1
|
Pedersen AK, Nygaard KH, Petersen SR, Specht K, Strøm T, Moos CM, Skjøt-Arkil H, Schønnemann JO. Adjusting perioperative methadone dose for elderly and fragile hip fracture patients (MetaHip-trial) - A statistical analysis plan for an adaptive dose-finding trial. Contemp Clin Trials Commun 2023; 36:101228. [PMID: 38047142 PMCID: PMC10689264 DOI: 10.1016/j.conctc.2023.101228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 10/24/2023] [Accepted: 11/04/2023] [Indexed: 12/05/2023] Open
Abstract
Background The elderly population is expanding globally. This gives numerous challenges especially regarding hip fracture patients. In the US alone over 300.000 hip fracture patients are treated each year, and a large amount of those develop opoid addiction. Hip fractures require surgical intervention within 24 h and is associated with significant pain even at rest. Postoperative analgesic treatment need to be optimized to ensure adequate pain relief and to prevent subsequent opioid addiction. Previous studies have shown that methadone effectively decreases post-operative opioid consumption but the studies focused on younger patients undergoing elective surgery. This study focus on the use of methadone on the elderly, fragile patients undergoing acute surgery, by first determining the maximal tolerable dose.The hypothesis is the maximal tolerable doses of these hip-fracture patients lies between 0.10 mg/kg and 0.20 mg/kg. This trial aims to estimate the maximum tolerable dose of methadone when administered to elderly patients undergoing surgery for a hip fracture. Method This project is an adaptive dose-finding trial. The continuous reassessment method will estimate the maximum tolerable dose of methadone. The primary outcome will be respiratory depression. The statistical analysis plan will be published a priori to the closure of patient recruitment and statistical analysis of database results. Conclusion The results of this study will give valuable information about the maximally tolerated dose of methadone for postoperative pain relief for elderly patients with hip fractures and potential adverse events.This trial is registered on clinicaltrials.gov with trial registration: NCT05581901. Registered 17 October 2022, https://www.clinicaltrials.gov/ct2/show/NCT05581901?term=methadone&cond = hip&draw = 2&rank = 1.
Collapse
Affiliation(s)
- Andreas Kristian Pedersen
- Department of Clinical Research, University Hospital of Southern Denmark, Kresten Phillipsens vej, Aabenraa, Denmark
| | - Kevin Heebøll Nygaard
- Department of Clinical Research, University Hospital of Southern Denmark, Kresten Phillipsens vej, Aabenraa, Denmark
- Department of Orthopedics, University Hospital of Southern Denmark, Kresten Phillipsens vej, Aabenraa, Denmark
| | - Sofie Ronja Petersen
- Department of Clinical Research, University Hospital of Southern Denmark, Kresten Phillipsens vej, Aabenraa, Denmark
| | - Kirsten Specht
- Center for COPD, Center for Health and Rehabilitation, Randersgade 60, 2100, København Ø, Denmark
| | - Thomas Strøm
- Department of Anesthesiology and Intensive Care, University Hospital of Southern Denmark, Kresten Philipsens vej 15, 6200, Aabenraa, Denmark
| | - Caroline Margaret Moos
- Department of Clinical Research, University Hospital of Southern Denmark, Kresten Phillipsens vej, Aabenraa, Denmark
| | - Helene Skjøt-Arkil
- Department of Clinical Research, University Hospital of Southern Denmark, Kresten Phillipsens vej, Aabenraa, Denmark
- Emergency Department, University Hospital of Southern Denmark, Kresten Phillipsens vej, Aabenraa, Denmark
| | - Jesper Ougaard Schønnemann
- Department of Orthopedics, University Hospital of Southern Denmark, Kresten Phillipsens vej, Aabenraa, Denmark
| |
Collapse
|
2
|
Visentin R, Brodersen K, Richelsen B, Møller N, Dalla Man C, Pedersen AK, Abrahamsen J, Holst JJ, Nielsen MF. Increased Insulin Secretion and Glucose Effectiveness in Obese Patients with Type 2 Diabetes following Bariatric Surgery. J Diabetes Res 2023; 2023:7127426. [PMID: 38020201 PMCID: PMC10663093 DOI: 10.1155/2023/7127426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Background β-cell dysfunction and insulin resistance are the main mechanisms causing glucose intolerance in type 2 diabetes (T2D). Bariatric surgeries, i.e., sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), are procedures both known to induce weight loss, increase insulin action, and enhance β-cell function, but hepatic insulin extraction and glucose effectiveness may also play a role. Methods To determine the contribution of these regulators on glucose tolerance after bariatric surgery, an oral glucose tolerance test (OGTT) was performed before and 2 months after surgery in 9 RYGB and 7 SG subjects. Eight healthy subjects served as metabolic controls. Plasma glucose, insulin, C-peptide, GLP-1, and GIP were measured during each OGTT. Insulin sensitivity and secretion, glucose effectiveness, and glucose rate of appearance were determined via oral minimal models. Results RYGB and SG resulted in similar weight reductions (13%, RYGB (p < 0.01); 14%, SG (p < 0.05)). Two months after surgery, insulin secretion (p < 0.05) and glucose effectiveness both improved equally in the two groups (11%, RYGB (p < 0.01); 8%, SG (p > 0.05)), whereas insulin sensitivity remained virtually unaltered. Bariatric surgery resulted in a comparable increase in the GLP-1 response during the OGTT, whereas GIP concentrations remained unaltered. Following surgery, oral glucose intake resulted in a comparable increase in hepatic insulin extraction, the response in both RYGB and SG patients significantly exceeding the response observed in the control subjects. Conclusions These results demonstrate that the early improvement in glucose tolerance in obese T2D after RYGB and SG surgeries is attributable mainly to increased insulin secretion and glucose effectiveness, while insulin sensitivity seems to play only a minor role. This trial is registered with NCT02713555.
Collapse
Affiliation(s)
- Roberto Visentin
- Department of Information Engineering, University of Padova, Padova, Italy
| | | | - Bjørn Richelsen
- Steno Diabetes Center Aarhus, Aarhus University Hospital & Clinical Medicine, Aarhus University, Denmark
| | - Niels Møller
- Steno Diabetes Center Aarhus, Aarhus University Hospital & Clinical Medicine, Aarhus University, Denmark
| | - Chiara Dalla Man
- Department of Information Engineering, University of Padova, Padova, Italy
| | | | - Jan Abrahamsen
- Department of Radiology, Viborg General Hospital, Denmark
| | - Jens Juul Holst
- Novo Nordisk Foundation, Center of Basic Metabolic Research and Department of Biomedical Sciences, The Panum Institute, University of Copenhagen, Denmark
| | | |
Collapse
|
3
|
Cartuliares MB, Rosenvinge FS, Mogensen CB, Skovsted TA, Andersen SL, Østergaard C, Pedersen AK, Skjøt-arkil H. Evaluation of point-of-care multiplex polymerase chain reaction in guiding antibiotic treatment of patients acutely admitted with suspected community-acquired pneumonia in Denmark: A multicentre randomised controlled trial. PLoS Med 2023; 20:e1004314. [PMID: 38015833 PMCID: PMC10684013 DOI: 10.1371/journal.pmed.1004314] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/26/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Rapid and accurate detection of pathogens is needed in community-acquired pneumonia (CAP) to enable appropriate antibiotics and to slow the development of antibiotic resistance. We aimed to compare the effect of point-of-care (POC) polymerase chain reaction (PCR) detection of respiratory pathogens added to standard care with standard care only (SCO) on antibiotic prescriptions after acute hospital admission. METHODS AND FINDINGS We performed a superiority, parallel-group, open-label, multicentre, randomised controlled trial (RCT) in 3 Danish medical emergency departments (EDs) from March 2021 to February 2022. Adults acutely admitted with suspected CAP during the daytime on weekdays were included and randomly assigned (1:1) to POC-PCR (The Biofire FilmArray Pneumonia Panel plus added to standard care) or SCO (routine culture and, if requested by the attending physician, target-specific PCR) analysis of respiratory samples. We randomly assigned 294 patients with successfully collected samples (tracheal secretion 78.4% or expectorated sputum 21.6%) to POC-PCR (n = 148, 50.4%) or SCO (146, 49.6%). Patients and investigators owning the data were blinded to the allocation and test results. Outcome adjudicators and clinical staff at the ED were not blinded to allocation and test results but were together with the statistician, blinded to data management and analysis. Laboratory staff performing standard care analyses was blinded to allocation. The study coordinator was not blinded. Intention-to-treat and per protocol analysis were performed using logistic regression with Huber-White clustered standard errors for the prescription of antibiotic treatment. Loss to follow-up comprises 3 patients in the POC-PCR (2%) and none in the SCO group. Intention-to-treat analysis showed no difference in the primary outcome of prescriptions of no or narrow-spectrum antibiotics at 4 h after admission for the POC-PCR (n = 91, 62.8%) odds ratio (OR) 1.13; (95% confidence interval (CI) [0.96, 1.34] p = 0.134) and SCO (n = 87, 59.6%). Secondary outcomes showed that prescriptions were significantly more targeted at 4-h OR 5.68; (95% CI [2.49, 12.94] p < 0.001) and 48-h OR 4.20; (95% CI [1.87, 9.40] p < 0.001) and more adequate at 48-h OR 2.11; (95% CI [1.23, 3.61] p = 0.006) and on day 5 in the POC-PCR group OR 1.40; (95% CI [1.18, 1.66] p < 0.001). There was no difference between the groups in relation to intensive care unit (ICU) admissions OR 0.54; (95% CI [0.10, 2.91] p = 0.475), readmission within 30 days OR 0.90; (95% CI [0.43, 1.86] p = 0.787), length of stay (LOS) IRR 0.82; (95% CI [0.63, 1.07] p = 0.164), 30 days mortality OR 1.24; (95% CI [0.32, 4.82] p = 0.749), and in-hospital mortality OR 0.98; (95% CI [0.19, 5.06] p = 0.986). CONCLUSIONS In a setting with an already restrictive use of antibiotics, adding POC-PCR to the diagnostic setup did not increase the number of patients treated with narrow-spectrum or without antibiotics. POC-PCR may result in a more targeted and adequate use of antibiotics. A significant study limitation was the concurrent Coronavirus Disease 2019 (COVID-19) pandemic resulting in an unusually low transmission of respiratory virus. TRIAL REGISTRATION ClinicalTrials.gov (NCT04651712).
Collapse
Affiliation(s)
- Mariana Bichuette Cartuliares
- Department of Emergency Medicine, University Hospital of Southern Denmark, Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark
| | - Flemming Schønning Rosenvinge
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Microbiology, University of Southern Denmark, Odense, Denmark
| | - Christian Backer Mogensen
- Department of Emergency Medicine, University Hospital of Southern Denmark, Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark
| | - Thor Aage Skovsted
- Department of Biochemistry and Immunology, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Steen Lomborg Andersen
- Department of Clinical Microbiology, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Claus Østergaard
- Department of Clinical Microbiology, Lillebaelt Hospital, Vejle, Denmark
| | | | - Helene Skjøt-arkil
- Department of Emergency Medicine, University Hospital of Southern Denmark, Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark
| |
Collapse
|
4
|
Kristensen GS, Kjeldgaard AH, Søndergaard J, Andersen-Ranberg K, Pedersen AK, Mogensen CB. Associations between care home residents' characteristics and acute hospital admissions - a retrospective, register-based cross-sectional study. BMC Geriatr 2023; 23:234. [PMID: 37072701 PMCID: PMC10114422 DOI: 10.1186/s12877-023-03895-1] [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: 11/02/2022] [Accepted: 03/15/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Care home residents are frail, multi-morbid, and have an increased risk of experiencing acute hospitalisations and adverse events. This study contributes to the discussion on preventing acute admissions from care homes. We aim to describe the residents' health characteristics, survival after care home admission, contacts with the secondary health care system, patterns of admissions, and factors associated with acute hospital admissions. METHOD Data on all care home residents aged 65 + years living in Southern Jutland in 2018-2019 (n = 2601) was enriched with data from highly valid Danish national health registries to obtain information on characteristics and hospitalisations. Characteristics of care home residents were assessed by sex and age group. Factors associated with acute admissions were analysed using Cox Regression. RESULTS Most care home residents were women (65.6%). Male residents were younger at the time of care home admission (mean 80.6 vs. 83.7 years), had a higher prevalence of morbidities, and shorter survival after care home admission. The 1-year survival was 60.8% and 72.3% for males and females, respectively. Median survival was 17.9 months and 25.9 months for males and females, respectively. The mean rate of acute hospitalisations was 0.56 per resident-year. One in four (24.4%) care home residents were discharged from the hospital within 24 h. The same proportion was readmitted within 30 days of discharge (24.6%). Admission-related mortality was 10.9% in-hospital and 13.0% 30 days post-discharge. Male sex was associated with acute hospital admissions, as was a medical history of various cardiovascular diseases, cancer, chronic obstructive pulmonary disease, and osteoporosis. In contrast, a medical history of dementia was associated with fewer acute admissions. CONCLUSION This study highlights some of the major characteristics of care home residents and their acute hospitalisations and contributes to the ongoing discussion on improving or preventing acute admissions from care homes. TRIAL REGISTRATION Not relevant.
Collapse
Affiliation(s)
- Gitte Schultz Kristensen
- Emergency Department, Aabenraa Hospital, Department of Regional Health Research, Faculty of Health Science, University Hospital of Southern Jutland, University of Southern Denmark, Odense, Denmark.
| | | | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Karen Andersen-Ranberg
- Geriatric Research Unit, Department of Clinical Research, Department of Public Health, Department of Regional Health Research, Faculty of Health Science, Clinical research Department, Aabenraa Hospital, University of Southern Denmark University Hospital of Southern Denmark, Odense, Denmark
| | - Andreas Kristian Pedersen
- Department of Regional Health Research, Faculty of Health Science, Emergency Department, Aabenraa Hospital, The University of Southern Denmark, University Hospital of Southern Denmark, Odense, Denmark
| | - Christian Backer Mogensen
- Department of Regional Health Research, Faculty of Health Science, Emergency Department, Aabenraa Hospital, The University of Southern Denmark, University Hospital of Southern Denmark, Odense, Denmark
| |
Collapse
|
5
|
Cuk P, Jawhara M, Al-Najami I, Helligsø P, Pedersen AK, Ellebæk MB. Robot-assisted versus laparoscopic short- and long-term outcomes in complete mesocolic excision for right-sided colonic cancer: a systematic review and meta-analysis. Tech Coloproctol 2023; 27:171-181. [PMID: 36001164 DOI: 10.1007/s10151-022-02686-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] [Received: 12/09/2021] [Accepted: 08/10/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Complete mesocolic excision (CME) surgery is increasingly implemented for the resection of right-sided colonic cancer, possibly resulting in improved 5-year overall and disease-free survival compared to non-CME surgery. However, it is not clear what surgical platform should be used. The aim of this study was to compare the following outcomes between robot-assisted and laparoscopic CME-surgery for right-sided colonic cancer: (i) short-term clinical outcomes, (ii) pathological specimen quality, and (iii) long-term oncological outcomes. METHODS Medline, Embase, and Cochrane Database of Systematic Reviews were searched from inception until August 2021. Pooled proportions were calculated by applying the inverse variance method. Heterogeneity was explored by I-square and supplemented by sensitivity- and meta-regression analyses. The risk of bias was evaluated by either MINORS or Cochrane's risk-of-bias tool (RoB 2). RESULTS Fifty-five studies with 5.357 patients (740 robot-assisted and 4617 laparoscopic) were included in the meta-analysis. Overall postoperative morbidity was 17% [95% CI (14-20%)] in the robot-assisted group and 13% [95%CI (12-13%)] in the laparoscopic group. Robot-assisted CME was associated with a shorter hospital stay, lower intraoperative blood loss, a higher amount of harvested lymph nodes, and better 3-year oerall and disease-free survival. MINORS and RoB2 indicated a serious risk of bias across studies included. CONCLUSIONS This review which includes predominantly non-randomized studies suggests a possible advantage of the robot-assisted CME compared with a laparoscopic technique for several short-term outcomes.
Collapse
Affiliation(s)
- Pedja Cuk
- Surgical Department, Hospital of Southern Jutland, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark. .,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Mohamad Jawhara
- Surgical Department, Hospital of Southern Jutland, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark
| | - Issam Al-Najami
- Research Unit for Surgery, Odense University Hospital, Odense, Denmark
| | - Per Helligsø
- Surgical Department, Hospital of Southern Jutland, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark
| | | | | |
Collapse
|
6
|
Valsamidis A, Allah Alnabhan A, Nielsen KA, Pedersen AK, Helligsø P, Mogensen CB, Nielsen MF. P-009 OPEN VS LAPAROSCOPIC VS ROBOT-ASSISTED INGUINAL HERNIA REPAIR: A CASE SERIES. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Aim
Minimally invasive inguinal hernia repair is thought to be associated with fewer complications. To address this hypothesis, we compared short- and long-term complications in patients undergoing elective open (Lichtenstein), laparoscopic (TAPP) and robot-assisted inguinal hernia repair (rTAPP).
Material & Methods
Patients undergoing either, Lichtenstein, TAPP or rTAPP at our institution between January 1st 2017 and December 30th 2019 were retrospectively identified. Short (haematoma, seroma, surgical-site infections) and long-term complications (chronic pain, recurrence) were recorded and compared between groups.
Results
636 patients were included in the study. 370 were treated with Lichtenstein, 125 TAPP and 141 with rTAPP. There was a significant overweight of men in all groups (p < 0,001). Among the rTAPP group, the overall rate of complications was reduced (open: 10.0%; laparoscopic: 8.8%; robot-assisted 5.7%) while the presence of chronic pain was slightly more prevalent (Lichtenstein: 1.6%; TAPP: 1.6%; rTAPP: 2.1%). The rate of recurrence was lower following rTAPP (Lichtenstein: 3.8%; TAPP: 2.4%; rTAPP: 1.4%). Same day discharged was more likely following the open technique (open: 88.9%; laparoscopic: 78.4%; robot-assisted 78.7%). Nevertheless, these results were not statistically significant (p>0.05).
Conclusions
The present case series demonstrates a comparable rate of short and long-term complications following open and minimally invasive inguinal hernia repair. The trend towards a lower overall complications rate and recurrence rate, though not statistically significant, implies that minimally invasive surgery might be associated with a lower complication and recurrence rate. However, a larger prospective study design with a longer follow-up is needed to test this hypothesis.
Collapse
Affiliation(s)
- A Valsamidis
- Department of General Surgery, University Hospital of Southern Denmark , Aabenraa , Denmark
| | - A Allah Alnabhan
- Department of General Surgery, University Hospital of Southern Denmark , Aabenraa , Denmark
| | - K A Nielsen
- Department of General Surgery, University Hospital of Southern Denmark , Aabenraa , Denmark
| | - A K Pedersen
- Department of Clinical Research, University Hospital of Southern Denmark , Aabenraa , Denmark
| | - P Helligsø
- Department of General Surgery, University Hospital of Southern Denmark , Aabenraa , Denmark
| | - C B Mogensen
- Department of Clinical Research, University Hospital of Southern Denmark , Aabenraa , Denmark
| | - M F Nielsen
- Department of General Surgery, University Hospital of Southern Denmark , Aabenraa , Denmark
| |
Collapse
|
7
|
Jøhnk C, Laigaard HH, Pedersen AK, Bauer EH, Brandt F, Bollig G, Wolff DL. Time to End-of-Life of Patients Starting Specialised Palliative Care in Denmark: A Descriptive Register-Based Cohort Study. Int J Environ Res Public Health 2022; 19:13017. [PMID: 36293593 PMCID: PMC9602996 DOI: 10.3390/ijerph192013017] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
Increasing numbers of patients are being referred to specialised palliative care (SPC) which, in order to be beneficial, is recommended to last more than three months. This cohort study aimed to describe time to end-of-life after initiating SPC treatment and to explore potential regional variations. We used national register data from all Danish hospital SPC teams. We included patients who started SPC treatment from 2015-2018 to explore if time to end-of-life was longer than three months. Descriptive statistics were used to summarise the data and a generalised linear model was used to assess variations among the five Danish regions. A total of 27,724 patients were included, of whom 36.7% (95% CI 36.2-37.1%) had over three months to end-of-life. In the Capital Region of Denmark, 40.1% (95% CI 39.0-41.3%) had over three months to end-of-life versus 32.5% (95% CI 30.9-34.0%) in North Denmark Region. We conclude that most patients live for a shorter period of time than the recommended three months after initiating SPC treatment. This is neither optimal for patient care, nor the healthcare system. A geographical variation between regions was shown indicating different practices, patient groups or resources. These results warrant further investigation to promote optimal SPC treatment.
Collapse
Affiliation(s)
- Camilla Jøhnk
- Department of Internal Medicine, Hospital Sønderjylland, University Hospital of Southern Denmark, Sydvang 1, 6400 Sønderborg, Denmark
| | - Helene Holm Laigaard
- Department of Internal Medicine, Hospital Sønderjylland, University Hospital of Southern Denmark, Sydvang 1, 6400 Sønderborg, Denmark
| | - Andreas Kristian Pedersen
- Department of Regional Health Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense, Denmark
- Department of Clinical Research, Hospital Sønderjylland, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200 Aabenraa, Denmark
| | - Eithne Hayes Bauer
- Department of Regional Health Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense, Denmark
- Internal Medicine Research Unit, Hospital Sønderjylland, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200 Aabenraa, Denmark
| | - Frans Brandt
- Department of Internal Medicine, Hospital Sønderjylland, University Hospital of Southern Denmark, Sydvang 1, 6400 Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense, Denmark
- Internal Medicine Research Unit, Hospital Sønderjylland, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200 Aabenraa, Denmark
| | - Georg Bollig
- Department of Internal Medicine, Hospital Sønderjylland, University Hospital of Southern Denmark, Sydvang 1, 6400 Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense, Denmark
- Internal Medicine Research Unit, Hospital Sønderjylland, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200 Aabenraa, Denmark
- Department of Anesthesiology, Intensive Care, Palliative Medicine and Pain Therapy, HELIOS Klinikum, 24837 Schleswig, Germany
| | - Donna Lykke Wolff
- Department of Regional Health Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense, Denmark
- Internal Medicine Research Unit, Hospital Sønderjylland, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200 Aabenraa, Denmark
| |
Collapse
|
8
|
Dalsgaard JL, Hansen MS, Thrysoee L, Ekholm O, Thorup CB, Mols R, Rasmussen TB, Christensen AV, Berg SK, Pedersen AK, Jensen LO, Mogensen CB, Borregaard B. Self-reported health and adverse outcomes among women living with symptoms of angina or unspecific chest pain but no diagnosis of obstructive coronary artery disease - findings from the DenHeart study. Eur J Cardiovasc Nurs 2022:6702642. [PMID: 36124692 DOI: 10.1093/eurjcn/zvac085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/14/2022]
Abstract
AIMS The objectives were to describe differences in self-reported health at discharge between women diagnosed with angina or unspecific chest pain and investigate the association between self-reported health and adverse outcomes within three years. METHODS AND RESULTS Data from a national cohort study were used, including data from the DenHeart survey combined with three years of register-based follow-up. The population included two groups of women with symptoms of angina but no diagnosis of obstructive coronary artery disease at discharge (women with angina and women with unspecific chest pain). Self-reported health measured with validated instruments was combined with register-based follow-up on adverse outcomes (a composite of unplanned cardiac readmissions, revascularisation, or all-cause mortality). Associations between self-reported health and time to first adverse outcomes were investigated with Cox Proportional Hazard Models; reported as hazards ratios (HR) with 95% confidence intervals (CI).In total, 1770 women completed the questionnaire (49%). Women with angina (n = 931) reported significantly worse self-reported health on several outcomes than women with unspecific chest pain (n = 839). Within the three years follow-up, women with angina were more often readmitted (29% vs 23%, p = 0.011) and more underwent revascularisation (10% vs 1%, p < 0.001), whereas mortality rates were similar (4% vs 4%, p = 0.750). Self-reported health (physical and mental) was associated with adverse outcomes between both groups (on most instruments). CONCLUSION Women with angina reported significantly worse self-reported health on most instruments compared to women with unspecific chest pain. Adverse outcomes varied between groups, with women diagnosed with angina experiencing more events. REGISTRATION ClinicalTrials.gov (NCT01926145).
Collapse
Affiliation(s)
- Jane Lange Dalsgaard
- Department of Cardiology, University Hospital of Southern Denmark, Aabenraa Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University Hospital of Southern Denmark, Aabenraa Denmark
| | - Michael Skov Hansen
- Department of Cardiology, University Hospital of Southern Denmark, Aabenraa Denmark
| | - Lars Thrysoee
- Department of Clinical Research, University of Southern Denmark, Odense
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Charlotte Brun Thorup
- Department of Cardiology, Cardiothoracic Surgery and Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Rikke Mols
- Department of Cardiology, Aarhus University Hospital, Skejby Sygehus, Aarhus, Denmark
| | - Trine Bernholdt Rasmussen
- Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Demark
- University of Copenhagen, Copenhagen, Denmark
| | | | - Selina Kikkenborg Berg
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | - Andreas Kristian Pedersen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University Hospital of Southern Denmark, Aabenraa Denmark
| | - Lisette Okkels Jensen
- Department of Clinical Research, University of Southern Denmark, Odense
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Christian Backer Mogensen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University Hospital of Southern Denmark, Aabenraa Denmark
- Department of Emergency Medicine, Hospital of Southern Denmark, Aabenraa, Denmark
| | - Britt Borregaard
- Department of Clinical Research, University of Southern Denmark, Odense
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Denmark
| |
Collapse
|
9
|
Rasmussen NF, Green A, Allin KH, Iversen AT, Madsen GI, Pedersen AK, Wolff DL, Jess T, Andersen V. Clinical procedures used to diagnose inflammatory bowel disease: real-world evidence from a Danish nationwide population-based study. BMJ Open Gastroenterol 2022; 9:bmjgast-2022-000958. [PMID: 36028261 PMCID: PMC9422868 DOI: 10.1136/bmjgast-2022-000958] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/03/2022] [Indexed: 12/07/2022] Open
Abstract
Objective Although clinical guidelines exist, the diagnostic work-up for diagnosing inflammatory bowel disease (IBD) is complex and varies in clinical practice. This study used real-life data to characterise the current diagnostic procedures used to establish IBD diagnoses in a Danish nationwide setting. Design Person-level data on patients diagnosed with IBD between 1 January 2014 and 30 June 2018 were linked between Danish health registers. Information on age, sex, registration of other gastrointestinal diseases, and diagnostic procedures (endoscopies, biopsies, and imaging) performed in relation to the first IBD hospital admission was analysed for the total study population and was stratified by IBD type, sex, and age. Results The majority of the 12 871 patients with IBD included underwent endoscopy (84%), had a biopsy taken (84%), and/or underwent imaging procedures (44%). In total, 7.5% of the population (6% for Crohn’s disease and 8% for ulcerative colitis) were diagnosed with IBD despite not undergoing any of these diagnostic procedures. Patients with Crohn’s disease underwent more procedures than patients with ulcerative colitis (94% vs 92%, p<0.001). Children underwent slightly fewer diagnostic procedures than adults (92% vs 93%, p=0.004). Slightly more men underwent at least one procedure than women (92% vs 94%, p<0.001). Conclusion For 7.5% of patients with IBD, this study did not detect any registrations of the recommended diagnostic procedures for establishing an IBD diagnosis. Further research is needed to examine whether these findings are mainly explained by limitations of the register data or also indicate shortcomings of the general approach to IBD.
Collapse
Affiliation(s)
- Nathalie Fogh Rasmussen
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark .,Research Unit of Molecular Diagnostics and Clinical Research, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Anders Green
- Steno Diabetes Center Odense, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kristine Højgaard Allin
- National Center of Excellence for Molecular Prediction of Inflammatory Bowel Disease, PREDICT, Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Copenhagen, Denmark.,Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Aske T Iversen
- National Center of Excellence for Molecular Prediction of Inflammatory Bowel Disease, PREDICT, Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Copenhagen, Denmark.,Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Gunvor Iben Madsen
- Department of Clinical Pathology, Odense University Hospital, Odense, Denmark
| | | | - Donna Lykke Wolff
- Department of Clinical Research, University Hospital of Southern Denmark, Aabenraa, Denmark.,Internal Medicine Research Unit, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Tine Jess
- National Center of Excellence for Molecular Prediction of Inflammatory Bowel Disease, PREDICT, Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Copenhagen, Denmark.,Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Vibeke Andersen
- Research Unit of Molecular Diagnostics and Clinical Research, University Hospital of Southern Denmark, Aabenraa, Denmark.,Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
10
|
Gerke O, Pedersen AK, Debrabant B, Halekoh U, Möller S. Sample size determination in method comparison and observer variability studies. J Clin Monit Comput 2022; 36:1241-1243. [PMID: 35438365 DOI: 10.1007/s10877-022-00853-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] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/22/2022] [Indexed: 11/30/2022]
Abstract
The comparison of two quantitative measuring devices is often performed with the Limits of Agreement proposed by Bland and Altman in their seminal Lancet paper back in 1986. Sample size considerations were rare for such agreement analyses in the past, but recently several proposals have been made depending on how agreement is to be assessed and the number of replicates to be used. We have summarized recent developments and recommendations in various situations including a distinction between method comparison and observer variability studies. These include current state-of-the-art analysis of and reporting guidelines for agreement studies. General recommendations close the paper.
Collapse
Affiliation(s)
- Oke Gerke
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark. .,Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.
| | - Andreas Kristian Pedersen
- Department of Research and Learning, Hospital of Southern Jutland, Aabenraa, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Birgit Debrabant
- Department of Mathematics and Computer Science, University of Southern Denmark, Odense, Denmark
| | - Ulrich Halekoh
- Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| |
Collapse
|
11
|
Mamoei S, Jensen HB, Pedersen AK, Nygaard MKE, Eskildsen SF, Dalgas U, Stenager E. Clinical, Neurophysiological, and MRI Markers of Fampridine Responsiveness in Multiple Sclerosis-An Explorative Study. Front Neurol 2021; 12:758710. [PMID: 34764932 PMCID: PMC8576138 DOI: 10.3389/fneur.2021.758710] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 09/16/2021] [Indexed: 01/18/2023] Open
Abstract
Objective: Persons with multiple sclerosis (PwMS), already established as responders or non-responders to Fampridine treatment, were compared in terms of disability measures, physical and cognitive performance tests, neurophysiology, and magnetic resonance imaging (MRI) outcomes in a 1-year explorative longitudinal study. Materials and Methods: Data from a 1-year longitudinal study were analyzed. Examinations consisted of the timed 25-foot walk test (T25FW), six spot step test (SSST), nine-hole peg test (9-HPT), five times sit-to-stand test (5-STS), symbol digit modalities test (SDMT), transcranial magnetic stimulation (TMS) elicited motor evoked potentials (MEP) examining central motor conduction times (CMCT), peripheral motor conduction times (PMCT) and their amplitudes, electroneuronography (ENG) of the lower extremities, and brain structural MRI measures. Results: Forty-one responders and eight non-responders to Fampridine treatment were examined. There were no intergroup differences except for the PMCT, where non-responders had prolonged conduction times compared to responders to Fampridine. Six spot step test was associated with CMCT throughout the study. After 1 year, CMCT was further prolonged and cortical MEP amplitudes decreased in both groups, while PMCT and ENG did not change. Throughout the study, CMCT was associated with the expanded disability status scale (EDSS) and 12-item multiple sclerosis walking scale (MSWS-12), while SDMT was associated with number of T2-weighted lesions, lesion load, and lesion load normalized to brain volume. Conclusions: Peripheral motor conduction time is prolonged in non-responders to Fampridine when compared to responders. Transcranial magnetic stimulation-elicited MEPs and SDMT can be used as markers of disability progression and lesion activity visualized by MRI, respectively. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03401307.
Collapse
Affiliation(s)
- Sepehr Mamoei
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Neurology, University Hospital of Southern Jutland, Sønderborg, Denmark.,Open Patient Data Explorative Network, Odense, Denmark.,Neurological Research Unit, MS Clinics of Southern Jutland (Sønderborg, Esbjerg, Kolding), University Hospital of Southern Jutland, Aabenraa, Denmark
| | - Henrik Boye Jensen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Open Patient Data Explorative Network, Odense, Denmark.,Department of Brain and Nerve Diseases, University Hospital of Lillebælt, Kolding, Denmark
| | | | - Mikkel Karl Emil Nygaard
- Center of Functionally Integrative Neuroscience (CFIN), Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Simon Fristed Eskildsen
- Center of Functionally Integrative Neuroscience (CFIN), Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Egon Stenager
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Neurology, University Hospital of Southern Jutland, Sønderborg, Denmark.,Neurological Research Unit, MS Clinics of Southern Jutland (Sønderborg, Esbjerg, Kolding), University Hospital of Southern Jutland, Aabenraa, Denmark
| |
Collapse
|
12
|
Cuk P, Kjær MD, Mogensen CB, Nielsen MF, Pedersen AK, Ellebæk MB. Short-term outcomes in robot-assisted compared to laparoscopic colon cancer resections: a systematic review and meta-analysis. Surg Endosc 2021; 36:32-46. [PMID: 34724576 PMCID: PMC8741661 DOI: 10.1007/s00464-021-08782-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 07/12/2021] [Accepted: 10/17/2021] [Indexed: 12/12/2022]
Abstract
Background Robot-assisted surgery is increasingly adopted in colorectal surgery. However, evidence for the implementation of robot-assisted surgery for colon cancer is sparse. This study aims to evaluate the short-term outcomes of robot-assisted colon surgery (RCS) for cancer compared to laparoscopic colon surgery (LCS). Methods Embase, MEDLINE, and Cochrane Library were searched between January 1, 2005 and October 2, 2020. Randomized clinical trials and observational studies were included. Non-original literature was excluded. Primary endpoints were anastomotic leakage rate, conversion to open surgery, operative time, and length of hospital stay. Secondary endpoints were surgical efficacy and postoperative morbidity. We evaluated risk of bias using RoB2 and ROBINS-I quality assessment tools. We performed a pooled analysis of primary and secondary endpoints. Heterogeneity was assessed by I2, and possible causes were explored by sensitivity- and meta-regression analyses. Publication bias was evaluated by Funnel plots and Eggers linear regression test. The level of evidence was assessed by GRADE. Results Twenty studies enrolling 13,799 patients (RCS 1740 (12.6%) and LCS 12,059 (87.4%) were included in the meta-analysis that demonstrated RCS was superior regarding: anastomotic leakage (odds ratio (OR) = 0.54, 95% CI [0.32, 0.94]), conversion (OR = 0.31, 95% CI [0.23, 0.41]), overall complication rate (OR = 0.85, 95% CI [0.73, 1.00]) and time to regular diet (MD = − 0.29, 95% CI [− 0.56, 0.02]). LCS proved to have a shortened operative time compared to RCS (MD = 42.99, 95% CI [28.37, 57.60]). Level of evidence was very low according to GRADE. Conclusion RCS showed advantages in colonic cancer surgery regarding surgical efficacy and morbidity compared to LCS despite a predominant inclusion of non-RCT with serious risk of bias assessment and a very low level of evidence. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08782-7.
Collapse
Affiliation(s)
- Pedja Cuk
- Surgical Department, University Hospital of Southern Jutland, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark. .,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Mie Dilling Kjær
- Research Unit for Surgery, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | | | - Michael Festersen Nielsen
- Surgical Department, University Hospital of Southern Jutland, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Mark Bremholm Ellebæk
- Research Unit for Surgery, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| |
Collapse
|
13
|
Cuk P, Pedersen AK, Lambertsen KL, Mogensen CB, Nielsen MF, Helligsø P, Gögenur I, Ellebæk MB. Systemic inflammatory response in robot-assisted and laparoscopic surgery for colon cancer (SIRIRALS): study protocol of a randomized controlled trial. BMC Surg 2021; 21:363. [PMID: 34635066 PMCID: PMC8507379 DOI: 10.1186/s12893-021-01355-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/23/2021] [Indexed: 01/10/2023] Open
Abstract
Background Robot-assisted surgery is being increasingly adopted in treating colorectal cancer, and the transition from laparoscopic surgery to robot-assisted surgery is a trend. The evidence of the benefits of robot-assisted surgery is sparse. However, findings are associated with improved patient-related outcomes and overall morbidity rates compared to laparoscopic surgery. This induction is unclear, considering both surgical modalities are characterized as minimally invasive. This study aims to evaluate the systemic and peritoneal inflammatory stress response induced by robot-assisted surgery compared with laparoscopic surgery for elective colon cancer resections in a prospective, randomized controlled clinical trial. Methods This study is a single-centre randomized controlled superiority trial with 50 colon cancer participants. The primary endpoint is the level of systemic inflammatory response expressed as serum C-reactive protein (CRP) and interleukin 6 (IL-6) levels between postoperative days one and three. Secondary endpoints include (i) levels of systemic inflammation in serum expressed by a panel of inflammatory and pro-inflammatory cytokines measured during the first three postoperative days, (ii) postoperative surgical and medical complications (30 days) according to Clavien-Dindo classification and Comprehensive Complication Index, (iii) intraoperative blood loss, (iv) conversion rate to open surgery, (v) length of surgery, (vi) operative time, (vii) the number of harvested lymph nodes, and (viii) length of hospital stay. The exploratory endpoints are (i) levels of peritoneal inflammatory response in peritoneal fluid expressed by inflammatory and pro-inflammatory cytokines between postoperative day one and three, (ii) patient-reported health-related quality of recovery-15 (QoR-15), (iii) 30 days mortality rate, (iv) heart rate variability and (v) gene transcript (mRNA) analysis. Discussion To our knowledge, this is the first clinical randomized controlled trial to clarify the inflammatory stress response induced by robot-assisted or laparoscopic surgery for colon cancer resections. Trial registration This trial is registered at Clinicaltrials.gov (Identifier: NCT04687384) on December, 29, 2020, Regional committee on health research ethics, Region of Southern Denmark (N75709) and Data Protection Agency, Hospital Sønderjylland, University Hospital of Southern Denmark (N20/46179). Supplementary Information The online version contains supplementary material available at 10.1186/s12893-021-01355-4.
Collapse
Affiliation(s)
- Pedja Cuk
- Surgical Department, Hospital Sønderjylland, University Hospital of Southern Denmark, Kresten Philipsens vej 15, 6200, Aabenraa, Denmark. .,OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark. .,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | | | - Kate Lykke Lambertsen
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark.,Department of Neurology, Odense University Hospital, Odense, Denmark.,BRIDGE, Brain Research - Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Michael Festersen Nielsen
- Surgical Department, Hospital Sønderjylland, University Hospital of Southern Denmark, Kresten Philipsens vej 15, 6200, Aabenraa, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Per Helligsø
- Surgical Department, Hospital Sønderjylland, University Hospital of Southern Denmark, Kresten Philipsens vej 15, 6200, Aabenraa, Denmark
| | - Ismail Gögenur
- Surgical Department, Center for Surgical Science, Zealand University Hospital, Roskilde, Denmark
| | - Mark Bremholm Ellebæk
- Surgical Research Unit, Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
| |
Collapse
|
14
|
Cartuliares MB, Skjøt-Arkil H, Rosenvinge FS, Mogensen CB, Skovsted TA, Pedersen AK. Effectiveness of expiratory technique and induced sputum in obtaining good quality sputum from patients acutely hospitalized with suspected lower respiratory tract infection: a statistical analysis plan for a randomized controlled trial. Trials 2021; 22:675. [PMID: 34600559 PMCID: PMC8487344 DOI: 10.1186/s13063-021-05639-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/15/2021] [Indexed: 11/22/2022] Open
Abstract
Background Targeted antimicrobial treatment is essential to avoid unnecessary use of broad-spectrum antibiotics and antimicrobial resistance. Targeted treatment relies on a precise microbiological diagnosis — in pneumonia, this poses a challenge as the usefulness of Gram stains and cultures is highly dependent on the quality of the sputum sample. This study aims to examine adverse effects and quality of sputum samples obtained by expiratory techniques (forced expiratory technique and sputum induction) compared with tracheal suction. The hypothesis is that expiratory techniques are non-inferior to tracheal suction in obtaining samples from the lower respiratory tract. This statistical analysis plan (SAP) describes the study design, method, and data analysis of the trial to increase transparency, avoid reporting bias or data-driven analysis and increase the study’s reproducibility. Method The design is a pragmatic, non-inferiority, parallel-arm randomized controlled trial including 280 patients admitted with suspected lower respiratory infection to two emergency departments. Patients are randomized to a usual care group, where sputum samples are collected by tracheal suction or to an intervention group where sputum samples are collected by forced expiratory technique and sputum induction. The statistical analysis will follow an intention-to-treat protocol. This SAP is developed and submitted before the end of recruitment, database closure, and statistical analyses. Discussion The results of this study will provide valuable knowledge to clinical practice by comparing adverse effects and sputum sample quality associated with different sample methods. Trial registration Clinicaltrials.gov, NCT04595526. Submitted on October 19, 2020 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05639-1.
Collapse
Affiliation(s)
- Mariana Bichuette Cartuliares
- Emergency Department, University Hospital of Southern Denmark, Kresten Philipsens vej 15, 6200, Aabenraa, Denmark. .,Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark.
| | - Helene Skjøt-Arkil
- Emergency Department, University Hospital of Southern Denmark, Kresten Philipsens vej 15, 6200, Aabenraa, Denmark.,Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark
| | | | - Christian Backer Mogensen
- Emergency Department, University Hospital of Southern Denmark, Kresten Philipsens vej 15, 6200, Aabenraa, Denmark.,Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark
| | - Thor Aage Skovsted
- Department of Biochemistry and Immunology, University Hospital of Southern Denmark, Kresten Philipsens vej 15, 6200, Aabenraa, Denmark
| | - Andreas Kristian Pedersen
- Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark.,Department of Research and Learning, University Hospital of Southern Denmark, Kresten Philipsens vej 15, 6200, Aabenraa, Denmark
| |
Collapse
|
15
|
Dualleh N, Chanchiri I, Skjøt-Arkil H, Pedersen AK, Rosenvinge FS, Johansen IS. Colonization with multiresistant bacteria in acute hospital care: the association of prior antibiotic consumption as a risk factor. J Antimicrob Chemother 2021; 75:3675-3681. [PMID: 32814968 DOI: 10.1093/jac/dkaa365] [Citation(s) in RCA: 4] [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: 06/04/2020] [Accepted: 07/24/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Antibiotic resistance poses a worldwide threat and knowledge concerning risk factors for colonization with multiresistant bacteria (MRB) is limited. OBJECTIVES To examine the impact of prior antibiotic consumption on MRB colonization, with focus on type of antibiotic and timeline between antibiotic prescription and MRB colonization. METHODS A nationwide case-control study was conducted and adults visiting emergency departments were invited to participate. All patients were swabbed in the throat, nose and rectum, and analysed for colonization with ESBL-producing Enterobacteriaceae (ESBL-E), MRSA, carbapenemase-producing enterobacteria and VRE. Antibiotic history 2 years prior to enrolment was collected at an individual level through a national register. Multivariate analyses were performed to examine the association between antibiotic consumption and MRB status. A subgroup analysis of ESBL-E-colonized cases was made. RESULTS We included 256 patients colonized with MRB and 4763 controls. In the 2 years prior to study inclusion, 77% of cases and 68% of controls had at least one antibiotic prescription (P = 0.002). We found a significant increase in risk of colonization with ESBL-E if penicillins (OR = 1.58-1.65) or fluoroquinolones (OR = 2.25-6.15) were prescribed. The analysis of all MRB-colonized patients showed similar results. An assessment of the timeline showed a significant increase in risk of colonization up to 2 years after exposure to penicillins, fluoroquinolones and macrolides. CONCLUSIONS The prevalence of ESBL-E colonization was related to fluoroquinolone, macrolide and penicillin consumption for at least 2 years after antibiotic treatment.
Collapse
Affiliation(s)
- Nasra Dualleh
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Iman Chanchiri
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Helene Skjøt-Arkil
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | | | - Isik Somuncu Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Research Unit for Infectious Diseases, Clinical Institute, University of Southern Denmark, Odense, Denmark.,Open Patient data Explorative Network (OPEN), Odense University Hospital, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
16
|
Jensen BB, Bruun MT, Jensen PM, Pedersen AK, Fournier PE, Skarphedinsson S, Chen M. Evaluation of factors influencing tick bites and tick-borne infections: a longitudinal study. Parasit Vectors 2021; 14:289. [PMID: 34051820 PMCID: PMC8164064 DOI: 10.1186/s13071-021-04751-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Various tick-borne infections like borreliosis and rickettsiosis pose a health risk to humans in many parts of the world. We investigated seroprevalence of and seroconversion to Borrelia burgdorferi and Rickettsia spp. and relation to tick-bites, weather and clinical manifestations in Denmark. METHODS Blood donors were enrolled at the Hospital of Southern Jutland in June-July with follow-up November-February of 2018 and 2019. Blood samples were collected, and a questionnaire regarding tick bites, potential exposures and symptoms was completed at each visit. Samples were tested for presence of IgM and IgG antibodies directed against B. burgdorferi and Rickettsia spp. using R. helvetica and R. felis as antigens. Data were examined for correlation between tick bites, serological results, potential exposures and symptoms. RESULTS Two-hundred and fourteen (93 follow-ups) and 130 (38 follow-ups) blood donors were included in 2018 and 2019, respectively. The total borrelia seroconversion rate was 6.3% (CI 2.1-10.5), while the prevalence of IgM and IgG antibodies was 7.8% (CI 4.9-10.6) and 6.7% (CI 4-9.3), respectively. Seroconversion to Rickettsia spp. was detected in one participant. Tick bites and seroconversion were not significantly associated with the reported unspecific symptoms, but unspecific symptoms were common in the study population. There was no significant difference in number of tick bites or seroconversion/prevalence between seasons with highly alternating weather. CONCLUSIONS Results suggest that weather conditions in an individual year have a limited impact. Anti-Borrelia-antibodies do not seem to persist in serum for several years. Rickettsiosis is of limited concern in Denmark.
Collapse
Affiliation(s)
- Bo Bødker Jensen
- Department of Clinical Microbiology, Hospital of Southern Jutland, Sydvang 1, 6400, Sønderborg, Denmark. .,Clinical Centre for Emerging and Vector-Borne Infections, Odense University Hospital, Odense, Denmark. .,Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
| | - Mie Topholm Bruun
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | | | | | - Pierre-Edouard Fournier
- Aix-Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Mediterranée Infection, Marseille, France
| | - Sigurdur Skarphedinsson
- Clinical Centre for Emerging and Vector-Borne Infections, Odense University Hospital, Odense, Denmark.,Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Ming Chen
- Department of Clinical Microbiology, Hospital of Southern Jutland, Sydvang 1, 6400, Sønderborg, Denmark.,Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
17
|
Cuk P, Simonsen RM, Komljen M, Nielsen MF, Helligsø P, Pedersen AK, Mogensen CB, Ellebæk MB. Improved perioperative outcomes and reduced inflammatory stress response in malignant robot-assisted colorectal resections: a retrospective cohort study of 298 patients. World J Surg Oncol 2021; 19:155. [PMID: 34022914 PMCID: PMC8141231 DOI: 10.1186/s12957-021-02263-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/11/2021] [Indexed: 02/07/2023] Open
Abstract
Background Robot-assisted surgery is increasingly implemented for the resection of colorectal cancer, although the scientific evidence for adopting this technique is still limited. This study’s main objective was to compare short-term complication rates, oncological outcomes, and the inflammatory stress response after colorectal resection for cancer performed laparoscopic or robot-assisted. Methods We conducted a retrospective cohort study comparing the robot-assisted approach to laparoscopic surgery for elective malignant colorectal neoplasm. Certified colorectal and da Vinci ® robotic surgeons performed resections at a Danish tertiary colorectal high volume center from May 2017 to March 2019. We analyzed the two surgical groups using uni- and multivariate regression analyses to detect differences in intra- and postoperative clinical outcomes and the inflammatory stress response. Results Two hundred and ninety-eight patients were enrolled in the study. Significant differences favoring robot-assisted surgery was demonstrated for; length of hospital stay (4 days, interquartile range (4, 5) versus 5 days, interquartile range (4–7), p < 0.001), and intraoperative blood loss (50 mL, interquartile range (20–100) versus 100 mL, interquartile range (50–150), p < 0.001) compared to laparoscopic surgery. The inflammatory stress response was significantly higher after laparoscopic compared to robot-assisted surgery reflected by an increase in C-reactive protein concentration (exponentiated coefficient = 1.23, 95% confidence interval (1.06–1.46), p = 0.008). No differences between the two groups were found concerning mortality, microradical resection rate, conversion to open surgery, and surgical or medical short-term complication rates. Conclusion Robot-assisted surgery is feasible and can be safely implemented for colorectal resections. The robot-assisted approach, when compared to laparoscopic surgery, was associated with improved intra- and postoperative outcomes. Extensive prospective studies are needed to determine the short- and long-term outcomes of robotic surgery for colorectal cancer.
Collapse
Affiliation(s)
- Pedja Cuk
- Department of Surgery, Hospital of Southern Jutland, Aabenraa, Denmark. .,Department of Regional Health Research, Hospital of Southern Jutland, University of Southern Denmark, Odense, Denmark. .,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark.
| | | | - Mirjana Komljen
- Department of Surgery, Hospital of Southern Jutland, Aabenraa, Denmark
| | - Michael Festersen Nielsen
- Department of Surgery, Hospital of Southern Jutland, Aabenraa, Denmark.,Department of Regional Health Research, Hospital of Southern Jutland, University of Southern Denmark, Odense, Denmark
| | - Per Helligsø
- Department of Surgery, Hospital of Southern Jutland, Aabenraa, Denmark
| | - Andreas Kristian Pedersen
- Department of Regional Health Research, Hospital of Southern Jutland, University of Southern Denmark, Odense, Denmark.,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Christian Backer Mogensen
- Department of Regional Health Research, Hospital of Southern Jutland, University of Southern Denmark, Odense, Denmark
| | - Mark Bremholm Ellebæk
- Research Unit for Surgery, Surgical Department, Odense University Hospital, Odense, Denmark
| |
Collapse
|
18
|
Primdahl J, Esbensen BA, Pedersen AK, Bech B, de Thurah A. Validation of the Danish versions of the Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaires (BRAFs). Scand J Rheumatol 2021; 50:351-359. [PMID: 33605192 DOI: 10.1080/03009742.2020.1869301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objective: This study aimed to validate the Danish versions of the Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire (BRAF-MDQ) and BRAF Numerical Rating Scale version 2 (NRSv2).Method: We tested face and content validity, internal consistency, criterion validity, construct validity, and reproducibility for the BRAF-MDQ, and face and criterion validity and reproducibility for the BRAF-NRS.Results: In all, 224/236 patients (95%) completed the questionnaires [70% female, mean ± sd age 59 ± 13.04 years, disease duration 11.2 ± 9.49 years, Health Assessment Questionnaire (HAQ) 0.724 ± 0.70, and 28-joint Disease Activity Score-C-reactive protein 2.55 ± 1.24]. The unidimensionality for the physical and cognitive fatigue subscales was confirmed, whereas the living with fatigue and emotional fatigue subscales were not unidimensional. Cronbach's α was 0.94 for the BRAF-MDQ total and 0.78-0.92 for the four subscales. The correlations between BRAF-MDQ and various measures were: 36-item Short Form Health Survey (SF-36) vitality subscale, 0.75; Hospital Anxiety and Depression Scale (HADS) anxiety subscale, 0.65; HADS depression subscale, 0.62; visual analogue scale (VAS) pain, 0.62; VAS global, 0.73; and HAQ, 0.62. The intraclass correlation coefficient for agreement was 0.995. A Bland-Altman plot showed a mean ± sd difference of -1.9 ± 3.62 for BRAF-MDQ. Correlation coefficients between the BRAF-NRSv2 subscales and other subscales were: BRAF-MDQ subscales, 0.57-0.93; SF-36 vitality subscale, 0.54-0.68; and VAS fatigue, 0.66-0.82.Conclusions: The Danish BRAFs are considered valid and reliable for use among Danish patients with rheumatoid arthritis, despite the subscales living with fatigue and emotional fatigue not being unidimensional, as they are in the original version.
Collapse
Affiliation(s)
- J Primdahl
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.,Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - B A Esbensen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - A K Pedersen
- Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - B Bech
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - A de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
19
|
Andersen V, Pedersen AK, Möller S, Green A. Chronic Inflammatory Diseases - Diabetes Mellitus, Rheumatoid Arthritis, Coeliac Disease, Crohn's Disease, and Ulcerative Colitis Among the Offspring of Affected Parents: A Danish Population-Based Registry Study. Clin Epidemiol 2021; 13:13-20. [PMID: 33442298 PMCID: PMC7800432 DOI: 10.2147/clep.s286623] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/17/2020] [Indexed: 12/27/2022] Open
Abstract
Background Chronic inflammatory diseases (CIDs) may share aetiological factors across diseases. We used registry data to evaluate the risk of developing five common childhood CIDs dependent on the parents' disease status. Methods We performed a national population-based registry study by linking data from the national Danish health registers from January 1973 to March 2016 to evaluate any potential associations between parents' disease and development of CIDs among the offspring. Results were adjusted for parental age at birth, the decade of birth, gender of the child, and type of birth. A cohort of 2,699,449 liveborn children was established for investigating the primary outcome measures: diabetes mellitus (DM), rheumatoid arthritis (RA), coeliac disease, Crohn's disease (CD), and ulcerative colitis (UC) and all diseases combined (CID). Results Children with one CID affected parent (Hazard ratio (HR), 95% confidence interval (95% CI)=1.75 (1.72-1.79, p<0.001)), one multiple CID affected parent (HR=2.23 (2.11-2.34), p<0.001), and both parents affected (HR=3.10 (2.98-3.22), p<0.001) were at higher risk than children without CID affected parents. Children with DM, RA, and COE affected parents were at increased risk of three specific diseases (DM, RA and COE), whereas children with CD and UC affected parents were at increased risk of two specific diseases (CD and UC). Conclusion Children with CID affected parents were at increased risk of the same CID as their parents as well as other specific CIDs dependent on the parents' CID. Future studies should address the aetiology underlying these findings to support the development of new strategies for prevention, treatment, and cure.
Collapse
Affiliation(s)
- Vibeke Andersen
- Focused Research Unit for Molecular Diagnostic and Clinical Research, University Hospital of Southern Denmark, Åbenrå, Denmark.,Institute of Regional Research (IRS-Center Sonderjylland), University of Southern Denmark, Odense, Denmark.,Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Andreas Kristian Pedersen
- Focused Research Unit for Molecular Diagnostic and Clinical Research, University Hospital of Southern Denmark, Åbenrå, Denmark
| | - Sören Möller
- Open Patient Data Explorative Network (OPEN), Department of Clinical Research, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Anders Green
- Open Patient Data Explorative Network (OPEN), Department of Clinical Research, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| |
Collapse
|
20
|
Jawhara M, Sørensen SB, Heitmann BL, Halldórsson ÞI, Pedersen AK, Andersen V. The Relation between Red Meat and Whole-Grain Intake and the Colonic Mucosal Barrier: A Cross-Sectional Study. Nutrients 2020; 12:nu12061765. [PMID: 32545531 PMCID: PMC7353246 DOI: 10.3390/nu12061765] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/07/2020] [Accepted: 06/08/2020] [Indexed: 11/16/2022] Open
Abstract
The Colonic Mucosal Barrier (CMB) is the site of interaction between the human body and the colonic microbiota. The mucus is the outer part of the CMB and is considered as the front-line defense of the colon. It separates the host epithelial lining from the colonic content, and it has previously been linked to health and diseases. In this study, we assessed the relationship between red meat and whole-grain intake and (1) the thickness of the colonic mucus (2) the expression of the predominant mucin gene in the human colon (MUC2). Patients referred to colonoscopy at the University Hospital of Southern Denmark- Sonderjylland were enrolled between June 2017 and December 2018, and lifestyle data was collected in a cross-sectional study design. Colonic biopsies, blood, urine, and fecal samples were collected. The colonic mucus and bacteria were visualized by immunostaining and fluorescence in situ hybridization techniques. We found a thinner mucus was associated with high red meat intake. Similarly, the results suggested a thinner mucus was associated with high whole-grain intake, albeit to a lesser extent than red meat. This is the first study assessing the association between red meat and whole-grain intake and the colonic mucus in humans. This study is approved by the Danish Ethics Committee (S-20160124) and the Danish Data Protecting Agency (2008-58-035). A study protocol was registered at clinical trials.gov under NCT04235348.
Collapse
Affiliation(s)
- Mohamad Jawhara
- Focused Research Unit for Molecular Diagnostic and Clinical Research, Institute of Regional Health Research, University Hospital of Southern Denmark- Sonderjylland, 6200 Aabenraa, Denmark; (S.B.S.); (V.A.)
- Institute of Molecular Medicine, University of Southern Denmark, 5230 Odense, Denmark
- Department of Surgery, University Hospital of Southern Denmark-Sonderjylland, 6200 Aabenraa, Denmark
- Correspondence: ; Tel.: +45-7997-0000
| | - Signe Bek Sørensen
- Focused Research Unit for Molecular Diagnostic and Clinical Research, Institute of Regional Health Research, University Hospital of Southern Denmark- Sonderjylland, 6200 Aabenraa, Denmark; (S.B.S.); (V.A.)
- Institute of Molecular Medicine, University of Southern Denmark, 5230 Odense, Denmark
| | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies, the Parker Institute, Bispebjerg and Frederiksberg, 2000 Frederiksberg, Denmark;
- Section for General Practice, Department of Public Health, University of Copenhagen, 2100 Copenhagen, Denmark
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Sydney, NSW 2006, Australia
| | - Þórhallur Ingi Halldórsson
- Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland, 101 Reykjavik, Iceland;
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, 2100 Copenhagen, Denmark
| | - Andreas Kristian Pedersen
- Lærings- og Forskningshuset, University Hospital of Southern Denmark, Sonderjylland, 6200 Aabenraa, Denmark;
| | - Vibeke Andersen
- Focused Research Unit for Molecular Diagnostic and Clinical Research, Institute of Regional Health Research, University Hospital of Southern Denmark- Sonderjylland, 6200 Aabenraa, Denmark; (S.B.S.); (V.A.)
- Institute of Molecular Medicine, University of Southern Denmark, 5230 Odense, Denmark
- Open Patient Data Explorative Network, University of Southern Jutland, 5230 Odense, Denmark
| |
Collapse
|
21
|
Skovsted TA, Petersen ERB, Fruekilde MB, Pedersen AK, Pielak T, Eugen-Olsen J. Validation of suPAR turbidimetric assay on Cobas® (c502 and c702) and comparison to suPAR ELISA. Scand J Clin Lab Invest 2020; 80:327-335. [PMID: 32186407 DOI: 10.1080/00365513.2020.1741674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
suPAR is a plasma marker of chronic inflammation, and an elevated suPAR is consistently associated with worse outcome in a variety of clinical conditions. Quantification of suPAR is useful for determining patient risk in triage, but there is no fast automatized method for quick determination of suPAR. We developed and validated a rapid latex particle-enhanced turbidimetric immunoassay for quantification of plasma suPAR on the c502 and the c702 Roche Cobas® 8000 measurment systems. The turbidimetric assay was validated against the suPARnostic® ELISA (ViroGates, Denmark). This validation demonstrates suPAR can be analysed by turbidimetry giving very similar results (<15% difference) compared to the ELISA method and the observed correlations (n = 103) were strong, r > 0.95. Roche Cobas® 8000 instruments demonstrated repeatability and repoducibility, CV % at 3.4-4.1 and 5.7-11.4, respectively. The estimated limit of detection was 1.30 µg/L and 1.31 µg/L for the Cobas® c502 and c702, respectively. Dilution tests showed linearity of suPAR from 1.8 to 26.5 μg/L. The acceptable concentrations of Bilirubin, Intralipid and Hemoglobin, were 350 µmol/L, 3.3 g/L and 1.4 g/L, respectively. suPAR can be quantified reproducibly within 10 min using a turbidimetry assay. This assay is faster than ELISA with similar results, making it suitable for clinical routine analysis.
Collapse
Affiliation(s)
- Thor A Skovsted
- Department of Biochemistry and Immunology, Hospital of Southern Jutland, Region of Southern Denmark, Aabenraa, Denmark
| | - Eva Rabing Brix Petersen
- Department of Biochemistry and Immunology, Hospital of Southern Jutland, Region of Southern Denmark, Aabenraa, Denmark
| | - Maj-Britt Fruekilde
- Department of Biochemistry and Immunology, Hospital of Southern Jutland, Region of Southern Denmark, Aabenraa, Denmark
| | | | - Tomasz Pielak
- ViroGates A/S, Birkerød, Denmark.,NUTOPI Sp. z o. o, Poznan, Poland
| | - Jesper Eugen-Olsen
- ViroGates A/S, Birkerød, Denmark.,Clinical Research Center, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| |
Collapse
|
22
|
Kuettel D, Primdahl J, Weber U, Terslev L, Østergaard M, Petersen R, Pedersen AK, Möller S, Hørslev-Petersen K. Pain and Self-reported Swollen Joints Are Main Drivers of Patient-reported Flares in Rheumatoid Arthritis: Results from a 12-month Observational Study. J Rheumatol 2019; 47:1305-1313. [PMID: 31787604 DOI: 10.3899/jrheum.190760] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To examine prospectively self-reported flare characteristics and their longitudinal association with disease activity and patient-reported outcomes (PRO) in patients with rheumatoid arthritis (RA). METHODS Consecutive RA patients with 28-joint count Disease Activity Score based on C-reactive protein (DAS28-CRP) < 3.2 and no swollen joints were examined at baseline, Month 6, and Month 12. Assessments included joint counts, DAS28-CRP, visual analog scale-evaluator's global assessment (EGA), and PRO. Every third month, patients completed the Flare Assessment in Rheumatoid Arthritis and RA Flare Questionnaire, and disclosed self-management strategies. Flaring and non-flaring patients were compared and longitudinal associations between self-reported flare status (yes/no) and disease activity, PRO, and treatment escalation were explored. RESULTS Among 80 patients with RA [74% females, mean (SD) age 63 (10) yrs, disease duration 11 (7) yrs, and baseline DAS28-CRP 1.9 (0.6)], 64 (80%) reported flare at least once during 12 months. Fifty-five percent of flares lasted less than 1 week. Common self-management strategies were analgesics (50%) and restricted activities (38%). Patients who reported being in flare had consistently higher disease activity measures and PRO compared to patients without flare. In a partly adjusted model, all flare domains, patient-reported swollen and tender joint counts and disease activity measures were associated with flares. In fully adjusted analyses, present flare was independently associated with pain (OR 1.85, 95% CI 1.34-2.60), patient-reported swollen joints (OR 1.18, 95% CI 1.03-1.36), and higher EGA (OR 1.15, 95% CI 1.04-1.28). Treatment escalation was associated with present flare (p ≤ 0.001). CONCLUSION In RA, self-reported flares were frequent, mainly managed by analgesics, substantiated by higher disease activity measures, independently associated with pain and patient-reported swollen joints, and related to treatment escalation.
Collapse
Affiliation(s)
- Dorota Kuettel
- From the Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg; Institute of Regional Health Research, University of Southern Denmark, Odense; Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, Glostrup; Open Patient data Explorative Network (OPEN), Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark. .,D. Kuettel, MD, PhD, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark; J. Primdahl, MSN, PhD, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; U. Weber, MD, Associate Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; L. Terslev, MD, PhD, Associate Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; R. Petersen, MSN, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark; A.K. Pedersen, MS, Hospital of Southern Jutland, University Hospital of Southern Denmark; S. Möller, MS, PhD, Associate Professor, OPEN, Odense University Hospital and Department of Clinical Research, University of Southern Denmark; K. Hørslev-Petersen, MD, DMSc, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark.
| | - Jette Primdahl
- From the Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg; Institute of Regional Health Research, University of Southern Denmark, Odense; Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, Glostrup; Open Patient data Explorative Network (OPEN), Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,D. Kuettel, MD, PhD, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark; J. Primdahl, MSN, PhD, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; U. Weber, MD, Associate Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; L. Terslev, MD, PhD, Associate Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; R. Petersen, MSN, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark; A.K. Pedersen, MS, Hospital of Southern Jutland, University Hospital of Southern Denmark; S. Möller, MS, PhD, Associate Professor, OPEN, Odense University Hospital and Department of Clinical Research, University of Southern Denmark; K. Hørslev-Petersen, MD, DMSc, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark
| | - Ulrich Weber
- From the Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg; Institute of Regional Health Research, University of Southern Denmark, Odense; Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, Glostrup; Open Patient data Explorative Network (OPEN), Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,D. Kuettel, MD, PhD, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark; J. Primdahl, MSN, PhD, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; U. Weber, MD, Associate Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; L. Terslev, MD, PhD, Associate Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; R. Petersen, MSN, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark; A.K. Pedersen, MS, Hospital of Southern Jutland, University Hospital of Southern Denmark; S. Möller, MS, PhD, Associate Professor, OPEN, Odense University Hospital and Department of Clinical Research, University of Southern Denmark; K. Hørslev-Petersen, MD, DMSc, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark
| | - Lene Terslev
- From the Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg; Institute of Regional Health Research, University of Southern Denmark, Odense; Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, Glostrup; Open Patient data Explorative Network (OPEN), Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,D. Kuettel, MD, PhD, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark; J. Primdahl, MSN, PhD, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; U. Weber, MD, Associate Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; L. Terslev, MD, PhD, Associate Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; R. Petersen, MSN, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark; A.K. Pedersen, MS, Hospital of Southern Jutland, University Hospital of Southern Denmark; S. Möller, MS, PhD, Associate Professor, OPEN, Odense University Hospital and Department of Clinical Research, University of Southern Denmark; K. Hørslev-Petersen, MD, DMSc, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark
| | - Mikkel Østergaard
- From the Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg; Institute of Regional Health Research, University of Southern Denmark, Odense; Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, Glostrup; Open Patient data Explorative Network (OPEN), Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,D. Kuettel, MD, PhD, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark; J. Primdahl, MSN, PhD, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; U. Weber, MD, Associate Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; L. Terslev, MD, PhD, Associate Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; R. Petersen, MSN, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark; A.K. Pedersen, MS, Hospital of Southern Jutland, University Hospital of Southern Denmark; S. Möller, MS, PhD, Associate Professor, OPEN, Odense University Hospital and Department of Clinical Research, University of Southern Denmark; K. Hørslev-Petersen, MD, DMSc, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark
| | - Randi Petersen
- From the Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg; Institute of Regional Health Research, University of Southern Denmark, Odense; Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, Glostrup; Open Patient data Explorative Network (OPEN), Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,D. Kuettel, MD, PhD, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark; J. Primdahl, MSN, PhD, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; U. Weber, MD, Associate Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; L. Terslev, MD, PhD, Associate Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; R. Petersen, MSN, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark; A.K. Pedersen, MS, Hospital of Southern Jutland, University Hospital of Southern Denmark; S. Möller, MS, PhD, Associate Professor, OPEN, Odense University Hospital and Department of Clinical Research, University of Southern Denmark; K. Hørslev-Petersen, MD, DMSc, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark
| | - Andreas Kristian Pedersen
- From the Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg; Institute of Regional Health Research, University of Southern Denmark, Odense; Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, Glostrup; Open Patient data Explorative Network (OPEN), Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,D. Kuettel, MD, PhD, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark; J. Primdahl, MSN, PhD, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; U. Weber, MD, Associate Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; L. Terslev, MD, PhD, Associate Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; R. Petersen, MSN, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark; A.K. Pedersen, MS, Hospital of Southern Jutland, University Hospital of Southern Denmark; S. Möller, MS, PhD, Associate Professor, OPEN, Odense University Hospital and Department of Clinical Research, University of Southern Denmark; K. Hørslev-Petersen, MD, DMSc, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark
| | - Sören Möller
- From the Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg; Institute of Regional Health Research, University of Southern Denmark, Odense; Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, Glostrup; Open Patient data Explorative Network (OPEN), Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,D. Kuettel, MD, PhD, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark; J. Primdahl, MSN, PhD, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; U. Weber, MD, Associate Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; L. Terslev, MD, PhD, Associate Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; R. Petersen, MSN, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark; A.K. Pedersen, MS, Hospital of Southern Jutland, University Hospital of Southern Denmark; S. Möller, MS, PhD, Associate Professor, OPEN, Odense University Hospital and Department of Clinical Research, University of Southern Denmark; K. Hørslev-Petersen, MD, DMSc, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark
| | - Kim Hørslev-Petersen
- From the Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg; Institute of Regional Health Research, University of Southern Denmark, Odense; Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, Glostrup; Open Patient data Explorative Network (OPEN), Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,D. Kuettel, MD, PhD, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark; J. Primdahl, MSN, PhD, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; U. Weber, MD, Associate Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; L. Terslev, MD, PhD, Associate Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; R. Petersen, MSN, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark; A.K. Pedersen, MS, Hospital of Southern Jutland, University Hospital of Southern Denmark; S. Möller, MS, PhD, Associate Professor, OPEN, Odense University Hospital and Department of Clinical Research, University of Southern Denmark; K. Hørslev-Petersen, MD, DMSc, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark
| |
Collapse
|
23
|
Pedersen AK, Mendes Lopes de Melo J, Mørup N, Tritsaris K, Pedersen SF. Tumor microenvironment conditions alter Akt and Na +/H + exchanger NHE1 expression in endothelial cells more than hypoxia alone: implications for endothelial cell function in cancer. BMC Cancer 2017; 17:542. [PMID: 28806945 PMCID: PMC5556346 DOI: 10.1186/s12885-017-3532-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 03/01/2017] [Accepted: 08/03/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Chronic angiogenesis is a hallmark of most tumors and takes place in a hostile tumor microenvironment (TME) characterized by hypoxia, low nutrient and glucose levels, elevated lactate and low pH. Despite this, most studies addressing angiogenic signaling use hypoxia as a proxy for tumor conditions. Here, we compared the effects of hypoxia and TME conditions on regulation of the Na+/H+ exchanger NHE1, Ser/Thr kinases Akt1-3, and downstream effectors in endothelial cells. METHODS Human umbilical vein endothelial cells (HUVEC) and Ea.hy926 endothelial cells were exposed to simulated TME (1% hypoxia, low serum, glucose, pH, high lactate) or 1% hypoxia for 24 or 48 h, with or without NHE1 inhibition or siRNA-mediated knockdown. mRNA and protein levels of NHE1, Akt1-3, and downstream effectors were assessed by qPCR and Western blotting, vascular endothelial growth factor (VEGF) release by ELISA, and motility by scratch assay. RESULTS Within 24 h, HIF-1α level and VEGF mRNA level were increased robustly by TME and modestly by hypoxia alone. The NHE1 mRNA level was decreased by both hypoxia and TME, and NHE1 protein was reduced by TME in Ea.hy926 cells. Akt1-3 mRNA was detected in HUVEC and Ea.hy926 cells, Akt1 most abundantly. Akt1 protein expression was reduced by TME yet unaffected by hypoxia, while Akt phosphorylation was increased by TME. The Akt loss was partly reversed by MCF-7 human breast cancer cell conditioned medium, suggesting that in vivo, the cancer cell secretome may compensate for adverse effects of TME on endothelial cells. TME, yet not hypoxia, reduced p70S6 kinase activity and ribosomal protein S6 phosphorylation and increased eIF2α phosphorylation, consistent with inhibition of protein translation. Finally, TME reduced Retinoblastoma protein phosphorylation and induced poly-ADP-ribose polymerase (PARP) cleavage consistent with inhibition of proliferation and induction of apoptosis. NHE1 knockdown, mimicking the effect of TME on NHE1 expression, reduced Ea.hy926 migration. TME effects on HIF-1α, VEGF, Akt, translation, proliferation or apoptosis markers were unaffected by NHE1 knockdown/inhibition. CONCLUSIONS NHE1 and Akt are downregulated by TME conditions, more potently than by hypoxia alone. This inhibits endothelial cell migration and growth in a manner likely modulated by the cancer cell secretome.
Collapse
Affiliation(s)
- A K Pedersen
- Department of Cellular and Molecular Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Panum Institute, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - J Mendes Lopes de Melo
- Department of Cellular and Molecular Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Panum Institute, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - N Mørup
- Department of Cellular and Molecular Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Panum Institute, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - K Tritsaris
- Department of Cellular and Molecular Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Panum Institute, Blegdamsvej 3B, 2200, Copenhagen, Denmark.
| | - S F Pedersen
- Section for Cell Biology and Physiology, Department of Biology, Faculty of Science, University of Copenhagen, Universitetsparken 13, 2100, Copenhagen, Denmark.
| |
Collapse
|
24
|
Pontoppidan J, Nielsen JC, Poulsen SH, Jensen HK, Walfridsson H, Pedersen AK, Hansen PS. Prophylactic cavotricuspid isthmus block during atrial fibrillation ablation in patients without atrial flutter: a randomised controlled trial. Heart 2009; 95:994-9. [PMID: 19261602 DOI: 10.1136/hrt.2008.153965] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This randomised trial evaluated if patients with atrial fibrillation (AF) and no history of atrial flutter (AFL) had any benefit of prophylactic cavotricuspid isthmus block (CTIB) in addition to circumferential pulmonary vein ablation (CPVA). METHODS 149 patients with AF (54% paroxysmal) were randomised to CPVA and CTIB (group CTIB+, n = 73) or CPVA alone (group CTIB-, n = 76). Patients were followed for 12 months with repetitive 7-day Holter monitoring after 3, 6 and 12 months. RESULTS Six patients (4%) had cardiac tamponade, and one patient had a stroke. No difference was found in the cumulative AFL-free rate between the two treatment groups (CTIB+: 88% vs CTIB-: 84%, hazard ratio (HR) 0.80, 95% CI (0.34 to 1.90), p = 0.61). There was no difference in the cumulative AF-free rate between the groups (CTIB+: 34% vs CTIB-: 32%, HR 0.93, 95% CI (0.63 to 1.38), p = 0.71). Overall, 33% of the patients were free of AF after a single procedure. Including reprocedures, a complete or partial beneficial effect was noted in 62% of the patients at 12 months. At 12-month follow-up, 24 (50%) patients with documented AF or AFL in the Holter recordings were asymptomatic. CONCLUSIONS It was not possible to demonstrate any beneficial effect of CTIB in addition to CPVA with regard to AFL or AF recurrences during follow-up. Repetitive long-term Holter monitoring demonstrated a 33% rate of freedom from AF during a 1-year follow-up. Including additional CPVA procedures, a clinical effect was noted in 62% of the patients at 12 months. Patients with AF or AFL recurrences were often asymptomatic.
Collapse
Affiliation(s)
- J Pontoppidan
- Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark.
| | | | | | | | | | | | | |
Collapse
|
25
|
Abstract
BACKGROUND The low reproducibility of the QT dispersion (QTD) method is a major reason why it is not used in clinics. The purpose of this study was to develop QT dispersion parameters with better reproducibility and identification of patients with a high risk of ventricular arrhythmia or death. METHODS AND RESULTS Three institutions using different methods for measuring QT intervals provided QT databases, which included more than 3500 twelve-lead surface ECGs. The data represented low and high risk subjects from the following groups: the normal population EpiSet (survivors vs dead from cardiovascular causes), acute myocardial infarction patients AmiSet (survivors vs dead) and remote myocardial infarction patients ArrSet (with vs without a history of ventricular arrhythmia). The EpiSet, AmiSet, and the ArrSet contributed with N = 122, 0, and 110 ECGs for reproducibility analysis, and 3244, 446, and 100 ECGs for the analysis of prognostic accuracy. The prognostic accuracy was measured as the area under the Receiver Operator Curve. The QT intervals were divided into six QT pairs; the longest pair consisted of the longest and the shortest QT intervals etc. The QT dispersion trend (QTDT) was defined as the slope of the linear regression of the N longest QT pairs after estimation of missing QT intervals by interpolation of measured QT intervals. The QTMAD and the QTSTD methods were defined as twice the mean absolute deviation and the standard deviation of the N longest QT pairs. The reproducibility was improved by 27% and 19% in the EpiSet and the ArrSet relative to the reproducibility of QTD. The accuracy improved for the EpiSet and the ArrSet and was maintained for the AmiSet. CONCLUSIONS By using the three longest and the three shortest QT intervals in QTDT, QTMAD, or QTSTD, the reproducibility improved significantly while maintaining or improving the prognostic accuracy compared to QTD.
Collapse
Affiliation(s)
- K Lund
- Department of Cardiology, Skejby University Hospital, DK-8200 Aarhus N, Denmark.
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Abstract
AIM To estimate the reproducibility of QT parameters derived from 24-hour ambulatory ECG recordings. METHOD Ten healthy volunteers aged 25 to 41 years participated. In two 24-hour ambulatory ECG recordings obtained 1 day apart, the QT interval was measured manually at stable heart rates in approximately 16 periods during daytime and 6 periods during nighttime. The association between the QT and RR interval was described by linear regression for day and nighttime separately and the following QT parameters were calculated: the QT interval at heart rate 60 beats/min during daytime (QT(60)day), slope(day), slope(night), and the difference in QT(60) between day and nighttime (DeltaQT(60)). The QT parameters were assessed four times for each participant to discriminate method inaccuracy from day to day variation. The reproducibility was estimated as the coefficient of repeatability, the relative error, and the ratio between within-subject variability and between-subject variability. RESULTS The coefficient of repeatability, the relative error and the ratio, respectively, were 19 ms, 1.8% and 0.5 for QT(60)day, 0.076, 21% and 0.68 for slope(day), 0.116, 43% and 1.37 for slope(night), and 37 ms, 325% and 1.19 for DeltaQT(60) when estimating the overall day to day reproducibility. Inaccuracy of QT measurement accounted for approximately 40% of this variation, whereas the error caused by selecting segments was small. CONCLUSION QT(60)day has a high reproducibility and may with advantage replace the conventional QT interval measured on a resting ECG. To assess QT dynamics, the slope of the regression line during daytime is suitable and the short term reproducibility acceptable for clinical trials. Regarding slope(night) and DeltaQT(60), the variation is high and the parameters should be used with caution.
Collapse
Affiliation(s)
- H Arildsen
- Department of Cardiology (Research unit), Skejby University Hospital, DK-8200 Aarhus N, Denmark.
| | | | | | | |
Collapse
|
27
|
Abstract
BACKGROUND Prolonged QT dispersion (QTD) is associated with an increased risk of arrhythmic death but its accuracy varies substantially between otherwise similar studies. This study describes a new type of bias that can explain some of these differences. MATERIAL One dataset (DiaSet) consisted of 356 subjects: 169 with diabetes, 187 nondiabetic control persons. Another dataset (ArrSet) consisted of 110 subjects with remote myocardial infarction: 55 with no history of arrhythmia and 55 with a recent history of ventricular tachycardia or fibrillation. METHODS 12-lead surface ECGs were recorded with an amplification of 10 mm/mV at a paper speed of 50 mm/s. The QT interval was measured manually by the tangent-method. The bias depends on the magnitude of the measurement errors and the measurable part of the bias increases with the number of the repeated measurements of QT. RESULTS The measurable bias was significant for both datasets and decreased for increasing QTD in the DiaSet (P < 0.001) and in the ArrSet (P = 0.11). The bias was 2.5 ms and 1.9 ms at QTD = 38 ms and 68 ms, respectively, in the ArrSet, and 7.5 ms and 2.8 ms at QTD = 19 ms and 55 ms, respectively, in the DiaSet. CONCLUSIONS This study shows that random measurement errors of QT introduces a type of bias in QTD that decreases as the dispersion increases, thus reducing the separation between patients with low versus high dispersion. The bias can also explain some of the differences in the mean QTD between studies of healthy populations. Averaging QT over three successive beats reduces the bias efficiently.
Collapse
Affiliation(s)
- K Lund
- Department of Cardiology, Skejby University Hospital, DK-8200 Aarhus N. Denmark.
| | | | | | | | | | | |
Collapse
|
28
|
Pontoppidan J, Nielsen JC, Poulsen SH, Mortensen PT, Pedersen AK, Jensen HK, Hansen PS. Radiofrequency ablation of atrial fibrillation: effectiveness and safety in 102 consecutive patients. Heart 2005; 91:1611-2. [PMID: 16287751 PMCID: PMC1769213 DOI: 10.1136/hrt.2004.053660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
29
|
Kristensen L, Nielsen JC, Mortensen PT, Pedersen OL, Pedersen AK, Andersen HR. Incidence of atrial fibrillation and thromboembolism in a randomised trial of atrial versus dual chamber pacing in 177 patients with sick sinus syndrome. Heart 2004; 90:661-6. [PMID: 15145874 PMCID: PMC1768274 DOI: 10.1136/hrt.2003.016063] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To analyse the occurrence of atrial fibrillation (AF) and thromboembolism in a randomised comparison of rate adaptive single chamber atrial pacing (AAIR) and dual chamber pacing (DDDR) in patients with sick sinus syndrome and normal atrioventricular (AV) conduction, in which left atrial dilatation and decreased left ventricular fractional shortening had been observed in the DDDR group. METHODS 177 consecutive patients with sick sinus syndrome (mean (SD) age 74 (9) years, 104 women) were randomly assigned to treatment with one of three pacemakers: AAIR (n = 54), DDDR with a short rate adaptive AV delay (n = 60) (DDDR-s); or DDDR with a fixed long AV delay (n = 63) (DDDR-l). Analysis was intention to treat. RESULTS Mean follow up was 2.9 (1.1) years. AF at one or more ambulatory visits was significantly less common in the AAIR group (4 (7.4%) v 14 (23.3%) in the DDDR-s group v 11 (17.5%) in the DDDR-l group; p = 0.03, log rank test). The risk of developing AF in the AAIR group compared with the DDDR-s group was significantly decreased after adjustment for brady-tachy syndrome in a Cox regression analysis (relative risk 0.27, 95% confidence interval (CI) 0.09 to 0.83, p = 0.02). The benefit of AAIR was highest among patients with brady-tachy syndrome. Brady-tachy syndrome and a thromboembolic event before pacemaker implantation were independent predictors of thromboembolism during follow up (relative risk 7.5, 95% CI 1.6 to 36.2, p = 0.01, and relative risk 4.7, 95% CI 1.2 to 17.9, p = 0.02, respectively). CONCLUSIONS During a mean follow up of 2.9 years AAIR was associated with significantly less AF. The beneficial effect of AAIR was still significant after adjustment for brady-tachy syndrome. Brady-tachy syndrome was associated with an increased risk of thromboembolism.
Collapse
Affiliation(s)
- L Kristensen
- Department of Cardiology, Skejby Hospital, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | | | | |
Collapse
|
30
|
Priori SG, Aliot E, Blømstrom-Lundqvist C, Bossaert L, Breithardt G, Brugada P, Camm JA, Cappato R, Cobbe SM, Di Mario C, Maron BJ, McKenna WJ, Pedersen AK, Ravens U, Schwartz PJ, Trusz-Gluza M, Vardas P, Wellens HJJ, Zipes DP. [Task Force on Sudden Cardiac Death, European Society of Cardiology. Summary of recommendations]. Ital Heart J Suppl 2002; 3:1051-65. [PMID: 12478833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Affiliation(s)
- S G Priori
- Cardiologia Molecolare IRCCS Fondazione S. Maugeri Via Ferrata, 8 27100 Pavia.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Søgaard P, Kim WY, Jensen HK, Mortensen P, Pedersen AK, Kristensen BØ, Egeblad H. Impact of acute biventricular pacing on left ventricular performance and volumes in patients with severe heart failure. A tissue doppler and three-dimensional echocardiographic study. Cardiology 2002; 95:173-82. [PMID: 11585992 DOI: 10.1159/000047369] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We used tissue velocity imaging (TVI) and three-dimensional echocardiography to evaluate the effect of acute biventricular pacing on left ventricular (LV) performance and volumes in patients with severe heart failure and bundle branch block. BACKGROUND Biventricular pacing causes acute hemodynamic improvement in patients with severe heart failure, and QRS duration has been used as a predictor of improved resynchronization. Tissue velocity has the potential of demonstrating the degree of LV resynchronization and three-dimensional echocardiography enables accurate quantitation of LV volumes and function. METHODS TVI and three-dimensional echocardiography were performed during sinus rhythm and biventricular pacing in 25 consecutive patients with severe heart failure. RESULTS Biventricular pacing significantly improved the extent of contracting myocardium in synchrony by 15.4% and the duration of contraction synchrony by 17% (p < 0.05 for both). Furthermore, end-diastolic and end-systolic volumes decreased by 7 +/- 4.5% and 13 +/- 6% (p < 0.01) and ejection fraction increased by 22.8 +/- 9% (p < 0.01). Baseline duration of QRS and the preejection period as well as the extent of myocardium with asynchronous contraction measured by TVI predicted pacing efficacy. In multivariate analysis, only the extent of myocardium with asynchronous contraction at the LV base predicted biventricular pacing efficacy. CONCLUSION Biventricular pacing improves LV systolic performance and reduces LV volumes during short-term treatment. TVI provides important pathophysiological information on the degree of LV resynchronization and may contribute to improved patient selection.
Collapse
Affiliation(s)
- P Søgaard
- Department of Cardiology, Skejby Hospital, Aarhus University, Denmark.
| | | | | | | | | | | | | |
Collapse
|
32
|
Priori SG, Aliot E, Blømstrom-Lundqvist C, Bossaert L, Breithardt G, Brugada P, Camm JA, Cappato R, Cobbe SM, Di MC, Maron BJ, McKenna WJ, Pedersen AK, Ravens U, Schwartz PJ, Trusz-Gluza M, Vardas P, Wellens HJJ, Zipes DP. Task Force on Sudden Cardiac Death, European Society of Cardiology. Europace 2002; 4:3-18. [PMID: 11858152 DOI: 10.1053/eupc.2001.0214] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The European Society of Cardiology has convened a Task Force on Sudden Cardiac Death in order to provide a comprehensive, educational document on this important topic. The main document has been published in the European Heart Journal in August 2001. The Task Force has now summarized the most important clinical issues on sudden cardiac death and provided tables with recommendations for risk stratification and for prophylaxis of sudden cardiac death. The present recommendations are specifically intended to encourage the development and revision of national guidelines on prevention of sudden cardiac death. The common challenge for cardiologists, physicians of other medical specialties and health professionals throughout Europe is to realize the potential for sudden cardiac death prevention and to contribute to public health efforts to reduce its burden.
Collapse
Affiliation(s)
- S G Priori
- Task Force on Sudden Cardiac Death of the European Society of Cardiology, Fondazione Salvatore Maugeri, University of Pavia, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Priori SG, Aliot E, Blomstrom-Lundqvist C, Bossaert L, Breithardt G, Brugada P, Camm AJ, Cappato R, Cobbe SM, Di Mario C, Maron BJ, McKenna WJ, Pedersen AK, Ravens U, Schwartz PJ, Trusz-Gluza M, Vardas P, Wellens HJ, Zipes DP. Task Force on Sudden Cardiac Death of the European Society of Cardiology. Eur Heart J 2001; 22:1374-450. [PMID: 11482917 DOI: 10.1053/euhj.2001.2824] [Citation(s) in RCA: 563] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
MESH Headings
- Algorithms
- Aortic Valve Stenosis/etiology
- Aortic Valve Stenosis/therapy
- Arrhythmias, Cardiac/etiology
- Arrhythmias, Cardiac/therapy
- Arrhythmogenic Right Ventricular Dysplasia/etiology
- Arrhythmogenic Right Ventricular Dysplasia/therapy
- Cardiomyopathy, Dilated/etiology
- Cardiomyopathy, Dilated/therapy
- Cardiomyopathy, Hypertrophic/etiology
- Cardiomyopathy, Hypertrophic/therapy
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Heart Failure/complications
- Humans
- Long QT Syndrome/etiology
- Long QT Syndrome/therapy
- Mitral Valve Prolapse/etiology
- Mitral Valve Prolapse/therapy
- Myocardial Infarction/complications
- Randomized Controlled Trials as Topic
- Resuscitation
- Risk Factors
- Torsades de Pointes/chemically induced
- Torsades de Pointes/mortality
- Wolff-Parkinson-White Syndrome/etiology
- Wolff-Parkinson-White Syndrome/therapy
Collapse
Affiliation(s)
- S G Priori
- Task Force on Sudden Cardiac Death, European Society of Cardiology, Fondazione Salvatore Maugeri, University of Pavia, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Kim WY, Søgaard P, Mortensen PT, Jensen HK, Pedersen AK, Kristensen BO, Egeblad H. Three dimensional echocardiography documents haemodynamic improvement by biventricular pacing in patients with severe heart failure. Heart 2001; 85:514-20. [PMID: 11303000 PMCID: PMC1729749 DOI: 10.1136/heart.85.5.514] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To quantify the short term haemodynamic effects of biventricular pacing in patients with heart failure and left bundle branch block by using three dimensional echocardiography. DESIGN Three dimensional echocardiography was performed in 15 consecutive heart failure patients (New York Heart Association functional class III or IV) with an implanted biventricular pacing system. Six minute walk tests were performed to investigate the effect of biventricular pacing on exercise capacity. Data were acquired at sinus rhythm and after short term (2-7 days) biventricular pacing. RESULTS Compared with baseline values, biventricular pacing significantly reduced left ventricular end diastolic volume (EDV) by mean (SD) 4.0 (5.1)% (p < 0.01) and end systolic volume (ESV) by 5.6 (6.4)% (p < 0.02). Mitral regurgitant fraction was significantly reduced by 11 (12.1)% (p < 0.003) and forward stroke volume (FSV) increased by 13.9 (18.6)% (p < 0.02). Exercise capacity was significantly improved with biventricular pacing by 48.4 (43.3)% (p < 0.00001). Regression analyses showed that the percentage increase in FSV independently predicted percentage improvement in walking distance (r(2) = 0.73, p < 0.0002). Both basal QRS duration and QRS narrowing predicted pacing efficacy, showing a significant correlation with %DeltaEDV, %DeltaESV, and %DeltaFSV. CONCLUSIONS In five of 15 consecutive patients with heart failure and left bundle branch block, biventricular pacing induced a more than 15% increase in FSV, which predicted a more than 25% increase in walking distance and was accompanied by an immediate reduction in left ventricular chamber size and mitral regurgitation.
Collapse
Affiliation(s)
- W Y Kim
- Department of Cardiology, Aarhus University Hospital, Skejby Sygehus, Denmark.
| | | | | | | | | | | | | |
Collapse
|
35
|
Bøtker HE, Lassen JF, Hermansen F, Wiggers H, Søgaard P, Kim WY, Bøttcher M, Thuesen L, Pedersen AK. Electromechanical mapping for detection of myocardial viability in patients with ischemic cardiomyopathy. Circulation 2001; 103:1631-7. [PMID: 11273989 DOI: 10.1161/01.cir.103.12.1631] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We evaluated the ability of electromechanical mapping of the left ventricle to distinguish between nonviable and viable myocardium in patients with ischemic cardiomyopathy. METHODS AND RESULTS Unipolar voltage amplitudes and local endocardial shortening were measured in 31 patients (mean+/-SD age, 62+/-8 years) with ischemic cardiomyopathy (ejection fraction, 30+/-9%). Dysfunctional regions, identified by 3D echocardiography, were characterized as nonviable when PET revealed matched reduction of perfusion and metabolism and as viable when perfusion was reduced or normal and metabolism was preserved. Mean unipolar voltage amplitudes and local shortening differed among normal, nonviable, and viable dysfunctional segments. Coefficient of variation for local shortening exceeded differences between groups and did not allow distinction between normal and dysfunctional myocardium. Optimum nominal discriminatory unipolar voltage amplitude between nonviable and viable dysfunctional myocardium was 6.5 mV, but we observed a great overlap between groups. Individual cutoff levels calculated as a percentage of electrical activity in normal segments were more accurate in the detection of viable dysfunctional myocardium than a general nominal cutoff level. The optimum normalized discriminatory value was 68%. Sensitivity and specificity were 78% for the normalized discriminatory value compared with 69% for the nominal value (P:<0.02). CONCLUSIONS Endocardial ECG amplitudes in patients with ischemic cardiomyopathy display a wide scatter, complicating the establishment of exact nominal values that allow distinction between viable and nonviable areas. Individual normalization of unipolar voltage amplitudes improves diagnostic accuracy. Electroanatomic mapping may enable identification of myocardial viability.
Collapse
Affiliation(s)
- H E Bøtker
- Department of Cardiology, Skejby Hospital, Aarhus, Denmark.
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Kristensen L, Nielsen JC, Pedersen AK, Mortensen PT, Andersen HR. AV block and changes in pacing mode during long-term follow-up of 399 consecutive patients with sick sinus syndrome treated with an AAI/AAIR pacemaker. Pacing Clin Electrophysiol 2001; 24:358-65. [PMID: 11310306 DOI: 10.1046/j.1460-9592.2001.00358.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This retrospective study included a large cohort of consecutive patients primarily implanted at Skejby University Hospital with an AAI/AAIR pacemaker because of sick sinus syndrome (SSS) from July 1981 to July 1999. The primary aim of the study was to analyze the risk of developing AV block during long-term follow-up. A secondary aim was to study the incidence and reasons for changes in pacing mode caused by other than AV block. A total of 399 patients (231 women, mean age 71 +/- 13.5 years) were identified. Mean follow-up was 4.6 +/- 3.4 years and occurred at death, reoperation with mode change, pacemaker explant, or end of study. During follow-up, 44 patients had a ventricular lead implanted with a mean delay of 2.8 +/- 3.1 years (range 1 day-10.4 years) after the primary implantation. A total of 30 patients received a ventricular lead because of AV block or AF with bradycardia (annual incidence 1.7%). Another 14 patients received a ventricular lead without having documented AV block or AF with pauses (annual incidence 0.8%). The present observational study documents that in patients with SSS treated with AAI/AAIR pacing, AV block requiring implantation of a ventricular lead occurs at a rate of 1.7% per year. It is considered that AAI/AAIR pacing is safe and reliable as treatment for patients with SSS and normal AV conduction.
Collapse
Affiliation(s)
- L Kristensen
- Department of Cardiology, Skejby University Hospital, Brendstrupgaardsvej, 8200 Aarhus N., Denmark
| | | | | | | | | |
Collapse
|
37
|
Kastrup JS, Linde V, Pedersen AK, Stoffer B, Iversen LF, Larsen IK, Rasmussen PB, Flodgaard HJ, Bjørn SE. Two mutants of human heparin binding protein (CAP37): toward the understanding of the nature of lipid A/LPS and BPTI binding. Proteins 2001; 42:442-51. [PMID: 11170199 DOI: 10.1002/1097-0134(20010301)42:4<442::aid-prot30>3.0.co;2-s] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Heparin binding protein (HBP) is an inactive serine protease homologue with important implications in host defense during infections and inflammations. Two mutants of human HBP, [R23S,F25E]HBP and [G175Q]HBP, have been produced to investigate structure-function relationships of residues in the putative lipid A/lipopolysaccharide (LPS) binding site and BPTI (bovine pancreatic trypsin inhibitor) binding site. The X-ray structures have been determined at 1.9 A resolution for [G175Q]HBP and at 2.5 A resolution for the [R23S,F25E]HBP mutant, and the structures have been fully refined to R-factors of 18.2 % and 20.7 %, respectively. The G175Q mutation does not alter the overall structure of the protein, but the ability to bind BPTI has been eliminated, and the mutant mediates only a limited stimulation of the LPS-induced cytokine release from human monocytes. The lipid A/LPS binding property of [G175Q]HBP is comparable with that of native HBP. The R23S,F25E mutations do not affect the binding of lipid A/LPS and BPTI or the LPS-induced cytokine release from human monocytes. This shows that two diverse ligands, lipid A/LPS and BPTI, do not share binding sites. Previously, there was convincing evidence for the proposed lipid A/LPS binding site of HBP. Unexpectedly, the extensive structural changes introduced by mutation of Arg23 and Phe25 do not affect the binding of lipid A/LPS, indicating that another not yet identified site on HBP is involved in the binding of lipid A/LPS.
Collapse
Affiliation(s)
- J S Kastrup
- Department of Medicinal Chemistry, Royal Danish School of Pharmacy, Copenhagen, Denmark.
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Christiansen EH, Frost L, Andreasen F, Mortensen P, Thomsen PE, Pedersen AK. Dose-related cardiac electrophysiological effects of intravenous magnesium. A double-blind placebo-controlled dose-response study in patients with paroxysmal supraventricular tachycardia. Europace 2000; 2:320-6. [PMID: 11194599 DOI: 10.1053/eupc.2000.0123] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIMS The role of magnesium as an antiarrhythmic drug is yet not conclusive. Therefore, we performed a double-blind, randomized, placebo-controlled dose-response study of cardiac electrophysiological effects of intravenous magnesium. METHODS AND RESULTS Thirty-six patients undergoing an electrophysiological evaluation for paroxysmal supraventricular tachycardia were randomized to one of the following dosages of intravenous magnesium (0, 5, 10 or 20 mmol). Conventional electrophysiological variables for sinus node function, atrial, atrioventricular node and ventricular conduction and refractoriness were measured before and after magnesium administration. Prolongation of the atrial-His interval was found at 5 mmol of magnesium compared with placebo and no further prolongation was observed at higher doses (-3 +/- 8, 11 +/- 9, 7 +/- 15, 11 +/- 16, for the dosages of 0, 5, 10 and 20 mmol of magnesium, respectively, P < 0.05). Measures of sinus node function, intra-atrial conduction and conduction through the Purkinje system were unaffected by magnesium. Male gender was associated with prolongation in atrial effective refractory period, in contrast to shortening in females: 2 +/- 43, 35 +/- 44, 36 +/- 33, 13 +/- 12 ms for males and 3 +/- 6, -12 +/- 11, -13 +/- 12, 0 +/- 23 ms for females, respectively (P < 0.001). CONCLUSION Atrioventricular node conduction was prolonged by 5 mmol intravenous magnesium and no further prolongation was observed at higher dosages. At dosages of 5 and 10 mmol magnesium the atrial effective refractoriness was prolonged in males and shortened in females.
Collapse
Affiliation(s)
- E H Christiansen
- Department of Cardiology, Skejby University Hospital, DK-8200 Aarhus N, Denmark
| | | | | | | | | | | |
Collapse
|
39
|
Nielsen JC, Bøttcher M, Nielsen TT, Pedersen AK, Andersen HR. Regional myocardial blood flow in patients with sick sinus syndrome randomized to long-term single chamber atrial or dual chamber pacing--effect of pacing mode and rate. J Am Coll Cardiol 2000; 35:1453-61. [PMID: 10807447 DOI: 10.1016/s0735-1097(00)00593-3] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study aimed to evaluate regional myocardial blood flow (MBF) and global left ventricular ejection fraction (LVEF) during chronic pacing in patients with sick sinus syndrome (SSS) randomized to either single chamber atrial (AAI) or dual chamber (DDD) pacing. BACKGROUND Experimental studies indicate that chronic pacing in the right ventricular apex changes regional MBF, thereby compromising left ventricular function. METHODS Thirty patients (age 74 +/- 10 years) were randomized to AAI (n = 15) or DDD (n = 15) pacemakers. After 22 +/- 7 months of pacing, MBF was quantified with 13N-labeled ammonia positron emission tomography scanning at 60 beats per min and 90 beats per min. Patients in the DDD group furthermore underwent MBF measurement at temporary AAI pacing, 60 beats per min. Myocardial blood flow was assessed in the anterior, lateral, inferior and septal regions, and the global mean MBF was calculated. Left ventricular ejection fraction was determined by echocardiography at pacemaker implantation and at the time of MBF measurements. RESULTS Myocardial blood flow at rates 60 and 90 beats per min did not differ between the AAI and DDD groups. During temporary AAI pacing in the DDD group, MBF was significantly higher than during DDD pacing in both the inferior (p = 0.001) and septal (p = 0.004) regions and also globally (0.61 +/- 0.15 vs. 0.53 +/- 0.13 mL x g(-1) x min(-1), p = 0.005). In the DDD group, LVEF decreased from pacemaker implantation to time of MBF measurements (0.61 +/- 0.09 vs. 0.56 +/- 0.07, p = 0.013). Left ventricular ejection fraction during temporary AAI pacing at time of MBF measurements was not different from LVEF at pacemaker implantation. CONCLUSIONS In patients with SSS, chronic DDD pacing reduced inferior, septal and global mean MBF as well as LVEF, as compared with temporary AAI pacing. The LVEF reversed to baseline level during temporary AAI pacing despite 22 months of permanent ventricular pacing preceding it. Augmenting pace rate to 90 beats per min increased MBF equally in the two treatment groups.
Collapse
Affiliation(s)
- J C Nielsen
- Department of Cardiology B, Skejby Sygehus, Aarhus University Hospital, Brendstrupgaardsvej, Denmark
| | | | | | | | | |
Collapse
|
40
|
Mogensen J, Klausen IC, Pedersen AK, Egeblad H, Bross P, Kruse TA, Gregersen N, Hansen PS, Baandrup U, Borglum AD. Alpha-cardiac actin is a novel disease gene in familial hypertrophic cardiomyopathy. J Clin Invest 1999; 103:R39-43. [PMID: 10330430 PMCID: PMC408458 DOI: 10.1172/jci6460] [Citation(s) in RCA: 234] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/1999] [Accepted: 04/14/1999] [Indexed: 11/17/2022] Open
Abstract
We identified the alpha-cardiac actin gene (ACTC) as a novel disease gene in a pedigree suffering from familial hypertrophic cardiomyopathy (FHC). Linkage analyses excluded all the previously reported FHC loci as possible disease loci in the family studied, with lod scores varying between -2.5 and -6.0. Further linkage analyses of plausible candidate genes highly expressed in the adult human heart identified ACTC as the most likely disease gene, showing a maximal lod score of 3.6. Mutation analysis of ACTC revealed an Ala295Ser mutation in exon 5 close to 2 missense mutations recently described to cause the inherited form of idiopathic dilated cardiomyopathy (IDC). ACTC is the first sarcomeric gene described in which mutations are responsible for 2 different cardiomyopathies. We hypothesize that ACTC mutations affecting sarcomere contraction lead to FHC and that mutations affecting force transmission from the sarcomere to the surrounding syncytium lead to IDC.
Collapse
Affiliation(s)
- J Mogensen
- Department of Cardiology, and Research Unit for Molecular Medicine, Skejby University Hospital, Brendstrupgaardsvej, DK-8200 Aarhus N, Denmark.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Abstract
AIMS Arrhythmogenic right ventricular dysplasia is a rarely diagnosed cardiomyopathy, but a frequent cause of ventricular arrhythmia and sudden cardiac death. QT interval dispersion, measured as an interlead variability of QT, is a marker of dispersion of ventricular repolarization and, hence, of electrical instability. The present study was conducted to assess the occurrence of QT dispersion and its modulation during treatment with sotalol. Methods Twenty-five patients with the diagnosis of arrhythmogenic right ventricular dysplasia were studied retrospectively. Fourteen patients were considered low risk for malignant ventricular arrhythmia and sudden cardiac death, and 11 high risk due to documented sustained ventricular arrhythmia, cardiac arrest, or sudden cardiac death. Twenty five healthy volunteers served as control subjects. RESULTS Dispersion of repolarization was significantly higher in patients than in control subjects (QTd and JTd: P<0.05). Dispersion of repolarization was equal in patients both with and without malignant arrhythmias. There was no significant change in dispersion after treatment with sotalol. Adjacent QT dispersion between leads V3-V4, V4-V5 and V5-V6, respectively, was higher in patients than in control subjects (P<0. 05), while no differences were seen in leads V1-V2 and V2-V3. CONCLUSION QT interval dispersion is increased in patients with arrhythmogenic right ventricular dysplasia. However, the degree of dispersion is not related to the severity of symptoms, nor is it influenced by treatment with sotalol.
Collapse
Affiliation(s)
- M Benn
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | | |
Collapse
|
42
|
Nielsen JC, Pedersen AK, Mortensen PT, Andersen HR. Programming a fixed long atrioventricular delay is not effective in preventing ventricular pacing in patients with sick sinus syndrome. Europace 1999; 1:113-20. [PMID: 11228853 DOI: 10.1053/eupc.1998.0026] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Most patients with sick sinus syndrome (SSS) and normal atrioventricular (AV) conduction receive dual chamber (DDDR) pacemakers. Programming a long AV delay has been proposed to avoid ventricular pacing. The present study aimed to evaluate ventricular stimulation in SSS patients with DDDR pacemakers with a long AV delay. METHODS AND RESULTS Thirty eight patients treated with DDDR pacemakers with a fixed long AV delay (300 ms) were studied. Data from the pacemaker event recorder were retrieved after 3 months and every year after implantation. Ten patients underwent 24 h Holter recording. Mean follow-up was 11.9 +/- 8.3 months. Median daily number of paced events in the ventricle was 2659 (25th-75th percentiles: 775-21 315) with a large inter-individual variation. The proportion of paced events in the ventricle correlated weakly with the baseline PQ interval (Spearman's rho 0.331, P = 0.043). In 12/38 patients the mean daily number of paced events in the ventricle exceeded 10,000. During 24 h Holter recording, pacemaker arrhythmias caused by repetitive retrograde atrioventricular conduction, known as VA (ventriculoatrial) conduction, occurred in five out of 10 patients. CONCLUSION DDDR pacing with a fixed long AV delay is inefficient in reducing ventricular pacing in one third of patients and is associated with a high risk of arrhythmias caused by repetitive retrograde AV conduction, and therefore cannot be recommended for general use in SSS patients.
Collapse
Affiliation(s)
- J C Nielsen
- Department of Cardiology, Skejby University Hospital, Brendstrupgaardsvej, 8200 Aarhus N., Denmark
| | | | | | | |
Collapse
|
43
|
Andersen HR, Nielsen JC, Thomsen PE, Thuesen L, Pedersen AK, Mortensen PT, Vesterlund T. Arterial thromboembolism in patients with sick sinus syndrome: prediction from pacing mode, atrial fibrillation, and echocardiographic findings. Heart 1999; 81:412-8. [PMID: 10092569 PMCID: PMC1729005 DOI: 10.1136/hrt.81.4.412] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate whether thromboembolism in sick sinus syndrome can be predicted by pacing mode, atrial fibrillation, or echocardiographic findings. METHODS Patients were randomised to single chamber atrial (n = 110) or ventricular (n = 115) pacing. They were divided into subgroups with and without brady-tachy syndrome at time of randomisation. The occurrence of atrial fibrillation and thromboembolism during follow up were investigated and compared with echocardiographic findings. RESULTS The annual risk of thromboembolism was 5.8% in patients with brady-tachy syndrome randomised to ventricular pacing, 3.2% in patients without brady-tachy syndrome randomised to ventricular pacing, 3% in patients with brady-tachy syndrome randomised to atrial pacing, and 1.5% in patients without brady-tachy syndrome randomised to atrial pacing. In atrial paced patients without brady-tachy syndrome at randomisation and without atrial fibrillation during follow up, the annual risk of thromboembolism was 1.4%. Left atrial size measured by M mode echocardiography was of no value in predicting thromboembolism. CONCLUSIONS Arterial thromboembolism in patients with sick sinus syndrome is very common and is associated primarily with brady-tachy syndrome at randomisation and with ventricular pacing. The risk of thromboembolism is small in atrial paced patients in whom atrial fibrillation has never been documented.
Collapse
Affiliation(s)
- H R Andersen
- Department of Cardiology, Skejby Sygehus, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | | | | | | | | | | | | |
Collapse
|
44
|
Nielsen JC, Mortensen PT, Thuesen L, Nielsen TV, Thomsen PE, Pedersen AK, Andersen HR. [Single-chamber atrial pacing is better than single chamber ventricular pacing in patients with sick sinus syndrome. Results of long-term follow up in a prospective randomized study]. Ugeskr Laeger 1999; 161:587-92. [PMID: 9989193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
In a study of 225 patients with sick sinus syndrome randomized to single chamber atrial pacing (n = 110) or ventricular pacing (n = 115), atrial pacing was associated with less atrial fibrillation and thromboembolism after 3.3 years follow-up. To determine whether this beneficial effect of atrial pacing is maintained at long-term, follow-up was extended. Follow-up visits were at 3 months, 12 months, and then once every year, and included physical examination, ECG, and pacemaker check-up. After 5.5 years follow-up, all-cause mortality, cardiovascular deaths, atrial fibrillation, thromboembolism, and heart failure were significantly less in the atrial group. AV block occurred in four patients in the atrial group. The beneficial effect of atrial pacing observed previously is enhanced substantially after extended follow-up. Patients with sick sinus syndrome should be treated with an atrial pacing system.
Collapse
Affiliation(s)
- J C Nielsen
- Arhus Universitetshospital, Skejby Sygehus, hjertemedicinsk afdeling B
| | | | | | | | | | | | | |
Collapse
|
45
|
Gras D, Mabo P, Tang T, Luttikuis O, Chatoor R, Pedersen AK, Tscheliessnigg HH, Deharo JC, Puglisi A, Silvestre J, Kimber S, Ross H, Ravazzi A, Paul V, Skehan D. Multisite pacing as a supplemental treatment of congestive heart failure: preliminary results of the Medtronic Inc. InSync Study. Pacing Clin Electrophysiol 1998; 21:2249-55. [PMID: 9825328 DOI: 10.1111/j.1540-8159.1998.tb01162.x] [Citation(s) in RCA: 262] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This report describes the initial results of the "InSync" study, a European and Canadian multicenter trial that examines the safety and efficacy of a multisite pacemaker (Medtronic InSync) and of left ventricular pacing leads (Medtronic 2187 and 2188) implanted via a cardiac vein as a supplemental treatment of refractory congestive heart failure. Over a 10-month period, the system was implanted successfully in 68 of the 81 (84%) patients who had been enrolled in the study. The 68 patients were, on average, 66 +/- 10 years old, had a mean left ventricular ejection fraction (LVEF) = 21% +/- 9%, and 63% were in NYHA functional Class III and 37% were in Class IV. No system implant related complication occurred. During follow-up, 7 of 10 patients who exited the study had died, 4 suddenly. There was a clinical benefit among surviving patients, which was corroborated by a significant improvement in NYHA functional class and in the Minnesota Living with Heart Failure Quality of Life Questionnaire Score (MLS) and by a longer distance covered during a 6-minute walk test. This clinical improvement was associated with a significant narrowing of the paced QRS complex during biventricular pacing, a significant decrease in the interventricular mechanical delay, and a trend towards an increase in the duration of ventricular filling. These encouraging preliminary results confirm the feasibility and reliability of this new multisite pacing system in the management of dilated cardiomyopathy and support the continuation of further evaluations of this complementary treatment of refractory congestive heart failure.
Collapse
Affiliation(s)
- D Gras
- Centre Chirurgical du Val d'Or, Saint-Cloud, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Andersen HR, Nielsen JC, Thomsen PE, Thuesen L, Vesterlund T, Pedersen AK, Mortensen PT. Atrioventricular conduction during long-term follow-up of patients with sick sinus syndrome. Circulation 1998; 98:1315-21. [PMID: 9751681 DOI: 10.1161/01.cir.98.13.1315] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND It has been claimed that patients with sick sinus syndrome have an increased risk of developing AV block, but this has never been assessed prospectively. The aim of the present study was to evaluate in a prospective trial AV conduction during the long-term follow-up of patients with sick sinus syndrome. METHODS Two hundred twenty-five consecutive patients with sick sinus syndrome and intact AV conduction were randomized to undergo single-chamber atrial pacing (110 patients) or single-chamber ventricular pacing (115 patients). Follow-up after 3 months and then yearly included measurement of the PQ interval and, in patients with atrial pacemakers, determination of the atrial stimulus-Q intervals at pacing rates of 100 and 120 bpm. The occurrence of AV block in the atrial group was recorded. During follow-up (mean, 5.5+/-2.4 years), there was no change in PQ interval in either group and no change in atrial stimulus-Q intervals or Wenckebach block point in the atrial group. Four of 110 patients in the atrial group developed grade 2 to 3 AV block that required upgrading of the pacemaker (0.6% per year). Two of these 4 patients had right bundle-branch block at pacemaker implantation. CONCLUSIONS AV conduction, estimated as PQ interval and atrial stimulus-Q interval at atrial pacing rates of 100 and 120 bpm and the Wenckebach block point, remains stable during long-term follow-up. Thus, treatment with single-chamber atrial pacing is safe and can be recommended to patients with sick sinus syndrome without bundle-branch block.
Collapse
Affiliation(s)
- H R Andersen
- Department of Cardiology, Skejby Sygehus, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | | | | | | |
Collapse
|
47
|
Abstract
A codon-based model designed to describe lentiviral evolution is developed. The model incorporates unequal base compositions in the three codon positions and selection against the CpG dinucleotide within codons to account for a deficit of this dinucleotide exhibited by lentiviral genes. The model is, to a large extent, able to account for the pattern of codon usage exhibited by the HIV1 genes gag, pol, and env, in spite of its parameter paucity. The model is extended to a similar model which operates on pentets (codons and their neighboring bases). The results obtained by the pentet model establish the importance of depression of CpGs across codon boundaries as well as within codons. The goodness of fit of the CpG depression model to the observed evolution in pairwise alignments of HIV1 sequences is assessed. The model provides a significantly better description of the observed evolution than the simpler models examined. The parameter estimates indicate that part of the unusually large biases in nucleotide frequencies observed in HIV1 genes is caused by selection against CpGs. We find that the estimates of expected numbers of substitutions, of transitions to transversions, and of synonymous to nonsynonymous substitution rates are robust to CpG depression, whereas the ratio of CpG-generating substitutions to other substitutions is strongly influenced by the choice of model.
Collapse
Affiliation(s)
- A K Pedersen
- Institute of Biological Sciences, University of Aarhus, Denmark.
| | | | | |
Collapse
|
48
|
Abstract
There is a growing interest in the analysis of beat-to-beat variations of the morphology (BBM) of cardiac waves in electrocardiograms (ECG). Such analyses are confronted with the low BBM-to-noise ratio. An ECG clustering technique is introduced that brings the benefits of signal averaging to BBM analysis and recovers the beat-to-beat pattern of BBM. ECG clustering aligns waves and sorts them into clusters. The precision of the alignment was enhanced by sub-sample alignment. Kohonen's self-organising neural networks identified the clusters of the cardiac waves during training. The subsequent clustering of a wave results in a label for the closest cluster, a distance to the cluster and optimal alignment. Furthermore, ECG clustering avoids base-line variations and amplitude modulation sufficiently to be applied to the QRS wave in the raw ECG. The technique is demonstrated on 14 subjects with coronary heart disease and no myocardial infarction, myocardial infarction, or inducible ventricular tachycardia. ECG clustering is a general-purpose technique for beat-to-beat analysis, where the variations are cyclic as in the sinus rhythm. Results show that beat-to-beat variations in the QRS morphology are in general cyclic, with a main period of about four cardiac cycles. All calculations were performed with the Cardio software.
Collapse
Affiliation(s)
- K Lund
- Department of Cardiology, Skejby University Hospital, Aarhus, Denmark.
| | | | | | | |
Collapse
|
49
|
Lund B, Hansen PS, Benn M, Pedersen AK. [Hereditary long QT syndrome]. Ugeskr Laeger 1998; 160:3533-9. [PMID: 9641038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The Long QT Syndrome (LQTS) is a hereditary disease, characterized by a prolonged QT-interval on the electrocardiogram and a high risk of syncope and sudden death due to ventricular arrhythmias. LQTS must be suspected in apparently healthy children and young people with syncope after emotional or physical stress. Untreated symptomatic patients have a high mortality, which is markedly reduced by sympathetic block. The knowledge of the diagnostic criteria for the LQTS, a detailed history including a family history and an ECG-recording with measurement of the QT-interval in every patient with inexplicable syncope will advance the diagnosis of the LQTS and improve the survival of these patients after proper therapy. The current knowledge on the molecular genetics, epidemiology, mechanisms of arrhythmias and therapy are presented with special emphasis on the defects in the control of ionic transport over the cell membrane caused by mutations in ion channels.
Collapse
Affiliation(s)
- B Lund
- Skejby Sygehus, Arhus Universitetshospital, hjertemedicinsk afdeling B
| | | | | | | |
Collapse
|
50
|
Nielsen JC, Andersen HR, Thomsen PE, Thuesen L, Mortensen PT, Vesterlund T, Pedersen AK. Heart failure and echocardiographic changes during long-term follow-up of patients with sick sinus syndrome randomized to single-chamber atrial or ventricular pacing. Circulation 1998; 97:987-95. [PMID: 9529267 DOI: 10.1161/01.cir.97.10.987] [Citation(s) in RCA: 142] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND In patients with sick sinus syndrome, choice of pacing mode has been implicated in the development of congestive heart failure. METHODS AND RESULTS A total of 225 consecutive patients with sick sinus syndrome and intact atrioventricular conduction were randomized to either single-chamber atrial pacing (n = 110) or single-chamber ventricular pacing (n = 115). Clinical assessment included New York Heart Association classification, medication, and M-mode echocardiography before pacemaker implantation, after 3 months, and subsequently once every year. At long-term follow-up (mean, 5.5+/-2.4 years), NYHA class was higher in the ventricular group than in the atrial group (NYHA class I/II/III/IV: 65/44/4/0 versus 84/22/2/1 patients, P=.010). Increase in NYHA class during follow-up was observed in 35 of 113 patients in the ventricular group versus 10 of 109 in the atrial group (P<.0005). Increase in dose of diuretics from randomization to last follow-up was significantly higher in the ventricular group than in the atrial group (21+/-49 versus 8+/-42 mg furosemide/d, P=.033). The left ventricular fractional shortening decreased significantly in the ventricular group (from 0.36+/-0.12 to 0.31+/-0.08, P<.0005) but not in the atrial group (from 0.35+/-0.13 to 0.33+/-0.09, P=.087). The left atrial diameter increased significantly in both treatment groups (ventricular group: from 34+/-7 to 41+/-7 mm, P<.0005; atrial group: from 34+/-6 to 37+/-7 mm, P=.002), but the increase was significantly higher in the ventricular group than in the atrial group (P<.0005). CONCLUSIONS During long-term follow-up, ventricular pacing is associated with a higher incidence of congestive heart failure and consumption of diuretics than atrial pacing. This is accompanied by a decrease in left ventricular fractional shortening and an increased dilatation of the left atrium in the ventricular paced patients.
Collapse
Affiliation(s)
- J C Nielsen
- Department of Cardiology, Skejby Sygehus, Aarhus University Hospital, Denmark
| | | | | | | | | | | | | |
Collapse
|