1
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Klett-Tammen CJ, Heise JK, Soja SM, Janzen I, Jenniches F, Kemmling Y, Behrens G, Schulz TF, Wegener R, Castell S. Self-reported vaccination against SARS-CoV-2 and adverse events in multiple cohorts. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.405] [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: 11/13/2022] Open
Abstract
Abstract
In two studies (“App-based infection assessment in RESIST (iAR)” and “Digital infection monitoring in persons living with immunodeficiency (DIMI)” ), we monitor health related items, as vaccination against SARS-CoV-2 and conduct syndromic surveillance of acute respiratory infections in high-risk populations, i.e. elderly persons and persons living with HIV, respectively. In a third very similar study (“Sensors for measuring aerosols and reactive gases to deduce health effects (SMARAGD)”) mainly healthy adults participate. To record incident or recurring transient health events, risk factors and further health data in real-time, we developed the eResearch system “PIA - Prospective Monitoring and Management App”. Recruitment for RESIST, SMARAGD and DIMI started in March 2021 and is ongoing. The questionnaire was presented in April 2022. Preliminary results include 86 participants from the three cohorts. In total, one indicated to be not vaccinated, none were vaccinated once, three (3.5%) twice, 63 (73.3%) three times and 19 (22.1%) four times. Participants reported the following adverse events after immunization (AEFI): after 40 applied doses with Vaxzevria® 24 AEFI (60%); after 158 doses of Comirnaty® 41 AEFI (26%); after 62 doses of Spikevax® 19 AEFI (30.7%); and after three doses of Janssen®, one AEFI (33.3%). In these cohorts, 20 (23.36%) participants stated having had a SARS-CoV-2 infection, of these 16 (80%) after the last vaccination dose, three (15%) before the first dose and one (5%) in between doses. Most participants were vaccinated three times, with Comirnaty being the most applied vaccine, as in officially reported numbers. AEFI varied according to vaccine and were higher than in the German surveillance system (1.64/1000 doses). Most infections were indicated to have been diagnosed after the booster vaccination. The results are limited by the small sample size and possible bias through self-reporting and social desirability regarding vaccination status.
Key messages
• Overall, most participants were vaccinated with Comirnaty and had three doses of vaccine. Of the participants with a diagnosed SARS-CoV-2-infection, most got infected after the booster vaccine.
• The number of reported AEFI was higher than in the official surveillance in Germany.
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Affiliation(s)
- CJ Klett-Tammen
- Helmholtz Centre for Infection Research Epidemiology, , Brunswick, Germany
| | - JK Heise
- Helmholtz Centre for Infection Research Epidemiology, , Brunswick, Germany
| | - SM Soja
- Helmholtz Centre for Infection Research Epidemiology, , Brunswick, Germany
| | - I Janzen
- Helmholtz Centre for Infection Research Epidemiology, , Brunswick, Germany
| | - F Jenniches
- Study Centre, Helmholtz Centre for Infection Research , Hanover, Germany
| | - Y Kemmling
- Study Centre, Helmholtz Centre for Infection Research , Hanover, Germany
| | - G Behrens
- Department for Rheumatology and Immunology, Hanover Medical School , Hanover, Germany
| | - TF Schulz
- Institute of Virology, Hanover Medical School , Hanover, Germany
| | - R Wegener
- Institute for Energy and Climate Research , IE, , Jülich, Germany
- Forschungszentrum Jülich , IE, , Jülich, Germany
| | - S Castell
- Helmholtz Centre for Infection Research Epidemiology, , Brunswick, Germany
- TI Bioressources, Biodata und Digital Health, German Centre for Infection Research , Hanover, Germany
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2
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Shaw E, Walpole S, McLean M, Alvarez-Nieto C, Barna S, Bazin K, Behrens G, Chase H, Duane B, El Omrani O, Elf M, Faerron Guzmán CA, Falceto de Barros E, Gibbs TJ, Groome J, Hackett F, Harden J, Hothersall EJ, Hourihane M, Huss NM, Ikiugu M, Joury E, Leedham-Green K, MacKenzie-Shalders K, Madden DL, McKimm J, Nayna Schwerdtle P, Peters S, Redvers N, Sheffield P, Singleton J, Tun S, Woollard R. AMEE Consensus Statement: Planetary health and education for sustainable healthcare. Med Teach 2021; 43:272-286. [PMID: 33602043 DOI: 10.1080/0142159x.2020.1860207] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The purpose of this Consensus Statement is to provide a global, collaborative, representative and inclusive vision for educating an interprofessional healthcare workforce that can deliver sustainable healthcare and promote planetary health. It is intended to inform national and global accreditation standards, planning and action at the institutional level as well as highlight the role of individuals in transforming health professions education. Many countries have agreed to 'rapid, far-reaching and unprecedented changes' to reduce greenhouse gas emissions by 45% within 10 years and achieve carbon neutrality by 2050, including in healthcare. Currently, however, health professions graduates are not prepared for their roles in achieving these changes. Thus, to reduce emissions and meet the 2030 Sustainable Development Goals (SDGs), health professions education must equip undergraduates, and those already qualified, with the knowledge, skills, values, competence and confidence they need to sustainably promote the health, human rights and well-being of current and future generations, while protecting the health of the planet.The current imperative for action on environmental issues such as climate change requires health professionals to mobilize politically as they have before, becoming strong advocates for major environmental, social and economic change. A truly ethical relationship with people and the planet that we inhabit so precariously, and to guarantee a future for the generations which follow, demands nothing less of all health professionals.This Consensus Statement outlines the changes required in health professions education, approaches to achieve these changes and a timeline for action linked to the internationally agreed SDGs. It represents the collective vision of health professionals, educators and students from various health professions, geographic locations and cultures. 'Consensus' implies broad agreement amongst all individuals engaged in discussion on a specific issue, which in this instance, is agreement by all signatories of this Statement developed under the auspices of the Association for Medical Education in Europe (AMEE).To ensure a shared understanding and to accurately convey information, we outline key terms in a glossary which accompanies this Consensus Statement (Supplementary Appendix 1). We acknowledge, however, that terms evolve and that different terms resonate variably depending on factors such as setting and audience. We define education for sustainable healthcare as the process of equipping current and future health professionals with the knowledge, values, confidence and capacity to provide environmentally sustainable services through health professions education. We define a health professional as a person who has gained a professional qualification for work in the health system, whether in healthcare delivery, public health or a management or supporting role and education as 'the system comprising structures, curricula, faculty and activities contributing to a learning process'. This Statement is relevant to the full continuum of training - from undergraduate to postgraduate and continuing professional development.
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Affiliation(s)
- Emily Shaw
- Newcastle University, Newcastle Upon Tyne, UK
| | - Sarah Walpole
- Newcastle University, Newcastle Upon Tyne, UK
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Centre for Sustainable Healthcare, Oxford, UK
| | - Michelle McLean
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
| | | | - Stefi Barna
- Centre for Sustainable Healthcare, Oxford, UK
| | - Kate Bazin
- Department of Physiotherapy, King's College London, London, UK
| | - Georgia Behrens
- School of Medicine Sydney, The University of Notre Dame Australia, Sydney, Australia
| | | | - Brett Duane
- School of Dentistry, Trinity College Dublin, Dublin, Ireland
| | - Omnia El Omrani
- International Federation of Medical Students' Associations, Copenhagen, Denmark
| | - Marie Elf
- School of Education, Health and Social Studies, Department of Nursing, Dalarna University, Falun, Sweden
| | - Carlos A Faerron Guzmán
- Planetary Health Alliance, Harvard University T H Chan School of Public Health, Boston, MA, USA
| | | | | | - Jonny Groome
- Greener Anaesthesia & Sustainability Project, Great Ormond Street Hospital for Children, London, UK
| | - Finola Hackett
- University of Calgary, CFMS Health and Environment, Lethbridge, Alberta, Canada
| | - Jeni Harden
- University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | | | - Maca Hourihane
- Irish Society of Chartered Physiotherapists Special Interest Group for Healthcare Professionals in International Health and Development and Irish Red Cross Society, Dublin, Ireland
| | | | - Moses Ikiugu
- Occupational Therapy, University of South Dakota School of Health Sciences, Vermillion, SD, USA
| | - Easter Joury
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kathleen Leedham-Green
- Medical Education Research Unit, Imperial College London Faculty of Medicine, London, UK
| | | | - Diana Lynne Madden
- School of Medicine Sydney, The University of Notre Dame Australia, Sydney, Australia
| | - Judy McKimm
- Medical School, Swansea University, Swansea, UK
| | | | | | - Nicole Redvers
- Department of Family & Community Medicine, University of North Dakota School of Medicine & Health Sciences, Grand Forks, ND, USA
| | - Perry Sheffield
- Departments of Environmental Medicine and Public Health and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Judith Singleton
- Pharmacy, School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - SanYuMay Tun
- Imperial College London Centre for Environmental Policy, London, UK
| | - Robert Woollard
- Family Practice, The University of British Columbia, Vancouver, Canada
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3
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Moreno S, Perno CF, Mallon PW, Behrens G, Corbeau P, Routy JP, Darcis G. Two-drug vs. three-drug combinations for HIV-1: Do we have enough data to make the switch? HIV Med 2020; 20 Suppl 4:2-12. [PMID: 30821898 DOI: 10.1111/hiv.12716] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2019] [Indexed: 01/01/2023]
Abstract
Three-drug combination antiretroviral therapy (ART) became available in 1996, dramatically improving the prognosis of people living with HIV. The clinical benefits of ART are due to the sustained viral load suppression and CD4 T cell gains. Major drawbacks of the first ART regimens were adverse events, and high pill burden, which led to the reduction of drug adherence resulting in frequent treatment discontinuations and the development of drug resistance. Due to increased viral potency of new antiretroviral drugs consideration of a two-drug combination therapy repositioning occurred in an effort to reduce adverse events, drug-drug interactions and cost, while maintaining a sustained antiviral effect. Various combinations of two-drug regimens have been studied, and non-inferiority compared to a three-drug regimen has been shown only for some of them. In addition, a two-drug combination regimen may not be suitable for every patient, especially those who are pregnant, those with tuberculosis or coexisting HBV infection. Furthermore no information has been generated concerning the secondary transmission of HIV from patients who have undetectable plasma viral load on two-drug regimens. Additional studies of two-drug combinations are also necessary to evaluate the debated existence of low viral replication in tissues and on immune activation. While there is no urgent need to routinely switch patients to two-drug combination therapy, due to the availability of drug combinations without significant toxicities, dual regimens represent a suitable option that deserve long-term evaluation before being introduced to clinical practice.
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Affiliation(s)
- S Moreno
- Department of Infectious Diseases, University Hospital Ramón y Cajal, Alcalá University, IRYCIS, Madrid, Spain
| | - C F Perno
- Department of Laboratory Medicine, ASST Niguarda Hospital, University of Milan, Milan, Italy
| | - P W Mallon
- HIV Molecular Research Group, School of Medicine, University College Dublin, Dublin, Ireland
| | - G Behrens
- Department for Rheumatology and Clinical Immunology, Hannover Medical School, Hannover, Germany
| | - P Corbeau
- Institute for Human Genetics, CNRS-Montpellier University UMR9002, Montpellier, France.,Immunology Department, University Hospital, Nîmes, France
| | - J-P Routy
- Division of Hematology and Chronic Viral Infection Service, McGill University Health Centre, Montréal, QC, Canada
| | - G Darcis
- Department of Infectious Diseases, Liege University Hospital, University of Liege, Liège, Belgium
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4
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Moseley G, Spajic L, Behrens G. Hospital food environments: a human and planetary health opportunity. Med J Aust 2020; 212:384-384.e1. [PMID: 32277481 DOI: 10.5694/mja2.50576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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5
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Tavernier SJ, Athanasopoulos V, Verloo P, Behrens G, Staal J, Bogaert DJ, Naesens L, De Bruyne M, Van Gassen S, Parthoens E, Ellyard J, Cappello J, Morris LX, Van Gorp H, Van Isterdael G, Saeys Y, Lamkanfi M, Schelstraete P, Dehoorne J, Bordon V, Van Coster R, Lambrecht BN, Menten B, Beyaert R, Vinuesa CG, Heissmeyer V, Dullaers M, Haerynck F. Author Correction: A human immune dysregulation syndrome characterized by severe hyperinflammation with a homozygous nonsense Roquin-1 mutation. Nat Commun 2019; 10:5337. [PMID: 31745085 PMCID: PMC6864049 DOI: 10.1038/s41467-019-13379-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- S J Tavernier
- Primary Immune Deficiency Research Lab, Department of Internal Medicine and Pediatrics, Centre for Primary Immunodeficiency Ghent, Jeffrey Modell Diagnosis and Research Centre, Ghent University Hospital, Ghent, Belgium.,VIB Center for Inflammation Research, Unit of Molecular Signal Transduction in Inflammation, Ghent, Belgium.,Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium
| | - V Athanasopoulos
- Department of Immunology and Infectious Disease and Center for Personalised Immunology (NHMRC Centre for Research Excellence), John Curtin School of Medical Research, Australian National University, Canberra, Australia.,Centre for Personalised Immunology (CACPI), Shanghai Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - P Verloo
- Department of Internal Medicine and Pediatrics, Division of Pediatric Neurology and Metabolism, Ghent University Hospital, Ghent, Belgium
| | - G Behrens
- Institute for Immunology, Biomedical Center, Ludwig-Maximilians-Universität München, Planegg-Martinsried, Germany.,Research Unit Molecular Immune Regulation, Helmholtz Zentrum München, Munich, Germany
| | - J Staal
- VIB Center for Inflammation Research, Unit of Molecular Signal Transduction in Inflammation, Ghent, Belgium.,Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium
| | - D J Bogaert
- Primary Immune Deficiency Research Lab, Department of Internal Medicine and Pediatrics, Centre for Primary Immunodeficiency Ghent, Jeffrey Modell Diagnosis and Research Centre, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Division of Pediatric Immunology and Pulmonology, Ghent University Hospital, Ghent, Belgium
| | - L Naesens
- Primary Immune Deficiency Research Lab, Department of Internal Medicine and Pediatrics, Centre for Primary Immunodeficiency Ghent, Jeffrey Modell Diagnosis and Research Centre, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - M De Bruyne
- Primary Immune Deficiency Research Lab, Department of Internal Medicine and Pediatrics, Centre for Primary Immunodeficiency Ghent, Jeffrey Modell Diagnosis and Research Centre, Ghent University Hospital, Ghent, Belgium.,Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - S Van Gassen
- VIB Center for Inflammation Research, Unit of Data Mining and Modeling for Biomedicine, Ghent, Belgium.,Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Gent, Belgium
| | - E Parthoens
- VIB Bioimaging Core, VIB Center for Inflammation Research, Ghent, Belgium
| | - J Ellyard
- Department of Immunology and Infectious Disease and Center for Personalised Immunology (NHMRC Centre for Research Excellence), John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - J Cappello
- Department of Immunology and Infectious Disease and Center for Personalised Immunology (NHMRC Centre for Research Excellence), John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - L X Morris
- The Australian Phenomics Facility, John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - H Van Gorp
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB Center for Inflammation Research, Ghent, Belgium
| | - G Van Isterdael
- Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium.,VIB Flow Core, VIB Center for Inflammation Research, Ghent, Belgium
| | - Y Saeys
- VIB Center for Inflammation Research, Unit of Data Mining and Modeling for Biomedicine, Ghent, Belgium.,Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Gent, Belgium
| | - M Lamkanfi
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB Center for Inflammation Research, Ghent, Belgium
| | - P Schelstraete
- Department of Internal Medicine and Pediatrics, Division of Pediatric Immunology and Pulmonology, Ghent University Hospital, Ghent, Belgium
| | - J Dehoorne
- Department of Internal Medicine and Pediatrics, Division of Pediatric Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - V Bordon
- Department of Internal Medicine and Pediatrics, Division of Pediatric Immunology and Pulmonology, Ghent University Hospital, Ghent, Belgium
| | - R Van Coster
- Department of Internal Medicine and Pediatrics, Division of Pediatric Neurology and Metabolism, Ghent University Hospital, Ghent, Belgium
| | - B N Lambrecht
- Department of Internal Medicine and Pediatrics, Division of Pulmonology, Ghent University Hospital, Ghent, Belgium.,VIB Center for Inflammation Research, Unit for Immunoregulation and Mucosal Immunology, Ghent, Belgium.,Department of Pulmonary Medicine, ErasmusMC, Rotterdam, The Netherlands
| | - B Menten
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - R Beyaert
- VIB Center for Inflammation Research, Unit of Molecular Signal Transduction in Inflammation, Ghent, Belgium.,Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium
| | - C G Vinuesa
- Department of Immunology and Infectious Disease and Center for Personalised Immunology (NHMRC Centre for Research Excellence), John Curtin School of Medical Research, Australian National University, Canberra, Australia.,Centre for Personalised Immunology (CACPI), Shanghai Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - V Heissmeyer
- Institute for Immunology, Biomedical Center, Ludwig-Maximilians-Universität München, Planegg-Martinsried, Germany.,Research Unit Molecular Immune Regulation, Helmholtz Zentrum München, Munich, Germany
| | - M Dullaers
- Primary Immune Deficiency Research Lab, Department of Internal Medicine and Pediatrics, Centre for Primary Immunodeficiency Ghent, Jeffrey Modell Diagnosis and Research Centre, Ghent University Hospital, Ghent, Belgium.,Ablynx, a Sanofi Company, Zwijnaarde, Belgium
| | - F Haerynck
- Primary Immune Deficiency Research Lab, Department of Internal Medicine and Pediatrics, Centre for Primary Immunodeficiency Ghent, Jeffrey Modell Diagnosis and Research Centre, Ghent University Hospital, Ghent, Belgium. .,Department of Internal Medicine and Pediatrics, Division of Pediatric Immunology and Pulmonology, Ghent University Hospital, Ghent, Belgium.
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6
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Benke IN, Leitzmann MF, Behrens G, Schmid D. Physical activity in relation to risk of prostate cancer: a systematic review and meta-analysis. Ann Oncol 2019; 29:1154-1179. [PMID: 29788165 DOI: 10.1093/annonc/mdy073] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Prostate cancer (PCa) is one of the most common cancers among men, yet little is known about its modifiable risk and protective factors. This study aims to quantitatively summarize observational studies relating physical activity (PA) to PCa incidence and mortality. Materials and methods Published articles pertaining to PA and PCa incidence and mortality were retrieved in July 2017 using the Medline and EMBASE databases. The literature review yielded 48 cohort studies and 24 case-control studies with a total of 151 748 PCa cases. The mean age of the study participants at baseline was 61 years. Results In random-effects models, comparing the highest versus the lowest level of overall PA showed a summary relative risk (RR) estimate for total PCa incidence close to the null [RR = 0.99, 95% confidence interval (CI) = 0.94-1.04]. The corresponding RRs for advanced and non-advanced PCa were 0.92 (95% CI = 0.80-1.06) and 0.95 (95% CI = 0.85-1.07), respectively. We noted a statistically significant inverse association between long-term occupational activity and total PCa (RR = 0.83, 95% CI = 0.71-0.98, n studies = 13), although that finding became statistically non-significant when individual studies were removed from the analysis. When evaluated by cancer subtype, an inverse association with long-term occupational activity was noted for non-advanced/non-aggressive PCa (RR = 0.51, 95% CI = 0.37-0.71, n studies = 2) and regular recreational activity was inversely related to advanced/aggressive PCa (RR = 0.75, 95% CI = 0.60-0.95, n studies = 2), although these observations are based on a low number of studies. Moreover, PA after diagnosis was related to reduced risk of PCa mortality among survivors of PCa (summary RR based on four studies = 0.69, 95% CI = 0.55-0.85). Conclusions Whether PA protects against PCa remains elusive. Further investigation taking into account the complex clinical and pathologic nature of PCa is needed to clarify the PA and PCa incidence relation. Moreover, future studies are needed to confirm whether PA after diagnosis reduces risk of PCa mortality.
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Affiliation(s)
- I N Benke
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - M F Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - G Behrens
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - D Schmid
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.
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7
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Tavernier SJ, Athanasopoulos V, Verloo P, Behrens G, Staal J, Bogaert DJ, Naesens L, De Bruyne M, Van Gassen S, Parthoens E, Ellyard J, Cappello J, Morris LX, Van Gorp H, Van Isterdael G, Saeys Y, Lamkanfi M, Schelstraete P, Dehoorne J, Bordon V, Van Coster R, Lambrecht BN, Menten B, Beyaert R, Vinuesa CG, Heissmeyer V, Dullaers M, Haerynck F. A human immune dysregulation syndrome characterized by severe hyperinflammation with a homozygous nonsense Roquin-1 mutation. Nat Commun 2019; 10:4779. [PMID: 31636267 PMCID: PMC6803705 DOI: 10.1038/s41467-019-12704-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 09/24/2019] [Indexed: 12/15/2022] Open
Abstract
Hyperinflammatory syndromes are life-threatening disorders caused by overzealous immune cell activation and cytokine release, often resulting from defects in negative feedback mechanisms. In the quintessential hyperinflammatory syndrome familial hemophagocytic lymphohistiocytosis (HLH), inborn errors of cytotoxicity result in effector cell accumulation, immune dysregulation and, if untreated, tissue damage and death. Here, we describe a human case with a homozygous nonsense R688* RC3H1 mutation suffering from hyperinflammation, presenting as relapsing HLH. RC3H1 encodes Roquin-1, a posttranscriptional repressor of immune-regulatory proteins such as ICOS, OX40 and TNF. Comparing the R688* variant with the murine M199R variant reveals a phenotypic resemblance, both in immune cell activation, hypercytokinemia and disease development. Mechanistically, R688* Roquin-1 fails to localize to P-bodies and interact with the CCR4-NOT deadenylation complex, impeding mRNA decay and dysregulating cytokine production. The results from this unique case suggest that impaired Roquin-1 function provokes hyperinflammation by a failure to quench immune activation. Roquin-1 is a posttranscriptional regulator that controls the expression of many immune-related genes such as ICOS and TNFA. Here, the authors report a homozygous R688* loss of function mutation in Roquin-1 in a patient with syndromic uncontrolled hyperinflammation associated with immune cell activation and hypercytokinemia.
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Affiliation(s)
- S J Tavernier
- Primary Immune Deficiency Research Lab, Department of Internal Medicine and Pediatrics, Centre for Primary Immunodeficiency Ghent, Jeffrey Modell Diagnosis and Research Centre, Ghent University Hospital, Ghent, Belgium.,VIB Center for Inflammation Research, Unit of Molecular Signal Transduction in Inflammation, Ghent, Belgium.,Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium
| | - V Athanasopoulos
- Department of Immunology and Infectious Disease and Center for Personalised Immunology (NHMRC Centre for Research Excellence), John Curtin School of Medical Research, Australian National University, Canberra, Australia.,Centre for Personalised Immunology (CACPI), Shanghai Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - P Verloo
- Department of Internal Medicine and Pediatrics, Division of Pediatric Neurology and Metabolism, Ghent University Hospital, Ghent, Belgium
| | - G Behrens
- Institute for Immunology, Biomedical Center, Ludwig-Maximilians-Universität München, Planegg-Martinsried, Germany.,Research Unit Molecular Immune Regulation, Helmholtz Zentrum München, Munich, Germany
| | - J Staal
- VIB Center for Inflammation Research, Unit of Molecular Signal Transduction in Inflammation, Ghent, Belgium.,Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium
| | - D J Bogaert
- Primary Immune Deficiency Research Lab, Department of Internal Medicine and Pediatrics, Centre for Primary Immunodeficiency Ghent, Jeffrey Modell Diagnosis and Research Centre, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Division of Pediatric Immunology and Pulmonology, Ghent University Hospital, Ghent, Belgium
| | - L Naesens
- Primary Immune Deficiency Research Lab, Department of Internal Medicine and Pediatrics, Centre for Primary Immunodeficiency Ghent, Jeffrey Modell Diagnosis and Research Centre, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - M De Bruyne
- Primary Immune Deficiency Research Lab, Department of Internal Medicine and Pediatrics, Centre for Primary Immunodeficiency Ghent, Jeffrey Modell Diagnosis and Research Centre, Ghent University Hospital, Ghent, Belgium.,Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - S Van Gassen
- VIB Center for Inflammation Research, Unit of Data Mining and Modeling for Biomedicine, Ghent, Belgium.,Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Gent, Belgium
| | - E Parthoens
- VIB Bioimaging Core, VIB Center for Inflammation Research, Ghent, Belgium
| | - J Ellyard
- Department of Immunology and Infectious Disease and Center for Personalised Immunology (NHMRC Centre for Research Excellence), John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - J Cappello
- Department of Immunology and Infectious Disease and Center for Personalised Immunology (NHMRC Centre for Research Excellence), John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - L X Morris
- The Australian Phenomics Facility, John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - H Van Gorp
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB Center for Inflammation Research, Ghent, Belgium
| | - G Van Isterdael
- Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium.,VIB Flow Core, VIB Center for Inflammation Research, Ghent, Belgium
| | - Y Saeys
- VIB Center for Inflammation Research, Unit of Data Mining and Modeling for Biomedicine, Ghent, Belgium.,Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Gent, Belgium
| | - M Lamkanfi
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB Center for Inflammation Research, Ghent, Belgium
| | - P Schelstraete
- Department of Internal Medicine and Pediatrics, Division of Pediatric Immunology and Pulmonology, Ghent University Hospital, Ghent, Belgium
| | - J Dehoorne
- Department of Internal Medicine and Pediatrics, Division of Pediatric Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - V Bordon
- Department of Internal Medicine and Pediatrics, Division of Pediatric Immunology and Pulmonology, Ghent University Hospital, Ghent, Belgium
| | - R Van Coster
- Department of Internal Medicine and Pediatrics, Division of Pediatric Neurology and Metabolism, Ghent University Hospital, Ghent, Belgium
| | - B N Lambrecht
- Department of Internal Medicine and Pediatrics, Division of Pulmonology, Ghent University Hospital, Ghent, Belgium.,VIB Center for Inflammation Research, Unit for Immunoregulation and Mucosal Immunology, Ghent, Belgium.,Department of Pulmonary Medicine, ErasmusMC, Rotterdam, The Netherlands
| | - B Menten
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - R Beyaert
- VIB Center for Inflammation Research, Unit of Molecular Signal Transduction in Inflammation, Ghent, Belgium.,Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium
| | - C G Vinuesa
- Department of Immunology and Infectious Disease and Center for Personalised Immunology (NHMRC Centre for Research Excellence), John Curtin School of Medical Research, Australian National University, Canberra, Australia.,Centre for Personalised Immunology (CACPI), Shanghai Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - V Heissmeyer
- Institute for Immunology, Biomedical Center, Ludwig-Maximilians-Universität München, Planegg-Martinsried, Germany.,Research Unit Molecular Immune Regulation, Helmholtz Zentrum München, Munich, Germany
| | - M Dullaers
- Primary Immune Deficiency Research Lab, Department of Internal Medicine and Pediatrics, Centre for Primary Immunodeficiency Ghent, Jeffrey Modell Diagnosis and Research Centre, Ghent University Hospital, Ghent, Belgium.,Ablynx, a Sanofi Company, Zwijnaarde, Belgium
| | - F Haerynck
- Primary Immune Deficiency Research Lab, Department of Internal Medicine and Pediatrics, Centre for Primary Immunodeficiency Ghent, Jeffrey Modell Diagnosis and Research Centre, Ghent University Hospital, Ghent, Belgium. .,Department of Internal Medicine and Pediatrics, Division of Pediatric Immunology and Pulmonology, Ghent University Hospital, Ghent, Belgium.
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Spajic L, Behrens G, Gralak S, Moseley G, Linholm D. Beyond tokenism: meaningful youth engagement in planetary health. Lancet Planet Health 2019; 3:e373-e375. [PMID: 31538620 DOI: 10.1016/s2542-5196(19)30172-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Luke Spajic
- Australian Medical Students' Association, University of Adelaide, Adelaide, SA 5005, Australia.
| | - Georgia Behrens
- Australian Medical Students' Association, University of Notre Dame Australia, Darlinghurst, NSW, Australia
| | | | - Genevieve Moseley
- Australian Medical Students' Association, Deakin University, Waurn Ponds, VIC, Australia
| | - Daniel Linholm
- Australian Medical Students' Association, University of Melbourne, Melbourne, VIC, Australia
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9
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Ryom L, Boesecke C, Bracchi M, Ambrosioni J, Pozniak A, Arribas J, Behrens G, Mallon P, Puoti M, Rauch A, Miro JM, Kirk O, Marzolini C, Lundgren JD, Battegay M. Highlights of the 2017 European AIDS Clinical Society (EACS) Guidelines for the treatment of adult HIV-positive persons version 9.0. HIV Med 2018; 19:309-315. [PMID: 29493093 PMCID: PMC5947127 DOI: 10.1111/hiv.12600] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2018] [Indexed: 01/17/2023]
Abstract
Background The European AIDS Clinical Society (EACS) Guidelines have since 2005 provided multidisciplinary recommendations for the care of HIV‐positive persons in geographically diverse areas. Guideline highlights Major revisions have been made in all sections of the 2017 Guidelines: antiretroviral treatment (ART), comorbidities, coinfections and opportunistic diseases. Newly added are also a summary of the main changes made, and direct video links to the EACS online course on HIV Management. Recommendations on the clinical situations in which tenofovir alafenamide may be considered over tenofovir disoproxil fumarate are provided, and recommendations on which antiretrovirals can be used safely during pregnancy have been revised. Renal and bone toxicity and hepatitis C virus (HCV) treatment have been added as potential reasons for ART switches in fully virologically suppressed individuals, and dolutegravir/rilpivirine has been included as a treatment option. In contrast, dolutegravir monotherapy is not recommended. New recommendations on non‐alcoholic fatty liver disease, chronic lung disease, solid organ transplantation, and prescribing in elderly are included, and human papilloma virus (HPV) vaccination recommendations have been expanded. All drug–drug interaction tables have been updated and new tables are included. Treatment options for direct‐acting antivirals (DAAs) have been updated and include the latest combinations of sofosbuvir/velpatasvir/voxilaprevir and glecaprevir/pibrentasvir. Recommendations on management of DAA failure and acute HCV infection have been expanded. For treatment of tuberculosis (TB), it is underlined that intermittent treatment is contraindicated, and for resistant TB new data suggest that using a three‐drug combination may be as effective as a five‐drug regimen, and may reduce treatment duration from 18‐24 to 6‐10 months. Conclusions Version 9.0 of the EACS Guidelines provides a holistic approach to HIV care and is translated into the six most commonly spoken languages.
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Affiliation(s)
- L Ryom
- CHIP, Department of Infectious Diseases, Section 2100, Finsencentret, Rigshospitalet, University Hospital of Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - C Boesecke
- Department of Medicine, University of Bonn, Bonn, Germany
| | - M Bracchi
- HIV/GUM Department, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - J Ambrosioni
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - A Pozniak
- Chelsea and Westminister Hospital NHS Foundation Trust, London, UK
| | - J Arribas
- HIV Unit, Hospital La Paz, Madrid, Spain
| | - G Behrens
- Clinic for Immunology and Rheumatology, Medical School Hannover, Hannover, Germany
| | - Pgm Mallon
- HIV Molecular Research Group, School of Medicine, University College Dublin, Dublin, Ireland
| | - M Puoti
- Department of Infectious Diseases, Hospital Niguerda Ca' Granda, Milan, Italy
| | - A Rauch
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - J M Miro
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - O Kirk
- CHIP, Department of Infectious Diseases, Section 2100, Finsencentret, Rigshospitalet, University Hospital of Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - C Marzolini
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Basel, Switzerland.,Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - J D Lundgren
- CHIP, Department of Infectious Diseases, Section 2100, Finsencentret, Rigshospitalet, University Hospital of Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - M Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Basel, Switzerland
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Schmid D, Behrens G, Matthews CE, Leitzmann MF. Physical activity and risk of colon cancer among diabetic and non-diabetic individuals. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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Schmid D, Ricci C, Behrens G, Leitzmann MF. Adiposity and risk of thyroid cancer: a systematic review and meta-analysis. Obes Rev 2015; 16:1042-54. [PMID: 26365757 DOI: 10.1111/obr.12321] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [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: 05/28/2015] [Revised: 08/11/2015] [Accepted: 08/11/2015] [Indexed: 11/30/2022]
Abstract
Thyroid cancer incidence has increased rapidly over time, as has obesity prevalence. A link between the two appears plausible, but the relation of adiposity to thyroid cancer remains incompletely understood. We performed a meta-analysis of adiposity measures and thyroid cancer using studies identified through October 2014. Twenty-one articles yielded data on 12,199 thyroid cancer cases. We found a statistically significant 25% greater risk of thyroid cancer in overweight individuals and a 55% greater thyroid cancer risk in obese individuals as compared with their normal-weight peers. Each 5-unit increase in body mass index (BMI), 5 kg increase in weight, 5 cm increase in waist or hip circumference and 0.1-unit increase in waist-to-hip ratio were associated with 30%, 5%, 5% and 14% greater risks of thyroid cancer, respectively. When evaluated by histologic type, obesity was significantly positively related to papillary, follicular and anaplastic thyroid cancers, whereas it revealed an inverse association with medullary thyroid cancer. Both general and abdominal adiposity are positively associated with thyroid cancer. However, relations with BMI vary importantly by tumour histologic type.
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Affiliation(s)
- D Schmid
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - C Ricci
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - G Behrens
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - M F Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
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Ryom L, Boesecke C, Gisler V, Manzardo C, Rockstroh JK, Puoti M, Furrer H, Miro JM, Gatell JM, Pozniak A, Behrens G, Battegay M, Lundgren JD. Essentials from the 2015 European AIDS Clinical Society (EACS) guidelines for the treatment of adult HIV-positive persons. HIV Med 2015; 17:83-8. [DOI: 10.1111/hiv.12322] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2015] [Indexed: 11/28/2022]
Affiliation(s)
- L Ryom
- CHIP; Rigshospitalet; University Hospital of Copenhagen; Department of Infectious Diseases; Section 2100, Finsencentret; University of Copenhagen; Copenhagen Denmark
| | - C Boesecke
- Department of Medicine; University of Bonn; Bonn Germany
| | - V Gisler
- Department of Infectious Diseases; Bern University Hospital and University of Bern; Bern Switzerland
| | - C Manzardo
- Infectious Diseases Service; Hospital Clinic; University of Barcelona; Barcelona Spain
| | - JK Rockstroh
- Department of Medicine; University of Bonn; Bonn Germany
| | - M Puoti
- Department of Infectious Diseases; Hospital Niguarda Ca’ Granda; Milan Italy
| | - H Furrer
- Department of Infectious Diseases; Bern University Hospital and University of Bern; Bern Switzerland
| | - JM Miro
- Infectious Diseases Service; Hospital Clinic; University of Barcelona; Barcelona Spain
| | - JM Gatell
- Infectious Diseases Service; Hospital Clinic; University of Barcelona; Barcelona Spain
| | - A Pozniak
- HIV Directorate; Chelsea and Westminster Hospital NHS Foundation Trust; London UK
| | - G Behrens
- Medical School Hannover; Clinic for Immunology and Rheumatology; Hannover Germany
| | - M Battegay
- Division of Infectious Diseases & Hospital Epidemiology; University Hospital Basel; Basel Switzerland
| | - JD Lundgren
- CHIP; Rigshospitalet; University Hospital of Copenhagen; Department of Infectious Diseases; Section 2100, Finsencentret; University of Copenhagen; Copenhagen Denmark
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Hoffmann C, Hentrich M, Gillor D, Behrens G, Jensen B, Stoehr A, Esser S, van Lunzen J, Krznaric I, Müller M, Oette M, Hensel M, Thoden J, Fätkenheuer G, Wyen C. Hodgkin lymphoma is as common as non-Hodgkin lymphoma in HIV-positive patients with sustained viral suppression and limited immune deficiency: a prospective cohort study. HIV Med 2014; 16:261-4. [PMID: 25252101 DOI: 10.1111/hiv.12200] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The incidence of HIV-related non-Hodgkin lymphoma (NHL) but not that of Hodgkin lymphoma (HL) has been declining. The aim of the study was to compare HIV-infected patients with NHL and HL with respect to antiretroviral therapy (ART) exposure at the time of lymphoma diagnosis. METHODS HIV-infected patients with NHL and HL included in a prospective multicentre cohort study since January 2005 were compared with respect to ART exposure and viral load at the time of lymphoma diagnosis. RESULTS As of 31 December 2012, data for 329 patients with NHL and 86 patients with HL from 31 participating centres were available. Patients with HL were more likely to be on ART (73.5% vs. 39.1%, respectively; P < 0.001) and more frequently had a viral load below the detection limit (57.3% vs. 27.9%, respectively; P < 0.001) than patients with NHL. The proportion of patients with HL was 8.0% in ART-naïve patients, 34.8% in patients with current HIV RNA < 50 HIV-1 RNA copies/mL, and 50.0% in patients with both HIV RNA < 50 copies/mL for > 12 months and a CD4 cell count of > 200 cells/μL. Of note, 45.8% of all patients with NHL were not currently on ART and had a CD4 count of < 350 cells/μL. CONCLUSIONS This prospective cohort study shows that HL was as common as NHL in patients with sustained viral suppression and limited immune deficiency. In contrast to NHL, the majority of patients with HL were on effective ART, suggesting that ART provides insufficient protection from developing HL. The high proportion of untreated patients with NHL suggests missed opportunities for earlier initiation of ART.
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Affiliation(s)
- C Hoffmann
- IPM Study Center, Hamburg, Germany; University of Schleswig Holstein, Campus Kiel, Kiel, Germany
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15
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Keimling M, Behrens G, Schmid D, Jochem C, Leitzmann MF. The association between physical activity and bladder cancer: systematic review and meta-analysis. Br J Cancer 2014; 110:1862-70. [PMID: 24594995 PMCID: PMC3974090 DOI: 10.1038/bjc.2014.77] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 12/20/2013] [Accepted: 12/24/2013] [Indexed: 12/25/2022] Open
Abstract
Background: Physical activity may protect against bladder cancer through several biologic pathways, such as enhanced immune function and decreased chronic inflammation. Physical activity may also indirectly prevent bladder cancer by reducing obesity. A sizeable number of epidemiologic studies have examined the association between physical activity and bladder cancer, but the available evidence has not yet been formally summarised using meta-analysis. Methods: We performed a systematic literature review and meta-analysis of English-language studies published from January 1975 through November 2013. We followed the PRISMA guidelines and used a random effects model to estimate the summary risk estimates for the association between physical activity and bladder cancer. Results: A total of 15 studies with 5 402 369 subjects and 27 784 bladder cancer cases were included. High vs low levels of physical activity were related to decreased bladder cancer risk (summary relative risk (RR)=0.85, 95% confidence interval (CI)=0.74–0.98; I2=83% P-value for heterogeneity across all studies<0.001). Results were similar for cohort studies (RR=0.89, 95% CI=0.80–1.00; I2=64%) and case–control studies (RR=0.71, 95% CI=0.43–1.16; I2=87% P-value for difference=0.108) and they were comparable for women (RR=0.83, 95% CI=0.73–0.94; I2=0%) and men (RR=0.92, 95% CI=0.82–1.05; I2=67; P-value for difference=0.657). Findings were also comparable for recreational (RR=0.81, 95% CI=0.66–0.99; I2=77%) and occupational physical activity (RR=0.90, 95% CI=0.76–1.0; I2=76% P-value for difference=0.374), and they were largely consistent for moderate (RR=0.85, 95% CI=0.75–0.98; I2=76%) and vigorous activity (RR=0.80, 95% CI=0.64–1.00;I2=87% P-value for difference=0.535). Conclusions: Physical activity is associated with decreased risk of bladder cancer. Further studies are required to assess the relations of intensity, frequency, duration, and timing in life of physical activity to bladder cancer risk.
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Affiliation(s)
- M Keimling
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - G Behrens
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - D Schmid
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - C Jochem
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - M F Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
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16
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Lu I, Eberhard J, Ahmad F, Bhatnagar N, Behrens G, Jacobs R, Schmidt R, Meyer-Olson D. Elevated CD57 and CD95 expressions are associated with lower numbers of CD4+ recent thymic emigrants in HIV-1 infected immune responders following antiretroviral treatment. Immunol Lett 2014; 158:1-6. [DOI: 10.1016/j.imlet.2013.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 11/13/2013] [Accepted: 11/20/2013] [Indexed: 10/26/2022]
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Abstract
Background: Physical activity may decrease renal cancer risk by reducing obesity, blood pressure, insulin resistance, and lipid peroxidation. Despite plausible biologic mechanisms linking increased physical activity to decreased risk for renal cancer, few epidemiologic studies have been able to report a clear inverse association between physical activity and renal cancer, and no meta-analysis is available on the topic. Methods: We searched the literature using PubMed and Web of Knowledge to identify published non-ecologic epidemiologic studies quantifying the relationship between physical activity and renal cancer risk in individuals without a cancer history. Following the PRISMA guidelines, we conducted a systematic review and meta-analysis, including information from 19 studies based on a total of 2 327 322 subjects and 10 756 cases. The methodologic quality of the studies was examined using a comprehensive scoring system. Results: Comparing high vs low levels of physical activity, we observed an inverse association between physical activity and renal cancer risk (summary relative risk (RR) from random-effects meta-analysis=0.88; 95% confidence interval (CI)=0.79–0.97). Summarising risk estimates from high-quality studies strengthened the inverse association between physical activity and renal cancer risk (RR=0.78; 95% CI=0.66–0.92). Effect modification by adiposity, hypertension, type 2 diabetes, smoking, gender, or geographic region was not observed. Conclusion: Our comprehensive meta-analysis provides strong support for an inverse relation of physical activity to renal cancer risk. Future high-quality studies are required to discern which specific types, intensities, frequencies, and durations of physical activity are needed for renal cancer risk reduction.
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Affiliation(s)
- G Behrens
- Department of Epidemiology and Preventive Medicine, Regensburg University Medical Center, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
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Ahrens D, Behrens G, Himmel W, Kochen MM, Chenot JF. Appropriateness of proton pump inhibitor recommendations at hospital discharge and continuation in primary care. Int J Clin Pract 2012; 66:767-773. [PMID: 22805269 DOI: 10.1111/j.1742-1241.2012.02973.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [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: 12/13/2022] Open
Abstract
Background: Inappropriate prescriptions of proton pump inhibitors (PPI) in hospital and primary care have been widely reported. Recommendations from hospital have been implicated as one reason for inappropriate prescriptions of PPI in primary care. Objective: To quantify the amount of appropriate PPI recommendations in hospital discharge letters and the influence of these recommendations on general practitioners' (GPs') PPI-prescriptions. Materials and Methods: This is an observational study in 31 primary care practices. We identified patients discharged from hospital with PPI recommendation between 2006 and 2007 and assessed practice records and PPI prescription six months prior and after hospital admission. Hospital recommendation for continuous PPI-treatment and continuation by GPs was classified as appropriate, inappropriate or uncertain. Logistic regression analysis was used to calculate factors associated with indicated and non-indicated PPI continuation. Results: In 263 (58%) out of 506 patients discharged from 35 hospitals with a PPI recommendation no indication could be found. Non-indicated PPIs were continued by GPs in 58% for at least 1 month. Indicated PPIs were discontinued in 33%. Two thirds of non-indicated PPIs were initiated in hospital. The strongest factor associated with non-indicated continuation was a PPI-prescription prior to hospital admission [OR: 3.0; 95% confidence interval (CI): 1.7-5.4]. This was also the strongest factor for continuation of an indicated PPI medication (OR: 3.2; 95% CI: 1.4-7.5). Conclusions: We found a strong influence of hospital recommendations and previous prescriptions on PPI prescriptions after discharge. Hospitals should critically review their practice of recommending PPI and document indications. GPs should carefully assess hospital recommendations and their medication prior to admission to avoid over- and under-prescribing.
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Affiliation(s)
- D Ahrens
- Department of Family Practice, Göttingen University Medical Center, Göttingen, Germany Department of Family Practice, University Medicine Greifswald, Institute for Community Medicine, Greifswald, Germany
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Behrens G, Leitzmann M, Sandin S, Löf M, Heid I, Weiderpass E. The association between alcohol consumption and mortality: the Swedish Women's Lifestyle and Health cohort study. Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Stellbrink HJ, Baldus S, Behrens G, Bogner JR, Harrer T, Hoffmann C, van Lunzen J, Münch J, Racz P, Scheller C, Stoll M, Tenner-Racz K, Rockstroh J. HIV-induced immune activation: pathogenesis and clinical relevance - summary of a workshop organized by the German AIDS Society (DAIG e.v.) and the ICH Hamburg, Hamburg, Germany, November 22, 2008. Eur J Med Res 2010; 15:1-12. [PMID: 20159665 PMCID: PMC3351841 DOI: 10.1186/2047-783x-15-1-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
This manuscript is communicated by the German AIDS Society (DAIG) http://www.daignet.de. It summarizes a series of presentations and discussions during a workshop on immune activation due to HIV infection. The workshop was held on November 22nd 2008 in Hamburg, Germany. It was organized by the ICH Hamburg under the auspices of the German AIDS Society (DAIG e.V.).
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Behrens G. Initiating and maintaining HAART - aiming for the long term in treatment-naive patients. Int J STD AIDS 2009. [DOI: 10.1258/ijsa.2009.09s003] [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: 11/18/2022]
Abstract
Efficacy and durability are particularly important when choosing highly active antiretroviral therapy (HAART) for treatment-naive patients with HIV, alongside long-term safety and tolerability, special circumstances (such as pregnancy) and risk of cardiovascular disease. Regimens containing non-nucleoside reverse transcriptase inhibitors (NNRTIs), including nevirapine (NVP), are as effective as efavirenz, and avoiding NVP in patients with CD4 cell counts >250 cells/mL (women) or >400 cells/mL (men) can prevent hepatotoxicity. In women who become pregnant while already on HAART, the current regimen should be maintained unless it involves potentially teratogenic drugs. Pregnancy is not an independent risk factor for developing liver enzyme elevations or rash with NVP. High levels of low-density lipoprotein (LDL) cholesterol should be controlled to a target, with HAART modified if it is suspected to be increasing the LDL. The European AIDS Clinical Society rate NVP as the drug with the lowest metabolic impact among the NNRTIs and other classes of antiretroviral therapy.
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Affiliation(s)
- G Behrens
- Hannover Medical School, Clinic for Immunology and Rheumatology, Hannover, Germany
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Behrens G, Gatell JM, Geretti AM, Waters L. Panel discussion. Int J STD AIDS 2009. [DOI: 10.1258/ijsa.2009.09s005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- G Behrens
- Infectious Diseases and AIDS Units, Hospital Clinic; University of Barcelona, Spain
| | - J M Gatell
- Infectious Diseases and AIDS Units, Hospital Clinic; University of Barcelona, Spain
| | - A M Geretti
- Royal Free Hampstead NHS Trust and UCL Medical School. London, UK
| | - L Waters
- Hannover Medical School, Clinic for Immunology & Rheumatology, Hannover, Germany
- Chelsea & Westminster Hospital. London, UK
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Horstkotte H, Hartwig C, Constabel H, Schütte H, Baeumer W, Behrens G, Witzenrath M, Tschernig T. NOD1-Aktivierung verringert die durch lienale dendritische Zellen hervorgerufene antigenspezifische Proliferation von T-Zellen. Pneumologie 2009. [DOI: 10.1055/s-0029-1213834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Behrens G, Giusto D, Ferral H, Van Thiel D. Abstract No. 94: Transjugular Liver Biopsy: Comparison of Sample Adequacy Using Two Automated Needle Systems. J Vasc Interv Radiol 2009. [DOI: 10.1016/j.jvir.2008.12.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Lundgren JD, Battegay M, Behrens G, De Wit S, Guaraldi G, Katlama C, Martinez E, Nair D, Powderly WG, Reiss P, Sutinen J, Vigano A. European AIDS Clinical Society (EACS) guidelines on the prevention and management of metabolic diseases in HIV. HIV Med 2008; 9:72-81. [PMID: 18257770 DOI: 10.1111/j.1468-1293.2007.00534.x] [Citation(s) in RCA: 161] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Metabolic diseases are frequently observed in HIV-infected persons and, as the risk of contracting these diseases is age-related, their prevalence will increase in the future as a consequence of the benefits of antiretroviral therapy (ART). SUMMARY OF GUIDELINES All HIV-infected persons should be screened at regular intervals for a history of metabolic disease, dyslipidaemia, diabetes mellitus, hypertension and alteration of body composition; cardiovascular risk and renal function should also be assessed. Efforts to prevent cardiovascular disease will vary in intensity depending on an individual's absolute risk of ischaemic heart disease and should be comprehensive in nature. Lifestyle interventions should focus on counselling to stop smoking, modify diet and take regular exercise. A healthy diet, exercise and maintaining normal body weight tend to reduce dyslipidaemia; if not effective, a change of ART should be considered, followed by use of lipid-lowering medication in high-risk patients. A pre-emptive switch from thymidine analogues is recommended to reduce the risk of development or progression of lipoatrophy. Intra-abdominal fat accumulation is best managed by exercise and diet. Prevention and management of type 2 diabetes mellitus and hypertension follow guidelines used in the general population. When using medical interventions to prevent and/or treat metabolic disease(s), impairment of the efficacy of ART should be avoided by considering the possibility of pharmacokinetic interactions and compromised adherence. Specialists in HIV and specialists in metabolic diseases should consult each other, in particular in difficult-to-treat cases. CONCLUSION Multiple and relatively simple approaches exist to prevent metabolic diseases in HIV-infected persons; priority should be given to patients at high risk of contracting these diseases.
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Affiliation(s)
- J D Lundgren
- Centre for Viral Diseases KMA, Rigshospitalet and Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
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Hartwig C, Mazzega M, Constabel H, Behrens G, Gessner E, Tschernig T. Inflammation beim Asthma: Einfluss von Fcγ-Rezeptoren. Pneumologie 2007. [DOI: 10.1055/s-2007-1032289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hartwig C, Constabel H, Behrens G, Tschernig T. Regulation allergischer Entzündungen im murinen Asthmamodell: Antigenaufnahme mittels Fc-Rezeptoren, Bedeutung von DC-Subpopulationen für Toleranz und Immunität. Pneumologie 2007. [DOI: 10.1055/s-2007-967231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hartwig C, Rochlitzer S, Braun A, Constabel H, Tschernig T, Behrens G. Isolierung und Differenzierung von dendritischen Zellen in der Mauslunge. Pneumologie 2007. [DOI: 10.1055/s-2007-973169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mauss S, Behrens G, Walker U. Appendix to the German-Austrian HIV Therapeutic Guidelines: strategies for treating morphological and metabolic alterations under antiretroviral treatment (current as of December 2004). Eur J Med Res 2006; 11:47-57. [PMID: 16504961] [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: 05/06/2023] Open
Abstract
The recommendations made in this review are based on the current clinical knowledge with regard to the origin and therapy of lipodystrophy. They should be regarded as provisional and will change with expanding knowledge. The recommendations for treating dyslipidaemia in particular are oriented closely on the American recommendations of the National Cholesterol Education Program (NCEP III), and may be regarded both by HIV practitioners and patients as excessive and too rigid. The therapeutic goals of the NCEP in the first intervention studies in HIV-positive individuals were only achieved for a small proportion of the HIV patients. In addition, preliminary results suggest a potentially higher risk of adverse events in HIV-patients under statins or fibrates. The clinical efficacy of interventions with lipid lowering drugs has not been validated in HIV-seropositive patients. However, therapeutic decisions so far have been based on data obtained in non-HIV cardiovascular intervention studies. With more and more results becoming available from the HIV patient population a revision of these recommendations will be required.
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Affiliation(s)
- S Mauss
- Center for HIV and Hepatogastroenterology, Düsseldorf, Germany
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Stoll M, Behrens G, Schmidt R. Immunrekonstitutionssyndrom. Dtsch Med Wochenschr 2004. [DOI: 10.1055/s-2001-17113-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schmidt HH, Behrens G, Genschel J, Stoll M, Dejam A, Haas R, Manns MP, Schmidt RE. Lipid evaluation in HIV-1-positive patients treated with protease inhibitors. Antivir Ther 2003; 4:163-70. [PMID: 12731756] [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: 03/02/2023]
Abstract
There is accumulating evidence that human immunodeficiency virus type 1 (HIV-1) protease inhibitors (PIs) can induce hyperlipidaemia. To evaluate the frequency and type of hyperlipidaemia in PI-treated patients, 98 outpatients were prospectively analysed for their lipoprotein characteristics at the Medizinische Hochschule in Hannover, Germany. Fifty-seven percent of the patients studied presented with hyperlipidaemia. Both hypertrigylceridaemia (type IV and V hyperlipoproteinaemia, 33%) and hypercholesterolaemia (type IIa hyperlipoproteinaemia, 6%) were detectable. The remaining 18% had a type IIb hyperlipoproteinaemia. Increased lipid levels were highly statistically significant compared to a control group of PI-naive HIV-1-infected patients [low-density lipoprotein (LDL) 146 mg/dl (range, 53-274 mg/dl) versus 105 mg/dl (range, 22-188 mg/dl; P=0.0006); very-low-density lipoprotein (VLDL) 35.5 mg/dl (5-253 mg/dl) versus 18 mg/dl (range, 3-94 mg/dl; P=0.0002)]. All PIs used (saquinavir, indinavir, nelfinavir and ritonavir) were associated with this variable form of hyperlipidaemia according to the Fredrickson classification. There was no significant correlation of any determined lipid value with the duration of treatment. A higher frequency of the apolipoprotein E2 allele and E4 allele was observed in the hyperlipidaemic subjects. Patients with excessive hypertriglyceridaemia showed a reduced lipoprotein lipase activity. Lipodystrophy was observed especially in hyperlipidaemic patients and to a lesser extent in normolipidaemic subjects. The frequency of hyperlipidaemic risk factors was surprisingly high in the group studied, which in turn may explain the proposed increased risk of atherogenesis in HIV-1 PI-treated patients. Therefore, PI-treated subjects should also be evaluated for their lipoprotein pattern, which may require antihyperlipidaemic interventions.
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Affiliation(s)
- H H Schmidt
- Department of Gastroenterology and Hepatology, Medizinische Hochschule Hannover, D-30623 Hannover, Germany
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Weber K, Heiken H, Stoll M, Schmidt RE, Behrens G. [Lipodystrophy syndrome. Therapeutic progress is still pending]. MMW Fortschr Med 2003; 145 Spec No 1:28-32. [PMID: 15011581] [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: 04/29/2023]
Abstract
A common problem seen with the long-term use of highly active antiretroviral therapy (HAART) is the HIV-associated lipodystrophy syndrome. Clinical signs include a loss of peripheral subcutaneous fatty tissue, an increase in visceral or local fat, and altered glucose and lipid metabolism. The physical changes frequently impair quality of life, and the patient's adherence to treatment regimens. Metabolic changes may possibly represent cardiovascular risks with incalculable consequences over the long term. Although the lipodystrophy syndrome was first described in 1998. It still lacks a definition. So far, therapeutic strategies have remained ineffective or have had only limited success. Proposed treatments include general recommendations (diet, physical exercise, etc.), changing the antiretroviral therapy, and treatment with metabolically active medication.
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Affiliation(s)
- K Weber
- Abteilung Klinische Immunologie, Medizinische Hochschule Hannover.
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Stoll M, Heiken H, Weber K, Hundt M, Behrens G, Schmidt RE. [Immune reconstituted inflammatory syndrome. Pitfalls of antiretroviral therapy]. MMW Fortschr Med 2003; 145 Spec No 1:42-7. [PMID: 15011587] [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: 04/29/2023]
Abstract
The pandemic HIV infection, the more frequent use of immunosuppressive treatment, and the improved long-term prognosis of immunocompromised patients due to better supporting therapies have resulted in an increase in the prevalence of immunodeficiencies. Highly active antiretroviral therapy (HAART) can improve immunocompetence in HIV patients, even when the immunodeficiency is far advanced. This has resulted in an impressive and lasting lowering of the morbidity and mortality associated with HIV infection. However, immune reconstitution may exacerbate subclinical opportunistic infections or autoimmune diseases, or result in an unexpected, paradoxical aggravation of intercurrent inflammatory diseases. The atypical inflammatory conditions have a number of synonymous names: immune restoration disease (IRD), immune reconstitution syndrome (IRS), or immune reconstitution inflammatory syndrome (IRIS). In the light of specific differential therapeutic consequences, it is important to distinguish the clinical presentation from that of corresponding opportunistic infections. However, diagnostic and therapeutic standards for IRIS have not yet been worked out. The present overview also points to possible diagnostic pitfalls, and makes suggestions for a possible classification of the condition and the therapeutic options.
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Affiliation(s)
- M Stoll
- Abteilung Klinische Immunologie, Medizinische Hochschule Hannover
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Schuchert A, Liebau M, Behrens G, Mueck AO, Meinertz T. [Are the acute effects of transdermal estradiol in postmenopausal women with coronary disease related to changes of the autonomic tone?]. Z Kardiol 2002; 91:156-60. [PMID: 11963733 DOI: 10.1007/s003920200005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The single application of estradiol in postmenopausal women with symptomatic coronary heart disease has an antiischemic effect, which seems to be mainly related to the relaxation of the vascular smooth muscle. Longterm replacement with estrogen in postmenopausal women reduces their increased sympathetic activity. The aim of the double-blinded study was to assess whether a single transdermal estradiol administration also has an effect on the sympathovagal balance and may additionally explain the acute effects of estradiol. Methods Fifteen women with symptomatic and angiographically proven coronary artery disease were cross-over randomized to two 100-microgram patches of estradiol or identical placebo. After one week the women received the opposite treatment. One day after patch application a 24-hour Holter-ECG recording was performed to assess the mean heart rate over 24 hours as well as time domain and frequency domain indices of the heart rate variability. Results The estradiol plasma concentration rose significantly from 354 +/- 176 pmol/l after placebo to 800 +/- 260 pmol/l after estradiol application. Heart rate during placebo was 74 +/- 15 bpm and during therapy 74 +/- 15 bpm. Heart rate variability was not different for time domain indices such as SDNN (estradiol: 64 +/- 31 ms; placebo: 65 +/- 33 ms) or for frequency domain indices such as LF (estradiol: 15.8 +/- 8.0 ms; placebo: 15.3 +/- 9.4 ms) and HF (estradiol: 12.1 +/- 8.5 ms; placebo: 12.9 +/- 9.9 ms). Conclusion A single transdermal application of estradiol did not modify heart rate or heart rate variability of women with coronary artery disease. The modulation of the autonomic tone does not seem to be a relevant mechanism of short-term estradiol effects.
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Affiliation(s)
- A Schuchert
- Medizinische Klinik Abteilung für Kardiologie Universitätsklinikum Hamburg-Eppendorf Martinistr. 52 20246 Hamburg, Germany.
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Stoll M, Behrens G, Schmidt R. Immunrekonstitutionssyndrom. Dtsch Med Wochenschr 2002. [DOI: 10.1055/s-2002-19588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schuchert A, Behrens G, Meinertz T. [Evaluation of infrequent episodes of palpitations with a patient-activated hand-held electrocardiograph]. Z Kardiol 2002; 91:62-7. [PMID: 11963209 DOI: 10.1007/s392-002-8373-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
UNLABELLED The disadvantage of most devices presently available for cardiac rhythm event monitoring is that they require either permanently attached electrodes or the subcutaneous implantation of the device. The aim of the study was to evaluate the feasibility and diagnostic yield of a hand-held, portable electrocardiograph for the evaluation of infrequent episodes of palpitations. In contrast to other devices, this electrocardiograph records and stores the electrocardiograms with integral electrodes, which makes long-term attached electrodes not unnecessary. METHODS The study included 55 consecutive patients with palpitations less than once a week. The patients received the electrocardiograph Miniscope MS-3 with integral tripod electrodes (Schiller AG, Switzerland) to record a one-channel electrocardiogram during a recurrent episode. The frequency of device activation and the atrial rhythm during an episode was assessed. RESULTS Forty-one (75%) patients had at least one episode within 38 +/- 22 days. The first episode occurred within the first week in 18 cases, during the 2nd in 9, during the 3rd in 9, during the 4th in 2 patients, and in 3 patients between the 4th and 12th week. All episodes could be properly analyzed: Twenty-three patients had sinus rhythm, 7 paroxysmal atrial fibrillation, 7 paroxysmal atrial flutter, and 4 an AV node reentry tachycardia. Eleven of the 23 patients with sinus rhythm additionally had premature atrial or ventricular contractions. Mean heart rate was 111 +/- 45 bpm. A second episode was recorded in 22 and a third episode in 12 patients. All patients had during the subsequent episode the same cardiac rhythm as during their first episode. CONCLUSIONS Patients evaluated for their infrequent palpitations had during event monitoring a recurrent episode in 75% that occurred in 88% within the first 4 weeks. All patients were able to activate the electrocardiograph and could store an electrocardiogram with the integral electrodes. Patient-activated event monitoring reliably identified patients with an atrial arrhythmia who need further invasive evaluation and treatment, and ruled out patients with sinus rhythm and premature contractions.
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Affiliation(s)
- A Schuchert
- Medizinische Klinik Abteilung für Kardiologie Universitätsklinikum Hamburg-Eppendorf Martinistr. 52 20246 Hamburg, Germany.
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van der Valk M, Kastelein JJ, Murphy RL, van Leth F, Katlama C, Horban A, Glesby M, Behrens G, Clotet B, Stellato RK, Molhuizen HO, Reiss P. Nevirapine-containing antiretroviral therapy in HIV-1 infected patients results in an anti-atherogenic lipid profile. AIDS 2001; 15:2407-14. [PMID: 11740191 DOI: 10.1097/00002030-200112070-00008] [Citation(s) in RCA: 183] [Impact Index Per Article: 8.0] [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: 12/19/2022]
Abstract
BACKGROUND Protease inhibitor-containing antiretroviral therapy for the treatment of HIV-1 infection is associated with elevated triglyceride and low-density lipoprotein (LDL)-cholesterol levels which may expose patients to an increased risk of coronary artery disease (CAD). We report the lipid and lipoprotein profiles of a representative subset of treatment-naive patients included in the Atlantic Study. This study compares patients treated with stavudine and didanosine plus the random addition of either the non-nucleoside reverse transcriptase inhibitor nevirapine (NVP), the protease inhibitor indinavir or the nucleoside reverse transcriptase inhibitor lamivudine. METHODS Lipids and lipoproteins were quantified from prospectively collected and cryopreserved plasma samples obtained at weeks 0, 6 and 24. RESULTS We observed a striking increase in high-density lipoprotein (HDL)-cholesterol (49%), apolipoprotein AI (19%), lipoprotein AI (38%) and HDL particle size (3%) in the NVP-treated patients (n = 34) at week 24. Much less pronounced changes in these parameters were seen to a similar extent both in patients receiving lamivudine (n = 39) and indinavir (n = 41). LDL-cholesterol also increased significantly both in the NVP and indinavir arms, but only in the NVP arm was this offset by a significant reduction (14%) in total over HDL-cholesterol ratio. Using a multivariate linear regression model, adjusting for CD4 cell count and plasma HIV RNA both at baseline and during treatment, randomization to the NVP-containing arm remained significant in explaining the observed changes in HDL-cholesterol and other HDL-related parameters. CONCLUSIONS In HIV-1 infected patients treated with a regimen of stavudine, didanosine and NVP we found changes in lipids and lipoproteins which are associated with a sharp decrease in risk for CAD in other settings. If confirmed in larger studies, these findings both may influence the initial choice of therapy for HIV-1 infection, and might lead to novel approaches targeted at raising HDL-cholesterol for CAD prevention.
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Affiliation(s)
- M van der Valk
- International Antiviral Therapy Evaluation Center and Department of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, Amsterdam, The Netherlands
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Jacobs R, Hintzen G, Kemper A, Beul K, Kempf S, Behrens G, Sykora KW, Schmidt RE. CD56bright cells differ in their KIR repertoire and cytotoxic features from CD56dim NK cells. Eur J Immunol 2001. [PMID: 11592089 DOI: 10.1002/1521-4141(2001010)31:10%3c3121::aid-immu3121%3e3.0.co;2-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In this study we present new differential characteristics of NK cells expressing CD56 surface antigen in low (CD56dim) or high (CD56bright) density. In contrast to CD56bright NK cells CD56dim cells express killer cell immunoglobulin (Ig)-like receptors (KIR) such as CD158a, CD158b, and NKB1. However, c-type lectin-like receptors (KLR) CD94/NKG2 and CD161 are present on both subsets. The ability to form conjugates with susceptible targets is approximately twice as strongly pronounced in CD56dim vs. CD56bright NK cells. Last but not least, granules of CD56dim cells contain about tenfold more perforin and granzyme A enabling potentially more effective cytolysis compared to CD56bright NK cells. On the other hand, CD56bright NK cells are superior in producing the proinflammatory cytokines IFN-gamma (28.5% vs. 20.8%, p<0.05) and TNF-alpha (28% vs. 15.8%, p<0.001). The different NK cell populations retained their specific phenotype in vitro during culture in the presence of IL-2 contradicting that they simply display different stages of maturity. Taken together our data support the view that CD56bright cells are specialized NK cells that regulate immunological response mechanisms rather by cytokine supply than by their cytotoxic potential. The poor cytolytic capacity of CD56bright NK cells can be explained by weak ability in forming conjugates with target cells and low contents of perforin and granzyme A in their granules.
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Affiliation(s)
- R Jacobs
- Department of Clinical Immunology, Hannover Medical School, Hannover, Germany.
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Jacobs R, Hintzen G, Kemper A, Beul K, Kempf S, Behrens G, Sykora KW, Schmidt RE. CD56bright cells differ in their KIR repertoire and cytotoxic features from CD56dim NK cells. Eur J Immunol 2001. [PMID: 11592089 DOI: 10.1002/1521-4141(2001010)31:10<3121::aid-immu3121>3.0.co;2-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this study we present new differential characteristics of NK cells expressing CD56 surface antigen in low (CD56dim) or high (CD56bright) density. In contrast to CD56bright NK cells CD56dim cells express killer cell immunoglobulin (Ig)-like receptors (KIR) such as CD158a, CD158b, and NKB1. However, c-type lectin-like receptors (KLR) CD94/NKG2 and CD161 are present on both subsets. The ability to form conjugates with susceptible targets is approximately twice as strongly pronounced in CD56dim vs. CD56bright NK cells. Last but not least, granules of CD56dim cells contain about tenfold more perforin and granzyme A enabling potentially more effective cytolysis compared to CD56bright NK cells. On the other hand, CD56bright NK cells are superior in producing the proinflammatory cytokines IFN-gamma (28.5% vs. 20.8%, p<0.05) and TNF-alpha (28% vs. 15.8%, p<0.001). The different NK cell populations retained their specific phenotype in vitro during culture in the presence of IL-2 contradicting that they simply display different stages of maturity. Taken together our data support the view that CD56bright cells are specialized NK cells that regulate immunological response mechanisms rather by cytokine supply than by their cytotoxic potential. The poor cytolytic capacity of CD56bright NK cells can be explained by weak ability in forming conjugates with target cells and low contents of perforin and granzyme A in their granules.
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Affiliation(s)
- R Jacobs
- Department of Clinical Immunology, Hannover Medical School, Hannover, Germany.
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Abstract
In this study we present new differential characteristics of NK cells expressing CD56 surface antigen in low (CD56dim) or high (CD56bright) density. In contrast to CD56bright NK cells CD56dim cells express killer cell immunoglobulin (Ig)-like receptors (KIR) such as CD158a, CD158b, and NKB1. However, c-type lectin-like receptors (KLR) CD94/NKG2 and CD161 are present on both subsets. The ability to form conjugates with susceptible targets is approximately twice as strongly pronounced in CD56dim vs. CD56bright NK cells. Last but not least, granules of CD56dim cells contain about tenfold more perforin and granzyme A enabling potentially more effective cytolysis compared to CD56bright NK cells. On the other hand, CD56bright NK cells are superior in producing the proinflammatory cytokines IFN-gamma (28.5% vs. 20.8%, p<0.05) and TNF-alpha (28% vs. 15.8%, p<0.001). The different NK cell populations retained their specific phenotype in vitro during culture in the presence of IL-2 contradicting that they simply display different stages of maturity. Taken together our data support the view that CD56bright cells are specialized NK cells that regulate immunological response mechanisms rather by cytokine supply than by their cytotoxic potential. The poor cytolytic capacity of CD56bright NK cells can be explained by weak ability in forming conjugates with target cells and low contents of perforin and granzyme A in their granules.
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MESH Headings
- Antigens, CD/analysis
- CD56 Antigen/analysis
- Cells, Cultured
- Cytokines/biosynthesis
- Cytotoxicity, Immunologic
- Humans
- Killer Cells, Natural/chemistry
- Killer Cells, Natural/immunology
- Lectins, C-Type
- Membrane Glycoproteins/analysis
- NK Cell Lectin-Like Receptor Subfamily D
- Perforin
- Pore Forming Cytotoxic Proteins
- Receptors, Immunologic/analysis
- Receptors, KIR
- Receptors, KIR2DL1
- Receptors, KIR2DL3
- Receptors, KIR3DL1
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Affiliation(s)
- R Jacobs
- Department of Clinical Immunology, Hannover Medical School, Hannover, Germany.
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Schuchert A, Behrens G, Meinertz T. Diurnal variations of the ventricular pacing threshold in patients with cardiac pacemakers are not related to changes in autonomic tone. Am J Cardiol 2000; 86:226-9. [PMID: 10913490 DOI: 10.1016/s0002-9149(00)00863-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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: 10/18/2022]
Affiliation(s)
- A Schuchert
- Department of Cardiology, University-Hospital Eppendorf, Hamburg, Germany.
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Meyer D, Behrens G, Stoll M, Schmidt RE. [Osteonecrosis: a rare complication of HIV infection. Association with certain risk factors]. MMW Fortschr Med 2000; 142 Suppl 1:64-7. [PMID: 10863317] [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: 02/16/2023]
Abstract
Osteonecrosis is a rare complication of HIV infection. The presumptive cause of the aseptic osteonecrosis is a disturbed blood supply to the bone. Most cases of osteonecrosis are associated with numerous risk factors, such as use of steroids, alcohol abuse, coagulopathies or metabolic derangements. Since conventional X-rays appear unremarkable, early forms often go unrecognized or are diagnosed late. Methods of establishing the diagnosis are NMR and three-phase skeletal scintigraphy. The pathogenesis of osteonecrosis in HIV infection is unclear. So far, about 30 cases have been reported in the literature. Since a number of these cases had no classical risk factors, it is assumed that the HIV infection itself is the causative agent. In other patients anticardiolipin antibodies, which are considered to be a risk factor, are found. Other HIV patients with aseptic osteonecrosis have elevated blood lipids; changes in blood fats have long been established as a risk factor in osteonecrosis. Furthermore, an association of osteonecrosis with proteinase inhibitor-induced metabolic lipid disorders was reported. Whether the risk for osteonecrosis in treatment with proteinase inhibitors actually is raised, or whether the association is a coincidence needs further investigation. We would recommend that in HIV patients with typical symptoms--in particular when classical risk factors are present--osteonecrosis be included in the differential diagnostic considerations.
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Affiliation(s)
- D Meyer
- Abteilung Klinische Immunologie, Medizinischen Hochschule Hannover
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Schuchert A, Behrens G, Meinertz T. [Not Available]. Herzschrittmacherther Elektrophysiol 2000; 11 Suppl 1:67-68. [PMID: 19495649 DOI: 10.1007/bf03042533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- A Schuchert
- Abteilung für Kardiologie, Medizinische Klinik und Poliklinik, Universitäts-Krankenhaus Eppendorf, Hamburg
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Behrens G, Dejam A, Schmidt H, Balks HJ, Brabant G, Körner T, Stoll M, Schmidt RE. Impaired glucose tolerance, beta cell function and lipid metabolism in HIV patients under treatment with protease inhibitors. AIDS 1999; 13:F63-70. [PMID: 10416516 DOI: 10.1097/00002030-199907090-00001] [Citation(s) in RCA: 372] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To evaluate metabolic abnormalities, beta-cell function, lipid profile and vascular risk factors in HIV patients on protease inhibitors (PI). DESIGN Prospective cross-sectional study. METHODS Thirty-eight HIV-1-infected patients receiving at least one PI were compared with 17 PI-naive HIV patients in an oral glucose tolerance test (OGTT). Serum glucose, insulin, proinsulin, and C-peptide were determined. The fasting lipid pattern was analysed using electrophoresis and the assessment of apolipoproteins including lipoprotein (a). Fibrinogen, homocysteine, and anticardiolipin antibodies were also assessed. RESULTS Twenty-seven (71%) of the PI-treated group had detectable hyperlipidaemia. Isolated hypertriglyceridaemia was present in 12 patients (44%), two (7%) of them had type V and 10 (37%) subjects had type IV hyperlipidaemia (Frederickson classification). Type IIb hyperlipidaemia defined as an increase of both very-low-density lipoproteins (VLDL) and low-density lipoproteins (LDL) was found in 10 (36%) subjects, and five (18%) patients presented with isolated hypercholesterolaemia (type IIa). PI treatment was associated with significant higher fasting cholesterol, triglycerides, LDL and VLDL levels. Apolipoprotein B and E concentrations were significantly increased in patients receiving PI. Elevated concentrations of lipoprotein (a) (> 30 mg/dl) were detected in six (16%) of the hyperlipidaemic patients on PI. Eighteen (46%) patients on PI had impaired oral glucose tolerance and five (13%) had diabetes. Although four (24%) of the PI-naive patients were glucose intolerant, none had diabetes. Fasting concentrations and secretion response of insulin, proinsulin, and C-peptide to glucose ingestion was significantly increased in the PI-treated group suggesting a beta-cell dysfunction in addition to peripheral insulin resistance. Beta-cell abnormalities were associated with the abnormal lipid pattern and PI treatment. CONCLUSION Combination drug regimens including PI are accompanied by impaired glucose tolerance, hyperproinsulinaemia as an indicator for beta-cell dysfunction, and lipid abnormalities proved to be significant risk factors for coronary heart disease. Moreover, PI may have an impact on the processing of proinsulin to insulin.
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Affiliation(s)
- G Behrens
- Department of Medicine, Hannover Medical School, Germany.
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Schuchert A, Behrens G, Meinertz T. Impact of long-term ECG recording on the detection of paroxysmal atrial fibrillation in patients after an acute ischemic stroke. Pacing Clin Electrophysiol 1999; 22:1082-4. [PMID: 10456638 DOI: 10.1111/j.1540-8159.1999.tb00574.x] [Citation(s) in RCA: 76] [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: 10/24/2022]
Abstract
An ECG recording time of 24 hours has a low yield to detect atrial arrhythmias in patients after an acute ischemic stroke. The present study investigated whether a recording time of 72 instead of 24 hours detects paroxysmal atrial fibrillation in more patients. The study prospectively included 82 consecutive patients 2-3 weeks after an acute ischemic stroke. All patients had sinus rhythm in the resting ECGs and no history of atrial fibrillation or flutter. The frequency of atrial fibrillation was assessed after 24, 48, and 72 hours of ambulatory ECG monitoring. An ECG monitoring time of 72 hours documented paroxysmal atrial fibrillation in five (6%) patients. The episode of paroxysmal atrial fibrillation occurred in only one patient within 24 hours. The other patients had their first episode of atrial fibrillation between 24 and 48 hours (n = 2) and between 48 and 72 hours (n = 2). These five patients were older (age = 70 +/- 5 years), whereas the mean age of the remaining patients was 59 +/- 13 years. All five patients had cardiovascular disease in comparison to 36 of 77 patients and reported palpitations in comparison to 6 of 77 of the remaining patients. In conclusion, ambulatory ECG monitoring over 72 hours detected after the first recording day four of five patients in whom paroxysmal atrial fibrillation could be documented for the first time. The 72-hour recording time improved, compared to the 24-hour period, the detection of paroxysmal atrial fibrillation in patients after an ischemic stroke. It seems to be more efficient to perform prolonged ECG recording mainly in older patients with a cardiovascular disease and/or a history of palpitations.
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Affiliation(s)
- A Schuchert
- Medical Clinic, Department of Cardiology, University-Hospital Eppendorf, Hamburg, Germany
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