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Isaksson GL, Hinrichs GR, Andersen H, Bach ML, Weyer K, Zachar R, Henriksen JE, Madsen K, Lund IK, Mollet G, Bistrup C, Birn H, Jensen BL, Palarasah Y. Amiloride Reduces Urokinase/Plasminogen-Driven Intratubular Complement Activation in Glomerular Proteinuria. J Am Soc Nephrol 2024; 35:410-425. [PMID: 38254266 PMCID: PMC11000727 DOI: 10.1681/asn.0000000000000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
SIGNIFICANCE STATEMENT Proteinuria predicts accelerated decline in kidney function in CKD. The pathologic mechanisms are not well known, but aberrantly filtered proteins with enzymatic activity might be involved. The urokinase-type plasminogen activator (uPA)-plasminogen cascade activates complement and generates C3a and C5a in vitro / ex vivo in urine from healthy persons when exogenous, inactive, plasminogen, and complement factors are added. Amiloride inhibits uPA and attenuates complement activation in vitro and in vivo . In conditional podocin knockout (KO) mice with severe proteinuria, blocking of uPA with monoclonal antibodies significantly reduces the urine excretion of C3a and C5a and lowers tissue NLRP3-inflammasome protein without major changes in early fibrosis markers. This mechanism provides a link to proinflammatory signaling in proteinuria with possible long-term consequences for kidney function. BACKGROUND Persistent proteinuria is associated with tubular interstitial inflammation and predicts progressive kidney injury. In proteinuria, plasminogen is aberrantly filtered and activated by urokinase-type plasminogen activator (uPA), which promotes kidney fibrosis. We hypothesized that plasmin activates filtered complement factors C3 and C5 directly in tubular fluid, generating anaphylatoxins, and that this is attenuated by amiloride, an off-target uPA inhibitor. METHODS Purified C3, C5, plasminogen, urokinase, and urine from healthy humans were used for in vitro / ex vivo studies. Complement activation was assessed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, immunoblotting, and ELISA. Urine and plasma from patients with diabetic nephropathy treated with high-dose amiloride and from mice with proteinuria (podocin knockout [KO]) treated with amiloride or inhibitory anti-uPA antibodies were analyzed. RESULTS The combination of uPA and plasminogen generated anaphylatoxins C3a and C5a from intact C3 and C5 and was inhibited by amiloride. Addition of exogenous plasminogen was sufficient for urine from healthy humans to activate complement. Conditional podocin KO in mice led to severe proteinuria and C3a and C5a urine excretion, which was attenuated reversibly by amiloride treatment for 4 days and reduced by >50% by inhibitory anti-uPA antibodies without altering proteinuria. NOD-, LRR- and pyrin domain-containing protein 3-inflammasome protein was reduced with no concomitant effect on fibrosis. In patients with diabetic nephropathy, amiloride reduced urinary excretion of C3dg and sC5b-9 significantly. CONCLUSIONS In conditions with proteinuria, uPA-plasmin generates anaphylatoxins in tubular fluid and promotes downstream complement activation sensitive to amiloride. This mechanism links proteinuria to intratubular proinflammatory signaling. In perspective, amiloride could exert reno-protective effects beyond natriuresis and BP reduction. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER Increased Activity of a Renal Salt Transporter (ENaC) in Diabetic Kidney Disease, NCT01918488 and Increased Activity of ENaC in Proteinuric Kidney Transplant Recipients, NCT03036748 .
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Affiliation(s)
- Gustaf L. Isaksson
- Department of Molecular Medicine–Cardiovascular and Renal Research, University of Southern Denmark, Odense, Denmark
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Gitte R. Hinrichs
- Department of Molecular Medicine–Cardiovascular and Renal Research, University of Southern Denmark, Odense, Denmark
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Henrik Andersen
- Department of Molecular Medicine–Cardiovascular and Renal Research, University of Southern Denmark, Odense, Denmark
| | - Marie L. Bach
- Department of Molecular Medicine–Cardiovascular and Renal Research, University of Southern Denmark, Odense, Denmark
| | - Kathrin Weyer
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Rikke Zachar
- Department of Molecular Medicine–Cardiovascular and Renal Research, University of Southern Denmark, Odense, Denmark
| | - Jan Erik Henriksen
- Steno Diabetes Center Odense, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kirsten Madsen
- Department of Molecular Medicine–Cardiovascular and Renal Research, University of Southern Denmark, Odense, Denmark
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Ida K. Lund
- The Finsen Laboratory, Rigshospitalet, Copenhagen, Denmark
- Biotech Research and Innovation Center (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Géraldine Mollet
- Laboratory of Hereditary Kidney Diseases, Inserm UMR1163, Imagine Institute, Université Paris Cité, Paris, France
| | - Claus Bistrup
- Department of Nephrology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Henrik Birn
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Boye L. Jensen
- Department of Molecular Medicine–Cardiovascular and Renal Research, University of Southern Denmark, Odense, Denmark
| | - Yaseelan Palarasah
- Department of Molecular Medicine–Cancer and Inflammation, University of Southern Denmark, Odense, Denmark
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Bouazzi M, Jørgensen DES, Andersen H, Krusenstjerna-Hafstrøm T, Ekelund CK, Jensen AN, Sandager P, Sperling L, Steensberg J, Sundberg K, Vejlstrup NG, Petersen OBB, Vedel C. Prevalence and detection rate of major congenital heart disease in twin pregnancies in Denmark. Ultrasound Obstet Gynecol 2023; 62:681-687. [PMID: 37191390 DOI: 10.1002/uog.26249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/24/2023] [Accepted: 05/02/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To investigate the national prevalence and prenatal detection rate (DR) of major congenital heart disease (mCHD) in twin pregnancies without twin-to-twin transfusion syndrome (TTTS)-associated CHD in a Danish population following a standardized prenatal screening program. METHODS This was a national registry-based study of data collected prospectively over a 10-year period. In Denmark, all women with a twin pregnancy are offered standardized screening and surveillance programs in addition to first- and second-trimester screening for aneuploidies and malformation, respectively: monochorionic (MC) twins every 2 weeks from gestational week 15 and dichorionic (DC) twins every 4 weeks from week 18. The data were retrieved from the Danish Fetal Medicine Database and included all twin pregnancies from 2009-2018, in which at least one fetus had a pre- and/or postnatal mCHD diagnosis. mCHD was defined as CHD requiring surgery within the first year of life, excluding ventricular septal defects. All pregnancy data were pre- and postnatally validated in the local patient files at the four tertiary centers covering the entire country. RESULTS A total of 60 cases from 59 twin pregnancies were included. The prevalence of mCHD was 4.6 (95% CI, 3.5-6.0) per 1000 twin pregnancies (1.9 (95% CI, 1.3-2.5) per 1000 live births). The prevalences for DC and MC were 3.6 (95% CI, 2.6-5.0) and 9.2 (95% CI, 5.8-13.7) per 1000 twin pregnancies, respectively. The national prenatal DR of mCHD in twin pregnancies for the entire period was 68.3%. The highest DRs were in cases with univentricular hearts (100%) and the lowest with aortopulmonary window, total anomalous pulmonary venous return, Ebstein's anomaly, aortic valve stenosis and coarctation of the aorta (0-25%). Mothers of children with prenatally undetected mCHD had a significantly higher body mass index (BMI) compared to mothers of children with a prenatally detected mCHD (median, 27 kg/m2 and 23 kg/m2 , respectively; P = 0.02). CONCLUSIONS The prevalence of mCHD in twins was 4.6 per 1000 pregnancies and was higher in MC than DC pregnancies. The prenatal DR of mCHD in twin pregnancies was 68.3%. Maternal BMI was higher in cases of prenatally undetected mCHD. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M Bouazzi
- Department of Obstetrics, Center of Fetal Medicine and Pregnancy, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - D E S Jørgensen
- Department of Obstetrics, Center of Fetal Medicine and Pregnancy, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - H Andersen
- Department of Pediatrics, Odense University Hospital, Odense, Denmark
| | | | - C K Ekelund
- Department of Obstetrics, Center of Fetal Medicine and Pregnancy, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - A N Jensen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
| | - P Sandager
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Center for Fetal Diagnostics, Aarhus University, Aarhus, Denmark
| | - L Sperling
- Fetal Medicine Unit, Odense University Hospital, Odense, Denmark
| | - J Steensberg
- Department of Pediatrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - K Sundberg
- Department of Obstetrics, Center of Fetal Medicine and Pregnancy, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - N G Vejlstrup
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - O B B Petersen
- Department of Obstetrics, Center of Fetal Medicine and Pregnancy, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - C Vedel
- Department of Obstetrics, Center of Fetal Medicine and Pregnancy, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Meldgaard M, Kristensen RS, Z'Graggen WJ, Tan SV, Søndergaard K, Qerama E, Andersen H, Fuglsang-Frederiksen A, Tankisi H. Muscle velocity recovery cycles in myopathy. Clin Neurophysiol 2023; 151:41-49. [PMID: 37148747 DOI: 10.1016/j.clinph.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To understand the pathophysiology of myopathies by using muscle velocity recovery cycles (MVRC) and frequency ramp (RAMP) methodologies. METHODS 42 patients with quantitative electromyography (qEMG) and biopsy or genetic verified myopathy and 42 healthy controls were examined with qEMG, MVRC and RAMP, all recorded from the anterior tibial muscle. RESULTS There were significant differences in the motor unit potential (MUP) duration, the early and late supernormalities of the MVRC and the RAMP latencies in myopathy patients compared to controls (p < 0.05 apart from muscle relatively refractory period (MRRP)). When dividing into subgroups, the above-mentioned changes in MVRC and RAMP parameters were increased for the patients with non-inflammatory myopathy, while there were no significant changes in the group of patients with inflammatory myopathy. CONCLUSIONS The MVRC and RAMP parameters can discriminate between healthy controls and myopathy patients, more significantly for non-inflammatory myopathy. MVRC differences with normal MRRP in myopathy differs from other conditions with membrane depolarisation. SIGNIFICANCE MVCR and RAMP may have a potential in understanding disease pathophysiology in myopathies. The pathogenesis in non-inflammatory myopathy does not seem to be caused by a depolarisation of the resting membrane potential but rather by the change in sodium channels of the muscle membrane.
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Affiliation(s)
- M Meldgaard
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - R S Kristensen
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - W J Z'Graggen
- Departments of Neurology and Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - S V Tan
- Department of Neurology and Neurophysiology, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - K Søndergaard
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - E Qerama
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark; Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - H Andersen
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - A Fuglsang-Frederiksen
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark; Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - H Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark; Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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Junkermann J, Wolter F, Mayerl J, Andersen H, Wieland T. Überschätzung der Impfquote gegen Covid-
19 in Bevölkerungsumfragen aufgrund von
Verzerrungen durch soziale Erwünschtheit: Ein
Survey-Experiment mit der Item Count Technique. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753748] [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: 12/12/2022]
Affiliation(s)
- J Junkermann
- Martin-Luther-Universität Halle-Wittenberg, Institut für
Medizinische Soziologie (IMS), Halle (Saale), Deutschland
| | - F Wolter
- Universität Konstanz, Fach Soziologie, Konstanz,
Deutschland
| | - J Mayerl
- Technische
Universität Chemnitz, Institut für Soziologie, Chemnitz, Deutschland
| | - H Andersen
- Technische
Universität Chemnitz, Institut für Soziologie, Chemnitz, Deutschland
| | - T Wieland
- Universität Konstanz, Cluster of Excellence "The Politics of Inequality",
Konstanz, Deutschland
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Holz M, Mayerl J, Andersen H, Maskow B. How Does Migration Background Affect COVID-19 Vaccination Intentions? A Complex Relationship Between General Attitudes, Religiosity, Acculturation and Fears of Infection. Front Public Health 2022; 10:854146. [PMID: 35462811 PMCID: PMC9019123 DOI: 10.3389/fpubh.2022.854146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives The aim of the study is to investigate the relationship between migration background and COVID-19 vaccine intentions, exploring multiple mediation paths. We argue that the migrational and sociocultural background influences general attitudes toward health and political/public institutions. The effects of these general attitudes on vaccination intentions are mediated by fears of infection. Additionally, we analyze a migrant-only model including acculturation variables (years since migration, foreign and host country media consumption) and region of origin (European vs. Non-European). Design: The data (n = 1027) stem from an online access panel collected between March 15 and March 25, 2021. Quotas for gender and age were set according the online population of Germany. The use of an oversampling framework for first generation migrants resulted in a sample with 50% first generation migrants and 50% native Germans without migration background. Models were calculated using a Structural Equation Modeling approach. Results Migration background both increases and decreases antecedents of vaccination intentions. Being a migrant increases positive antecedents like religiosity, which in turn positively influence general attitudes and thus fears of infection and vaccination intentions. But being a migrant has also a significant direct negative association with vaccination intentions, implying missing mediators. Increasing years since migration increase host country (German) media consumption and decrease consumption of media from the country of origin. Both media variables are positively associated with political trust and health consciousness. Additionally, European compared to Non-European migrants have less political trust, fear of personal infection and lower vaccination intentions on the whole. Conclusions The study found that vaccination intentions can be understood by applying the proposed hypothetical structure. We found complex associations of the migration and sociocultural background and COVID-19 vaccination intentions, where antecedents of vaccination intentions are both increased and decreased by migration background and migration specific factors.
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Affiliation(s)
- Manuel Holz
- Chemnitz University of Technology, Chemnitz, Germany
| | - Jochen Mayerl
- Chemnitz University of Technology, Chemnitz, Germany
| | | | - Britta Maskow
- Chemnitz University of Technology, Chemnitz, Germany
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Huynh K, Andersen H. Uterine torsion in a full-term pregnancy presenting as prolonged latent phase and fetal intolerance of labor: A case report. Case Rep Womens Health 2021; 32:e00353. [PMID: 34485098 PMCID: PMC8405958 DOI: 10.1016/j.crwh.2021.e00353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 11/04/2022] Open
Abstract
Background Uterine torsion is defined as torsion of the uterus around its longitudinal axis exceeding 45 degrees. It is a rare obstetric complication. It is a dangerous complication that can lead to placental abruption and intrauterine fetal death. Although rare, early diagnosis is crucial to expedite intervention and optimize outcomes. While the few cases in the current literature have documented acute presentations of uterine torsion, our case is unique in that it had a slower evolution. Case A 38-year-old woman, G2P0, was admitted at 37 weeks 0 days of gestation for induction of labor for gestational diabetes mellitus, pre-eclampsia, and maternal BMI of 60. Due to a prolonged latent phase of labor and fetal intolerance of labor, primary cesarean was recommended. Through a sub-umbilical approach, the uterus was dextro-rotated almost 180 degrees and blanched with engorged uterine vessels. A vertical uterine incision was made, and a asphyxiated female infant was delivered via breech extraction. APGAR scores were 2, 7, and 8. The infant required brief respiratory support following delivery. The postoperative course was uncomplicated, with normal recovery time. Conclusion Uterine torsion poses significant risk to both mother and fetus. The phenomenon is so rare that epidemiological data are difficult to gather. In our case, the presentation was gradual compared with the acute presentations that have been reported, which may mislead clinicians toward more benign diagnoses. Our case report aims to add to the literature on uterine torsion, providing a unique presentation, clinical features, and treatment. Uterine torsion is torsion of the uterus around its longitudinal axis exceeding 45 degrees. It is a rare obstetric complication. Severe acute uterine torsion can result in placental abruption, intrauterine fetal death, and maternal death. This case of uterine torsion presented as prolonged latent phase and fetal intolerance of labor. Delivery was achieved via classical cesarean section.
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Affiliation(s)
- Kimberly Huynh
- Harbor-UCLA Medical Center, Department of Obstetrics & Gynecology, Torrance, California 90502, United States.,Washington State University Elson S. Floyd College of Medicine, United States
| | - H Andersen
- Harbor-UCLA Medical Center, Department of Obstetrics & Gynecology, Torrance, California 90502, United States.,Washington State University Elson S. Floyd College of Medicine, United States
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Agergaard J, Leth S, Pedersen TH, Harbo T, Blicher JU, Karlsson P, Østergaard L, Andersen H, Tankisi H. Reply to "Maybe myopathic EMG but not myopathy" and to "Exclude differentials before attributing post-COVID fatigue to myopathy". Clin Neurophysiol 2021; 132:2326-2327. [PMID: 34326011 DOI: 10.1016/j.clinph.2021.07.005] [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] [Received: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Affiliation(s)
- J Agergaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - S Leth
- Department of Medicine, Regional Hospital Unit West, Jutland, Denmark
| | - T H Pedersen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - T Harbo
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - J U Blicher
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark; Centre of Functionally Integrated Neuroscience, Aarhus University, Aarhus, Denmark
| | - P Karlsson
- Danish Pain Research Center, Aarhus University, Denmark
| | - L Østergaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - H Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - H Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.
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Agergaard J, Leth S, Pedersen TH, Harbo T, Blicher JU, Karlsson P, Østergaard L, Andersen H, Tankisi H. Myopathic changes in patients with long-term fatigue after COVID-19. Clin Neurophysiol 2021; 132:1974-1981. [PMID: 34020890 PMCID: PMC8102077 DOI: 10.1016/j.clinph.2021.04.009] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 12/15/2022]
Abstract
Objective To investigate the peripheral nerve and muscle function electrophysiologically in patients with persistent neuromuscular symptoms following Coronavirus disease 2019 (COVID-19). Methods Twenty consecutive patients from a Long-term COVID-19 Clinic referred to electrophysiological examination with the suspicion of mono- or polyneuropathy were included. Examinations were performed from 77 to 255 (median: 216) days after acute COVID-19. None of the patients had received treatment at the intensive care unit. Of these, 10 patients were not even hospitalized. Conventional nerve conduction studies (NCS) and quantitative electromyography (qEMG) findings from three muscles were compared with 20 age- and sex-matched healthy controls. Results qEMG showed myopathic changes in one or more muscles in 11 patients (55%). Motor unit potential duration was shorter in patients compared to healthy controls in biceps brachii (10.02 ± 0.28 vs 11.75 ± 0.21), vastus medialis (10.86 ± 0.37 vs 12.52 ± 0.19) and anterior tibial (11.76 ± 0.31 vs 13.26 ± 0.21) muscles. All patients with myopathic qEMG reported about physical fatigue and 8 patients about myalgia while 3 patients without myopathic changes complained about physical fatigue. Conclusions Long-term COVID-19 does not cause large fibre neuropathy, but myopathic changes are seen. Significance Myopathy may be an important cause of physical fatigue in long-term COVID-19 even in non-hospitalized patients.
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Affiliation(s)
- J Agergaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - S Leth
- Department of Medicine, Regional Hospital Unit West, Jutland, Denmark
| | - T H Pedersen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - T Harbo
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - J U Blicher
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark; Centre of Functionally Integrated Neuroscience, Aarhus University, Aarhus, Denmark
| | - P Karlsson
- Danish Pain Research Center, Aarhus University, Denmark
| | - L Østergaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - H Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - H Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.
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Kristensen AG, Gylfadottir S, Itani M, Kuwabara S, Krøigård T, Khan KS, Finnerup NB, Andersen H, Jensen TS, Sindrup S, Tankisi H. Sensory and motor axonal excitability testing in early diabetic neuropathy. Clin Neurophysiol 2021; 132:1407-1415. [PMID: 34030050 DOI: 10.1016/j.clinph.2021.02.397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/30/2021] [Accepted: 02/01/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of the present study was to gain insight into the pathophysiology of diabetic polyneuropathy (DPN) and examine the diagnostic value of sensory and motor axonal excitability testing. METHODS One hundred and eleven type 2 diabetics with and without DPN (disease duration: 6.36 ± 0.25 years) and 60 controls were included. All participants received a thorough clinical examination including Michigan Neuropathy Screening Instrument (MNSI) score, nerve conduction studies (NCS), and sensory and motor excitability tests. Patients were compared by the likelihood of neuropathy presence, ranging from no DPN (17), possible/probable DPN (46) to NCS-confirmed DPN (48). RESULTS Motor excitability tests showed differences in rheobase and depolarizing threshold electrotonus measures between NCS-confirmed DPN group and controls but no changes in hyperpolarising threshold electrotonus or recovery cycle parameters. Sensory excitability showed even less changes despite pronounced sensory NCS abnormalities. There were only weak correlations between the above motor excitability parameters and clinical scores. CONCLUSIONS Changes in excitability in the examined patient group were subtle, perhaps because of the relatively short disease duration. SIGNIFICANCE Less pronounced excitability changes than NCS suggest that axonal excitability testing is not of diagnostic value for early DPN and does not provide information on the mechanisms.
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Affiliation(s)
- A G Kristensen
- Department of Clinical Neurophysiology, Aarhus University Hospital, Denmark; Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Denmark
| | - S Gylfadottir
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Denmark; Department of Neurology, Aarhus University Hospital, Denmark
| | - M Itani
- Department of Neurology, Odense University Hospital, Denmark
| | - S Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
| | - T Krøigård
- Department of Neurology, Odense University Hospital, Denmark
| | - K S Khan
- Department of Neurology, Aarhus University Hospital, Denmark
| | - N B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Denmark; Department of Neurology, Aarhus University Hospital, Denmark
| | - H Andersen
- Department of Neurology, Aarhus University Hospital, Denmark
| | - T S Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Denmark; Department of Neurology, Aarhus University Hospital, Denmark
| | - S Sindrup
- Department of Neurology, Odense University Hospital, Denmark
| | - H Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Denmark.
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Steenkjaer CH, Mencagli RA, Vaeggemose M, Andersen H. Isokinetic strength and degeneration of lower extremity muscles in patients with myotonic dystrophy; an MRI study. Neuromuscul Disord 2021; 31:198-211. [PMID: 33568272 DOI: 10.1016/j.nmd.2020.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 01/10/2023]
Abstract
Our aim was to determine isokinetic strength and degeneration of lower extremity muscles in patients with Myotonic Dystrophy (DM1). In 19 patients with DM1 and 19 matched controls, strength measured by isokinetic dynamometry was expressed as percentage of expected strength (ePct), adjusted for age, height, weight and gender. MRI of the hip, thigh and calf muscles were obtained. Fat fraction (FF), mean contractile cross-sectional area (cCSA) and specific strength (Nm/cm2) were calculated. Patients' ankle plantar flexors, knee flexors and extensors had higher FF (Δ: 0.08 - 0.42) and lower cCSA (Δ: 3.2 -17.1 cm2) compared to controls (p ≤ 0.005). EPct (Δ: 19.5 - 41.6%) and specific strength (Δ: 0.27 - 0.96 Nm/cm2) were lower in the majority of patients muscle groups (p˂0.05). Close correlations were found for patients when relating ePct to; FF for plantar flexors (R2=0.742, p<0.001) and knee extensors (R2=0.732, p<0.001), cCSA for plantar flexors (R2=0.696, p<0.001) and knee extensors (R2=0.633, p<0.001), and specific strength for dorsal flexors (ρ=0.855, p = 0.008). In conclusion, patients had weaker lower extremity muscles with higher FF, lower cCSA and specific strength compared to controls. Muscle degeneration determined by quantitative MRI strongly correlated to strength supporting its feasibility to quantify muscle dysfunction in DM1.
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Affiliation(s)
- C H Steenkjaer
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
| | - R A Mencagli
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - M Vaeggemose
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - H Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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11
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Andersen H, Hansen MH, Buhl KB, Stæhr M, Friis UG, Enggaard C, Supramaniyam S, Lund IK, Svenningsen P, Hansen PBL, Jensen BL. Plasminogen Deficiency and Amiloride Mitigate Angiotensin II-Induced Hypertension in Type 1 Diabetic Mice Suggesting Effects Through the Epithelial Sodium Channel. J Am Heart Assoc 2020; 9:e016387. [PMID: 33215566 PMCID: PMC7763785 DOI: 10.1161/jaha.120.016387] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Diabetic nephropathy is a common diabetes mellitus complication associated with hypertension, proteinuria, and excretion of urinary plasmin that activates the epithelial sodium channel, ENaC, in vitro. Here we hypothesized that the deletion of plasminogen and amiloride treatment protect against hypertension in diabetes mellitus. Methods and Results Male plasminogen knockout (plasminogen-deficient [Plg-/-]) and wild-type mice were rendered diabetic with streptozotocin. Arterial blood pressure was recorded continuously by indwelling catheters before and during 10 days of angiotensin II infusion (ANGII; 30-60 ng/kg per minute). The effect of amiloride infusion (2 mg/kg per day, 4 days) was tested in wild-type, diabetic ANGII-treated mice. Streptozotocin increased plasma and urine glucose concentrations and 24-hour urine albumin and plasminogen excretion. Diabetic Plg-/- mice displayed larger baseline albuminuria and absence of urine plasminogen. Baseline mean arterial blood pressure did not differ between groups. Although ANGII elevated blood pressure in wild-type, diabetic wild-type, and Plg-/- control mice, ANGII did not change blood pressure in diabetic Plg-/- mice. Compared with ANGII infusion alone, wild-type ANGII-infused diabetic mice showed blood pressure reduction upon amiloride treatment. There was no difference in plasma renin, ANGII, aldosterone, tissue prorenin receptor, renal inflammation, and fibrosis between groups. Urine from wild-type mice evoked larger amiloride-sensitive current than urine from Plg-/- mice with or without diabetes mellitus. Full-length γ-ENaC and α-ENaC subunit abundances were not changed in kidney homogenates, but the 70 kDa γ-ENaC cleavage product was increased in diabetic versus nondiabetic mice. Conclusions Plasmin promotes hypertension in diabetes mellitus with albuminuria likely through the epithelial sodium channel.
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Affiliation(s)
- Henrik Andersen
- Department of Cardiovascular and Renal Research Institute of Molecular Medicine University of Southern Denmark Odense Denmark
| | - Maria Høj Hansen
- Department of Cardiovascular and Renal Research Institute of Molecular Medicine University of Southern Denmark Odense Denmark
| | - Kristian B Buhl
- Department of Cardiovascular and Renal Research Institute of Molecular Medicine University of Southern Denmark Odense Denmark
| | - Mette Stæhr
- Department of Cardiovascular and Renal Research Institute of Molecular Medicine University of Southern Denmark Odense Denmark
| | - Ulla G Friis
- Department of Cardiovascular and Renal Research Institute of Molecular Medicine University of Southern Denmark Odense Denmark
| | - Camilla Enggaard
- Department of Cardiovascular and Renal Research Institute of Molecular Medicine University of Southern Denmark Odense Denmark
| | - Shanya Supramaniyam
- Department of Cardiovascular and Renal Research Institute of Molecular Medicine University of Southern Denmark Odense Denmark
| | - Ida K Lund
- The Finsen Laboratory Copenhagen University Hospital, and Biotech Research and Innovation Center (BRIC) University of Copenhagen Denmark
| | - Per Svenningsen
- Department of Cardiovascular and Renal Research Institute of Molecular Medicine University of Southern Denmark Odense Denmark
| | - Pernille B L Hansen
- Department of Cardiovascular and Renal Research Institute of Molecular Medicine University of Southern Denmark Odense Denmark.,Research and Early Development Cardiovascular, Renal and Metabolism BioPharmaceuticals R&D AstraZeneca Gothenburg Sweden
| | - Boye L Jensen
- Department of Cardiovascular and Renal Research Institute of Molecular Medicine University of Southern Denmark Odense Denmark
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12
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Gylfadottir SS, Itani M, Krøigård T, Kristensen AG, Christensen DH, Nicolaisen SK, Karlsson P, Callaghan BC, Bennett DL, Andersen H, Tankisi H, Nielsen JS, Andersen NT, Jensen TS, Thomsen RW, Sindrup SH, Finnerup NB. Diagnosis and prevalence of diabetic polyneuropathy: a cross-sectional study of Danish patients with type 2 diabetes. Eur J Neurol 2020; 27:2575-2585. [PMID: 32909392 DOI: 10.1111/ene.14469] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/29/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND PURPOSE Diabetic polyneuropathy (DPN) is a common complication of diabetes. Using the Toronto criteria for diabetic polyneuropathy and the grading system for neuropathic pain, the performance of neuropathy scales and questionnaires were assessed by comparing them to a clinical gold standard diagnosis of DPN and painful DPN in a cohort of patients with recently diagnosed type 2 diabetes. METHODS A questionnaire on neuropathy and pain was sent to a cohort of 5514 Danish type 2 diabetes patients. A sample of 389 patients underwent a detailed clinical examination and completed neuropathy questionnaires and scales. RESULTS Of the 389 patients with a median diabetes duration of 5.9 years, 126 had definite DPN (including 53 with painful DPN), 88 had probable DPN and 53 had possible DPN. There were 49 patients with other causes of polyneuropathy, neuropathy symptoms or pain, 10 with subclinical DPN and 63 without DPN. The sensitivity of the Michigan Neuropathy Screening Instrument questionnaire to detect DPN was 25.7% and the specificity 84.6%. The sensitivity of the Toronto Clinical Neuropathy Scoring System, including questionnaire and clinical examination, was 62.9% and the specificity was 74.6%. CONCLUSIONS Diabetic polyneuropathy affects approximately one in five Danish patients with recently diagnosed type 2 diabetes but neuropathic pain is not as common as previously reported. Neuropathy scales with clinical examination perform better compared with questionnaires alone, but better scales are needed for future epidemiological studies.
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Affiliation(s)
- S S Gylfadottir
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - M Itani
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - T Krøigård
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - A G Kristensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - D H Christensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - S K Nicolaisen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - P Karlsson
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Core Center for Molecular Morphology, Section for Stereology and Microscopy, Aarhus University, Aarhus, Denmark
| | - B C Callaghan
- Department of Neurology, University of Michigan, Ann Arbor,, MI, USA
| | - D L Bennett
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - H Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - H Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - J S Nielsen
- Danish Centre for Strategic Research in Type 2 Diabetes, Steno Diabetes Center, Odense, Denmark
| | - N T Andersen
- Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - T S Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - R W Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - S H Sindrup
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - N B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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13
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Mullerpatan A, Kane E, Ghosh R, Nascimento A, Andersen H, Cramer S, Karande P. Single-step purification of a small non-mAb biologic by peptide-ELP-based affinity precipitation. Biotechnol Bioeng 2020; 117:3775-3784. [PMID: 32813285 DOI: 10.1002/bit.27539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 12/12/2022]
Abstract
Affinity precipitation using stimulus-responsive biopolymers such as elastin-like polypeptides (ELPs) have been successfully employed for the purification of monoclonal antibodies. In the current work, we extend these studies to the development of an ELP-peptide fusion for the affinity precipitation of the therapeutically relevant small non-mAb biologic, AdP. A 12-mer affinity peptide ligand (P10) was identified by a primary phage biopanning followed by a secondary in-solution fluorescence polarization screen. Peptide P10 and AdP interacted with a KD of 19.5 µM. A fusion of P10 with ELP was then shown to be successful in selectively capturing the biologic from a crude mixture. While pH shifts alone were not sufficient for product elution, the use of pH in concert with fluid-phase modifiers such as NaCl, arginine, or ethylene glycol was effective. In particular, the use of pH 8.5 and an arginine concentration of 500 mM enabled >80% product recovery. The overall process performance evaluated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and reversed-phase ultra-performance liquid chromatography analyses indicated successful single-step purification of the biologic from an Escherichia coli lysate resulting in ∼90% purity and >80% recovery. These results demonstrate that phage display can be readily employed to identify a peptide ligand capable of successfully carrying out the purification of a non-antibody biological product using ELP-based affinity precipitation.
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Affiliation(s)
- Akshat Mullerpatan
- The Howard P. Isermann Department of Chemical and Biological Engineering, Rensselaer Polytechnic Institute, Troy, New York.,Center for Biotechnology and Interdisciplinary Studies (CBIS), Rensselaer Polytechnic Institute, Troy, New York
| | - Erin Kane
- The Howard P. Isermann Department of Chemical and Biological Engineering, Rensselaer Polytechnic Institute, Troy, New York.,Center for Biotechnology and Interdisciplinary Studies (CBIS), Rensselaer Polytechnic Institute, Troy, New York
| | - Ronit Ghosh
- The Howard P. Isermann Department of Chemical and Biological Engineering, Rensselaer Polytechnic Institute, Troy, New York.,Center for Biotechnology and Interdisciplinary Studies (CBIS), Rensselaer Polytechnic Institute, Troy, New York
| | - André Nascimento
- Center for Biotechnology and Interdisciplinary Studies (CBIS), Rensselaer Polytechnic Institute, Troy, New York.,iBB-Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Henrik Andersen
- Biologics Development, Global Product Development and Supply, Bristol Myers Squibb Company, Devens, Massachusetts
| | - Steven Cramer
- The Howard P. Isermann Department of Chemical and Biological Engineering, Rensselaer Polytechnic Institute, Troy, New York.,Center for Biotechnology and Interdisciplinary Studies (CBIS), Rensselaer Polytechnic Institute, Troy, New York
| | - Pankaj Karande
- The Howard P. Isermann Department of Chemical and Biological Engineering, Rensselaer Polytechnic Institute, Troy, New York.,Center for Biotechnology and Interdisciplinary Studies (CBIS), Rensselaer Polytechnic Institute, Troy, New York
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14
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Kristensen AG, Khan KS, Bostock H, Khan BS, Gylfadottir S, Andersen H, Finnerup NB, Jensen TS, Tankisi H. MScanFit motor unit number estimation and muscle velocity recovery cycle recordings in diabetic polyneuropathy. Clin Neurophysiol 2020; 131:2591-2599. [PMID: 32927215 DOI: 10.1016/j.clinph.2020.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/04/2020] [Accepted: 07/22/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Motor Unit Number Estimation (MUNE) methods may be valuable in tracking motor unit loss in diabetic polyneuropathy (DPN). Muscle Velocity Recovery Cycles (MVRCs) provide information about muscle membrane properties. This study aimed to examine the utility of the MScanFit MUNE in detecting motor unit loss and to test whether the MVRCs could improve understanding of DPN pathophysiology. METHODS Seventy-nine type-2 diabetic patients were compared to 32 control subjects. All participants were examined with MScanFit MUNE and MVRCs in anterior tibial muscle. Lower limb nerve conduction studies (NCS) in peroneal, tibial and sural nerves were applied to diagnose large fiber neuropathy. RESULTS NCS confirmed DPN for 47 patients (DPN + ), with 32 not showing DPN (DPN-). MScanFit showed significantly decreased MUNE values and increased motor unit sizes, when comparing DPN + patients with controls (MUNE = 71.3 ± 4.7 vs 122.7 ± 3.8), and also when comparing DPN- patients (MUNE = 103.2 ± 5.1) with controls. MVRCs did not differ between groups. CONCLUSIONS MScanFit is more sensitive in showing motor unit loss than NCS in type-2 diabetic patients, whereas MVRCs do not provide additional information. SIGNIFICANCE The MScanFit results suggest that motor changes are seen as early as sensory, and the role of axonal membrane properties in DPN pathophysiology should be revisited.
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Affiliation(s)
- A G Kristensen
- Department of Clinical Neurophysiology, Aarhus University Hospital, Denmark; Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Denmark
| | - K S Khan
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Denmark; Department of Neurology, Aarhus University Hospital, Denmark
| | - H Bostock
- Institute of Neurology, University College London, Queen Square, London, UK
| | - B S Khan
- Department of Neurology, Aarhus University Hospital, Denmark
| | - S Gylfadottir
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Denmark; Department of Neurology, Aarhus University Hospital, Denmark
| | - H Andersen
- Department of Neurology, Aarhus University Hospital, Denmark
| | - N B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Denmark; Department of Neurology, Aarhus University Hospital, Denmark
| | - T S Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Denmark; Department of Neurology, Aarhus University Hospital, Denmark
| | - H Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Denmark.
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15
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Tankisi H, Tankisi A, Harbo T, Markvardsen LK, Andersen H, Pedersen TH. Critical illness myopathy as a consequence of Covid-19 infection. Clin Neurophysiol 2020; 131:1931-1932. [PMID: 32619798 PMCID: PMC7834604 DOI: 10.1016/j.clinph.2020.06.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/06/2020] [Indexed: 12/02/2022]
Affiliation(s)
- H Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.
| | - A Tankisi
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - T Harbo
- Department of Neurology, Aarhus University Hospital, Denmark
| | - L K Markvardsen
- Department of Neurology, Aarhus University Hospital, Denmark
| | - H Andersen
- Department of Neurology, Aarhus University Hospital, Denmark
| | - T H Pedersen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
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16
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Vaeggemose M, Haakma W, Pham M, Ringgaard S, Tankisi H, Ejskjaer N, Heiland S, Poulsen PL, Andersen H. Diffusion tensor imaging MR Neurography detects polyneuropathy in type 2 diabetes. J Diabetes Complications 2020; 34:107439. [PMID: 31672457 DOI: 10.1016/j.jdiacomp.2019.107439] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/22/2019] [Accepted: 08/26/2019] [Indexed: 12/17/2022]
Abstract
AIM To evaluate if diffusion-tensor-imaging MR-Neurography (DTI-MRN) can detect lesions of peripheral nerves due to polyneuropathy in patients with type 2 diabetes. METHODS Ten patients with type 2 diabetes with polyneuropathy (DPN), 10 patients with type 2 diabetes without polyneuropathy (nDPN) as well as 20 healthy controls (HC) were included. DTI-MRN covered proximal (sciatic nerve) and distal regions (tibial nerve) of the lower extremity. Fractional-anisotropy (FA) and diffusivity (mean (MD), axial (AD) and radial (RD)) were calculated and compared to neuropathy severity. Conventional T2-relaxation-time and proton-spin-density data were obtained from a multi-echo SE sequence. Furthermore, we evaluated sensitivity and specificity of DTI-MRN from receiver operating characteristics (ROC). RESULTS The proximal and distal FA was lowest in patients with DPN compared with nDPN and HC (p < 0.01). Likewise, proximal and distal RD was highest in patients with DPN (p < 0.01). MD and AD were also significantly different though less pronounced. ROC curve analyses of DTI separated nDPN and DPN with area-under-the-curve values ranging from 0.65 to 0.98. T2-relaxation-time and proton-spin-density could not differentiate between nDPN and DPN. CONCLUSION DTI-MRN accurately detects DPN by lower nerve FA and higher RD. These alterations are likely to reflect both proximal and distal nerve fiber pathology in patients with type 2 diabetes.
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Affiliation(s)
- M Vaeggemose
- Department of Neurology, Aarhus University Hospital, Denmark; Danish Diabetes Academy, Odense, Denmark.
| | - W Haakma
- Department of Radiology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - M Pham
- Department of Neuroradiology, Heidelberg University Hospital, Germany; Department of Neuroradiology, Würzburg University Hospital, Germany
| | - S Ringgaard
- MR Research Centre, Aarhus University Hospital, Denmark
| | - H Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Denmark
| | - N Ejskjaer
- Department of Clinical Medicine, Aalborg University Hospital, Denmark
| | - S Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Germany
| | - P L Poulsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark
| | - H Andersen
- Department of Neurology, Aarhus University Hospital, Denmark; The International Diabetic Neuropathy Consortium, Aarhus University Hospital, Denmark
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17
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Toh CT, Zhang H, Lin J, Mayorov AS, Wang YP, Orofeo CM, Ferry DB, Andersen H, Kakenov N, Guo Z, Abidi IH, Sims H, Suenaga K, Pantelides ST, Özyilmaz B. Synthesis and properties of free-standing monolayer amorphous carbon. Nature 2020; 577:199-203. [DOI: 10.1038/s41586-019-1871-2] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 09/26/2019] [Indexed: 11/09/2022]
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18
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Tankisi H, Pugdahl K, Beniczky S, Andersen H, Fuglsang-Frederiksen A. Evidence-based recommendations for examination and diagnostic strategies of polyneuropathy electrodiagnosis. Clin Neurophysiol Pract 2019; 4:214-222. [PMID: 31886447 PMCID: PMC6921232 DOI: 10.1016/j.cnp.2019.10.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/14/2019] [Accepted: 10/29/2019] [Indexed: 11/25/2022] Open
Abstract
The best approach for electrodiagnosis of polyneuropathy (PNP) were tested in 313 patients. Electrodiagnostic screening for distal symmetric PNP (DSP) should start with tibial and sural NCS. Examination of lower limbs at one side is sufficient for electrodiagnostic screening of DSP.
The purpose of this report is to recommend evidence-based strategies for polyneuropathy (PNP) electrodiagnosis based on a large cohort of patients examined prospectively. Nerve conduction studies (NCS) of bilateral tibial, peroneal and sural nerves, the latter with both near-nerve-technique (NNT) and surface recordings, were done in 313 patients with clinically suspected PNP. Bilateral dorsal sural and medial plantar nerves, and unilateral median and ulnar nerves were further examined in a subgroup of patients. The final clinical diagnosis retrieved from the patientś medical records 1–6 years after the neurophysiological investigation served as diagnostic reference standard. The clinical follow-up diagnosis confirmed PNP in 219 patients. The tibial nerve was the most sensitive nerve (75%), with prolonged tibial F-wave as the most sensitive parameter (72%). Sural NNT recordings were more sensitive (66%) than surface recordings (49%) (p < 0.05), however, dorsal sural (68%) and medial planter (70%) nerves had similar sensitivities as NNT. There was no side difference in the incidence of abnormality for any nerve. Based on these results, we recommend a strategy starting with tibial and sural NCS on one side for electrophysiological screening for distal symmetric PNP. If one of these is abnormal, we recommend examining the other lower and upper extremity nerves, including distal sensory nerves, particularly if NNT is not applicable. While one abnormal parameter is sufficient to interpret a nerve as abnormal, we recommend at least two abnormal nerves for PNP diagnosis, preferentially one being the sural nerve. We believe that the strategies recommended in this study may improve PNP electrodiagnosis.
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Affiliation(s)
- H Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - K Pugdahl
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - S Beniczky
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - H Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - A Fuglsang-Frederiksen
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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19
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Steenkjaer C, Mencagli R, Vaeggemose M, Andersen H. E-POSTERS – MUSCLE IMAGING. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Kallestrup M, Frystyk J, Espelund U, Hjortebjerg R, Tankisi H, Andersen H. PAPP-A activity is increased in cerebrospinal fluid from patients with diabetic polyneuropathy and correlates with peripheral nerve impairment. Growth Horm IGF Res 2019; 48-49:53-59. [PMID: 31670029 DOI: 10.1016/j.ghir.2019.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/29/2019] [Accepted: 10/08/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Insulin-like growth factors (IGFs) have neuroprotective effects. IGF activity is partly controlled by pregnancy-associated plasma protein-A (PAPP-A), an enzyme which enhances IGF-action by cleavage of IGF-binding protein-4 (IGFBP-4). To study the role of PAPP-A and the IGF system in diabetic polyneuropathy (DPN), we measured immunoreactive (total) concentrations of IGF-I and IGF-II, bioactive IGF by cell-based bioassay, PAPP-A, as well as intact and PAPP-A-cleaved IGFBP-4 in cerebrospinal fluid (CSF) and serum from patients with type 2 diabetes (T2D) with and without DPN. DESIGN Twenty-three patients with T2D were included. Based on clinical examination, vibratory perception thresholds and nerve conduction studies, patients were diagnosed with (n = 9) or without (n = 14) DPN. RESULTS In CSF, PAPP-A activity, as estimated by IGFBP-4 fragment levels, was higher in patients with than without DPN (34.57 vs 13.79 μg/L, p = .003) and concentrations correlated with peripheral nerve impairment measures (r = 0.73, p < .01). Furthermore, serum bioactive IGF was lower in patients with than without DPN (0.8 vs 1.3 μg/L, p = .006) and correlated inversely to the severity of DPN (r = -0.67, p < .01). CONCLUSIONS In both CSF and serum, members of the IGF system correlated with measures of peripheral nerve impairment in patients with T2D. This supports a relationship between the IGF system and the development of DPN. Further studies are needed to clarify if these changes are causally linked to the pathogenesis of DPN.
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Affiliation(s)
- M Kallestrup
- Department of Neurology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark.
| | - J Frystyk
- Medical Research Laboratory, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5000 Odense, Denmark; Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 5000 Odense, Denmark
| | - U Espelund
- Medical Research Laboratory, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
| | - R Hjortebjerg
- Medical Research Laboratory, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark; The Danish Diabetes Academy, 5000 Odense, Denmark
| | - H Tankisi
- Department of Neurophysiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
| | - H Andersen
- Department of Neurology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
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Kristensen A, Bostock H, Finnerup N, Andersen H, Jensen T, Gylfadottir S, Itani M, Krøigård T, Sindrup S, Tankisi H. Detection of early motor involvement in diabetic polyneuropathy using a novel MUNE method – MScanFit MUNE. Clin Neurophysiol 2019; 130:1981-1987. [DOI: 10.1016/j.clinph.2019.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/05/2019] [Accepted: 08/12/2019] [Indexed: 12/13/2022]
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Andersen H, Götz P, Bremer JP, Laudien M. [Manifestation of eosinophilic granulomatosis with polyangiitis in the head and neck area over time taking systemic disease activity into consideration]. Z Rheumatol 2019; 77:928-937. [PMID: 29569004 DOI: 10.1007/s00393-018-0439-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare granulomatous vasculitis of the small and medium sized blood vessels of unknown etiology. A regular involvement of the head and neck area is known. Since it is not yet known whether the inflammatory processes in the head and neck area are parallel to the systemic disease activity, the course of systemic and local disease activity was investigated in a comparative study. MATERIAL AND METHODS Between 1990 and 2010 the disease progression of 25 patients with a total of 90 consultations and an average observation period of 7.02 years was recorded. The anamnesis, clinical observation and testing were performed in order to describe ear nose and throat (ENT) manifestations. Moreover, systemic data, such as the Birmingham Vasculitis Activity Score (BVAS), the Vasculitis Damage Index (VDI) and the serological parameters C‑reactive protein (CRP), eosinophilic cationic protein (ECP) and absolute eosinophil count (EOS) were collected. In order to define the activity in the head and neck area the existing manifestations were summarized and statistically compared to the systemic data using Spearman's rank correlation coefficient. RESULTS Overall the statistical analysis showed a very weak correlation between the disease activity in the ENT area and systemic disease activity, which is not considered as significant. Comparing activity in the nose region to systemic activity, significant values were found in 22.9% of all consultations. Comparing activity in the ear region to systemic activity, 11.8% of all consultations showed significant values. CONCLUSION The results indicate that the disease activity in the head and neck area is independent of the systemic activity. Moreover, they point out a potential independent autoimmune inflammatory process in the mentioned regions; therefore, treatment should include long-term follow-up and an interdisciplinary management.
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Affiliation(s)
- Henrik Andersen
- Klinik für HNO-Heilkunde, Kopf- und Halschirurgie, Christian-Albrechts-Universität zu Kiel, Arnold-Heller-Str. 3, Haus 27, 24105, Kiel, Deutschland
| | - Paul Götz
- Klinik für HNO-Heilkunde, Kopf- und Halschirurgie, Christian-Albrechts-Universität zu Kiel, Arnold-Heller-Str. 3, Haus 27, 24105, Kiel, Deutschland
| | - Jan Phillip Bremer
- Klinik für Rheumatologie und Immunologie, Klinikum Bad Bramstedt, Bad Bramstedt, Deutschland
| | - Martin Laudien
- Klinik für HNO-Heilkunde, Kopf- und Halschirurgie, Christian-Albrechts-Universität zu Kiel, Arnold-Heller-Str. 3, Haus 27, 24105, Kiel, Deutschland.
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Kristensen R, Bostock H, Tan S, Witt A, Fuglsang-Frederiksen A, Qerama E, Andersen H, Tankisi H. MScanFit motor unit number estimation (MScan) and muscle velocity recovery cycle recordings in amyotrophic lateral sclerosis patients. Clin Neurophysiol 2019; 130:1280-1288. [DOI: 10.1016/j.clinph.2019.04.713] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/08/2019] [Accepted: 04/14/2019] [Indexed: 12/13/2022]
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Al‐Zuhairy A, Jakobsen J, Andersen H, Sindrup SH, Markvardsen LK. Randomized trial of facilitated subcutaneous immunoglobulin in multifocal motor neuropathy. Eur J Neurol 2019; 26:1289-e82. [DOI: 10.1111/ene.13978] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 04/23/2019] [Indexed: 12/14/2022]
Affiliation(s)
- A. Al‐Zuhairy
- Department of Neurology Copenhagen University Hospital (Rigshospitalet) Copenhagen Denmark
| | - J. Jakobsen
- Department of Neurology Copenhagen University Hospital (Rigshospitalet) Copenhagen Denmark
| | - H. Andersen
- Department of Neurology Aarhus University Hospital Aarhus Denmark
| | - S. H. Sindrup
- Department of Neurology Odense University Hospital Odense Denmark
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25
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Ydegaard R, Andersen H, Oxlund CS, Jacobsen IA, Hansen PBL, Jürgensen JF, Peluso AA, Vanhoutte PM, Staehr M, Svenningsen P, Jensen BL. The acute blood pressure-lowering effect of amiloride is independent of endothelial ENaC and eNOS in humans and mice. Acta Physiol (Oxf) 2019; 225:e13189. [PMID: 30240139 DOI: 10.1111/apha.13189] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 09/11/2018] [Accepted: 09/17/2018] [Indexed: 01/15/2023]
Abstract
AIMS The epithelial sodium channel (ENaC) is expressed in cultured endothelial cells and inhibitory coupling to eNOS activity has been proposed. The present study tested the hypothesis that ENaC blockers increase systemic NO-products and lower blood pressure in patients and mice, depending on eNOS. METHODS NO-products and cGMP were measured in diabetes patient urine and plasma samples before and after amiloride treatment (20-40 mg for two days, plasma n = 22, urine n = 12 and 5-10 mg for eight weeks, plasma n = 52, urine n = 55). Indwelling catheters were implanted in the femoral artery and vein in mice for continuous arterial blood pressure and heart rate recordings and infusion. RESULTS Treatment with amiloride for two days increased plasma and urine NO-products, while plasma cGMP decreased and urinary cGMP was unchanged in patient samples. Eight weeks of treatment with amiloride did not alter NO-products and cGMP. In mice, amiloride boli of 5, 50, and 500 µg/kg lowered heart rate and arterial blood pressure significantly and acutely. Benzamil had no effect on pressure and raised heart rate. In hypertensive eNOS-/- and L-NAME-treated mice, amiloride lowered blood pressure significantly. L-NAME infusion significantly decreased NO-products in plasma; amiloride and eNOS-deletion had no effect. An acetylcholine bolus resulted in acute blood pressure drop that was attenuated in eNOS-/- and L-NAME mice. ENaC subunit expressions were not detected consistently in human and mouse arteries and endothelial cells. CONCLUSION Amiloride has an acute hypotensive action not dependent on ENaC and eNOS and likely related to the heart.
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Affiliation(s)
- Rikke Ydegaard
- Department of Cardiovascular and Renal Research, Institute for Molecular Medicine; University of Southern Denmark; Odense C Denmark
| | - Henrik Andersen
- Department of Cardiovascular and Renal Research, Institute for Molecular Medicine; University of Southern Denmark; Odense C Denmark
| | | | - Ib A. Jacobsen
- Department of Endocrinology; Odense University Hospital; Odense Denmark
| | - Pernille B. L. Hansen
- Department of Cardiovascular and Renal Research, Institute for Molecular Medicine; University of Southern Denmark; Odense C Denmark
- Cardiovascular and Metabolic Disease, IMED Biotech Unit; AstraZeneca; Gothenburg Sweden
| | - Jonathan F. Jürgensen
- Department of Cardiovascular and Renal Research, Institute for Molecular Medicine; University of Southern Denmark; Odense C Denmark
| | - Antonio Augusto Peluso
- Department of Cardiovascular and Renal Research, Institute for Molecular Medicine; University of Southern Denmark; Odense C Denmark
| | - Paul M. Vanhoutte
- Department of Pharmacology and Pharmacy; Hong Kong University; China
| | - Mette Staehr
- Department of Cardiovascular and Renal Research, Institute for Molecular Medicine; University of Southern Denmark; Odense C Denmark
| | - Per Svenningsen
- Department of Cardiovascular and Renal Research, Institute for Molecular Medicine; University of Southern Denmark; Odense C Denmark
| | - Boye L. Jensen
- Department of Cardiovascular and Renal Research, Institute for Molecular Medicine; University of Southern Denmark; Odense C Denmark
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Omri A, Delaloye JF, Andersen H, Bachmann F. Low Molecular Weight Heparin Novo (LHN-1) Does Not Cross the Placenta During the Second Trimester of Pregnancy. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1646526] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryUnfractionated heparin (UF-H) has been the drug of choice for the treatment of thromboembolic disorders during pregnancy. Low molecular weight heparin (LMW-H) preparations may present some advantages over UF-H. They have longer half-lives and a better bioavailability after subcutaneous (s. c.) injection and may cause less bleeding. It has not yet been established whether LMW-H Novo (LHN-1) crosses the placenta. 17 women admitted for abortion during the second trimester of pregnancy (induced by application of prostaglandine PGE2 gel at a concentration of 0.25 mg/ml into the cervix) were given s. c. 35 anti-Xa units per kg of body weight of LHN-1 (Novo). 10 patients not receiving LHN- 1 and their fetuses served as a control group. 7 women in whom the time interval between injection of LHN-1 and expulsion of the fetus was less than 3 h or more than 7 h were excluded from further study. In one fetus blood collection failed. Anti-Xa and anti-IIa levels increased approximately ten-fold in women receiving LHN-1 [anti-Xa units/ml from 0.02 ± 0.01 (mean ± SD) to 0.17 ± 0.01, p <0.001; anti-IIa units/ml from less than 0.01 ± 0.01 to 0.07 ± 0.03], but remained below the detection limit in their fetuses as well as in the women and fetuses of the control group.We conclude that LHN-1 at these doses does not cross the placenta during the second trimester of pregnancy to suggest that LHN-1 may be a safe alternative to heparin in the management of the thromboembolic complications during pregnancy.
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Affiliation(s)
- A Omri
- The Haematology Division, Department of Medicine, CHUV, Lausanne, Switzerland
| | - J F Delaloye
- The Department of Gynaecology and Obstetrics, CHUV, Lausanne, Switzerland
| | - H Andersen
- The Clinical Research and Development Unit, Novo Industri A/S, Bagsvaerd, Denmark
| | - F Bachmann
- The Haematology Division, Department of Medicine, CHUV, Lausanne, Switzerland
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Hansen JS, Pedersen EG, Gaist D, Bach FW, Vilholm OJ, Sandal B, Weitemeyer L, Nielsen K, Schlesinger FE, Preisler N, Vissing J, Andersen H. Screening for late-onset Pompe disease in western Denmark. Acta Neurol Scand 2018; 137:85-90. [PMID: 28832912 DOI: 10.1111/ane.12811] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Late-onset Pompe disease (LOPD) is a rare autosomal recessively inherited metabolic myopathy caused by reduced activity of the lysosomal enzyme alpha-glucosidase. In a previous screening study at two large neuromuscular university clinics in Denmark, three patients with LOPD were identified out of 103 patients screened. No systematic screening has been performed at the other neurological departments in the western part of Denmark. Thus, patients with a diagnosis of unspecified myopathy were screened for LOPD. MATERIALS AND METHODS At seven neurological departments in the western part of Denmark, medical records were evaluated for all patients registered with myopathy diagnosis codes (ICD 10 codes: G 71.0-71.9 and G 72.0-72.9) during the period January 1, 2002, to December 31, 2012. If no specific diagnosis has been reached, patients were invited for screening. Dried blood spot (DBS) test was used to analyze the activity of the enzyme alpha-glucosidase. RESULT A total of 654 patients were identified. From the medical records, information was obtained concerning symptoms, family history, electromyography, muscle biopsy results and creatine kinase levels. Eighty-seven patients (13.3%) (males 61%) at a mean age of 53.3 years (SD 16.5) fulfilled the criteria for screening. A DBS test was performed in 47 (54%) patients. In all patients, the enzyme activity was within reference values. CONCLUSION None of the screened patients had a reduced activity of the enzyme alpha-glucosidase. Although the cohort studied was small, our findings do not suggest that LOPD is underdiagnosed in patients with unspecified myopathy in western Denmark.
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Affiliation(s)
- J. S. Hansen
- Department of Neurology; Aarhus University Hospital; Aarhus C Denmark
| | - E. G. Pedersen
- Department of Neurology; Odense University Hospital; Odense Denmark
| | - D. Gaist
- Department of Neurology; Odense University Hospital; Odense Denmark
| | - F. W. Bach
- Department of Neurology; Aalborg University Hospital; Aalborg Denmark
| | - O. J. Vilholm
- Department of Neurology; Lillebaelt Hospital; Vejle Hospital; Vejle Denmark
| | - B. Sandal
- Department of Neurology; Regional Hospital West Jutland; Holstebro Hospital; Holstebro Denmark
| | - L. Weitemeyer
- Department of Neurology; Sønderborg Hospital; Sønderborg Denmark
| | - K. Nielsen
- Department of Neurology; Esbjerg Hospital; Esbjerg Denmark
| | - F. E. Schlesinger
- Department of Neurology; Regional Hospital Central Jutland; Viborg Hospital; Viborg Denmark
| | - N. Preisler
- Department of Neurology; Copenhagen Neuromuscular Center; Rigshospitalet; Copenhagen Denmark
| | - J. Vissing
- Department of Neurology; Copenhagen Neuromuscular Center; Rigshospitalet; Copenhagen Denmark
| | - H. Andersen
- Department of Neurology; Aarhus University Hospital; Aarhus C Denmark
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Celicanin M, Blaabjerg M, Maersk-Moller C, Beniczky S, Marner L, Thomsen C, Bach FW, Kondziella D, Andersen H, Somnier F, Illes Z, Pinborg LH. Autoimmune encephalitis associated with voltage-gated potassium channels-complex and leucine-rich glioma-inactivated 1 antibodies - a national cohort study. Eur J Neurol 2017; 24:999-1005. [PMID: 28544133 DOI: 10.1111/ene.13324] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 04/03/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to describe clinical and paraclinical characteristics of all Danish patients who tested positive for anti-voltage-gated potassium channels (VGKC)-complex, anti-leucine-rich glioma-inactivated 1 (LGI1) and anti-contactin-associated protein-2 antibodies in the serum/cerebrospinal fluid between 2009 and 2013 with follow-up interviews in 2015 and 2016. METHODS We evaluated antibody status, symptoms leading to testing, course of disease, suspected diagnosis and time of admission as well as diagnosis and treatment. All magnetic resonance imaging, electroencephalography and 18 F-fluorodeoxyglucose positron emission tomography scans were re-evaluated by experts in the field. RESULTS A total of 28/192 patients tested positive for VGKC-complex antibodies by radioimmunoassay and indirect immunofluorescence; 17 had antibodies to LGI1 and 6/7 of the available cerebrospinal fluids from these patients were seropositive. These 17 patients all had a clinical phenotype appropriate to LGI1 antibodies. The remaining 11 were LGI1 negative (n = 4) or not tested (n = 7). Of these, two had a phenotype consistent with limbic encephalitis. The remaining phenotypes were Guillain-Barré syndrome, Creutzfeldt-Jakob disease, neuromyotonia and anti-N-methyl-D-aspartate receptor encephalitis. Magnetic resonance imaging abnormalities were demonstrated in 69% of the LGI1-positive patients. Two patients with normal magnetic resonance imaging demonstrated temporal lobe hypermetabolism using 18 F-fluorodeoxyglucose positron emission tomography. Abnormal electroencephalography recordings were found in 86% of the patients. Upon follow-up (median 3.2 years), the median modified Rankin Scale score of anti-LGI1-positive patients was 2 and only two patients reported seizures in the past year. CONCLUSIONS Patients diagnosed with anti-LGI1 autoimmune encephalitis increased significantly from 2009 to 2014, probably due to increased awareness. In contrast to seropositive anti-VGKC-complex patients, all anti-LGI1-positive patients presented with a classical limbic encephalitis. The majority of patients recovered well.
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Affiliation(s)
- M Celicanin
- Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark
| | - M Blaabjerg
- Department of Neurology, Roskilde University Hospital, Roskilde, Denmark
| | - C Maersk-Moller
- Department of Neurology, Aalborg University Hospital, Aalborg, Denmark
| | - S Beniczky
- Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark
| | - L Marner
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen, Denmark
| | - C Thomsen
- Department of Diagnostic Radiology, Rigshospitalet, Copenhagen, Denmark
| | - F W Bach
- Department of Neurology, Aalborg University Hospital, Aalborg, Denmark
| | - D Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen, Denmark
| | - H Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - F Somnier
- Department of Autoimmunology, Statens Serum Institut, Copenhagen, Denmark
| | - Z Illes
- Department of Neurology, University of Southern Denmark, Odense, Denmark
| | - L H Pinborg
- Neurobiology Research Unit, Department of Neurology, Rigshospitalet, Copenhagen, Denmark
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Markvardsen LH, Sindrup SH, Christiansen I, Olsen NK, Jakobsen J, Andersen H. Subcutaneous immunoglobulin as first-line therapy in treatment-naive patients with chronic inflammatory demyelinating polyneuropathy: randomized controlled trial study. Eur J Neurol 2016; 24:412-418. [PMID: 28000311 DOI: 10.1111/ene.13218] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 11/07/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Subcutaneous immunoglobulin (SCIG) is effective as maintenance treatment in chronic inflammatory demyelinating polyneuropathy (CIDP). We investigated whether multiple subcutaneous infusions are as effective as conventional therapy with intravenous loading doses in treatment-naive patients with CIDP. METHODS Twenty patients fulfilling the clinical and electrophysiological criteria for CIDP were included and treated with either SCIG (0.4 g/kg/week) for 5 weeks or intravenous immunoglobulin (IVIG) (0.4 g/kg/day) for 5 days. After 10 weeks, patients were switched to the opposite treatment arm and followed for a further 10 weeks. All participants were evaluated at weeks 0, 2, 5 and 10 during both therapies. Primary outcome was combined isokinetic muscle strength (cIKS). Secondary outcomes were disability, clinical evaluation of muscle strength and the performance of various function tests. RESULTS All participants received both therapies, 14 completing the protocol. Overall, cIKS increased by 7.4 ± 14.5% (P = 0.0003) during SCIG and by 6.9 ± 16.8% (P = 0.002) during IVIG, the effect being similar (P = 0.80). Improvement of cIKS peaked 2 weeks after IVIG and 5 weeks after SCIG. Disability improved during SCIG treatment only. Muscle strength determined by manual muscle testing improved after 5 and 10 weeks during SCIG but only after 5 weeks during IVIG. The remaining parameters improved equally during both treatments. Plasma immunoglobulin G levels at baseline and improvement of cIKS were related. CONCLUSION In treatment-naive patients with CIDP, short-lasting SCIG and IVIG therapy improve motor performance to a similar degree, but with earlier maximal improvement following IVIG than SCIG treatment.
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Affiliation(s)
- L H Markvardsen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - S H Sindrup
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - I Christiansen
- Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - N K Olsen
- Department of Neurology, Aalborg University Hospital, Aalborg, Denmark
| | - J Jakobsen
- Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - H Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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Damsgaard J, Andersen H, Hjerrild S, Marinovskij E, Deutch S, Schembri A, Tarp B, Hagelskjaer Kristensen L, Age Lindberg J, Erlandsen M, Leutscher PDC. Neuropsychiatric symptoms among adult patients with aseptic meningitis: a prospective case series. Acta Psychiatr Scand 2016; 133:426-7. [PMID: 26685715 DOI: 10.1111/acps.12539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- J Damsgaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark.
| | - H Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark
| | - S Hjerrild
- Department of Affective Disorders Unit, Aarhus University Hospital, Risskov, Denmark
| | - E Marinovskij
- Department of Diagnostic Imaging, Aarhus University Hospital, Aarhus N, Denmark
| | - S Deutch
- Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark
| | - A Schembri
- Cogstate Ltd, Melbourne, Vic., Australia
| | - B Tarp
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - L Hagelskjaer Kristensen
- Department of Internal Medicine, Infectious Disease Unit, Viborg Regional Hospital, Viborg, Denmark
| | - J Age Lindberg
- Department of Internal Medicine, Herning Regional Hospital, Herning, Denmark
| | - M Erlandsen
- Department of Public Health, Section for Biostatistics, Aarhus University, Aarhus, Denmark
| | - P D C Leutscher
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark
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Vaeggemose M, Fuglsang-Frederiksen A, Andersen H, Isak B, Harbo T, Tankisi H. ID 266 – Motor unit number estimation in acute inflammatory demyelinating polyneuropathy. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2015.11.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Durakovic A, Andersen H, Christiansen A, Hammen I. Retrospective analysis of radial EBUS outcome for the diagnosis of peripheral pulmonary lesion: sensitivity and complications. Eur Clin Respir J 2015; 2:28947. [PMID: 26689214 PMCID: PMC4685291 DOI: 10.3402/ecrj.v2.28947] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 11/28/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The purpose of the current study was to clarify the sensitivity and complication rate of the radial (endobronchial ultrasound, EBUS) without the use of guide-sheath (GS) and fluoroscopy for lung cancer (LC), by measuring the distance from the orifice of the bronchus to the pulmonary lesion, as well as to analyze factors that can predict the diagnostic outcome. MATERIALS AND METHODS A total of 147 patients with peripheral pulmonary lesions (PPL) underwent radial EBUS-guided transbronchial biopsy (TBB) in between August 1, 2013, and August 31, 2014. We analyzed retrospectively radiological data, diagnostic work-up in everyday clinical settings, final diagnosis and complication rates, as well as factors influencing the diagnostic outcome. RESULTS Around 63.9% of PPLs were visualized by ultrasound. A definitive malignant diagnosis was established in 39 patients (26.5%) using radial EBUS. In the remaining 108 patients, additional procedures were performed. We missed LC diagnosis in 40 cases that results in a sensitivity of 49%. For malignant lesions visualized by radial EBUS, the sensitivity was 60%, compared with 24% for not visualized lesions. For malignant lesions, logistic regression was performed to identify the factors that had significant influence on visualization of the lesion and on diagnostic yield. Logistic regression analysis showed significant odds ratios (OR) for visualization depending on location of the lesion; upper lobe lesions were identified more frequent with OR of 3.85 (95% CI 1.42 - 10.98, p=0.009). Size above 30 mm had a non-significant OR of 2.11 (95% CI 0.80-5.73, p=0.134) for visualization.Diagnostic yield was only significantly influenced by visualization with the radial EBUS, OR 3.70 (95% CI 1.35-11.02, p=0.014). Location (p=0.745) and size above 30 mm (p=0.308) showed no significant increase in diagnostic yield.Other lesion characteristics defined on computed tomography, such as distance to carina and pleura, did not show any significant influence on the diagnostic yield. The complications rate was low with three cases of pneumothorax. CONCLUSION Radial EBUS has definitely its place in the diagnostic work-up of PPL, especially for the lesions that can be visualized by radial ultrasound. However, prospective randomized controlled studies are necessary to raise the diagnostic yield and to define factors that can predict the outcome, which will consequently enable selection of the 'right' patients for this diagnostic procedure.
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Affiliation(s)
- Amal Durakovic
- Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark
| | - Henrik Andersen
- Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark;
| | - Anders Christiansen
- Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark
| | - Irena Hammen
- Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark
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Zhao C, Andersen H, Ozyilmaz B, Ramaprabhu S, Pastorin G, Ho HK. Spontaneous and specific myogenic differentiation of human mesenchymal stem cells on polyethylene glycol-linked multi-walled carbon nanotube films for skeletal muscle engineering. Nanoscale 2015; 7:18239-18249. [PMID: 26486984 DOI: 10.1039/c5nr04303d] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study explored the influence of polyethylene glycol-linked multi-walled carbon nanotube (PEG-CNT) films on skeletal myogenic differentiation of human mesenchymal stem cells (hMSCs). PEG-CNT films were prepared with nanoscale surface roughness, orderly arrangement of PEG-CNTs, high hydrophilicity and high mechanical strength. Notably, PEG-CNT films alone could direct the skeletal myogenic differentiation of hMSCs in the absence of myogenic induction factors. The quantitative real-time polymerase chain reaction (RT-PCR) showed that the non-induced hMSCs plated on the PEG-CNT films, compared to the negative control, presented significant up-regulation of general myogenic markers including early commitment markers of myoblast differentiation protein-1 (MyoD) and desmin, as well as a late phase marker of myosin heavy chain-2 (MHC). Corresponding protein analysis by immunoblot assays corroborated these results. Skeletal muscle-specific markers, fast skeletal troponin-C (TnC) and ryanodine receptor-1 (Ryr) were also significantly increased in the non-induced hMSCs on PEG-CNT films by RT-PCR. For these cells, the commitment to specific skeletal myoblasts was further proved by the absence of enhanced adipogenic, chondrogenic and osteogenic markers. This study elucidated that PEG-CNT films supported a dedicated differentiation of hMSCs into a skeletal myogenic lineage and can work as a promising material towards skeletal muscle injury repair.
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Affiliation(s)
- Chunyan Zhao
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore 117543. and NanoCore, Engineering Block A, EA, Faculty of Engineering, National University of Singapore, Singapore 117576
| | - Henrik Andersen
- Department of Physics, National University of Singapore, Singapore 117542 and Graphene Research Center, National University of Singapore, Singapore 117546
| | - Barbaros Ozyilmaz
- Department of Physics, National University of Singapore, Singapore 117542 and Graphene Research Center, National University of Singapore, Singapore 117546
| | - Sundara Ramaprabhu
- Department of Physics, Indian Institute of Technology Madras, Chennai, 600036, India
| | - Giorgia Pastorin
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore 117543. and NanoCore, Engineering Block A, EA, Faculty of Engineering, National University of Singapore, Singapore 117576
| | - Han Kiat Ho
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore 117543.
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Siegel H, Andersen H, Olsen KS. [The fasting regime prior to anaesthesia]. Ugeskr Laeger 2015; 177:V03150241. [PMID: 26418710] [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: 06/05/2023]
Abstract
In modern anaesthesiology fasting preoperatively has been introduced in order to minimise the incidence of aspiration to the lungs. Since the 1990's studies have confirmed the safety of the current fasting regime of six hours for solids and two hours for fluids. By allowing the intake of carbohydrate-rich fluids until two hours before induction of anaesthesia, it has been shown that the negative effects of fasting such as thirst, starvation and anxiety are minimised. In the future, ultrasound technology might be used to assess the gastric volume prior to induction of anaesthesia.
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Abstract
OBJECTIVES To assess the effect and tolerability of zonisamide (ZNS) as adjunctive treatment for difficult-to-treat epilepsy in adult Scandinavian patients. MATERIAL AND METHODS 151 outpatients (mean age: 42.5 years) from 18 centres in Denmark, Sweden and Norway were recruited to the study. 81.5% had focal epilepsy, and the mean number of previously tried AEDs was 4.5. The patients were given ZNS as add-on treatment, and the ZNS dosing and the visit frequency were governed by the treating physician. The primary efficacy endpoint was the retention rate after 12-month treatment. Assessments included also responder rate, type and frequency of adverse events, healthcare resource utilization (HCRU) and quality of life (QOLIE-31). RESULTS 90 patients (59.6%) completed the study. Mean daily ZNS dose was 300.8 mg. After 12 months, 81 patients were still on ZNS, that is a retention rate of 53.6%. The mean reduction of seizure frequency at 12 months was 27%. Best effect was seen in those with focal and those with secondary generalized seizures. In the QOLIE-31, there was a mean increase from baseline of 4.8 points. The tolerability was generally good. The majority of side effects were CNS-related, dizziness, fatigue, seizure aggravation, and headache being most prevalent. 21.2% had adverse events leading to withdrawal of ZNS. CONCLUSIONS A retention rate of 53.6% after 1 year of treatment with ZNS is roughly in accordance with the retention rates found for lamotrigine, oxcarbazepine, levetiracetam and topiramate in drug-resistant patients.
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Affiliation(s)
| | - P. Lindstrøm
- Neurological Department; Karolinska Institute; Stockholm Sweden
| | - H. Andersen
- Neurological Department; Århus Hospital; Århus Denmark
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Andersen H, Friis UG, Hansen PBL, Svenningsen P, Henriksen JE, Jensen BL. Diabetic nephropathy is associated with increased urine excretion of proteases plasmin, prostasin and urokinase and activation of amiloride-sensitive current in collecting duct cells. Nephrol Dial Transplant 2015; 30:781-9. [PMID: 25609736 DOI: 10.1093/ndt/gfu402] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 12/02/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Diabetic nephropathy (DN) is associated with hypertension, expanded extracellular volume and impaired renal Na(+) excretion. It was hypothesized that aberrant glomerular filtration of serine proteases in DN causes proteolytic activation of the epithelial sodium channel (ENaC) in the kidney by excision of an inhibitory peptide tract from the γ subunit. METHODS In a cross-sectional design, urine, plasma and clinical data were collected from type 1 diabetic patients with DN (n = 19) and matched normoalbuminuric type 1 diabetics (controls, n = 20). Urine was examined for proteases by western immunoblotting, patch clamp and ELISA. Urine exosomes were isolated to elucidate potential cleavage of γENaC by a monoclonal antibody directed against the 'inhibitory' peptide tract. RESULTS Compared with control, DN patients displayed significantly higher blood pressure and urinary excretion of plasmin(ogen), prostasin and urokinase that correlated directly with urine albumin. Western blotting confirmed plasmin, prostasin and urokinase in urine from the DN group predominantly. Urine from DN evoked a significantly larger amiloride-sensitive inward current in single collecting duct cells compared with controls. Immunoblotting of urine exosomes showed aquaporin 2 in all patient samples. Exosomes displayed a virtual absence of intact γENaC while moieties compatible with cleavage by furin only, were shown in both groups. Proteolytic cleavage by the extracellular serine proteases plasmin or prostasin was observed in DN samples predominantly. CONCLUSION DN is associated with increased urinary excretion of plasmin, prostasin and urokinase and proteolytic activation of ENaC that might contribute to impaired renal Na(+) excretion and hypertension.
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Affiliation(s)
- Henrik Andersen
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense C, Denmark Department of Endocrinology, Odense University Hospital, Odense C, Denmark
| | - Ulla G Friis
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense C, Denmark
| | - Pernille B L Hansen
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense C, Denmark
| | - Per Svenningsen
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense C, Denmark
| | - Jan Erik Henriksen
- Department of Endocrinology, Odense University Hospital, Odense C, Denmark
| | - Boye L Jensen
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense C, Denmark
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Cherian CT, Giustiniano F, Martin-Fernandez I, Andersen H, Balakrishnan J, Özyilmaz B. 'Bubble-free' electrochemical delamination of CVD graphene films. Small 2015; 11:189-94. [PMID: 25179223 DOI: 10.1002/smll.201402024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 07/22/2014] [Indexed: 05/08/2023]
Abstract
The production of large amounts of hydrogen bubbles, typical of electrochemical delamination methods based on the electrolysis of water, results in mechanical damage to graphene during the delamination, transfer, and drying steps. Here a novel 'bubble-free' delamination method is introduced which exploits the electrochemical dissolution of native copper oxide at a potential lower than that required for the formation of hydrogen bubbles, enabling the production of defect-free graphene stack.
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Affiliation(s)
- Christie Thomas Cherian
- Department of Physics, National University of Singapore, Singapore, 117542; Graphene Research Center, National University of Singapore, Singapore, 117542
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Kallestrup M, Møller HJ, Tankisi H, Andersen H. Soluble CD163 levels are elevated in cerebrospinal fluid and serum in people with Type 2 diabetes mellitus and are associated with impaired peripheral nerve function. Diabet Med 2015; 32:54-61. [PMID: 25156085 DOI: 10.1111/dme.12568] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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] [Received: 03/25/2014] [Revised: 06/26/2014] [Accepted: 08/20/2014] [Indexed: 12/13/2022]
Abstract
AIMS To measure soluble CD163 levels in the cerebrospinal fluid and serum of people with Type 2 diabetes, with and without polyneuropathy, and to relate the findings to peripheral nerve function. METHODS A total of 22 people with Type 2 diabetes and 12 control subjects without diabetes were included in this case-control study. Participants with diabetes were divided into those with neuropathy (n = 8) and those without neuropathy (n = 14) based on clinical examination, vibratory perception thresholds and nerve conduction studies. Serum and cerebrospinal fluid soluble CD163 levels were analysed using an enzyme-linked immunosorbent assay. RESULTS Soluble CD163 levels were significantly higher in the cerebrospinal fluid and serum of the participants with Type 2 diabetes compared with the control participants [cerebrospinal fluid: median (range) 107 (70-190) vs 84 (54-115) μg/l, P < 0.01 and serum: 2305 (920-7060) vs 1420 (780-2740) μg/l, P < 0.01). Cerebrospinal fluid soluble CD163 was positively related to impaired peripheral nerve conduction (nerve conduction study rank score: r = 0.42; P = 0.0497) and there was a trend for higher levels of soluble CD163 in the cerebrospinal fluid and serum in participants with neuropathy than in those without neuropathy [cerebrospinal fluid: median (range) 131 (86-173) vs 101 (70-190) μg/l, P = 0.08 and serum: 3725 (920-7060) vs 2220 (1130-4780), P = 0.06). CONCLUSIONS Cerebrospinal fluid soluble CD163 level is associated with impaired peripheral nerve function. Higher levels of soluble CD163 in people with diabetic polyneuropathy suggest that inflammation plays a role in the development of neural impairment. The relationship between cerebrospinal fluid soluble CD163 level and peripheral nerve conduction indicates that soluble CD163 may be a potential biomarker for the severity of diabetic polyneuropathy.
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MESH Headings
- Adult
- Aged
- Antigens, CD/blood
- Antigens, CD/cerebrospinal fluid
- Antigens, Differentiation, Myelomonocytic/blood
- Antigens, Differentiation, Myelomonocytic/cerebrospinal fluid
- Biomarkers/blood
- Biomarkers/cerebrospinal fluid
- Body Mass Index
- Case-Control Studies
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/cerebrospinal fluid
- Diabetes Mellitus, Type 2/physiopathology
- Diabetic Neuropathies/blood
- Diabetic Neuropathies/cerebrospinal fluid
- Diabetic Neuropathies/physiopathology
- Enzyme-Linked Immunosorbent Assay
- Female
- Humans
- Inflammation/blood
- Inflammation/cerebrospinal fluid
- Inflammation/physiopathology
- Male
- Middle Aged
- Neural Conduction
- Receptors, Cell Surface/blood
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Affiliation(s)
- M Kallestrup
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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Svenningsen P, Andersen H, Nielsen LH, Jensen BL. Urinary serine proteases and activation of ENaC in kidney--implications for physiological renal salt handling and hypertensive disorders with albuminuria. Pflugers Arch 2014; 467:531-42. [PMID: 25482671 DOI: 10.1007/s00424-014-1661-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 11/21/2014] [Accepted: 11/25/2014] [Indexed: 12/21/2022]
Abstract
Serine proteases, both soluble and cell-attached, can activate the epithelial sodium channel (ENaC) proteolytically through release of a putative 43-mer inhibitory tract from the ectodomain of the γ-subunit. ENaC controls renal Na(+) excretion and loss-of-function mutations lead to low blood pressure, while gain-of-function mutations lead to impaired Na(+) excretion, hypertension, and hypokalemia. We review an emerging pathophysiological concept that aberrant glomerular filtration of plasma proteases, e.g., plasmin, prostasin, and kallikrein, contributes to proteolytic activation of ENaC, both in acute conditions with proteinuria, like nephrotic syndrome and preeclampsia, and in chronic diseases, such as diabetes with microalbuminuria. A vast literature on renin-angiotensin-aldosterone system and volume homeostasis from the last four decades show a number of common characteristics for conditions with albuminuria compatible with impaired renal Na(+) excretion: hypertension and volume retention is secondary to proteinuria in, e.g., preeclampsia and nephrotic syndrome; plasma concentrations of renin, angiotensin II, and aldosterone are frequently suppressed in proteinuric conditions, e.g., preeclampsia and diabetic nephropathy; blood pressure is salt-sensitive in conditions with microalbuminuria/proteinuria; and extracellular volume is expanded, plasma atrial natriuretic peptide (ANP) concentration is increased, and diuretics, like amiloride and spironolactone, are effective blood pressure-reducing add-ons. Active plasmin in urine has been demonstrated in diabetes, preeclampsia, and nephrosis. Urine from these patients activates, plasmin-dependently, amiloride-sensitive inward current in vitro. The concept predicts that patients with albuminuria may benefit particularly from reduced salt intake with RAS blockers; that distally acting diuretics, in particular amiloride, are warranted in low-renin/albuminuric conditions; and that urine serine proteases and their activators may be pharmacological targets.
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Affiliation(s)
- Per Svenningsen
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
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Jensen K, Andersen H, Tyrsted C, Bøjesen E, Lock N, Billinge S, Iversen B, Christensen M. Formation of γ-Fe2O3 in hydrothermal synthesis: In situ total scattering studies. Acta Crystallogr A Found Adv 2014. [DOI: 10.1107/s2053273314088196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
The properties of metal oxide nanoparticles are highly dependent on particle characteristics such as size, crystallinity, and structural defects. To obtain particles with tailormade properties, it is crucial to understand the mechanisms that govern these characteristics during material synthesis. For this purpose, in situ studies of particle synthesis have proven powerful.[1] Here, in situ Total Scattering (TS) combined with in situ PXRD studies of the hydrothermal synthesis of γ-Fe2O3 (maghemite) from ammonium iron citrate will be presented. In situ TS with Pair Distribution Function (PDF) analysis has recently shown to be an efficient tool for understanding the fundamental chemical processes in particle crystallization.[2,3] The full γ-Fe2O3 crystallization process from ionic complexes over nanoclusters to crystalline particles is followed and material formation mechanisms are suggested. The study shows that the local atomic structure of the precursor solution is similar to that of the crystalline coordination polymer [Fe(H2citrate)(H2O)]n where corner sharing [FeO6] octahedra are linked by citrate. As hydrothermal treatment of the solution is initiated, clusters of edge sharing [FeO6] units form. Tetrahedrally coordinated iron subsequently appears in the structure and as the synthesis continues, the clusters slowly assemble into nanocrystalline maghemite. The primary transformation from amorphous clusters to nanocrystallites takes place by condensation of the large clusters along corner sharing tetrahedral iron units. The crystallization process is related to large changes in the local structure as the interatomic distances in the clusters change dramatically with cluster growth. The local atomic structure is size dependent, and particles below 6 nm are highly disordered. Whole Powder Pattern Modelling of the PXRD data shows that the final crystallite size (<10 nm) is dependent on synthesis temperature and that the size distribution of the particles broadens with synthesis time.
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Markvardsen LH, Harbo T, Sindrup SH, Christiansen I, Andersen H, Jakobsen J. Subcutaneous immunoglobulin preserves muscle strength in chronic inflammatory demyelinating polyneuropathy. Eur J Neurol 2014; 21:1465-70. [DOI: 10.1111/ene.12513] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 05/26/2014] [Indexed: 11/30/2022]
Affiliation(s)
| | - T. Harbo
- Department of Neurology; Aarhus University Hospital; Aarhus Denmark
| | - S. H. Sindrup
- Department of Neurology; Odense University Hospital; Odense Denmark
| | | | - H. Andersen
- Department of Neurology; Aarhus University Hospital; Aarhus Denmark
| | - J. Jakobsen
- Department of Neurology; Aarhus University Hospital; Aarhus Denmark
- Department of Neurology; Rigshospitalet; Copenhagen Denmark
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Thuesen AD, Andersen H, Cardel M, Toft A, Walter S, Marcussen N, Jensen BL, Bie P, Hansen PBL. Differential effect of T-type voltage-gated Ca2+ channel disruption on renal plasma flow and glomerular filtration rate in vivo. Am J Physiol Renal Physiol 2014; 307:F445-52. [PMID: 24966091 DOI: 10.1152/ajprenal.00016.2014] [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] [Indexed: 12/16/2022] Open
Abstract
Voltage-gated Ca(2+) (Cav) channels play an essential role in the regulation of renal blood flow and glomerular filtration rate (GFR). Because T-type Cav channels are differentially expressed in pre- and postglomerular vessels, it was hypothesized that they impact renal blood flow and GFR differentially. The question was addressed with the use of two T-type Cav knockout (Cav3.1(-/-) and Cav3.2(-/-)) mouse strains. Continuous recordings of blood pressure and heart rate, para-aminohippurate clearance (renal plasma flow), and inulin clearance (GFR) were performed in conscious, chronically catheterized, wild-type (WT) and Cav3.1(-/-) and Cav3.2(-/-) mice. The contractility of afferent and efferent arterioles was determined in isolated perfused blood vessels. Efferent arterioles from Cav3.2(-/-) mice constricted significantly more in response to a depolarization compared with WT mice. GFR was increased in Cav3.2(-/-) mice with no significant changes in renal plasma flow, heart rate, and blood pressure. Cav3.1(-/-) mice had a higher renal plasma flow compared with WT mice, whereas GFR was indistinguishable from WT mice. No difference in the concentration response to K(+) was observed in isolated afferent and efferent arterioles from Cav3.1(-/-) mice compared with WT mice. Heart rate was significantly lower in Cav3.1(-/-) mice compared with WT mice with no difference in blood pressure. T-type antagonists significantly inhibited the constriction of human intrarenal arteries in response to a small depolarization. In conclusion, Cav3.2 channels support dilatation of efferent arterioles and affect GFR, whereas Cav3.1 channels in vivo contribute to renal vascular resistance. It is suggested that endothelial and nerve localization of Cav3.2 and Cav3.1, respectively, may account for the observed effects.
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Affiliation(s)
- Anne D Thuesen
- Cardiovascular and Renal Research, University of Southern Denmark, Odense, Denmark
| | - Henrik Andersen
- Cardiovascular and Renal Research, University of Southern Denmark, Odense, Denmark
| | - Majken Cardel
- Cardiovascular and Renal Research, University of Southern Denmark, Odense, Denmark
| | - Anja Toft
- Department of Urology, Odense University Hospital, Odense, Denmark; and
| | - Steen Walter
- Department of Urology, Odense University Hospital, Odense, Denmark; and
| | - Niels Marcussen
- Clinical Pathology, Odense University Hospital, Odense, Denmark
| | - Boye L Jensen
- Cardiovascular and Renal Research, University of Southern Denmark, Odense, Denmark
| | - Peter Bie
- Cardiovascular and Renal Research, University of Southern Denmark, Odense, Denmark
| | - Pernille B L Hansen
- Cardiovascular and Renal Research, University of Southern Denmark, Odense, Denmark;
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Paramanathan S, Tankisi H, Andersen H, Fuglsang-Frederiksen A. P966: Motor unit number estimation in patients with inflammatory demyelinating polyneuropathies. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)51000-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kallestrup MM, Paramanathan S, Andersen H, Fuglsang-Frederiksen A, Tankisi H. P968: Motor unit number estimation in diabetes mellitus patients with and without polyneuropathy. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)51002-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Roende G, Petersen J, Ravn K, Fuglsang K, Andersen H, Nielsen JB, Brøndum-Nielsen K, Jensen JEB. Low bone turnover phenotype in Rett syndrome: results of biochemical bone marker analysis. Pediatr Res 2014; 75:551-8. [PMID: 24375084 DOI: 10.1038/pr.2013.252] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 09/19/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Patients with Rett syndrome (RTT) are at risk of having low bone mass and low-energy fractures. METHODS We characterized bone metabolism by both bone formation and resorption markers in blood in a RTT population of 61 girls and women and 122 well-matched healthy controls. Levels of N-terminal propeptides of collagen type 1 (P1NP), C-terminal telopeptide cross links (CTX), osteocalcin (OC), and bone-specific alkaline phosphatase (B-ALP) were compared between RTT patients and controls in regression models adjusted for BMI, vitamin D status, volumetric bone mineral apparent density of the lumbar spine (vBMAD spine), and femoral neck (vBMAD neck). We examined biochemical bone marker levels overall and stratified to persons younger than age 25 y or equal to or older than age 25 y. RESULTS The RTT patients had reduced levels of all biochemical bone markers (P < 0.05), which remained significant in persons younger than 25 y (P ≤ 0.001) regarding P1NP, CTX, and OC. Bone marker levels were not significantly associated to methyl-CpG-binding protein 2 (MECP2) mutation group, walking ability, or previous low-energy fractures. CONCLUSION Our findings of a low bone turnover state in girls with RTT suggest critical attention to medical treatment of low bone mass in young RTT patients.
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Affiliation(s)
- Gitte Roende
- Center for Rett Syndrome, Kennedy Center, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Janne Petersen
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
| | - Kirstine Ravn
- Center for Rett Syndrome, Kennedy Center, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Kathrine Fuglsang
- Center for Rett Syndrome, Kennedy Center, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Henrik Andersen
- Department of Exercise and Sports Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jytte B Nielsen
- Center for Rett Syndrome, Kennedy Center, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Karen Brøndum-Nielsen
- Genetic Counseling Clinic, Kennedy Center, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Jens-Erik B Jensen
- Department of Endocrinology, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
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Niswender K, Piletic M, Andersen H, Conradsen Hiort L, Hollander P. Weight change upon once-daily initiation of insulin detemir with or without dietary intervention in overweight or obese insulin-naïve individuals with type 2 diabetes: results from the DIET trial. Diabetes Obes Metab 2014; 16:186-92. [PMID: 24112375 DOI: 10.1111/dom.12218] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 07/07/2013] [Accepted: 09/24/2013] [Indexed: 12/21/2022]
Abstract
AIMS Weight gain upon insulin initiation is opposite to clinical goals in diabetes management. This trial aimed to determine the impact of modest dietary intervention on weight change and examine weight change in baseline body mass index strata when initiating once-daily insulin detemir (IDet) in overweight or obese insulin-naïve individuals with type 2 diabetes (T2D). METHODS DIET (Impact of Dietary Intervention on Weight Change in Subjects With Type 2 Diabetes) was a 26-week, randomized, treat-to-target, stratified, controlled, open-label, multinational trial. Subjects were randomized 1 : 1 to either the IDet group, which received basic dietary and physical exercise advice at baseline, or the Diet+IDet group, which had additional dietary consultations with a certified dietician (three face-to-face meetings, three phone contacts). RESULTS Mean estimated change in body weight from baseline ± standard error (SE) was -1.05 ± 0.23 kg for Diet+IDet and -0.56 ± 0.23 kg for IDet alone. Estimated mean difference was 0.49 kg (95% confidence interval: -0.15; 1.13, p = 0.132). Glycaemic control, measured by haemoglobin A1c (HbA1c) and fasting plasma glucose, improved similarly in both groups. Both groups reported variable reductions in caloric intake and overall physical activity levels. No difference in hypoglycaemia rates between groups was observed. CONCLUSION This study suggests that a modest dietary intervention plus basic lifestyle advice, compared with basic lifestyle advice alone, resulted in similar weight change, efficacy, safety and tolerability when initiating IDet once daily in overweight or obese insulin-naïve individuals with T2D.
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Affiliation(s)
- K Niswender
- Tennessee Valley Healthcare System and Vanderbilt University School of Medicine, Vanderbilt University, Nashville, TN, USA
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Andersen H, Meyer J, Freeman J, Doyle SE, Klucher K, Miller DM, Hausman D, Hillson JL. Peginterferon Lambda-1a, a New Therapeutic for Hepatitis C Infection, from Bench to Clinic. J Clin Transl Hepatol 2013; 1:116-24. [PMID: 26357610 PMCID: PMC4521278 DOI: 10.14218/jcth.2013.00014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 11/11/2013] [Accepted: 11/15/2013] [Indexed: 12/18/2022] Open
Abstract
Chronic infection with hepatitis C virus (HCV) is estimated to affect approximately 3% of the world's population and cause 350,000 deaths each year. For a number of years, the standard of care has been combination therapy with recombinant alfa interferons-originally as native proteins but more recently as polyethyleneglycol-modified derivatives-and ribavirin, with the recent addition of an NS3 protease inhibitor for HCV genotype 1. However, therapeutic alfa interferons are associated with a significant burden of treatment-limiting adverse events, including musculoskeletal and influenza-like symptoms, hematologic cytopenias, autoimmune disease, fatigue, and other neurologic events. In 2003, a team at ZymoGenetics (now a fully owned subsidiary of Bristol-Myers Squibb) and a second, independent group simultaneously identified a new class of interferons-the type III lambda interferons-with near-identical activity to the type I alfa interferons in hepatocytes but with an unrelated and less ubiquitous receptor. Subsequent evaluation of the type III interferon system demonstrated antiviral activity against HCV in vitro with limited activity in peripheral blood mononuclear cells and other nonhepatocyte cell types, supporting its development as a potentially better-tolerated therapy for viral hepatitis. Peginterferon lambda-1a (Lambda) is an investigational type III therapeutic agent originally developed at ZymoGenetics that is currently in Phase 3 studies for the treatment of HCV. In this review, we describe the selection of the Lambda molecule and its preclinical and early clinical development, and how the resulting data have helped to establish the differentiated safety profile for Lambda-with fewer influenza-like and musculoskeletal symptoms and less hematologic toxicity than the alfa interferons-that was seen in later studies.
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Affiliation(s)
| | - Jeff Meyer
- ZymoGenetics/Bristol-Myers Squibb, Seattle, WA 98102, USA
| | | | - Sean E. Doyle
- ZymoGenetics/Bristol-Myers Squibb, Seattle, WA 98102, USA
| | | | | | | | - Jan L. Hillson
- ZymoGenetics/Bristol-Myers Squibb, Seattle, WA 98102, USA
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Idorn L, Juul K, Jensen A, Hanel B, Nielsen K, Andersen H, Reimers J, Sørensen K, Søndergaard L. Arrhythmia and exercise intolerance in Fontan patients: Current status and future burden. Int J Cardiol 2013; 168:1458-65. [DOI: 10.1016/j.ijcard.2012.12.055] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 12/01/2012] [Accepted: 12/24/2012] [Indexed: 10/27/2022]
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Mirsaidov U, Mokkapati VRSS, Bhattacharya D, Andersen H, Bosman M, Özyilmaz B, Matsudaira P. Scrolling graphene into nanofluidic channels. Lab Chip 2013; 13:2874-2878. [PMID: 23702655 DOI: 10.1039/c3lc50304f] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Here we report on the "scrolling" of planar graphene induced by water as a result of the interplay between water capillarity and graphene elasticity. This scrolling leads to the formation of stable nanochannels that encapsulate water and nanoscale objects. We demonstrate that these graphene nanochannels can be used as nanofluidic platforms for dynamic imaging of nanoscale processes in liquids with Transmission Electron Microscopes (TEMs). These water-impermeable graphene nanochannels have practical application in the design of nanofluidic devices used in biosensors and many analytical separation devices.
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Affiliation(s)
- Utkur Mirsaidov
- Mechanobiology Institute-Singapore, National University of Singapore, 5A Engineering Drive 1, 117411, Singapore.
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Liebl A, Andersen H, Svendsen AL, Vora J, Yale JF. Resource utilisation and quality of life following initiation of insulin detemir in patients with type 2 diabetes mellitus. Int J Clin Pract 2013; 67:740-9. [PMID: 23869677 DOI: 10.1111/ijcp.12133] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 01/21/2013] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Barriers to insulin initiation in type 2 diabetes mellitus (T2DM) include fear of treatment complexity and perceived lack of time and resources by primary care physicians. The SOLVE study investigated the effect of insulin initiation on resource utilisation and patient quality of life. METHODS SOLVE was a 24-week cohort study in 10 countries evaluating the safety and effectiveness of initiating once-daily insulin detemir in patients with T2DM. Patient quality of life was assessed using the Insulin Treatment Appraisal Scale (ITAS). RESULTS A total of 14,611 (84%) patients completed the 24-week study. During the study, HbA1c improved by 1.3 ± 1.5%. The corresponding insulin dose increased from 13 ± 6 IU (0.16 ± 0.09 IU/kg) at baseline, to 22 ± 16 IU (0.27 ± 0.17 IU/kg) at final visit. FlexPen was the preferred device (63%) for insulin administration. The time taken to teach patients to self-inject and perform dose self-adjustment was 15 ± 13 min and 11 ± 11 min, respectively. The quality of life analysis included 6875 patients. The addition of insulin was associated with an improvement in mean ITAS score [-3.5 (95% CI -3.8, -3.3), p < 0.001]. Physicians reported the use or self-adjustment of insulin detemir as easy or very easy in 79% of participants; and satisfaction with the level of glycaemic control was reported for 74% of patients. CONCLUSIONS Initiating basal insulin therapy resulted in a substantial decrease in HbA1c and improved patients' perceptions of insulin treatment.
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Affiliation(s)
- A Liebl
- Center for Diabetes and Metabolism, m&i-Fachklinik Bad Heilbrunn, Bad Heilbrunn, Germany.
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