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Morgans AK, Ebrahimi R, Bobbili PJ, Nwokeji E, Gandhi R, Desai R, Horvath K, Ryan M, Hanson S, Duh MS, Preston MA. Association of intermittent vs continuous androgen deprivation therapy with cardiovascular disease and endocrine/metabolic disorders in patients with metastatic prostate cancer. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
82 Background: There is mixed evidence on the risks of cardiovascular disease (CVD) and endocrine/metabolic disorders associated with long-term intermittent and continuous androgen deprivation therapy (iADT and cADT, respectively) for metastatic prostate cancer (mPC). This study examined these risks in patients (pts) with mPC receiving iADT vs cADT in the US. Methods: This was a retrospective cohort study of SEER-Medicare pts with mPC initiating ADT (2010–2017), with ≥36 months of continuous insurance coverage, unless death occurred, who did not receive chemotherapy or a second-generation anti-androgen during follow-up. iADT and cADT cohorts were defined by treatment patterns and gaps in therapy. Comorbidities and clinical events were identified using ICD-9/10-CM codes. Outcomes examined were major adverse cardiovascular events (MACE [myocardial infarction (MI), stroke, cardiomyopathy/heart failure (HF), pulmonary embolism (PE), ischemic heart disease (IHD), or all-cause mortality]) and endocrine/metabolic events (diabetes, hypercholesterolemia, bone fractures, or osteoporosis). Inverse probability of treatment weighting (IPTW) was used to adjust for differences between cohorts; weighted Cox models were used to estimate the hazard ratio (HR) of the outcomes. Subgroup analyses examined pts by CVD history; a sensitivity analysis was performed restricting the definition of MACE to include CVD-related mortality as a component, i.e., MACESA (MI, stroke, cardiomyopathy/HF, PE, IHD, or CVD-related mortality). Results: 2234 pts with mPC were included; 478 (21%) received iADT and 1756 (79%) cADT. Median follow-up time was 27 and 13 months, and time on ADT (excluding gaps for iADT pts) was 24 and 19 months for the iADT and cADT cohorts, respectively. Deaths occurred in 39% of iADT pts vs 55% of cADT pts; PC was the most common cause of death in both cohorts. In adjusted analyses, pts receiving cADT had a higher risk of MACE vs iADT. No differences in risk of endocrine/metabolic events were observed. Subgroup analysis showed that baseline history of CVD did not alter the results for MACE. Sensitivity analysis results showed no difference in risk of MACESA between pts receiving cADT vs iADT. Conclusions: Pts with mPC receiving cADT had a higher risk of MACE (including all-cause mortality), and no difference in risk of endocrine/metabolic events, compared with those receiving iADT. When MACE was restricted to include CVD-related mortality, there was no difference in risk between cohorts. [Table: see text]
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Freiberg A, Horvath K, Hahne TM, Drössler S, Kämpf D, Spura A, Buhs B, Seidler A. Impact of mask-wearing on child and adolescent psychosocial development: a systematic review. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Wearing face masks in public is recommended under certain circumstances in order to prevent infectious diseases transmitted through droplets. The objective was to compile all German and English research results from peer-reviewed journal articles using a sensitive literature search on the effects of mask-wearing for preventing infectious diseases on the psychosocial development of children and adolescents.
Methods
A systematic review was conducted considering different study designs (search period up until 12 July 2021). The risk of bias in the studies was determined using a risk of bias procedure. A descriptive-narrative synthesis of the results was performed. A search update will be conducted shortly before the conference.
Results
Thirteen studies were included, and the overall risk of bias was estimated to be high in all primary studies. There are some indications from the included surveys that children, adolescents, and their teachers in (pre)schools perceived facial expression processing as impaired due to mask-wearing, which were confirmed by several experimental studies. Two studies reported psychological symptoms like anxiety and stress as well as concentration and learning problems due to wearing a mask during the COVID-19 pandemic. One survey study during the 2002/2003 SARS pandemic examined oral examination performance in English as a foreign language and showed no difference between the “mask” and “no mask” conditions. The results are preliminary and may be extended due to the search update.
Conclusions
Only little evidence can be derived on the effects of face masks on different developmental areas of children and adolescents based on the small number of studies. There is a lack of research data regarding the following outcomes: psychological development, language development, emotional development, social behaviour, school success, and participation. Further cluster-randomized controlled trials or longitudinal studies are required.
Key messages
• Empirical and experimental evidence shows that mask-wearing impairs facial expression among children, adolescents, and teachers in (pre)schools.
• Research on the following developmental areas is missing: psychological development, language development, emotional development, social behaviour, school success, and participation.
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Affiliation(s)
| | | | | | | | - D Kämpf
- IPAS, TU Dresden , Dresden, Germany
| | - A Spura
- Federal Centre for Health Education , Cologne, Germany
| | - B Buhs
- Federal Centre for Health Education , Cologne, Germany
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3
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Drössler S, Horvath K, Freiberg A, Kämpf D, Spura A, Buhs B, Seidler A. Beeinflussung der psychosozialen Entwicklung von Kindern und
Jugendlichen durch das Tragen von Gesichtsmasken im öffentlichen Raum
zur Prävention von Infektionskrankheiten: Eine
Interviewstudie. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- S Drössler
- Technische Universität Dresden Medizinische Fakultät,
Institut und Poliklinik für Arbeits- und Sozialmedizin (IPAS), Dresden,
Deutschland
| | - K Horvath
- Helios Park-Klinikum, Klinik für Kinder- und Jugendpsychiatrie,
Psychosomatik und Psychotherapie, Leipzig, Deutschland
| | - A Freiberg
- Technische Universität Dresden Medizinische Fakultät,
Institut und Poliklinik für Arbeits- und Sozialmedizin (IPAS), Dresden,
Deutschland
| | - D Kämpf
- Technische Universität Dresden Medizinische Fakultät,
Institut und Poliklinik für Arbeits- und Sozialmedizin (IPAS), Dresden,
Deutschland
| | - A Spura
- Bundeszentrale für gesundheitliche Aufklärung,
Köln, Deutschland
| | - B Buhs
- Bundeszentrale für gesundheitliche Aufklärung,
Köln, Deutschland
| | - A Seidler
- Technische Universität Dresden Medizinische Fakultät,
Institut und Poliklinik für Arbeits- und Sozialmedizin (IPAS), Dresden,
Deutschland
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Hawkins SS, Horvath K, Noble A, Baum CF. ACA and Medicaid Expansion Increased Breast Pump Claims and Breastfeeding for Women with Public and Private Insurance. Womens Health Issues 2021; 32:114-121. [PMID: 34802860 DOI: 10.1016/j.whi.2021.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 10/08/2021] [Accepted: 10/14/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The Patient Protection and Affordable Care Act (ACA) required new private insurance plans to provide breast pumps with no cost sharing beginning August 2012, and in January 2014 expanded this requirement to Marketplace plans and expanded Medicaid coverage. We first examined the associations between the ACA reforms in 2012 and 2014 with rates of breast pump claims between Medicaid enrollees and those with private insurance. We next examined the associations between the monthly rate of breast pump claims with breastfeeding initiation and duration by insurance type. METHODS Using 2011-2015 public and private health insurance claims in All-Payer Claims Databases from Massachusetts, Maine, and New Hampshire, we conducted a linear regression model to evaluate the associations between the 2012 and 2014 ACA health insurance reforms with rates of breast pump claims by health insurance status. We then linked the monthly rates of breast pump claims per 1,000 live births to the Pregnancy Risk Assessment Monitoring System with self-reported breastfeeding initiation and duration. We estimated probit regression models to examine the associations between monthly rates of breast pump claims per state, insurance type, age group, and breastfeeding outcomes. RESULTS For the 2012 ACA reform, breast pump claims increased by 183.4 (143.7-223.1) per 1,000 live births for women with private insurance, but decreased for Medicaid enrollees (-99.3 [-139.0 to -59.6]). For the 2014 ACA reforms, the opening of health insurance Marketplaces had no effect on breast pump claims for women with private insurance (8.3 [-43.6 to 60.2]), whereas Medicaid expansion increased claims by 119.4 (67.5-171.3) per 1,000 live births for Medicaid enrollees. Every additional 10 breast pump claims per 1,000 live births was associated with a 1.08 percentage point increase in breastfeeding initiation among women with private insurance (0.108 [0.018-0.198]), but not Medicaid enrollees (0.076 [-0.078 to 0.230]). In contrast, every additional 10 breast pump claims per 1,000 live births was associated with a 1.79 percentage point increase in breastfeeding for 4 or more weeks for women with private insurance (0.179 [0.063-0.294]) and a 2.05 percentage point increase among women with public insurance (0.205 [0.033-0.376]). Interaction analysis revealed no significant differences in associations by insurance type across breastfeeding outcomes. CONCLUSIONS The ACA breastfeeding coverage requirements fill a gap for women wanting to obtain a breast pump to support breastfeeding. The monthly rate of breast pump claims, as an indicator of access, translated into higher levels of breastfeeding for women with private and public insurance with the potential to reduce socioeconomic disparities.
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Affiliation(s)
| | - Krisztina Horvath
- Department of Economics, Boston College, Chestnut Hill, Massachusetts
| | - Alice Noble
- Boston College Law School, Newton, Massachusetts
| | - Christopher F Baum
- School of Social Work, Boston College, Chestnut Hill, Massachusetts; Department of Economics, Boston College, Chestnut Hill, Massachusetts; German Institute for Economic Research (DIW Berlin), Department of Macroeconomics, Berlin, Germany
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Powell B, Horvath K, Wickens C, Miller-Cushon E, Keil A, Brooks S. 35 Refined phenotyping methods for the equine cardiac startle response. J Equine Vet Sci 2021. [DOI: 10.1016/j.jevs.2021.103498] [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: 11/26/2022]
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Hawkins SS, Horvath K, Cohen J, Pace LE, Baum CF. Associations between ACA-related policies and a clinical recommendation with HPV vaccine initiation. Cancer Causes Control 2021; 32:783-790. [PMID: 33866458 DOI: 10.1007/s10552-021-01430-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/02/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE We examined associations between the 2010 Affordable Care Act (ACA) provisions, 2011 Advisory Committee on Immunization Practices (ACIP) recommendation, and 2014 ACA-related health insurance reforms with HPV vaccine initiation rates by sex and health insurance type. METHODS Using 2009-2015 public and private health insurance claims for 551,764 males and females aged 9-26 years (referred to as youth) from Maine, New Hampshire, and Massachusetts, we conducted linear regression models to examine the associations between three policy changes and HPV vaccine initiation rates by sex and health insurance type. RESULTS In 2009, HPV vaccine initiation rates for males and females were 0.003 and 0.604 per 100 enrollees, respectively. Among males, the 2010 ACA provisions and ACIP recommendation were associated with significant increases in HPV vaccine uptake among those with private plans (0.207 [0.137, 0.278] and 0.419 [0.353, 0.486], respectively) and Medicaid (0.157 [0.083, 0.230] and 0.322 [0.257, 0.386], respectively). Among females, the 2010 ACA provisions were associated with significant increases in HPV vaccine uptake among Medicaid enrollees only (0.123 [0.033, 0.214]). The ACA-related health insurance reforms were associated with significant increases in HPV vaccine uptake for male and female Medicaid enrollees (0.257 [0.137, 0.377] and 0.214 [0.102, 0.327], respectively), but no differences among privately insured youth. By 2015, there were no differences in HPV vaccine initiation rates between males (0.278) and females (0.305). CONCLUSIONS Both ACA provisions and the ACIP recommendation were associated with significant increases in HPV vaccine initiation rates among privately and publicly insured males in three New England states, closing the gender gap. In contrast, females and youth with private insurance did not exhibit the same changes in HPV vaccine uptake over the study period.
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Affiliation(s)
- Summer Sherburne Hawkins
- School of Social Work, Boston College, McGuinn Hall, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.
| | | | - Jessica Cohen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Christopher F Baum
- School of Social Work, Boston College, McGuinn Hall, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.,Department of Economics, Boston College, Chestnut Hill, MA, USA.,Department of Macroeconomics, German Institute for Economic Research (DIW Berlin), Berlin, Germany
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7
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Hawkins SS, Horvath K, Cohen J, Pace LE, Baum CF. Associations between insurance-related affordable care act policy changes with HPV vaccine completion. BMC Public Health 2021; 21:304. [PMID: 33549075 PMCID: PMC7866643 DOI: 10.1186/s12889-021-10328-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/25/2021] [Indexed: 11/15/2022] Open
Abstract
Background Although all 11- or 12-year-olds in the US were recommended to receive a 3-dose series of the human papillomavirus (HPV) vaccine within a 12-month period prior to 2016, rates of completion of the HPV vaccine series remained suboptimal. The effects of the Affordable Care Act (ACA), including private insurance coverage with no cost-sharing and health insurance expansions, on HPV vaccine completion are largely unknown. The aim of this study was to examine the associations between the ACA’s 2010 provisions and 2014 insurance expansions with HPV vaccine completion by sex and health insurance type. Methods Using 2009–2015 public and private health insurance claims from Maine, New Hampshire, and Massachusetts, we identified 9-to-26-year-olds who had at least one HPV vaccine dose. We conducted a logistic regression model to examine the associations between the ACA policy changes with HPV vaccine completion (defined as receiving a 3-dose series within 12 months from the date of initiation) as well as interactions by sex and health insurance type. Results Over the study period, among females and males who initiated the HPV vaccine, 27.6 and 28.0%, respectively, completed the series within 12 months. Among females, the 2010 ACA provision was associated with a 4.3 percentage point increases in HPV vaccine completion for the privately-insured (0.043; 95% CI: 0.036–0.061) and a 5.7 percentage point increase for Medicaid enrollees (0.057; 95% CI: 0.032–0.081). The 2014 health insurance expansions were associated with a 9.4 percentage point increase in vaccine completion for females with private insurance (0.094; 95% CI: 0.082–0.107) and a 8.5 percentage point increase for Medicaid enrollees (0.085; 95% CI: 0.068–0.102). Among males, the 2014 ACA reforms were associated with a 5.1 percentage point increase in HPV vaccine completion for the privately-insured (0.051; 95% CI: 0.039–0.063) and a 3.4 percentage point increase for Medicaid enrollees (0.034; 95% CI: 0.017–0.050). In a sensitivity analysis, findings were similar with HPV vaccine completion within 18 months. Conclusions Despite low HPV vaccine completion overall, both sets of ACA provisions were associated with increases in completion among females and males. Our results suggest that expanding Medicaid across the remaining states could increase HPV vaccine completion among publicly-insured youth and prevent HPV-related cancers. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10328-4.
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Affiliation(s)
- Summer Sherburne Hawkins
- Boston College, School of Social Work, McGuinn Hall, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.
| | | | - Jessica Cohen
- Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Boston, MA, USA
| | | | - Christopher F Baum
- Boston College, School of Social Work, McGuinn Hall, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.,Boston College, Department of Economics, Chestnut Hill, MA, USA.,German Institute for Economic Research (DIW Berlin), Department of Macroeconomics, Berlin, Germany
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8
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Josa V, Ferenczi S, Szalai R, Fuder E, Kuti D, Horvath K, Hegedus N, Kovacs T, Bagamery G, Juhasz B, Winkler Z, Veres DS, Zrubka Z, Mathe D, Baranyai Z. Thrombocytosis and Effects of IL-6 Knock-Out in a Colitis-Associated Cancer Model. Int J Mol Sci 2020; 21:ijms21176218. [PMID: 32867390 PMCID: PMC7504541 DOI: 10.3390/ijms21176218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/17/2020] [Accepted: 08/22/2020] [Indexed: 12/11/2022] Open
Abstract
There is an increasing number of studies showing that thrombocytosis—accompanying a variety of solid tumors including colorectal cancer (CRC)—is associated with shorter survival and earlier development of metastases. The mechanisms of cancer-associated thrombocytosis are not completely understood yet. The aim of our study was to evaluate the role of IL-6 in tumor development and thrombocytosis in mice with inflammation-induced CRC, using a CRISPR/cas9 IL-6 knockout (KO) strain. Adult male FB/Ant mice (n = 39) were divided into four groups: (1) IL-6 KO controls (n = 5); (2) IL-6 KO CRC model group (n = 18); (3) Wild-type (WT) controls (n = 6); and (4) WT CRC model group (n = 10). CRC model animals in (2) and (4) received azoxymethane (AOM)/dextran sodium sulfate (DSS) treatment to induce inflammation-related CRC. Plasma and liver tissues were obtained to determine platelet counts, IL-6 and thrombopoietin-1 (TPO) levels. In 1 WT and 2 IL-6 KO mice in vivo confocal endomicroscopy and 18F-fluorodeoxyglucose (FDG) PET/MRI examinations were performed to evaluate the inflammatory burden and neoplastic transformation. At the end of the study, tumorous foci could be observed macroscopically in both CRC model groups. Platelet counts were significantly elevated in the WT CRC group compared to the IL-6 KO CRC group. TPO levels moved parallelly with platelet counts. In vivo fluorescent microscopy showed signs of disordered and multi-nuclear crypt morphology with increased mucus production in a WT animal, while regular mucosal structure was prominent in the IL-6 KO animals. The WT animal presented more intense and larger colonic FDG uptake than IL-6 KO animals. Our study confirmed thrombocytosis accompanying inflammation-related CRC and the crucial role of IL-6 in this process. Significantly higher platelet counts were found in the WT CRC group compared to both the control group and the IL-6 KO group. Concomitantly, the tumor burden of WT mice was also greater than that of IL-6 KO mice. Our findings are in line with earlier paraneoplastic IL-6 effect suggestions.
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Affiliation(s)
- Valeria Josa
- Jahn Ferenc Del-pesti Korhaz es Rendelointezet, Department of Otorhinolaryngology and Head and Neck Surgery, 1135 Budapest, Hungary
- Correspondence:
| | - Szilamer Ferenczi
- Laboratory of Molecular Neuroendocrinology, Institute of Experimental Medicine, 1083 Budapest, Hungary; (S.F.); (D.K.); (K.H.); (B.J.); (Z.W.)
| | - Rita Szalai
- Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary;
| | - Eniko Fuder
- Department of Pathology, Uzsoki utcai Hospital, 1145 Budapest, Hungary;
| | - Daniel Kuti
- Laboratory of Molecular Neuroendocrinology, Institute of Experimental Medicine, 1083 Budapest, Hungary; (S.F.); (D.K.); (K.H.); (B.J.); (Z.W.)
| | - Krisztina Horvath
- Laboratory of Molecular Neuroendocrinology, Institute of Experimental Medicine, 1083 Budapest, Hungary; (S.F.); (D.K.); (K.H.); (B.J.); (Z.W.)
| | - Nikolett Hegedus
- Department of Biophysics and Radiation Biology, Semmelweis University, 1094 Budapest, Hungary; (N.H.); (D.S.V.); (D.M.)
- CROmed Translational Research Ltd., 1094 Budapest, Hungary
| | - Tibor Kovacs
- Department of Biophysics and Radiation Biology, University of Pannonia, Institute of Radiochemistry and Radioecology, 8200 Veszprém, Hungary;
| | - Gergo Bagamery
- Mediso Medical Imaging Systems Ltd., 1037 Budapest, Hungary;
| | - Balazs Juhasz
- Laboratory of Molecular Neuroendocrinology, Institute of Experimental Medicine, 1083 Budapest, Hungary; (S.F.); (D.K.); (K.H.); (B.J.); (Z.W.)
| | - Zsuzsanna Winkler
- Laboratory of Molecular Neuroendocrinology, Institute of Experimental Medicine, 1083 Budapest, Hungary; (S.F.); (D.K.); (K.H.); (B.J.); (Z.W.)
| | - Daniel S. Veres
- Department of Biophysics and Radiation Biology, Semmelweis University, 1094 Budapest, Hungary; (N.H.); (D.S.V.); (D.M.)
| | - Zsombor Zrubka
- University Research, Innovation and Service Center, University of Óbuda, 1034 Budapest, Hungary;
| | - Domokos Mathe
- Department of Biophysics and Radiation Biology, Semmelweis University, 1094 Budapest, Hungary; (N.H.); (D.S.V.); (D.M.)
- CROmed Translational Research Ltd., 1094 Budapest, Hungary
- Hungarian Center for Excellence in Molecular Medicine, 6723 Szeged, Hungary
| | - Zsolt Baranyai
- 1st Department of Surgery, Semmelweis University, 1082 Budapest, Hungary;
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Horvath K, Eisenberg D, Stone R, Anderson J, Kark J, Aviv A. Paternal Age and Transgenerational Telomere Length Maintenance: A Simulation Model. Sci Rep 2019; 9:20. [PMID: 30631124 PMCID: PMC6328556 DOI: 10.1038/s41598-018-36923-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 11/23/2018] [Indexed: 02/07/2023] Open
Abstract
Telomere length (TL) in offspring is positively correlated with paternal age at the time of the offspring conception. The paternal-age-at-conception (PAC) effect on TL is puzzling, and its biological implication at the population level is unknown. Using a probabilistic model of transgenerational TL and population dynamics, we simulated the effect of PAC on TL in individuals over the course of 1,000 years. Findings suggest a key role for an isometric PAC midpoint (PACmp) in modulating TL across generations, such that offspring conceived by males younger than the isometric PACmp have comparatively short telomeres, while offspring conceived by males older than the isometric PACmp have comparatively long telomeres. We further show that when cancer incidence escalates, the average PAC drops below the isometric PACmp and transgenerational adaptation to cancer ensues through TL shortening. We propose that PAC serves to maintain an optimal TL across generations.
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Affiliation(s)
- K Horvath
- Center of Human Development and Aging, Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, New Jersey, United States of America
| | - D Eisenberg
- Department of Anthropology, and Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington, United States of America
| | - R Stone
- Center of Human Development and Aging, Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, New Jersey, United States of America
| | - J Anderson
- University of Washington, School of Aquatic and Fishery Sciences, Seattle, Washington, United States of America
| | - J Kark
- Hebrew University-Hadassah School of Public Health and Community Medicine, Jerusalem, Israel
| | - A Aviv
- Center of Human Development and Aging, Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, New Jersey, United States of America.
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Smadi Y, Deb C, Bornstein J, Safder S, Horvath K, Mehta D. Blind esophageal brushing offers a safe and accurate method to monitor inflammation in children and young adults with eosinophilic esophagitis. Dis Esophagus 2018; 31:5037795. [PMID: 29905784 DOI: 10.1093/dote/doy056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Patients with eosinophilic esophagitis (EoE) require frequent evaluation of mucosal inflammation via endoscopy. Instead of endoscopy, mucosal evaluation in adults with esophageal cancer and candidiasis is achieved using a cytology brush inserted through a nasogastric tube (NGT). We conducted a prospective cross-sectional study in children and young adults scheduled for routine esophagogastroduodenoscopy (EGD) where in Phase 1, we performed esophageal brushing through the endoscope under direct visualization and in Phase 2, we inserted the brush through a Cortrak® NGT prior to endoscopy. Eosinophil-derived neurotoxin (EDN) measured by ELISA in the samples extracted from brushes was validated as the sensitive biomarker. We collected 209 esophageal brushing samples from 94 patients and we found that EDN in brushing samples collected via EGD or NGT was significantly higher in patients having active EoE (n = 81, mean EDN 381 mcg/mL) compared with patients having gastroesophageal reflux disease (n = 31, mean EDN 1.9 mcg/mL, P = 0.003), EoE in remission (n = 47, mean EDN 3.7 mcg/mL, P = 0.003), or no disease (n = 50, mean EDN 1.1 mcg/mL, P = 0.003). EDN at a concentration of ≥10 mcg/mL of brushing sample was found to accurately detect active EoE. NGT brushing did not cause any significant adverse effects. We concluded that blind esophageal brushing using an NGT is a fast, less invasive, safe, and well-tolerated technique compared with EGD to detect and monitor EoE inflammation using EDN as the sensitive biomarker.
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Affiliation(s)
- Y Smadi
- Center for Digestive Health and Nutrition, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - C Deb
- Gastrointestinal Translational Laboratory, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - J Bornstein
- Center for Digestive Health and Nutrition, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - S Safder
- Center for Digestive Health and Nutrition, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - K Horvath
- Center for Digestive Health and Nutrition, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - D Mehta
- Center for Digestive Health and Nutrition, Arnold Palmer Hospital for Children, Orlando, Florida, USA
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DiChiacchio L, Singh A, Chan J, Corcoran P, Lewis B, Thomas M, Ayares D, Horvath K, Horvath K, Mohiuddin M. Human Thrombomodulin Expression Confers Prolonged Graft Survival over Costimulation Blockade Alone in a Pig-to-Baboon Heterotopic Cardiac Xenotransplant Model. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.034] [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: 11/16/2022] Open
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12
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Laporta J, Fabris T, Skibiel A, Powell J, Hayen M, Horvath K, Miller-Cushon E, Dahl G. In utero exposure to heat stress during late gestation has prolonged effects on the activity patterns and growth of dairy calves. J Dairy Sci 2017; 100:2976-2984. [DOI: 10.3168/jds.2016-11993] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 12/03/2016] [Indexed: 11/19/2022]
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Agbor-Enoh S, Chan J, Tunc I, Singh A, Gorham S, Zhu J, Pirooznia M, Corcoran P, Thomas M, Lewis B, Jang M, Ayares D, Horvath K, Valantine H, Mohiuddin M. Circulating Xenograft-Derived Cell-Free DNA as a Reliable Marker for Injury After Xenotransplantation. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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14
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Abuzahra M, Semlitsch T, Horvath K, Stigler F, Posch N, Jeitler K, Siebenhofer-Kroitzsch A. Effect Of Delegation Or Substitution Of GPś Activities By Nurses– An Overview Of Systematic Reviews. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw169.064] [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: 11/14/2022] Open
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15
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Horvath K, Vultur F, Simon V, Voidazan S, Mühlfay G. Research on intraoperative iris behavior in rabbits treated with tamsulosin and finasteride. Hippokratia 2015; 19:20-24. [PMID: 26435641 PMCID: PMC4574580] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM The purpose of this study was to investigate intraoperative iris behavior during some phacoemulsification maneuvers in rabbits treated with tamsulosin or finasteride. MATERIAL AND METHOD An experimental study was conducted on 26 Metis male rabbits aged 1.5 - 2 years, body weight between 3.4 and 5.6 kg, divided into three groups: Group 1 - Control, 6 rabbits; Group 2 - tamsulosin, 10 rabbits; Group 3 - finasteride, 10 rabbits. Dose calculation was performed according to body surface area ratio man/rabbit, taking into account the median lethal dose LD50. Surgery study in rabbits was done over two days by the same specialist using an adapted protocol. He was not informed before or during surgeries which group the animal belonged to, the order being random with a quasi-uniform distribution. Valid results for a modified iris behavior were obtained from two steps of the procedure (cannula irrigation maneuver and irrigation-aspiration). The iris billowing was graded from 0 to 3, according to severity. RESULTS The risk of intraoperative iris billowing was higher in rabbits included in tamsulosin group [OR=8.33 (CI 95% 0.63-110.09)], but insignificant statistically compare with control group (p= 0.13). In rabbits treated with finasteride the risk of intraoperative iris billowing is increased compared with those without treatment [OR=11.6 (CI 95% 0.92-147.6)], but insignificant statistically (p= 0.11). CONCLUSION In our research, we showed an increased risk of intraoperative iris billowing in rabbits treated with finasteride, almost similar with those obtained in rabbits treated with tamsulosin. Further experimental or clinical studies to confirm the role of finasteride in the etiology of intraoperative floppy iris syndrome in humans are needed. Hippokratia 2015, 19 (1): 20-24.
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Affiliation(s)
- K Horvath
- Department of Ophthalmology, University of Medicine and Pharmacy
| | - F Vultur
- Department of Ophthalmology, University of Medicine and Pharmacy
| | | | - S Voidazan
- Department of Epidemiology, University of Medicine and Pharmacy
| | - Gh Mühlfay
- Department of Otorhinolaryngology, University of Medicine and Pharmacy, Tirgu-Mures, Romania
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Singh A, Corcoran P, Thomas M, Lewis B, Ayares D, Reimann K, Horvath K, Mohiuddin M. Costimulation Blockade With Anti CD40 Antibody Maintains CD4+ and Treg Cell Numbers in Pig To Baboon Cardiac Transplantation Model. Transplantation 2014. [DOI: 10.1097/00007890-201407151-00096] [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: 11/25/2022]
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17
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Horvath K, Acs P, Bosnyák E, Deli G, Pál E, Késmárki I, Takács K, Komoly S, Bokor M, Rigó E, Lajtos J, Klivényi P, Dibó G, Vécsei L, Takáts A, Tóth A, Imre P, Nagy F, Herceg M, Hidasi E, Kovács N. [VALIDATION OF THE HUNGARIAN MDS-UPDRS: WHY DO WE NEED A NEW PARKINSON SCALE?]. Ideggyogy Sz 2014; 67:129-134. [PMID: 26118257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) has been published in 2008 as the successor of the original UPDRS. The MDS-UPDRS organizing team developed guidelines for the development of official non-English translations consisting of four steps: translation/back-translation, cognitive pretesting, large field testing, and clinimetric analysis. The aim of this paper was to introduce the new MDS-UPDRS and its validation process into Hungarian. METHODS Two independent groups of neurologists translated the text of the MDS-UPDRS into Hungarian and subsequently back-translated into English. After the review of the back-translated English version by the MDS-UPDRS translation administration team, cognitive pretesting was conducted with ten patients. Based on the results of the initial cognitive pretesting, another round was conducted. For the large field testing phase, the Hungarian official working draft version of MDS-UPDRS was tested with 357 patients with Parkinson's disease (PD). Confirmatory factor analyses (CFA) determined whether the factor structure for the English-language MDS-UPDRS could be confirmed in data collected using the Hungarian Official Draft Version. To become an official translation, the Comparative Fit Index (CFI) had to be ≥ 0.90 compared to the English-language version. RESULTS For all four parts of the Hungarian MDS-UPDRS, the CFI was ≥ 0.94. CONCLUSION The overall factor structure of the Hungarian version was consistent with that of the English version based on the high CFIs for all the four parts of the MDS-UPDRS in the CFA; therefore, this version was designated as the "OFFICIAL GUNGARIAN VERSION OF THE MDS-UPDRS'.
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Mader JK, Olynec J, Köhler G, Horvath K, Pieber TR, Bock G. Einsatz der Insulinpumpentherapie während der Schwangerschaft von Frauen mit Diabetes mellitus Typ 1. Geburtshilfe Frauenheilkd 2012. [DOI: 10.1055/s-0032-1313665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Remenar E, Lövey J, Koltai P, Horvath K, Gödeny M, Kasler M. 8533 POSTER First Results of an Uncontrolled, Phase II Trial of Induction Chemotherapy With Cetuximab and Docetaxel-Cisplatin-5FU Followed by Cetuximab+Radiotherapy in the Responders in Locally Advanced Resectable Squamous Cell Cancer of the Head and Neck. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72175-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Affiliation(s)
- K Horvath
- Medical University of Graz, Graz, Austria.
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21
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Abstract
The publication of the scientific report of the Institute for Quality and Efficiency in Health Care (IQWiG) in Germany on the 'Comparative evaluation of the benefits and harms of different antihypertensive drug classes [diuretics, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, calcium-channel blockers and angiotensin II (AT-II) blockers] as first-choice therapy for patients with essential hypertension' raised an enormous public debate, particularly as diabetes incidence was not judged to be a patient-relevant outcome. In this assessment, the overall view of the patient-relevant results was that diuretics can be used as first-line antihypertensive treatment. Diabetes incidence is highest with diuretics, but minimal differences in fasting plasma glucose of approximately 0.28 mmol/l are magnified by the transformation of continuous blood glucose values into categorical data: with the establishment of thresholds, the diagnosis of diabetes depends on being above a certain blood glucose value. The protective cardiovascular effects of diuretics do not seem to be reduced in hypertensive patients who develop new-onset diabetes during treatment. Since blood pressure control is often worse, detection, treatment and control should be urgently improved. The debate on antihypertensive agents is mainly of scientific interest and has only minor clinical relevance for everyday patient care.
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Affiliation(s)
- A Siebenhofer
- Department of Internal Medicine, Medical University of Graz, Graz, Austria.
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22
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Berven S, Horvath K, Brooks DC. The effect of topical intraperitoneal bupivacaine on post-operative pain following laparoscopic cholecystectomy. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/13645709509152758] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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23
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Russo G, Asztalos B, Horvath K, di Benedetto A, Giandalia A, Schaefer E, Cucinotta D. Abstract: P369 INFLUENCE OF CETP TAQ IB POLYMORPHISM ON LIPID PROFILE AND HDL SUBPOPULATIONS DISTRIBUTION IN WOMEN WITH AND WITHOUT DIABETES. ATHEROSCLEROSIS SUPP 2009. [DOI: 10.1016/s1567-5688(09)70664-6] [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: 10/20/2022]
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24
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Kiss DS, Zsarnovszky A, Horvath K, Gyorffy A, Bartha T, Hazai D, Sotonyi P, Somogyi V, Frenyo LV, Diano S. Ecto-nucleoside triphosphate diphosphohydrolase 3 in the ventral and lateral hypothalamic area of female rats: morphological characterization and functional implications. Reprod Biol Endocrinol 2009; 7:31. [PMID: 19383175 PMCID: PMC2676295 DOI: 10.1186/1477-7827-7-31] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Accepted: 04/22/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Based on its distribution in the brain, ecto-nucleoside triphosphate diphosphohydrolase 3 (NTPDase3) may play a role in the hypothalamic regulation of homeostatic systems, including feeding, sleep-wake behavior and reproduction. To further characterize the morphological attributes of NTPDase3-immunoreactive (IR) hypothalamic structures in the rat brain, here we investigated: 1.) The cellular and subcellular localization of NTPDase3; 2.) The effects of 17beta-estradiol on the expression level of hypothalamic NTPDase3; and 3.) The effects of NTPDase inhibition in hypothalamic synaptosomal preparations. METHODS Combined light- and electron microscopic analyses were carried out to characterize the cellular and subcellular localization of NTPDase3-immunoreactivity. The effects of estrogen on hypothalamic NTPDase3 expression was studied by western blot technique. Finally, the effects of NTPDase inhibition on mitochondrial respiration were investigated using a Clark-type oxygen electrode. RESULTS Combined light- and electron microscopic analysis of immunostained hypothalamic slices revealed that NTPDase3-IR is linked to ribosomes and mitochondria, is predominantly present in excitatory axon terminals and in distinct segments of the perikaryal plasma membrane. Immunohistochemical labeling of NTPDase3 and glutamic acid decarboxylase (GAD) indicated that gamma-amino-butyric-acid- (GABA) ergic hypothalamic neurons do not express NTPDase3, further suggesting that in the hypothalamus, NTPDase3 is predominantly present in excitatory neurons. We also investigated whether estrogen influences the expression level of NTPDase3 in the ventrobasal and lateral hypothalamus. A single subcutaneous injection of estrogen differentially increased NTPDase3 expression in the medial and lateral parts of the hypothalamus, indicating that this enzyme likely plays region-specific roles in estrogen-dependent hypothalamic regulatory mechanisms. Determination of mitochondrial respiration rates with and without the inhibition of NTPDases confirmed the presence of NTPDases, including NTPDase3 in neuronal mitochondria and showed that blockade of mitochondrial NTPDase functions decreases state 3 mitochondrial respiration rate and total mitochondrial respiratory capacity. CONCLUSION Altogether, these results suggest the possibility that NTPDases, among them NTPDase3, may play an estrogen-dependent modulatory role in the regulation of intracellular availability of ATP needed for excitatory neuronal functions including neurotransmission.
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Affiliation(s)
- David S Kiss
- Department of Physiology & Biochemistry, Szent Istvan University Faculty of Veterinary Science, Budapest, Hungary
| | - Attila Zsarnovszky
- Department of Physiology & Biochemistry, Szent Istvan University Faculty of Veterinary Science, Budapest, Hungary
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Krisztina Horvath
- Department of Physiology & Biochemistry, Szent Istvan University Faculty of Veterinary Science, Budapest, Hungary
| | - Andrea Gyorffy
- Department of Physiology & Biochemistry, Szent Istvan University Faculty of Veterinary Science, Budapest, Hungary
| | - Tibor Bartha
- Department of Physiology & Biochemistry, Szent Istvan University Faculty of Veterinary Science, Budapest, Hungary
| | - Diana Hazai
- Department of Anatomy & Histology, Szent Istvan University Faculty of Veterinary Science, Budapest, Hungary
| | - Peter Sotonyi
- Department of Anatomy & Histology, Szent Istvan University Faculty of Veterinary Science, Budapest, Hungary
| | - Virag Somogyi
- Department of Physiology & Biochemistry, Szent Istvan University Faculty of Veterinary Science, Budapest, Hungary
| | - Laszlo V Frenyo
- Department of Physiology & Biochemistry, Szent Istvan University Faculty of Veterinary Science, Budapest, Hungary
| | - Sabrina Diano
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06510, USA
- Department of Neurobiology, Yale University School of Medicine, New Haven, CT 06510, USA
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25
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Siebenhofer A, Jeitler K, Berghold A, Horvath K, Pieber TR. Severe hypoglycaemia and glycaemic control in Type 1 diabetes: meta-analysis of multiple daily insulin injections compared with continuous subcutaneous insulin infusion. Diabet Med 2009; 26:311-2; author reply 312-3. [PMID: 19317829 DOI: 10.1111/j.1464-5491.2009.02668.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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26
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Kovacs N, Auer T, Balas I, Karadi K, Zambo K, Schwarcz A, Klivenyi P, Jokeit H, Horvath K, Nagy F, Janszky J. Neuroimaging and cognitive changes during déjà vu. Epilepsy Behav 2009; 14:190-6. [PMID: 18804184 DOI: 10.1016/j.yebeh.2008.08.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [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: 07/21/2008] [Revised: 08/28/2008] [Accepted: 08/29/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The cause or the physiological role of déjà vu (DV) in healthy people is unknown. The pathophysiology of DV-type epileptic aura is also unresolved. Here we describe a 22-year-old woman treated with deep brain stimulation (DBS) of the left internal globus pallidus for hemidystonia. At certain stimulation settings, DBS elicited reproducible episodes of DV. METHODS Neuropsychological tests and single-photon-emission computed tomography (SPECT) were performed during DBS-evoked DV and during normal DBS stimulation without DV. RESULTS SPECT during DBS-evoked DV revealed hyperperfusion of the right (contralateral to the electrode) hippocampus and other limbic structures. Neuropsychological examinations performed during several evoked DV episodes revealed disturbances in nonverbal memory. CONCLUSION Our results confirm the role of mesiotemporal structures in the pathogenesis of DV. We hypothesize that individual neuroanatomy and disturbances in gamma oscillations or in the dopaminergic system played a role in DBS-elicited DV in our patient.
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Affiliation(s)
- Norbert Kovacs
- Department of Neurology, University of Pecs, Pecs, Hungary.
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27
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Jeitler K, Horvath K, Berghold A, Gratzer TW, Neeser K, Pieber TR, Siebenhofer A. Continuous subcutaneous insulin infusion versus multiple daily insulin injections in patients with diabetes mellitus: systematic review and meta-analysis. Diabetologia 2008; 51:941-51. [PMID: 18351320 DOI: 10.1007/s00125-008-0974-3] [Citation(s) in RCA: 226] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Accepted: 02/05/2008] [Indexed: 12/13/2022]
Abstract
AIMS We compared the effects of continuous subcutaneous insulin infusion (CSII) with those of multiple daily insulin (MDI) injections on glycaemic control, risk of hypoglycaemic episodes, insulin requirements and adverse events in type 1 and type 2 diabetes mellitus. METHODS The electronic databases MEDLINE, EMBASE and CENTRAL were systematically searched for randomised controlled trials up to March 2007. A systematic review and meta-analysis were performed. RESULTS Overall, 22 studies were included (17 on type 1 diabetes mellitus, two on type 2 diabetes mellitus, three on children). With regard to adults with type 1 diabetes mellitus, our meta-analysis found a between-treatment difference of -0.4% HbA(1c) (six studies) in favour of CSII therapy. Available median rates of mild or overall hypoglycaemic events were comparable between the different interventions (1.9 [0.9-3.1] [CSII] vs 1.7 [1.1-3.3] [MDI] events per patient per week). Total daily insulin requirements were lower with CSII than with MDI therapy. In patients with type 2 diabetes mellitus, CSII and MDI treatment showed no statistically significant difference for HbA(1c). The incidence of mild hypoglycaemic events was comparable between the treatment groups. In adolescents with type 1 diabetes mellitus, glycated haemoglobin and insulin requirements were significantly lower in the CSII groups; no data were available on hypoglycaemic events. The only study performed in younger children did not provide enough data for conclusive inferences. No overall conclusions were possible for severe hypoglycaemia and adverse events for any of the different patient groups due to rareness of such events, different definitions and insufficient reporting. CONCLUSIONS/INTERPRETATION CSII therapy in adults and adolescents with type 1 diabetes mellitus resulted in a greater reduction of glycated haemoglobin, in adult patients without a higher rate of hypoglycaemia. No beneficial effect of CSII therapy could be detected for patients with type 2 diabetes mellitus.
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Affiliation(s)
- K Jeitler
- Diabetes and Metabolism Outpatient Clinic, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
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28
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Horvath K, Bock G, Regittnig W, Bodenlenz M, Wutte A, Plank J, Magnes C, Sinner F, Fürst-Recktenwald S, Theobald K, Pieber TR. Insulin glulisine, insulin lispro and regular human insulin show comparable end-organ metabolic effects: an exploratory study. Diabetes Obes Metab 2008; 10:484-91. [PMID: 17764465 DOI: 10.1111/j.1463-1326.2007.00734.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS To compare the end-organ metabolic effects of insulin glulisine (glulisine), insulin lispro (lispro) and regular human insulin (RHI) in patients with type 1 diabetes mellitus. METHODS Eighteen patients with type 1 diabetes mellitus (mean age 36.9 +/- 8.6 years, BMI 23.6 +/- 2.8 kg/m(2), haemoglobin A(1c) 7.4 +/- 0.9%) were randomized in this single-centre, double-blind, three-period cross-over, standard Latin-square, euglycaemic glucose clamp trial. Patients received sequential, primed stepwise intravenous infusions of glulisine, lispro or RHI (infusion rates were increased in a stepwise manner from an initial rate of 0.33 [180 min] to 0.66 [180 min] and 1.00 [180 min] mU/kg/min). The primary variables were the suppression of endogenous glucose production (S(EGP)) and glucose uptake (GU). RESULTS Mean basal endogenous glucose production (EGP) was 1.88, 2.12 and 2.12 mg/kg/min for glulisine, lispro and RHI respectively. Mean (+/-s.e.) maximum absolute S(EGP) (adjusted for basal EGP) was -1.64 +/- 0.06, -1.72 +/- 0.05 and -1.56 +/- 0.05 mg/kg/min respectively. Mean (+/-s.e.) maximum absolute increase in GU (adjusted for basal GU) was 6.46 +/- 0.26, 6.23 +/- 0.24 and 6.72 +/- 0.24 mg/kg/min respectively. There were no clinically relevant differences between the three insulin treatments with respect to serum insulin, free fatty acid (FFA), glycerol or lactate levels. No serious adverse events and no episodes of severe hypoglycaemia were reported. CONCLUSIONS This study shows that glulisine, lispro and RHI have similar effects on S(EGP), GU, FFA, glycerol and lactate levels, providing evidence for similar end-organ metabolic effects.
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Affiliation(s)
- K Horvath
- Department of Internal Medicine, Medical University of Graz, Graz, Austria.
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29
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Whittle BJR, Varga C, Berko A, Horvath K, Posa A, Riley JP, Lundeen KA, Fourie AM, Dunford PJ. Attenuation of inflammation and cytokine production in rat colitis by a novel selective inhibitor of leukotriene A4 hydrolase. Br J Pharmacol 2007; 153:983-91. [PMID: 18157165 DOI: 10.1038/sj.bjp.0707645] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND PURPOSE Leukotriene B(4) (LTB(4)), formed by the sequential actions of the 5-lipoxygenase (5-LO) and leukotriene A(4) hydrolase (LTA(4)H), is a pro-inflammatory mediator implicated in the pathogenesis of inflammatory bowel disease. However, inhibitors of 5-LO have not proved to be consistent in their therapeutic efficacy in colitis. Another approach to inhibiting LTB(4) synthesis is through the use of inhibitors of LTA(4)H, such as the novel, potent and selective compound, JNJ 26993135. EXPERIMENTAL APPROACH The effect of oral administration of JNJ 26993135 has been evaluated in a rat model of colitis provoked by colonic instillation of trinitrobenzenesulphonic acid (TNBS). The extent and severity of the macroscopic inflammatory response, the colonic levels of myeloperoxidase (MPO) and LTB(4) and of the pro-inflammatory cytokines, tumour necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) were measured. KEY RESULTS Oral administration of JNJ 26993135 (5, 15 and 30 mg kg(-1), twice a day) dose-dependently reduced both the extent and intensity of the colonic inflammatory damage observed 3 days after TNBS challenge. JNJ 26993135 also dose-dependently reduced the elevated colonic levels of LTB(4), as well as the inflammatory biomarkers, MPO, IL-6 and TNF-alpha. This dosing regimen was supported by the pharmacokinetic profile of JNJ 26993135, along with the demonstration of the inhibition of ex vivo production of LTB(4) in whole blood following oral administration. CONCLUSIONS AND IMPLICATIONS These results with JNJ 26993135 in the rat TNBS model support the role of LTB(4) in colitis and the potential value of targeting LTA(4)H for the treatment of inflammatory bowel diseases.
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Affiliation(s)
- B J R Whittle
- William Harvey Research Institute, Barts and the London, Queen Mary's School of Medicine, Charterhouse Square, London, UK.
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Horvath K, Jeitler K, Berghold A, Ebrahim SH, Gratzer TW, Plank J, Kaiser T, Pieber TR, Siebenhofer A. Long-acting insulin analogues versus NPH insulin (human isophane insulin) for type 2 diabetes mellitus. Cochrane Database Syst Rev 2007:CD005613. [PMID: 17443605 DOI: 10.1002/14651858.cd005613.pub3] [Citation(s) in RCA: 173] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite indications from epidemiological trials that higher blood glucose concentrations are associated with a higher risk for developing micro- and macrovascular complications, evidence for a beneficial effect of antihyperglycaemic therapy in patients with type 2 diabetes mellitus is conflicting. Two large studies, the United Kingdom Prospective Diabetes Study (UKPDS) and the University Group Diabetes Program (UGDP), did not find a reduction of cardiovascular endpoints through improvement of metabolic control. The theoretical benefits of newer insulin analogues might result in fewer macrovascular and microvascular events. OBJECTIVES To assess the effects of long-term treatment with long-acting insulin analogues (insulin glargine and insulin detemir) compared to NPH insulin in patients with type 2 diabetes mellitus. SEARCH STRATEGY Studies were obtained from computerised searches of MEDLINE, EMBASE, The Cochrane Library and communication with experts in the field as well as insulin producing companies. SELECTION CRITERIA Studies were included if they were randomised controlled trials in adults with diabetes mellitus type 2 and had a trial duration of at least 24 weeks. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality and extracted data. Pooling of studies by means of random-effects meta-analyses was performed. MAIN RESULTS Six studies comparing insulin glargine to NPH (Neutral Protamine Hagedorn) insulin and two studies comparing insulin detemir to NPH insulin were identified. In these trials, 1715 patients were randomised to insulin glargine and 578 patients to insulin detemir. Duration of the included trials ranged from 24 to 52 weeks. Metabolic control, measured by glycosylated haemoglobin A1c (HbA1c) as a surrogate endpoint, and adverse effects did not differ in a clinical relevant way between treatment groups. While no statistically significant difference for severe hypoglycaemia rates was shown in any of the trials, the rate of symptomatic, overall and nocturnal hypoglycaemia was statistically significantly lower in patients treated with either insulin glargine or detemir. No evidence for a beneficial effect of long-acting analogues on patient-oriented outcomes like mortality, morbidity, quality of life or costs could be obtained. AUTHORS' CONCLUSIONS Our analysis suggests, if at all only a minor clinical benefit of treatment with long-acting insulin analogues for patients with diabetes mellitus type 2 treated with "basal" insulin regarding symptomatic nocturnal hypoglycaemic events. Until long-term efficacy and safety data are available, we suggest a cautious approach to therapy with insulin glargine or detemir.
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Affiliation(s)
- K Horvath
- Medical University Graz, Department of Internal Medicine, Auenbruggerplatz 15, Graz,Austria, 8036.
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Möbius C, Max D, Uhlmann D, Gumpp K, Behrbohm J, Horvath K, Hauss J, Witzigmann H. Five-year follow-up of a prospective non-randomised study comparing duodenum-preserving pancreatic head resection with classic Whipple procedure in the treatment of chronic pancreatitis. Langenbecks Arch Surg 2007; 392:359-64. [PMID: 17375317 DOI: 10.1007/s00423-007-0175-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [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: 11/25/2006] [Accepted: 02/13/2007] [Indexed: 01/02/2023]
Abstract
BACKGROUND Three prospective randomised studies were conducted to compare pancreatoduodenectomy (PD) with duodenum-preserving pancreatic head resection (DPPHR) in patients suffering from chronic pancreatitis (cP). In these three series, the superiority of the duodenum-preserving technique with regard to quality of life (QOL) and pain relief has been demonstrated. Long-term follow-up investigations have not been published so far. The present paper reports on a 5-year follow-up study of a prospective, non-randomised trial comparing classic Whipple procedure (PD) with Beger DPPHR. MATERIALS AND METHODS Seventy patients were initially enrolled in this study. Fifty-one patients were left for the present long-term outcome analysis (PD, n = 24; DPPHR, n = 27). The follow-up included the following parameters: QOL, pain intensity, endocrine and exocrine function, and body mass index (BMI). RESULTS The median follow-up was 63.5 (range 56-67) months. Two patients in the DPPHR group and none in the PD group underwent a re-operation. The QOL scores of the relevant symptom scales (nausea, pain, diarrhoea) and functional parameters (physical status, working ability, global QOL) were significantly better in the DPPHR group than in the PD group. Pain intensity as self-assessed by the patients was less pronounced in the DPPHR group (P < 0.001), whereas the frequency of acute episodes and analgesic medication did not differ between the two groups. No difference was observed between the two groups with regard to endocrine and exocrine function. The values of the median body mass index (BMI) in the PD group [23.4 (range 18.5-25.0) kg/m(2)] and in the DPPHR group [24.2 (range 17.9-27.8) kg/m(2)] were comparable. The 5-year outcome remained stable compared to the early post-operative data published elsewhere. CONCLUSION This 5-year long-term outcome analysis documents the superiority of the Beger duodenum-preserving technique over the classic Whipple procedure in terms of QOL and pain intensity as self-assessed by the patients.
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Affiliation(s)
- C Möbius
- Department of Surgery II, University of Leipzig, Leipzig, Germany
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Varga C, Laszlo F, Fritz P, Cavicchi M, Lamarque D, Horvath K, Posa A, Berko A, Whittle BJR. Modulation by heme and zinc protoporphyrin of colonic heme oxygenase-1 and experimental inflammatory bowel disease in the rat. Eur J Pharmacol 2007. [PMID: 17292349 DOI: 10.1016/j.ejphar.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
Reactive oxygen species, suggested to be involved in inflammatory bowel disease, may be modulated by endogenous anti-oxidant products of heme oxygenase-1 (HO-1). In the present work, HO-1 expression in trinitrobenzene sulphonic acid (TNBS)-induced colitis in the rat and the effects of HO-1 modulation, particularly by the HO-1 inducer, heme, were further evaluated. Colitis was induced by intracolonic challenge with TNBS and assessed macroscopically and by myeloperoxidase (MPO) assay. Heme oxygenase activity was determined by measurement of bilirubin formation and HO-1 protein expression was determined by Western blotting. TNBS challenge led to an early and substantial induction of HO-1 protein expression and heme oxygenase activity in the colon that peaked after 48-72 h and declined over 10 days. Heme (30 micromol/kg/day, s.c) increased colonic HO-1 protein expression and enzyme activity and decreased colonic damage and myeloperoxidase activity. Short-term administration of cadmium chloride (2 mg/kg, s.c.), another known HO-1 inducer, also reduced the colonic injury and myeloperoxidase levels. In contrast, the HO-1 inhibitor, zinc protoporphyrin (50 micromol/kg/day, s.c) significantly increased the colonic damage and myeloperoxidase activity over 10 days, as did tin protoporphyrin (30 micromol/kg/day, s.c). These results support the proposal that induction of HO-1 provides a protective mechanism in this model under both acute and more-chronic conditions, and that its selective up-regulation could thus be of therapeutic potential in colitis.
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Affiliation(s)
- Csaba Varga
- Department Comparative Physiology, Faculty of Sciences, University Szeged, Szeged, Hungary.
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Varga C, Laszlo F, Fritz P, Cavicchi M, Lamarque D, Horvath K, Posa A, Berko A, Whittle BJR. Modulation by heme and zinc protoporphyrin of colonic heme oxygenase-1 and experimental inflammatory bowel disease in the rat. Eur J Pharmacol 2007; 561:164-71. [PMID: 17292349 DOI: 10.1016/j.ejphar.2006.12.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2006] [Revised: 12/20/2006] [Accepted: 12/21/2006] [Indexed: 01/12/2023]
Abstract
Reactive oxygen species, suggested to be involved in inflammatory bowel disease, may be modulated by endogenous anti-oxidant products of heme oxygenase-1 (HO-1). In the present work, HO-1 expression in trinitrobenzene sulphonic acid (TNBS)-induced colitis in the rat and the effects of HO-1 modulation, particularly by the HO-1 inducer, heme, were further evaluated. Colitis was induced by intracolonic challenge with TNBS and assessed macroscopically and by myeloperoxidase (MPO) assay. Heme oxygenase activity was determined by measurement of bilirubin formation and HO-1 protein expression was determined by Western blotting. TNBS challenge led to an early and substantial induction of HO-1 protein expression and heme oxygenase activity in the colon that peaked after 48-72 h and declined over 10 days. Heme (30 micromol/kg/day, s.c) increased colonic HO-1 protein expression and enzyme activity and decreased colonic damage and myeloperoxidase activity. Short-term administration of cadmium chloride (2 mg/kg, s.c.), another known HO-1 inducer, also reduced the colonic injury and myeloperoxidase levels. In contrast, the HO-1 inhibitor, zinc protoporphyrin (50 micromol/kg/day, s.c) significantly increased the colonic damage and myeloperoxidase activity over 10 days, as did tin protoporphyrin (30 micromol/kg/day, s.c). These results support the proposal that induction of HO-1 provides a protective mechanism in this model under both acute and more-chronic conditions, and that its selective up-regulation could thus be of therapeutic potential in colitis.
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Affiliation(s)
- Csaba Varga
- Department Comparative Physiology, Faculty of Sciences, University Szeged, Szeged, Hungary.
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Horvath K, Brody F, Davis B, Vitale G, Burtin P, Waschke KA, Callery M. Minimally invasive management of pancreatic disease: SAGES and SSAT pancreas symposium, Ft. Lauderdale, Florida, April 2005. Surg Endosc 2006; 21:367-72. [PMID: 17103282 DOI: 10.1007/s00464-006-9023-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Revised: 06/09/2006] [Accepted: 07/05/2006] [Indexed: 12/17/2022]
Affiliation(s)
- K Horvath
- Department of Surgery, University of Washington, Seattle, WA, USA
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Siebenhofer A, Plank J, Berghold A, Jeitler K, Horvath K, Narath M, Gfrerer R, Pieber TR. Short acting insulin analogues versus regular human insulin in patients with diabetes mellitus. Cochrane Database Syst Rev 2006:CD003287. [PMID: 16625575 DOI: 10.1002/14651858.cd003287.pub4] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [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: 12/11/2022]
Abstract
BACKGROUND Short acting insulin analogue use for diabetic patients is still controversial, as reflected in many scientific debates. OBJECTIVES To assess the effects of short acting insulin analogues versus regular human insulin. SEARCH STRATEGY The Cochrane Library (Issue 3, 2005), MEDLINE, EMBASE until September 2005. SELECTION CRITERIA Randomised controlled trials with an intervention duration of at least 4 weeks. DATA COLLECTION AND ANALYSIS Trial selection and evaluation of study quality was done independently by two reviewers. MAIN RESULTS Altogether 8274 participants took part in 49 randomised controlled studies. Most studies were of poor methodological quality. In patients with type 1 diabetes, the weighted mean difference (WMD) of HbA1c was -0.1% (95% CI: -0.2 to -0.1) in favour of insulin analogue, whereas in patients with type 2 diabetes the WMD was 0.0% (95% CI: -0.1 to 0.0). In subgroup analyses of different types of interventions in type 1 diabetic patients, the WMD in HbA1c was -0.2% (95% CI: -0.3 to -0.1) in favour of insulin analogue in studies using continuous subcutaneous insulin injections (CSII), whereas for conventional intensified insulin therapy (IIT) studies the WMD in HbA1c was -0.1% (95% CI: -0.1 to 0.0). The WMD of the overall mean hypoglycaemic episodes per patient per month was -0.2 (95% CI: -1.1 to 0.7) and -0.2 (95% CI: -0.5 to 0.1) for analogues in comparison to regular insulin in patients with type 1 diabetes and type 2 diabetes, respectively. For studies in type 1 diabetes patients the incidence of severe hypoglycaemia ranged from 0 to 247.3 (median 21.8) episodes per 100 person-years for insulin analogues and from 0 to 544 (median 46.1) for regular insulin, in type 2 the incidence ranged from 0 to 30.3 (median 0.3) episodes per 100 person-years for insulin analogues and from 0 to 50.4 (median 1.4) for regular insulin. No study was designed to investigate possible long term effects (e.g. mortality, diabetic complications), in particular in patients with diabetes related complications. AUTHORS' CONCLUSIONS Our analysis suggests only a minor benefit of short acting insulin analogues in the majority of diabetic patients treated with insulin. Until long term efficacy and safety data are available we suggest a cautious response to the vigorous promotion of insulin analogues. For safety purposes, we need a long-term follow-up of large numbers of patients and well designed studies in pregnant women to determine the safety profile for both the mother and the unborn child.
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Affiliation(s)
- A Siebenhofer
- Leopold Auenbrugger Medical University of Graz, University of Medicine, Auenbruggerplatz 15, Graz, Austria, 8036.
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Horvath K, Jeitler K, Berghold A, Plank J, Pieber TR, Siebenhofer A. Long acting insulin analogues versus NPH insulin (human isophane insulin) for type 2 diabetes mellitus. Hippokratia 2006. [DOI: 10.1002/14651858.cd005613] [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: 11/06/2022]
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Varga C, Horvath K, Berko A, Thurmond RL, Dunford PJ, Whittle BJR. Inhibitory effects of histamine H4 receptor antagonists on experimental colitis in the rat. Eur J Pharmacol 2005; 522:130-8. [PMID: 16213481 DOI: 10.1016/j.ejphar.2005.08.045] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2005] [Revised: 07/01/2005] [Accepted: 08/18/2005] [Indexed: 11/23/2022]
Abstract
The histamine H(4) receptor is a G-protein coupled receptor with little homology to the pro-inflammatory histamine H(1) receptor, expressed on cells of the immune system with hematopoietic lineage such as eosinophils and mast cells. The effects of the recently described highly selective histamine H(4) receptor antagonists JNJ 10191584 and JNJ 7777120 have now been investigated on the acute colitis provoked by trinitrobenzene sulphonic acid over 3 days in the rat. Treatment with JNJ 10191584 (10-100 mg/kg p.o., b.i.d.) caused a dose-dependent reduction in macroscopic damage, inhibition of the TNBS-provoked elevation of both colonic myeloperoxidase and tumour necrosis factor-alpha (TNF-alpha), and a reduction in the histologically assessed increase in mucosal and submucosal thickness and neutrophil infiltration. JNJ 7777120 (100 mg/kg p.o., b.i.d.) likewise reduced the macroscopic injury and the increases in colonic myeloperoxidase and TNF-alpha levels. These findings indicate a pro-inflammatory role for the histamine H(4) receptor in this model and suggest a novel pharmacological approach to the treatment of colitis.
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Affiliation(s)
- Csaba Varga
- Department of Comparative Physiology, Szeged University, Hungary
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Siebenhofer A, Plank J, Berghold A, Horvath K, Sawicki PT, Beck P, Pieber TR. Meta-analysis of short-acting insulin analogues in adult patients with type 1 diabetes: continuous subcutaneous insulin infusion versus injection therapy. Diabetologia 2004; 47:1895-905. [PMID: 15599696 DOI: 10.1007/s00125-004-1545-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2004] [Accepted: 04/19/2004] [Indexed: 10/26/2022]
Abstract
AIMS/HYPOTHESIS This study aimed to compare the effect of treatment with short-acting insulin (SAI) analogues versus structurally unchanged short-acting insulin (regular insulin) on glycaemic control and on the risk of hypoglycaemic episodes in type 1 diabetic patients using different insulin treatment strategies. METHODS We performed a meta-analysis of 27 randomised controlled trials that compared the effect of SAI analogues with regular insulin in patients with type 1 diabetes mellitus. The treatments were administered either via continuous subcutaneous insulin infusion (CSII) or by conventional intensified insulin therapy (IIT) with short-acting insulin injections before meals and basal insulin administered once or twice daily in most cases. RESULTS HbA(1)c levels were reported for 20 studies. For studies using CSII, the weighted mean difference between values obtained using SAI analogues and regular insulin was -0.19% (95% CI: -0.27 to -0.12), whereas the corresponding value for injection studies was -0.08% (95% CI: -0.15 to -0.02). For the analysis of overall hypoglycaemia, we used the results from nine studies that reported the mean frequency of hypoglycaemic episodes per patient per month. For studies using CSII, the standardised mean difference between SAI analogues and regular insulin was -0.07 (95% CI: -0.43 to 0.28), whereas for IIT studies the corresponding value was -0.04 (95% CI: -0.24 to 0.16). CONCLUSIONS/INTERPRETATION Taking into consideration the low quality of the trials included, we can conclude that use of a short-acting insulin analogue in CSII therapy provides a small, but statistically significant improvement in glycaemic control compared with regular insulin. An even smaller effect was obtained with the use of ITT. The rate of overall hypoglycaemic episodes was not significantly reduced with short-acting insulin analogues in either injection regimen.
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Affiliation(s)
- A Siebenhofer
- Division of Diabetes and Metabolism, Department of Internal Medicine, Medical University, Leopold Auenbrugger University Hospital, Auenbruggerplatz 15, 8036 Graz, Austria.
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Plank J, Köhler G, Rakovac I, Semlitsch BM, Horvath K, Bock G, Kraly B, Pieber TR. Long-term evaluation of a structured outpatient education programme for intensified insulin therapy in patients with Type 1 diabetes: a 12-year follow-up. Diabetologia 2004; 47:1370-5. [PMID: 15258736 DOI: 10.1007/s00125-004-1456-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2004] [Accepted: 06/10/2004] [Indexed: 10/26/2022]
Abstract
AIMS/HYPOTHESIS This study was conducted to evaluate the long-term outcome of a structured outpatient diabetes teaching and treatment programme (DTTP) for intensified insulin therapy in patients with Type 1 diabetes, which aims to improve metabolic control without increasing the risk of severe hypoglycaemia. METHODS All 123 diabetic outpatients (age 41+/-14 years; 64 women; BMI 23.5+/-3.1; diabetes duration 17+/-11 years; HbA1c 7.9+/-1.6%; 32 patients with a history of severe hypoglycaemia; 18 with overt nephropathy; 22 with proliferative retinopathy) who participated in the DTTP between June 1989 and June 1990 were invited for follow-up visits after 3, 6 and 12 years. RESULTS Out of the 123 patients, 11 died during the follow-up period, two were lost for follow-up, and one was not willing to participate in re-evaluation after 12 years. Mean HbA1c levels decreased from 7.9+/-1.6% to 7.1+/-1.2% (p<0.01) after 3 years, and were 7.8+/-1.5% (NS) and 7.8+/-1.2% (NS) after 6 and 12 years respectively. Frequency of hypoglycaemia decreased from 0.49 episodes per patient per year to 0.14 after 3 years (p<0.01), 0.19 after 6 years (p<0.01) and 0.16 after 12 years (p<0.01). Of the participants, 41% were able to lower HbA1c levels without episodes of severe hypoglycaemia and to maintain this improvement at all follow-up visits over the 12-year period. At follow-up, intensified insulin therapy was carried out by 94% of the patients. CONCLUSIONS/INTERPRETATION A sustained reduction of the incidence of severe hypoglycaemia was observed in patients with Type 1 diabetes after participation in a structured outpatient DTTP over a 12-year period.
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Affiliation(s)
- J Plank
- Division of Diabetes and Metabolism, Department of Internal Medicine, Medical University Hospital, Graz, Austria.
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Neri E, Not T, Horvath K, Kryszak D, Drago S, Di Pierro MR, Tommasini A, Ventura A, Fasano A. Human tissue transglutaminase ELISA and an old study: a revision of the blood donor screening study for coeliac disease in the USA. Scand J Gastroenterol 2004; 39:195-7. [PMID: 15000284 DOI: 10.1080/00365520310007530] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- E Neri
- Center for Celiac Research, University of Maryland at Baltimore, USA.
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Siebenhofer A, Plank J, Horvath K, Berghold A, Sutton AJ, Sommer R, Pieber TR. Angiotensin receptor blockers as anti-hypertensive treatment for patients with diabetes mellitus: meta-analysis of controlled double-blind randomized trials. Diabet Med 2004; 21:18-25. [PMID: 14706049 DOI: 10.1111/j.1464-5491.2004.01122.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To assess the evidence for possible reduction of all-cause mortality, cardiovascular morbidity and mortality, and end-stage renal disease in diabetic patients treated with angiotensin II type 1 receptor blockers (ARBs) as an anti-hypertensive treatment. METHODS Systematic review and meta-analysis of randomized, double-blind controlled trials of at least 1 year's duration. ARBs were used in the intervention group vs. placebo or standard anti-hypertensive treatment in the control group. The main outcome measures were all-cause mortality, cardiovascular morbidity and mortality, and end-stage renal disease. RESULTS Three studies fulfilled the inclusion criteria. Separate analyses were conducted for comparisons of ARBs with groups given placebo and those given standard anti-hypertensive treatment. There was no significant difference in mortality between the ARBs and placebo groups, with an estimated odds ratio (OR) of 0.99 [95% confidence interval (CI) 0.81, 1.20]. There was a non-significant difference in patients treated with ARBs compared with standard anti-hypertensive treatment, with an OR of 0.78 (95% CI 0.45, 1.36). No statistically significant difference in cardiovascular morbidity and mortality between the intervention and placebo groups was found, with an OR of 0.91 (95% CI 0.77, 1.08). When ARBs were compared with standard treatment, the OR was estimated at 0.85 (0.54, 1.33). Data on end-stage renal disease were available for two studies comparing ARBs vs. placebo and showed a statistically significant advantage of ARBs, with an OR of 0.73 (95% CI 0.6, 0.89). As only one study compared end-stage renal disease outcome for ARBs vs. standard treatment, a meta-analysis was not possible. This study reported a considerable benefit of ARBs [OR = 0.73 (0.54, 1.01)] compared with the calcium channel blocker amlodipine. CONCLUSIONS ARBs failed to show significant reduction in total mortality and cardiovascular morbidity and mortality in diabetic patients. The only statistical benefit was the reduction of end-stage renal disease compared with placebo. Therefore, at this time ARBs have not proved to be superior to standard anti-hypertensive treatment in diabetic patients.
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Affiliation(s)
- A Siebenhofer
- Department of Internal Medicine, Division of Diabetes and Metabolism, Karl-Franzens University Hospital, Graz, Austria.
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Spertus JA, Jones PG, Coen M, Garg M, Bliven B, O'Keefe J, March RJ, Horvath K. Transmyocardial CO(2) laser revascularization improves symptoms, function, and quality of life: 12-month results from a randomized controlled trial. Am J Med 2001; 111:341-8. [PMID: 11583635 DOI: 10.1016/s0002-9343(01)00878-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To describe differences in health status (symptoms, physical function, and quality of life) between continued medical management and transmyocardial revascularization with a carbon dioxide laser in patients with severe, symptomatic, inoperable coronary artery disease. SUBJECTS AND METHODS This prospective, multicenter trial randomized 98 patients to transmyocardial revascularization and 99 to continued medical therapy. Health status was assessed with the Seattle Angina Questionnaire and the Short Form-36 at baseline and at 3, 6, and 12 months. A new analytic technique, the benefit statistic, was developed to facilitate interpretability of disease-specific health status assessments over time. RESULTS Of the 99 patients assigned to medical therapy, 59 (60%) subsequently underwent transmyocardial revascularization. By an intention-to-treat analysis, patients initially randomized to transmyocardial revascularization had 44% of their angina eliminated versus 21% for the medical treatment group (difference = 23%; 95% confidence interval [CI], 11% to 34%). Differences in the benefits of transmyocardial revascularization on physical limitations (33% vs 11% in the medical arm [difference = 23%; 95% CI, 15% to 31%]) and quality of life (47% vs 20% in the medical arm [difference = 26%; 95% CI, 18% to 35%]) were similarly large. These benefits were apparent at 3 months and sustained throughout the 1 year of follow-up. An efficacy analysis that excluded patients who crossed over from the medical treatment to transmyocardial revascularization arm suggested greater treatment benefits. CONCLUSIONS Transmyocardial revascularization may offer a valuable palliative alternative to patients with severe limitations in health status for whom no standard revascularization options exist.
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Affiliation(s)
- J A Spertus
- Section of Cardiology, Mid America Heart Institute/University of Missouri--Kansas City 64111, USA
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Planet WG, Miller AJ, Horvath K, Nagatani R, Flynn LE, Hilsenrath E, Kondragunta S, Cebula RP, DeLand MT. Total ozone determinations from National Oceanic and Atmospheric Administration operational solar backscattered ultraviolet 2 instrument observations: An update. ACTA ACUST UNITED AC 2001. [DOI: 10.1029/2000jd900729] [Citation(s) in RCA: 6] [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: 11/09/2022]
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Abstract
OBJECTIVE Macroamylasemia is considered to be rarely associated with celiac disease (CD). We have evaluated patients in whom macroamylasemia or elevated total amylase (TA) led to the diagnosis of CD. These cases served as a catalyst for examining the prevalence of elevated TA and macroamylase (MA) in patients with active CD. METHOD Total amylase and MA measurements were performed in the sera of 124 celiac patients with positive antiendomysium and tissue transglutaminase tests, in 100 patients on gluten-free diet (GFD) with negative serology test results, and in the sera of 89 healthy controls. Macroamylasemia was measured by using the PEG precipitation method. RESULTS Twenty-three newly diagnosed celiac patients had elevated serum amylase levels (>2 SD above the controls). The average TA and MA levels were significantly elevated in both celiac groups. The nonprecipitated amylase levels (pancreatic and salivary amylase fractions) were not different from those of the controls. Three controls (3.4%), 21 newly diagnosed celiac (16.8%), and seven patients on GFD (7%) had significantly elevated MA activity in their sera. CONCLUSIONS A significant percentage of the newly diagnosed patients with CD have macroamylasemia. Serum MA remained elevated in some patients on strict GFD. In addition, in the presence of an elevated amylase or MA the possibility of CD should be considered.
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Affiliation(s)
- A Rabsztyn
- Department of Pediatrics, University of Maryland at Baltimore, USA
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Sievert H, Horvath K, Zadan E, Krumsdorf U, Fach A, Merle H, Scherer D, Schräder R, Spies H, Nowak B, Lissmann-Jensen H. Patent foramen ovale closure in patients with transient ischemia attack/stroke. J Interv Cardiol 2001; 14:261-6. [PMID: 12053315 DOI: 10.1111/j.1540-8183.2001.tb00745.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Paradoxical embolism through a patent foramen ovale (PFO) has been recognized as a potential cause of transient ischemia attack (TIA) and stroke especially in younger patients. The therapeutic options are medical treatment (antiaggregation or anticoagulation) with an annual recurrence rate of 3% to 4% for stroke or TIA, surgical PFO closure, or catheter closure. Randomized studies are ongoing; however, the results will not be available soon. Since August 1994, we have attempted catheter closure of a PFO in 281 patients (age 17 to 79 years, mean 46.8 +/- 13.2) with paradoxical embolism. Of these, 184 patients had at least one embolic stroke, 112 patients at least one TIA, and 15 patients at least one peripheral embolism. The diameter of the PFO, measured with a balloon catheter, ranged from 3 mm to 24 mm with a mean of 10 +/- 3.5 mm. Implantation of the occluder was technically successful in all patients (two attempts in four patients). Seven different devices were used: 26 Sideris buttoned, 11 ASDOS, 19 Angel Wings, 98 PFO-Star, 37 Cardioseal-Starflex, 57 Amplatzer and, 33 Helex devices. One patient suffered from septicemia and subsequently died. In 2 patients, device embolization occurred during or after the procedure (1 Sideris, 1 PFO-Star; catheter retrieval successful). Thirty-seven patients had other minor complications without long-term sequelae: atrial fibrillation within the first weeks after implantation in five patients, asymptomatic thrombus on the device at routine transesophageal echocardiogram (TEE) in 7 patients (1 Angel Wings, 1 ASDOS, 1 CardioSeal, 4 PFO-Star), and device frame fracture in 25 patients (2 Sideris, 4 ASDOS, 1 Angel Wings, 1 CardioSeal, 17 PFO-Star). No complications occurred with the newer devices (Amplatzer and Helex). A residual shunt after 6 months was found in 5.5% of the patients who had completed their 6-month TEE follow-up. In two patients, a second occluder was implanted because of a residual shunt. During a follow-up period of 1 month to 71 months (mean 12 +/- 16 months, 268 patient years), a recurrence of an embolic event (seven TIA, two stroke) occurred in eight patients. None of these occurred with the newer devices (Amplatzer, Helex). Freedom from recurrence of the combined end point of TIA, ischemic stroke, and peripheral embolism was 95.7% (95% CI: 89.0%-98.4%) at 1 year and 94.1% (95% CI: 80.1-98.4%) at 3 years. Catheter PFO closure is a technically simple procedure. With the newer devices and increasing experience, the success rate has improved and the complication rate has decreased. The advantage of the procedure is that closing the defect means a causal treatment. However, catheter closure of PFO despite a very low morbidity has inherent potential risks like any other interventional procedure. Furthermore, selection of patients who definitely have PFO as the cause of their cerebral event has not been defined. For these reasons, further studies are warranted.
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Affiliation(s)
- H Sievert
- Cardiovascular Center Bethanien CCB, Im Prüfling 23, 60389 Frankfurt, Germany.
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Horvath K, Stolnicu S, Sireteanu L. [Orbital mesenchymal tumors--orbital fibrous histiocytoma. Their clinical and histopathological aspects]. Oftalmologia 2001; 50:84-7. [PMID: 11021112] [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: 02/17/2023]
Abstract
Histiocytoma is a tumor with mesenchymal etiology, whose primary orbital form is very rare. (1) Although it is a benign tumor, there have been written--in a few cases--it's metastatic forms too. This article describes the case of a female patient with this tumor which had been extirpated successfully and without any recurrences till now. The disease had been appeared with a chronic sphenoidal and maxillary sinusitis. At the same time there are described the latest concepts about these tumors' etiology, classification and their treatment.
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Affiliation(s)
- K Horvath
- Clinica de Oftalmologie, Târgu-Mureş
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Krumsdorf U, Keppeler P, Horvath K, Zadan E, Schrader R, Sievert H. Catheter closure of atrial septal defects and patent foramen ovale in patients with an atrial septal aneurysm using different devices. J Interv Cardiol 2001; 14:49-55. [PMID: 12053327 DOI: 10.1111/j.1540-8183.2001.tb00711.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Atrial septal aneurysm is frequently associated with patent foramen ovale (PFO) and atrial septal defects (ASD). Moreover, a relationship between atrial septal aneurysm and embolic cerebrovascular events has been suggested. The aims of this study were to analyze morphological and functional characteristics of atrial septal aneurysm in PFO and ASD patients and to assess the feasibility and efficacy of different devices for transcatheter closure and the influence of atrial septal aneurysm. METHODS Between March 1997 and May 2000 transcatheter ASD or PFO closure was attempted in 63 patients (mean age 47 +/- 13 years) with an atrial septal aneurysm using one of the following devices: Angelwings (n = 3), Cardioseal (n = 5), Cardioseal-Starflex (n = 7), Amplatzer (n = 11), Amplatzer-PFO (n = 5), PFO-Star (n = 25), or Helex (n = 7). RESULTS Implantation was primarily successful (after the first or second attempt) in all patients. One PFO-Star device embolized 12 hours after the procedure. During follow-up (0.6-37 months, mean 10.4 +/- 9.2) a residual shunt could be detected by transesophageal echocardiography after 2 weeks in four patients and after 6 months in one patient. Three PFO patients had cerebrovascular events after implantation. Two patients had a transient ischemic attack (TIA) and one patient a stroke. A thrombus formation on the device detected in three patients disappeared after antithrombotic therapy. CONCLUSION We conclude that ASDs and PFOs with an associated atrial septal aneurysm can be closed with different available devices. There seem to be no additional risks compared with patients without atrial septal aneurysm.
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Affiliation(s)
- U Krumsdorf
- Cardiovascular Center Bethanien CCB, Im Prüfling 23, 60389 Frankfurt, Germany
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Abstract
Celiac disease and dermatitis herpetiformis are caused by the alcohol soluble fractions of wheat, barley, and rye. Reliable serological tests are available for both mass and risk group screening and recent epidemiological studies on celiac disease suggest that the prevalence varies between 1:100-300 in different continents. The clinical manifestations of the disease has changed in the West and the classical symptomatic cases represent only approximately 1/7th of all diagnosed cases. Symptoms such as, anemia, short stature, dental enamel defect or osteoporosis can be the only manifestations of the atypical disease. There is an increased prevalence of celiac disease in patients with autoimmune diseases. Recent data suggest that there is a correlation between the prevalence of autoimmune diseases and the number of years that an individual consumes gluten-containing foods. Genetic studies revealed a high prevalence of certain HLA antigens in celiac patients, however, there is likelihood that non-HIA genes are also important in the pathomechanism. An interesting new development is the recognition of tissue transglutaminase (tTG), an enzyme that probably forms an autoantigen with gluten. It is generally accepted that antibodies to tTG are identical to the previously described antiendomysium antibodies. Whether or not tTG is responsible for the initiation of an immunoreaction against prolamines or just exacerbates the immune response is a subject of further investigations.
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Affiliation(s)
- K Horvath
- Division of Pediatric Gastroenterology and Nutrition, University of Maryland School of Medicine, Baltimore, USA.
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