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Wichmann S, Lange T, Perner A, Gluud C, Itenov TS, Berthelsen RE, Nebrich L, Wiis J, Brøchner AC, Nielsen LG, Behzadi MT, Damgaard K, Andreasen AS, Strand K, Järvisalo M, Strøm T, Eschen CT, Vang ML, Hildebrandt T, Andersen FH, Sigurdsson MI, Thomar KM, Thygesen SK, Troelsen TT, Uusalo P, Jalkanen V, Illum D, Sølling C, Keus F, Pfortmueller CA, Wahlin RR, Ostermann M, Aneman A, Bestle MH. Furosemide versus placebo for fluid overload in intensive care patients-The randomised GODIF trial second version: Statistical analysis plan. Acta Anaesthesiol Scand 2024; 68:130-136. [PMID: 37691474 DOI: 10.1111/aas.14320] [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: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Fluid overload is associated with increased mortality in intensive care unit (ICU) patients. The GODIF trial aims to assess the benefits and harms of fluid removal with furosemide versus placebo in stable adult patients with moderate to severe fluid overload in the ICU. This article describes the detailed statistical analysis plan for the primary results of the second version of the GODIF trial. METHODS The GODIF trial is an international, multi-centre, randomised, stratified, blinded, parallel-group, pragmatic clinical trial, allocating 1000 adult ICU patients with moderate to severe fluid overload 1:1 to furosemide versus placebo. The primary outcome is days alive and out of hospital within 90 days post-randomisation. With a power of 90% and an alpha level of 5%, we may reject or detect an improvement of 8%. The primary analyses of all outcomes will be performed in the intention-to-treat population. For the primary outcome, the Kryger Jensen and Lange method will be used to compare the two treatment groups adjusted for stratification variables supplemented with sensitivity analyses in the per-protocol population and with further adjustments for prognostic variables. Secondary outcomes will be analysed with multiple linear regressions, logistic regressions or the Kryger Jensen and Lange method as suitable with adjustment for stratification variables. CONCLUSION The GODIF trial data will increase the certainty about the effects of fluid removal using furosemide in adult ICU patients with fluid overload. TRIAL REGISTRATIONS EudraCT identifier: 2019-004292-40 and ClinicalTrials.org: NCT04180397.
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Affiliation(s)
- Sine Wichmann
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-North Zealand, Hilleroed, Denmark
| | - Theis Lange
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anders Perner
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- The Faculty of Health Sciences, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Theis S Itenov
- Department of Anaesthesia, Copenhagen University Hospital-Bispebjerg, Copenhagen, Denmark
| | - Rasmus E Berthelsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Nebrich
- Department of Anaesthesia and Intensive Care, Zealand University Hospital, Koege, Denmark
| | - Jørgen Wiis
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne C Brøchner
- Department of Anaesthesia and Intensive Care, University Hospital of Southern Denmark, Kolding, Denmark
| | - Louise G Nielsen
- Department of Intensive Care, Odense University Hospital, Odense, Denmark
| | - Meike T Behzadi
- Department of Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Kjeld Damgaard
- Department of Anaesthesia and Intensive Care, Regionshospital Nordjylland, Hjoerring, Denmark
| | - Anne S Andreasen
- Department of Intensive Care, Copenhagen University Hospital-Herlev, Herlev, Denmark
| | - Kristian Strand
- Department of Intensive Care, Stavanger University Hospital, Stavanger, Norway
| | - Mikko Järvisalo
- Department of Internal Medicine, Kanta-Häme Central Hospital, Hameenlinna, Finland
| | - Thomas Strøm
- Department of Anaesthesia and Intensive Care, Sygehus Soenderjylland, Aabenraa, Denmark
| | - Camilla T Eschen
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-Gentofte Hospital, Gentofte, Denmark
| | - Marianne L Vang
- Department of Intensive Care, Regionshospitalet Randers, Randers, Denmark
| | - Thomas Hildebrandt
- Department of Anaesthesia and Intensive Care, Zealand University Hospital, Roskilde, Denmark
| | - Finn H Andersen
- Department of Intensive Care, Aalesund Hospital, Moere and Romsdal Health Trust, Aalesund, Norway
- Faculty of Medicine and Health Science, Department of Health Science, Norwegian University of Science and Technology, Aalesund, Norway
| | - Martin I Sigurdsson
- Department of Anaesthesia and Intensive Care, Landspitali, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Katrin M Thomar
- Department of Anaesthesia and Intensive Care, Landspitali, Reykjavik, Iceland
| | - Sandra K Thygesen
- Department of Anaesthesia and Intensive Care, Regionshospitalet Goedstrup, Herning, Denmark
| | - Thomas T Troelsen
- Department of Anaesthesia and Intensive Care, Regionshospitalet Goedstrup, Herning, Denmark
| | - Panu Uusalo
- Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
| | - Ville Jalkanen
- Department of Intensive Care, Tampere University Hospital, Tampere, Finland
| | - Dorte Illum
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | | | - Frederik Keus
- Department of Critical Care, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Rebecka R Wahlin
- Department of Anaesthesia and Intensive Care, Sodersjukhuset AB, Stockholm, Sweden
| | - Marlies Ostermann
- Department of Intensive Care, King's College London, Guy's & St. Thomas' Hospital, London, UK
| | - Anders Aneman
- Department of Intensive Care, Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia
- South Western Clinical School, University of New South Wales, Sydney, Australia
| | - Morten H Bestle
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-North Zealand, Hilleroed, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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François B, Lambden S, Fivez T, Gibot S, Derive M, Grouin JM, Salcedo-Magguilli M, Lemarié J, De Schryver N, Jalkanen V, Hicheur T, Garaud JJ, Cuvier V, Ferrer R, Bestle M, Pettilä V, Mira JP, Bouisse C, Mercier E, Vermassen J, Huberlant V, Vinatier I, Anguel N, Levy M, Laterre PF. Prospective evaluation of the efficacy, safety, and optimal biomarker enrichment strategy for nangibotide, a TREM-1 inhibitor, in patients with septic shock (ASTONISH): a double-blind, randomised, controlled, phase 2b trial. Lancet Respir Med 2023; 11:894-904. [PMID: 37269870 DOI: 10.1016/s2213-2600(23)00158-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Activation of the triggering receptor expressed on myeloid cells-1 (TREM-1) pathway is associated with septic shock outcomes. Data suggest that modulation of this pathway in patients with activated TREM-1 might improve survival. Soluble TREM-1 (sTREM-1), a potential mechanism-based biomarker, might facilitate enrichment of patient selection in clinical trials of nangibotide, a TREM-1 modulator. In this phase 2b trial, we aimed to confirm the hypothesis that TREM1 inhibition might improve outcomes in patients with septic shock. METHODS This double-blind, randomised, placebo-controlled, phase 2b trial assessed the efficacy and safety of two different doses of nangibotide compared with placebo, and aimed to identify the optimum treatment population, in patients across 42 hospitals with medical, surgical, or mixed intensive care units (ICUs) in seven countries. Non-COVID-19 patients (18-85 years) meeting the standard definition of septic shock, with documented or suspected infection (lung, abdominal, or urinary [in patients ≥65 years]), were eligible within 24 h of vasopressor initiation for the treatment of septic shock. Patients were randomly assigned in a 1:1:1 ratio to intravenous nangibotide 0·3 mg/kg per h (low-dose group), nangibotide 1·0 mg/kg per h (high-dose group), or matched placebo, using a computer-generated block randomisation scheme (block size 3). Patients and investigators were masked to treatment allocation. Patients were grouped according to sTREM-1 concentrations at baseline (established from sepsis observational studies and from phase 2a change to data) into high sTREM-1 (≥ 400 pg/mL). The primary outcome was the mean difference in total Sequential Organ Failure Assessment (SOFA) score from baseline to day 5 in the low-dose and high-dose groups compared with placebo, measured in the predefined high sTREM-1 (≥ 400 pg/mL) population and in the overall modified intention-to-treat population. Secondary endpoints included all-cause 28-day mortality, safety, pharmacokinetics, and evaluation of the relationship between TREM-1 activation and treatment response. This study is registered with EudraCT, 2018-004827-36, and Clinicaltrials.gov, NCT04055909. FINDINGS Between Nov 14, 2019, and April 11, 2022, of 402 patients screened, 355 were included in the main analysis (116 in the placebo group, 118 in the low-dose group, and 121 in the high-dose group). In the preliminary high sTREM-1 population (total 253 [71%] of 355; placebo 75 [65%] of 116; low-dose 90 [76%] of 118; high-dose 88 [73%] of 121), the mean difference in SOFA score from baseline to day 5 was 0·21 (95% CI -1·45 to 1·87, p=0·80) in the low-dose group and 1·39 (-0·28 to 3·06, p=0·104) in the high-dose group versus placebo. In the overall population, the difference in SOFA score from baseline to day 5 between the placebo group and low-dose group was 0·20 (-1·09 to 1·50; p=0·76),and between the placebo group and the high-dose group was 1·06 (-0·23 to 2·35, p=0·108). In the predefined high sTREM-1 cutoff population, 23 (31%) patients in the placebo group, 35 (39%) in the low-dose group, and 25 (28%) in the high-dose group had died by day 28. In the overall population, 29 (25%) patients in the placebo, 38 (32%) in the low-dose, and 30 (25%) in the high-dose group had died by day 28. The number of treatment-emergent adverse events (111 [96%] patients in the placebo group, 113 [96%] in the low-dose group, and 115 [95%] in the high-dose group) and serious treatment-emergent adverse events (28 [24%], 26 [22%], and 31 [26%]) was similar between all three groups. High-dose nangibotide led to a clinically relevant improvement in SOFA score (of two points or more) from baseline to day 5 over placebo in those with higher cutoff concentrations (≥532 pg/mL) of sTREM-1 at baseline. Low dose nangibotide displayed a similar pattern with lower magnitude of effect across all cutoff values. INTERPRETATION This trial did not achieve the primary outcome of improvement in SOFA score at the predefined sTREM-1 value. Future studies are needed to confirm the benefit of nangibotide at higher concentrations of TREM-1 activation. FUNDING Inotrem.
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Affiliation(s)
- Bruno François
- Medical-Surgical ICU Department and Inserm CIC1435 & UMR1092, CRICS-TRIGGERSEP Network, CHU Limoges, Limoges, France.
| | - Simon Lambden
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK; Inotrem, Paris, France
| | - Tom Fivez
- Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Sebastien Gibot
- Intensive Care Unit, Centre Hospitalier Regional Universitaire, Nancy, France
| | | | - Jean-Marie Grouin
- Statistics Department, Université de Rouen, Mont Saint-Aignan, France
| | | | | | | | - Ville Jalkanen
- Tampere University Hospital, Intensive Care Unit, Tampere, Finland
| | | | | | | | - Ricard Ferrer
- Intensive Care Department, Hospital Universitari Vall d'Hebron, SODIR Research Group, Vall d'Hebron Institut de Recerca, Spain; Paseig de la Vall d'Hebron, Barcelona, Spain
| | - Morten Bestle
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-North Zealand, Denmark; Department of Clinical Medicine, University of Copenhagen, Hilleroed, Denmark
| | - Ville Pettilä
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jean-Paul Mira
- Groupe Hospitalier Cochin St Vincent de Paul La Roche Guyon, Paris, France
| | - Camille Bouisse
- Centre Hospitalier de Bourg-en-Bresse, Bourg-en-Bresse, France
| | | | | | | | - Isabelle Vinatier
- Centre Hospitalier Départemental de Vendée, La Roche-sur-Yon, France
| | | | - Mitchell Levy
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Warren Alpert School of Medicine at Brown University, Providence, RI, USA
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Wetterslev M, Hylander Møller M, Granholm A, Hassager C, Haase N, Lange T, Myatra SN, Hästbacka J, Arabi YM, Shen J, Cronhjort M, Lindqvist E, Aneman A, Young PJ, Szczeklik W, Siegemund M, Koster T, Aslam TN, Bestle MH, Girkov MS, Kalvit K, Mohanty R, Mascarenhas J, Pattnaik M, Vergis S, Haranath SP, Shah M, Joshi Z, Wilkman E, Reinikainen M, Lehto P, Jalkanen V, Pulkkinen A, An Y, Wang G, Huang L, Huang B, Liu W, Gao H, Dou L, Li S, Yang W, Tegnell E, Knight A, Czuczwar M, Czarnik T, Perner A. Atrial Fibrillation (AFIB) in the ICU: Incidence, Risk Factors, and Outcomes: The International AFIB-ICU Cohort Study. Crit Care Med 2023; 51:1124-1137. [PMID: 37078722 DOI: 10.1097/ccm.0000000000005883] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
OBJECTIVES To assess the incidence, risk factors, and outcomes of atrial fibrillation (AF) in the ICU and to describe current practice in the management of AF. DESIGN Multicenter, prospective, inception cohort study. SETTING Forty-four ICUs in 12 countries in four geographical regions. SUBJECTS Adult, acutely admitted ICU patients without a history of persistent/permanent AF or recent cardiac surgery were enrolled; inception periods were from October 2020 to June 2021. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We included 1,423 ICU patients and analyzed 1,415 (99.4%), among whom 221 patients had 539 episodes of AF. Most (59%) episodes were diagnosed with continuous electrocardiogram monitoring. The incidence of AF was 15.6% (95% CI, 13.8-17.6), of which newly developed AF was 13.3% (11.5-15.1). A history of arterial hypertension, paroxysmal AF, sepsis, or high disease severity at ICU admission was associated with AF. Used interventions to manage AF were fluid bolus 19% (95% CI 16-23), magnesium 16% (13-20), potassium 15% (12-19), amiodarone 51% (47-55), beta-1 selective blockers 34% (30-38), calcium channel blockers 4% (2-6), digoxin 16% (12-19), and direct current cardioversion in 4% (2-6). Patients with AF had more ischemic, thromboembolic (13.6% vs 7.9%), and severe bleeding events (5.9% vs 2.1%), and higher mortality (41.2% vs 25.2%) than those without AF. The adjusted cause-specific hazard ratio for 90-day mortality by AF was 1.38 (95% CI, 0.95-1.99). CONCLUSIONS In ICU patients, AF occurred in one of six and was associated with different conditions. AF was associated with worse outcomes while not statistically significantly associated with 90-day mortality in the adjusted analyses. We observed variations in the diagnostic and management strategies for AF.
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Affiliation(s)
- Mik Wetterslev
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Morten Hylander Møller
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anders Granholm
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Nicolai Haase
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Theis Lange
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Sheila N Myatra
- Department of Anaesthesiology Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Johanna Hästbacka
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Yaseen M Arabi
- Department of Intensive Care Medicine, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Jiawei Shen
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Maria Cronhjort
- Department of Clinical Science and Education, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Elin Lindqvist
- Department of Clinical Science and Education, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Anders Aneman
- Department of Intensive Care Medicine, Liverpool Hospital, Liverpool, NSW, Australia
- South Western Clinical School, University of New South Wales, Warwick Farm, NSW, Australia
| | - Paul J Young
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Martin Siegemund
- Intensive Care Medicine, Department of Acute Medicine and Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Thijs Koster
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Tayyba Naz Aslam
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Morten H Bestle
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - North Zealand, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mia S Girkov
- Department of Anaesthesia and Intensive Care, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kushal Kalvit
- Department of Anaesthesiology Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Rakesh Mohanty
- Department of Anaesthesiology Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Joanne Mascarenhas
- Department of Medicine and Critical Care, Breach Candy Hospital Trust, Mumbai, India
| | - Manoranjan Pattnaik
- Department of Pulmonary Medicine, SCB Medical College & Hospital, Cuttack, India
| | - Sara Vergis
- Department of Anaesthesia and Critical Care, MOSC Medical College, Kolenchery, India
| | | | - Mehul Shah
- Department of Critical Care Medicine, Sir H N Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Ziyokov Joshi
- Department of Cardiac Anaesthesiology and Critical Care, Tagore Hospital, Jalandhar, India
| | - Erika Wilkman
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Pasi Lehto
- Department of Anaesthesia and Intensive Care, Oulu University Hospital, Oulu, Finland
| | - Ville Jalkanen
- Department of Intensive Care, Tampere University Hospital, Tampere, Finland
| | - Anni Pulkkinen
- Department of Anesthesia and Intensive Care, Central Finland Central Hospital, Central Finland Health Care District, Jyväskylä, Finland
| | - Youzhong An
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Guoxing Wang
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lei Huang
- Department of Intensive Care Medicine, Peking University Shenzhen Hospital, Shenzhen, China
| | - Bin Huang
- Department of Critical Care Medicine, Peking University Shenzhen Hospital, Shenzhen, China
| | - Wei Liu
- Department of Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Hengbo Gao
- Department of Critical Care Medicine, The Second Hospital, Hebei Medical University, Hebei, China
| | - Lin Dou
- Department of Intensive Care Medicine, Tianjin First Center Hospital, Tianjin, China
| | - Shuangling Li
- Department of Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Wanchun Yang
- Emergency Intensive Care Unit, Xinjiang Production and Construction Crops 13 div Red Star Hospital
| | - Emily Tegnell
- Department of Anesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Agnes Knight
- Department of Anaesthesia and Intensive Care, Hudiksvall Hospital, Hudiksvall, Sweden
| | - Miroslaw Czuczwar
- Second Department of Anesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland
| | - Tomasz Czarnik
- Department of Anesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Anders Perner
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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4
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Anthon CT, Pène F, Perner A, Azoulay E, Puxty K, Van De Louw A, Barret‐Due A, Chawla S, Castro P, Povoa P, Coelho L, Metaxa V, Munshi L, Kochanek M, Liebregts T, Kander T, Hästbacka J, Møller MH, Russell L, Anthon CT, Hildebrandt T, Vogelius MK, Clausen N, Bestle M, Lorentzen K, Nielsen LB, Andreasen JB, Hvas CL, Juhl CS, Lundqvist L, Lindquist E, Barret‐Due A, Bådstøløkken PM, Holten AR, Kvåle R, Strand K, Klepstad P, Hästbacka J, Jalkanen V, Reinikainen M, Péju E, Marin N, Pène F, Vimpere D, Menat S, Voiriot G, Schmidt J, Dufranc E, Uhel F, Lafarge A, Missri L, Ait‐Oufella H, Canet E, Metexa V, Puxty K, Wright C, Castro P, Costa C, Coelho L, Povoa P, Paulino MC, Graça C, Torres JCS, Chawla S, Voigt L, Van de Louw A, Munshi L, Lueck C, Kochanek M, Liebgrets T. Platelet transfusions and thrombocytopenia in intensive care units: protocol for an international inception cohort study (PLOT‐ICU). Acta Anaesthesiol Scand 2022; 66:1146-1155. [PMID: 36054145 PMCID: PMC9542787 DOI: 10.1111/aas.14124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 07/15/2022] [Indexed: 11/30/2022]
Abstract
Introduction Thrombocytopenia is frequent in intensive care unit (ICU) patients and has been associated with worse outcome. Platelet transfusions are often used in the management of ICU patients with severe thrombocytopenia. However, the reported frequencies of thrombocytopenia and platelet transfusion practices in the ICU vary considerably. Therefore, we aim to provide contemporary epidemiological data on thrombocytopenia and platelet transfusion practices in the ICU. Methods We will conduct an international inception cohort, including at least 1000 acutely admitted adult ICU patients. Routinely available data will be collected at baseline (ICU admission), and daily during ICU stay up to a maximum of 90 days. The primary outcome will be the number of patients with thrombocytopenia (a recorded platelet count < 150 × 109/L) at baseline and/or during ICU stay. Secondary outcomes include mortality, days alive and out of hospital, days alive without life‐support, the number of patients with at least one bleeding episode, at least one thromboembolic event and at least one platelet transfusion in the ICU, the number of platelet transfusions and the indications for transfusion. The primary and secondary outcomes will be presented descriptively. In addition, we will assess risk factors for developing thrombocytopenia during ICU stay and the association between thrombocytopenia at baseline and 90‐day mortality using logistic regression analyses. Conclusion The outlined international PLOT‐ICU cohort study will provide contemporary epidemiological data on the burden and clinical significance of thrombocytopenia in adult ICU patients and describe the current platelet transfusion practice.
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Affiliation(s)
- Carl Thomas Anthon
- Department of Intensive Care, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Frédéric Pène
- Médecine Intensive & Réanimation, Hôpital Cochin, Assistance Publique – Hôpitaux de Paris Université Paris Cité Paris France
| | - Anders Perner
- Department of Intensive Care, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Elie Azoulay
- Médecine Intensive et Réanimation, Hôpital Saint‐Louis, Assistance Publique – Hôpitaux de Paris Université Paris Cité Paris France
| | - Kathryn Puxty
- Department of Intensive Care Glasgow Royal Infirmary Glasgow United Kingdom
| | - Andry Van De Louw
- Division of Pulmonary and Critical Care Penn State University College of Medicine Hershey PA USA
| | - Andreas Barret‐Due
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Rikshospitalet Oslo University Hospital Oslo Norway
| | - Sanjay Chawla
- Critical Care Medicine Service, Department of Anesthesiology & Critical Care Medicine Memorial Sloan Kettering Cancer Center New York NY USA
| | - Pedro Castro
- Medical Intensive Care Unit, Hospital Clinic of Barcelona; IDIBAPS; University of Barcelona Barcelona Spain
| | - Pedro Povoa
- Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal and NOVA Medical School New University of Lisbon Lisbon Portugal
| | - Luis Coelho
- Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal and NOVA Medical School New University of Lisbon Lisbon Portugal
| | - Victoria Metaxa
- Department of Critical Care King's College Hospital NHS Foundation Trust London United Kingdom
| | - Laveena Munshi
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, Mount Sinai Hospital/University Health Network University of Toronto Toronto Ontario Canada
| | - Matthias Kochanek
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne University of Cologne Cologne Germany
| | - Tobias Liebregts
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen University of Duisburg‐Essen Essen Germany
| | - Thomas Kander
- Department of Intensive and Perioperative Care, Skåne University Hospital, Sweden and Department of Clinical Sciences Lund University Sweden
| | - Johanna Hästbacka
- Department of Perioperative, Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Morten Hylander Møller
- Department of Intensive Care, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Lene Russell
- Department of Intensive Care, Rigshospitalet University of Copenhagen Copenhagen Denmark
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Wetterslev M, Møller MH, Granholm A, Hassager C, Haase N, Aslam TN, Shen J, Young PJ, Aneman A, Hästbacka J, Siegemund M, Cronhjort M, Lindqvist E, Myatra SN, Kalvit K, Arabi YM, Szczeklik W, Sigurdsson MI, Balik M, Keus F, Perner A, Huang B, Yan M, Liu W, Deng Y, Zhang L, Suk P, Mørk Sørensen K, Andreasen AS, Bestle MH, Krag M, Poulsen LM, Hildebrandt T, Møller K, Møller‐Sørensen H, Bove J, Kilsgaard TA, Salam IA, Brøchner AC, Strøm T, Sølling C, Kolstrup L, Boczan M, Rasmussen BS, Darfelt IS, Jalkanen V, Lehto P, Reinikainen M, Kárason S, Sigvaldason K, Olafsson O, Vergis S, Mascarenhas J, Shah M, Haranath SP, Van Der Poll A, Gjerde S, Fossum OK, Strand K, Wangberg HL, Berta E, Balsliemke S, Robertson AC, Pedersen R, Dokka V, Brügger‐Synnes P, Czarnik T, Albshabshe AA, Almekhlafi G, Knight A, Tegnell E, Sjövall F, Jakob S, Filipovic M, Kleger G, Eck RJ. Management of acute atrial fibrillation in the intensive care unit: An international survey. Acta Anaesthesiol Scand 2022; 66:375-385. [PMID: 34870855 DOI: 10.1111/aas.14007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/11/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is common in intensive care unit (ICU) patients and is associated with poor outcomes. Different management strategies exist, but the evidence is limited and derived from non-ICU patients. This international survey of ICU doctors evaluated the preferred management of acute AF in ICU patients. METHOD We conducted an international online survey of ICU doctors with 27 questions about the preferred management of acute AF in the ICU, including antiarrhythmic therapy in hemodynamically stable and unstable patients and use of anticoagulant therapy. RESULTS A total of 910 respondents from 70 ICUs in 14 countries participated in the survey with 24%-100% of doctors from sites responding. Most ICUs (80%) did not have a local guideline for the management of acute AF. The preferred first-line strategy for the management of hemodynamically stable patients with acute AF was observation (95% of respondents), rhythm control (3%), or rate control (2%). For hemodynamically unstable patients, the preferred strategy was observation (48%), rhythm control (48%), or rate control (4%). Overall, preferred antiarrhythmic interventions included amiodarone, direct current cardioversion, beta-blockers other than sotalol, and magnesium in that order. A total of 67% preferred using anticoagulant therapy in ICU patients with AF, among whom 61% preferred therapeutic dose anticoagulants and 39% prophylactic dose anticoagulants. CONCLUSION This international survey indicated considerable practice variation among ICU doctors in the clinical management of acute AF, including the overall management strategies and the use of antiarrhythmic interventions and anticoagulants.
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Affiliation(s)
- Mik Wetterslev
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Morten Hylander Møller
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Anders Granholm
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Christian Hassager
- Department of Cardiology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Nicolai Haase
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Tayyba Naz Aslam
- Department of Anaesthesiology Division of Emergencies and Critical Care Rikshospitalet Oslo University Hospital Oslo Norway
| | - Jiawei Shen
- Department of Critical Care Medicine Peking University People's Hospital Beijing China
| | - Paul J. Young
- Intensive Care Specialist and co‐Director, Intensive Care Unit Wellington Hospital Wellington New Zealand
- Intensive Care Programme Director Medical Research Institute of New Zealand Wellington New Zealand
- Australian and New Zealand Intensive Care Research Centre Department of Epidemiology and Preventive Medicine School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Anders Aneman
- Department of Intensive Care Medicine Liverpool Hospital South Western Sydney Local Health District and South Western Sydney Clinical School University of New South Wales Sydney Australia
| | - Johanna Hästbacka
- Department of Anaesthesiology, Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Martin Siegemund
- Department of Intensive Care Medicine Department of Clinical Research University Hospital Basel and University of Basel Basel Switzerland
| | - Maria Cronhjort
- Department of Clinical Science and Education Section of Anaesthesia and Intensive Care Södersjukhuset Karolinska Institutet Stockholm Sweden
| | - Elin Lindqvist
- Department of Clinical Science and Education Section of Anaesthesia and Intensive Care Södersjukhuset Karolinska Institutet Stockholm Sweden
| | - Sheila N. Myatra
- Department of Anaesthesiology Critical Care and Pain Tata Memorial Hospital Homi Bhabha National Institute Mumbai India
| | - Kushal Kalvit
- Department of Anaesthesiology Critical Care and Pain Tata Memorial Hospital Homi Bhabha National Institute Mumbai India
| | - Yaseen M. Arabi
- Department of Intensive Care Medicine Ministry of National Guard Health Affairs King Saud bin Abdulaziz University for Health Sciences King Abdullah International Medical Research Center Riyadh Saudi Arabia
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine Jagiellonian University Medical College Kraków Poland
| | - Martin I. Sigurdsson
- Division of Anaesthesia and Intensive Care Perioperative Services at Landspitali The National University Hospital of Iceland Reykjavik Iceland
- Faculty of Medicine University of Iceland Reykjavik Iceland
| | - Martin Balik
- Department of Anesthesiology and Intensive Care 1st Faculty of Medicine General University Hospital Charles University Prague Czech Republic
| | - Frederik Keus
- Department of Critical Care University of Groningen University Medical Center Groningen Groningen the Netherlands
| | - Anders Perner
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
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Uljas E, Jalkanen V, Kuitunen A, Hynninen M, Hästbacka J. Prevalence of risk-drinking in critically ill patients, screened with carbohydrate-deficient transferrin and AUDIT-C score: A retrospective study. Acta Anaesthesiol Scand 2020; 64:216-223. [PMID: 31541613 DOI: 10.1111/aas.13484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/19/2019] [Accepted: 09/11/2019] [Indexed: 12/13/2022]
Abstract
Background Studies demonstrate that up to one-third of intensive care unit (ICU) admissions are directly or indirectly related to alcohol. Screening for alcohol use is not routine. This study examined the prevalence of elevated %CDT (carbohydrate-deficient transferrin) and above risk-level AUDIT-C (Alcohol Use Disorders Identification Test, Consumption) in patients admitted to ICU. Methods We conducted a retrospective analysis of clinical and laboratory data from a single ICU where %CDT and AUDIT-C were included in routine assessment. After excluding readmissions, 2532 adult patients from a 21-month period were included. Admission values of %CDT were available for 2049 patients, and AUDIT-C was available for 1617 patients. The association of %CDT and AUDIT-C with short- and long-term outcome was studied by using univariate and multivariate logistic regression analysis. Results %CDT was above the reference value in 23.7% (486/2048) of patients with available %CDT. Of patients with available AUDIT-C, 33% (544/1617) had a risk-level AUDIT-C score. Patients with a risk-level AUDIT-C score were significantly younger than those with a lower score (51 vs 64 years, P < .0001). Increased %CDT was associated with higher severity of illness. AUDIT-C was associated independently with increased risk of long-term mortality in multivariate analysis (P = .007). Conclusion One in three of ICU patients are risk-level alcohol users as measured with AUDIT-C score, and one in four are analysed with %CDT. The prevalence varies according to the method used and any method alone may be insufficient to detect risk-level consumption reliably. Editorial Comment Alcohol overconsumption is associated with need for ICU admission and with less favorable outcomes. Diagnosis of alcohol overconsumption though is problematic due to low sensitivity in screening. In a pilot study, a biomarker and a screening tool are compared. The finding is that multiple tools are needed to achieve an adequate sensitivity for detection.
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Affiliation(s)
- Eliisa Uljas
- Division of Intensive Care Department of Anaesthesiology, Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Ville Jalkanen
- Department of Intensive Care University of Tampere Tampere University Hospital Tampere Finland
| | - Anne Kuitunen
- Department of Intensive Care University of Tampere Tampere University Hospital Tampere Finland
| | - Marja Hynninen
- Division of Intensive Care Department of Anaesthesiology, Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Johanna Hästbacka
- Division of Intensive Care Department of Anaesthesiology, Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland
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7
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Åstrand AP, Andersson BM, Jalkanen V, Ljungberg B, Bergh A, Lindahl OA. Prostate Cancer Detection with a Tactile Resonance Sensor-Measurement Considerations and Clinical Setup. Sensors (Basel) 2017; 17:s17112453. [PMID: 29072592 PMCID: PMC5713103 DOI: 10.3390/s17112453] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 10/16/2017] [Accepted: 10/24/2017] [Indexed: 12/11/2022]
Abstract
Tumors in the human prostate are usually stiffer compared to surrounding non-malignant glandular tissue, and tactile resonance sensors measuring stiffness can be used to detect prostate cancer. To explore this further, we used a tactile resonance sensor system combined with a rotatable sample holder where whole surgically removed prostates could be attached to detect tumors on, and beneath, the surface ex vivo. Model studies on tissue phantoms made of silicone and porcine tissue were performed. Finally, two resected human prostate glands were studied. Embedded stiff silicone inclusions placed 4 mm under the surface could be detected in both the silicone and biological tissue models, with a sensor indentation of 0.6 mm. Areas with different amounts of prostate cancer (PCa) could be distinguished from normal tissue (p < 0.05), when the tumor was located in the anterior part, whereas small tumors located in the dorsal aspect were undetected. The study indicates that PCa may be detected in a whole resected prostate with an uneven surface and through its capsule. This is promising for the development of a clinically useful instrument to detect prostate cancer during surgery.
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Affiliation(s)
- Anders P Åstrand
- Department of Applied Physics and Electronics, Umeå University, SE-90187 Umeå, Sweden.
- Centre for Biomedical Engineering and Physics, Umeå University, SE-90187 Umeå, Sweden.
| | - Britt M Andersson
- Department of Applied Physics and Electronics, Umeå University, SE-90187 Umeå, Sweden.
- Centre for Biomedical Engineering and Physics, Umeå University, SE-90187 Umeå, Sweden.
| | - Ville Jalkanen
- Department of Applied Physics and Electronics, Umeå University, SE-90187 Umeå, Sweden.
- Centre for Biomedical Engineering and Physics, Umeå University, SE-90187 Umeå, Sweden.
| | - Börje Ljungberg
- Department of Surgical and Perioperative Science, Urology and Andrology, Umeå University, SE-90187 Umeå, Sweden.
| | - Anders Bergh
- Department of Medical Biosciences, Pathology, Umeå University, SE-90187 Umeå, Sweden.
| | - Olof A Lindahl
- Centre for Biomedical Engineering and Physics, Umeå University, SE-90187 Umeå, Sweden.
- Department of Radiation Sciences, Biomedical Engineering, Umeå University, SE-90187 Umeå, Sweden.
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8
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Kiiski H, Jalkanen V, Ala-Peijari M, Hämäläinen M, Moilanen E, Peltola J, Tenhunen J. Plasma Soluble Urokinase-Type Plasminogen Activator Receptor Is Not Associated with Neurological Outcome in Patients with Aneurysmal Subarachnoid Hemorrhage. Front Neurol 2017; 8:144. [PMID: 28458650 PMCID: PMC5394110 DOI: 10.3389/fneur.2017.00144] [Citation(s) in RCA: 5] [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: 02/15/2017] [Accepted: 03/30/2017] [Indexed: 12/31/2022] Open
Abstract
Object Aneurysmal subarachnoid hemorrhage (aSAH) is a common cause of death or long-term disability. Despite advances in neurocritical care, there is still only a very limited ability to monitor the development of secondary brain injury or to predict neurological outcome after aSAH. Soluble urokinase-type plasminogen activator receptor (suPAR) has shown potential as a prognostic and as an inflammatory biomarker in a wide range of critical illnesses since it displays an association with overall immune system activation. This is the first time that suPAR has been evaluated as a prognostic biomarker in aSAH. Methods In this prospective population-based study, plasma suPAR levels were measured in aSAH patients (n = 47) for up to 5 days. suPAR was measured at 0, 12, and 24 h after patient admission to the intensive care unit (ICU) and daily thereafter until he/she was transferred from the ICU. The patients’ neurological outcome was evaluated with the modified Rankin Scale (mRS) at 6 months after aSAH. Results suPAR levels (n = 47) during the first 24 h after aSAH were comparable in groups with a favorable (mRS 0–2) or an unfavorable (mRS 3–6) outcome. suPAR levels during the first 24 h were not associated with the findings in the primary brain CT, with acute hydrocephalus, or with antimicrobial medication use during 5-days’ follow-up. suPAR levels were associated with generally accepted inflammatory biomarkers (C-reactive protein, leukocyte count). Conclusion Plasma suPAR level was not associated with either neurological outcome or selected clinical conditions. While suPAR is a promising biomarker for prognostication in several conditions requiring intensive care, it did not reveal any value as a prognostic biomarker after aSAH.
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Affiliation(s)
- Heikki Kiiski
- Critical Care Medicine Research Group, Department of Intensive Care, Tampere University Hospital, Tampere, Finland
| | - Ville Jalkanen
- Critical Care Medicine Research Group, Department of Intensive Care, Tampere University Hospital, Tampere, Finland
| | - Marika Ala-Peijari
- Critical Care Medicine Research Group, Department of Intensive Care, Tampere University Hospital, Tampere, Finland
| | - Mari Hämäläinen
- The Immunopharmacology Research Group, Faculty of Medicine and Life Sciences, University of Tampere, Tampere University Hospital, Tampere, Finland
| | - Eeva Moilanen
- The Immunopharmacology Research Group, Faculty of Medicine and Life Sciences, University of Tampere, Tampere University Hospital, Tampere, Finland
| | - Jukka Peltola
- Department of Neurology, University of Tampere, Tampere University Hospital, Tampere, Finland
| | - Jyrki Tenhunen
- Critical Care Medicine Research Group, Department of Intensive Care, Tampere University Hospital, Tampere, Finland.,Department of Surgical Sciences, Division of Anesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
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Jalkanen V, Värelä V, Kalliomäki J. Case report: Two severe cases of suicide attempts using nicotine containing e-cigarette liquid. Duodecim 2016; 132:1480-1483. [PMID: 29188936] [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: 06/07/2023]
Abstract
The use of electronic cigarettes and nicotine-containing liquids is getting more common, thus increasing the risk for intentional or unintentional nicotine poisoning. The results of ingestion of nicotine can be severe, even fatal. We describe two different cases of severe poisonings caused by nicotine-containing electronic cigarette liquids.
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10
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Nyberg M, Jalkanen V, Ramser K, Ljungberg B, Bergh A, Lindahl OA. Dual-modality probe intended for prostate cancer detection combining Raman spectroscopy and tactile resonance technology--discrimination of normal human prostate tissues ex vivo. J Med Eng Technol 2015; 39:198-207. [PMID: 25762203 DOI: 10.3109/03091902.2015.1021430] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Prostate cancer is the most common cancer for men in the western world. For the first time, a dual-modality probe, combining Raman spectroscopy and tactile resonance technology, has been used for assessment of fresh human prostate tissue. The study investigates the potential of the dual-modality probe by testing its ability to differentiate prostate tissue types ex vivo. Measurements on four prostates show that the tactile resonance modality was able to discriminate soft epithelial tissue and stiff stroma (p < 0.05). The Raman spectra exhibited a strong fluorescent background at the current experimental settings. However, stroma could be discerned from epithelia by integrating the value of the spectral background. Combining both parameters by a stepwise analysis resulted in 100% sensitivity and 91% specificity. Although no cancer tissue was analysed, the results are promising for further development of the instrument and method for discriminating prostate tissues and cancer.
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Affiliation(s)
- M Nyberg
- Department of Engineering Sciences and Mathematics, Luleå University of Technology , Luleå , Sweden
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11
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Åstrand AP, Andersson BM, Jalkanen V, Lindahl OA. Initial Measurements on Whole Human Prostate ex vivo with a Tactile Resonance Sensor in Order to Detect Prostate Cancer. IFMBE Proceedings 2015. [DOI: 10.1007/978-3-319-12967-9_33] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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12
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Åstrand AP, Jalkanen V, Andersson BM, Lindahl OA. Detection of Stiff Nodules Embedded in Soft Tissue Phantoms, Mimicking Cancer Tumours, Using a Tactile Resonance Sensor. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/jbise.2014.74022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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13
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Jalkanen V, Andersson BM, Bergh A, Ljungberg B, Lindahl OA. Indentation loading response of a resonance sensor--discriminating prostate cancer and normal tissue. J Med Eng Technol 2013; 37:416-23. [PMID: 23978075 DOI: 10.3109/03091902.2013.824510] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Prostate cancer is the most common type of cancer among men worldwide. Mechanical properties of prostate tissue are promising for distinguishing prostate cancer from healthy prostate tissue. The aim was to investigate the indentation loading response of a resonance sensor for discriminating prostate cancer tissue from normal tissue. Indentation measurements were done on prostate tissue specimens ex vivo from 10 patients from radical prostatectomy. The measurement areas were analysed using standard histological methods. The stiffness parameter was linearly dependent on the loading force (average R(2 )= 0.90) and an increased loading force caused a greater stiffness contrast of prostate cancer vs normal tissue. The accuracy of the stiffness contrast was assessed by the ROC curve with the area under the curve being 0.941 for a loading force of 12.8 mN. The results are promising for the development of a resonance sensor instrument for detecting prostate cancer.
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Åstrand AP, Jalkanen V, Andersson BM, Lindahl OA. Contact angle and indentation velocity dependency for a resonance sensor—Evaluation on soft tissue silicone models. J Med Eng Technol 2013; 37:185-96. [DOI: 10.3109/03091902.2013.773097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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15
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Arbelius-Iltanen M, Siren R, Heinilä J, Korhonen P, Sutinen T, Jalkanen V, Ahonen T, Karlsson S. First-hour protocol clarifies resource management and nursing staff education in the ICU. Crit Care 2013. [PMCID: PMC3642907 DOI: 10.1186/cc12441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Jalkanen V, Andersson BM, Bergh A, Ljungberg B, Lindahl OA. Explanatory models for a tactile resonance sensor system—elastic and density-related variations of prostate tissuein vitro. Physiol Meas 2008; 29:729-45. [DOI: 10.1088/0967-3334/29/7/003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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17
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Jalkanen V, Andersson BM, Bergh A, Ljungberg B, Lindahl OA. Spatial variations in prostate tissue histology as measured by a tactile resonance sensor. Physiol Meas 2007; 28:1267-81. [PMID: 17906393 DOI: 10.1088/0967-3334/28/10/011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In recent years, tactile sensors based on piezoelectric resonance sensor technology have been used for medical diagnosis where the sensor's stiffness-measuring properties can reflect tissue pathology. The change in the frequency of the resonating system and the change in force when contact is made with tissue are used as a stiffness parameter. Earlier stiffness measurements of prostate tissue in vitro demonstrate variations related to tissue composition. In this study, measured stiffness from two human prostate specimens was compared to histological composition of prostate tissue below and around the measurement points. Tissue stiffness was measured with the resonance sensor system. Tissue composition was measured at four different depths in the tissue specimen using a microscopic-image-based morphometrical method. With this method, the proportion of tissue types was determined at the points of intersections in a circular grid on the images representing each measurement point. Numerical values were used for weighting the tissue proportions at different depths in the tissue specimen. For an impression depth of 1.0 mm, the sensing depth in this study was estimated to be 3.5-5.5 mm. Stiffness variations due to horizontal tissue variations were investigated by studying the dependence of the size of the circular grid area relative to the contact area of the sensor tip. The sensing area (grid radius) was estimated to be larger than the contact area (contact radius) between the sensor tip and the tissue. Thus, the sensor tip registers spatial variations in prostate tissue histology, both directly below and lateral to the tip itself. These findings indicate that tumours around the sensor tip could be detected, which in turn supports the idea of a future resonance-sensor-based clinical device for detecting tumours and for guiding biopsies.
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Affiliation(s)
- Ville Jalkanen
- Department of Applied Physics and Electronics, Umeå University, SE-90187 Umeå, Sweden.
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Jalkanen V, Andersson BM, Bergh A, Ljungberg B, Lindahl OA. Resonance sensor measurements of stiffness variations in prostate tissuein vitro—a weighted tissue proportion model. Physiol Meas 2006; 27:1373-86. [PMID: 17135706 DOI: 10.1088/0967-3334/27/12/009] [Citation(s) in RCA: 33] [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: 11/12/2022]
Abstract
Prostate cancer is the most common type of cancer in men in Europe and the US. The methods to detect prostate cancer are still precarious and new techniques are needed. A piezoelectric transducer element in a feedback system is set to vibrate with its resonance frequency. When the sensor element contacts an object a change in the resonance frequency is observed, and this feature has been utilized in sensor systems to describe physical properties of different objects. For medical applications it has been used to measure stiffness variations due to various patho-physiological conditions. In this study the sensor's ability to measure the stiffness of prostate tissue, from two excised prostatectomy specimens in vitro, was analysed. The specimens were also subjected to morphometric measurements, and the sensor parameter was compared with the morphology of the tissue with linear regression. In the probe impression interval 0.5-1.7 mm, the maximum R(2) > or = 0.60 (p < 0.05, n = 75). An increase in the proportion of prostate stones (corpora amylacea), stroma, or cancer in relation to healthy glandular tissue increased the measured stiffness. Cancer and stroma had the greatest effect on the measured stiffness. The deeper the sensor was pressed, the greater, i.e., deeper, volume it sensed. Tissue sections deeper in the tissue were assigned a lower mathematical weighting than sections closer to the sensor probe. It is concluded that cancer increases the measured stiffness as compared with healthy glandular tissue, but areas with predominantly stroma or many stones could be more difficult to differ from cancer.
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Affiliation(s)
- Ville Jalkanen
- Department of Applied Physics and Electronics, Umeå University, SE-90187 Umeå, Sweden.
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Jalkanen V, Andersson BM, Bergh A, Ljungberg B, Lindahl OA. Prostate tissue stiffness as measured with a resonance sensor system: a study on silicone and human prostate tissue in vitro. Med Biol Eng Comput 2006; 44:593-603. [PMID: 16937195 DOI: 10.1007/s11517-006-0069-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [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: 01/13/2006] [Accepted: 05/05/2006] [Indexed: 12/01/2022]
Abstract
Prostate cancer is the most common form of cancer in men in Europe and in the USA. Some prostate tumours are stiffer than the surrounding normal tissue, and it could therefore be of interest to measure prostate tissue stiffness. Resonance sensor technology based on piezoelectric resonance detects variations in tissue stiffness due to a change in the resonance frequency. An impression-controlled resonance sensor system was used to detect stiffness in silicone rubber and in human prostate tissue in vitro using two parameters, both combinations of frequency change and force. Variations in silicone rubber stiffness due to the mixing ratio of the two components could be detected (p<0.05) using both parameters. Measurements on prostate tissue showed that there existed a statistically significant (MANOVA test, p<0.001) reproducible difference between tumour tissue (n=13) and normal healthy tissue (n=98) when studying a multivariate parameter set. Both the tumour tissue and normal tissue groups had variations within them, which were assumed to be related to differences in tissue composition. Other sources of error could be uneven surfaces and different levels of dehydration for the prostates. Our results indicated that the resonance sensor could be used to detect stiffness variations in silicone and in human prostate tissue in vitro. This is promising for the development of a future diagnostic tool for prostate cancer.
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Affiliation(s)
- Ville Jalkanen
- Department of Applied Physics and Electronics, Umeå University, Umeå, Sweden.
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Pihlajamäki M, Tanila H, Hänninen T, Könönen M, Mikkonen M, Jalkanen V, Partanen K, Aronen HJ, Soininen H. Encoding of novel picture pairs activates the perirhinal cortex: an fMRI study. Hippocampus 2003; 13:67-80. [PMID: 12625459 DOI: 10.1002/hipo.10049] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
It is well established in nonhuman primates that the medial temporal lobe (MTL) structures, the hippocampus and the entorhinal and perirhinal cortices, are necessary for declarative memory encoding. In humans, the neuropathological and neuropsychological changes in early Alzheimer's disease (AD) further support a role for the rhinal cortex in the consolidation of new events into long-term memory. Little is known, however, regarding the function of the rhinal cortex in humans in vivo. To examine the participation of the interconnected MTL structures as well as the whole-brain network of activated brain areas in visual associative long-term memory, functional magnetic resonance imaging (fMRI) was used to determine the brain regions that are activated during encoding and retrieval of paired pictures in 12 young control subjects. The most striking finding in the MTL activation pattern was the consistent activation of the perirhinal cortex in the encoding-baseline and encoding-retrieval comparisons with a strict statistical threshold (P < 0.00001). In contrast, no perirhinal cortex activation was detected in the retrieval-baseline or retrieval-encoding comparisons even with a low statistical threshold (P < 0.05). The location of the perirhinal activation area was in the transentorhinal part of the perirhinal cortex, in the medial bank of the collateral sulcus. The hippocampus and the more posterior parahippocampal gyrus were activated in both encoding and retrieval conditions. During the encoding processing, MTL activations were more consistent and the hippocampal activation area located more anteriorly than during retrieval. The frontal, parietal, temporal, and occipital association cortices were also activated in the encoding-baseline and retrieval-baseline comparisons. The data suggest that encoding, but not retrieval, of novel picture pairs activates the perirhinal cortex. To our knowledge, this is the first fMRI study reporting encoding activation in this transentorhinal part of the perirhinal cortex, the site of the very earliest neuropathological changes in AD.
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Affiliation(s)
- Maija Pihlajamäki
- Department of Neuroscience and Neurology, University of Kuopio, Kuopio, Finland
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