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Breinbauer R, Mäling M, Ehnert S, Blumenstock G, Schwarz T, Jazewitsch J, Erne F, Reumann MK, Rollmann MF, Braun BJ, Histing T, Nüssler AK. B7-1 and PlGF-1 are two possible new biomarkers to identify fracture-associated trauma patients at higher risk of developing complications: a cohort study. BMC Musculoskelet Disord 2024; 25:677. [PMID: 39210389 PMCID: PMC11360573 DOI: 10.1186/s12891-024-07789-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 08/16/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Around 10% of fractures lead to complications. With increasing fracture incidences in recent years, this poses a serious burden on the healthcare system, with increasing costs for treatment. In the present study, we aimed to identify potential 'new' blood markers to predict the development of post-surgical complications in trauma patients following a fracture. METHODS A total of 292 trauma patients with a complete three-month follow-up were included in this cohort study. Blood samples were obtained from 244 of these patients. Two complication groups were distinguished based on the Clavien-Dindo (CD) classification: CD grade I and CD grade III groups were compared to the controls (CD 0). The Mann-Whitney U test was used to compare the complication groups to the control group. RESULTS Analysis of the patients' data revealed that risk factors are dependent on sex. Both, males and females who developed a CD III complication showed elevated blood levels of B7-1 (p = 0.015 and p = 0.018, respectively) and PlGF-1 (p = 0.009 and p = 0.031, respectively), with B7-1 demonstrating greater sensitivity (B7-1: 0.706 (male) and 0.692 (female), PlGF-1: 0.647 (male) and 0.615 (female)). Further analysis of the questionnaires and medical data revealed the importance of additional risk factors. For males (CD 0: 133; CD I: 12; CD III: 18 patients) alcohol consumption was significantly increased for CD I and CD III compared to control with p = 0.009 and p = 0.007, respectively. For females (CD 0: 107; CD I: 10; CD III: 12 patients) a significantly increased average BMI [kg/m2] from 25.5 to 29.7 with CD III was observed, as well as an elevation from one to three comorbidities (p = 0.003). CONCLUSIONS These two potential new blood markers hold promise for predicting complication development in trauma patients. Nevertheless, further studies are necessary to evaluate the diagnostic utility of B7-1 and PlGF-1 in predicting complications in trauma patients and consider sex differences before their possible use as routine clinical screening tools.
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Affiliation(s)
- Regina Breinbauer
- Siegfried-Weller-Institute, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
| | - Michelle Mäling
- Siegfried-Weller-Institute, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
| | - Sabrina Ehnert
- Siegfried-Weller-Institute, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
| | - Gunnar Blumenstock
- Department of Clinical Epidemiology and Applied Biometry, Eberhard Karls University Tuebingen, Silcherstrasse 5, 72076, Tuebingen, Germany
| | - Tobias Schwarz
- Siegfried-Weller-Institute, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
| | - Johann Jazewitsch
- Siegfried-Weller-Institute, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
| | - Felix Erne
- Siegfried-Weller-Institute, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076, Tuebingen, Germany
| | - Marie K Reumann
- Siegfried-Weller-Institute, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076, Tuebingen, Germany
| | - Mika F Rollmann
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076, Tuebingen, Germany
| | - Benedikt J Braun
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076, Tuebingen, Germany
| | - Tina Histing
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076, Tuebingen, Germany
| | - Andreas K Nüssler
- Siegfried-Weller-Institute, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany.
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Gamper M, Seidel J, Kupfer A, Keim-Klärner S, Klärner A. Gender and Health Inequalities: Social Networks in the Context of Health and Health Behavior. SOCIAL NETWORKS AND HEALTH INEQUALITIES 2022:245-272. [DOI: 10.1007/978-3-030-97722-1_14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
AbstractThere are significant differences in morbidity (incidence of disease) and mortality (death rate) between men and women. By puberty, male adolescents are more likely to have health problems. During puberty, girls suffer from chronic and mental illnesses and male adolescents are more likely to suffer from acute and life-threatening diseases. Boys and men have riskier health behavior. The field of research mainly relates to the binarity of the sexes—men and women. Studies on trans and queer persons are rare in this field. Networks have a gender-specific effect on risk behavior. Women provide more and more time-consuming social support, even in case of illness. After widowhood, networks have both negative and positive effects, which are gender-specific.
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Settelmeier S, Rassaf T, Hochadel M, Voigtländer T, Münzel T, Senges J, Breuckmann F, Giannitsis E. Gender Differences in Patients Admitted to a Certified German Chest Pain Unit: Results from the German Chest Pain Unit Registry. Cardiology 2020; 145:562-569. [PMID: 32781458 DOI: 10.1159/000509276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/05/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Gender-specific atypical clinical presentation in acute coronary syndrome and sex-specific outcomes in cardiovascular disease in women are well known. The aim of this study is to analyze possible differences between men and women presenting to certified German chest pain units (CPUs). METHODS Data from 13,900 patients derived from the German CPU registry were analyzed for gender differences in patient characteristics, cardiovascular disease manifestation, critical time intervals, treatment and prognosis. RESULTS A total of 37.8% of patients were female. Typical chest pain occurred more frequently in men, while atypical symptoms occurred more frequently in women. Female gender was associated with longer pre- and in-hospital time delays. Women were more often diagnosed with a nonischemic origin of pain. In a 3-month follow-up, there was no gender-specific difference in combined major adverse coronary and cerebrovascular events. DISCUSSION/CONCLUSION This study points out gender-specific differences in prehospital time intervals and a significantly higher percentage of atypical symptoms in suspected myocardial ischemia as well as more noncoronary diagnoses in women. Symptom awareness and a broader diagnostic workup in women are essential.
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Affiliation(s)
- Stephan Settelmeier
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
| | - Matthias Hochadel
- Institute for Myocardial Infarction Research Foundation, Ludwigshafen, Germany
| | | | - Thomas Münzel
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jochen Senges
- Institute for Myocardial Infarction Research Foundation, Ludwigshafen, Germany
| | - Frank Breuckmann
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany,
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Regitz-Zagrosek V. [Gender-specific aspects of chronic coronary artery disease in everyday practice. Results of the AURORA health care study]. MMW Fortschr Med 2020; 162:21-27. [PMID: 32661891 DOI: 10.1007/s15006-020-0660-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/25/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Sex/gender differences pose a challenge in the care of patients with chronic coronary artery disease (CAD) especially in the resident sector. The aim of the AURORA trial was to obtain a nationwide overview on how resident cardiologists deal with sex/gender-specific aspects of symptomatic chronic CAD in their medical routine care and in the interplay with general practitioners, as well as derive insights out of it for general practice. METHOD Between October 2018 and April 2019 a survey among German cardiologists (n = 360) in the outpatient sector was performed using a structured questionnaire. Items focused on the cardiologists' personal assessment of sex/gender aspects in the diagnosis and treatment and consequences for the overall medical care of patients with chronic CAD. RESULTS The range of symptoms of chronic CAD in male and female patients was differently assessed by the participating male or female cardiologists. General practitioners referred men at an earlier stage than women to a cardiologist for further testing. In male and female patients with non-obstructive CAD cardiovascular risk was largely assessed as comparable to patients with obstructive CAD. In terms of medical care, it was shown that therapeutic decisions made by cardiologists were generally considered and continued by the general practitioners. CONCLUSIONS Results from previous trials on sex/gender differences in ischemic heart disease have made their way into medical care. However, they also show potential for optimization in diagnosis, treatment and collaboration between resident cardiologists and general practitioners. Overall the results indicate that sex/gender differences in chronic CAD gain more medical attention. However, there is a current lack of concise sex-specific guidelines for prevention, diagnosis and treatment.
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Affiliation(s)
- Vera Regitz-Zagrosek
- GIM, Charité, Universitätsmedizin Berlin, Universitätsmedizin Zürich, Deutschland.
- GIM, Charité, Universitätsmedizin Berlin, Universitätsmedizin Zürich, Hessische Straße 3-4, D-10115, Berlin, Deutschland.
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Rrustemi I, Locatelli I, Schwarz J, Lagro-Janssen T, Fauvel A, Clair C. Gender awareness among medical students in a Swiss University. BMC MEDICAL EDUCATION 2020; 20:156. [PMID: 32487129 PMCID: PMC7268694 DOI: 10.1186/s12909-020-02037-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 04/07/2020] [Indexed: 05/10/2023]
Abstract
BACKGROUND Gender is an important social determinant, that influences healthcare. The lack of awareness on how gender influences health might lead to gender bias and can contribute to substandard patient care. Our objectives were to assess gender sensitivity and the presence of gender stereotypes among swiss medical students. METHODS A validated scale (N-GAMS - Nijmegen Gender Awareness in Medicine Scale), with 3 subscores assessing gender sensitivity (GS) and gender stereotypes toward patients (GRIP) and doctors (GRID) (ranging from 1 to 5), was translated into French and was distributed to all medical students registered at the University of Lausanne, Switzerland in April-May 2017. Reliability of the three subscales was assessed calculating the alpha Cronbach coefficient. Mean subscales were calculated for male and female students and compared using two sample t-tests. A linear model was built with each subscale as a dependent variable and students' sex and age as covariables. RESULTS In total, 396 students answered the N-GAMS questionnaire, their mean age was 22 years old, 62.6% of them were women. GS and GRID sub-scores were not significantly different between female and male students (GS 3.62 for women, 3.70 for men, p = 0.27, GRID 2.10 for women, 2.13 for men, p = 0.76). A statistically significant difference was found in the GRIP subscale, with a mean score of 1.83 for women and 2.07 for men (p < 0.001), which suggests a more gender stereotyped opinion toward patients among male students. A trend was observed with age, gender sensibility increased (p < 0.001) and stereotypes decreased (GRIP p = 0.04, GRID p = 0.02) with students getting older. CONCLUSION Medical students' gender sensitivity seems to improve throughout the medical curriculum, and women students have less stereotypes towards patients than men do. The implementation of a gender-sensitive teaching in the medical curriculum could improve students' knowledge, limit gender bias and improve patients' care.
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Affiliation(s)
- Ilire Rrustemi
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Center for Primary Care and Public Health (Unisanté), Lausanne, Rue du Bugnon 44, CH-1011 Lausanne, Switzerland
| | - Isabella Locatelli
- Center for Primary Care and Public Health (Unisanté), Lausanne, Rue du Bugnon 44, CH-1011 Lausanne, Switzerland
| | - Joëlle Schwarz
- Center for Primary Care and Public Health (Unisanté), Lausanne, Rue du Bugnon 44, CH-1011 Lausanne, Switzerland
| | - Toine Lagro-Janssen
- Dept. of Primary and Community Care, Radboud University Medical Center, Geert Grooteplein 21, 6525 EZ Nijmegen, Netherlands
| | - Aude Fauvel
- Institute of Humanities in Medicine, Lausanne University Hospital (CHUV), Lausanne, Avenue de Provence 82, 1007 Lausanne, Switzerland
| | - Carole Clair
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Center for Primary Care and Public Health (Unisanté), Lausanne, Rue du Bugnon 44, CH-1011 Lausanne, Switzerland
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Carè A, Bellenghi M, Matarrese P, Gabriele L, Salvioli S, Malorni W. Sex disparity in cancer: roles of microRNAs and related functional players. Cell Death Differ 2018; 25:477-485. [PMID: 29352271 PMCID: PMC5864217 DOI: 10.1038/s41418-017-0051-x] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 11/13/2017] [Accepted: 11/24/2017] [Indexed: 01/08/2023] Open
Abstract
A sexual dimorphism at the cellular level has been suggested to play a role in cancer onset and progression. In particular, very recent studies have unraveled striking differences between cells carrying XX or XY chromosomes in terms of response to stressful stimuli, indicating the presence of genetic and epigenetic differences determining sex-specific metabolic or phenotypic traits. Although this field of investigation is still in its infancy, available data suggest a key role of sexual chromosomes in determining cell life or death. In particular, cells carrying XX chromosomes exhibit a higher adaptive potential and survival behavior in response to microenvironmental variations with respect to XY cells. Cells from females also appear to be equipped with more efficient epigenetic machinery than the male counterpart. In particular, the X chromosome contains an unexpected high number of microRNAs (miRs), at present 118, in comparison with only two miRs localized on chromosome Y, and an average of 40-50 on the autosomes. The regulatory power of these small non-coding RNAs is well recognized, as 30-50% of all protein-coding genes are targeted by miRs and their role in cell fate has been well demonstrated. In addition, several further insights, including DNA methylation patterns that are different in males and females, claim for a significant gender disparity in cancer and in the immune system activity against tumors. In this brief paper, we analyze the state of the art of our knowledge on the implication of miRs encoded on sex chromosomes, and their related functional paths, in the regulation of cell homeostasis and depict possible perspectives for the epigenetic research in the field.
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Affiliation(s)
- Alessandra Carè
- Oncology Unit, Center for Gender-specific Medicine Istituto Superiore di Sanita', Viale Regina Elena, 299 00161, Rome, Italy
| | - Maria Bellenghi
- Oncology Unit, Center for Gender-specific Medicine Istituto Superiore di Sanita', Viale Regina Elena, 299 00161, Rome, Italy
| | - Paola Matarrese
- Oncology Unit, Center for Gender-specific Medicine Istituto Superiore di Sanita', Viale Regina Elena, 299 00161, Rome, Italy
| | - Lucia Gabriele
- Immunotherapy Unit, Department of Oncology and Molecular Medicine, Istituto Superiore di Sanita', Viale Regina Elena, 299 00161, Rome, Italy
| | - Stefano Salvioli
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Via San Giacomo 12, 40126, Bologna, Italy
| | - Walter Malorni
- Oncology Unit, Center for Gender-specific Medicine Istituto Superiore di Sanita', Viale Regina Elena, 299 00161, Rome, Italy.
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