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Bak MTJ, Hammoudi N, Allez M, Silverberg MS, Schellekens IM, Erler NS, Dijkstra G, Romberg-Camps M, de Boer NKH, Jansen SV, van der Marel S, Horjus CS, Visschedijk MC, Goetgebuer RL, van Dop WA, Hoekstra J, Bodelier AGL, Molendijk I, Derikx LAAP, van Schaik FDM, West RL, Duijvestein M, van der Woude CJ, van Ruler O, de Vries AC. Interobserver agreement of current and new proposed endoscopic scores for postoperative recurrence in Crohn's disease. Gastrointest Endosc 2024:S0016-5107(24)00164-0. [PMID: 38462057 DOI: 10.1016/j.gie.2024.03.011] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/17/2024] [Accepted: 03/04/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND AND AIMS The modified Rutgeerts' score (mRS) is widely used for the assessment of endoscopic postoperative recurrence (ePOR) in Crohn's disease (CD) after ileocolic resection to guide therapeutic decisions. To improve the validity and prognostic value of this endoscopic assessment, two new scores have been proposed. This study assessed the interobserver agreement of the current (mRS) and new endoscopic scores for ePOR in CD. METHODS Sixteen Dutch academic and non-academic IBD specialists assessed endoscopic videos (n=71) of postoperative CD patients (n=66) retrieved from nine Dutch centers. Each video was assessed for the degree of inflammation by four gastroenterologists using the mRS and the new proposed endoscopic score: REMIND score (separate score of anastomosis and neoterminal ileum) and updated Rutgeerts score (assessment of lesions at the anastomotic line, ileal inlet, ileal body and neoterminal ileum). In addition, lesions at the ileal body, ileal inlet, neoterminal ileum, colonic and/or ileal blind loop were separately assessed. Interobserver agreement was assessed using Fleiss' weighted kappa. RESULTS Fleiss' weighted kappa for the mRS was 0.67 (95% confidence interval [CI] 0.59-0.74). The weighted kappa for the REMIND score was 0.73 (95% CI 0.65-0.80) for lesions in the neoterminal ileum and 0.46 (95% CI 0.35-0.58) for anastomotic lesions. The weighted kappa for the updated Rutgeerts' score was 0.69 (95% CI 0.62-0.77). The weighted kappa for lesions in the ileal body, ileal inlet, neoterminal ileum, colonic and ileal blind loop was 0.61 (95% CI 0.49-0.73), 0.63 (95% CI 0.54-0.72), 0.61 (95% CI 0.49-0.74), 0.83 (95% CI 0.62-1.00) and 0.68 (95% CI 0.46-0.89). CONCLUSION The interobserver agreement of the mRS is substantial. Similarly, the interobserver agreement is substantial for the updated Rutgeerts' score. According to the REMIND score, the interobserver agreement was substantial for lesions in the neoterminal ileum, whereas only moderate for anastomotic lesions. Since therapeutic decisions in clinical practice are based on these assessments and these scores are used as outcome measure in clinical studies, further improvement of the interobserver agreement is essential.
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Affiliation(s)
- Michiel T J Bak
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Nassim Hammoudi
- Gastroenterology Department, Hôpital Saint-Louis - APHP, Université Paris Cité, INSERM U1160, Paris, France
| | - Matthieu Allez
- Gastroenterology Department, Hôpital Saint-Louis - APHP, Université Paris Cité, INSERM U1160, Paris, France
| | - Mark S Silverberg
- Division of Gastroenterology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Isa M Schellekens
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Nicole S Erler
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Gerard Dijkstra
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Mariëlle Romberg-Camps
- Department of Gastroenterology, Geriatrics, Internal and Intensive Care Medicine (Co-MIK), Zuyderland Medical Centre, Heerlen-Sittard-Geleen, the Netherlands
| | - Nanne K H de Boer
- Department of Gastroenterology and Hepatology, AGEM Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sita V Jansen
- Department of Gastroenterology and Hepatology, Reinier de Graaf Groep, Delft, the Netherlands
| | - Sander van der Marel
- Department of Gastroenterology and Hepatology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Carmen S Horjus
- Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Marijn C Visschedijk
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Rogier L Goetgebuer
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Willemijn A van Dop
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jildou Hoekstra
- Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, The Netherlands
| | | | - Ilse Molendijk
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Lauranne A A P Derikx
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Fiona D M van Schaik
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rachel L West
- Department of Gastroenterology and Hepatology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Marjolijn Duijvestein
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - C Janneke van der Woude
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Oddeke van Ruler
- Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, the Netherlands; Department of Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Annemarie C de Vries
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.
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2
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Straatmijer T, van Schaik FDM, Bodelier AGL, Visschedijk M, de Vries AC, Ponsioen CY, Pierik M, van Bodegraven AA, West RL, de Boer NKH, Srivastava N, Romkens TEH, Hoekstra J, Oldenburg B, Dijkstra G, van der Woude JC, Löwenberg M, Mujagic Z, Biemans VBC, van der Meulen-de Jong AE, Duijvestein M. Effectiveness and safety of tofacitinib for ulcerative colitis: two-year results of the ICC Registry. Aliment Pharmacol Ther 2023; 57:117-126. [PMID: 36282200 PMCID: PMC10092078 DOI: 10.1111/apt.17248] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/30/2022] [Accepted: 09/26/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Tofacitinib is an oral Janus kinase (JAK) inhibitor and is registered for the treatment of ulcerative colitis (UC). The effectiveness of tofacitinib has been evaluated up to 12 months of treatment. AIM The aim of this study was to assess the effectiveness and safety of 24 months of tofacitinib use in UC patients in the Netherlands. METHODS Patients initiating tofacitinib treatment were included in the ICC Registry, a nationwide, observational registry. Patients were prospectively evaluated for up to 24 months. The primary outcome was corticosteroid-free clinical remission (CSFR, Simple Clinical Colitis Activity Index [SCCAI] ≤2) at week 104. Secondary outcomes included biochemical remission (C-reactive protein (CRP) ≤5 mg/L and faecal calprotectin (FC) ≤250 μg/g), safety, and discontinuation rate. RESULTS We included 110 patients of whom 104 (94.5%) were anti-TNF experienced. After 104 weeks of tofacitinib, 31.8% (34/107) were in CSFR, 23.4% (25/107) in biochemical remission and 18.7% (20/107) in combined clinical and biochemical remission. Of the patients in CSFR at week 52, 76.5% (26/34) remained so after 104 weeks of treatment. Sixty-one patients (55.5%) discontinued tofacitinib after a median duration of 13 weeks (IQR 7-34). The main reasons for discontinuation were non-response (59%), loss of response (14.8%), and adverse events (18%). There were 33.9 possible tofacitinib-related adverse events per 100 patient-years during follow-up. Adverse events most probably related to tofacitinib were skin reactions and headaches. There were 6.4 herpes zoster infections per 100 patient-years. CONCLUSION Tofacitinib was effective in 31.8% of patients after 24 months of treatment.
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Affiliation(s)
- Tessa Straatmijer
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Marijn Visschedijk
- University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Cyriel Y Ponsioen
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marieke Pierik
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ad A van Bodegraven
- Department of Gastroenterology and Hepatology, Zuyderland Hospital, Sittard, The Netherlands
| | - Rachel L West
- Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Nanne K H de Boer
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | | | | | - Bas Oldenburg
- University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Gerard Dijkstra
- University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Mark Löwenberg
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Zlatan Mujagic
- Maastricht University Medical Centre, Maastricht, The Netherlands
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3
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Straatmijer T, Biemans VBC, Visschedijk M, Hoentjen F, de Vries A, van Bodegraven AA, Bodelier A, de Boer NKH, Dijkstra G, Festen N, Horjus C, Jansen JM, Jharap B, Mares W, van Schaik FDM, Ponsioen C, Romkens T, Srivastava N, van der Voorn MMPJA, West R, van der Woude J, Wolvers MDJ, Pierik M, van der Meulen-de Jong AE, Duijvestein M, van Workum M, de Jong D, van Dop W, van der Marel S, El Ghabzouri H, Talhaoui K, Oldenburg B, Boontje N, Fidder H, Hirdes M, Creemers RH, Hoekstra J, Smid J, Mujagic Z, François-Verweij M, Schakel- van den Berge T, Maljaars J, Theeuwen R, van den Berg D, Gerretsen S, Yocarini X, D’Haens G, Lowenberg M, Grootjans J, Gecse K, Bouma G, Waaijenberg P, Muskens B. Superior Effectiveness of Tofacitinib Compared to Vedolizumab in Anti-TNF-experienced Ulcerative Colitis Patients: A Nationwide Dutch Registry Study. Clin Gastroenterol Hepatol 2023; 21:182-191.e2. [PMID: 35644343 DOI: 10.1016/j.cgh.2022.04.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/21/2022] [Accepted: 04/29/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Clinicians face difficulty in when and in what order to position biologics and Janus kinase inhibitors in patients with anti-tumor necrosis factor-alpha (TNF) refractory ulcerative colitis (UC). We aimed to compare the effectiveness and safety of vedolizumab and tofacitinib in anti-TNF-exposed patients with UC in our prospective nationwide Initiative on Crohn and Colitis Registry. METHODS Patients with UC who failed anti-TNF treatment and initiated vedolizumab or tofacitinib treatment were identified in the Initiative on Crohn and Colitis Registry in the Netherlands. We selected patients with both clinical as well as biochemical or endoscopic disease activity at initiation of therapy. Patients previously treated with vedolizumab or tofacitinib were excluded. Corticosteroid-free clinical remission (Simple Clinical Colitis Activity Index ≤2), biochemical remission (C-reactive protein ≤5 mg/L or fecal calprotectin ≤250 μg/g), and safety outcomes were compared after 52 weeks of treatment. Inverse propensity score-weighted comparison was used to adjust for confounding and selection bias. RESULTS Overall, 83 vedolizumab- and 65 tofacitinib-treated patients were included. Propensity score-weighted analysis showed that tofacitinib-treated patients were more likely to achieve corticosteroid-free clinical remission and biochemical remission at weeks 12, 24, and 52 compared with vedolizumab-treated patients (odds ratio [OR], 6.33; 95% confidence interval [CI], 3.81-10.50; P < .01; OR, 3.02; 95% CI, 1.89-4.84; P < .01; and OR, 1.86; 95% CI, 1.15-2.99; P = .01; and OR, 3.27; 95% CI, 1.96-5.45; P < .01; OR, 1.87; 95% CI, 1.14-3.07; P = .01; and OR, 1.81; 95% CI, 1.06-3.09; P = .03, respectively). There was no difference in infection rate or severe adverse events. CONCLUSIONS Tofacitinib was associated with superior effectiveness outcomes compared with vedolizumab in anti-TNF-experienced patients with UC along with comparable safety outcomes.
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Affiliation(s)
- Tessa Straatmijer
- Amsterdam UMC, University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Research Institute, Amsterdam, the Netherlands; Leiden University Medical Centre, Department of Gastroenterology and Hepatology, Leiden, The Netherlands
| | | | - Marijn Visschedijk
- University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Frank Hoentjen
- Department of Gastroenterology, Radboud university medical centre, Nijmegen, The Netherlands; Division of Gastroenterology, University of Alberta, Edmonton, Canada
| | | | - Adriaan A van Bodegraven
- Department of Gastroenterology, Geriatrics, Internal, and Intensive Care Medicine (COMIK), Zuyderland Medical Centre, Heerlen-Sittard-Geleen, The Netherlands
| | | | - Nanne K H de Boer
- Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Research Institute, Amsterdam, The Netherlands
| | - Gerard Dijkstra
- University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Noortje Festen
- University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | | | | | - Bindia Jharap
- Meander Medisch Centrum, Amersfoort, The Netherlands
| | - Wout Mares
- Ziekenhuis Geldersche Vallei, Ede, The Netherlands
| | | | - Cyriel Ponsioen
- Amsterdam UMC, University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Research Institute, Amsterdam, the Netherlands
| | | | | | | | - Rachel West
- Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | | | - Marije D J Wolvers
- Amsterdam UMC, department of Epidemiology and Data Science, Amsterdam, The Netherlands
| | - Marieke Pierik
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Marjolijn Duijvestein
- Department of Gastroenterology, Radboud university medical centre, Nijmegen, The Netherlands.
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4
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Biemans VBC, Sleutjes JAM, de Vries AC, Bodelier AGL, Dijkstra G, Oldenburg B, Löwenberg M, van Bodegraven AA, van der Meulen-de Jong AE, de Boer NKH, Srivastava N, West RL, Römkens TEH, Horjus Talabur Horje CS, Jansen JM, van der Woude CJ, Hoekstra J, Weersma RK, van Schaik FDM, Hoentjen F, Pierik MJ. Tofacitinib for ulcerative colitis: results of the prospective Dutch Initiative on Crohn and Colitis (ICC) registry. Aliment Pharmacol Ther 2020. [PMID: 32237087 DOI: 10.1111/apt.1568933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
BACKGROUND Tofacitinib is a Janus kinase inhibitor approved for the treatment of ulcerative colitis (UC). AIM To evaluate effectiveness, safety and use of tofacitinib in daily practice. METHODS UC patients initiating tofacitinib were prospectively enrolled in 15 hospitals in the Netherlands. Corticosteroid-free clinical remission (short clinical colitis activity index [SCCAI] ≤2), biochemical remission (faecal calprotectin level ≤250 µg/g), combined corticosteroid-free clinical and biochemical remission, predictors of remission, safety outcomes, treatment dose and effect on lipids were determined at weeks 12 and 24. Endoscopic outcomes were evaluated in centres with routine endoscopic evaluation. RESULTS In total, 123 UC patients (95% anti-TNF, 62% vedolizumab and 3% ustekinumab experienced) were followed for a median duration of 24 weeks (interquartile range 12-26). The proportion of patients in corticosteroid-free clinical, biochemical, and combined corticosteroid-free clinical and biochemical remission rate at week 24 was 29% (n: 22/77), 25% (n: 14/57), and 19% (n: 11/57) respectively. Endoscopic remission (Mayo = 0) was achieved in 21% of patients at week 12 (n: 7/33). Prior vedolizumab exposure was associated with reduced clinical remission (odds ratio 0.33, 95% confidence interval [CI] 0.11-0.94). At week 24, 33% (n: 14/42) of patients still on tofacitinib treatment used 10 mg twice daily. In total, 33 tofacitinib-related adverse events (89 per 100 patient years) occurred, 7 (6% of total cohort) resulted in discontinuation. Cholesterol, HDL and LDL levels increased during induction treatment by 18% (95% CI 9-26), 18% (95% CI 8-28) and 21% (95% CI 14-39) respectively. CONCLUSION Tofacitinib is an effective treatment for UC after anti-TNF and vedolizumab failure. However, a relatively high rate of adverse events was observed resulting in discontinuation in 6% of patients.
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Affiliation(s)
- Vince B C Biemans
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | | | | | - Gerard Dijkstra
- University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Bas Oldenburg
- University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Mark Löwenberg
- Amsterdam University Medical Centre, Academic Medical Centre, Amsterdam, The Netherlands
| | | | | | - Nanne K H de Boer
- Amsterdam University Medical Centre, Vrije Universiteit, Amsterdam Gastroenterology & Metabolism research institute, Amsterdam, The Netherlands
| | | | - Rachel L West
- Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | | | | | | | | | | | - Rinse K Weersma
- University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Frank Hoentjen
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Marieke J Pierik
- Department of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, The Netherlands
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5
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Biemans VBC, Sleutjes JAM, de Vries AC, Bodelier AGL, Dijkstra G, Oldenburg B, Löwenberg M, van Bodegraven AA, van der Meulen‐de Jong AE, de Boer NKH, Srivastava N, West RL, Römkens TEH, Horjus Talabur Horje CS, Jansen JM, van der Woude CJ, Hoekstra J, Weersma RK, van Schaik FDM, Hoentjen F, Pierik MJ. Tofacitinib for ulcerative colitis: results of the prospective Dutch Initiative on Crohn and Colitis (ICC) registry. Aliment Pharmacol Ther 2020; 51:880-888. [PMID: 32237087 PMCID: PMC7187329 DOI: 10.1111/apt.15689] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 01/21/2020] [Accepted: 02/24/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Tofacitinib is a Janus kinase inhibitor approved for the treatment of ulcerative colitis (UC). AIM To evaluate effectiveness, safety and use of tofacitinib in daily practice. METHODS UC patients initiating tofacitinib were prospectively enrolled in 15 hospitals in the Netherlands. Corticosteroid-free clinical remission (short clinical colitis activity index [SCCAI] ≤2), biochemical remission (faecal calprotectin level ≤250 µg/g), combined corticosteroid-free clinical and biochemical remission, predictors of remission, safety outcomes, treatment dose and effect on lipids were determined at weeks 12 and 24. Endoscopic outcomes were evaluated in centres with routine endoscopic evaluation. RESULTS In total, 123 UC patients (95% anti-TNF, 62% vedolizumab and 3% ustekinumab experienced) were followed for a median duration of 24 weeks (interquartile range 12-26). The proportion of patients in corticosteroid-free clinical, biochemical, and combined corticosteroid-free clinical and biochemical remission rate at week 24 was 29% (n: 22/77), 25% (n: 14/57), and 19% (n: 11/57) respectively. Endoscopic remission (Mayo = 0) was achieved in 21% of patients at week 12 (n: 7/33). Prior vedolizumab exposure was associated with reduced clinical remission (odds ratio 0.33, 95% confidence interval [CI] 0.11-0.94). At week 24, 33% (n: 14/42) of patients still on tofacitinib treatment used 10 mg twice daily. In total, 33 tofacitinib-related adverse events (89 per 100 patient years) occurred, 7 (6% of total cohort) resulted in discontinuation. Cholesterol, HDL and LDL levels increased during induction treatment by 18% (95% CI 9-26), 18% (95% CI 8-28) and 21% (95% CI 14-39) respectively. CONCLUSION Tofacitinib is an effective treatment for UC after anti-TNF and vedolizumab failure. However, a relatively high rate of adverse events was observed resulting in discontinuation in 6% of patients.
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Affiliation(s)
- Vince B. C. Biemans
- Department of Gastroenterology and HepatologyRadboud University Medical CentreNijmegenThe Netherlands,Department of Gastroenterology and HepatologyMaastricht University Medical CentreMaastrichtThe Netherlands
| | | | | | | | - Gerard Dijkstra
- University Medical Centre GroningenUniversity of GroningenGroningenThe Netherlands
| | - Bas Oldenburg
- University Medical Centre UtrechtUtrechtThe Netherlands
| | - Mark Löwenberg
- Amsterdam University Medical CentreAcademic Medical CentreAmsterdamThe Netherlands
| | | | | | - Nanne K. H. de Boer
- Amsterdam University Medical CentreVrije UniversiteitAmsterdam Gastroenterology & Metabolism research instituteAmsterdamThe Netherlands
| | | | | | | | | | | | | | | | - Rinse K. Weersma
- University Medical Centre GroningenUniversity of GroningenGroningenThe Netherlands
| | | | - Frank Hoentjen
- Department of Gastroenterology and HepatologyRadboud University Medical CentreNijmegenThe Netherlands
| | - Marieke J. Pierik
- Department of Gastroenterology and HepatologyMaastricht University Medical CentreMaastrichtThe Netherlands
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Bolderduk RF, Milas JE, Asperger H, Becker H, Chatron S, Cordier JL, DeSmedt J, Gonzalez D, Hammers A, Hoekstra J, Kanitz L, McDonagh S, Nowacki R, Oggel J, Quinlan J, Stolpenir L, Trottier YL, Van Gestel G, Van Oudenallen A, West W, Zschaler R. Salmonella Detection in Dried Milk Products by Motility Enrichment on Modified Semisolid Rappaport-Vassiliadis Medium: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/79.2.441] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
A collaborative study involving 19 laboratories was performed to validate motility enrichment on modified semisolid Rappaport-Vassiliadis (MSRV) medium for rapid detection of motile Salmonella in dried milk products. The MSRV method was compared with the AOAC culture method for detection of Salmonella in nonfat milk powder, whole milk powder, whey powder, casein powder, and butter milk powder. Samples were artificially inoculated with Salmonella at 2 levels of contamination. Un-inoculated control samples were included for each type of product. The sensitivity rates were 100% for the MSRV method and 99.0% for the AOAC culture method, while the specificity rate was 100.0% for both methods. Only for the samples of whey powder, which were inoculated with H2S negative S. tennessee, was there a significant difference in the proportion of samples positive by MSRV and the culture procedure. The MSRV method for detection of motileSalmonella in dried milk products has been adopted first action by AOAC INTERNATIONAL.
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Affiliation(s)
- Robert F Bolderduk
- Jacobs Suchard, Corporate Microbiological Services, Montezumalaan 1, B-2200 Herentals, Belgium
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Hoekstra J, Rutten VPMG, van den Hout M, Spaninks MP, Benedictus L, Koop G. Differences between Staphylococcus aureus lineages isolated from ovine and caprine mastitis but not between isolates from clinical or subclinical mastitis. J Dairy Sci 2019; 102:5430-5437. [PMID: 30981476 DOI: 10.3168/jds.2018-16196] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/14/2019] [Indexed: 01/31/2023]
Abstract
Staphylococcus aureus is an important mastitis pathogen, causing both clinical mastitis (CM) and subclinical mastitis (SCM) in small ruminants. In general, CM has a low incidence in sheep and goats but can be very severe and costly. In contrast, subclinical mastitis (SCM) is common but is associated with less cost. For both sheep and goats, S. aureus is the main cause of CM and is associated with SCM cases with a high SCC. Recently, specific lineages of S. aureus have been identified that are associated with CM rather than SCM in dairy cows. It is unknown whether specific S. aureus lineages are associated with CM in goats and sheep. The aim of this study was to compare the clonal complex (CC), staphylococcal protein A (spa) type, leukocidin lukM-lukF' presence, and potential to produce LukMF' in vitro between CM and SCM S. aureus mastitis isolates obtained from sheep and goats. Differences between isolates from different host species were also compared. Ovine (CM, n = 12; SCM, n = 29) and caprine (CM, n = 14; SCM, n = 30) isolates were obtained from 8 sheep flocks and 8 goat herds in the Netherlands. Overall, the isolates belonged to CC133 (85%), CC398 (7%), CC425 (5%), and CC45 (2%). Seventeen spa types were found, including 6 novel types; the predominant types were t2678 (34%), t544 (18%), and t3583 (18%). Although CC133 was dominant among both sheep and goat isolates, spa type CC133/t2678 was associated with ovine isolates, whereas CC133/t544 and CC133/t3583 were found mostly in goats. The presence of lukM-lukF' among the S. aureus isolates was high (87%), especially in CC133 (96%) and CC425 (100%), but the genes were absent in CC45 and CC398. In vitro-cultured lukM-lukF'-positive isolates produced LukM (71 out of 74 positive isolates tested) in the range of 0.4 to 5.0 µg/mL. Interestingly, the goat-associated lineages CC133/t544 and CC133/t3583 produced more LukM in vitro than the sheep-associated CC133/t2678. We found no difference in LukMF' production potential between CM and SCM isolates. In sheep as well as in goats, no association was found between genotype and CM or SCM, demonstrating that the same lineages of S. aureus are responsible for both CM and SCM. These results suggest that subclinically infected animals in a herd or flock likely act as the reservoir of S. aureus causing CM. This highlights the importance of early identification and control of SCM and suggests that controlling SCM within a herd is an effective intervention to prevent CM in small ruminants.
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Affiliation(s)
- J Hoekstra
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 CL Utrecht, the Netherlands; Department of Farm Animal Health, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 7, 3584 CL Utrecht, the Netherlands.
| | - V P M G Rutten
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 CL Utrecht, the Netherlands; Department of Veterinary Tropical Diseases, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa
| | - M van den Hout
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 CL Utrecht, the Netherlands
| | - M P Spaninks
- Department of Farm Animal Health, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 7, 3584 CL Utrecht, the Netherlands
| | - L Benedictus
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 CL Utrecht, the Netherlands; Division of Infection and Immunity, The Roslin Institute, The University of Edinburgh, Easter Bush, Midlothian EH25 9RG, Scotland
| | - G Koop
- Department of Farm Animal Health, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 7, 3584 CL Utrecht, the Netherlands
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Rijckborst V, Hoekstra J, Claessen MMH, Duvekot JJ, de Man RA. [Pregnancy and lever cirrhosis: a high-risk combination]. Ned Tijdschr Geneeskd 2018; 162:D2457. [PMID: 30379499] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Pregnancy rarely occurs in women with liver cirrhosis. However, for those who do become pregnant there are substantial maternal and foetal risks. CASE DESCRIPTION A 29-year-old pregnant woman with fully compensated liver cirrhosis was referred to a tertiary centre. No oesophageal or stomach varices were identified, nor indications for decompensation of the liver disease. Following an uneventful pregnancy, she gave (vaginal) birth at term to a healthy son. CONCLUSION The risk of complications in pregnant patients with liver cirrhosis is related to the degree of liver dysfunction and the presence of portal hypertension, emphasizing the importance of individualised preconception counselling. Oesophageal or stomach variceal bleeding during pregnancy carries a considerable risk of mortality. Therefore, screening endoscopy in the second trimester is advised to facilitate primary prophylaxis of variceal bleeding. Although the risk of variceal bleeding is increased during delivery, elective caesarean sections are not routinely performed because of an increased risk of bleeding due to abdominal wall varices. Pregnant women with liver cirrhosis should ideally be managed in a tertiary centre and in a multidisciplinary setting, to include input from a gynaecologist and gastroenterologist/hepatologist.
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Affiliation(s)
| | | | | | | | - Robert A de Man
- Erasmus MC, afd. Maag-, Darm- en Leverziekten, Rotterdam
- Contact: R.A. de Man
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Mekonnen SA, Lam TJGM, Hoekstra J, Rutten VPMG, Tessema TS, Broens EM, Riesebos AE, Spaninks MP, Koop G. Characterization of Staphylococcus aureus isolated from milk samples of dairy cows in small holder farms of North-Western Ethiopia. BMC Vet Res 2018; 14:246. [PMID: 30139356 PMCID: PMC6107951 DOI: 10.1186/s12917-018-1558-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [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: 03/26/2018] [Accepted: 07/31/2018] [Indexed: 01/01/2023] Open
Abstract
Background Staphylococcus aureus is a contagious, opportunistic pathogen that causes clinical or subclinical mastitis in dairy cattle. The genetic background and antimicrobial resistance of isolates from Ethiopian dairy farms has not been studied. Therefore, the aim of this study was to characterize S. aureus from Ethiopian hand milked dairy cows, by spa, MLST and virulence factor typing, and by assessment of antimicrobial susceptibility. A total of 79 S. aureus isolates from intramammary infections was studied. A PCR was used to detect lukM-lukF’ and pvl genes encoding the bovine and human associated bi-component leukocidins, and the toxic shock syndrome toxin gene-1 (tst). Antimicrobial susceptibility was determined using the broth microdilution method. Results Twenty different spa types were identified, most isolates were t042 (58%), and the closely related t15786 (11%). The proportion of isolates positive for lukM-lukF’, tst and pvl was low at 0.04, 0.10 and 0.09 respectively, with lukM-lukF’ often co-occurring with tst, but not with pvl. Methicillin-resistance was not found, but resistance to penicillin/ampicillin (86%) and tetracycline (54%) was very common. Conclusions We found a high degree of relatedness among bovine S. aureus isolates in North-Western Ethiopia, suggesting contagious within and between farm transmission of strains that are often resistant to commonly used antimicrobials. This highlights the need for effective preventive measures that aim at limiting transmission of bacteria rather than using antimicrobials to control S. aureus mastitis in Ethiopia. Electronic supplementary material The online version of this article (10.1186/s12917-018-1558-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S A Mekonnen
- Department of Farm Animal Health, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 7, 3584, CL, Utrecht, The Netherlands. .,Faculty of Veterinary Medicine, University of Gondar, P.O. Box 196, Gondar, Ethiopia.
| | - T J G M Lam
- Department of Farm Animal Health, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 7, 3584, CL, Utrecht, The Netherlands.,GD Animal Health, P.O. Box 9, 7400 AA, Deventer, The Netherlands
| | - J Hoekstra
- Department of Farm Animal Health, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 7, 3584, CL, Utrecht, The Netherlands.,Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 CL, Utrecht, The Netherlands
| | - V P M G Rutten
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 CL, Utrecht, The Netherlands.,Department of Veterinary Tropical Diseases, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort, Pretoria, 0110, South Africa
| | - T S Tessema
- Institute of Biotechnology, Addis Ababa University, P.O. Box 1176, Addis Ababa, Ethiopia
| | - E M Broens
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 CL, Utrecht, The Netherlands
| | - A E Riesebos
- Department of Farm Animal Health, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 7, 3584, CL, Utrecht, The Netherlands
| | - M P Spaninks
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 CL, Utrecht, The Netherlands
| | - G Koop
- Department of Farm Animal Health, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 7, 3584, CL, Utrecht, The Netherlands
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Hoekstra J, Sauter W. What Standard for Excessive Pricing in EU law? A Discussion of the Competition Appeal Tribunal’s Judgment in the Pfizer/Flynn v CMA Case. ACTA ACUST UNITED AC 2018. [DOI: 10.21552/eplr/2018/4/9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Harki J, Plompen EPC, van Noord D, Hoekstra J, Kuipers EJ, Janssen HLA, Tjwa ETTL. GI ischemia in patients with portal vein thrombosis: a prospective cohort study. Gastrointest Endosc 2016; 83:627-36. [PMID: 26324386 DOI: 10.1016/j.gie.2015.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 02/04/2015] [Accepted: 07/05/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS GI ischemia is a concerning adverse event of portal vein thrombosis (PVT). Minimally invasive techniques, such as visible light spectroscopy (VLS), have greatly improved the ability to diagnose GI ischemia. The aim of this study was to assess the clinical presentation and characteristics of GI ischemia in patients with PVT. METHODS Patients with noncirrhotic, nonmalignant PVT were included in this prospective cohort study. Clinical symptoms of GI ischemia were assessed by a structured questionnaire, VLS, and radiologic evaluation of the mesenteric vasculature. VLS measurements were compared with those in patients with cirrhosis and with a reference population. RESULTS We included 15 patients with chronic PVT and 1 patient with acute PVT (median age 46.1 years [interquartile range [IQR], 30.9-53.7]; 44% male). Decreased mucosal oxygenation in at least 1 location of the GI tract was found in 12 patients (75%). Compared with the reference population (median 60.0 [IQR, 56.2-61.7]), VLS measurements were mostly decreased in the descending duodenum in patients with PVT (median 55.5 [IQR, 52.3-58.8]; P = .02) and patients with cirrhosis (median 52.0 [IQR, 46.5-54.0], P = .003). Symptoms typical for GI ischemia, such as postprandial pain and exercise-induced pain, were reported in 10 patients (63%) with PVT. In patients with extension of thrombosis into the superior mesenteric vein and splenic vein and/or presence of hypercoagulability, decreased VLS measurements were observed compared with historical control subjects. CONCLUSIONS In patients with chronic PVT, GI ischemia is frequent. VLS enables objective and quantitative determination of GI mucosal ischemia. Onset of abdominal symptoms such as postprandial pain should prompt the physician to re-evaluate extent, cause, and treatment of PVT.
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Affiliation(s)
- Jihan Harki
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Elisabeth P C Plompen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Désirée van Noord
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jildou Hoekstra
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Internal Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Harry L A Janssen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands; Toronto Centre for Liver Disease, Toronto Western and General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Eric T T L Tjwa
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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Deinhardt F, Wolfe L, Massey R, Hoekstra J, McDonald R. Simian sarcoma virus: oncogenicity, focus assay, presence of associated virus, and comparison with avian and feline sarcoma virus-induced neoplasia in marmoset monkeys. Bibl Haematol 2015; 39:258-62. [PMID: 4360159 DOI: 10.1159/000427850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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van den Burg P, Wagenmans E, Hoekstra J, de Kort W. The European Donor Health Care Project: fulfilling needs and challenges for the future. J Eur CME 2014. [DOI: 10.3402/jecme.v3.24522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - E. Wagenmans
- Sanquin Blood Supply. Plesmanlaan 125, 1066 CX Amsterdam, The Netherlands
| | - J. Hoekstra
- Ho-Extra ConsultingP/A Plesmanlaan 125, 1066 CX Amsterdam, The Netherlands
| | - W.L.A.M. de Kort
- Sanquin Blood Supply. Plesmanlaan 125, 1066 CX Amsterdam, The Netherlands
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Berjia F, Hoekstra J, Verhagen H, Poulsen M, Andersen R, Nauta M. Finding the Optimum Scenario in Risk-benefit Assessment: An Example on Vitamin D. ACTA ACUST UNITED AC 2014. [DOI: 10.9734/ejnfs/2014/9285] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Seijo S, Plessier A, Hoekstra J, Dell'era A, Mandair D, Rifai K, Trebicka J, Morard I, Lasser L, Abraldes JG, Darwish Murad S, Heller J, Hadengue A, Primignani M, Elias E, Janssen HLA, Valla DC, Garcia-Pagan JC. Good long-term outcome of Budd-Chiari syndrome with a step-wise management. Hepatology 2013; 57:1962-8. [PMID: 23389867 DOI: 10.1002/hep.26306] [Citation(s) in RCA: 179] [Impact Index Per Article: 16.3] [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: 10/22/2012] [Revised: 12/13/2012] [Accepted: 12/17/2012] [Indexed: 12/13/2022]
Abstract
UNLABELLED Budd-Chiari syndrome (BCS) is a rare, life-threatening disease caused by obstruction of hepatic venous outflow. The aim of the study was to assess long-term outcome and identify prognostic factors in BCS patients managed by a step-wise approach using anticoagulation, angioplasty/thrombolysis, transjugular intrahepatic portosystemic shunting (TIPS), and orthotopic liver transplantation (OLT). We reviewed long-term data on 157 patients previously included by the European Network for Vascular Disorders of the Liver, a multicenter prospective study of newly diagnosed BCS patients in nine European countries. Patients were followed for a median of 50 months (range, 0.1-74.0). During the study, 88 patients (56%) received at least one invasive intervention (22 patients angioplasty/thrombolysis, 62 TIPS, and 20 OLT) and 36 (22.9%) died. Most interventions and/or deaths occurred in the first 2 years after diagnosis. The Rotterdam score was excellent in predicting intervention-free survival, and no other variable could significantly improve its prognostic ability. Moreover, BCS-TIPS prognostic index (PI) score (based on international normalized ratio, bilirubin, and age) was strongly associated with survival and had a discriminative capacity, which was superior to the Rotterdam score. CONCLUSIONS The current study confirms, in a large cohort of patients with BCS recruited over a short period, that a step-wise treatment approach provides good long-term survival. In addition, the study validates the Rotterdam score for predicting intervention-free survival and the BCS-TIPS PI score for predicting survival.
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Affiliation(s)
- Susana Seijo
- Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, IDIBAPS and CIBERehd, Barcelona, Spain
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Spaander MCW, Hoekstra J, Hansen BE, Van Buuren HR, Leebeek FWG, Janssen HLA. Anticoagulant therapy in patients with non-cirrhotic portal vein thrombosis: effect on new thrombotic events and gastrointestinal bleeding. J Thromb Haemost 2013; 11:452-9. [PMID: 23289370 DOI: 10.1111/jth.12121] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 12/10/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS It remains unclear when anticoagulant therapy should be given in patients with non-cirrhotic portal vein thrombosis (PVT). The aim of this study was to assess the effect of anticoagulation on recurrent thrombotic events and gastrointestinal bleeding in non-cirrhotic PVT patients. METHODS Retrospective study of all patients with non-cirrhotic PVT (n = 120), seen at our hospital from 1985 to 2009. Data were collected by systematic chart review. RESULTS Sixty-six of the 120 patients were treated with anticoagulants. Twenty-two recurrent thrombotic events occurred in 19 patients. The overall thrombotic risk at 1, 5 and 10 years was 4%, 8% and 27%, respectively. Seventy-four percent of all recurrent thrombotic events occurred in patients with a prothrombotic disorder. Anticoagulant therapy tended to lower the risk of recurrent thrombosis (hazard ratio [HR] 0.2, P = 0.1), yet the only significant predictor of recurrent thrombotic events was the presence of a prothrombotic disorder (HR 3.1, P = 0.03). In 37 patients, 83 gastrointestinal bleeding events occurred. The re-bleeding risk at 1, 5 and 10 years was 19%, 46% and 49%, respectively. Anticoagulation therapy (HR 2.0, P ≤ 0.01) was a significant predictor of (re)bleeding. Anticoagulation therapy had no effect on the severity of gastrointestinal bleeding. Poor survival was associated with recurrent thrombotic events (HR 3.1 P = 0.02), whereas bleeding (HR 1.6 P = 0.2) and anticoagulant treatment (HR 0.5 P = 0.2) had no significant effect on survival. CONCLUSIONS In non-cirrhotic PVT patients recurrent thrombotic events are mainly observed in patients with underlying prothrombotic disorders. Anticoagulation therapy tends to prevent recurrent thrombosis but also significantly increases the risk of gastrointestinal bleeding.
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Affiliation(s)
- M C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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Hoekstra J, Seijo S, Rautou PE, Ducarme G, Boudaoud L, Luton D, Alijotas-Reig J, Casellas-Caro M, Condat B, Bresser E, Thabut D, Larroque B, Gárcia-Pagán JC, Janssen HLA, Valla DC, Plessier A. Pregnancy in women with portal vein thrombosis: results of a multicentric European study on maternal and fetal management and outcome. J Hepatol 2012; 57:1214-9. [PMID: 22885716 DOI: 10.1016/j.jhep.2012.07.034] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [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: 06/15/2012] [Revised: 07/16/2012] [Accepted: 07/26/2012] [Indexed: 12/04/2022]
Abstract
BACKGROUND & AIMS Women of childbearing age account for approximately 25% of patients with non-cirrhotic portal vein thrombosis (PVT). We aimed at assessing maternal and fetal outcome in pregnant women with known PVT. METHODS We performed a retrospective analysis of the files of women with chronic PVT in three European referral centers between 1986 and 2010. RESULTS Forty-five pregnancies, 28 (62%) treated with low molecular weight heparin, occurred in 24 women. Nine (20%) were lost before gestation week 20. Preterm birth occurred in 38% of deliveries: there were 3 births at week 24-25, 7 at week 32-36, and 26 after week 37. A term birth with a healthy infant occurred in 58% of pregnancies. Cesarean section was used in 53% of deliveries. Two women developed HELLP syndrome. A favorable outcome happened in 64% of pregnancies. Pregnancies with an unfavorable outcome were associated with a higher platelet count at diagnosis. Bleeding from esophageal varices occurred in 3 patients during pregnancy, all without adequate primary prophylaxis. Genital or parietal bleeding occurred postpartum in 4 patients, only one being on anticoagulation therapy. Thrombotic events occurred in 2 patients, none related to lower limbs or mesenteric veins. There were no maternal deaths. CONCLUSIONS In pregnant PVT patients treated with anticoagulation on an individual basis, the rate of miscarriage and preterm birth appears to be increased. However, fetal and maternal outcomes are favorable for most pregnancies reaching gestation week 20. High platelet counts appear to increase the risk for unfavorable outcome. Pregnancy should not be contraindicated in stable PVT patients.
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Affiliation(s)
- J Hoekstra
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Hoekstra J, Bresser EL, Smalberg JH, Spaander MCW, Leebeek FWG, Janssen HLA. Long-term follow-up of patients with portal vein thrombosis and myeloproliferative neoplasms. J Thromb Haemost 2011; 9:2208-14. [PMID: 22040061 DOI: 10.1111/j.1538-7836.2011.04484.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Myeloproliferative neoplasms (MPNs) are frequently identified as an underlying cause in patients with non-cirrhotic portal vein thrombosis (PVT). The aim of this study was to describe the long-term outcome of patients with PVT and MPN. METHODS A cohort study was performed including all adult patients referred to our hospital between 1980 and 2008 with non-cirrhotic, non-malignant PVT and confirmed MPN. RESULTS A total of 44 patients (70% female) were included, with a median age at PVT-diagnosis of 48 years (range 18-79). In 31 patients (70%) PVT was the first manifestation of an MPN. Additional risk factors for thrombosis were present in 20 patients (45%). Median follow-up was 5.8 years (range 0.4-21). Twenty-three patients (52%) were treated with oral anticoagulants after diagnosis of PVT, of whom 15 (34%) received long-term therapy. During follow-up, 17 patients (39%) experienced at least one episode of gastrointestinal bleeding. Additional thrombotic events occurred in 12 patients (27%). Twelve patients (27%) had progression of the underlying MPN. Seventeen patients (39%) died at a median age of 64 years (range 30-88). Death was directly related to end-stage MPN in eight patients (47%) and to a new thrombotic event in three patients (18%). No patients died from gastrointestinal bleeding. CONCLUSIONS PVT is often the presenting symptom of an underlying MPN, highlighting the need for thorough screening for this disease. Recurrent thrombosis is a common and severe complication in patients with PVT and MPN. Mortality is primarily related to the underlying MPN and not to complications of portal hypertension.
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Affiliation(s)
- J Hoekstra
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam
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Verhagen⁎ H, Luteijn J, White B, Eussen S, Rompelberg C, Hoekstra J, Tijhuis M. Integrated benefit–risk assessment of food and pharma. Eur J Pharmacol 2011. [DOI: 10.1016/j.ejphar.2011.09.226] [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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Tijhuis MJ, de Jong N, Pohjola MV, Gunnlaugsdóttir H, Hendriksen M, Hoekstra J, Holm F, Kalogeras N, Leino O, van Leeuwen FXR, Luteijn JM, Magnússon SH, Odekerken G, Rompelberg C, Tuomisto JT, Ueland Ø, White BC, Verhagen H. State of the art in benefit-risk analysis: food and nutrition. Food Chem Toxicol 2011; 50:5-25. [PMID: 21679741 DOI: 10.1016/j.fct.2011.06.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 04/22/2011] [Accepted: 06/01/2011] [Indexed: 10/18/2022]
Abstract
Benefit-risk assessment in food and nutrition is relatively new. It weighs the beneficial and adverse effects that a food (component) may have, in order to facilitate more informed management decisions regarding public health issues. It is rooted in the recognition that good food and nutrition can improve health and that some risk may be acceptable if benefit is expected to outweigh it. This paper presents an overview of current concepts and practices in benefit-risk analysis for food and nutrition. It aims to facilitate scientists and policy makers in performing, interpreting and evaluating benefit-risk assessments. Historically, the assessments of risks and benefits have been separate processes. Risk assessment is mainly addressed by toxicology, as demanded by regulation. It traditionally assumes that a maximum safe dose can be determined from experimental studies (usually in animals) and that applying appropriate uncertainty factors then defines the 'safe' intake for human populations. There is a minor role for other research traditions in risk assessment, such as epidemiology, which quantifies associations between determinants and health effects in humans. These effects can be both adverse and beneficial. Benefit assessment is newly developing in regulatory terms, but has been the subject of research for a long time within nutrition and epidemiology. The exact scope is yet to be defined. Reductions in risk can be termed benefits, but also states rising above 'the average health' are explored as benefits. In nutrition, current interest is in 'optimal' intake; from a population perspective, but also from a more individualised perspective. In current approaches to combine benefit and risk assessment, benefit assessment mirrors the traditional risk assessment paradigm of hazard identification, hazard characterization, exposure assessment and risk characterization. Benefit-risk comparison can be qualitative and quantitative. In a quantitative comparison, benefits and risks are expressed in a common currency, for which the input may be deterministic or (increasingly more) probabilistic. A tiered approach is advocated, as this allows for transparency, an early stop in the analysis and interim interaction with the decision-maker. A general problem in the disciplines underlying benefit-risk assessment is that good dose-response data, i.e. at relevant intake levels and suitable for the target population, are scarce. It is concluded that, provided it is clearly explained, benefit-risk assessment is a valuable approach to systematically show current knowledge and its gaps and to transparently provide the best possible science-based answer to complicated questions with a large potential impact on public health.
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Affiliation(s)
- M J Tijhuis
- National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands.
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Talens S, Hoekstra J, Dirkx SPG, Darwish Murad S, Trebicka J, Elias E, Primignani M, García-Pagán JC, Valla DC, Janssen HLA, Leebeek FWG, Rijken DC. Proteomic analysis reveals that apolipoprotein A1 levels are decreased in patients with Budd-Chiari syndrome. J Hepatol 2011; 54:908-14. [PMID: 21145806 DOI: 10.1016/j.jhep.2010.08.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [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: 04/16/2010] [Revised: 07/29/2010] [Accepted: 08/17/2010] [Indexed: 12/04/2022]
Abstract
BACKGROUND & AIMS Budd-Chiari syndrome (BCS) is a rare vascular liver disorder caused by thrombosis of the hepatic veins. In some patients, no known thrombophilic factor can be identified. This study aimed to identify novel factors that might play a role in thrombosis in BCS-patients by using a proteomic approach. METHODS The abundance of plasma clot-bound proteins was compared between nine BCS-patients and nine controls by using two-dimensional difference gel electrophoresis. The protein with the most significant decrease in patients was identified by mass spectrometry. Plasma levels of this protein were measured and the results were validated in a large cohort of BCS-patients. RESULTS A total of 26 protein spots significantly differed (p<0.001). The spot that decreased with the highest statistical significance in patients was identified by mass spectrometry as apolipoprotein A1 (apo A1). The mean level of apo A1 in the plasma of these BCS-patients (0.74 g/L) was also significantly lower than in controls (1.45 g/L, p=0.002). This finding was validated in a large cohort of 101 BCS-patients and 101 controls (0.97 g/L vs. 1.32 g/L, p<0.0001). There was no major correlation between plasma levels of apo A1 and various liver function tests. CONCLUSIONS BCS-patients show decreased clot-bound protein abundance and plasma levels of apo A1. Decreased levels of apo A1 may play a role in the etiology of thrombosis in BCS-patients and possibly in other patients with venous thrombosis.
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Affiliation(s)
- Simone Talens
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
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van der Vlies CH, Hoekstra J, Ponsen KJ, Reekers JA, van Delden OM, Goslings JC. Impact of splenic artery embolization on the success rate of nonoperative management for blunt splenic injury. Cardiovasc Intervent Radiol 2011; 35:76-81. [PMID: 21431976 PMCID: PMC3261389 DOI: 10.1007/s00270-011-0132-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 02/09/2011] [Indexed: 01/10/2023]
Abstract
Introduction Nonoperative management (NOM) has become the treatment of choice for hemodynamically stable patients with blunt splenic injury. Results of outcome after NOM are predominantly based on large-volume studies from level 1 trauma centers in the United States. This study was designed to assess the results of NOM in a relatively low-volume Dutch level 1 trauma center. Methods An analysis of a prospective trauma registry was performed for a 6-year period before (period 1) and after the introduction and implementation of splenic artery embolization (SAE) (period 2). Primary outcome was the failure rate of initial treatment. Results A total of 151 patients were reviewed. An increased use of SAE and a reduction of splenic operations during the second period was observed. Compared with period 1, the failure rate after observation in period 2 decreased from 25% to 10%. The failure rate after SAE in period 2 was 18%. The splenic salvage rate (SSR) after observation increased from 79% in the first period to 100% in the second period. During the second period, all patients with failure after observation were successfully treated with SAE. The SSR after SAE in periods 1 and 2 was respectively 100% and 86%. Conclusions SAE of patients with blunt splenic injuries is associated with a reduction in splenic operations. The failure and splenic salvage rates in this current study were comparable with the results from large-volume studies of level 1 trauma centers. Nonoperative management also is feasible in a relatively low-volume level 1 trauma center outside the United States.
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Affiliation(s)
- C H van der Vlies
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 Amsterdam, The Netherlands.
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Hoekstra J, Leebeek FWG, Plessier A, Raffa S, Darwish Murad S, Heller J, Hadengue A, Chagneau C, Elias E, Primignani M, Garcia-Pagan JC, Valla DC, Janssen HLA. Paroxysmal nocturnal hemoglobinuria in Budd-Chiari syndrome: findings from a cohort study. J Hepatol 2009; 51:696-706. [PMID: 19664836 DOI: 10.1016/j.jhep.2009.06.019] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Revised: 05/27/2009] [Accepted: 06/16/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND/AIMS A well recognized cause of Budd-Chiari syndrome (BCS) is paroxysmal nocturnal hemoglobinuria (PNH). PNH is an acquired disorder of hematopoietic stem cells, characterized by intravascular hemolysis and venous thrombosis. Testing for this hematological disorder should be considered in all BCS patients. METHODS Using data from the EN-Vie study, a multi-center study of 163 patients with BCS, we investigated the relationship between BCS and PNH in 15 patients with combined disease and compared the results to 62 BCS patients in whom PNH was excluded. RESULTS Median follow-up for the study group (n=77) was 20 months (range 0-44 months). BCS patients with PNH presented with a significantly higher percentage of additional splanchnic vein thrombosis (SVT) as compared to BCS patients without PNH (47% vs. 10%, p=0.002). During follow-up, type and frequency of interventions for BCS was similar between both groups. Six patients with BCS and PNH were successfully treated with a transjugular intrahepatic portosystemic shunt (TIPS). Of 15 patients with PNH, six underwent allogenic stem cell transplantation after diagnosis of BCS. PNH was successfully cured in five cases. There was no significant difference in survival between BCS patients with and without PNH. CONCLUSIONS This study shows that despite a higher frequency of additional SVT, short-term prognosis of BCS patients with PNH does not differ from BCS patients without PNH. Treatment with TIPS can be safely performed in patients with PNH. Stem cell transplantation appears to be a feasible treatment option for PNH in BCS patients.
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Affiliation(s)
- Jildou Hoekstra
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, 's Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
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Affiliation(s)
- T. N. Todorov
- a Department of Materials , University of Oxford , Parks Road, Oxford OX1 3PH, UK
- b School of Mathematics and Physics, The Queen's University of Belfast , Belfast BT7 INN, UK E-mail:
| | - J. Hoekstra
- a Department of Materials , University of Oxford , Parks Road, Oxford OX1 3PH, UK
| | - A. P. Sutton
- a Department of Materials , University of Oxford , Parks Road, Oxford OX1 3PH, UK
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Abstract
BACKGROUND In 2007, the American College of Cardiology/American Heart Association (ACC/AHA) published new guidelines for the diagnosis and management of patients with unstable angina/non-ST segment elevation myocardial infarction (UA/NSTEMI). These guidelines include some important updates on the use of clopidogrel, fondaparinux, bivalirudin and low-molecular-weight heparins (LMWHs) all of which have published landmark clinical trials in patients with acute coronary syndromes (ACS) since the publication of the 2002 guidelines. While these 2007 guidelines are more comprehensive and up-to-date compared with the recommendations published in 2002, they also raise many questions for practising emergency physicians and cardiologists. METHODS This article presents a critical review of the 2007 ACC/AHA UA/NSTEMI guidelines, highlighting some of the areas of controversy, with the aim of providing some further guidance to practising physicians. CONCLUSIONS Despite recent updates to the ACC/AHA UA/NSTEMI guidelines, additional factors need to be taken into consideration in the management of UA/NSTEMI patients. Integrating initial responses with early or selectively invasive strategies and the risks of complications in subsequent procedures require careful consideration. Protocol development within an institution is required to risk-stratify patients rapidly, provide optimum precatheterisation medical management and allow seamless and rapid transitions to the catheterisation laboratory in patients at risk for adverse events.
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Affiliation(s)
- J Hoekstra
- Department of Emergency Medicine, Wake Forest University Health Science, Winston-Salem, NC, USA
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Hoekstra J, Janssen HLA. Vascular liver disorders (II): portal vein thrombosis. Neth J Med 2009; 67:46-53. [PMID: 19299846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Portal vein thrombosis (PVT) is a rare disorder that is associated with a variety of underlying conditions, of which liver cirrhosis, malignancy and myeloproliferative disorders are the most common. Based on clinical presentation and results of imaging, two different entities can be identified, acute and chronic PVT. Anticoagulation therapy is recommended for all patients with acute PVT in an attempt to prevent further thrombosis and to promote recanalisation of the obstructed veins. Chronic PVT is characterised by the presence of a portal cavernoma and development of portal hypertension. Bleeding from ruptured oesophageal or gastric varices is the main complication of portal hypertension in these patients. Both endoscopic therapy and beta-adrenergic blockade are used for the prevention and treatment of gastrointestinal bleeding. In the absence of bleeding, continuous anticoagulant therapy should be considered for the group of chronic PVT patients in whom an underlying prothrombotic factor can be identified. With adequate management of complications and concurrent diseases, prognosis of PVT is good in patients without underlying cirrhosis or malignancies.
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Affiliation(s)
- J Hoekstra
- Department of Gastroenterology and Hepatology (room Ha 206), Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Hoekstra J, Janssen HLA. Vascular liver disorders (I): diagnosis, treatment and prognosis of Budd-Chiari syndrome. Neth J Med 2008; 66:334-339. [PMID: 18809980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Budd-Chiari syndrome (BCS) is a venous outflow obstruction of the liver that has a dismal outcome if left untreated. Most cases of BCS in the Western world are caused by thrombosis of the hepatic veins, sometimes in combination with thrombosis of the inferior vena cava. Typical presentation consists of abdominal pain, hepatomegaly and ascites, although symptoms may vary significantly. Currently, a prothrombotic risk factor, either inherited or acquired, can be identified in the majority of patients. Moreover, in many patients with BCS a combination of risk factors is present. Myeloproliferative disorders are the most frequent underlying cause, occurring in approximately half of the patients. Recent discovery of the Janus Kinase 2 (JAK2) mutation has significantly contributed to the diagnosis of myeloproliferative disorders. Anticoagulation is indicated for all patients with BCS and additional therapy depends on the severity of symptoms and the extent of venous obstruction. A stepwise therapeutic approach is recommended, with increasing invasiveness and guided by the response to previous treatment. A transjugular intrahepatic portosystemic shunt (TIPS) is proving to be a good therapeutic option in patients with BCS, diminishing the need for surgical shunts. When all other therapy is unsuccessful or in patients with fulminant hepatic failure, a liver transplantation should be considered. Advances in diagnosis and treatment have dramatically improved the prognosis of patients with BCS. Still, many aspects of this complicated disorder remain to be clarified.
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Affiliation(s)
- J Hoekstra
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, University Medical Center Rotterdam, the Netherlands
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Kurth K, Hoekstra J, van Urk H. Obstruktion der oberen Harnwege nach arterieller Rekonstruktion im aortoiliakalen Gefäßbereich. Aktuelle Urol 2008. [DOI: 10.1055/s-2008-1062811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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van der Leij FR, Bloks VW, Grefhorst A, Hoekstra J, Gerding A, Kooi K, Gerbens F, te Meerman G, Kuipers F. Gene expression profiling in livers of mice after acute inhibition of beta-oxidation. Genomics 2007; 90:680-9. [PMID: 17933490 DOI: 10.1016/j.ygeno.2007.08.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Revised: 08/06/2007] [Accepted: 08/06/2007] [Indexed: 02/07/2023]
Abstract
Inborn errors of mitochondrial beta-oxidation cause ectopic fat accumulation, particularly in the liver. Fatty liver is associated with insulin resistance and predisposes to hepatic fibrosis. The factors underlying the pathophysiological consequences of hepatic fat accumulation have remained poorly defined. Gene expression profiling in a model of acute fatty liver disease induced by blocking long-chain fatty acid beta-oxidation was performed to study the early effects of steatosis on the transcriptome. Tetradecylglycidic acid (TDGA) was used to irreversibly inhibit carnitine palmitoyltransferase 1, a key enzyme in the control of mitochondrial beta-oxidation. TDGA treatment induced massive microvesicular hepatic steatosis within a 12-h time frame in male C57BL6/J mice. Increased hepatic long-chain acyl-CoA content, particularly of C16:0, C16:1 and C18:1, was associated with profound effects on the transcriptome as revealed by unbiased gene expression profiling and quantitative real-time PCR. The results indicate drastic changes in the expression of genes encoding proteins involved in lipid, carbohydrate, and amino acid metabolism. Pathway analysis identified transcription factors and coregulators such as hepatocyte nuclear factor 4 (HNF4), peroxisome proliferator-activated receptor-alpha (PPAR-alpha), and PPAR gamma coactivator 1alpha (PGC-1alpha ) as key players in these metabolic adaptations. Apoptotic and profibrotic responses were also affected. Surprisingly, a strong reduction in the expression of genes involved in hepatic bile salt metabolism and transport was observed. Therefore, this transcriptome analysis opens new avenues for research.
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Affiliation(s)
- Feike R van der Leij
- Center for Liver, Digestive, and Metabolic Diseases, Laboratory of Pediatrics, University Medical Center Groningen, University of Groningen, CMCV, Groningen, The Netherlands
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Pollack C, Hollander J, Brogan G, Diercks D, Hoekstra J, Stone G. The Relationship between Duration of Antithrombotic Therapy and Ischemic Outcomes in High-risk NSTE ACS Patients in the Acuity Trial. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.1165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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McMullin N, Lindsell C, Lei L, Mafi J, Jois-Bilowich P, Anantharaman V, Pollack C, Hollander J, Gibler B, Hoekstra J, Diercks D, Peacock W. Outcomes Associated with Small Changes in Normal Range Cardiac Markers. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.1038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Grefhorst A, Hoekstra J, Derks TGJ, Ouwens DM, Baller JFW, Havinga R, Havekes LM, Romijn JA, Kuipers F. Acute hepatic steatosis in mice by blocking beta-oxidation does not reduce insulin sensitivity of very-low-density lipoprotein production. Am J Physiol Gastrointest Liver Physiol 2005; 289:G592-8. [PMID: 15817811 DOI: 10.1152/ajpgi.00063.2005] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Accumulation of triglycerides (TG) in the liver is generally associated with hepatic insulin resistance. We questioned whether acute hepatic steatosis induced by pharmacological blockade of beta-oxidation affects hepatic insulin sensitivity, i.e., insulin-mediated suppression of VLDL production and insulin-induced activation of phosphatidylinositol 3-kinase (PI3-kinase) and PKB. Tetradecylglycidic acid (TDGA), an inhibitor of carnitine palmitoyl transferase-1 (CPT1), was used for this purpose. Male C57BL/6J mice received 30 mg/kg TDGA or its solvent intraperitoneally and were subsequently fasted for 12 h. CPT1 inhibition resulted in severe microvesicular hepatic steatosis (19.9 +/- 8.3 vs. 112.4 +/- 25.2 nmol TG/mg liver, control vs. treated, P < 0.05) with elevated plasma nonesterified fatty acid (0.68 +/- 0.25 vs. 1.21 +/- 0.41 mM, P < 0.05) and plasma TG (0.39 +/- 0.16 vs. 0.60 +/- 0.10 mM, P < 0.05) concentrations. VLDL-TG production rate was not affected on CPT1 inhibition (74.9 +/- 15.2 vs. 79.1 +/- 12.8 mumol TG.kg(-1).min(-1), control vs. treated) although treated mice secreted larger VLDL particles (59.3 +/- 3.6 vs. 66.6 +/- 4.5 nm diameter, P < 0.05). Infusion of insulin under euglycemic conditions suppressed VLDL production rate in control and treated mice by 43 and 54%, respectively, with formation of smaller VLDL particles (51.2 +/- 2.5 and 53.2 +/- 2.8 nm diameter). Insulin-induced insulin receptor substrate (IRS)1- and IRS2-associated PI3-kinase activity and PKB-phosphorylation were not affected on TDGA treatment. In conclusion, acute hepatic steatosis caused by pharmacological inhibition of beta-oxidation is not associated with reduced hepatic insulin sensitivity, indicating that hepatocellular fat content per se is not causally related to insulin resistance.
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Affiliation(s)
- Aldo Grefhorst
- Center for Liver, Digestive and Metabolic Diseases, Laboratory of Pediatrics, Univ. Medical Center Groningen, Groningen, The Netherlands.
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Sutton AP, Todorov TN, Cawkwell MJ, Hoekstra J. A simple model of atomic interactions in noble metals based explicitly on electronic structure. ACTA ACUST UNITED AC 2001. [DOI: 10.1080/01418610108216639] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Recent experiments suggest that gold single-atom contacts and atomic chains break at applied voltages of 1 to 2 V. In order to understand why current flow affects these defect-free conductors, we have calculated the current-induced forces on atoms in a Au chain between two Au electrodes. These forces are not by themselves sufficient to rupture the chain. However, the current reduces the work to break the chain, which results in a dramatic increase in the probability of thermally activated spontaneous fracture of the chain. This current-induced embrittlement poses a fundamental limit to the current-carrying capacity of atomic wires.
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Affiliation(s)
- T N Todorov
- School of Mathematics and Physics, The Queen's University of Belfast, Belfast BT7 1NN, United Kingdom.
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Hoekstra J. Glycoprotein IIb/IIIa receptor inhibitor use in unstable angina/non-ST-segment elevation myocardial infarction: an appropriate-use model for the emergency department. J Emerg Med 2000; 19:13S-19S. [PMID: 11050379 DOI: 10.1016/s0736-4679(00)00250-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The introduction of new platelet glycoprotein (GP) IIb/IIIa receptor inhibitors has the potential to revolutionize the treatment of certain patients with unstable angina and non-ST-segment elevation myocardial infarction (MI). Treatment with these potent platelet inhibitors has been shown to improve patient outcomes prior to percutaneous intervention (PCI), following PCI, and even in the absence of PCI. In addition, there are data from clinical studies that support a time-dependence to the beneficial effects of platelet inhibitor therapy. Patients who are treated early-for example, in the emergency department (ED)-appear to have improved outcomes over those treated later. Platelet inhibitors have been used extensively in the cardiac catheterization laboratory and in the coronary care unit (CCU). In many institutions, however, their introduction and uptake in the ED has been slow. These agents are relatively expensive and have the potential to cause major bleeding complications. This review will examine the pathophysiology of acute coronary syndromes (ACS) as it relates to the mechanism of action of GPIIb/IIIa inhibitors. The available GPIIb/IIIa inhibitors will be discussed including their indications, contraindications, doses, and mechanisms of action. Data from clinical studies supporting the use of GPIIb/IIIa inhibitors will be illustrated in the context of their applications in the ED. Finally, an algorithm for GPIIb/IIIa inhibitors in the ED will be presented.
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Affiliation(s)
- J Hoekstra
- The Ohio State University, Dublin, Ohio, USA
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Vaal M, van der Wal JT, Hoekstra J, Hermens J. Variation in the sensitivity of aquatic species in relation to the classification of environmental pollutants. Chemosphere 1997; 35:1311-1327. [PMID: 9308162 DOI: 10.1016/s0045-6535(97)00167-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Differences in species sensitivity to toxicants can be substantial. In this study this among-species variation in sensitivity was analyzed in relation to chemical's mode of action. Chemicals were classified as: non-polar narcotics, polar narcotics, reactive compounds and specifically acting compounds. Acute toxicity data of aquatic species were derived from the literature. Levels of enhanced toxicity, averaged over all species, and interspecies variation in sensitivity were analyzed for 35 chemicals, with data ranging from 12 to 62 aquatic species per compound. Non-polar and polar narcotic chemicals demonstrate the smallest variation in sensitivity and have levels of toxicity, which are highly predictable on the basis of their hydrophobicity. Reactive and specifically acting compounds can be much more toxic than predicted and variation in species sensitivity can be as large as 10(5) to 10(6). In general, the larger this interspecies variation the more asymmetric is the toxicity distribution due to extremely sensitive species. Reactive and specifically acting compounds pose a potentially larger risk for species in ecosystems than polar and non-polar narcotic compounds. They will need more testing to derive precisely equal estimates of safe environmental concentrations.
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Affiliation(s)
- M Vaal
- National Institute of Public Health and the Environment, Bilthoven, The Netherlands
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Abstract
Our aim in this study was to identify groups of species showing a similar pattern in their sensitivity to toxicants and to relate the patterns to the mode of toxic action and biological species characteristics. A data matrix was composed of acute toxicity data for 26 aquatic species and 21 compounds. Most of the variation in the toxicological data was due to differences in toxicity of compounds and not intrinsic differences between species, so that practically every species can be used to order compounds with respect to average toxicity. Compounds with high overall toxicity also had large interspecies variation in sensitivity. The toxicity of non-polar narcotics correlated well with the log Kow. Compounds with a specific or reactive mode of action were more than a factor 10 toxic than predicted by their log Kow. Patterns in species sensitivity were more diffuse because only part of the variance in species sensitivity could be explained. Fishes and amphibians were more sensitive to dieldrin, lindane and pentachlorophenol than were invertebrates. Among the arthropods, the Phyllopoda (daphnids) were the most sensitive species. They were very sensitive to aniline, the heavy metals, malathion and parathion.
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Affiliation(s)
- M Vaal
- National Institute of Public Health and the Environment, Bilthoven, The Netherlands
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Hoekstra J. Randomized trials and common sense. Ann Emerg Med 1997; 29:164-6. [PMID: 8998098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Graff L, Joseph T, Andelman R, Bahr R, DeHart D, Espinosa J, Gibler B, Hoekstra J, Mathers-Dunbar L, Ornato JP. American College of Emergency Physicians information paper: chest pain units in emergency departments--a report from the Short-Term Observation Services Section. Am J Cardiol 1995; 76:1036-9. [PMID: 7484857 DOI: 10.1016/s0002-9149(99)80291-4] [Citation(s) in RCA: 83] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- L Graff
- American College of Emergency physicians, Dallas, Texas, USA
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Hoekstra J, van der Lugt A, van der Werf J, Ouweltjes W. Genetic and phenotypic parameters for milk production and fertility traits in upgraded dairy cattle. ACTA ACUST UNITED AC 1994. [DOI: 10.1016/0301-6226(94)90090-6] [Citation(s) in RCA: 85] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Griffith RF, Anstadt M, Hoekstra J, Van Ligten PF, Anstadt GV, Mitchell L, Brown CG. Regional cerebral blood flow with manual internal cardiac massage versus direct mechanical ventricular assistance. Ann Emerg Med 1992; 21:137-41. [PMID: 1739198 DOI: 10.1016/s0196-0644(05)80147-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
STUDY HYPOTHESIS Previous studies have not discerned the best method for generating regional cerebral blood flow during internal cardiac massage. We hypothesized that regional cerebral blood flow generated by a mechanical method--direct mechanical ventricular assistance (DMVA)--would be superior to manual internal cardiac massage (MAN). STUDY POPULATION Twelve adult Yucatan minipigs weighing more than 44 kg each were studied. METHODS Swine were instrumented for regional cerebral blood flow measurements using tracer microspheres. After 15 minutes of ventricular fibrillation, swine were randomized to receive either MAN or DMVA. Regional cerebral blood flow was measured during normal sinus rhythm and at one minute (VF-1) and six minutes (VF-2) after initiation of circulatory support. Regional cerebral blood flow values were compared using a Wilcoxon rank sum test. RESULTS During VF-1, there was a tendency for DMVA to produce greater regional cerebral blood flow than MAN, although these differences were not statistically significant (DMVA vs MAN as mL/min/100 g): cerebral cortex, 28 versus 11; cerebellum, 49 versus 22; midbrain, 43 versus 16; pons, 55 versus 18; medulla, 55 versus 19; and spinal cord, 33 versus 10. During VF-2, DMVA produced greater regional cerebral blood flows than were produced by MAN: cerebral cortex, 39 versus 12 (P less than .06); cerebellum, 58 versus 20 (P less than 0.5); midbrain, 50 versus 18 (P less than .05); pons, 52 versus 22 (P less than .06); medulla, 53 versus 20 (P less than .05); and spinal cord, 31 versus 12 (P less than .05). CONCLUSION DMVA produces greater regional cerebral blood flow than is produced during MAN after 15 minutes of ventricular fibrillation. DMVA is effective at maintaining regional cerebral blood flow after a prolonged cardiac arrest.
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Affiliation(s)
- R F Griffith
- Department of Emergency Medicine, Ohio State University, Columbus
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Brown CG, Griffith RF, Van Ligten P, Hoekstra J, Nejman G, Mitchell L, Dzwonczyk R. Median frequency--a new parameter for predicting defibrillation success rate. Ann Emerg Med 1991; 20:787-9. [PMID: 2064101 DOI: 10.1016/s0196-0644(05)80843-1] [Citation(s) in RCA: 102] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
STUDY HYPOTHESIS Current American Heart Association guidelines recommend immediate defibrillation of ventricular fibrillation. When this is unsuccessful, there are no guidelines to help determine the optimum time at which to defibrillate after the administration of an alpha-adrenergic agonist. Previous studies have shown that the median frequency of the ventricular fibrillation ECG signal correlates with myocardial perfusion during CPR. We hypothesized that median frequency could predict the success of defibrillation and thus accurately determine the most appropriate time at which to defibrillate during ventricular fibrillation. STUDY POPULATION Twenty-two mixed-breed swine weighing more than 15 kg were studied. METHODS Ventricular fibrillation was induced electrically, and the ventricular fibrillation ECG signal was analyzed using fast Fourier analysis. After ten minutes of ventricular fibrillation, mechanical CPR was begun. After three minutes of CPR, the animals received one of three alpha-adrenergic agonists and CPR was continued. Defibrillation was attempted three and one-half minutes after drug administration. The average median frequency 20 seconds before defibrillation was calculated. Sensitivity and specificity of median frequency with respect to defibrillation success were determined. RESULTS A median frequency of 9.14 Hz had a sensitivity of 100% and a specificity of 92.31% in predicting the results of defibrillation in this model. CONCLUSION The median frequency may serve as a valuable parameter to guide defibrillation therapy during ventricular fibrillation.
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Affiliation(s)
- C G Brown
- Department of Emergency Medicine, Ohio State University, Columbus 43210
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De Zutter L, De Smedt JM, Abrams R, Beckers H, Catteau M, de Borchgrave J, Debevere J, Hoekstra J, Jonkers F, Lenges J. Collaborative study on the use of motility enrichment on modified semisolid Rappaport-Vassiliadis medium for the detection of Salmonella from foods. Int J Food Microbiol 1991; 13:11-20. [PMID: 1863525 DOI: 10.1016/0168-1605(91)90131-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A collaborative study was performed in 15 laboratories to evaluate the use of motility enrichment on modified semisolid Rappaport-Vassiliadis (MSRV) medium for rapid Salmonella detection in a variety of food products. The results of this procedure were compared with those obtained by the cultural procedure using Rappaport-Vassiliadis (RV) broth as selective enrichment and modified brilliant green agar for selective plating. The tests were performed with Salmonella reference samples (SRS) as well as with naturally contaminated food products. When SRS were used without added food the productivity of both MSRV and RV was 96%. When SRS were combined with reference samples containing competitive bacteria the productivity was 98% for MSRV and 95% for RV. In the tests with food samples the productivity of MSRV was 92% with SRS added to food and 96% with naturally contaminated samples, while the productivity of RV was 88% and 90%, respectively. Statistical analysis showed that there was no significant difference between the procedures.
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Affiliation(s)
- L De Zutter
- Faculty of Veterinary Medicine, Gent, Belgium
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Nejman GD, Griffith R, Van Ligten P, Hoekstra J, Casto L, Miller DD, Brown CG. Hemodynamic effects of 1-[3,4-dihydroxyphenyl]-1,2-diaminoethane versus norepinephrine during ventricular fibrillation and cardiopulmonary resuscitation. Resuscitation 1990; 20:243-52. [PMID: 1965347 DOI: 10.1016/0300-9572(90)90007-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We hypothesized that substitution of the hydroxyl group (OH) on the beta carbon of norepinephrine (NE) with an amino group would yield a compound, 1-(3,4-dihydroxyphenyl)-1,2-diaminoethane (DHPDAE), that would maintain the hemodynamic properties of NE during CPR, but would decrease the rate of post-defibrillation dysrhythmias. Six mixed breed swine weighing greater than 28 kg were studied. The animals were instrumented for cerebral (CBF) and myocardial blood flow (MBF) measurements. Ventricular fibrillation (VF) was induced. After 10 min of VF, CPR was begun. After 3 min of CPR, 2.5 mg/kg of DHPDAE was administered and CPR continued. Defibrillation was attempted 3.5 min after drug administration. CBF, MBF and defibrillation rates were compared to an historical control group receiving 0.16 mg/kg of NE. Outcome variables were compared using a Wilcoxon Rank Sum test and Fisher-exact test. NE significantly improved CBF and MBF compared to DHPDAE. All the animals in the NE group were successfully defibrillated into a perfusing rhythm. Sixty percent of the NE treated animals experienced post-defibrillation ventricular dysrhythmias. None of the animals in the DHPDAE were successfully defibrillated into a perfusing rhythm. Substitution of the hydroxyl group on the beta-carbon of NE with an amino group significantly decreases the hemodynamic properties of the parent molecule.
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Affiliation(s)
- G D Nejman
- Division of Emergency Medicine, Ohio State University, Columbus 43210
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Affiliation(s)
- J Hoekstra
- Ohio State University, Division of Emergency Medicine, Columbus 43210-1228
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Affiliation(s)
- G Nejman
- Division of Emergency Medicine, Ohio State University, Columbus 43210
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Stolwijk JA, Minke JM, Rutteman GR, Hoekstra J, Prop FJ, Misdorp W. Feline mammary carcinomas as a model for human breast cancer. II. Comparison of in vivo and in vitro adriamycin sensitivity. Anticancer Res 1989; 9:1045-8. [PMID: 2817785] [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: 01/02/2023]
Abstract
Feline mammary carcinomas were tested for their in vitro and in vivo sensitivity to Adriamycin. In vitro, twenty randomly chosen tumor islands were studied to test the effect of concentrations of the drug ranging from 0.25-2.00 micrograms/ml. In vivo, parts of primary tumors left in situ after surgical biopsy were used to assess the response to five i.v. injections of 30 mg/m2 Adriamycin. When comparing the in vitro and in vivo response, the best sensitivity (100%) was obtained using 2.00 micrograms/ml Adriamycin and the best specificity (75%) using 1.00 microgram/ml Adriamycin, both in vitro. Tumors recurring after treatment showed acquired resistance in vitro.
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Affiliation(s)
- J A Stolwijk
- Department of Pathology, Faculty of Veterinary Medicine, State University, Utrecht, The Netherlands
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