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  • 1
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    Examinations and assessments in patients with a newly acquired spinal cord injury – retrospective chart analysis as part of a quality improvement project
    SMW Supporting Association ; 2020
    In:  Swiss Medical Weekly Vol. 150, No. 2930 ( 2020-07-30), p. w20291-
    Details
    In: Swiss Medical Weekly, SMW Supporting Association, Vol. 150, No. 2930 ( 2020-07-30), p. w20291-
    Abstract: AIMS OF THE STUDY Examinations and assessments can be used to ensure good quality rehabilitation. Within the framework of a quality improvement project, the aims of the current analysis were: first, to analyse the time points of selected examinations and assessments in the rehabilitation process of patients with a newly acquired spinal cord injury. Second, to identify differences between the subgroups with different aetiologies, levels and completeness of spinal cord injuries. And third, to compare the examinations and assessments performed with the guideline recommendations and to use discrepancies as a starting point for a quality improvement project. METHODS In this retrospective chart analysis, adult patients with a newly acquired spinal cord injury who were admitted to a single specialised acute care and rehabilitation clinic for their first rehabilitation between December 2013 and December 2014 were included and assessed until discharge. The main objective was to assess the time to examinations or assessments after injury or hospital admission in comparison to the respective recommendations. Analyses were done using time-to-event analysis and represented graphically using Kaplan-Meier plots. RESULTS Of the 105 patients included in this study (median age 58 years, 29% female), 61% had a traumatic and 39% a non-traumatic spinal cord injury; 39% were paraplegic and 61% were quadriplegic; and 59% had a motor complete and 41% a sensor-motor incomplete spinal cord injury. The percentage of patients for whom the respective assessment or examination was performed and the percentage of these patients for whom it performed within the recommended time were: 90% and 71% for magnetic resonance imaging; 85% and 90% for computed tomography; 87% and 79% for the manual muscle test; 95% and 59% for the International Standards for Neurological Classification of Spinal Cord (ISNCSCI); 84% and 50% for electrophysiological assessment; 73% and 90% for urodynamic testing; and 49% and 53% for lung function testing. CONCLUSIONS Our data suggest a relevant gap between recommendations and clinical routine for time to some assessments after spinal cord injury. Within the framework of a quality improvement project, the next steps should be to build a national and international consensus on specific time frames for examinations and assessments in patients with a newly acquired spinal cord injury and thereafter, to develop an institutional implementation strategy.
    Type of Medium: Online Resource
    ISSN: 1424-3997
    URL: Article
    DOI: 10.4414/smw.2020.20291
    Language: Unknown
    Publisher: SMW Supporting Association
    Publication Date: 2020
    detail.hit.zdb_id: 2031164-3
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  • 2
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    Oxytocin Levels in Response to Pituitary Provocation Tests in Healthy Volunteers
    The Endocrine Society ; 2021
    In:  Journal of the Endocrine Society Vol. 5, No. Supplement_1 ( 2021-05-03), p. A631-A631
    Details
    In: Journal of the Endocrine Society, The Endocrine Society, Vol. 5, No. Supplement_1 ( 2021-05-03), p. A631-A631
    Abstract: Background: Oxytocin, secreted into the circulation through the posterior pituitary, regulates lactation, weight, and socio-behavioral functioning. Oxytocin deficiency has been suggested in patients with hypopituitarism, however, diagnostic testing for oxytocin deficiency has not been developed. Known stimuli used in the diagnosis of pituitary deficiencies - the hypertonic saline and arginine infusion tests stimulating copeptin levels, and the oral macimorelin test stimulating growth hormone levels - have also been shown to stimulate oxytocin secretion in animal models. We hypothesized that these provocation tests would stimulate plasma oxytocin levels in humans. Methods: Basal plasma oxytocin levels were measured for all three tests. Stimulated plasma oxytocin was measured once plasma sodium & gt;150 mmol/l for the hypertonic saline and after 45 minutes for the arginine infusion and the oral macimorelin test, expected peak of copeptin and growth hormone levels, respectively. Primary outcome was change between basal and stimulated oxytocin levels using a paired t-test. Results: Median (IQR) age of all participants was 24 years (22, 28), 51% were female. As expected, copeptin increased in response to hypertonic saline from 4.0 pmol/L [3.3, 6.7] to 34.2 pmol/L [23.2, 45.4] (p-value & lt;0.001) and in response to arginine infusion from 4.6 pmol/L [3.2, 6.2] to 8.3 pmol/L [6.4, 10.8] (p-value & lt;0.001). Growth hormone increased in response to oral macimorelin from 1.6 ng/mL [0.3, 17.2] to 106.0 ng/mL [73.3, 127.2] (p-value & lt;0.001). Oxytocin levels increased in response to hypertonic saline infusion from 0.3 pg/mL [0.3, 0.5] to 0.6 pg/mL [0.4, 0.7] (p-value 0.007), while there was no change in response to arginine infusion (basal 0.4 pg/mL [0.4, 0.6], stimulated 0.4 pg/mL [0.3, 0.6] , p-value 0.6), nor to oral macimorelin (basal 38.7 pg/mL [31.1, 66.9], stimulated 34.2 pg/mL [31.2, 48.2] , p-value 0.3). Conclusion: We found that hypertonic saline infusion results in doubling of oxytocin levels. Further research will be important to determine whether this test could be used diagnostically to identify patients with oxytocin deficiency. In contrast to animal data, arginine and macimorelin did not stimulate oxytocin.
    Type of Medium: Online Resource
    ISSN: 2472-1972
    URL: Article
    DOI: 10.1210/jendso/bvab048.1286
    Language: English
    Publisher: The Endocrine Society
    Publication Date: 2021
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  • 3
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    GLP1 Receptor Agonists Reduce Fluid Intake in Primary Polydipsia
    The Endocrine Society ; 2021
    In:  Journal of the Endocrine Society Vol. 5, No. Supplement_1 ( 2021-05-03), p. A514-A515
    Details
    In: Journal of the Endocrine Society, The Endocrine Society, Vol. 5, No. Supplement_1 ( 2021-05-03), p. A514-A515
    Abstract: Background Primary polydipsia, characterized by excessive fluid intake, carries the risk of water intoxication and hyponatremia, but treatment options are scarce. Glucagon-like peptide-1 (GLP-1) reduces appetite and food intake. In experimental models, they also play a role in thirst and drinking behavior in. The aim of this trial was to investigate whether GLP-1 receptor agonists reduce fluid intake in patients with primary polydipsia. Methods: In this randomized, double-blind, placebo-controlled, 3-week crossover-trial, 34 patients with primary polydipsia received weekly dulaglutide (Trulicity®) 1.5mg and placebo (0.9% sodium chloride). During the last treatment week, patients attended an 8-hour evaluation visit with free water access. The primary endpoint was total fluid intake during the evaluation visits. The treatment effect was estimated using a linear mixed-effects model. In a subset of 15 patients and matched controls, thirst perception and neuronal activity in response to beverage pictures were assessed by functional MRI. Results Median [IQR] total fluid intake was 2250ml [1600-2600] on dulaglutide versus 2400ml [1850-3400] on placebo. Patients on dulaglutide reduced fluid intake by 490ml [95%-CI -780, -199] , p=0.002, corresponding to a relative reduction of 17%. 24-hour urinary output was reduced by -943ml [95%-CI -1473, -413]. Thirst perception in response to beverage pictures was higher in patients with primary polydipsia versus controls and lower on dulaglutide versus placebo, but functional neuronal activity was similar between groups and treatments. Conclusion: GLP-1 receptor agonists reduce fluid intake and thirst perception in patients with primary polydipsia and could therefore be a novel treatment option for these patients.
    Type of Medium: Online Resource
    ISSN: 2472-1972
    URL: Article
    DOI: 10.1210/jendso/bvab048.1052
    Language: English
    Publisher: The Endocrine Society
    Publication Date: 2021
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  • 4
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    THU627 Fertility Outcomes And Anti Mullerian Hormone Levels In Women With Hypopituitarism
    The Endocrine Society ; 2023
    In:  Journal of the Endocrine Society Vol. 7, No. Supplement_1 ( 2023-10-05)
    Details
    In: Journal of the Endocrine Society, The Endocrine Society, Vol. 7, No. Supplement_1 ( 2023-10-05)
    Abstract: Disclosure: V.W. Fitz: None. C.O. Sailer: None. I. Remba-Shapiro: None. N. Bomani Gonzalez: None. W. Pierre: None. C. Bormann: None. I. Souter: None. L.B. Nachtigall: None. Background: Disruption of the hypothalamic-pituitary-gonadal (HPG) axis due to pituitary gland disorders presents a challenge for patients who desire conception. Women with hypopituitarism often require assisted reproductive technology (ART) to conceive. Anti-Mullerian Hormone (AMH) has been established as a marker of ovarian reserve in patients with normal HPG function, however, levels in women with hypopituitarism have not been reported. In this cohort, we investigate pre-conception AMH levels, reproductive treatments and fertility outcomes in women with hypopituitarism. Methods: We reviewed a large database and identified 19 patients with hypopituitarism who had undergone fertility treatment and 142 age-matched controls with male factor infertility. Clinical characteristics and AMH levels are shown using mean (SD) or median (IQR). AMH ratio using the lower limit of normal as denominator is used to normalize to the reference range as several assays with different reference ranges were used during the timeframe of data collection. Mann-Whitney U was used to compare AMH levels. A p value of & lt;0.05 was considered statistically significant. Results: Patients with hypopituitarism and controls had a mean age of 33.4 years (2.5) and 33.3 years (2.2) p=0.857, at initial fertility evaluation, respectively. 17/19 (89.5%) patients in the hypopituitarism group experienced spontaneous menarche and had a post-pubertal onset of hypopituitarism. Hormonal deficiencies included GH (9), ACTH (8), TSH (10), FSH/LH (13), and vasopressin (3). Causes of hypopituitarism included 8 pituitary adenomas (7 functioning and 1 non-functioning), 3 Rathke’s cleft cysts, 4 intracranial neoplasms, 2 congenital or idiopathic hypopituitarism and 1 intracranial trauma. Median AMH level was 2.60 ng/mL (0.90-3.50) vs. 3.48ng/mL (1.99-4.70) p=0.017, and AMH ratio was 3.11ng/mL (1.13-4.17) vs. 4.11ng/mL (2.60-6.25) p=0.070, in the hypopituitary group and in controls, respectively. Among the 19 patients with hypopituitarism, 13 underwent ovulation induction (OI) with intrauterine insemination (IUI) or timed intercourse (TIC), 12 underwent in vitro fertilization (IVF), and 6 were treated with both OI and IVF. 18/19 (94.7%) conceived and 16/19 (84.2%) had a livebirth. Four patients (21%) conceived spontaneously. Among the patients who underwent OI, 4/13 (30.8%) had ≥1 livebirth with a median of 2 cycles (range 1-4) until first birth. Among the patients who underwent IVF, 10/12 (83.3%) had ≥ 1 livebirth with a median of 1.50 cycles (range 1-4) until first birth. Conclusions/Impact: Patients with hypopituitarism conceive through a variety of assisted reproductive technologies and may conceive spontaneously. Overall, AMH levels are comparable to age matched controls. Reproductive interventions among women with hypopituitarism are successful, with most patients achieving at least one livebirth. Presentation: Thursday, June 15, 2023
    Type of Medium: Online Resource
    ISSN: 2472-1972
    URL: Article
    DOI: 10.1210/jendso/bvad114.1532
    Language: English
    Publisher: The Endocrine Society
    Publication Date: 2023
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  • 5
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    Copeptin improves prediction of treatment response in children with monosymptomatic nocturnal enuresis
    Oxford University Press (OUP) ; 2023
    In:  European Journal of Endocrinology Vol. 188, No. 3 ( 2023-03-02), p. 266-272
    Details
    In: European Journal of Endocrinology, Oxford University Press (OUP), Vol. 188, No. 3 ( 2023-03-02), p. 266-272
    Abstract: One of the main medical treatment options for monosymptomatic nocturnal enuresis (MNE) is the vasopressin analog desmopressin. But not all children respond to desmopressin treatment, and no reliable treatment predictor has yet been established. We hypothesize that plasma copeptin, a surrogate marker for vasopressin, can be used to predict treatment response to desmopressin in children with MNE. Design/Methods In this prospective observational study, we included 28 children with MNE. At baseline, we assessed the number of wet nights, morning, and evening plasma copeptin, and plasma sodium and started treatment with desmopressin (120 µg daily). Desmopressin was increased to 240 µg daily if clinically necessary. The primary endpoint was reduction in the number of wet nights following 12 weeks of treatment with desmopressin using plasma copeptin ratio (evening/morning copeptin) at baseline. Results Eighteen children responded to desmopressin treatment at 12 weeks, while 9 did not. A copeptin ratio cutoff of 1.34 (sensitivity 55.56%, specificity 94.12%, area under the curve 70.6%, P = .07) was best at predicting treatment response, with a lower ratio indicating a better treatment response. In contrast, neither the number of wet nights at baseline (P = .15) nor serum sodium (P = .11) alone or in combination with plasma copeptin improved outcome prediction. Conclusions Our results indicate that, of our investigated parameters, plasma copeptin ratio is the best predictor for treatment response in children with MNE. Plasma copeptin ratio could thus be useful to identify children with the highest benefit of desmopressin treatment and improve individualized treatment of MNE.
    Type of Medium: Online Resource
    ISSN: 0804-4643 , 1479-683X
    URL: Article
    DOI: 10.1093/ejendo/lvad022
    RVK:
    WA 15000
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 1485160-X
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  • 6
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    FGF-21 levels in polyuria-polydipsia syndrome
    Bioscientifica ; 2018
    In:  Endocrine Connections Vol. 7, No. 12 ( 2018-12), p. 1501-1506
    Details
    In: Endocrine Connections, Bioscientifica, Vol. 7, No. 12 ( 2018-12), p. 1501-1506
    Abstract: The pathomechanism of primary polydipsia is poorly understood. Recent animal data reported a connection between fibroblast growth factor 21 (FGF-21) and elevated fluid intake independently of hormonal control by the hormone arginine-vasopressin (AVP) and osmotic stimulation. We therefore compared circulating FGF-21 levels in patients with primary polydipsia to patients with AVP deficiency (central diabetes insipidus) and healthy volunteers. In this prospective cohort study, we analyzed FGF-21 levels of 20 patients with primary polydipsia, 20 patients with central diabetes insipidus and 20 healthy volunteers before and after stimulation with hypertonic saline infusion targeting a plasma sodium level ≥150 mmol/L. The primary outcome was the difference in FGF-21 levels between the three groups. Baseline characteristics were similar between the groups except for patients with central diabetes insipidus being heavier. There was no difference in baseline FGF-21 levels between patients with primary polydipsia and healthy volunteers (122 pg/mL (52,277) vs 193 pg/mL (48,301), but higher levels in patients with central diabetes insipidus were observed (306 pg/mL (114,484); P  = 0.037). However, this was not confirmed in a multivariate linear regression analysis after adjusting for age, sex, BMI and smoking status. Osmotic stimulation did not affect FGF-21 levels in either group (difference to baseline: primary polydipsia −23 pg/mL (−43, 22); central diabetes insipidus 17 pg/mL (−76, 88); healthy volunteers −6 pg/mL (−68, 22); P  = 0.45). To conclude, FGF-21 levels are not increased in patients with primary polydipsia as compared to central diabetes insipidus or healthy volunteers. FGF-21 therefore does not seem to be causal of elevated fluid intake in these patients.
    Type of Medium: Online Resource
    ISSN: 2049-3614
    URL: Article
    DOI: 10.1530/EC-18-0469
    Language: Unknown
    Publisher: Bioscientifica
    Publication Date: 2018
    detail.hit.zdb_id: 2668428-7
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  • 7
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    Markers of systemic inflammation in response to osmotic stimulus in healthy volunteers
    Bioscientifica ; 2019
    In:  Endocrine Connections Vol. 8, No. 9 ( 2019-09), p. 1282-1287
    Details
    In: Endocrine Connections, Bioscientifica, Vol. 8, No. 9 ( 2019-09), p. 1282-1287
    Abstract: Osmotic stimulus or stress results in vasopressin release. Animal and human in vitro studies have shown that inflammatory parameters, such as interleukin-8 (IL-8) and tumor necrosis factor-α (TNF-α), increase in parallel in the central nervous system and bronchial, corneal or intestinal epithelial cell lines in response to osmotic stimulus. Whether osmotic stimulus directly causes a systemic inflammatory response in humans is unknown. We therefore investigated the influence of osmotic stimulus on circulatory markers of systemic inflammation in healthy volunteers. In this prospective cohort study, 44 healthy volunteers underwent a standardized test protocol with an osmotic stimulus leading into the hyperosmotic/hypernatremic range (serum sodium ≥150 mmol/L) by hypertonic saline infusion. Copeptin – a marker indicating vasopressin activity – serum sodium and osmolality, plasma IL-8 and TNF-α were measured at baseline and directly after osmotic stimulus. Median (range) serum sodium increased from 141 mmol/L (136, 147) to 151 mmol/L (145, 154) ( P   〈  0.01), serum osmolality increased from 295 mmol/L (281, 306) to 315 mmol/L (304, 325) ( P   〈  0.01). Median (range) copeptin increased from 4.3 pg/L (1.1, 21.4) to 28.8 pg/L (19.9, 43.4) ( P   〈  0.01). Median (range) IL-8 levels showed a trend to decrease from 0.79 pg/mL (0.37, 1.6) to 0.7 pg/mL (0.4, 1.9) ( P   〈  0.09) and TNF-α levels decreased from 0.53 pg/mL (0.11, 1.1) to 0.45 pg/mL (0.12, 0.97) ( P   〈  0.036). Contrary to data obtained in vitro , circulating proinflammatory cytokines tend to or decrease in human plasma after osmotic stimulus. In this study, osmotic stimulus does not increase circulating markers of systemic inflammation.
    Type of Medium: Online Resource
    ISSN: 2049-3614
    URL: Article
    DOI: 10.1530/EC-19-0280
    Language: Unknown
    Publisher: Bioscientifica
    Publication Date: 2019
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  • 8
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    OR20-06 Diagnosing Central Diabetes Insipidus Using Copeptin Upon Hypertonic Saline Versus Arginine Stimulation
    The Endocrine Society ; 2023
    In:  Journal of the Endocrine Society Vol. 7, No. Supplement_1 ( 2023-10-05)
    Details
    In: Journal of the Endocrine Society, The Endocrine Society, Vol. 7, No. Supplement_1 ( 2023-10-05)
    Abstract: Disclosure: J. Refardt: None. C. Atila: None. I.O. Chifu: None. E. Ferrante: None. Z. Erlic: None. J.B. Drummond: None. B. Mantovani: None. R. Drexhage: None. C.O. Sailer: None. A. Widmer: None. S. Felder: None. A.S. Powlson: None. N. Hutter: None. D. Vogt: None. M. Gurnell: None. B. Rocha: None. J. Hofland: None. F. Beuschlein: None. M. Fassnacht: None. B.F. Winzeler: None. M. Christ-Crain: None. Background: The main challenge in the diagnosis of central diabetes insipidus (cDI) is its distinction against primary polydipsia (PP). Hypertonic saline stimulated copeptin has a high diagnostic accuracy of 97%, but comprises discomfort for patients and requires close sodium monitoring. Arginine stimulated copeptin showed similar diagnostic accuracy of 93% with better tolerability, but a head-to-head comparison is lacking. We hypothesized that arginine stimulated copeptin is non-inferior (non-inferiority margin 10%) to hypertonic saline stimulated copeptin for the diagnosis of cDI. Methods: In this prospective randomized multicentre study conducted between 2018-2022 in seven tertiary medical centres, consecutive patients with cDI and PP underwent diagnostic evaluation with hypertonic saline and arginine stimulation. Serum copeptin levels were measured at sodium-level of & gt;149 mmol/L after hypertonic saline and 60 minutes after arginine infusion, respectively. The final diagnosis was made after treatment response assessment at three-month follow-up blinded to copeptin levels. The main outcome measure was the overall diagnostic accuracy using the pre-defined copeptin cut-off of 4.9 pmol/L for hypertonic saline and 3.8 pmol/L for arginine stimulation. Results: 158 patients underwent both tests, of which 69 (44%) were diagnosed with cDI and 89 (56%) with PP. Forty-one (59%) patients had a complete and 28 (41%) patients had partial cDI. The diagnostic accuracy [95% CI] to differentiate patients with cDI from patients with PP was 95.6% [91.1,97.8] for hypertonic saline stimulated copeptin compared to 74.4% [67.0, 80.6] for arginine stimulated copeptin. Accordingly, arginine stimulation was inferior to hypertonic saline stimulation (estimated difference [95% CI] -21.2% [-28.7, -14.3] ). Side effects were less frequent and less severe under arginine stimulation, resulting in a clear 72% of patients preferring the arginine stimulation over hypertonic saline stimulation. In addition, arginine stimulated copeptin of 3.0 pmol/L diagnosed cDI with a specificity of 90.9% (sensitivity of 59.5%), while a cut-off of 5.2 pmol/L diagnosed PP with a specificity of 91.4% (sensitivity of 56.4%). Conclusion: In the diagnostic evaluation of cDI, copeptin upon hypertonic saline stimulation was superior to arginine stimulation. Arginine stimulation can be used as a first well-tolerated test diagnosing & gt;50% of patients with high accuracy, but hypertonic saline stimulation remains the test with the highest diagnostic accuracy. Presentation: Saturday, June 17, 2023
    Type of Medium: Online Resource
    ISSN: 2472-1972
    URL: Article
    DOI: 10.1210/jendso/bvad114.1315
    Language: English
    Publisher: The Endocrine Society
    Publication Date: 2023
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  • 9
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    Relationship Between Oxytocin Levels and Brain Volume in Anorexia Nervosa Compared to Healthy Controls
    The Endocrine Society ; 2021
    In:  Journal of the Endocrine Society Vol. 5, No. Supplement_1 ( 2021-05-03), p. A633-A634
    Details
    In: Journal of the Endocrine Society, The Endocrine Society, Vol. 5, No. Supplement_1 ( 2021-05-03), p. A633-A634
    Abstract: Background: A disruption in food motivation pathways has been described in females with anorexia nervosa (AN), a psychiatric disorder characterized by food restriction despite low weight. We have shown that in AN and healthy controls (HC), levels of oxytocin (OXT), a hormone involved in lactation, social behavior and weight regulation, decrease after a meal. In HC, we identified a relationship between postprandial change in OXT and subjective appetite, yet this association was absent in females with AN, suggesting a disconnect between OXT and appetite regulation in AN. Prior studies have shown that gray matter volume of the amygdala and hippocampus, areas rich in OXT receptors, correlate with OXT levels in HC. Furthermore, these regions play a central role in food reward and decreased volume has been reported in AN. We hypothesized that the relationship between postprandial change in OXT and amygdala and hippocampal gray matter volume would differ between AN and HC. Methods: We performed a cross-sectional study of 51 females (23 restrictive AN; 28 HC). We drew blood for OXT levels fasting and 60 min after a standard meal and performed T1-weighted MRI scans of the brain in the fasted state. MRI data was quality controlled and processed with FreeSurfer. Average gray matter brain volumes were extracted from the bilateral amygdala and hippocampus for each subject. Linear regression models were used to determine differences between AN and HC of postprandial percent change in OXT on amygdala and hippocampus gray matter volume. Results: Median [IQR] age was higher in females with AN (20.6 years [19.3, 21.5] ) than HC (18.8 years [IQR 17.6, 20.3], p=0.02), and percentage of ideal body weight was lower in AN (75.5%) than HC (97.4%, p & lt;0.01). Right hippocampus volume, adjusted for age and total intracranial volume, was significantly lower in AN (estimated difference -188 dm3 [95%-CI -360, -17], p=0.04). Percent change in OXT was not different (p=0.5) but there was a trend for a positive interaction effect (p=0.08) for AN and percent change in OXT on right hippocampus volume. Posthoc exploratory analysis indicated a positive correlation in AN (R2=0.41, p=0.02) and no correlation in HC (R2=0.17,p=0.4) between percent change in OXT and right hippocampus volume. There was no significant between group difference in volume nor postprandial change in OXT for the bilateral amygdala or left hippocampus between groups. Discussion: Our results indicate smaller right hippocampus volume and a trend towards a positive association with postprandial change in OXT in AN compared to HC. Future studies will be important to better define the relationships between OXT secretion and food motivation brain regions and the impact on eating behavior in AN.
    Type of Medium: Online Resource
    ISSN: 2472-1972
    URL: Article
    DOI: 10.1210/jendso/bvab048.1291
    Language: English
    Publisher: The Endocrine Society
    Publication Date: 2021
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  • 10
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    The challenges of sodium measurements: indirect versus direct ion-selective method
    Oxford University Press (OUP) ; 2019
    In:  European Journal of Endocrinology Vol. 181, No. 2 ( 2019-08), p. 193-199
    Details
    In: European Journal of Endocrinology, Oxford University Press (OUP), Vol. 181, No. 2 ( 2019-08), p. 193-199
    Abstract: Diagnosis and treatment of dysnatremia is challenging and further complicated by the pitfalls of different sodium measurement methods. Routinely used sodium measurements are the indirect (plasma/serum) and direct (whole blood) ion-selective electrode (ISE) method, showing discrepant results especially in the setting of acute illness. Few clinicians are aware of the differences between the methods in clinically stable patients or healthy volunteers. Methods Data of 140 patients and 91 healthy volunteers undergoing osmotic stimulation with hypertonic saline infusion were analyzed. Sodium levels were measured simultaneously by indirect and direct ISE method before and at different time points during osmotic stimulation up to a sodium threshold of ≥150 mmol/L. The primary outcome was the difference in sodium levels between the indirect and direct ISE method. Results 878 sodium measurements were analyzed. Mean ( s.d. ) sodium levels ranged from 141 mmol/L (2.9) to 151 mmol/L (2.1) by the indirect ISE compared to 140 mmol/L (3) to 149 mmol/L (2.8) by the direct ISE method. The interclass correlation coefficient between the two methods was 0.844 (95% CI: 0.823–0.863). On average, measurements by the indirect ISE were 1.9 mmol/L (95% CI limits: −3.2 to 6.9) higher than those by the direct ISE method ( P   〈  0.001). The tendency of the indirect ISE method resulting in higher levels increased with increasing sodium levels. Conclusion Intra-individual sodium levels differ significantly between the indirect and direct ISE method also in the absence of acute illness. It is therefore crucial to adhere to the same method in critical situations to avoid false decisions due to measurement differences.
    Type of Medium: Online Resource
    ISSN: 0804-4643 , 1479-683X
    URL: Article
    DOI: 10.1530/EJE-19-0101
    RVK:
    WA 15000
    Language: Unknown
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 1485160-X
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