Vascular endothelial growth factor (VEGF) has been shown to stimulate angiogenesis and myocardial perfusion. The short-term safety of VEGF gene therapy is excellent. However, there are only limited ...results regarding the long-term effects. The Kuopio Angiogenesis Trial (KAT) studied the efficiency and short-term safety of the local VEGF-A(165) gene transfer in 103 patients with coronary artery disease. Three patient groups received either VEGF as an adenoviral (n=37), or as a plasmid/liposome vector (n=28), or as a placebo (n=38), during coronary angioplasty and stenting (percutaneous coronary intervention, PCI)AQ1. The aim of this study was to examine the long-term effects and safety of VEGF gene therapy. Patients were interviewed by telephone or with a questionnaire on their current status of health, coronary and other cardiovascular events and symptoms, working ability, exercise tolerance, other diseases, such as cancer and diabetes, as well as their personal experience of the treatment. Causes of death were clarified from hospital records. The total follow-up time was 8.1 years (range 6.9-9.7 years). Overall 82% of the patients were reached across the study. Eight (7.5%) of the patients died during the follow-up, but there was no significant difference in mortality between the groups (3/32 vs 2/26 vs 3/31 VEGF-adenovirus vs VEGF-plasmid/liposome vs placebo, respectively; P=0.88). The incidence of major adverse cardiovascular events (MACEs) (10 vs 11 vs 15; P=0.85), cancer (1 vs 4 vs 2; P=0.38) or diabetes (2 vs 2 vs 2; P=0.97) did not differ between the groups. Local intracoronary VEGF gene transfer is safe and does not increase the risk of MACE, arrhythmias, cancer, diabetes or other diseases.
Treatments for hyperemesis gravidarum: A systematic review Vinnars, Marie‐Therese; Forslund, Maria; Claesson, Ing‐Marie ...
Acta obstetricia et gynecologica Scandinavica,
January 2024, 2024-Jan, 2024-01-00, 20240101, 2024, Letnik:
103, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Introduction
Hyperemesis gravidarum affects 0.3%–3% of pregnant women each year and is the leading cause of hospitalization in early pregnancy. Previous systematic reviews of available treatments ...have found a lack of consistent evidence, and few studies of high quality. Since 2016, no systematic review has been conducted and an up‐to date review is requested. In a recent James Lind Alliance collaboration, it was clear that research on effective treatments is a high priority for both patients and clinicians.
Material and methods
Searches without time limits were performed in the AMED, CINAHL, Cochrane Library, EMBASE, Medline, PsycINFO, and Scopus databases until June 26, 2023. Studies published before October 1, 2014 were identified from the review by O'Donnell et al., 2016. Selection criteria were randomized clinical trials and non‐randomized studies of interventions comparing treatment of hyperemesis gravidarum with another treatment or placebo. Outcome variables included were: degree of nausea; vomiting; inability to tolerate oral fluids or food; hospital treatment; health‐related quality of life, small‐for‐gestational‐age infant; and preterm birth. s and full texts were screened, and risk of bias of the studies was assessed independently by two authors. Synthesis without meta‐analysis was performed, and certainty of evidence was assessed using the GRADE approach. PROSPERO (CRD42022303150).
Results
Twenty treatments were included in 25 studies with low or moderate risk of bias. The certainty of evidence was very low for all treatments except for acupressure in addition to standard care, which showed a possible moderate decrease in nausea and vomiting, with low certainty of evidence.
Conclusions
Several scientific knowledge gaps were identified. Studies on treatments for hyperemesis gravidarum are few, and the certainty of evidence for different treatments is either low or very low. To establish more robust evidence, it is essential to use validated scoring systems, the recently established diagnostic criteria, clear descriptions and measurements of core outcomes and to perform larger studies.
The certainty of evidence according to GRADE (The Grading of Recommendations Assessment, Development and Evaluation) was very low for all treatments of hyperemesis gravidarum except for acupressure in addition to standard care, which showed a possible moderate decrease in nausea and vomiting, with low certainty of evidence.
The role of Everyday Technology (ET) use is presented as subsidiary or neutral in policy for age- and dementia-friendly communities; and yet, research suggests that older people, especially those ...with dementia, experience increased challenges using ET in their everyday lives. Through the lens of micro-citizenship, the study aims to deepen the knowledge about how use of ET outside the home, including portable ETs, relates to participation in places visited within public space among people with dementia over time. Using a longitudinal study design, 35 people with dementia were recruited at baseline and followed over three years. Data were collected through semi-structured interviews using standardised questionnaires: the Participation in ACTivities and Places OUTside Home Questionnaire (ACT-OUT) and the Everyday Technology Use Questionnaire (ETUQ). Random intercept modelling and descriptive statistics were used to analyse the data. Throughout the three-year study, decreasing use of ET outside the home, including portable ETs, was associated with decreasing participation in places visited within public space, in a statistically significant way when controlling for age (F = 7.59, p = 0.01). The findings indicate that facilitating access and use of ET outside the home, among people with dementia, should be integral to promoting and maintaining participation in age- and dementia-friendly communities.
Background : Immunoglobulin E (IgE) sensitization is associated with asthma and allergic diseases. Gestational age influences early immune system development, thereby potentially affecting the ...process of tolerance induction to allergens. We aimed to study IgE sensitization to common allergens by gestational age from childhood up to early adulthood.
Method : Population-based birth cohort, data from the Swedish BAMSE study was used. Allergen-specific IgE to a mix of common food (fx5) and inhalant (Phadiatop) allergens were analysed at 4, 8, 16 and 24 years. Sensitization was defined as allergen-specific IgE ≥0.35 kU A /l to fx5 and/or Phadiatop at each time-point. Using logistic regression and generalized estimated equations, adjusted odds ratios (aORs) for sensitization in relation to gestational age were calculated. Replication was sought within the Swedish twin study STOPPA.
Results : In BAMSE, 3523 participants were screened for IgE anti-bodies during follow-up; of these, 197 (5.6%) were born preterm (<37 gestational weeks), and 330 (9.4%) post-term (≥42 weeks). Preterm birth was inversely associated with sensitization to common food and/or inhalant allergens up to early adulthood; overall aOR = 0.71 (95% CI = 0.51- 0.98). An inverse association was also observed between preterm birth and sensitization to food allergens specifically; overall aOR = 0.59 (95% CI = 0.38- 0.95). No relation was found between post-term birth and IgE sensitization at any time-point. Replication analyses in STOPPA ( N = 675) showed similar risk estimates for sensitization to food and/or inhalant allergens (aOR = 0.76; 95% CI: 0.45- 1.26), which resulted in a combined meta-analysis aOR = 0.72 (95% CI: 0.55- 0.95).
Conclusion : Our study suggests an inverse association between preterm birth and later IgE sensitization.
Objective
The risk of certain psychiatric disorders is elevated among immigrants. To date, no population studies on immigrant health have addressed eating disorders. We examined whether risk of ...eating disorders in first‐ and second‐generation immigrants differs from native‐born Danes and Swedes.
Method
All individuals born 1984–2002 (Danish cohort) and 1989–1999 (Swedish cohort) and residing in the respective country on their 10th birthday were included. They were followed up for the development of eating disorders based on out‐patient and in‐patient data.
Results
The risks of all eating disorder types were lower among first‐generation immigrants compared to the native populations: Incidence‐rate ratio (95% confidence interval) was 0.39 (0.29, 0.51) for anorexia nervosa, 0.60 (0.42, 0.83) for bulimia nervosa, and 0.62 (0.47, 0.79) for other eating disorders in Denmark and 0.27 (0.21, 0.34) for anorexia nervosa, 0.30 (0.18, 0.51) for bulimia nervosa, and 0.39 (0.32, 0.47) for other eating disorders in Sweden. Likewise, second‐generation immigrants by both parents were at lower risk, whereas those with only one foreign‐born parent were not.
Conclusion
The decreased risk of eating disorders among immigrants is opposite to what has been observed for other psychiatric disorders, particularly schizophrenia. Possible explanations include buffering sociocultural factors and underdetection in health care.
•We assessed if highly suggestible (HS) individuals have poor metacognition of agency.•HS and control participants completed a task in which motor control was manipulated.•The groups did not differ ...in performance or metacognition of performance.•HS participants reported greater control, but only when their control was reduced.•Highly suggestible individuals’ sense of agency is less sensitive to manipulation.
A disruption in the sense of agency is the primary phenomenological feature of response to hypnotic suggestions but its cognitive basis remains elusive. Here we tested the proposal that distorted volition during response to suggestions arises from poor metacognition pertaining to the sources of one’s control. Highly suggestible and control participants completed a motor task in which performance was reduced through surreptitious manipulations of cursor lag and stimuli speed. Highly suggestible participants did not differ from controls in performance or metacognition of performance, but their sense of agency was less sensitive to cursor lag manipulations, suggesting reduced awareness that their control was being manipulated. These results indicate that highly suggestible individuals have aberrant metacognition of agency and may be a valuable population for studying distortions in the sense of agency.
Aims/hypothesis
The aim of this study was to determine whether exenatide improves haemodynamic function in patients with type 2 diabetes with congestive heart failure (CHF).
Methods
The main ...eligibility criteria for inclusion were: male/female (18–80 years) with type 2 diabetes and CHF (ejection fraction ≤35%, and New York Heart Association functional class III or IV). Out of 237 patients screened, 20 male type 2 diabetic patients participated in this crossover trial design and were allocated (sequentially numbered) to i.v. infusions during two consecutive days with (1) exenatide (0.12 pmol/kg/min); and (2) placebo for 6 h followed by a washout period for 18 h, at Stockholm South Hospital, Sweden. Patients and researchers were blinded to the assignment. Cardiac haemodynamic variables were determined by right heart catheterisation. The primary endpoint was defined as an increase in cardiac index (CI) or a decrease in pulmonary capillary wedge pressure (PCWP) of ≥20%. Secondary endpoints were tolerability and safety of exenatide infusion.
Results
CI increased at 3 and 6 h by 0.4 ± 0.1 (23%) and 0.33 ± 0.1 (17%) l min
−1
m
−2
, during exenatide infusion vs −0.02 ± 0.1 (−1%) and −0.08 ± 0.1 (−5%) l min
−1
m
−2
during placebo (
p
= 0.003); and heart rate (HR) increased at 1, 3 and 6 h by 8 ± 3 (11%), 15 ± 4 (21%) and 21 ± 5 (29%) beats per min (bpm), during exenatide infusion vs −1 ± 2 (−2%), 1 ± 1 (2%) and 6 ± 2 (8%) bpm, during placebo (
p
= 0.006); and PCWP decreased at 1, 3 and 6 h by −1.3 ± 0.8 (−8%), −1.2 ± 1 (−8%) and −2.2 ± 0.9 (−15%) mmHg, during exenatide infusion vs 0.3 ± 0.5 (2%), 1 ± 0.6 (6%) and 1.4 ± 0.7 (8%) mmHg, during placebo (
p
= 0.001). No serious adverse event was observed. Adverse events were reported in nine patients (six, nausea; two, increased HR; one, increased systolic blood pressure).
Conclusions/interpretation
Infusion of exenatide in male type 2 diabetic patients with CHF increased the CI as a result of chronotropy, with concomitant favourable effects on PCWP and reasonable tolerability of the drug. The clinical implications of using exenatide in patients with CHF are still not clear and further studies are warranted.
Trial registration:
www.isrctn.org/ISRCTN47533126
Funding:
This study was funded through the regional agreement on medical training and clinical research (ALF) between Stockholm County Council and the Karolinska Institute, by the Swedish Society for Medical Research, the Swedish Society of Medicine, Stiftelsen Serafimerlasarettet, the Swedish Heart and Lung foundation, Eli Lilly Amylin Alliance, the European Foundation for the Study of Diabetes, Karolinska Institutet Foundations, and Stiftelsen Olle Engkvist Byggmästare.
Skin contamination with radionuclides may cause local radiation damage, but also systemic distribution if the nuclides penetrate the epidermal membrane. Detailed information of the skin absorption of ...radionuclides is of importance for e.g. dose estimations and development of decontamination strategies. In the present study, penetration of 131I through human epidermis was studied using an in vitro flow through diffusion chamber. Epidermis was exposed to a Na131I-solution, used in nuclear medicine, and the potential concentration-dependency of skin penetration was examined by including two concentrations of non-radioactive NaI. Penetration of 131I occurred after a few minutes of exposure and steady state penetration rate was obtained after about 50–70min independently of the iodine concentration and receptor solution used. The two receptor solutions evaluated; phosphate buffered saline solution and an ethanol and water-mixture (1:1), resulted in significantly higher penetration rate of 131I using the ethanol and water-mixture. The penetration of iodine was calculated to be concentration-dependent independently of the receptor solution utilized. In addition, radioactive iodine did not accumulate in epidermis in the in vitro-model used.
In conclusion, the present study provides detailed information on the rapid iodine penetration at the early phase of radionuclide exposure, defined as the first 30min of the experiment, and is clearly suitable for decontamination studies. In addition, methodological aspects, e.g. impact of the receptor solution, should carefully be considered in studies of radionuclide skin penetration using in vitro-techniques.
•Rapid penetration of 131I through human epidermis was observed.•Skin penetration of stable iodine was calculated to be highly concentration-dependent.•Receptor fluid composition had a strong impact on the iodine penetration.
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