The present study investigated the cardiac effects of a 10-week football training intervention for school children aged 9-10 years using comprehensive transthoracic echocardiography as a part of a ...larger ongoing study. A total of 97 pupils from four school classes were cluster-randomized into a control group that maintained their usual activities (CON; two classes, n = 51, 21 boys and 30 girls) and a football training group that performed an additional 3 x 40 min of small-sided football training per week (FT; two classes, n = 46, 23 boys and 23 girls). No baseline differences were observed in age, body composition, or echocardiographic variables between FT and CON. After the 10-week intervention, left ventricular posterior wall diameter was increased in FT compared with CON 0.4 ± 0.7 vs -0.1 ± 0.6 (± SD) mm; P ( 0.01 as was the interventricular septum thickness (0.2 ± 0.7 vs -0.2 ± 0.8 mm; P ( 0.001). Global isovolumetric relaxation time increased more in FT than in CON (3.8 ± 10.4 vs -0.9 ± 6.6 ms, P ( 0.05) while the change in ventricular systolic ejection fraction tended to be higher (1.4 ± 8.0 vs -1.1 ± 5.5%; P = 0.08). No changes were observed in resting heart rate or blood pressure. In conclusion, a short-term, school-based intervention comprising small-sided football sessions resulted in significant structural and functional cardiac adaptations in pre-adolescent children. Verf.-Referat.
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BFBNIB, FSPLJ, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Delay in diagnosis of cancer may worsen prognosis. The aim of this study is to explore patient-, general practitioner (GP)- and system-related delay in the interval from first cancer symptom to ...diagnosis and treatment, and to analyse the extent to which delays differ by cancer type.
Population-based cohort study conducted in 2004-05 in the County of Aarhus, Denmark (640,000 inhabitants). Data were collected from administrative registries and questionnaires completed by GPs on 2,212 cancer patients newly diagnosed during a 1-year period. Median delay (in days) with interquartile interval (IQI) was the main outcome measure.
Median total delay was 98 days (IQI 57-168). Most of the total delay stemmed from patient (median 21 days (7-56)) and system delay (median 55 days (32-93)). Median GP delay was 0 (0-2) days. Total delay was shortest among patients with ovarian (median 60 days (45-112)) and breast cancer (median 65 days (39-106)) and longest among patients with prostate (median 130 days (89-254)) and bladder cancer (median 134 days (93-181)).
System delay accounted for a substantial part of the total delay experienced by cancer patients. This points to a need for shortening clinical pathways if possible. A long patient delay calls for research into patient awareness of cancer. For all delay components, special focus should be given to the 4th quartile of patients with the longest time intervals and we need research into the quality of the diagnostic work-up process. We found large variations in delay for different types of cancer. Improvements should therefore target both the population at large and the specific needs associated with individual cancer types and their symptoms.
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CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Glucagon is believed to be a pancreas-specific hormone, and hyperglucagonemia has been shown to contribute significantly to the hyperglycemic state of patients with diabetes. This hyperglucagonemia ...has been thought to arise from α-cell insensitivity to suppressive effects of glucose and insulin combined with reduced insulin secretion. We hypothesized that postabsorptive hyperglucagonemia represents a gut-dependent phenomenon and subjected 10 totally pancreatectomized patients and 10 healthy control subjects to a 75-g oral glucose tolerance test and a corresponding isoglycemic intravenous glucose infusion. We applied novel analytical methods of plasma glucagon (sandwich ELISA and mass spectrometry-based proteomics) and show that 29-amino acid glucagon circulates in patients without a pancreas and that glucose stimulation of the gastrointestinal tract elicits significant hyperglucagonemia in these patients. These findings emphasize the existence of extrapancreatic glucagon (perhaps originating from the gut) in man and suggest that it may play a role in diabetes secondary to total pancreatectomy.
To evaluate the prevalence of survey-based criteria for fibromyalgia (FM) among newly referred patients in a rheumatic outpatient clinic, and to compare the use of secondary healthcare services ...between survey-based FM and non-FM cases.
Newly referred patients to an outpatient clinic were screened for the fulfilment of the 2011 FM survey criteria during a 6 month period in 2013 in this observational cohort study. Demographic data were obtained at baseline. Patients' medical files were evaluated and comparisons between groups were made regarding the use of hospital healthcare facilities during the 7 year observation period.
Out of 300 invited patients, 248 (83%) completed the questionnaire; 90 patients (36%) fulfilled survey-based criteria for FM at enrolment. FM cases were primarily women (80% vs 54% of non-FM cases), and received more medications (median 4 vs 3 drugs) and public economic support (62% vs 20%). At the 7 year follow-up, crude analyses showed that FM cases had a higher number of hospital courses (median 10 vs 8) and had undergone more invasive procedures (78% vs 60%). Neurologists (42% vs 28%), gastroenterologists (30% vs 13%), endocrinologists (40% vs 21%), pain specialists (13% vs 3%), psychiatrists (20% vs 7%), and abdominal surgeons (43% vs 30%) were consulted more often by FM than by non-FM cases.
Fulfilment of FM survey criteria among newly referred patients to a rheumatic outpatient clinic is frequent. Our study findings show that FM continues to present a challenge for healthcare professionals as well as for patients.
● Fulfilment of FM survey criteria among newly referred patients to a rheumatic outpatient clinic is frequent.
● The burden on the secondary healthcare system for these patients is significant.
● This study suggests the need for increased awareness about the diagnosis of FM among certain medical and surgical specialties.
Diabet. Med. 27, 1144–1150 (2010)
Aims Our aim was to evaluate the markers of tubulointerstitial damage, neutrophil gelatinase‐associated lipocalin (NGAL) and kidney injury molecule 1 (KIM1) in Type ...1 diabetic patients with different levels of albuminuria and in control subjects. In addition, the effect of renoprotective treatment on urinary NGAL was evaluated in diabetic nephropathy.
Methods This was a cross‐sectional study in 58 normoalbuminuric (u‐albumin < 30mg/24 h), 45 microalbuminuric (30–300 mg/24 h) and 45 macroalbuminuric (> 300 mg/24 h) Type 1 diabetic patients and 55 non‐diabetic control subjects. Furthermore, in a second study, urine‐NGAL was measured in a randomized cross‐over study of 56 Type 1 diabetic patients with diabetic nephropathy treated with lisinopril 20, 40 and 60 mg daily.
Results Urine‐NGAL levels were geometric mean (95% CI): control subjects 74 (52–104) (pg/mmol creatinine), normoalbuminuric 146 (97–221), microalbuminuric 222 (158–312) and macroalbuminuric group 261 (175–390). Urine‐NGAL increased significantly from the normo‐ to the micro‐ and further to the macroalbuminuric group (P < 0.05). Urine‐NGAL was higher in normoalbuminuric vs. control subjects (P < 0.01). Plasma‐NGAL was significantly higher in the normoalbuminuric and macroalbuminuric groups than in the control group. Urine‐KIM1 was higher in all diabetic groups than in the control group (P < 0.001), with no difference between diabetic groups. During lisinopril treatment,
urine‐NGAL was reduced (95% CI) 17% (11–50) (not significant).
Conclusions Urine‐NGAL and urine‐KIM1 (u‐KIM1) are elevated in Type 1 diabetic patients, with or without albuminuria, indicating tubular damage at an early stage. Urine‐NGAL increases significantly with increasing albuminuria. The ACE inhibitor lisinopril reduced urine‐NGAL, but this was not statistically significant.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Mesenchymal stem cells (MSCs) have been investigated as promising candidates for use in new cell-based therapeutic strategies such as mesenchyme-derived tissue repair. MSCs are easily isolated from ...adult tissues and are not ethically restricted. MSC-related literature, however, is conflicting in relation to MSC differentiation potential and molecular markers. Here we compared MSCs isolated from bone marrow (BM), umbilical cord blood (UCB), and adipose tissue (AT). The isolation efficiency for both BM and AT was 100%, but that from UCB was only 30%. MSCs from these tissues are morphologically and immunophenotypically similar although their differentiation diverges. Differentiation to osteoblasts and chondroblasts was similar among MSCs from all sources, as analyzed by cytochemistry. Adipogenic differentiation showed that UCB-derived MSCs produced few and small lipid vacuoles in contrast to those of BM-derived MSCs and AT-derived stem cells (ADSCs) (arbitrary differentiation values of 245.57 +/- 943 and 243.89 +/- 145.52 mum(2) per nucleus, respectively). The mean area occupied by individual lipid droplets was 7.37 mum(2) for BM-derived MSCs and 2.36 mum(2) for ADSCs, a finding indicating more mature adipocytes in BM-derived MSCs than in treated cultures of ADSCs. We analyzed FAPB4, ALP, and type II collagen gene expression by quantitative polymerase chain reaction to confirm adipogenic, osteogenic, and chondrogenic differentiation, respectively. Results showed that all three sources presented a similar capacity for chondrogenic and osteogenic differentiation and they differed in their adipogenic potential. Therefore, it may be crucial to predetermine the most appropriate MSC source for future clinical applications.
Background
Psoriasis is a common disease and is associated with cardiovascular diseases. Systemic anti‐inflammatory drugs may reduce risk of cardiovascular events. We therefore examined the rate of ...cardiovascular events, i.e. cardiovascular death, myocardial infarction and stroke, in patients with severe psoriasis treated with systemic anti‐inflammatory drugs.
Methods
Individual‐level linkage of administrative registries was used to perform a longitudinal nationwide cohort study. Time‐dependent multivariable adjusted Cox regression was used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) of cardiovascular events associated with use of biological drugs, methotrexate, cyclosporine, retinoids and other antipsoriatic therapies, including topical treatments, phototherapy and climate therapy.
Results
A total of 6902 patients (9662 treatment exposures) with a maximum follow‐up of 5 years were included. Incidence rates per 1000 patients‐years for cardiovascular events were 4.16, 6.28, 6.08, 18.95 and 14.63 for biological drugs, methotrexate, cyclosporine, retinoid and other therapies respectively. Relative to other therapies, methotrexate (HR 0.53; CI 0.34–0.83) was associated with reduced risk of the composite endpoint and a comparable but non‐significant protective effect was observed with biological drugs (HR 0.58; CI 0.30–1.10), whereas no protective effect was apparent with cyclosporine (HR 1.06; CI 0.26–4.27) and retinoids (HR 1.80; CI 1.03–2.96). Tumour necrosis factor inhibitors (HR 0.46; CI 0.22–0.98) were linked to reduced event rates, whereas the interleukin‐12/23 inhibitor ustekinumab (HR 1.52; CI 0.47–4.94) was not.
Conclusion
Systemic anti‐inflammatory treatment with methotrexate was associated with significantly lower rates of cardiovascular events during long‐term follow‐up compared to patients treated with other antipsoriatic therapies. The treatment strategy in patients with severe psoriasis may have an impact on cardiovascular outcomes and randomized trials to evaluate the cardiovascular safety and efficacy of systemic antipsoriatic therapies are called for.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Organisations and governments seeking to implement genomics into clinical practice face numerous challenges across multiple, diverse aspects of the health care system. It is not sufficient to tackle ...any one aspect in isolation: to create a system that supports genomic medicine, they must be addressed simultaneously. The growing body of global knowledge can guide decision-making, but each jurisdiction or organisation needs a model for genomic (or personalised) medicine that is tailored to its unique context, its priorities and the funds available. Poor decisions could greatly reduce the benefits that could potentially arise from genomic medicine. Demonstration projects enable models to be tested, providing valuable evidence and experience for subsequent implementation. Here, we present the Melbourne Genomics Health Alliance demonstration project as an exemplar of a collaborative, holistic approach to phased implementation of genomics across multiple autonomous institutions. The approach and lessons learned may assist others in determining how best to integrate genomics into their healthcare system.
An arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis treatment. After creation many of the AVFs will never mature or if functioning will need an intervention within 1 year ...due to an AVF stenosis. Studies investigating possible therapies that improves the AVF maturation and survival are scarce. Far infrared therapy (FIR) has shown promising results. In minor single centre and industry supported trials FIR has shown improved AVF maturation and survival. There is a need of a randomized multicentre controlled trial to examine the effect of FIR on the AVF maturation and survival and to explore the possible AVF protective mechanism induced by the FIR treatment.
This investigator initiated, randomized, controlled, open-labeled, multicenter clinical trial will examine the effect of FIR on AVF maturation in patients with a newly created AVF (incident) and AVF patency rate after 1 year of treatment in patients with an existing AVF (prevalent) compared to a control group. The intervention group will receive FIR to the skin above their AVF three times a week for 1 year. The control group will be observed without any treatment. The primary outcome for incident AVFs is the time from surgically creation of the AVF to successful cannulation. The primary outcome for the prevalent AVFs is the difference in number of AVFs without intervention and still functioning in the treatment and control group after 12 months. Furthermore, the acute changes in inflammatory and vasodilating factors during FIR will be explored. Arterial stiffness as a marker of long term AVF patency will also be examined.
FIR is a promising new treatment modality that may potentially lead to improved AVF maturation and survival. This randomized controlled open-labelled trial will investigate the effect of FIR and its possible mechanisms.
Clinicaltrialsgov NCT04011072 (7th of July 2019).
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