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Browsing Artikler, rapporter og annet (klinisk medisin) by Title
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Maniaol, Angelina; Elsais, Ahmed; Lorentzen, Åslaug Rudjord; Owe, Jone Furulund; Viken, Marte K; Sæther, Hanne Skarpodde; Flåm, Siri Tennebø; Bråthen, Geir; Kampman, Margitta Theodora; Midgard, Rune; Christensen, Marte; Rognerud, Anna Kaja; Kerty, Emilia; Gilhus, Nils Erik; Tallaksen, Chantal; Lie, Benedicte Alexandra; Harbo, Hanne Flinstad (Journal article; Tidsskriftartikkel; Peer reviewed, 2012)[+][-]
Abstract: Acquired myasthenia gravis (MG) is a rare antibody-mediated autoimmune disease caused by impaired neuromuscular transmission, leading to abnormal muscle fatigability. The aetiology is complex, including genetic risk factors of the human leukocyte antigen (HLA) complex and unknown environmental factors. Although associations between the HLA complex and MG are well established, not all involved components of the HLA predisposition to this heterogeneous disease have been revealed. Well-powered and comprehensive HLA analyses of subgroups in MG are warranted, especially in late onset MG. This case-control association study is of a large population-based Norwegian cohort of 369 MG patients and 651 healthy controls. We performed comprehensive genotyping of four classical HLA loci (HLA-A, -B, -C and -DRB1) and showed that the DRB1*15:01 allele conferred the strongest risk in late onset MG (LOMG; onset ≥60years) (OR 2.38, pc7.4×10−5). DRB1*13:01 was found to be a protective allele for both early onset MG (EOMG) and LOMG (OR 0.31, pc 4.71×10−4), a finding not previously described. No significant association was found to the DRB1*07:01 allele (pnc = 0.18) in a subset of nonthymomatous anti-titin antibody positive LOMG as reported by others. HLA-B*08 was mapped to give the strongest contribution to EOMG, supporting previous studies. The results from this study provide important new information concerning the susceptibility of HLA alleles in Caucasian MG, with highlights on DRB1*15:01 as being a major risk allele in LOMG. URI: http://hdl.handle.net/10037/4906 File(s) in this item: 1
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Hjortdahl, Magnus; Wisborg, Torben; Ringen, Amund H; Næss, Anne Cathrine Braarud (Journal article; Tidsskriftartikkel; Peer reviewed, 2009)[+][-]
Abstract: Background: Trauma is the leading cause of death for young people in Norway. Studies indicate that several of these deaths are avoidable if the patient receives correct initial treatment. The trauma team is responsible for initial hospital treatment of traumatized patients, and team members have previously reported that non-technical skills as communication, leadership and cooperation are the major challenges. Better team function could improve patient outcome. The aim of this study was to obtain a deeper understanding of which non-technical skills are important to members of the trauma team during initial examination and treatment of trauma patients. Methods: Twelve semi-structured interviews were conducted at four different hospitals of various sizes and with different trauma load. At each hospital a nurse, an anaesthesiologist and a team leader (surgeon) were interviewed. The conversations were transcribed and analyzed using systematic text condensation according to the principles of Giorgi's phenomenological analysis as modified by Malterud. Results and conclusion: Leadership was perceived as an essential component in trauma management. The ideal leader should be an experienced surgeon, have extensive knowledge of trauma care, communicate clearly and radiate confidence. Team leaders were reported to have little trauma experience, and the team leaders interviewed requested more guidance and supervision. The need for better training of trauma teams and especially team leaders requires further investigation and action. URI: http://hdl.handle.net/10037/3278 File(s) in this item: 1
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Dalhaug, A; Nieder, Carsten; Haukland, E (Journal article; Tidsskriftartikkel; Peer reviewed, 2010)[+][-]
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Fattah, Sabina; Krüger, Andreas J.; Andersen, Jan Einar; vigerust, trond; Rehn, Marius (Journal article; Tidsskriftartikkel; Peer reviewed, 2012)[+][-]
Abstract: A major incident has occurred when the number of live casualties, severity, type of incident or location requires extraordinary resources. Major incident management is interdisciplinary and involves triage, treatment and transport of patients. We aimed to investigate experiences within major incident preparedness and management among Norwegian rescue workers. A questionnaire was answered by 918 rescue workers across Norway. Questions rated from 1 (doesn’t work) to 7 (works excellently) are presented as median and range. Health-care personnel constituted 34.1% of the participants, firefighters 54.1% and police 11.8%. Training for major incident response scored 5 (1, 7) among health-care workers and 4 (1, 7) among firefighters and police. Preparedness for major incident response scored 5 (1, 7) for all professions. Interdisciplinary cooperation scored 5 (3, 7) among health-care workers and police and 5 (1, 7) among firefighters. Among health-care workers, 77.5% answered that a system for major-incident triage exists; 56.3% had triage equipment available. The majority – 45.1% of health-care workers, 44.7% of firefighters and 60.4% of police – did not know how long it would take to get emergency stretchers to the scene. Rescue personnel find major incident preparedness and on-scene multidisciplinary cooperation to function well. Some shortcomings are reported with regard to systems for major incident triage, tagging equipment for triage and knowledge about access to emergency stretchers. URI: http://hdl.handle.net/10037/4933 File(s) in this item: 1
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Kirov, Mikhail; Bjertnæs, Lars J.; Kuzkov, Vsevolod V.; Fernandez-Mondejar, Enrique (Journal article; Tidsskriftartikkel; Peer reviewed, 24-Jul-2006)[+][-]
Abstract: The evolution of extravascular lung water (EVLW) monitoring is an important step forward in the hemodynamic assessment of critically ill patients. URI: http://hdl.handle.net/10037/1109 File(s) in this item: 1
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Elvevåg, Brita; Helsen, Kim; De Hert, Marc; Sweers, Kim; Storms, Gert (Journal article; Tidsskriftartikkel; Peer reviewed, 2011)[+][-]
Abstract: The nature of putative semantic anomalies in schizophrenia is controversial. Metaphor interpretation and use provide a useful methodology with which to probe semantics since metaphors are critical in reasoning processes and in how conceptual knowledge is organized. The first study examined free speech for figurative language. The second study explored whether emotional versus non-emotional metaphorical language interpretation elicits differences in the tendencies to produce idiosyncratic (bizarre) or literal interpretations or use of other metaphors to describe the meaning of a metaphor. The third study examined the interpretation of time metaphors. We expected the time perspective in ambiguous sentences to be differentially influenced by previously presented unambiguous sentences of a specific perspective, either events moving relative to a stationary observer (moving-time) or an observer moving relative to a stationary event (moving-ego). First, we found that patients used a similar amount of figurative language as control participants. Second, we did not find any difference between the groups in terms of idiosyncratic interpretations, although patients did interpret more metaphors literally and controls utilized more figurative language. Third, we did not find evidence of a difference between the groups in terms of time perspectives influencing ambiguous target sentences differentially. As operationalized here, the interpretation and use of metaphors is similar in patients with schizophrenia to that of healthy control participants. To the extent that metaphors recruit semantic processes this area of cognition is generally intact in schizophrenia. URI: http://hdl.handle.net/10037/4095 File(s) in this item: 1
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Ekeland, Anne G.; Bowes, Alison; Flottorp, Signe (Journal article; Tidsskriftartikkel; Peer reviewed, 2012)[+][-]
Abstract: Previous reviews have expressed concerns about the quality of telemedicine studies. There is debate about shortcomings and appropriate methodologies. The aim of this review of systematic reviews of telemedicine is to summarize methodologies used in telemedicine research, discuss knowledge gaps and recommendations and suggest methodological approaches for further research. URI: http://hdl.handle.net/10037/4591 File(s) in this item: 1
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Dønnem, Tom; Fenton, Christopher Graham; Lønvik, Kenneth; Berg, Thomas; Eklo, Katrine; Andersen, Sigve; Stenvold, Helge; Al-Shibli, Khalid Ibrahim; Al-Saad, Samer; Bremnes, Roy M.; Busund, Lill-Tove (Journal article; Tidsskriftartikkel; Peer reviewed, 2012)[+][-]
Abstract: Angiogenesis is regarded as a hallmark in cancer development, and anti-angiogenic treatment is presently used in non-small cell lung cancer (NSCLC) patients. MicroRNAs (miRs) are small non-coding, endogenous, single stranded RNAs that regulate gene expression. In this study we aimed to identify significantly altered miRs related to angiogenesis in NSCLC. From a large cohort of 335 NSCLC patients, paraffin-embedded samples from 10 patients with a short disease specific survival (DSS), 10 with a long DSS and 10 normal controls were analyzed. The miRs were quantified by microarray hybridization and selected miRs were validated by real-time qPCR. The impacts of different pathways, including angiogenesis, were evaluated by Gene Set Enrichment Analysis (GSEA) derived from Protein ANalysis THrough Evolutionary Relationship (PANTHER). One of the most interesting candidate markers, miR-155, was validated by in situ hybridization (ISH) in the total cohort (n = 335) and correlation analyses with several well-known angiogenic markers were done. 128 miRs were significantly up- or down-regulated; normal versus long DSS (n = 68) and/or normal versus short DSS (n = 63) and/or long versus short DSS (n = 37). The pathway analysis indicates angiogenesis-related miRs to be involved in NSCLC. There were strong significant correlations between the array hybridization and qPCR validation data. The significantly altered angiogenesis-related miRs of high interest were miR-21, miR-106a, miR-126, miR-155, miR-182, miR-210 and miR-424. miR-155 correlated significantly with fibroblast growth factor 2 (FGF2) in the total cohort (r = 0.17, P = 0.002), though most prominent in the subgroup with nodal metastasis (r = 0.34, P,0.001). Several angiogenesis-related miRs are significantly altered in NSCLC. Further studies to understand their biological functions and explore their clinical relevance are warranted. URI: http://hdl.handle.net/10037/4430 File(s) in this item: 1
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Røe, Oluf Dimitri; Szulkin, Adam; Anderssen, Endre; Flatberg, Arnar; Sandeck, Helmut; Amundsen, Tore; Erlandsen, Sten Even; Dobra, Katalin; Sundstrøm, Stein Harald (Journal article; Tidsskriftartikkel; Peer reviewed, 2012)[+][-]
Abstract: Pemetrexed, a multi-folate inhibitor combined with a platinum compound is the first-line treatment of malignant mesothelioma, but median survival is still one year. Intrinsic and acquired resistance to pemetrexed is common, but its biological basis is obscure. Here we report for the first time a genome-wide profile of acquired resistance in the tumour from an exceptional case with advanced pleural mesothelioma and almost six years survival after 39 cycles of second-line pemetrexed/carboplatin treatment. Genome-wide analysis with Illumina BeadChip Kit of 25,000 genes was performed on mRNA from pre-treatment and post-resistance biopsies from this individual as well on case and control samples from our previously published study (in total 17 samples). Cell specific expression of proteins encoded by selected genes were analysed by immunohistochemistry. Serial serum levels of CA125, CYFRA21-1 and SMRP levels were examined. TS protein, the main target of pemetrexed was overexpressed. Proteins and genes related to DNA damage response, elongation and telomere extension and repair related directly and indirectly to platinum resistance were overexpressed, as the CHK1 protein and the genes CHEK2, LIG3, POLD1, POLA2, FANCD2, PRPF19, RECQ5 respectively, the last two not previously described in mesothelioma. We observed a down-regulation of leukocyte transendothelial migration and cell adhesion molecules pathways. Silencing of NT5C in two mesothelioma cell lines did not sensitize the cells to Pemetrexed. Proposed resistance markers are TS, KRT7/ CK7, TYMP/ thymidine phosphorylase and down-regulated SPARCL1 and CDKN1B. Moreover, comparison of the primary expression of the sensitive versus a primary resistant case showed multi-fold overexpressed DNA repair, cell cycle, cytokinesis, and spindle formation in the latter. Serum CA125 and SMRP reflected the clinical and radiological course and tumour burden. Genome-wide microarray of mesothelioma pre- and post-resistance biopsies indicated a novel resistance signature to pemetrexed/carboplatin that deserve validation in a larger cohort. URI: http://hdl.handle.net/10037/4926 File(s) in this item: 1
article.pdf (2.144Mb) -
Haug, Bjørn Helge; Henriksen, Jørn Remi; Buechner, Jochen; Kogner, Per; Martinsson, Tommy; Flægstad, Trond; Sveinbjørnsson, Baldur; Einvik, Christer (Journal article; Tidsskriftartikkel; Peer reviewed, 2011)[+][-]
Abstract: The MYCN oncogene is frequently amplified in neuroblastoma. It is one of the most consistent markers of a bad prognosis for this disease. Dickkopf-3 (DKK3) is a secreted protein of the Dickkopf family of Wnt regulators. It functions as a tumor suppressor in a range of cancers, including neuroblastoma. MYCN was recently found to downregulate DKK3 mRNA. In this study, we show that MYCN knockdown in MYCN-amplified (MNA) neuroblastoma cell lines increases secretion of endogenous DKK3 to the culture media. MiRNAs are ~20-nt-long RNAs encoded by the genome that downregulate mRNAs by targeting the 3`untranslated region (3’UTR). Many miRNAs regulate genes involved in the pathogenesis of cancer and are extensively deregulated in different tumors. Using miRNA target prediction software, we found several MYCN-regulated miRNAs that could target the 3’UTR sequence of DKK3, including mir-92a, mir-92b and let-7e. Luciferase expression from a reporter vector containing the DKK3-3`UTR was decreased when this construct was cotransfected with mir-92a, mir-92b and let-7e in HEK293 cells. Mutation of the mir-92 seed sequence in the 3’UTR completely rescued the observed decrease in reporter expression when cotransfected with mir-92a and mir-92b. Antagomir and miRNA-mimic transfections in neuroblastoma cell lines confirmed that DKK3 secretion to the culture media is regulated by these miRNAs. Consistent with reports from other cancers, we found DKK3 to be expressed in the endothelium of primary neuroblastoma samples and to be absent in tumors with MYCN amplification. These data demonstrate a previously unknown tumor promoting mechanism for MYCN-regulated miRNAs. Description: Accepted manuscript version, reprinted with permission (Carciongenesis). Published version available at http://dx.doi.org/10.1093/carcin/bgr073
This article is part of Jørn Remi Henriksen's doctoral thesis which is available in Munin at http://hdl.handle.net/10037/2966
This article is part of Jochen Büchner's doctoral thesis which is available in Munin at http://hdl.handle.net/10037/3653URI: http://hdl.handle.net/10037/3550 File(s) in this item: 1
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Vyas, HV; Eidem, BW; Cetta, F; Acharya, Ganesh; Huhta, J.; Roberson, D; Cuneo, B (Journal article; Tidsskriftartikkel; Peer reviewed, 2011)[+][-]
Abstract: Tissue Doppler Imaging (TDI) is a sensitive index of myocardial function. Its role in the fetus has not been extensively evaluated. To compare myocardial tissue Doppler velocities in fetuses with hypoplastic left heart syndrome (HLHS) to those of normal fetuses (matched for gestational age.) Cross-sectional retrospective study conducted at 2 large perinatal centers (2003-2007). Fetuses with HLHS ( n = 13) were compared with normal fetuses ( n = 207) in 5 gestational age groups. TDI data included peak systolic (s'), peak early (e'), and late diastolic velocities (a'). Linear regression was used to compare TDI parameters in fetuses with HLHS to normal fetuses matched for gestational age. Fetuses with HLHS had significantly reduced lateral tricuspid annular e' as compared to normal fetuses. Both normal fetuses and those with HLHS had linear increase in TDI velocities with advancing gestational age. TDI velocities are abnormal in fetuses with HLHS. TDI can be useful in serial follow-up of cardiac function in fetuses with HLHS. URI: http://hdl.handle.net/10037/3957 File(s) in this item: 1
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Ringen, Amund Hovengen; Hjortdahl, Magnus; Wisborg, Torben (Journal article; Tidsskriftartikkel; Peer reviewed, 2011)[+][-]
Abstract: The treatment of trauma victims is a complex multi-professional task in a stressful environment. We previously found that trauma team members perceive leadership as the most important human factor. The aim of the present study was to assess the experience and education of Norwegian trauma team leaders, and allow them to describe their perceived educational needs. We conducted an anonymous descriptive study using a point prevalence methodology based on written questionnaires. All 45 hospitals in Norway receiving severely injured trauma victims were contacted on a randomly selected weeknight during November 2009. Team leaders were asked to specify what trauma related training programs they had participated in, how much experience they had, and what further training they wished, if any. Response rate was 82%. Slightly more than half of the team leaders were residents. The median working experience as a surgeon among team leaders was 7.5 years. Sixty-eight percent had participated in multiprofessional training in non-technical skills, while 54% had passed the advanced trauma life support(ATLS) course. Fifty-one percent were trained in damage control surgery. A median of one course per team leader was needed to comply with the new proposed national standards. Team leaders considered training in damage control surgery the most needed educational objective. Level of experience among team leaders was highly variable and their educational background insufficient according to international and proposed national standards. Proposed national standards should be urgently implemented to ensure equal access to high quality trauma care. URI: http://hdl.handle.net/10037/3968 File(s) in this item: 1
article.pdf (235.9Kb) -
Jorde, Rolf; Sneve, Monica; Torjesen, Peter A; Figenschau, Yngve; Hansen, John-Bjarne; Grimnes, Guri (Journal article; Tidsskriftartikkel; Peer reviewed, 2010)[+][-]
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Hofsø, Dag; Nordstrand, Njord; Johnson, Line Kristin; Karlsen, Tor-Ivar; Hager, Helle; Jenssen, Trond Geir; Bollerslev, Jens; Godang, Kristin; Sandbu, Rune; Røislien, Jo; Hjelmesæth, Jøran (Journal article; Tidsskriftartikkel; Peer reviewed, 2010)[+][-]
Abstract: Objective: Weight reduction improves several obesity-related health conditions. We aimed to compare the effect of bariatric surgery and comprehensive lifestyle intervention on type 2 diabetes and obesityrelated cardiovascular risk factors. Design: One-year controlled clinical trial (ClinicalTrials.gov identifier NCT00273104). Methods: Morbidly obese subjects (19–66 years, mean (S.D.) body mass index 45.1 kg/m2 (5.6), 103 women) were treated with either Roux-en-Y gastric bypass surgery (nZ80) or intensive lifestyle intervention at a rehabilitation centre (nZ66). The dropout rate within both groups was 5%. Results: Among the 76 completers in the surgery group and the 63 completers in the lifestyle group, mean (S.D.) 1-year weight loss was 30% (8) and 8% (9) respectively. Beneficial effects on glucose metabolism, blood pressure, lipids and low-grade inflammation were observed in both groups. Remission rates of type 2 diabetes and hypertension were significantly higher in the surgery group than the lifestyle intervention group; 70 vs 33%, PZ0.027, and 49 vs 23%, PZ0.016. The improvements in glycaemic control and blood pressure were mediated by weight reduction. The surgery group experienced a significantly greater reduction in the prevalence of metabolic syndrome, albuminuria and electrocardiographic left ventricular hypertrophy than the lifestyle group. Gastrointestinal symptoms and symptomatic postprandial hypoglycaemia developed more frequently after gastric bypass surgery than after lifestyle intervention. There were no deaths. Conclusions: Type 2 diabetes and obesity-related cardiovascular risk factors were improved after both treatment strategies. However, the improvements were greatest in those patients treated with gastric bypass surgery. URI: http://hdl.handle.net/10037/4129 File(s) in this item: 1
article.pdf (248.2Kb) -
Andersen, Sigve; Dønnem, Tom; Stenvold, Helge; Al-Saad, Samer; Al-Shibli, Khalid Ibrahim; Busund, Lill-Tove; Bremnes, Roy M. (Journal article; Tidsskriftartikkel; Peer reviewed, 2011)[+][-]
Abstract: Hypoxia induced factors (HIFs) are at the heart of the adaptive mechanisms cancer cells must implement for survival. HIFs are regulated by four hydroxylases; Prolyl hydroxylase (PHD)-1,-2,-3 and factor inhibiting HIF (FIH). We aimed to investigate the prognostic impact of these oxygen sensors in NSCLC. Tumor tissue samples from 335 resected stages I to IIIA NSCLC patients was obtained and tissue microarrays (TMAs) were constructed. Hydroxylase expression was evaluated by immunohistochemistry. Principal Findings: There was scorable expression for all HIF hydroxylases in tumor cells, but not in stroma. In univariate analyses, high tumor cell expression of all the HIF hydroxylases were unfavorable prognosticators for disease-specific survival (DSS); PHD1 (P = 0.023), PHD2 (P = 0.013), PHD3 (P = 0.018) and FIH (P = 0.033). In the multivariate analyses we found high tumor cell expression of PHD2 (HR = 2.03, CI 95% 1.20–3.42, P = 0.008) and PHD1 (HR = 1.45, CI 95% 1.01–2.10, P = 0.047) to be significant independent prognosticators for DSS. Besides, there was an additive prognostic effect by the increasing number of highly expressed HIF hydroxylases. Provided none high expression HIF hydroxylases, the 5-year survival was 80% vs. 23% if all four were highly expressed (HR = 6.48, CI 95% 2.23–18.8, P = 0.001). HIF hydroxylases are, in general, poor prognosticators for NSCLC survival. PHD1 and PHD2 are independent negative prognostic factors in NSCLC. Moreover, there is an additive poor prognostic impact by an increasing number of highly expressed HIF hydroxylases. URI: http://hdl.handle.net/10037/3970 File(s) in this item: 1
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Haug, Bjørn; Kjelsberg, Kjærsti; Lappegård, Knut Tore (Journal article; Tidsskriftartikkel; Peer reviewed, 2011)[+][-]
Abstract: Some countries have a demography that makes it necessary to maintain relatively small pacemaker centres. We wanted to assess the quality of pacemaker surgery in two such hospitals. Through patient records we gathered information on ∼535 consecutive primary pacemaker implantations in two small pacemaker centres with 30 and 80 annual operations, respectively. All patients were followed for 3 years. All complications documented in the patient records were registered. Furthermore, we performed a non-systematic literature search comparing our data with reports from major centres published over the last 10 years.We found 72 complications in 64 (12.0%) of the patients, the most common being bleeding, lead failure, and pneumothorax. If minor bleedings without any consequences for the patients are excluded, the number of complications was 46 in 40 patients (7.5%). We had to reoperate on 5.2% of the patients. There was no statistically significant difference in complication rates between the two hospitals. Education candidates generated statistically significant more complications than experienced doctors (13.7 vs. 7.1%, P < 0.05). There are no generally accepted norms of complication rates in pacemaker surgery. However, we found no indications that our centres have a rate of complications that is unacceptably high. URI: http://hdl.handle.net/10037/4110 File(s) in this item: 1
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Ozolina, A.; Strike, E.; Jaunalksne, I.; Krumina, A.; Bjertnaes, Lars J.; Vanags, I. (Journal article; Tidsskriftartikkel; Peer reviewed, 2012)[+][-]
Abstract: Enhanced bleeding remains a serious problem after cardiac surgery, and fibrinolysis is often involved. We speculate that lower plasma concentrations of plasminogen activator inhibitor – 1 (PAI-1) preoperatively and tissue plasminogen activator/PAI-1 (t-PA/PAI-1) complex postoperatively might predispose for enhanced fibrinolysis and increased postoperative bleeding. Totally 88 adult patients (mean age 66 ± 10 years) scheduled for cardiac surgery, were enrolled into a prospective study. Blood samples were collected pre-operatively, on admission to the recovery and at 6 and 24 hours postoperatively. Patients with a surgical bleeding that was diagnosed during reoperation were discarded from the study. The patients were allocated to two groups depending on the 24-hour postoperative chest tube drainage (CTD): Group I > 500ml, Group II ≤ 500ml. Associations between CTD, PAI-1, t-PA/PAI-1 complex and D-dimer were analyzed with SPSS. Nine patients were excluded because of surgical bleeding. Of the 79 remaining patients, 38 were allocated to Group I and 41 to Group II. The CTD volumes correlated with the preoperative plasma levels of PAI-1 (r = − 0.3, P = 0.009). Plasma concentrations of preoperative PAI-1 and postoperative t-PA/PAI-1 complex differed significantly between the groups (P < 0.001 and P = 0.012, respectively). Group I displayed significantly lower plasma concentrations of fibrinogen and higher levels of D-dimer from immediately after the operation and throughout the first 24 hours postoperatively. Lower plasma concentrations of PAI-1 preoperatively and t-PA/PAI-1 complex postoperatively leads to higher plasma levels of D-dimer in association with more postoperative bleeding after cardiac surgery. URI: http://hdl.handle.net/10037/4887 File(s) in this item: 1
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Hjelmesæth, Jøran; Hofsø, Dag; Aasheim, Erlend T.; Jenssen, Trond Geir; Moan, Johan; Hager, Helle; Røislien, Jo; Bollerslev, Jens (Journal article; Tidsskriftartikkel; Peer reviewed, 03-Feb-2009)[+][-]
Abstract: Background: The prevalence of vitamin D insufficiency and secondary hyperparathyroidism is high among morbidly obese subjects. Further, low serum levels of 25-hydroxyvitamin D (25 [OH]D) and magnesium have been associated with increased risk of the metabolic syndrome (MS), and recently, a possible link between PTH and MS has been reported. Although it is well known that the synthesis and secretion of PTH is regulated by serum levels of calcium, phosphate, magnesium and 25(OH)D, less is known about the possible clustered affiliation of these parameters with MS. We aimed to explore whether MS is associated with abnormal serum levels of PTH, 25(OH)D and magnesium in a population of morbidly obese patients.
Methods: Fasting serum levels of 25(OH)D, PTH and magnesium were assessed in a cross-sectional cohort study of 1,017 consecutive morbidly obese patients (68% women). Multiple logistic regression analyses were used to assess the independent effect of PTH, 25(OH)D and magnesium on the odds for MS (National Cholesterol Education Program [NCEP]) after adjustment for confounding factors.
Results: Sixty-eight percent of the patients had MS. Patients with MS had lower mean serum magnesium (P < 0.001) and higher mean PTH (P = 0.067) than patients without MS, whereas mean 25(OH)D did not differ significantly. Patients with PTH levels in the second to fourth quartiles had higher odds of prevalent MS (odds ratio 1.47 [95% CI 0.92–2.35], 2.33 [95% CI 1.40–3.87] and 2.09 [95% CI 1.23–3.56], respectively), after adjustment for 25(OH)D, magnesium, calcium, phosphate, creatinine, age, gender, season of serum sampling, BMI, current smoking, albuminuria, CRP, insulin resistance and type 2 diabetes. Further, PTH was significantly correlated with systolic and diastolic pressure (both P < 0.001), but not with the other components of MS. The levels of 25(OH)D and magnesium were not associated with MS in the multivariate model.
Conclusion: The PTH level, but not the vitamin D level, is an independent predictor of MS in treatment seeking morbidly obese Caucasian women and men. Randomized controlled clinical trials, including different therapeutic strategies to lower PTH, e.g. calcium/vitamin D supplementation and weight reduction, are necessary to explore any cause-and-effect relationship.URI: http://hdl.handle.net/10037/2185 File(s) in this item: 1
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Krogstad, Unni; Gilbert, Mads; Ormstad, Sari Susanna; Rygh, Liv; Arntzen, Elisabeth; Baalsrud, Anders; Nilsen, Stein Tore (Research report; Forskningsrapport, 2007)[+][-]
Abstract: Helse Øst RHF har bedt Kunnskapssenteret om å vurdere dokumentasjonen for de seks satsingsområdene kampanjen fokuserer på: Etablere 'Rapid response team' (ekspertgruppe som tilkalles ved forverret tilstand hos pasienter) gjennomføre evidensbaserte behandlingstiltak for alle hjerteinfarktpasienter, forebygge legemiddelrelaterte pasientskader, forebygge postoperative sårinfeksjoner, forebygge respiratorassosierte lungebetennelse og forebygge alvorlige infeksjoner i forbindelse med sentralt venekateter."Pasientsikkerhet i sykehus – kunnskap eller kampanje?" (no english title) URI: http://hdl.handle.net/10037/3214 File(s) in this item: 1
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Norderhaug, Inger Natvig; Ingebrigsten, Tor; Krogstad, Unni; Søreide, Odd; Myhre, Hans Olav; Wiseth, Rune (Research report; Forskningsrapport, 2007)[+][-]
Abstract: Kunnskapssenteret har gjennomgått og sammenstilt forskningen om pasientvolum og behandlingskvalitet med grunnlag i litteratur for perioden 2001–2006. Denne delrapporten tar for seg behandling av hjerte- og karsykdommer.The influence of hospital or physician volume on qality of health care URI: http://hdl.handle.net/10037/3215 File(s) in this item: 1
article.pdf (816.4Kb)
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