statistics Denmark. The outcome measure was BP control defined as BP <140/90 mmHg in general and <130/80 mmHg in diabetics. RESULTS Patients <65 years and with an educational level of 10-12 years had increased odds ratio (OR) of BP control compared to patients with an educational level <10 years. Patients ≥65 years had increased OR of BP control if they were married/cohabiting as compared to being single, whereas education and income had no impact in this age group. Diabetics had significantly reduced odds of BP control irrespective of age, educational or income level. CONCLUSIONS Despite equal access to care for all patients, SES had significant impact on BP control in this survey. Diabetes and cardiovascular disease also had a substantial influence irrespective of age, educational and income level.
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Affiliation(s)
- M S Paulsen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark.
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Demant D, Lund K, Christensen B, Segerdahl M, Sjögren N, Jensen T, Sindrup S, Finnerup N. Sensory phenotypes in patients with peripheral neuropathic pain evaluated with quantitative sensory testing. Scand J Pain 2012. [DOI: 10.1016/j.sjpain.2012.05.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Abstract
Background
In patients with neuropathic pain, Quantitative Sensory Testing (QST) can define different sensory phenotypes thought to be related to different underlying mechanisms. One phenotype with abnormal sensitization of cutaneous nociceptors has been termed irritable nociceptors.
Methods
This study is a part of a randomized, double-blind, placebo controlled, crossover trial with the anticonvulsant oxcarbazepine. The study is ongoing. In this report, baseline QST measures from patients with peripheral neuropathic pain due to either polyneuropathy (PNP) or peripheral nerve injury (PNI) are analyzed. QST evaluates thresholds for cold and heat detection (CDT, WDT), thermal pain (CPT, HPT), vibration (VDT), pin prick, mechanical detection and pressure pain. Furthermore, wind-up ratio and dynamic mechanical allodynia (DMA) are evaluated. Patients with irritable nociceptors are defined as patient with normal CDT and WDT and either mechanical or thermal allodynia or hyperalgesia.
Results
By March 2012, 28 patients with PNI and 24 with PNP were included. There was no difference in pain duration (66.2 (53.7) vs. 64.0 (43.3) months, p = 0.87) or pain intensity (NRS, 0 10) (6.6 (1.6) vs. 6.3 (1.7), p = 0.54), but patients with PNI were significantly younger (48.8 (15.1) years) compared to patients with PNP (62.4 (8.5) years), p < 0.001. The percentage of irritable nociceptors in the PNI group was 39.3% and in the PNP group 29.2% (p = 0.44). The percentage of patients with DMA was 39.3% and 33.3%, respectively (p = 0.66). Significantly more patients with PNI had thermal allodynia (28.6% vs. 0%, p = 0.005), 6 reported cold allodynia and 4 heat allodynia.
Conclusion
Preliminary results show that there was no significant difference in percentage of irritable nociceptors between the two groups, but more patients with PNI had thermal allodynia.
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Affiliation(s)
- D. Demant
- Odense University Hospital , Neurological Department , Odense Denmark
| | - K. Lund
- Danish Pain Research Center , Aarhus University Hospital , Aarhus Denmark
| | - B. Christensen
- Danish Pain Research Center , Aarhus University Hospital , Aarhus Denmark
| | | | | | - T.S. Jensen
- Danish Pain Research Center , Aarhus University Hospital , Aarhus Denmark
| | - S. Sindrup
- Odense University Hospital , Neurological Department , Odense Denmark
| | - N.B. Finnerup
- Danish Pain Research Center , Aarhus University Hospital , Aarhus Denmark
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Paulsen MS, Sondergaard J, Reuther L, Larsen PS, Munck AP, Larsen PV, Damsgaard J, Poulsen L, Hansen DG, Jacobsen IA, Larsen ML, Christensen HR, Christensen B, Andersen M. Treatment of 5413 hypertensive patients: a cross-sectional study. Fam Pract 2011; 28:599-607. [PMID: 21596691 DOI: 10.1093/fampra/cmr027] [Citation(s) in RCA: 14] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Most hypertensive patients are managed in primary care in Denmark, but previous studies have shown that only 21-43% of hypertensive patients achieve optimal blood pressure (BP) control. Antihypertensive drug treatment, risk factors and cardiovascular disease (CVD) are some of the important factors to consider when optimizing the individual treatment strategy in hypertensive patients. OBJECTIVE To examine treatment of BP according to Danish guidelines (BP < 140/90 mmHg generally and <130/80 mmHg for diabetics) in a population from general practice in relation to risk factors, CVD and diagnosis of diabetes. METHODS A cross-sectional study comprising 184 practices and 5413 hypertensive patients was carried out in Denmark. The general practitioners filled in information on each patient's risk factors, CVD and antihypertensive drug treatment. Patients filled in a questionnaire on risk factors. The outcome measures were optimal BP control according to Danish guidelines and antihypertensive drug treatment. RESULTS Mean patient age was 65.9 years [95% confidence interval (CI): 65.6-66.1]. Optimal BP control was achieved in 29.1% (95% CI: 27.9-30.3) of the study population. Among 842 diabetics with or without CVD, optimal BP control was achieved in 10.9% (95% CI: 8.8-10.3), while 38.7% (35.5-41.9) of patients with CVD achieved optimal BP control. The majority of all patients were treated with 1 (32.5%, 95% CI: 32.5 (31.3-33.8)) or two antihypertensive drugs (39.0%, 95% CI: 38.2-40.8). In hypertensive diabetics, 17.7% were not treated with an angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker. CONCLUSION In general practice, the proportion of hypertensive patients achieving optimal BP control is inadequate. The majority of hypertensive patients are treated with only one or two antihypertensive drugs.
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Affiliation(s)
- M S Paulsen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense.
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Ilhan A, Wagner L, Maj M, Woehrer A, Czech T, Heinzl H, Marosi C, Base W, Preusser M, Jeuken JW, Navis AC, Sijben A, Boots-Sprenger SH, Bleeker FE, Gijtenbeek JM, Wesseling P, Seyed Sadr E, Tessier A, Seyed Sadr M, Alshami J, Anan M, Sabau C, Del Maestro R, Agnihotri S, Gajadhar A, Wolf A, Mischel PM, Hawkins C, Guha A, Guan X, Chance MR, Barnholtz-Sloan JS, Larson JD, Rodriguez FJ, Demer AM, Sarver AL, Dubac A, Jenkins RB, Dupuy AJ, Copeland NG, Jenkins NA, Taylor MD, Largaespada DA, Lusis EA, Stuart JE, Scheck AC, Coons SW, Lal A, Perry A, Gutmann DH, Barnholtz-Sloan JS, Adams MD, Cohen M, Devine K, Wolinsky Y, Bambakidis N, Selman W, Miller R, Sloan AE, Suchorska B, Mehrkens JH, Eigenbrod S, Eroes CA, Tonn JC, Kretzschmar HA, Kreth FW, Buczkowicz P, Bartels U, Morrison A, Zarghooni M, Bouffet E, Hawkins C, Kollmeyer TM, Wrensch M, Decker PA, Xiao Y, Rynearson AL, Fink S, Kosel ML, Johnson DR, Lachance DH, Yang P, Fridley BL, Wiemels J, Wiencke J, Jenkins RB, Zhou YH, Hess KR, Yu L, Raj VR, Liu L, Alfred Yung WK, Hutchins LF, Linskey ME, Roldan G, Kachra R, McIntyre JB, Magliocco A, Easaw J, Hamilton M, Northcott PA, Van Meter T, Eberhart C, Weiss W, Rutka JT, Gupta N, Korshunov A, French P, Kros J, Michiels E, Kloosterhof N, Hauser P, Montange MF, Jouvet A, Bouffet E, Jung S, Kim SK, Wang KC, Cho BK, Di Rocco C, Massimi L, Leonard J, Scheurlen W, Pfister S, Robinson S, Yang SH, Yoo JY, Cho DG, Kim HK, Kim SW, Lee SW, Fink S, Kollmeyer T, Rynearson A, Decker P, Sicotte H, Yang P, Jenkins R, Lai A, Kharbanda S, Tran A, Pope W, Solis O, Peale F, Forrest W, Purjara K, Carrillo J, Pandita A, Ellingson B, Bowers C, Soriano R, Mohan S, Yong W, Aldape K, Mischel P, Liau L, Nghiemphu P, James CD, Prados M, Westphal M, Lamszus K, Cloughesy T, Phillips H, Thon N, Kreth S, Eigenbrod S, Lutz J, Ledderose C, Tonn JC, Kretzschmar H, Kreth FW, Mokhtari K, Ducray F, Kros JM, Gorlia T, Idbaih A, Marie Y, Taphoorn M, Wesseling P, Brandes AA, Hoang-Xuan K, Delattre JY, Van den Bent M, Sanson M, Lavon I, Shahar T, Granit A, Smith Y, Nossek E, Siegal T, Ram Z, Marko NF, Quackenbush J, Weil RJ, Ducray F, Criniere E, Idbaih A, Paris S, Marie Y, Carpentier C, Houillier C, Dieme M, Adam C, Hoang-Xuan K, Delattre JY, Duyckaerts C, Sanson M, Mokhtari K, Zinn PO, Kozono D, Kasper EM, Warnke PC, Chin L, Chen CC, Saito K, Mukasa A, Saito N, Stieber D, Lenkiewicz E, Evers L, Vallar L, Bjerkvig R, Barrett M, Niclou SP, Gorlia T, Brandes A, Stupp R, Rampling R, Fumoleau P, Dittrich C, Campone M, Twelves C, Raymond E, Lacombe D, van den Bent MJ, Potter N, Ashmore S, Karakoula K, Ward S, Suarez-Merino B, Luxsuwong M, Thomas DG, Darling J, Warr T, Gutman DA, Cooper L, Kong J, Chisolm C, Van Meir EG, Saltz JH, Moreno CS, Brat DJ, Brennan CW, Brat DJ, Aldape KD, Cohen M, Lehman NL, McLendon RE, Miller R, Schniederjan M, Vandenberg SR, Weaver K, Phillips S, Pierce L, Christensen B, Smith A, Zheng S, Koestler D, Houseman EA, Marsit CJ, Wiemels JL, Nelson HH, Karagas MR, Wrensch MR, Kelsey KT, Wiencke JK, Al-Nedawi K, Meehan B, Micallef J, Guha A, Rak J. -Omics and Prognostic Markers. Neuro Oncol 2010. [DOI: 10.1093/neuonc/noq116.s8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Spencer J, King JP, Bennett PJ, Sekuler AB, Christensen B. Effects of face inversion and noise in persons with schizophrenia. J Vis 2010. [DOI: 10.1167/9.8.486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Schack L, Lange A, Kelsen J, Agnholt J, Christensen B, Petersen TE, Sørensen ES. Considerable variation in the concentration of osteopontin in human milk, bovine milk, and infant formulas. J Dairy Sci 2010; 92:5378-85. [PMID: 19841198 DOI: 10.3168/jds.2009-2360] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Osteopontin (OPN) is a multifunctional bioactive protein that is implicated in numerous biological processes such as bone remodeling, inhibition of ectopic calcification, and cellular adhesion and migration, as well as several immune functions. Osteopontin has cytokine-like properties and is a key factor in the initiation of T helper 1 immune responses. Osteopontin is present in most tissues and body fluids, with the highest concentrations being found in milk. In the present study, ELISA for human and bovine milk OPN were developed and OPN concentration in human breast milk, bovine milk, and infant formulas was measured and compared. The OPN concentration in human milk was measured to approximately 138 mg/L, which corresponds to 2.1% (wt/wt) of the total protein in human breast milk. This is considerably higher than the corresponding OPN concentrations in bovine milk (approximately 18 mg/L) and infant formulas (approximately 9 mg/L). Moreover, bovine milk OPN is shown to induce the expression of the T helper 1 cytokine IL-12 in cultured human lamina propria mononuclear cells isolated from intestinal biopsies. Finally, the OPN concentration in plasma samples from umbilical cords, 3-mo-old infants, and pregnant and nonpregnant adults was measured. The OPN level in plasma from 3-mo-old infants and umbilical cords was found to be 7 to 10 times higher than in adults. Thus, the high levels of OPN in milk and infant plasma suggest that OPN is important to infants and that ingested milk OPN is likely to induce cytokine production in neonate intestinal immune cells.
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Affiliation(s)
- L Schack
- Protein Chemistry Laboratory, Department of Molecular Biology, Aarhus university, Aarhus, Denmark
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Nybo L, Pedersen K, Christensen B, Aagaard P, Brandt N, Kiens B. Impact of carbohydrate supplementation during endurance training on glycogen storage and performance. Acta Physiol (Oxf) 2009; 197:117-27. [PMID: 19432594 DOI: 10.1111/j.1748-1716.2009.01996.x] [Citation(s) in RCA: 43] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Glucose ingestion may improve exercise endurance, but it apparently also influences the transcription rate of several metabolic genes and it alters muscle metabolism during an acute exercise bout. Therefore, we investigated how chronic training responses are affected by glucose ingestion. METHODS In previously untrained males performance and various muscular adaptations were evaluated before and after 8 weeks of supervised endurance training conducted either with (n = 8; CHO group) or without (n = 7; placebo) glucose supplementation. RESULTS The two groups achieved similar improvements in maximal oxygen uptake and peak power output during incremental cycling (both parameters elevated by 17% on average) and both groups lost approximately 3 kg of fat mass during the 8 weeks of training. An equal reduction in respiratory exchange ratio (0.02 units) during submaximal exercise was observed in both groups. Beta-hydroxyacyl-CoA-dehydrogenase activity was increased in both groups, however, to a larger extent in the placebo group (45 +/- 11%) than CHO (23 +/- 9%, P < 0.05). GLUT-4 protein expression increased by 74 +/- 14% in the placebo group and 45 +/- 14% in CHO (both P < 0.05), while resting muscle glycogen increased (P < 0.05) to a larger extent in the placebo group (96 +/- 4%) than CHO (33 +/- 2%). CONCLUSION These results show that carbohydrate supplementation consumed during exercise training influences various muscular training adaptations, but improvements in cardiorespiratory fitness and reductions in fat mass are not affected.
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Affiliation(s)
- L Nybo
- Institute of Exercise and Sport Sciences, University of Copenhagen, Copenhagen, Denmark.
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Danielsen PL, Koudahl V, Christensen B, Olsen J. Optimization of RNA Preservation in Granulation Tissue in the Expanded Polytetrafluoroethylene (ePTFE) Tube Model. Prep Biochem Biotechnol 2009; 39:413-8. [DOI: 10.1080/10826060903209695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Meier K, Christensen B, Nikolajsen L, Sorensen J, Jensen T. 855 QUANTITATIVE SENSORY TESTING IN PATIENTS BEFORE AND DURING TREATMENT WITH SPINAL CORD STIMULATION. Eur J Pain 2009. [DOI: 10.1016/s1090-3801(09)60858-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- K. Meier
- Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark
| | - B. Christensen
- Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark
| | - L. Nikolajsen
- Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark
| | - J.C. Sorensen
- Dept. of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
| | - T.S. Jensen
- Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark
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Tsikitis VL, Malireddy K, Green EA, Christensen B, Whelan R, Hyder J, Lauter D, Marcello P, Larach S, Sargent D, Nelson H. Postoperative surveillance recommendations for early-stage colon cancer based on results from the clinical outcomes of surgical therapy trial. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4013 Background: Intensive postoperative surveillance is associated with improved survival and recommended for patients with late stage (stage IIB & III) colon cancer. We hypothesized that stage I & IIA colon cancer patients would experience similar benefits. Methods: Secondary analysis of data from the Clinical Outcomes of Surgical Therapy trial was performed by analyzing results according to TNM stage; early (stage I & IIA; 537 patients) and late (stage IIB & III; 254 patients) stage disease. Five-year recurrence rates were higher in patients with late (35.7%) versus early stage disease (9.5%). Early and late stage salvage rates, recurrence patterns and methods of first detection were compared by χ2 test. Results: Salvage rates for early and late stage disease patients with recurrence were the same (35.9% versus 37%, p=0.9 respectively). Median survival following second surgery after recurrence was 35.8 months late stage and 51.2 months for early stage patients respectively. Sites of first recurrence did not significantly differ between late and early stage disease: liver (37.4% vs. 27.2%); lung (29.7% vs.23.6%); intraabdominal (24.2% vs.10.9%); and locoregional (12.1% vs.10.9%). Methods of first detection of recurrence were also not significantly different: CEA (37.4% vs. 29.1%); CT scan (26.4% vs. 23.6%); chest X-ray (12.1% vs. 7.3%); and colonoscopy (8.8% vs. 12.7%), for late versus early stage disease, respectively. Conclusions: Patients with early stage colon cancer have similar sites of recurrence, and receive similar benefit from post-recurrence therapy as later stage patients; implementation of existing surveillance guidelines for early stage patients is appropriate. No significant financial relationships to disclose.
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Affiliation(s)
- V. L. Tsikitis
- Mayo Clinic, Rochester, MN; LDS Hospital, Salt Lake City, UT; Columbia Presbyterian Hospital, New York, NY; Midwest Surgical P.A., Wichita, KS; Group Health Cooperative, Seattle, WA; Lahey Clinic, Burlington, MA; M. D. Anderson Orlando Cancer Center, Orlando, FL
| | - K. Malireddy
- Mayo Clinic, Rochester, MN; LDS Hospital, Salt Lake City, UT; Columbia Presbyterian Hospital, New York, NY; Midwest Surgical P.A., Wichita, KS; Group Health Cooperative, Seattle, WA; Lahey Clinic, Burlington, MA; M. D. Anderson Orlando Cancer Center, Orlando, FL
| | - E. A. Green
- Mayo Clinic, Rochester, MN; LDS Hospital, Salt Lake City, UT; Columbia Presbyterian Hospital, New York, NY; Midwest Surgical P.A., Wichita, KS; Group Health Cooperative, Seattle, WA; Lahey Clinic, Burlington, MA; M. D. Anderson Orlando Cancer Center, Orlando, FL
| | - B. Christensen
- Mayo Clinic, Rochester, MN; LDS Hospital, Salt Lake City, UT; Columbia Presbyterian Hospital, New York, NY; Midwest Surgical P.A., Wichita, KS; Group Health Cooperative, Seattle, WA; Lahey Clinic, Burlington, MA; M. D. Anderson Orlando Cancer Center, Orlando, FL
| | - R. Whelan
- Mayo Clinic, Rochester, MN; LDS Hospital, Salt Lake City, UT; Columbia Presbyterian Hospital, New York, NY; Midwest Surgical P.A., Wichita, KS; Group Health Cooperative, Seattle, WA; Lahey Clinic, Burlington, MA; M. D. Anderson Orlando Cancer Center, Orlando, FL
| | - J. Hyder
- Mayo Clinic, Rochester, MN; LDS Hospital, Salt Lake City, UT; Columbia Presbyterian Hospital, New York, NY; Midwest Surgical P.A., Wichita, KS; Group Health Cooperative, Seattle, WA; Lahey Clinic, Burlington, MA; M. D. Anderson Orlando Cancer Center, Orlando, FL
| | - D. Lauter
- Mayo Clinic, Rochester, MN; LDS Hospital, Salt Lake City, UT; Columbia Presbyterian Hospital, New York, NY; Midwest Surgical P.A., Wichita, KS; Group Health Cooperative, Seattle, WA; Lahey Clinic, Burlington, MA; M. D. Anderson Orlando Cancer Center, Orlando, FL
| | - P. Marcello
- Mayo Clinic, Rochester, MN; LDS Hospital, Salt Lake City, UT; Columbia Presbyterian Hospital, New York, NY; Midwest Surgical P.A., Wichita, KS; Group Health Cooperative, Seattle, WA; Lahey Clinic, Burlington, MA; M. D. Anderson Orlando Cancer Center, Orlando, FL
| | - S. Larach
- Mayo Clinic, Rochester, MN; LDS Hospital, Salt Lake City, UT; Columbia Presbyterian Hospital, New York, NY; Midwest Surgical P.A., Wichita, KS; Group Health Cooperative, Seattle, WA; Lahey Clinic, Burlington, MA; M. D. Anderson Orlando Cancer Center, Orlando, FL
| | - D. Sargent
- Mayo Clinic, Rochester, MN; LDS Hospital, Salt Lake City, UT; Columbia Presbyterian Hospital, New York, NY; Midwest Surgical P.A., Wichita, KS; Group Health Cooperative, Seattle, WA; Lahey Clinic, Burlington, MA; M. D. Anderson Orlando Cancer Center, Orlando, FL
| | - H. Nelson
- Mayo Clinic, Rochester, MN; LDS Hospital, Salt Lake City, UT; Columbia Presbyterian Hospital, New York, NY; Midwest Surgical P.A., Wichita, KS; Group Health Cooperative, Seattle, WA; Lahey Clinic, Burlington, MA; M. D. Anderson Orlando Cancer Center, Orlando, FL
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Christensen B, Lomholt B, Jelnes JE. Selection and mechanical mixing operating on a 2-allele amylase system in Asellus aquaticus (Isopoda, Crustacea). Hereditas 2009; 77:255-62. [PMID: 4448687 DOI: 10.1111/j.1601-5223.1974.tb00938.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Christensen B, Berg U, Jelnes J. A comparative study on enzyme polymorphism in sympatric diploid and triploid forms of Lumbricillus lineatus (Enchytraeidae, Oligochaeta). Hereditas 2009; 84:41-8. [PMID: 1010758 DOI: 10.1111/j.1601-5223.1976.tb01194.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Bardia A, Novotny PJ, Sloan JA, Barton DL, Steen PD, Watson C, Christensen B, Loprinzi CL. Does efficacy of non-estrogenic therapies for hot flashes among women vary by breast cancer history and tamoxifen use? A pooled analysis. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.9595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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