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Gilhus NE, Andersen H, Andersen LK, Boldingh M, Laakso S, Leopoldsdottir MO, Madsen S, Piehl F, Popperud TH, Punga AR, Schirakow L, Vissing J. Generalized myasthenia gravis with acetylcholine receptor antibodies: A guidance for treatment. Eur J Neurol 2024; 31:e16229. [PMID: 38321574 DOI: 10.1111/ene.16229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Generalized myasthenia gravis (MG) with antibodies against the acetylcholine receptor is a chronic disease causing muscle weakness. Access to novel treatments warrants authoritative treatment recommendations. The Nordic countries have similar, comprehensive health systems, mandatory health registers, and extensive MG research. METHODS MG experts and patient representatives from the five Nordic countries formed a working group to prepare treatment guidance for MG based on a systematic literature search and consensus meetings. RESULTS Pyridostigmine represents the first-line symptomatic treatment, while ambenonium and beta adrenergic agonists are second-line options. Early thymectomy should be undertaken if a thymoma, and in non-thymoma patients up to the age of 50-65 years if not obtaining remission on symptomatic treatment. Most patients need immunosuppressive drug treatment. Combining corticosteroids at the lowest possible dose with azathioprine is recommended, rituximab being an alternative first-line option. Mycophenolate, methotrexate, and tacrolimus represent second-line immunosuppression. Plasma exchange and intravenous immunoglobulin are used for myasthenic crises and acute exacerbations. Novel complement inhibitors and FcRn blockers are effective and fast-acting treatments with promising safety profiles. Their use depends on local availability, refunding policies, and cost-benefit analyses. Adapted physical training is recommended. Planning of pregnancies with optimal treatment, information, and awareness of neonatal MG is necessary. Social support and adaptation of work and daily life activities are recommended. CONCLUSIONS Successful treatment of MG rests on timely combination of different interventions. Due to spontaneous disease fluctuations, comorbidities, and changes in life conditions, regular long-term specialized follow-up is needed. Most patients do reasonably well but there is room for further improvement. Novel treatments are promising, though subject to restricted access due to costs.
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Affiliation(s)
- Nils Erik Gilhus
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Henning Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Linda Kahr Andersen
- Copenhagen Neuromuscular Center, Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marion Boldingh
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Sini Laakso
- Department of Neurology, Brain Center, Helsinki University Hospital, Helsinki, Finland
- Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| | | | - Sidsel Madsen
- The National Rehabilitation Center for Neuromuscular Diseases, Aarhus, Denmark
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Anna Rostedt Punga
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Department of Clinical Neurophysiology, Uppsala University Hospital, Uppsala, Sweden
| | | | - John Vissing
- Copenhagen Neuromuscular Center, Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
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Slipsager A, Andersen LK, Voermans NC, Lucia A, Karazi W, Santalla A, Vissing J, Løkken N. Fatigue and associated factors in 172 patients with McArdle disease: An international web-based survey. Neuromuscul Disord 2024; 34:19-26. [PMID: 38042739 DOI: 10.1016/j.nmd.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 12/04/2023]
Abstract
McArdle disease is an autosomal recessive inherited disease caused by pathogenic variants in the PYGM gene, resulting in virtual absence of the myophosphorylase enzyme in skeletal muscle. Patients experience physical activity intolerance, muscle pain, and muscle fatigue. This study aimed to investigate other fatigue domains with the Multidimensional Fatigue Inventory (MFI-20) along with an investigation of potential contributing factors, including relevant disease and lifestyle-related factors. We conducted a survey in an international cohort of patients with McArdle disease. The survey included questions on demographics and McArdle disease-related symptoms, and the questionnaires: MFI-20, Insomnia Severity Index (ISI), and International Physical Activity Questionnaire Short-Form (IPAQ-SF). One hundred seventy-four responses were included in the data analyses. We found relatively high fatigue scores in all five domains (general fatigue (12.9 ± 2.2), mental fatigue (10.1 ± 4.1), physical fatigue (13.7 ± 4.1), reduced activity (12.1 ± 4.1), and reduced motivation (10.4 ± 3.4)). Fatigue associated with McArdle symptom severity (p < 0.005), lower levels of physical activity (assessed by IPAQ-SF) (p < 0.05), and poor sleep (assessed by ISI) (p < 0.05). These findings call for clinical focus and future research into fatigue, sleep and mental health in patients with McArdle disease.
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Affiliation(s)
- Anna Slipsager
- Copenhagen Neuromuscular Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Linda Kahr Andersen
- Copenhagen Neuromuscular Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Nicol Cornelia Voermans
- The Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, The Netherlands
| | - Alejandro Lucia
- Physical Activity Health Research Group (PaHerg), Research Institute of Hospital 12 de Octubre ('i+12'). Madrid, Spain; Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Walaa Karazi
- The Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, The Netherlands
| | | | - John Vissing
- Copenhagen Neuromuscular Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nicoline Løkken
- Copenhagen Neuromuscular Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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Kahr Andersen L, Vissing J. Habitual Physical Activity in Patients with Myasthenia Gravis Assessed by Accelerometry and Questionnaire. J Neuromuscul Dis 2021; 9:161-169. [PMID: 34334414 DOI: 10.3233/jnd-210693] [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] [Indexed: 12/17/2022]
Abstract
BACKGROUND Physical activity (PA) in patients with myasthenia gravis (MG) is considered safe and beneficial, and an active lifestyle is required to obtain the health benefits of exercise. However, as the disease leads to physical impairments an insight into the overall PA habits in this patient population is relevant but lacking. OBJECTIVE To measure habitual physical activity in a Danish cohort of patients with MG measured by accelerometer and questionnaire, and to determine relevant predictors for PA intensities. METHODS Habitual physical activity was assessed by; 1) the accelerometer Acti Graph in a cohort of patients recruited from our neuromuscular clinic, 2) the International Physical Activity Questionnaire (IPAQ) in a web-based survey. PA levels were compared to international recommendations. Predictors for PA (age, sex, body mass index, disease severity and duration) were included in the regression analyses. RESULTS Habitual physical activity was measured by accelerometer for 7 days in 69 patients and by questionnaire in 691 patients. Measured by the accelerometer, 46%of the patients did not meet the international recommendations for PA at moderate/vigorous intensity and 57%were below the recommendations for steps per day. Measured by the IPAQ, 48%did not meet the recommendations. Disease severity and age were predictors for PA intensities. CONCLUSIONS This study found that around half of the included patients did not meet the recommendations for PA. This is a concern, as it increases the risk of life-style related diseases. Disease severity and age may be taking into consideration when counseling the patients about PA.
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Affiliation(s)
- Linda Kahr Andersen
- Copenhagen Neuromuscular Center, Department of Neurology, Copenhagen University Hospital -Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - John Vissing
- Copenhagen Neuromuscular Center, Department of Neurology, Copenhagen University Hospital -Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Andersen LK, Aadahl M, Vissing J. Fatigue, physical activity and associated factors in 779 patients with myasthenia gravis. Neuromuscul Disord 2021; 31:716-725. [PMID: 34303571 DOI: 10.1016/j.nmd.2021.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/21/2021] [Accepted: 05/19/2021] [Indexed: 12/17/2022]
Abstract
The objective of the study was to examine the association between fatigue (measured by the Multidimensional Fatigue Inventory; MFI-20) and physical activity (measured by the Saltin-Grimby Physical Activity Level Scale; SGPALS) in a large cohort of patients (≥18 years) with myasthenia gravis (MG) including relevant disease - and lifestyle-related factors. A total of 1463 persons, registered at the Danish National Registry of Patients with a MG diagnosis, according to the International Classification of Diseases, received a web-based survey. A total of 779 patients (53% women, mean [SD] age 60.8 [15.5]) responded. The remaining persons were either non-responders (n = 390) or could not confirm the MG diagnosis (n = 294). The most prominent MFI-20 fatigue domains were general fatigue (median [inter-quartile ranges, IQR], 13 [10-16]) and physical fatigue (median [IQR], 13 [9-15]), and 386 (53%) patients reported low levels of physical activity. All fatigue domains were associated with physical activity (p<.01). Higher level of physical activity was associated with lower levels of fatigue. Important factors for the association were myasthenia gravis disease severity (measured by the Myasthenia Gravis Activities of Daily Living profile), body mass index, insomnia (measured by the Insomnia Severity Index) job-status, comorbidity, and cohabitation.
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Affiliation(s)
- Linda Kahr Andersen
- Copenhagen Neuromuscular Center, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Inge Lehmanns Vej 8, 2100 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Mette Aadahl
- Center for Clinical Research and Prevention, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - John Vissing
- Copenhagen Neuromuscular Center, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Inge Lehmanns Vej 8, 2100 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Andersen LK, Witting N, Vissing J. Effects of rhythmic auditory stimulation on walking during the 6-minute walk test in patients with generalised Myasthenia Gravis. European Journal of Physiotherapy 2021. [DOI: 10.1080/21679169.2021.1876760] [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: 10/22/2022]
Affiliation(s)
- Linda Kahr Andersen
- Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Nanna Witting
- Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - John Vissing
- Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Ryan SF, Adamson NL, Aktipis A, Andersen LK, Austin R, Barnes L, Beasley MR, Bedell KD, Briggs S, Chapman B, Cooper CB, Corn JO, Creamer NG, Delborne JA, Domenico P, Driscoll E, Goodwin J, Hjarding A, Hulbert JM, Isard S, Just MG, Kar Gupta K, López-Uribe MM, O'Sullivan J, Landis EA, Madden AA, McKenney EA, Nichols LM, Reading BJ, Russell S, Sengupta N, Shapiro LR, Shell LK, Sheard JK, Shoemaker DD, Sorger DM, Starling C, Thakur S, Vatsavai RR, Weinstein M, Winfrey P, Dunn RR. The role of citizen science in addressing grand challenges in food and agriculture research. Proc Biol Sci 2018; 285:20181977. [PMID: 30464064 PMCID: PMC6253361 DOI: 10.1098/rspb.2018.1977] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 10/30/2018] [Indexed: 11/12/2022] Open
Abstract
The power of citizen science to contribute to both science and society is gaining increased recognition, particularly in physics and biology. Although there is a long history of public engagement in agriculture and food science, the term 'citizen science' has rarely been applied to these efforts. Similarly, in the emerging field of citizen science, most new citizen science projects do not focus on food or agriculture. Here, we convened thought leaders from a broad range of fields related to citizen science, agriculture, and food science to highlight key opportunities for bridging these overlapping yet disconnected communities/fields and identify ways to leverage their respective strengths. Specifically, we show that (i) citizen science projects are addressing many grand challenges facing our food systems, as outlined by the United States National Institute of Food and Agriculture, as well as broader Sustainable Development Goals set by the United Nations Development Programme, (ii) there exist emerging opportunities and unique challenges for citizen science in agriculture/food research, and (iii) the greatest opportunities for the development of citizen science projects in agriculture and food science will be gained by using the existing infrastructure and tools of Extension programmes and through the engagement of urban communities. Further, we argue there is no better time to foster greater collaboration between these fields given the trend of shrinking Extension programmes, the increasing need to apply innovative solutions to address rising demands on agricultural systems, and the exponential growth of the field of citizen science.
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Affiliation(s)
- S F Ryan
- Department of Applied Ecology, NC State Extension, Raleigh, NC, USA
- Department of Entomology and Plant Pathology, University of Tennessee, Knoxville, TN, USA
| | - N L Adamson
- Xerces Society for Invertebrate Conservation/USDA NRCS ENTSC, Greensboro, NC, USA
| | - A Aktipis
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - L K Andersen
- Department of Applied Ecology, NC State Extension, Raleigh, NC, USA
| | - R Austin
- Department of Crop and Soil Sciences, NC State Extension, Raleigh, NC, USA
| | - L Barnes
- Lincoln Heights Environmental Connections Magnet Elementary School, Fuquay-Varina, NC, USA
| | - M R Beasley
- Knightdale High School of Collaborative Design, Knightdale, NC, USA
| | - K D Bedell
- School of Education, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S Briggs
- NC Plant Sciences Initiative, College of Agriculture and Life Sciences, NC State Extension, Raleigh, NC, USA
| | - B Chapman
- Department of Agricultural and Human Sciences, NC State Extension, Raleigh, NC, USA
| | - C B Cooper
- Department of Forestry and Environmental Resources, NC State Extension, Raleigh, NC, USA
| | - J O Corn
- William and Ida Friday Institute for Educational Innovation, NC State Extension, Raleigh, NC, USA
| | - N G Creamer
- Department of Horticultural Science, NC State Extension, Raleigh, NC, USA
| | - J A Delborne
- Department of Forestry and Environmental Resources, NC State Extension, Raleigh, NC, USA
| | - P Domenico
- Curriculum Enhancement Programs at Wake County Public School System, Cary, NC, USA
| | - E Driscoll
- Department of Horticultural Science, NC State Extension, Raleigh, NC, USA
| | - J Goodwin
- Department of Communication, NC State Extension, Raleigh, NC, USA
| | - A Hjarding
- North Carolina Wildlife Federation, Charlotte, NC, USA
- The University of North Carolina at Charlotte, Charlotte, NC, USA
| | - J M Hulbert
- Forestry and Agricultural Biotechnology Institute, University of Pretoria, Pretoria, South Africa
| | - S Isard
- Department of Plant Pathology and Environmental Microbiology, Pennsylvania State University, State College, PA, USA
- Department of Meteorology and Atmospheric Sciences, Pennsylvania State University, State College, PA, USA
| | - M G Just
- Department of Entomology and Plant Pathology, NC State Extension, Raleigh, NC, USA
| | - K Kar Gupta
- Biodiversity Lab, North Carolina Museum of Natural Sciences, Raleigh, NC, USA
| | - M M López-Uribe
- Department of Entomology, Center for Pollinator Research, Pennsylvania State University, State College, PA, USA
| | - J O'Sullivan
- Center for Environmental Farming Systems, North Carolina A&T State University, Greensboro, NC, USA
| | - E A Landis
- Department of Biology, Tufts University, Medford, MA, USA
| | - A A Madden
- Department of Applied Ecology, NC State Extension, Raleigh, NC, USA
| | - E A McKenney
- Department of Applied Ecology, NC State Extension, Raleigh, NC, USA
- Research and Collections, North Carolina Museum of Natural Sciences, Raleigh, NC, USA
| | - L M Nichols
- Department of Applied Ecology, NC State Extension, Raleigh, NC, USA
| | - B J Reading
- Department of Applied Ecology, NC State Extension, Raleigh, NC, USA
| | - S Russell
- Millbrook Environmental Connections Magnet Elementary School, Raleigh, NC, USA
| | - N Sengupta
- Consultant - Biodiversity Conservation & Sustainable Development, Auroville, Tamil Nadu, India
| | - L R Shapiro
- Department of Applied Ecology, NC State Extension, Raleigh, NC, USA
| | - L K Shell
- Research and Collections, North Carolina Museum of Natural Sciences, Raleigh, NC, USA
| | - J K Sheard
- Center for Macroecology, Evolution and Climate, Natural History Museum of Denmark, Copenhagen University, Copenhagen, Denmark
| | - D D Shoemaker
- Department of Entomology and Plant Pathology, University of Tennessee, Knoxville, TN, USA
| | - D M Sorger
- Department of Applied Ecology, NC State Extension, Raleigh, NC, USA
- Research and Collections, North Carolina Museum of Natural Sciences, Raleigh, NC, USA
| | - C Starling
- Heritage High School, Wake Forest, NC, USA
| | - S Thakur
- College of Veterinary Medicine, NC State Extension, Raleigh, NC, USA
| | - R R Vatsavai
- Department of Computer Science, NC State Extension, Raleigh, NC, USA
| | - M Weinstein
- Evaluation and Accountability Coordinator Extension Administration, NC State Extension, Raleigh, NC, USA
| | - P Winfrey
- Arizona State University Biodesign Institute, Tempe, AZ, USA
| | - R R Dunn
- Department of Applied Ecology, NC State Extension, Raleigh, NC, USA
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Hedermann G, Dahlqvist JR, Løkken N, Vissing CR, Knak KL, Andersen LK, Thomsen C, Vissing J. Progressive fat replacement of muscle contributes to the disease mechanism of patients with single, large-scale deletions of mitochondrial DNA. Neuromuscul Disord 2018; 28:408-413. [DOI: 10.1016/j.nmd.2018.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 12/23/2017] [Accepted: 02/13/2018] [Indexed: 10/18/2022]
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Abstract
OBJECTIVE The 2- and 6-minute walk tests are used to evaluate walking capacity, but reliability has been sparsely investigated in patients with neuromuscular diseases. The aim of this study was to investigate the relative and absolute reliability of the 2- and 6-minute walk tests in patients with neuromuscular diseases. DESIGN Each patient performed a 2- and a 6-minute walk test on 2 test days separated by 1-2 weeks. SUBJECTS A total of 93 adult patients (mean age 53 years, age range 22-83 years) with 12 different neuromuscular diseases were included. RESULTS The mean walking distance increased by 4.3 and 11.2 m (p < 0.001) in repeated 2- and 6-minute walk tests, respectively. Intraclass correlation coefficient in the 2- and 6-minute walk tests was 0.99 (p < 0.001). Standard error of measurement was 4.9 m in the 2-minute walk test and 14.0 m in the 6-minute walk test. Minimal detectable difference was 13.7 m in the 2-minute walk test and 38.8 m in the 6-minute walk test. CONCLUSION These findings show good relative reliability of the 2- and 6-minute walk tests in patients with neuromuscular diseases. However, absolute reliability demonstrated variability in neuromuscular diseases. This should be considered when interpreting a change in walking distance.
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Affiliation(s)
- Kirsten Lykke Knak
- Department of Neurology, Copenhagen Neuromuscular Center, Rigshospitalet, 2100 Copenhagen, Denmark.
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Andersen LK, Knak KL, Witting N, Vissing J. Two- and 6-minute walk tests assess walking capability equally in neuromuscular diseases. Neurology 2016; 86:442-5. [PMID: 26740680 DOI: 10.1212/wnl.0000000000002332] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 10/07/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This methodologic study investigates if the 2-minute walk test (2MWT) can be a valid alternative to the 6-minute walk test (6MWT) to describe walking capability in patients with neuromuscular diseases. METHODS Patients (n = 115) with different neuromuscular diseases were invited to participate on 2 test days, each consisting of 1 2MWT and 1 6MWT separated by a minimum 30-minute period of rest. The order of the walk tests was randomly assigned via sealed envelopes. A group of 38 healthy controls completed 1 6MWT. RESULTS The mean walking distance for the 2MWT was 142.8 meters and for the 6MWT 405.3 meters. The distance walked in the 2MWT was highly correlated to the distance walked in the 6MWT (r = 0.99, p < 0.001). There was a significant decrease in walking speed from the first to last minute in the 6MWT, both among patients and healthy controls, which was not evident in the 2MWT. Results were consistent across diagnoses and levels of disease severity. CONCLUSION The 2MWT is a potential alternative to the 6MWT to describe walking capability among patients with neuromuscular diseases during clinical trials.
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Affiliation(s)
- Linda Kahr Andersen
- From the Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark.
| | - Kirsten Lykke Knak
- From the Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - Nanna Witting
- From the Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - John Vissing
- From the Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
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Bailey CH, Andersen LK, Lowe GC, Pittelkow MR, Bostwick JM, Davis MDP. A population-based study of the incidence of delusional infestation in Olmsted County, Minnesota, 1976-2010. Br J Dermatol 2015; 170:1130-5. [PMID: 24472115 DOI: 10.1111/bjd.12848] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Delusional infestation (DI) is a well-recognized clinical entity but there is a paucity of reliable data concerning its epidemiology. Knowledge of the epidemiology is fundamental to an understanding of any disease and its implications. Epidemiology is most accurately assessed using population-based studies, which are most generalizable to the wider population in the U.S. and worldwide. To our knowledge, no population-based study of the epidemiology (particularly incidence) of DI has been reported to date. OBJECTIVES To determine the incidence of delusional infestation (DI) using a population-based study. METHODS Medical records of Olmsted County residents were reviewed using the resources of the Rochester Epidemiology Project to confirm the patient's status as a true incident case of DI and to gather demographic information. Patients with a first-time diagnosis of DI or synonymous conditions between 1 January 1976 and 31 December 2010 were considered incident cases. RESULTS Of 470 identified possible diagnoses, 64 were true incident cases of DI in this population-based study. The age- and sex-adjusted incidence was 1·9 [95% confidence interval (CI) 1·5-2·4] per 100 000 person-years. Mean age at diagnosis was 61·4 years (range 9-92 years). The incidence of DI increased over the four decades from 1·6 (95% CI 0·6-2·6) per 100 000 person-years in 1976-1985 to 2·6 (95% CI 1·4-3·8) per 100 000 person-years in 2006-2010. CONCLUSIONS Our data indicate that DI is a rare disease, with incidence increasing across the life span, especially after the age of 40 years.
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Affiliation(s)
- C H Bailey
- Mayo Medical School, Mayo Clinic College of Medicine, Rochester, MN, U.S.A
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Andersen LK, Steiniche T, Hansen IT, Deleuran MS. Concurrent cutaneous polyarteritis nodosa and arteritis temporalis in a 68-year-old woman. Br J Dermatol 2014; 171:201-2. [PMID: 24641333 DOI: 10.1111/bjd.12907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- L K Andersen
- Department of Dermato-Venereology, Aarhus University Hospital, 8000, Aarhus C, Denmark
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12
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Justesen J, Lorentzen M, Andersen LK, Hansen O, Chevallier J, Modin C, Füchtbauer A, Foss M, Besenbacher F, Duch M, Pedersen FS. Spatial and temporal changes in the morphology of preosteoblastic cells seeded on microstructured tantalum surfaces. J Biomed Mater Res A 2009; 89:885-94. [PMID: 18465820 DOI: 10.1002/jbm.a.32032] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
It has been widely reported that surface morphology on the micrometer scale affects cell function as well as cell shape. In this study, we have systematically compared the influence of 13 topographically micropatterned tantalum surfaces on the temporal development of morphology, including spreading, and length of preosteoblastic cells (MC3T3-E1). Cells were examined after 0.5, 1, 4, and 24 h on different Ta microstructures with vertical dimensions (heights) of 0.25 and 1.6 mum. Cell morphologies depended upon the underlying surface topography, and the length and spreading of cells varied as a function of time with regard to the two-dimensional pattern and vertical dimension of the structure. Microstructures of parallel grooves/ridges caused elongated cell growth after 1 and 4 h in comparison to a flat, nonstructured, reference surface. For microstructures consisting of pillars, cell spreading was found to depend on the distance between the pillars with one specific pillar structure exhibiting a decreased spreading combined with a radical change in morphology of the cells. Interestingly, this morphology on the particular pillar structure was associated with a markedly different distribution of the actin cytoskeleton. Our results provide a basis for further work toward topographical guiding of cell function.
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Affiliation(s)
- J Justesen
- Interdisciplinary Nanoscience Center (iNANO), University of Aarhus, DK-8000 Aarhus C, Denmark
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Abstract
The time-resolved absorption spectrum of singlet oxygen [O2(a1 delta g)-->O2(b1 sigma g+)] has been recorded in the region approximately 5100-5300 cm-1 from air-saturated polystyrene samples using a microscope attached to a step-scan Fourier transform IR spectrometer. Singlet oxygen signals were observed with a time resolution of approximately 160 ns from sample volumes of approximately 20 nL using moderate data-acquisition times. These data indicate that it is reasonable and worthwhile to consider the further development of a transmission microscope as a viable tool to create singlet oxygen images of inhomogeneous samples including samples of biological importance.
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Affiliation(s)
- L K Andersen
- Department of Chemistry, Aarhus University, Aarhus, Denmark
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14
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Abstract
The effects of periodic chemotherapy administration are evaluated within the context of a G(0)model of the cell cycle. Parameters are estimated for normal bone marrow cells and malignant cells in acute myelogenous leukemia (AML). This model explicitly includes the resting G(0)phase and the feedback mechanism that recruits the cells back into the cell cycle. Periodic chemotherapy administration can induce resonance within our model under high cell kill rate where the average cell cycle times may change during the course of treatment, and therapeutic benefits from these resonances cannot be solely based on cell cycle times in untreated tissue. The depletion rate under chemotherapy and the regrowth rate may differ between the cell populations, and our analysis suggests that this favors the tumour cells. We were able to distinguish between the effects of cycle-non-specific, S -phase-specific and M -phase-specific drugs, and found that these can show differences in sharpness and location of the resonance phenomenon. We conclude that resonance chemotherapy (chronotherapy) is unlikely to be efficacious in the treatment of AML.
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Affiliation(s)
- L K Andersen
- Department of Physics, The Technical University of Denmark, Lyngby, Denmark
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15
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Andersen LK, Jensen HK, Juul S, Faergeman O. [Attitude of patients toward detection of hereditary disease. Heterozygote familial hypercholesterolemia]. Ugeskr Laeger 1998; 160:6075-81. [PMID: 9800511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Molecular biology has enabled us to identify apparently healthy persons at high risk of genetic disease. The purpose of the present study was to examine attitudes to detection of disease and the present well-being in persons at risk of disease with a modifiable outcome-heterozygous Familial Hypercholesterolaemia (heFH). A questionnaire collecting information on impact on well-being and on attitudes to screening family members for heFH was mailed to heFH index patients and hypercholesterolaemic relatives. Anxiety was expressed by 44%, fear of ischaemic heart disease by 37% and diminished well-being by 13% of respondents. Six percent regretted that they were aware of their diagnosis, and 84% were in favour of screening their family. We conclude that a substantial proportion of persons with heFH experience anxiety due to heFH. A small minority regret being informed of the diagnosis of heFH, however, and a majority are in favour of family screening.
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Affiliation(s)
- L K Andersen
- Arhus Universitetshospital, medicinsk-kardiologisk afdeling A
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16
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Andersen LK, Jensen HK, Juul S, Faergeman O. Patients' attitudes toward detection of heterozygous familial hypercholesterolemia. Arch Intern Med 1997; 157:553-60. [PMID: 9066460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Molecular biology has improved the diagnostic abilities of physicians and enabled them to identify apparently healthy persons with a high risk of genetic disease. OBJECTIVE To examine the attitudes toward detection of disease and the present well-being in persons at risk of disease with a modifiable outcome, in this case heterozygous familial hypercholesterolemia (FH) and their hypercholesterolemic relatives. MATERIALS AND METHODS A questionnaire was developed that collected information on the impact on well-being at present and at the time of diagnosis of hypercholesterolemia and on attitudes toward screening family members for heterozygous FH. It was mailed to 62 index patients with heterozygous FH, which was defined by using clinical criteria, and 108 hypercholesterolemic relatives. The response rate was 88%. Results were related to demographic data, experience of psychological or physiologic reactions in relation to awareness of hypercholesterolemia, cardiovascular symptoms, lipid-lowering drug treatment, and information on the DNA-based diagnosis. RESULTS Of the respondents, anxiety was expressed by 44%, fear of coronary heart disease by 37%, and diminished well-being by 13%. These findings were most pronounced in persons who had experienced physiologic or psychological reactions at the time of diagnosis of hypercholesterolemia or who already had heart disease. Six percent regretted that they were aware of their disease diagnosis, and 84% were in favor of screening for affected individuals in families with a history of heterozygous FH. CONCLUSIONS The results indicated that a substantial proportion of persons with heterozygous FH had some degree of anxiety. A small minority regretted that they were informed of the diagnosis of heterozygous FH, however, and a majority were in favor of family screening for heterozygous FH.
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Affiliation(s)
- L K Andersen
- Department of Medicine and Cardiology, Aarhus Amtssygehus University Hospital, Denmark
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