1
|
Gregersen H, Sun D, Field F, Combs W, Christensen P, Mousa H, Moawad FJ, Eisenstein S, Kassab GS. Fecobionics in proctology: review and perspectives. Surg Open Dig Adv 2023; 12:100117. [PMID: 38313319 PMCID: PMC10838111 DOI: 10.1016/j.soda.2023.100117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Fecobionics is a novel integrated technology for assessment of anorectal function. It is a defecatory test with simultaneous measurements of pressures, orientation, and device angle (a proxy of the anorectal angle). Furthermore, the latest Fecobionics prototypes measure diameters (shape) using impedance planimetry during evacuation of the device. The simultaneous measurement of multiple variables in the integrated test allows new metrics to be developed including more advanced novel defecation indices, enabling mechanistic insight in the defecation process at an unprecedented level in patients with anorectal disorders including patients suffering from obstructed defecation, fecal incontinence, and low anterior resection syndrome. The device has the consistency and shape of a normal stool (type 3-4 on the Bristol Stool Form Scale). Fecobionics has been validated on the bench and in animal studies and used in clinical trials to study defecation phenotypes in normal human subjects and patients with obstructed defecation, fecal incontinence, and low anterior resection syndrome after rectal cancer surgery. Subtypes have been defined, especially of patients with obstructed defecation. Furthermore, Fecobionics has been used to monitor biofeedback therapy in patients with fecal incontinence to predict the outcome of the therapy (responder versus non-responder). Most Fecobionics studies showed a closer correlation to symptoms as compared to current technologies for anorectal assessment. The present article outlines previous and ongoing work, and perspectives for future studies in proctology, including in physiological assessment of function, diagnostics, monitoring of therapy, and as a tool for biofeedback therapy.
Collapse
Affiliation(s)
- H Gregersen
- California Medical Innovations Institute, San Diego, California, USA
| | - D Sun
- School of Microelectronics and Communication Engineering, Chongqing University, Chongqing, China
| | - F Field
- S3DT Holdings, San Diego, California, USA
| | - W Combs
- S3DT Holdings, San Diego, California, USA
| | - P Christensen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - H Mousa
- CHOP, University of Pennsylvania, Philadelphia, Pennsylvania
| | - F J Moawad
- Scripps Clinic, Division of Gastroenterology, La Jolla, California, USA
| | - S Eisenstein
- Department of Surgery, University of California San Diego, La Jolla, California, USA
| | - G S Kassab
- California Medical Innovations Institute, San Diego, California, USA
| |
Collapse
|
2
|
Qvist N, Hansen UD, Christensen P, Rijkhoff NMJ, Klarskov N, Duelund-Jakobsen J. Electrical stimulation of the dorsal clitoral nerve in the treatment of idiopathic defecatory urgency. A pilot study. Tech Coloproctol 2023; 27:459-463. [PMID: 36648602 PMCID: PMC10169878 DOI: 10.1007/s10151-023-02752-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023]
Abstract
PURPOSE To investigate the effect of dorsal clitoral nerve stimulation (DCNS) on bothersome urgency to defecate with or without fecal incontinence and the patient-reported discomfort or adverse effect with the method. METHODS For dorsal clitoral nerve stimulation, a battery powered, handheld stimulator was used, set to a pulse width of 200 µs and a frequency of 20 Hz. One electrode was placed at the preputium of the clitoris and acted as cathode while an anode electrode was placed on the belly. Prior to stimulation the patients were asked to complete a bowel habit diary throughout 14 consecutive days before and during stimulation. RESULTS Fourteen out of the 16 patients included completed the study. A decrease in the number of episodes (per day) with strong urgency declined in eight patients but increased in four cases during the stimulation period. An increase in episodes with moderate or mild urgency was observed in 11 and 6 cases, respectively, and a decrease in defecation without the feeling of urgency or passive incontinence decreased in two thirds of the patients. Two patients discontinued the study prematurely, on due to worsening in symptoms and one due to pelvic pain. CONCLUSION Although the results may be promising, much still must be learned about the method including mode and duration of stimulation, better electrodes and more patient friendly equipment together with the development of better questionnaires to assess the patient burden of urgency.
Collapse
Affiliation(s)
- N Qvist
- Research Unit for Surgery, Odense University Hospital Odense, Odense, Denmark.
- University of Southern Denmark, Odense, Denmark.
| | - U D Hansen
- University of Southern Denmark, Odense, Denmark
- Research Unit for Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - P Christensen
- Department of Surgery, Pelvic Floor Clinic, Aarhus University Hospital, Aarhus, Denmark
| | - N M J Rijkhoff
- Research Unit for Surgery, Odense University Hospital Odense, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - N Klarskov
- Department of Gynecology and Obstetrics, Herlev Hospital, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - J Duelund-Jakobsen
- Department of Surgery, Pelvic Floor Clinic, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
3
|
Amiri HES, Brain D, Sharaf O, Withnell P, McGrath M, Alloghani M, Al Awadhi M, Al Dhafri S, Al Hamadi O, Al Matroushi H, Al Shamsi Z, Al Shehhi O, Chaffin M, Deighan J, Edwards C, Ferrington N, Harter B, Holsclaw G, Kelly M, Kubitschek D, Landin B, Lillis R, Packard M, Parker J, Pilinski E, Pramman B, Reed H, Ryan S, Sanders C, Smith M, Tomso C, Wrigley R, Al Mazmi H, Al Mheiri N, Al Shamsi M, Al Tunaiji E, Badri K, Christensen P, England S, Fillingim M, Forget F, Jain S, Jakosky BM, Jones A, Lootah F, Luhmann JG, Osterloo M, Wolff M, Yousuf M. The Emirates Mars Mission. Space Sci Rev 2022; 218:4. [PMID: 35194256 PMCID: PMC8830993 DOI: 10.1007/s11214-021-00868-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 11/22/2021] [Indexed: 06/14/2023]
Abstract
The Emirates Mars Mission (EMM) was launched to Mars in the summer of 2020, and is the first interplanetary spacecraft mission undertaken by the United Arab Emirates (UAE). The mission has multiple programmatic and scientific objectives, including the return of scientifically useful information about Mars. Three science instruments on the mission's Hope Probe will make global remote sensing measurements of the Martian atmosphere from a large low-inclination orbit that will advance our understanding of atmospheric variability on daily and seasonal timescales, as well as vertical atmospheric transport and escape. The mission was conceived and developed rapidly starting in 2014, and had aggressive schedule and cost constraints that drove the design and implementation of a new spacecraft bus. A team of Emirati and American engineers worked across two continents to complete a fully functional and tested spacecraft and bring it to the launchpad in the middle of a global pandemic. EMM is being operated from the UAE and the United States (U.S.), and will make its data freely available.
Collapse
Affiliation(s)
- H. E. S. Amiri
- UAE Ministry of Industry and Advanced Technology, Abu Dhabi, United Arab Emirates
| | - D. Brain
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - O. Sharaf
- Mohammed Bin Rashid Space Centre, Dubai, United Arab Emirates
| | - P. Withnell
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - M. McGrath
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - M. Alloghani
- Mohammed Bin Rashid Space Centre, Dubai, United Arab Emirates
| | - M. Al Awadhi
- Mohammed Bin Rashid Space Centre, Dubai, United Arab Emirates
| | - S. Al Dhafri
- Mohammed Bin Rashid Space Centre, Dubai, United Arab Emirates
| | - O. Al Hamadi
- Mohammed Bin Rashid Space Centre, Dubai, United Arab Emirates
| | - H. Al Matroushi
- Mohammed Bin Rashid Space Centre, Dubai, United Arab Emirates
| | - Z. Al Shamsi
- Mohammed Bin Rashid Space Centre, Dubai, United Arab Emirates
| | - O. Al Shehhi
- Mohammed Bin Rashid Space Centre, Dubai, United Arab Emirates
| | - M. Chaffin
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - J. Deighan
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - C. Edwards
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
- Northern Arizona University, Flagstaff, AZ USA
| | - N. Ferrington
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - B. Harter
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - G. Holsclaw
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - M. Kelly
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - D. Kubitschek
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - B. Landin
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - R. Lillis
- Space Sciences Lab, University of California, Berkeley, USA
| | - M. Packard
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | | | - E. Pilinski
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - B. Pramman
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - H. Reed
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - S. Ryan
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - C. Sanders
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - M. Smith
- NASA Goddard Space Flight Center, Greenbelt, MD USA
| | - C. Tomso
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - R. Wrigley
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - H. Al Mazmi
- UAE Space Agency, Abu Dhabi, United Arab Emirates
| | - N. Al Mheiri
- Mohammed Bin Rashid Space Centre, Dubai, United Arab Emirates
| | - M. Al Shamsi
- Mohammed Bin Rashid Space Centre, Dubai, United Arab Emirates
| | - E. Al Tunaiji
- Mohammed Bin Rashid Space Centre, Dubai, United Arab Emirates
| | - K. Badri
- Mohammed Bin Rashid Space Centre, Dubai, United Arab Emirates
| | | | - S. England
- Virgina Tech University, Blacksburg, VA USA
| | - M. Fillingim
- Space Sciences Lab, University of California, Berkeley, USA
| | - F. Forget
- Laboratoire de Météorologie Dynamique, Paris, France
| | - S. Jain
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - B. M. Jakosky
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - A. Jones
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, USA
| | - F. Lootah
- Mohammed Bin Rashid Space Centre, Dubai, United Arab Emirates
| | - J. G. Luhmann
- Space Sciences Lab, University of California, Berkeley, USA
| | - M. Osterloo
- Space Science International, Boulder, CO USA
| | - M. Wolff
- Space Science International, Boulder, CO USA
| | - M. Yousuf
- Mohammed Bin Rashid Space Centre, Dubai, United Arab Emirates
| |
Collapse
|
4
|
Borre M, Fassov J, Juul T, Laurberg S, Christensen P, Drewes A, Faaborg P, Krogh K, Bräuner A, Ussing OT, Lauritsen MB. Diet and bowel symptoms among colon cancer survivors. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
5
|
Affiliation(s)
- P Christensen
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.
| | - N S Fearnhead
- Department of Colorectal Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - J Martellucci
- General, Emergency and Mini-Invasive Surgery, Careggi University Hospital, Florence, Italy
| |
Collapse
|
6
|
Kristensen HØ, Krogsgaard M, Christensen P, Thomsen T. Validation of the colostomy impact score in patients ostomized for a benign condition. Colorectal Dis 2020; 22:2270-2277. [PMID: 32741098 DOI: 10.1111/codi.15290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/17/2020] [Indexed: 02/08/2023]
Abstract
AIM The colostomy impact (CI) score is a patient-reported outcome measure assessing reduction in health-related quality of life (HRQL) due to a stoma. The score was originally developed and validated in a cohort of rectal cancer survivors with a permanent colostomy. For the CI score to be applied to patients with a colostomy after surgery for a benign condition it must be validated in this patient group. The aim of this study was to assess construct validity and known groups validity of the CI score in patients with a colostomy after surgery for a benign condition. METHOD In a cross-sectional survey among ostomates in the Capital Region of Denmark, patients completed the CI score and the SF-36 v2 questionnaires. Construct validity was assessed by Pearson's correlation coefficients and known groups validity was assessed by t-test when dividing patients into groups of minor or major CI. RESULTS The CI score showed a moderate negative correlation with the Physical Component Summary (PCS) of -0.41 and a weak negative correlation with the Mental Component Summary (MCS) of -0.39. The strength of the correlation depended on the underlying condition leading to stoma formation. Differences were significant between the minor and major CI groups in mean PSC and MCS with t-values of 5.32 and 3.86, respectively. CONCLUSION The CI score is a valid instrument for assessing stoma-related impact on HRQL regardless of the underlying condition leading to stoma formation, and the CI score discriminates meaningfully between groups with known differences in stoma-related reduced HRQL.
Collapse
Affiliation(s)
- H Ø Kristensen
- Research Unit, Department of Surgery, Aarhus University Hospital, Aarhus N, Denmark
| | - M Krogsgaard
- Department of Surgical Gastroenterology, Clinic C, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Gastroenterology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - P Christensen
- Department of Surgery, Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects after Cancer in the Pelvic Organs, Aarhus University Hospital, Aarhus N, Denmark
| | - T Thomsen
- Department of Anaesthesiology, Herlev and Gentofte Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
7
|
Haas S, Faaborg PM, Gram M, Lundby L, Brock C, Drewes AM, Laurberg S, Krogh K, Christensen P. Cortical processing to anorectal stimuli after rectal resection with and without radiotherapy. Tech Coloproctol 2020; 24:721-730. [PMID: 32323098 DOI: 10.1007/s10151-020-02210-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/06/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Bowel dysfunction is common after surgery for rectal cancer, especially when neoadjuvant radiotherapy is used. The role of sensory function in the pathogenesis remains obscure, and the aim of the present study was to characterize the sensory pathways of the brain-gut axis in rectal cancer patients treated with resection ± radiotherapy compared with healthy volunteers. METHODS Sensory evaluation by (neo)rectal distensions was performed and sensory evoked potentials (SEPs) were recorded during rapid balloon distensions of the (neo)rectum and anal canal in resected patients with (n = 8) or without (n = 12) radiotherapy. Twenty healthy volunteers were included for comparison. (Neo)rectal latencies and amplitudes of SEPs were compared and spectral band analysis from (neo)rectal and anal distensions was used as a proxy of neuronal processing. RESULTS Neorectal sensation thresholds were significantly increased in both patient categories (all p < 0.008). There were no differences in (neo)rectal SEP latencies and amplitudes between groups. However, spectral analysis of (neo)rectal SEPs showed significant differences between all groups in all bands (all p < 0.01). On the other hand, anal SEP analyses only showed significant differences between the delta (0-4 Hz), theta (4-8 Hz) and, gamma 32-50 Hz) bands (all p < 0.02) between the subgroup of patients that also received radiotherapy and healthy volunteers. CONCLUSIONS Surgery for rectal cancer leads to abnormal cortical processing of neorectal sensation. Additional radiotherapy leads to a different pattern of central sensory processing of neorectal and anal sensations. This may play a role in the functional outcome of these patients.
Collapse
Affiliation(s)
- S Haas
- Department of Surgery, Aarhus University Hospital, Palle Juul-Jensens Blvd 99, 8200, Århus N, Denmark. .,Danish Cancer Society Centre for Research and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus and Aalborg University Hospitals, Aalborg, Denmark.
| | - P M Faaborg
- Department of Surgery, Vejle Hospital, Vejle, Denmark.,Danish Cancer Society Centre for Research and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus and Aalborg University Hospitals, Aalborg, Denmark
| | - M Gram
- Mech-Sense, Department of Gastroenterology and Hepatology, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
| | - L Lundby
- Department of Surgery, Aarhus University Hospital, Palle Juul-Jensens Blvd 99, 8200, Århus N, Denmark.,Danish Cancer Society Centre for Research and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus and Aalborg University Hospitals, Aalborg, Denmark
| | - C Brock
- Mech-Sense, Department of Gastroenterology and Hepatology, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
| | - A M Drewes
- Mech-Sense, Department of Gastroenterology and Hepatology, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark.,Danish Cancer Society Centre for Research and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus and Aalborg University Hospitals, Aalborg, Denmark
| | - S Laurberg
- Department of Surgery, Aarhus University Hospital, Palle Juul-Jensens Blvd 99, 8200, Århus N, Denmark.,Danish Cancer Society Centre for Research and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus and Aalborg University Hospitals, Aalborg, Denmark
| | - K Krogh
- Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aalborg, Denmark.,Danish Cancer Society Centre for Research and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus and Aalborg University Hospitals, Aalborg, Denmark
| | - P Christensen
- Department of Surgery, Aarhus University Hospital, Palle Juul-Jensens Blvd 99, 8200, Århus N, Denmark.,Danish Cancer Society Centre for Research and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus and Aalborg University Hospitals, Aalborg, Denmark
| |
Collapse
|
8
|
Ketheeswaran S, Pors SE, Zuniga Jara LA, Lemser CE, Høj TK, Bøtkjær JA, Christensen P, Humaidan P, Kristensen SG. Effect of whey protein supplementation on sperm quality and fertility in male mice. Food Chem Toxicol 2020; 141:111366. [PMID: 32315685 DOI: 10.1016/j.fct.2020.111366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 04/06/2020] [Accepted: 04/13/2020] [Indexed: 11/27/2022]
Abstract
Protein supplements are a billion-dollar industry and the intake of these supplements is increasing, especially among young men. However, little is known about whether consumption of these products affects the reproductive health. The aim of this study was to assess the effect of whey protein supplementation on the sperm quality and reproductive health of male mice. A total of 48 male NMRI mice were fed with either plain tap water or a high dose of whey protein (Whey100, BodyLab) supplemented in the drinking water for 3 months. Mice was individually housed with two female mice for five days and reproductive parameters were assessed. DNA fragmentation index (DFI) was assessed at 0 h and 4 h of in vitro incubation using a sperm DNA integrity test (SDI®-test). No significant differences were detected between the groups in the epididymal sperm count, sperm motility, DFI, oxidation-reduction potential (ORP), serum testosterone, body and seminal vesicles weights, relative testis and epididymal weights, testicular morphology, number of impregnated females, or litter size. No correlation was found between ORP and DFI. These results suggest that the highest recommended human dose of whey protein supplementation do not significantly impair the sperm quality and fertility in male mice.
Collapse
Affiliation(s)
- Shathmigha Ketheeswaran
- The Fertility Clinic, Skive Regional Hospital, Resenvej 25, 7800, Skive, Denmark; Faculty of Health, Aarhus University, Aarhus, Denmark.
| | - Susanne Elisabeth Pors
- Laboratory of Reproductive Biology, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lenin Arturo Zuniga Jara
- Laboratory of Reproductive Biology, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Camilla Engel Lemser
- Laboratory of Reproductive Biology, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Terese Kimmie Høj
- Laboratory of Reproductive Biology, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Jane Alrø Bøtkjær
- Laboratory of Reproductive Biology, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | | | - Peter Humaidan
- The Fertility Clinic, Skive Regional Hospital, Resenvej 25, 7800, Skive, Denmark; Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Stine Gry Kristensen
- Laboratory of Reproductive Biology, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| |
Collapse
|
9
|
Bjørsum-Meyer T, Christensen P, Jakobsen MS, Baatrup G, Qvist N. Correlation of anorectal manometry measures to severity of fecal incontinence in patients with anorectal malformations - a cross-sectional study. Sci Rep 2020; 10:6016. [PMID: 32265467 PMCID: PMC7138810 DOI: 10.1038/s41598-020-62908-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 03/16/2020] [Indexed: 12/15/2022] Open
Abstract
Anorectal malformations (ARM) are a spectrum of anomalies of the rectum and anal canal affecting 1 in 2500 to 5000 live births. Functional problems are common and related to the type of ARM and associated malformations. We aimed to evaluate the results of Three-dimensional High Resolution Anorectal Manometry (3D-HRAM) in long-term follow-up after surgical correction of ARM with special reference to fecal incontinence. Twenty-one patients with anorectal malformations and primary repair at our center consented to participate in the study. Pressures of the anal sphincter muscles and defects were addressed by 3D-HRAM. Fecal incontinence and disease-specific quality of life were evaluated by the Fecal Incontinence Quality of Life score and Wexner incontinence score respectively. The study was approved by the Committee in Health Research Ethics and the Danish Data Protection Agency. Median age was 22(12–31) years and 13(67%) participants were females. Sphincter defect was present in 48% (N = 10) of participants. Participants with sphincter defects had significant higher Wexner score and size of sphincter defects and mean anal squeeze pressure were correlated to Wexner score. Participants with or without sphincter defects did not differ on manometry parameters including resting anal and squeeze pressure or disease-specific quality of life. In a study of the long-term outcome after repair of anorectal malformations we found a higher Wexner incontinence score in the presence of an anal sphincter defect and the size of the defect and mean anal squeeze pressure were correlated to the Wexner incontinence score.
Collapse
Affiliation(s)
- T Bjørsum-Meyer
- Department of Surgery, Odense University Hospital, Odense C, 5000, Denmark. .,University of Southern Denmark, Faculty of Health Science, Department of Clinical research, Odense C, 5000, Denmark.
| | - P Christensen
- Department of Surgery, Aarhus University Hospital, Odense, 9000, Denmark
| | - M S Jakobsen
- Department of Pediatrics, Odense University Hospital, Odense, 5000, Denmark
| | - G Baatrup
- Department of Surgery, Odense University Hospital, Odense C, 5000, Denmark.,University of Southern Denmark, Faculty of Health Science, Department of Clinical research, Odense C, 5000, Denmark
| | - N Qvist
- Department of Surgery, Odense University Hospital, Odense C, 5000, Denmark.,University of Southern Denmark, Faculty of Health Science, Department of Clinical research, Odense C, 5000, Denmark
| |
Collapse
|
10
|
Keane C, Fearnhead NS, Bordeianou L, Christensen P, Espin Basany E, Laurberg S, Mellgren A, Messick C, Orangio GR, Verjee A, Wing K, Bissett I. International consensus definition of low anterior resection syndrome. Colorectal Dis 2020; 22:331-341. [PMID: 32037685 DOI: 10.1111/codi.14957] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 08/23/2019] [Indexed: 12/13/2022]
Abstract
AIM Low anterior resection syndrome (LARS) is pragmatically defined as disordered bowel function after rectal resection leading to a detriment in quality of life. This broad characterization does not allow for precise estimates of prevalence. The LARS score was designed as a simple tool for clinical evaluation of LARS. Although the LARS score has good clinical utility, it may not capture all important aspects that patients may experience. The aim of this collaboration was to develop an international consensus definition of LARS that encompasses all aspects of the condition and is informed by all stakeholders. METHOD This international patient-provider initiative used an online Delphi survey, regional patient consultation meetings, and an international consensus meeting. Three expert groups participated: patients, surgeons and other health professionals from five regions (Australasia, Denmark, Spain, Great Britain and Ireland, and North America) and in three languages (English, Spanish, and Danish). The primary outcome measured was the priorities for the definition of LARS. RESULTS Three hundred twenty-five participants (156 patients) registered. The response rates for successive rounds of the Delphi survey were 86%, 96% and 99%. Eighteen priorities emerged from the Delphi survey. Patient consultation and consensus meetings refined these priorities to eight symptoms and eight consequences that capture essential aspects of the syndrome. Sampling bias may have been present, in particular, in the patient panel because social media was used extensively in recruitment. There was also dominance of the surgical panel at the final consensus meeting despite attempts to mitigate this. CONCLUSION This is the first definition of LARS developed with direct input from a large international patient panel. The involvement of patients in all phases has ensured that the definition presented encompasses the vital aspects of the patient experience of LARS. The novel separation of symptoms and consequences may enable greater sensitivity to detect changes in LARS over time and with intervention.
Collapse
Affiliation(s)
- C Keane
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - N S Fearnhead
- Department of Colorectal Surgery, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - L Bordeianou
- Colorectal Surgery Centre/Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - P Christensen
- Danish Cancer Society National Research Centre for Survivorship and Late Side Effect to Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - E Espin Basany
- Colon and Recto Unit, Department of General Surgery, Vall de Hebron Hospital, Universitat Autonoma de Barcelona, Spain
| | - S Laurberg
- Danish Cancer Society National Research Centre for Survivorship and Late Side Effect to Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - A Mellgren
- Division of Colon and Rectal Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - C Messick
- Department of Surgical Oncology, Section of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - G R Orangio
- Department of Surgery/School of Medicine, Louisiana State University, New Orleans, Louisiana, USA
| | - A Verjee
- Bowel Disease Research Foundation, London, UK
| | - K Wing
- Otago Community Hospice, Dunedin, New Zealand
| | - I Bissett
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| | | |
Collapse
|
11
|
Barbosa M, Glavind-Kristensen M, Moller Soerensen M, Christensen P. Secondary sphincter repair for anal incontinence following obstetric sphincter injury: functional outcome and quality of life at 18 years of follow-up. Colorectal Dis 2020; 22:71-79. [PMID: 31347749 DOI: 10.1111/codi.14792] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/07/2019] [Indexed: 12/12/2022]
Abstract
AIM Secondary sphincter repair has been the conventional management of anal incontinence (AI) when a structural defect in the sphincter is recognized. However, disappointing long-term results have contributed to a tendency towards an increasing use of alternative treatment methods. This study aimed to assess the long-term functional outcomes following a secondary sphincter repair in women with AI after obstetric sphincter injury. METHOD This is a questionnaire study of women who underwent a secondary sphincter repair in Denmark between January 1990 and December 2005. Patients were identified through the Danish National Patient Registry. Functional outcomes were assessed by a self-administered questionnaire in 2010 and 2018. Primary outcomes were Wexner and St. Mark's scores. Impact on quality of life was assessed using the Fecal Incontinence Quality of Life Scale. RESULTS Functional outcome was assessed in 370 women in 2010 and 255 women in 2018. At 18.3 [interquartile range (IQR 15.0-22.0)] years of follow-up, the mean ± SD Wexner score was 8.8 ± 4.8 and the mean St. Mark's score was 11.7 ± 5.0. Flatus incontinence was the most frequent symptom, reported by 97%. Incontinence for liquid and solid stools was reported by 75% and 54%, respectively. There were no significant changes in incontinence frequencies over time. Women with a Wexner score of ≥ 9 had a significantly lower quality of life score in all domains than did women with a Wexner score of < 9 (P < 0.001). CONCLUSION At long-term follow-up, few patients are fully continent following a secondary sphincter repair. However, it appears that the functional results remain stable at very long-term follow-up.
Collapse
Affiliation(s)
- M Barbosa
- Pelvic Floor Unit, Department of Surgery, Aarhus University Hospital, Aarhus N, Denmark
| | - M Glavind-Kristensen
- Pelvic Floor Unit, Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus N, Denmark
| | - M Moller Soerensen
- Pelvic Floor Unit, Department of Surgery, Aarhus University Hospital, Aarhus N, Denmark
| | - P Christensen
- Pelvic Floor Unit, Department of Surgery, Aarhus University Hospital, Aarhus N, Denmark
| |
Collapse
|
12
|
Sanderson DCW, Carmichael LA, Fisk S, Christensen P, Delincée H, Hammerton K, Nootenboom H, Pfordt J, Pinnioja S, Schreiber GA, Toyoda M. Thermoluminescence Detection of Irradiated Fruits and Vegetables: International Interlaboratory Trial. J AOAC Int 2019. [DOI: 10.1093/jaoac/86.5.971] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
An international interlaboratory trial was conducted to validate thermoluminescence methods for detecting irradiated fruits and vegetables. Five products were used in this study. This paper presents the results from prestudy material, homogeneity testing, details of sample preparation, and participants' results. Prestudy results provided a basis for cross comparison of instruments in different laboratories. A wide range of sensitivities, reproducibilities, and signal-to-background ratios were observed. Homogeneity testing showed that the method can distinguish between nonirradiated and irradiated products, including those bleached with 100 J/cm2 artificial daylight, provided that sensitivity rejection criteria are rigorously applied. Blind results were returned by 9 participants in the form of first and second glow integrals and glow ratios for all samples and a qualitative classification for each product. Of the 387 results reported, 327 valid results were obtained from participants. Where valid data were obtained, correct qualitative identifications were made by participants in all cases. Participants' results and homogeneity testing both confirm the validity of the thermoluminescence method for detecting irradiated fruits and vegetables.
Collapse
Affiliation(s)
- David C W Sanderson
- Scottish Universities Research and Reactor Centre (SURRC), Scottish Enterprise Technology Park, Rankine Ave, East Kilbride, G75 OQF, UK
| | - Lorna A Carmichael
- Scottish Universities Research and Reactor Centre (SURRC), Scottish Enterprise Technology Park, Rankine Ave, East Kilbride, G75 OQF, UK
| | - Saffron Fisk
- Scottish Universities Research and Reactor Centre (SURRC), Scottish Enterprise Technology Park, Rankine Ave, East Kilbride, G75 OQF, UK
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Sanderson DCW, Carmichael LA, Fisk S, Christensen P, Delincée H, Nootenboom H, Pfordt J, Pinnioja S, Schreiber GA, Wagner U. Thermoluminescence Detection of Irradiated Shellfish: International Interlaboratory Trial. J AOAC Int 2019. [DOI: 10.1093/jaoac/86.5.976] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
An international interlaboratory trial was conducted using thermoluminescence for the detection of irradiated shellfish, aimed at validating the method for routine use. Nephrops norvegicus, mussels, brown shrimps, black tiger prawns, and king scallops were presented as nonirradiated and irradiated to 0.5 and 2.5 kGy. The protocol called for the use of 3 preparation methods: extraction of silicates from whole shellfish by acid hydrolysis and physical separation, and of carbonates from powdered shells. Homogeneity was tested on each product and each treatment. Results verified that all methods were able to distinguish between nonirradiated and irradiated samples regardless of dose. Silicate methods produced better discrimination than powdered shell, and acid hydrolysis showed some evidence of better separation between the 2 doses than the physical method. Participants received each product in each treatment category for blind analysis. Six participants returned results for acid hydrolysis, 7 for physical separation, and 5 for the powdered shell method. Their results confirmed the homogeneity testing. Qualitative results gave 100% correct classification for both silicate methods and 85.3% for powdered shell. Silicate methods are therefore preferable unless only shell is available. Overall, the results confirmed the case for validation.
Collapse
Affiliation(s)
- David C W Sanderson
- Scottish Universities Research and Reactor Centre (SURRC), Scottish Enterprise Technology Park, Rankine Ave, East Kilbride, G75 OQF, UK
| | - Lorna A Carmichael
- Scottish Universities Research and Reactor Centre (SURRC), Scottish Enterprise Technology Park, Rankine Ave, East Kilbride, G75 OQF, UK
| | - Saffron Fisk
- Scottish Universities Research and Reactor Centre (SURRC), Scottish Enterprise Technology Park, Rankine Ave, East Kilbride, G75 OQF, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Kronborg C, Serup-Hansen E, Wind K, Christensen P, Spindler K. Patient-reported outcomes including LARS score and quality of life one year after chemoradiotherapy for anal cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
15
|
Elfeki H, Duelund-Jakobsen J, Christensen P. Chait trapdoor cecostomy catheter for treatment of intractable constipation - a video vignette. Colorectal Dis 2019; 21:733. [PMID: 30951241 DOI: 10.1111/codi.14634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 03/16/2019] [Indexed: 02/08/2023]
Affiliation(s)
- H Elfeki
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Surgery, Mansoura University Hospital, Mansoura, Egypt
| | | | - P Christensen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
16
|
Elfeki H, Larsen HM, Emmertsen KJ, Christensen P, Youssef M, Khafagy W, Omar W, Laurberg S. Bowel dysfunction after sigmoid resection for cancer and its impact on quality of life. Br J Surg 2019; 106:805. [DOI: 10.1002/bjs.11174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
17
|
Kronborg C, Christensen P, Pedersen B, Spindler K. EP-1469 Radiation dose to pelvic floor muscles and functional outcome after treatment for anal cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31889-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
18
|
Elfeki H, Larsen HM, Emmertsen KJ, Christensen P, Youssef M, Khafagy W, Omar W, Laurberg S. Bowel dysfunction after sigmoid resection for cancer and its impact on quality of life. Br J Surg 2018; 106:142-151. [PMID: 30211443 DOI: 10.1002/bjs.10979] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/12/2018] [Accepted: 07/13/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Several studies have explored functional outcomes after rectal cancer surgery, but bowel dysfunction after sigmoid resection for cancer has hardly been considered. The aim of this study was to identify the prevalence and pattern of bowel dysfunction after resection for sigmoid cancer, and the impact of bowel function on quality of life (QoL) by comparison with patients who had polypectomy for cancer. METHODS This was a national cross-sectional study. Data were collected from the Danish Colorectal Cancer Group database, and a questionnaire regarding bowel function and European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 QoL questionnaire was sent to all Danish colonic cancer survivors treated with sigmoid resection or polypectomy between 2001 and 2014. RESULTS A total of 3295 patients (3061 sigmoid resection, 234 polypectomy) responded to the questionnaire (response rate 63·8 per cent). Twelve bowel symptoms were more prevalent after sigmoid resection, including: excessive straining, fragmentation, bloating, nocturnal defaecation, bowel false alarm, liquid stool incontinence, incomplete evacuation and sense of outlet obstruction. QoL impairment owing to bowel symptoms was reported in 16·6 per cent of patients in the resection group and 10·1 per cent after polypectomy (P = 0·008). Obstructed defaecation symptoms (ODS) were encountered significantly more often after sigmoid resection than following polypectomy (17·9 versus 7·3 per cent; P < 0·001). In the resection group, patients with ODS had substantial impairment on most aspects of QoL assessed by the EORTC QLQ-C30. CONCLUSION Sigmoid resection for cancer is associated with an increased risk of long-term bowel dysfunction; obstructed defaecation is prevalent and associated with substantial impairment of QoL.
Collapse
Affiliation(s)
- H Elfeki
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus University Hospital, Aarhus, Denmark.,Colorectal Surgery Unit, Department of Surgery, Mansoura University Hospital, Mansoura, Egypt
| | - H M Larsen
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus University Hospital, Aarhus, Denmark
| | - K J Emmertsen
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus University Hospital, Aarhus, Denmark.,Department of Surgery, Regional Hospital Randers, Randers, Denmark
| | - P Christensen
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus University Hospital, Aarhus, Denmark
| | - M Youssef
- Colorectal Surgery Unit, Department of Surgery, Mansoura University Hospital, Mansoura, Egypt
| | - W Khafagy
- Colorectal Surgery Unit, Department of Surgery, Mansoura University Hospital, Mansoura, Egypt
| | - W Omar
- Colorectal Surgery Unit, Department of Surgery, Mansoura University Hospital, Mansoura, Egypt
| | - S Laurberg
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
19
|
Affiliation(s)
- P. Christensen
- Department of Anatomy and Physiology Royal Veterinary and Agricultural University, Copenhagen, Denmark
| | - J.M. Parlevliet
- Department of Herd Health and Reproduction Veterinary School, Utrecht University, The Netherlands
| | - A. Van Buiten
- Department of Herd Health and Reproduction Veterinary School, Utrecht University, The Netherlands
| | - P. Hyttel
- Department of Anatomy and Physiology Royal Veterinary and Agricultural University, Copenhagen, Denmark
| | - B. Colenbrander
- Department of Herd Health and Reproduction Veterinary School, Utrecht University, The Netherlands
| |
Collapse
|
20
|
Elfeki H, Thyø A, Nepogodiev D, Pinkney TD, White M, Laurberg S, Christensen P. Patient and healthcare professional perceptions of colostomy-related problems and their impact on quality of life following rectal cancer surgery. BJS Open 2018; 2:336-344. [PMID: 30263985 PMCID: PMC6156164 DOI: 10.1002/bjs5.69] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 02/11/2018] [Accepted: 03/16/2018] [Indexed: 01/01/2023] Open
Abstract
Background The perception of colostomy‐related problems and their impact on health‐related quality of life (QoL) may differ between patients and healthcare professionals. The aim of this study was to investigate this using the Colostomy Impact Score (CIS) tool. Methods Healthcare professionals including consultant colorectal surgeons, stoma nurses, ward nurses, trainees and medical students were recruited. An online survey was designed. From the 17 items used to develop the CIS, participants chose the seven factors they thought to confer the strongest negative impact on the QoL of patients with a colostomy. They were then asked to rank the 12 responses made by patients to the final seven factors contained in the CIS. Results were compared with the original patient rankings at the time of development of the CIS. Results A total of 156 healthcare professionals (50·4 per cent of the pooled professionals) from 17 countries completed the survey. Of the original seven items in the CIS, six were above the threshold for random selection. Ranking the responses, a poor match between participants and the original score was detected for 49·7 per cent of the professionals. The most under‐rated item originally present in the CIS was stool consistency, reported by 47 of the 156 professionals (30·1 per cent), whereas frequency of changing the stoma bag was the item not included in the CIS that was chosen most often by professionals (124, 79·5 per cent). Significant differences were not observed between different groups of professionals. Conclusion The perspective of colostomy‐related problems differs between patients with a colostomy and healthcare professionals.
Collapse
Affiliation(s)
- H Elfeki
- Colorectal Surgical Unit, Department of Surgery Aarhus University Hospital Aarhus Denmark.,Colorectal Surgical Unit, Department of Surgery Mansoura University Hospital Mansoura Egypt
| | - A Thyø
- Colorectal Surgical Unit, Department of Surgery Aarhus University Hospital Aarhus Denmark
| | - D Nepogodiev
- Academic Department of Surgery, University of Birmingham Birmingham UK
| | - T D Pinkney
- Academic Department of Surgery, University of Birmingham Birmingham UK
| | - M White
- Colorectal Surgery Department, Queen Elizabeth Hospital University Hospitals Birmingham NHS Foundation Trust Birmingham UK
| | - S Laurberg
- Colorectal Surgical Unit, Department of Surgery Aarhus University Hospital Aarhus Denmark
| | - P Christensen
- Colorectal Surgical Unit, Department of Surgery Aarhus University Hospital Aarhus Denmark
| | | |
Collapse
|
21
|
Skovmand A, Jacobsen Lauvås A, Christensen P, Vogel U, Sørig Hougaard K, Goericke-Pesch S. Pulmonary exposure to carbonaceous nanomaterials and sperm quality. Part Fibre Toxicol 2018; 15:10. [PMID: 29386028 PMCID: PMC5793436 DOI: 10.1186/s12989-018-0242-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/08/2018] [Indexed: 11/29/2022] Open
Abstract
Background Semen quality parameters are potentially affected by nanomaterials in several ways: Inhaled nanosized particles are potent inducers of pulmonary inflammation, leading to the release of inflammatory mediators. Small amounts of particles may translocate from the lungs into the lung capillaries, enter the systemic circulation and ultimately reach the testes. Both the inflammatory response and the particles may induce oxidative stress which can directly affect spermatogenesis. Furthermore, spermatogenesis may be indirectly affected by changes in the hormonal milieu as systemic inflammation is a potential modulator of endocrine function. The aim of this study was to investigate the effects of pulmonary exposure to carbonaceous nanomaterials on sperm quality parameters in an experimental mouse model. Methods Effects on sperm quality after pulmonary inflammation induced by carbonaceous nanomaterials were investigated by intratracheally instilling sexually mature male NMRI mice with four different carbonaceous nanomaterials dispersed in nanopure water: graphene oxide (18 μg/mouse/i.t.), Flammruss 101, Printex 90 and SRM1650b (0.1 mg/mouse/i.t. each) weekly for seven consecutive weeks. Pulmonary inflammation was determined by differential cell count in bronchoalveolar lavage fluid. Epididymal sperm concentration and motility were measured by computer-assisted sperm analysis. Epididymal sperm viability and morphological abnormalities were assessed manually using Hoechst 33,342/PI flourescent and Spermac staining, respectively. Epididymal sperm were assessed with regard to sperm DNA integrity (damage). Daily sperm production was measured in the testis, and testosterone levels were measured in blood plasma by ELISA. Results Neutrophil numbers in the bronchoalveolar fluid showed sustained inflammatory response in the nanoparticle-exposed groups one week after the last instillation. No significant changes in epididymal sperm parameters, daily sperm production or plasma testosterone levels were found. Conclusion Despite the sustained pulmonary inflammatory response, an eight week exposure to graphene oxide, Flammruss 101, Printex 90 and the diesel particle SRM1650b in the present study did not appear to affect semen parameters, daily sperm production or testosterone concentration in male NMRI mice. Electronic supplementary material The online version of this article (10.1186/s12989-018-0242-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Astrid Skovmand
- The National Research Center for the Working Environment, Lersø Parkallé, DK-2100, Copenhagen Ø, Denmark.,Section for Veterinary Reproduction and Obstetrics, Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlægvej 68, DK-1870, Frederiksberg C, Denmark
| | - Anna Jacobsen Lauvås
- Section for Veterinary Reproduction and Obstetrics, Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlægvej 68, DK-1870, Frederiksberg C, Denmark
| | | | - Ulla Vogel
- The National Research Center for the Working Environment, Lersø Parkallé, DK-2100, Copenhagen Ø, Denmark.,Department of Micro- and Nanotechnology, Technical University of Denmark, DK-2800, Kongens Lyngby, Denmark
| | - Karin Sørig Hougaard
- The National Research Center for the Working Environment, Lersø Parkallé, DK-2100, Copenhagen Ø, Denmark.,Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, DK-1014, Copenhagen K, Denmark
| | - Sandra Goericke-Pesch
- Section for Veterinary Reproduction and Obstetrics, Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlægvej 68, DK-1870, Frederiksberg C, Denmark.
| |
Collapse
|
22
|
Affiliation(s)
| | - Peter Humaidan
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark.,Faculty of Health, Aarhus University, Aarhus, Denmark
| |
Collapse
|
23
|
Mortensen AR, Grossmann I, Rosenkilde M, Wara P, Laurberg S, Christensen P. Double-blind randomized controlled trial of collagen mesh for the prevention of abdominal incisional hernia in patients having a vertical rectus abdominis myocutaneus flap during surgery for advanced pelvic malignancy. Colorectal Dis 2017; 19:491-500. [PMID: 27805791 DOI: 10.1111/codi.13552] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 07/18/2016] [Indexed: 02/08/2023]
Abstract
AIM The study investigated the effect of collagen mesh-assisted closure at the donor site in preventing the formation of incisional hernia following construction of a vertical rectus abdominis myocutaneus (VRAM) flap as part of pelvic surgery for recurrent colorectal cancer. METHOD The study was a double-blinded randomized controlled superiority trial that was designed and performed according to the Consolidated Standards of Reporting Trials (CONSORT) Statement. Eligible patients undergoing surgery that included a VRAM flap for advanced colorectal pelvic malignancy were prospectively randomized to conventional abdominal wound closure or collagen mesh-assisted closure. The primary end-point was incisional herniation at 1 year confirmed by CT. Secondary end-points were CT-verified incisional herniation at 3 and 36 months, clinically recognizable incisional herniation, donor-site and reconstructive-site complications, surgical mortality, postoperative morbidity, postoperative recovery and survival. RESULTS In total, 58 (29 conventional closure; 29 mesh-assisted closure) patients were included. At 1 year, incisional herniation on the CT scan was found in 12 (50%) of 24 patients in the conventional closure group, and in 8 (33%) of 24 in the mesh-assisted closure group (P = 0.38). No significant difference between the groups was found in surgical mortality, early or late complications or survival. Donor-site morbidity was comparable between the two groups. CONCLUSION No preventative effect of collagen mesh-assisted closure was observed following VRAM flap reconstruction.
Collapse
Affiliation(s)
- A R Mortensen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - I Grossmann
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - M Rosenkilde
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - P Wara
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - S Laurberg
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - P Christensen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
24
|
Thyø A, Emmertsen KJ, Pinkney TD, Christensen P, Laurberg S. The colostomy impact score: development and validation of a patient reported outcome measure for rectal cancer patients with a permanent colostomy. A population-based study. Colorectal Dis 2017; 19:O25-O33. [PMID: 27883253 DOI: 10.1111/codi.13566] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 09/29/2016] [Indexed: 12/12/2022]
Abstract
AIM The aim was to develop and validate a simple scoring system evaluating the impact of colostomy dysfunction on quality of life (QOL) in patients with a permanent stoma after rectal cancer treatment. METHOD In this population-based study, 610 patients with a permanent colostomy after previous rectal cancer treatment during the period 2001-2007 completed two questionnaires: (i) the basic stoma questionnaire consisting of 22 items about stoma function with one anchor question addressing the overall stoma impact on QOL and (ii) the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) C30. Answers from half of the cohort were used to develop the score and subsequently validated on the remaining half. Logistic regression analyses identified and selected items for the score and multivariate analysis established the score value allocated to each item. RESULTS The colostomy impact score includes seven items with a total range from 0 to 38 points. A score of ≥ 10 indicates major colostomy impact (Major CI). The score has a sensitivity of 85.7% for detecting patients with significant stoma impact on QOL. Using the EORTC QLQ scales, patients with Major CI experienced significant impairment in their QOL compared to the Minor CI group. CONCLUSION This new scoring system appears valid for the assessment of the impact on QOL from having a permanent colostomy in a Danish rectal cancer population. It requires validation in non-Danish populations prior to its acceptance as a valuable patient-reported outcome measure for patients internationally.
Collapse
Affiliation(s)
- A Thyø
- Colorectal Surgical Unit, Aarhus University Hospital, Aarhus, Denmark
| | - K J Emmertsen
- Colorectal Surgical Unit, Aarhus University Hospital, Aarhus, Denmark
| | - T D Pinkney
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - P Christensen
- Colorectal Surgical Unit, Aarhus University Hospital, Aarhus, Denmark
| | - S Laurberg
- Colorectal Surgical Unit, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
25
|
Christensen P. From misbelieve to proofs in transanal irrigation for functional bowel problems. Tech Coloproctol 2016; 20:609-10. [DOI: 10.1007/s10151-016-1510-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 07/19/2016] [Indexed: 11/28/2022]
|
26
|
Nielsen SD, Faaborg PM, Christensen P, Krogh K, Finnerup NB. Chronic abdominal pain in long-term spinal cord injury: a follow-up study. Spinal Cord 2016; 55:290-293. [DOI: 10.1038/sc.2016.124] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 11/09/2022]
|
27
|
Tankisi H, Pugdahl K, Rasmussen MM, Clemmensen D, Rawashdeh YF, Christensen P, Krogh K, Fuglsang-Frederiksen A. Pelvic floor electrophysiology in spinal cord injury. Clin Neurophysiol 2016; 127:2319-24. [PMID: 26975618 DOI: 10.1016/j.clinph.2015.12.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/08/2015] [Accepted: 12/20/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The study aimed to investigate sacral peripheral nerve function and continuity of pudendal nerve in patients with chronic spinal cord injury (SCI) using pelvic floor electrophysiological tests. METHODS Twelve patients with low cervical or thoracic SCI were prospectively included. Quantitative external anal sphincter (EAS) muscle electromyography (EMG), pudendal nerve terminal motor latency (PNTML) testing, bulbocavernosus reflex (BCR) testing and pudendal short-latency somatosensory-evoked potential (SEP) measurement were performed. RESULTS In EAS muscle EMG, two patients had abnormal increased spontaneous activity and seven prolonged motor unit potential duration. PNTML was normal in 10 patients. BCR was present with normal latency in 11 patients and with prolonged latency in one. The second component of BCR could be recorded in four patients. SEPs showed absent cortical responses in 11 patients and normal latency in one. CONCLUSIONS Pudendal nerve and sacral lower motor neuron involvement are significantly associated with chronic SCI, most prominently in EAS muscle EMG. The frequent finding of normal PNTML latencies supports earlier concerns on the utility of this test; however, BCR and pudendal SEPs may have clinical relevance. SIGNIFICANCE As intact peripheral nerves including pudendal nerve are essential for efficient supportive therapies, pelvic floor electrophysiological testing prior to these interventions is highly recommended.
Collapse
Affiliation(s)
- H Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.
| | - K Pugdahl
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - M M Rasmussen
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark; Pelvic Floor Unit, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - D Clemmensen
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
| | - Y F Rawashdeh
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - P Christensen
- Pelvic Floor Unit, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - K Krogh
- Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | | |
Collapse
|
28
|
Juul T, Battersby NJ, Christensen P, Janjua AZ, Branagan G, Laurberg S, Emmertsen KJ, Moran B. Validation of the English translation of the low anterior resection syndrome score. Colorectal Dis 2015; 17:908-16. [PMID: 25807963 DOI: 10.1111/codi.12952] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 01/25/2015] [Indexed: 02/08/2023]
Abstract
AIM Many patients having anterior resection for rectal cancer suffer from severe long-term bowel dysfunction, known as low anterior resection syndrome (LARS). The LARS score was developed in Denmark, and Swedish, Spanish and German versions have been validated. The aim of this study was to validate the English translation of the LARS score in British rectal cancer patients. METHOD Rectal cancer patients who underwent an anterior resection in 12 UK centres received the LARS score questionnaire, the EORTC QLQ-C30 and a single ad hoc quality of life question. A subgroup of patients received the LARS score questionnaire twice. RESULTS The response rate was 80% and 451 patients were included in the analyses. A strong association between LARS score and quality of life (convergent validity) was found (P < 0.01), discriminative validity was good (P < 0.02) and the test-retest reliability was high (intraclass correlation coefficient 0.83). CONCLUSION The English translation of the LARS score has shown good psychometric properties comparable with recently published results from an international multicentre study. Thus, the English translation of the LARS score can be considered a valid and reliable tool for measuring LARS.
Collapse
Affiliation(s)
- T Juul
- Department of Surgery - Section for Colorectal Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - N J Battersby
- The Pelican Cancer Foundation, The Ark, Basingstoke, UK.,Department of Colorectal Surgery, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - P Christensen
- Department of Surgery - Section for Colorectal Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - A Z Janjua
- The Pelican Cancer Foundation, The Ark, Basingstoke, UK.,Department of Colorectal Surgery, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - G Branagan
- Colorectal Surgery, Salisbury NHS Foundation Trust, Basingstoke, UK
| | - S Laurberg
- Department of Surgery - Section for Colorectal Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - K J Emmertsen
- Department of Surgery - Section for Colorectal Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - B Moran
- The Pelican Cancer Foundation, The Ark, Basingstoke, UK.,Department of Colorectal Surgery, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | | |
Collapse
|
29
|
Tylén K, Christensen P, Roepstorff A, Lund T, Østergaard S, Donald M. Brains striving for coherence: Long-term cumulative plot formation in the default mode network. Neuroimage 2015. [PMID: 26216276 DOI: 10.1016/j.neuroimage.2015.07.047] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Many everyday activities, such as engaging in conversation or listening to a story, require us to sustain attention over a prolonged period of time while integrating and synthesizing complex episodic content into a coherent mental model. Humans are remarkably capable of navigating and keeping track of all the parallel social activities of everyday life even when confronted with interruptions or changes in the environment. However, the underlying cognitive and neurocognitive mechanisms of such long-term integration and profiling of information remain a challenge to neuroscience. While brain activity is generally traceable within the short time frame of working memory (milliseconds to seconds), these integrative processes last for minutes, hours or even days. Here we report two experiments on story comprehension. Experiment I establishes a cognitive dissociation between our comprehension of plot and incidental facts in narratives: when episodic material allows for long-term integration in a coherent plot, we recall fewer factual details. However, when plot formation is challenged, we pay more attention to incidental facts. Experiment II investigates the neural underpinnings of plot formation. Results suggest a central role for the brain's default mode network related to comprehension of coherent narratives while incoherent episodes rather activate the frontoparietal control network. Moreover, an analysis of cortical activity as a function of the cumulative integration of narrative material into a coherent story reveals to linear modulations of right hemisphere posterior temporal and parietal regions. Together these findings point to key neural mechanisms involved in the fundamental human capacity for cumulative plot formation.
Collapse
Affiliation(s)
- K Tylén
- Center for Semiotics, Department for Aesthetics and Communication, Aarhus University, Jens Chr. Skous Vej 2, 8000 Aarhus C, Denmark; Center for Functionally Integrative Neuroscience, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark; The Interacting Minds Center, Department of Culture and Society, Aarhus University, Jens Chr. Skous Vej 4, 8000 Aarhus C, Denmark.
| | - P Christensen
- The Interacting Minds Center, Department of Culture and Society, Aarhus University, Jens Chr. Skous Vej 4, 8000 Aarhus C, Denmark; Centre for Languages and Literature, Lund University, Helgonabacken 12, 221 00 Lund, Sweden
| | - A Roepstorff
- Center for Functionally Integrative Neuroscience, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark; The Interacting Minds Center, Department of Culture and Society, Aarhus University, Jens Chr. Skous Vej 4, 8000 Aarhus C, Denmark
| | - T Lund
- Center for Functionally Integrative Neuroscience, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - S Østergaard
- Center for Semiotics, Department for Aesthetics and Communication, Aarhus University, Jens Chr. Skous Vej 2, 8000 Aarhus C, Denmark
| | - M Donald
- Department of Psychology, Hunphrey Hall, 62 Arch St., Queens University, Kingston, Ontario K7L3N6, Canada
| |
Collapse
|
30
|
Rasmussen MM, Krogh K, Clemmensen D, Tankisi H, Fuglsang-Frederiksen A, Rawashdeh Y, Bluhme H, Christensen P. The artificial somato-autonomic reflex arch does not improve bowel function in subjects with spinal cord injury. Spinal Cord 2015; 53:705-10. [DOI: 10.1038/sc.2015.75] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 03/28/2015] [Accepted: 04/01/2015] [Indexed: 11/10/2022]
|
31
|
|
32
|
Christensen KK, Christensen P, Seger RA. Intravenous administration of human IgG to newborn infants: changes in serum antibody levels to GBS. Antibiot Chemother (1971) 2015; 35:247-53. [PMID: 3901901 DOI: 10.1159/000410378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
33
|
Christensen KK, Christensen P. Chlorhexidine for prevention of neonatal colonization with GBS. Antibiot Chemother (1971) 2015; 35:296-302. [PMID: 3901906 DOI: 10.1159/000410383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
34
|
Christensen KK, Christensen P. Immunological characterization of mothers of infants with neonatal GBS infection: definition of a risk group. Antibiot Chemother (1971) 2015; 35:190-3. [PMID: 3901895 DOI: 10.1159/000410372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
35
|
Bartels EM, Christensen R, Christensen P, Henriksen M, Bennett A, Gudbergsen H, Boesen M, Bliddal H. Effect of a 16 weeks weight loss program on osteoarthritis biomarkers in obese patients with knee osteoarthritis: a prospective cohort study. Osteoarthritis Cartilage 2014; 22:1817-25. [PMID: 25106676 DOI: 10.1016/j.joca.2014.07.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 06/26/2014] [Accepted: 07/29/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Changes in biomarkers for bone and cartilage in knee osteoarthritis (KOA) may reflect changes in tissue turnover induced by interventions. The aim of this study was to assess the effect on osteoarthritis biomarkers of an intensive weight loss intervention in obese KOA patients. METHODS 192 obese KOA patients followed a 16 weeks weight loss intervention (ClinicalTrials.gov: NCT00655941). Serum Cartilage Oligomeric Matrix Protein (sCOMP), Urine C-terminal telopeptide of collagen type II (uCTX-II) and type I (uCTX-I) were determined by enzyme-linked immunoassay (ELISA) at baseline and after 16 weeks. Patient-reported symptoms were assessed by the Knee Injury and Osteoarthritis Outcome Score (KOOS) Questionnaire without the sports and recreation score (KOOS-4). Change from baseline was analyzed using Analysis of CoVariance (ANCOVA) adjusting for sex, age, and body mass index (BMI). Bivariate associations were analyzed using Spearman's test of rank correlation. RESULTS 175 patients completed the treatment and lost mean 13.4 (95% CI: 12.5-14.4) kg. sCOMP concentration decreased on average 1.1 (95% CI: -1.5 to -0.8) U/L with a correlation to weight loss (r = -0.17, P = 0.028), but not to change in KOOS-4 (r = -0.13, P = 0.091). uCTX-II increased significantly, mean 69 (95% CI: 31-106) ng/mmol creatinine, with no relation to weight loss (P = 0.14). Change in uCTX-II was reversely related to change in KOOS-4 (r = -0.28, P = 0.0003). uCTX-I increased, mean 67 (95% CI: 47-87) μg/mmol creatinine, and correlated to weight loss (r = 0.22, P = 0.0007), while not to KOOS-4 (P = 0.93). CONCLUSION A rapid substantial weight loss in obese KOA patients was weakly, while significantly associated with a reduction in sCOMP, and increases in both uCTX-II and uCTX-I.
Collapse
Affiliation(s)
- E M Bartels
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark.
| | - R Christensen
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark; Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.
| | - P Christensen
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark; Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark.
| | - M Henriksen
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark.
| | - A Bennett
- Immunodiagnostic Systems Limited (IDS), UK.
| | - H Gudbergsen
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark; Knowledgecentre for Telemedicine, The Capital Region of Denmark, Denmark; Department of Rheumatology, Copenhagen University Hospitals, Glostrup, Frederiksberg and Bispebjerg, Denmark.
| | - M Boesen
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark; Department of Radiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark.
| | - H Bliddal
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark; Faculty of Health Science, University of Copenhagen, Denmark; SMI, Aalborg University, Denmark.
| |
Collapse
|
36
|
Hughes AT, Milan AM, Christensen P, Ross G, Davison AS, Gallagher JA, Dutton JJ, Ranganath LR. Urine homogentisic acid and tyrosine: simultaneous analysis by liquid chromatography tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2014; 963:106-12. [PMID: 24952314 DOI: 10.1016/j.jchromb.2014.06.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 05/28/2014] [Accepted: 06/01/2014] [Indexed: 11/17/2022]
Abstract
Alkaptonuria (AKU) is a rare debilitating autosomal recessive disorder of tyrosine metabolism. Deficiency of homogentisate 1,2-dioxygenase results in increased homogentisic acid (HGA) which although excreted in gram quantities in the urine, is deposited as an ochronotic pigment in connective tissues, especially cartilage. Ochronosis leads to a severe, early-onset form of osteoarthritis, increased renal and prostatic stone formation and hardening of heart vessels. Treatment with the orphan drug, Nitisinone, an inhibitor of the enzyme 4-hydroxyphenylpyruvate dioxygenase has been shown to reduce urinary excretion of HGA, resulting in accumulation of the upstream pre-cursor, tyrosine. Using reverse phase LC-MS/MS, a method has been developed to simultaneously quantify urinary HGA and tyrosine. Using matrix-matched calibration standards, two product ion transitions were identified for each compound and their appropriate isotopically labelled internal standards. Validation was performed across the AKU and post-treatment concentrations expected. Intrabatch accuracy for acidified urine was 96-109% for tyrosine and 94-107% for HGA; interbatch accuracy (n=20 across ten assays) was 95-110% for tyrosine and 91-109% for HGA. Precision, both intra- and interbatch was <10% for tyrosine and <5% for HGA. Matrix effects observed with acidified urine (12% decrease, CV 5.6%) were normalised by the internal standard. Tyrosine and HGA were proved stable under various storage conditions and no carryover, was observed. Overall the method developed and validated shows good precision, accuracy and linearity appropriate for the monitoring of patients with AKU, pre and post-nitisinone therapy.
Collapse
Affiliation(s)
- A T Hughes
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool and Broadgreen University Hospital Trust, Duncan Building, Liverpool L7 8XP, United Kingdom; Bone and Joint Research Group, Musculoskeletal Biology, Sherrington Building, University of Liverpool, Liverpool L69 3GE, United Kingdom
| | - A M Milan
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool and Broadgreen University Hospital Trust, Duncan Building, Liverpool L7 8XP, United Kingdom; Bone and Joint Research Group, Musculoskeletal Biology, Sherrington Building, University of Liverpool, Liverpool L69 3GE, United Kingdom.
| | - P Christensen
- Agilent Technologies, 5500 Lakeside, Cheadle Royal Business Park, Cheadle, Stockport SK8 3GR, United Kingdom
| | - G Ross
- Agilent Technologies, 5500 Lakeside, Cheadle Royal Business Park, Cheadle, Stockport SK8 3GR, United Kingdom
| | - A S Davison
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool and Broadgreen University Hospital Trust, Duncan Building, Liverpool L7 8XP, United Kingdom
| | - J A Gallagher
- Bone and Joint Research Group, Musculoskeletal Biology, Sherrington Building, University of Liverpool, Liverpool L69 3GE, United Kingdom
| | - J J Dutton
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool and Broadgreen University Hospital Trust, Duncan Building, Liverpool L7 8XP, United Kingdom
| | - L R Ranganath
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool and Broadgreen University Hospital Trust, Duncan Building, Liverpool L7 8XP, United Kingdom; Bone and Joint Research Group, Musculoskeletal Biology, Sherrington Building, University of Liverpool, Liverpool L69 3GE, United Kingdom
| |
Collapse
|
37
|
Tankisi H, Rasmussen M, Pugdahl K, Clemmensen D, Rawashdeh Y, Christensen P, Krogh K, Fuglsang-Frederiksen A. P875: Pelvic floor electrophysiology in spinal cord injury. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50907-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
38
|
Bliddal H, Christensen P, Bartels E, Leeds A, Astrup A, Christensen R. AB0778 Long-Term Intervention with Weight Loss in Patients with Concomitant Obesity and Knee Osteoarthritis: A Randomised Trial (The Light Study). Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
39
|
Faaborg PM, Christensen P, Krassioukov A, Laurberg S, Frandsen E, Krogh K. Autonomic dysreflexia during bowel evacuation procedures and bladder filling in subjects with spinal cord injury. Spinal Cord 2014; 52:494-8. [PMID: 24777164 DOI: 10.1038/sc.2014.45] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 01/27/2014] [Accepted: 02/03/2014] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Randomized, controlled clinical trial. OBJECTIVES Bladder and bowel management may cause serious autonomic dysreflexia (AD) in subjects with high spinal cord injury (SCI). We aimed at investigating autonomic responses to digital rectal evacuation (DE), transanal irrigation (TAI) with 500 ml and filling cystometry (FC) in SCI. SETTING Aarhus University Hospital, Denmark. METHODS Eight subjects with SCI (AIS A) at or above T6 (high SCI) and a previous history of AD were compared with three subjects with SCI (AIS A) between T10 and L2 (low SCI). In randomized order, DE, TAI and FC were performed. AD was defined as an acute rise in systolic blood pressure (sBP) of ⩾30 mm Hg above baseline. Blood levels of norepinephrine and epinephrine were determined before and shortly after the procedures. RESULTS During all three procedures, AD occurred in all patients with high SCI but not in those with low SCI. In high SCI subjects, DE increased median sBP from 127 (range: 86-154) to 188 (range: 140-206) mm Hg (P<0.02), TAI from 126 (range: 91-146) to 163 (range: 130-188) mm Hg (P<0.02) and FC from 125 (range: 106-149) to 200 (range: 179-220) mm Hg (P<0.01). The sBP increase was lower during TAI than during DE (P<0.05) or FC (P<0.02). In high SCI subjects, the blood levels of norepinephrine, but not those of epinephrine, increased significantly during all three stimuli (all P<0.05). CONCLUSION Bowel and bladder management caused AD in high SCI. The response is less severe during TAI than during FC or DE.
Collapse
Affiliation(s)
- P M Faaborg
- 1] Pelvic Floor Unit, Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark [2] Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - P Christensen
- Pelvic Floor Unit, Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark
| | - A Krassioukov
- Division of Physical Medicine and Rehabilitation, ICORD, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - S Laurberg
- Pelvic Floor Unit, Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark
| | - E Frandsen
- Department of Clinical Physiology and Nuclear Medicine, Glostrup University Hospital, Copenhagen, Denmark
| | - K Krogh
- Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
40
|
Rasmussen MM, Krogh K, Clemmensen D, Bluhme H, Rawashdeh Y, Christensen P. Colorectal transport during defecation in subjects with supraconal spinal cord injury. Spinal Cord 2013; 51:683-7. [PMID: 23774126 DOI: 10.1038/sc.2013.58] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 04/17/2013] [Accepted: 05/08/2013] [Indexed: 01/07/2023]
Abstract
STUDY DESIGN Clinical study. OBJECTIVES To explore how supraconal spinal cord injury (SCI) affects colorectal emptying at defecation. Further, to relate findings to subject symptomatology expressed by bowel function scores and gastrointestinal transit time (GITT). SETTING Aarhus University Hospital, Denmark. METHODS Colorectal contents were marked by oral intake of (111)In-coated resin pellets. Movement of stools at defecation was assessed by comparing scintigrams performed before and just after defecation. Results from 15 subjects with SCI (14 males, median age=47 years (range: 22-74 years), SCI level: C5-Th9) were compared with those from 16 healthy volunteers (12 males, median age=31 years (range: 24-42 years)). Bowel symptoms were described from standard symptom scores, and GITT was assessed by radiopaque markers. RESULTS Median emptying at defecation was 31% of the rectosigmoid (range: 0% to complete emptying of the rectosigmoid and 49% of the descending colon) in subjects with SCI and 89% of the rectosigmoid (range: 53% to complete emptying of the rectosigmoid and the descending colon, and 3% of the transverse colon) in the control group (P<0.01). Colorectal emptying at defecation was associated with the St Mark's fecal incontinence score (P=0.02) but not with the Cleveland constipation score (P=0.17), the neurogenic bowel dysfunction score (P=0.12) or GITT (P=0.99). CONCLUSION Supraconal SCI results in significantly reduced emptying of stools at defecation. This is independent of changes in GITT.
Collapse
Affiliation(s)
- M M Rasmussen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.
| | | | | | | | | | | |
Collapse
|
41
|
Carchenilla MSC, Agudo D, Rubio S, Becerra D, Bronet F, Garcia-Velasco JA, Pacheco A, Lardone M, Piottante A, Parada-Bustamante A, Argandona F, Florez M, Espinoza A, Ebensperger M, Castro A, Cohen-Bacrie M, Belloc S, Dalleac A, Amar E, Izard V, Hazout A, Cohen-Bacrie P, de Mouzon J, Muzzonigro F, Crivello AM, Stanghellini I, Bernardini L, Ferraretti AP, Magli C, Gianaroli L, Martin PS, Duvison MH, Silva MD, Gosalvez J, Martin FS, Pomante A, Muzzonigro F, Colombo F, Mattioli M, Barboni B, Ferraretti AP, Magli MC, Gianaroli L, Hacifazlioglu O, Findikli N, Goktolga U, Bahceci M, Jakab A, Mokanszki A, Varga A, Benyo M, Kassai Z, Olah E, Molnar Z, Gundogan GI, Bozkurt HH, Irez T, Domingo A, Anarte C, Presilla N, Calvo I, Aguirre O, Oroquieta A, Agirregoikoa JA, De Pablo JL, Barrenetxea G, Moragues I, Medrano ML, Montoya A, Ramos B, Torres MJG, Aizpurua J, Ibala SR, Ghedir H, Mehri A, Zidi I, Brahem S, Mehdi M, Ajina M, Saad A, Medrano ML, Moragues I, Gomez-Torres MJ, Montoya A, Aizpurua J, Cavaco JE, Rato L, Alves MG, Dias TR, Lopes G, Socorro S, Oliveira PF, Lobascio AM, Minasi MG, Greco E, Bungum M, Bungum A, Silver N, Zahiri M, Movahedin M, Mowla SJ, Noruzinia M, Huleihel M, Abarbanel Y, Haber EP, Azab M, Lan D, Lunenfeld E, Smith MJ, Neri QV, Harvey L, Rosenwaks Z, Palermo GD, Alhalabi M, Samawi S, Droubi H, Khalaf M, Taha A, Khatib R, Bednarowska-flisiak A, Wcislo M, Liss J, Swider A, Szczyglinska J, Grzymkowska M, Bruszczynska A, Glowacka J, Kitowska-Marszalkowska K, Krapchev M, Mirecka A, Wisniewska K, Lukaszuk K, Natali I, Tamburrino L, Cambi M, Marchiani S, Noci I, Maggi M, Forti G, Baldi E, Muratori M, Ferraretto X, Pasquet B, Damond F, Matheron S, Epelboin S, Yahi S, Demailly P, Rougier N, Yazbeck C, Delaroche L, Longuet P, Llabador M, Estellat C, Patrat C, Wcislo M, Liss J, Swider A, Szczyglinska J, Grzymkowska M, Bruszczynska A, Glowacka J, Krapchev M, Mirecka A, Kitowska-Marszalkowska K, Wisniewska K, Lukaszuk K, Askarijahromi M, Movahedin M, Amanlu M, Mowla SJ, Mazaheri Z, Christensen P, Sills ES, Fischer R, Naether OGJ, Walsh D, Rudolf K, Coull G, Baukloh V, Labouriau R, Birck A, Parisi F, Parrilla B, Oneta M, Savasi V, Veleva L, Milachich T, Bochev I, Antonova I, Shterev A, Vlaisavljevic V, Breznik BP, Kovacic B, Serrano M, Gonzalvo MC, Clavero A, Fernandez MF, Mozas J, Martinez L, Fontes J, Carrillo S, Lopez-Regalado ML, Lopez-Leria B, Orozco I, Mantilla A, Castilla JA, Mskhalaya G, Zakharova E, Zaletova V, Kasatonova E, Melnik Y, Efremov E, Breznik BP, Kovacic B, Vlaisavljevic V, Schiewe MC, Verheyen G, Tournaye H, Phletincx I, Sims CA, Rothman C, Borges E, Setti AS, Braga DPAF, Vingris L, Iaconelli A, Dupont C, Faure C, Sermondade N, Gautier B, Herbemont C, Aknin I, Klein JP, Cedrin-Durnerin I, Wolf JP, Czernichow S, Levy R, Rondanino C, Chauffour C, Ouchchane L, Artonne C, Janny L, Lobaccaro JM, Volle DH, Brugnon F, Colacurci N, Piomboni P, Ruvolo G, Lombardo F, Verde EL, De Leo V, Lispi M, Papaleo E, De Palo R, Gandini L, Longobardi S, Yokota Y, Yokota M, Yokota H, Araki Y, Araki Y, Alshahrani S, Durairajanayagam D, Sharma R, Sabanegh E, Agarwal A, Hattori H, Nakajo Y, Ikeno T, Sato Y, Kyoya T, Kyono K, Li B, Li JB, Xiao XF, Ma YF, Wang J, Liang XX, Zhao HX, Jiang F, Yao YQ, Wang XH, Roan NR, Liu H, Muller J, Avila-Herrera A, Pollard KS, Lishko P, Kirchhoff F, Munch J, Witkowska HE, Greene WC, Mangiarini A, Paffoni A, Restelli L, Guarneri C, Somigliana E, Ragni G, Anarte C, Domingo A, Calvo I, Presilla N, Aguirre O, Bou R, Aleman M, Guardiola F, Agirregoikoa JA, De Pablo JL, Barrenetxea G, Camargo C, Oliveira JBA, Petersen CG, Mauri AL, Massaro FC, Nicoletti A, Nascimento AM, Vagnini LD, Martins AMVC, Cavagna M, Baruffi RLR, Franco JG. Andrology. Hum Reprod 2013. [DOI: 10.1093/humrep/det206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
42
|
Mao W, Huang C, Kearney V, Song K, Christensen P, Sun X, Hao Y, Solberg T. WE-E-108-01: BEST IN PHYSICS (THERAPY) - Radiotherapy Enhancement with a Novel Class of Hollow Nanoconstructs. Med Phys 2013. [DOI: 10.1118/1.4815579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
43
|
Christensen P, Stenvang JP, Godfrey WL. A Flow Cytometric Method for Rapid Determination of Sperm Concentration and Viability in Mammalian and Avian Semen. ACTA ACUST UNITED AC 2013; 25:255-64. [PMID: 14760012 DOI: 10.1002/j.1939-4640.2004.tb02786.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A new flow cytometric method has been developed to rapidly determine sperm concentration and viability in semen from bulls and boars. Sperm viability was determined on the basis of staining with SYBR-14 and propidium iodide (PI), and this allowed detection of live (membrane-intact) sperm, dying (moribund) sperm, as well as dead cells. Fluorescent microspheres (beads) were used to determine sperm concentration. The use of SYBR-14 at 50 nM and PI at 12 micro M in combination with the FACSCount diluent in the counting tubes resulted in a uniform staining after 2.5-5 minutes at room temperature. Reagent staining was reproducible enough to allow subsequent semiautomated analysis of data using Attractors software. In experiment 1, this method was used to analyze semen from boars, rams, rats, rabbits, humans, and turkeys. In experiment 2, Attractors analysis was performed by the FACSCount AF flow cytometer, and sperm concentration determination with this system was compared with results obtained by a spectrophotometer and an electronic cell counter, which is routinely used by bull artificial insemination centers. When compared to microscopic counting in a hemocytometer, the FACSCount AF flow cytometer was two and four times more accurate than the spectrophotometer and the electronic cell counter, respectively. In addition, the FACSCount AF flow cytometer determined both sperm concentration (coefficient of variation 3.3%) and sperm viability (coefficient of variation 0.7%) with high precision.
Collapse
Affiliation(s)
- Preben Christensen
- Department of Production Animals and Horses, Section for Reproduction, Royal Veterinary and Agricultural University, Frederiksberg, Denmark.
| | | | | |
Collapse
|
44
|
Gudbergsen H, Boesen M, Lohmander LS, Christensen R, Henriksen M, Bartels EM, Christensen P, Rindel L, Aaboe J, Danneskiold-Samsøe B, Riecke BF, Bliddal H. Weight loss is effective for symptomatic relief in obese subjects with knee osteoarthritis independently of joint damage severity assessed by high-field MRI and radiography. Osteoarthritis Cartilage 2012; 20:495-502. [PMID: 22401872 DOI: 10.1016/j.joca.2012.02.639] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [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] [Received: 08/09/2011] [Revised: 02/20/2012] [Accepted: 02/27/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE With an increasing prevalence of older and obese citizens, the problems of knee osteoarthritis (KOA) will escalate. Weight loss is recommended for obese KOA patients and in a majority of cases this leads to symptomatic relief. We hypothesized that pre-treatment structural status of the knee joint, assessed by radiographs, 1.5 T magnetic resonance imaging (MRI) and knee-joint alignment, may influence the symptomatic changes following a significant weight reduction. DESIGN Patients were recruited from a Department of Rheumatology. Eligibility criteria were age above 50 years, body mass index ≥ 30 kg/m(2), primary KOA diagnosed according to the American College of Rheumatology (ACR) criteria and having verified structural damage. Patients underwent a 16 weeks dietary programme with formula products and counselling. MRI and radiographs of the most symptomatic knee were obtained at baseline and assessed for structural damage using the Boston-Leeds Osteoarthritis of the Knee Score, minimum joint space width and Kellgren-Lawrence score. Imaging variables, muscle strength and degree of alignment, were examined as predictors of changes in Knee Osteoarthritis Outcome Score (KOOS) and Outcome Measures in Rheumatoid Arthritis Clinical Trials (OMERACT) - Osteoarthritis Research Society International (OARSI) Responder Criterion. RESULTS Structural damage at baseline assessed by imaging, muscle strength or knee-joint alignment showed no statistically significant association to changes in KOOS pain and function in daily living (r ≤ 0.13; P>0.05) or the OMERACT-OARSI Responder Criterion (OR 0.48-1.68; P-values ≥ 0.13). CONCLUSIONS Presence of joint damage did not preclude symptomatic relief following a clinically relevant weight loss in older obese patients with KOA. Neither muscle strength nor knee-joint alignment was associated with the degree of symptomatic relief.
Collapse
Affiliation(s)
- H Gudbergsen
- The Parker Institute, Copenhagen University Hospital, Frederiksberg, Denmark.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Abstract
BACKGROUND Though uniquely placed in the health care system, GPs only become aware of a small number of children with behavioural and emotional problems. Research evaluating the challenges and barriers in general practice for identifying children with problems is therefore important. OBJECTIVES To identify and articulate GPs' experiences and perceptions of the GP-parent dialogue about children's health problems, in order to broaden our understanding of the challenges inherent to the dialogue. METHODS The GPs' experiences and recollections were explored in a qualitative study comprising four focus group discussions and nine individual interviews. The focus of study was to explore GP consultations with children 0-5 years of age and their parent/s. RESULTS Though expressing a family-focused approach to the child consultation, the GPs often did not succeed in making the consultation family focused. The analysis revealed that the GPs often were 'stuck' in the traditional role of expert and this made it difficult for them to explore the child's well-being. The consultation became more family focused when the GPs moved away from the role of expert. The GPs experienced that by sharing their uncertainty with parents, they often got more insight into the child's everyday life and family circumstances. CONCLUSION The study indicates that through open reflective dialogue the GP is able to assess the child and strengthen mutual trust in the doctor-parent relationship to the benefit of children with special needs.
Collapse
Affiliation(s)
- K Lykke
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, DK.
| | | | | |
Collapse
|
46
|
Christensen P, Labouriau R, Birck A, Boe-Hansen GB, Pedersen J, Borchersen S. Relationship among seminal quality measures and field fertility of young dairy bulls using low-dose inseminations. J Dairy Sci 2011; 94:1744-54. [PMID: 21426963 DOI: 10.3168/jds.2010-3087] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2010] [Accepted: 11/01/2010] [Indexed: 11/19/2022]
Abstract
Optimal use of genetically superior bulls through artificial insemination (AI) is highly dependent on precise assessment of seminal quality which allows for reasonable estimations of field fertility with normal or low-dose inseminations. In the present study, seminal measures such as sperm motility and morphology, sperm viability, sperm DNA fragmentation, and the ability of the sperm to display an acrosome reaction were tested. The relationships between field fertility and the seminal measures were investigated using 3 ejaculates from each of 195 bulls (156 Holstein and 39 Jersey) participating in a progeny test program. A range of AI doses, varying from 2×10(6) to 15×10(6) sperm/straw, was obtained by a controlled dilution process applied to each ejaculate. The different AI doses were distributed at random among 75,610 experimental first inseminations in 4,721 herds and 208 AI technicians. Most of the seminal measures appeared to contain a predictive value for the nonreturn to estrus at 56 d post-AI (NRR56) regardless of the number of sperm per AI dose and can be regarded as noncompensable sperm traits. But, due to correlations between the individual measures, the best model for describing (and predicting) NRR56 was based on sperm concentration and viability in the neat (raw) semen, and post-thaw sperm viability. The statistical models for describing NRR56 included the following explanatory variables: strength of the estrus, number of sperm per AI dose, breed, parity, and random components representing herds and AI technicians. The present results show that the most precise estimation of a bull's NRR56 can be achieved through flow cytometric detection of sperm concentration and viability in neat semen as well as flow cytometric detection of post-thaw sperm viability.
Collapse
Affiliation(s)
- P Christensen
- Copenhagen University, Faculty of Life Sciences, Department of Large Animal Sciences, Veterinary Reproduction and Obstetrics, DK-1870 Frederiksberg, Denmark.
| | | | | | | | | | | |
Collapse
|
47
|
Juul T, Bazzocchi G, Coggrave M, Johannesen IL, Hansen RBM, Thiyagarajan C, Poletti E, Krogh K, Christensen P. Reliability of the international spinal cord injury bowel function basic and extended data sets. Spinal Cord 2011; 49:886-91. [PMID: 21445082 DOI: 10.1038/sc.2011.23] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN This study was designed as an international validation study. OBJECTIVE The objective of this study was to assess the inter-rater reliability of the International Spinal Cord Injury Bowel Function Basic and Extended Data Sets. SETTING Three European spinal cord injury centers. METHODS In total, 73 subjects with spinal cord injury and a history of bowel dysfunction, out of which 77% were men and median age of the subjects was 49 years (range 20-81), were studied. The inter-rater reliability was estimated by having two raters complete both data sets on the same subject. First and second tests were separated by 14 days. Cohen's kappa was computed as a measure of agreement between raters. RESULTS Inter-rater reliability assessed by kappa statistics was very good (≥0.81) in 5 items, good (0.61-0.80) in 11 items, moderate (0.41-0.60) in 20 items, fair (0.21-0.40) in 11 and poor (<0.20) in 5 items. CONCLUSION Most items within the International Spinal Cord Injury Bowel Function Data sets have acceptable inter-rater reliability and are useful tools for data collection in international clinical practice and research. However, minor adjustments are recommended.
Collapse
Affiliation(s)
- T Juul
- Surgical Research Unit, Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark.
| | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Abstract
Osteoarthritis (OA) and obesity are related diseases, which occur in a large proportion of the population. Epidemiological evidence show that weight is of great importance for the development of OA in the knee, and to some extent also in hip and finger joints. Once acquired, the OA contributes to further weight problems by decreasing the daily activity level. Weight loss will be beneficial for the knee and experimental data point at a highly significant effect on knee function and recent results even point at a positive effect on the cartilage of the knee joint. Recommending patients with a combination of knee OA and obesity to lose at least 5% body weight, and aim for 10% is predicted to correspond to 26% improvement in physical function. A programme for this weight loss has been tested with good results applying an initial formula diet with maintenance therapy in groups during follow-up.
Collapse
Affiliation(s)
- H Bliddal
- The Parker Institute, Copenhagen University Hospital Frederiksberg, Denmark
| | - P Christensen
- The Parker Institute, Copenhagen University Hospital Frederiksberg, Denmark
| | - B F Riecke
- The Parker Institute, Copenhagen University Hospital Frederiksberg, Denmark
| | - J Aaboe
- The Parker Institute, Copenhagen University Hospital Frederiksberg, Denmark
| | - R Frederiksen
- The Parker Institute, Copenhagen University Hospital Frederiksberg, Denmark
| | - E Bartels
- The Parker Institute, Copenhagen University Hospital Frederiksberg, Denmark
| | - R Christensen
- The Parker Institute, Copenhagen University Hospital Frederiksberg, Denmark
| |
Collapse
|
49
|
Christensen P, Riecke BF, Christensen R, Bliddal H. A 60-year-old obese woman with osteoarthritis of the knee: a case-report. Clin Obes 2011; 1:53-56. [PMID: 25586976 DOI: 10.1111/j.1758-8111.2010.00009.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A case is presented of a 60-year-old woman with concomitant obesity and knee osteoarthritis. The bad knees prevented the patient from exercising; however, with a focused dietary intervention employing food supplements for the first period of 8 weeks, an ordinary low-energy diet for another 8 weeks, the patient lost 17.3 kg; and a further weight loss was achieved during 1-year follow-up totalling 30.6 kg. Lean body mass only changed slightly, 96.8% of the weight loss being fat mass. Along with this her metabolic syndrome decreased and her gait improved. It is suggested that a major weight loss is the treatment of choice in patients with this combination of diseases.
Collapse
Affiliation(s)
- P Christensen
- The Parker Institute, Copenhagen University Hospital, Frederiksberg, Denmark
| | - B F Riecke
- The Parker Institute, Copenhagen University Hospital, Frederiksberg, Denmark
| | - R Christensen
- The Parker Institute, Copenhagen University Hospital, Frederiksberg, Denmark
| | - H Bliddal
- The Parker Institute, Copenhagen University Hospital, Frederiksberg, Denmark
| |
Collapse
|
50
|
Christensen P, Bliddal H, Riecke BF, Leeds AR, Astrup A, Christensen R. Comparison of a low-energy diet and a very low-energy diet in sedentary obese individuals: a pragmatic randomized controlled trial. Clin Obes 2011; 1:31-40. [PMID: 25586973 DOI: 10.1111/j.1758-8111.2011.00006.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
UNLABELLED There is no consensus on whether 'very low-energy diets' (VLED; <800 kcal d(-1) ) cause greater weight loss in obese individuals than 'low-energy diets' (LED; 800-1200 kcal d(-1) ). The objective was to determine whether a very low-energy formula diet would cause greater weight loss than a formula 810 kcal d(-1) LED in older sedentary individuals. This is a pragmatic randomized controlled trial. INCLUSION CRITERIA obesity (body mass index [BMI] > 30); age >50 years, with knee osteoarthritis. Participants were randomized to VLED (420-554 kcal d(-1) ) or LED (810 kcal d(-1) ) for 8 weeks, followed by a fixed-energy (1200 kcal d(-1) ) diet with food and two diet products daily for 8 weeks. In all, 192 participants were randomized. Mean age was 63 years (standard deviation: 6), mean weight 103.2 kg (15.0) and BMI of 37.3 kg m(-2) (4.8) at baseline. Mean weight losses in VLED and LED groups were 11.4 kg (standard error: 0.5) and 10.7 kg (0.5) at week 8 and 13.3 kg (0.7) and 12.2 kg (0.6) at week 16. Mean differences between groups were 0.76 kg (95% confidence interval: -0.59 to 2.10; P = 0.27) and 1.08 kg (-0.66 to 2.81; P = 0.22) at 8 and 16 weeks, respectively. Loss of lean body mass was 2.1 kg (0.2) and 1.2 kg (0.4) (17% and 11% of the weight lost, respectively) at week 16 in the VLED and LED group with a mean difference of 0.85 kg (0.01 to 1.69; P = 0.047). Significant adverse effects comparing VLED and LED, were bad breath: 34 (35%) vs. 21 (22%), intolerance to cold: 39 (41%) vs. 17 (18%) and flatulence: 43 (45%) vs. 28 (29%) for VLED and LED at 8 weeks (P < 0.05 in all cases). The VLED and LED regimens were equally successful in inducing weight loss. The significantly lower loss of lean tissue in the LED group together with more frequently reported side effects in the VLED group, favours the choice of low-energy diet (LED) for the treatment of obesity.
Collapse
Affiliation(s)
- P Christensen
- The Parker Institute, Copenhagen University Hospital, Frederiksberg, DenmarkDepartment of Human Nutrition, Faculty of Life Sciences, University of Copenhagen, Frederiksberg, DenmarkUniversity of Surrey and North London Obesity Surgery Service, Whittington and Central Middlesex Hospitals, London, UK
| | - H Bliddal
- The Parker Institute, Copenhagen University Hospital, Frederiksberg, DenmarkDepartment of Human Nutrition, Faculty of Life Sciences, University of Copenhagen, Frederiksberg, DenmarkUniversity of Surrey and North London Obesity Surgery Service, Whittington and Central Middlesex Hospitals, London, UK
| | - B F Riecke
- The Parker Institute, Copenhagen University Hospital, Frederiksberg, DenmarkDepartment of Human Nutrition, Faculty of Life Sciences, University of Copenhagen, Frederiksberg, DenmarkUniversity of Surrey and North London Obesity Surgery Service, Whittington and Central Middlesex Hospitals, London, UK
| | - A R Leeds
- The Parker Institute, Copenhagen University Hospital, Frederiksberg, DenmarkDepartment of Human Nutrition, Faculty of Life Sciences, University of Copenhagen, Frederiksberg, DenmarkUniversity of Surrey and North London Obesity Surgery Service, Whittington and Central Middlesex Hospitals, London, UK
| | - A Astrup
- The Parker Institute, Copenhagen University Hospital, Frederiksberg, DenmarkDepartment of Human Nutrition, Faculty of Life Sciences, University of Copenhagen, Frederiksberg, DenmarkUniversity of Surrey and North London Obesity Surgery Service, Whittington and Central Middlesex Hospitals, London, UK
| | - R Christensen
- The Parker Institute, Copenhagen University Hospital, Frederiksberg, DenmarkDepartment of Human Nutrition, Faculty of Life Sciences, University of Copenhagen, Frederiksberg, DenmarkUniversity of Surrey and North London Obesity Surgery Service, Whittington and Central Middlesex Hospitals, London, UK
| |
Collapse
|