Browsing by Subject "Glucose"

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  • Koponen, Hannu; Kautiainen, Hannu; Leppanen, Esa; Mantyselka, Pekka; Vanhala, Mauno (2015)
    Background: Disturbances in lipid metabolism have been linked to suicidal behaviour, but little is known about the association between suicide risk and abnormal glucose metabolism in depression. Hyperglycaemia and hyperinsulinaemia may increase the risk of depression and also the risk for suicide, we therefore studied associations between suicidal behaviour and disturbances in glucose metabolism in depressive patients who had been referred to depression nurse case managers. Methods: Patients aged 35 years and older (N = 448, mean age 51 years) who were experiencing a new depressive episode, who were referred to depression nurse case managers in 2008-2009 and who scored = 10 on the Beck Depression Inventory were enrolled in this study. The study was conducted in municipalities within the Central Finland Hospital District (catchment area of 274 000 inhabitants) as part of the Finnish Depression and Metabolic Syndrome in Adults study. The patients' psychiatric diagnoses and suicidal behaviour were confirmed by the Mini-International Neuropsychiatric Interview. Blood samples, for glucose and lipid determinations, were drawn from participants after 12 h of fasting, which was followed by a 2-hour oral glucose tolerance test (OGTT) when blood was drawn at 0 and 2 h. Insulin resistance was measured by the Quantitative Insulin Sensitivity Check Index (QUICKI) method.' Results: Suicidal ideation (49 %) and previous suicide attempts (16 %) were common in patients with major depressive disorder or dysthymia. Patients with depression and suicidal behaviour had higher blood glucose concentrations at baseline and at 2 hours in the OGTT. Glucose levels associated positively with the prevalence of suicidal behaviour, and the linearity was significant at baseline (p for linearity: 0.012, adjusted for age and sex) and for 2-hour OGTT glucose (p for linearity: 0.004, adjusted for age and sex). QUICKI levels associated with suicidal behavior (p for linearity across tertiles of QUICKI: 0.026). Total and LDL cholesterol and triglyceride levels were also higher in those patients with suicidal behaviour. Multivariate analysis revealed that blood glucose levels, BDI scores and antidepressive medications associated with suicidal behaviour. Conclusion: Insulin resistance and disturbances in glucose and lipid metabolism may be more common in middle-aged depressive patients with suicidal behaviour.
  • Pakkanen, Soile Anja Eliisa; de Vries, Annemarie; Raekallio, Marja Riitta; Mykkänen, Anna Kristina; Palviainen, Mari Johanna; Sankari, Satu Marja; Vainio, Outi Maritta (2018)
    Background: Romifidine, an alpha-2 adrenoceptor agonist, is a widely-used sedative in equine medicine. Besides the desired sedative and analgesic actions, alpha-2 adrenoceptor agonists have side effects like alterations of plasma concentrations of glucose and certain stress-related hormones and metabolites in various species. Vatinoxan (previously known as MK-467), in turn, is an antagonist of alpha-2 adrenoceptors. Because vatinoxan does not cross the blood brain barrier in significant amounts, it has only minor effect on sedation induced by alpha-2 adrenoceptor agonists. Previously, vatinoxan is shown to prevent the hyperglycaemia, increase of plasma lactate concentration and the decrease of insulin and non-esterified free fatty acids (FFAs) caused by alpha-2 adrenoceptor agonists in different species. The aim of our study was to investigate the effects of intravenous romifidine and vatinoxan, alone and combined, on plasma concentrations of glucose and some stress-related hormones and metabolites in horses. Results: Plasma glucose concentration differed between all intravenous treatments: romifidine (80 mu g/kg; ROM), vatinoxan (200 mu g/kg; V) and the combination of these (ROM+V). Glucose concentration was the highest after ROM and the lowest after V. Serum FFA concentration was higher after V than after ROM or ROM+V. The baseline serum concentration of insulin varied widely between the individual horses. No differences were detected in serum insulin, cortisol or plasma adrenocorticotropic hormone (ACTH) concentrations between the treatments. Plasma lactate, serum triglyceride or blood sodium and chloride concentrations did not differ from baseline or between the treatments. Compared with baseline, plasma glucose concentration increased after ROM and ROM+V, serum cortisol, FFA and base excess increased after all treatments and plasma ACTH concentration increased after V. Serum insulin concentration decreased after V and blood potassium decreased after all treatments. Conclusions: Romifidine induced hyperglycaemia, which vatinoxan partially prevented despite of the variations in baseline levels of serum insulin. The effects of romifidine and vatinoxan on the insulin concentration in horses need further investigation.
  • Pakkanen, Soile A E; de Vries, Annemarie; Raekallio, Marja R; Mykkänen, Anna K; Palviainen, Mari J; Sankari, Satu M; Vainio, Outi M (BioMed Central, 2018)
    Abstract Background Romifidine, an α-2 adrenoceptor agonist, is a widely-used sedative in equine medicine. Besides the desired sedative and analgesic actions, α-2 adrenoceptor agonists have side effects like alterations of plasma concentrations of glucose and certain stress-related hormones and metabolites in various species. Vatinoxan (previously known as MK-467), in turn, is an antagonist of α-2 adrenoceptors. Because vatinoxan does not cross the blood brain barrier in significant amounts, it has only minor effect on sedation induced by α-2 adrenoceptor agonists. Previously, vatinoxan is shown to prevent the hyperglycaemia, increase of plasma lactate concentration and the decrease of insulin and non-esterified free fatty acids (FFAs) caused by α-2 adrenoceptor agonists in different species. The aim of our study was to investigate the effects of intravenous romifidine and vatinoxan, alone and combined, on plasma concentrations of glucose and some stress-related hormones and metabolites in horses. Results Plasma glucose concentration differed between all intravenous treatments: romifidine (80 μg/kg; ROM), vatinoxan (200 μg/kg; V) and the combination of these (ROM + V). Glucose concentration was the highest after ROM and the lowest after V. Serum FFA concentration was higher after V than after ROM or ROM + V. The baseline serum concentration of insulin varied widely between the individual horses. No differences were detected in serum insulin, cortisol or plasma adrenocorticotropic hormone (ACTH) concentrations between the treatments. Plasma lactate, serum triglyceride or blood sodium and chloride concentrations did not differ from baseline or between the treatments. Compared with baseline, plasma glucose concentration increased after ROM and ROM + V, serum cortisol, FFA and base excess increased after all treatments and plasma ACTH concentration increased after V. Serum insulin concentration decreased after V and blood potassium decreased after all treatments. Conclusions Romifidine induced hyperglycaemia, which vatinoxan partially prevented despite of the variations in baseline levels of serum insulin. The effects of romifidine and vatinoxan on the insulin concentration in horses need further investigation.
  • Cruz, Cristina D.; Shah, Shreya; Tammela, Paivi (2018)
    BackgroundBiofilms are formed by a complex bacterial community encapsulated by a polymeric matrix, with strong adherent properties and persistent phenotype. Biofilms are considered one of the most challenging areas of modern medicine. Existing antibiotics have been developed against free-floating bacterial cells, and thus, many treatments of biofilm-related infection fail. In this study, we compared the effects of different media on biofilm growth of clinical reference strains of Staphylococci and Enterococci, including multi-drug resistant representatives. Further, we optimized the resazurin-based assay for determining the minimal biofilm inhibitory concentration (MBIC) of standard antibiotics, and evaluated its use for the determination of minimal biofilm eradication concentration (MBEC).ResultsWe showed that tryptic soy broth supplemented with 1% glucose was an optimal media for maximum biofilm growth of all strains tested, with an extended incubation time for Enterococci. A range of parameters were tested for the resazurin assay, including concentration, temperature and time of incubation. Using quality parameters to analyze the assay's performance, the conditions for the resazurin assay were set as follows: 4g/mL and 8g/mL, with incubation at 25 degrees C for 20min and 40min for Staphylococci and Enterococci, respectively.ConclusionsIn summary, we defined conditions for optimal biofilm growth and for standardized resazurin assay for MBIC determination against six Gram-positive clinical reference strains. We also observed that MBEC determination by the resazurin-based assay is limited due to the poor detection limit of the assay. Complementary cell counting data is needed for precise determination of MBEC.
  • Cruz, Cristina D.; Shah, Shreya; Tammela, Päivi (BioMed Central, 2018)
    Abstract Background Biofilms are formed by a complex bacterial community encapsulated by a polymeric matrix, with strong adherent properties and persistent phenotype. Biofilms are considered one of the most challenging areas of modern medicine. Existing antibiotics have been developed against free-floating bacterial cells, and thus, many treatments of biofilm-related infection fail. In this study, we compared the effects of different media on biofilm growth of clinical reference strains of Staphylococci and Enterococci, including multi-drug resistant representatives. Further, we optimized the resazurin-based assay for determining the minimal biofilm inhibitory concentration (MBIC) of standard antibiotics, and evaluated its use for the determination of minimal biofilm eradication concentration (MBEC). Results We showed that tryptic soy broth supplemented with 1% glucose was an optimal media for maximum biofilm growth of all strains tested, with an extended incubation time for Enterococci. A range of parameters were tested for the resazurin assay, including concentration, temperature and time of incubation. Using quality parameters to analyze the assay’s performance, the conditions for the resazurin assay were set as follows: 4 μg/mL and 8 μg/mL, with incubation at 25 °C for 20 min and 40 min for Staphylococci and Enterococci, respectively. Conclusions In summary, we defined conditions for optimal biofilm growth and for standardized resazurin assay for MBIC determination against six Gram-positive clinical reference strains. We also observed that MBEC determination by the resazurin-based assay is limited due to the poor detection limit of the assay. Complementary cell counting data is needed for precise determination of MBEC.
  • Liimatta, Jani; Utriainen, Pauliina; Voutilainen, Raimo; Jääskeläinen, Jarmo (2020)
  • Tanner, Timo; Antikainen, Osmo; Ehlers, Henrik; Blanco, David; Yliruusi, Jouko (2018)
    The compression physics of powders must be considered when developing a suitable tablet formulation. In the present study, the gravitation-based high-velocity method was utilized to analyze mechanical properties of eight common pharmaceutical excipients: two grades of lactose, anhydrous glucose, anhydrous calcium hydrogen phosphate, three grades of microcrystalline cellulose and starch. Samples were compressed five times consecutively with varying pressure and speed so that Setup A produced higher pressure and longer contact time than Setup B. The important parameters obtained from samples were porosity profiles, compaction pressure, contact time, internal energy change and the amount of elastic recovery. All acquired data was only based on distance-time profile of the compression event. Lactose and glucose fragmented effectively while calcium hydrogen phosphate remained in rearrangement phase, due to its hardness and insufficient pressure applied. Microcrystalline cellulose samples showed plastic behaviour and starch was most elastic of all the samples. By utilizing the method, examined excipients could be categorized according to their compression behaviour in an accurate and cost-efficient manner.
  • Vihonen, Hanna; Kuisma, Markku; Nurmi, Jouni (2018)
    Background: The current study investigates the incidence, aetiology, and outcome of hypoglycaemia of patients without diabetes in the EMS. Methods: The study was a retrospective cohort study that utilized electronic EMS patient record system (population of one million). All patients encountered by EMS with plasma glucose Results: From EMS cases with a plasma glucose measurement a total of 5467 hypoglycaemic patients without diabetes were encountered by EMS during the study period with an incidence of 1082 (CI95% 1019-1148) per 100,000 inhabitants per year, corresponding 41.6%, (CI95% 40.8-42.3) of all hypoglycaemic patients. Of those patients, 3856 [71.6%, (CI95% 70.4-72.8)] were transported to hospital and 910 [23.2%, (CI95% 22.0-24.6)] had serious hypoglycaemia. The three main diagnosis groups that appeared in the subsequent hospital treatment associated with hypoglycaemia in all transported cases without diabetes as well with serious hypoglycaemia cases were: alcohol abuse [41.2%, (CI95% 39.7-42.8) and 42.2%, (CI95% 39.0-45.4)], hypothermia [17.2%, (CI95% 16.0-18.4) and 27.4%, (CI95% 24.6-30.4)], and malnutrition [16.9%, (CI95% 15.8-18.1) and 25.1%, (CI95% 22.4-28.0)]. Mortality ranged from 0.6-65.4% depending of admission reason and increased significantly at long-term. Non-Diabetics survival was less than with diabetics, when serious hypoglycaemia was present. Discussion: The most common possible hypoglycaemia related aetiological causes encountered in the EMS, alcohol abuse, hypothermia, and malnutrition, although frequent are often relatively benign conditions. These possible causes of hypoglycaemia can often be treated at scene or need only short hospital admissions. Hence they are not so prevalent in hospital studies. Conclusions: Hypoglycaemia without diabetes is commonly observed among the hypoglycaemic EMS cases. Main causes for it are alcohol abuse, hypothermia, and malnutrition. Mortality correlated with age, higher priority dispatch codes, and plasma glucose rate in multivariate logistic regression analysis. Some of the etiological subgroups carry a markedly high mortality rate.
  • Araújo, Francisca; Shrestha, Neha; João Gomes, Maria; Herranz Blanco, Bárbara; Liu, Dongfei; Hirvonen, Jouni Tapio; L. Granja, Pedro; Almeida Santos, Helder; Sarmento, Bruno (2016)
    Oral delivery of proteins is still a challenge in the pharmaceutical field. Nanoparticles are among the most promising carrier systems for the oral delivery of proteins by increasing their oral bioavailability. However, most of the existent data regarding nanosystems for oral protein delivery is from in vitro studies, lacking in vivo experiments to evaluate the efficacy of these systems. Herein, a multifunctional composite system, tailored by droplet microfluidics, was used for dual delivery of glucagon like peptide-1 (GLP-1) and dipeptidyl peptidase-4 inhibitor (iDPP4) in vivo. Oral delivery of GLP-1 with nano- or micro-systems has been studied before, but the simultaneous nanodelivery of GLP-1 with iDPP4 is a novel strategy presented here. The type 2 diabetes mellitus (T2DM) rat model, induced through the combined administration of streptozotocin and nicotinamide, a non-obese model of T2DM, was used. The combination of both drugs resulted in an increase in the hypoglycemic effects in a sustained, but prolonged manner, where the iDPP4 improved the therapeutic efficacy of GLP-1. Four hours after the oral administration of the system, blood glucose levels were decreased by 44%, and were constant for another 4 h, representing half of the glucose area under the curve when compared to the control. An enhancement of the plasmatic insulin levels was also observed 6 h after the oral administration of the dual-drug composite system and, although no statistically significant differences existed, the amount of pancreatic insulin was also higher. These are promising results for the oral delivery of GLP-1 to be pursued further in a chronic diabetic model study.
  • Kaye, Sanna; Heinonen, Sini; Pietiläinen, Kirsi (2020)
    Vertailemalla harvinaisia identtisiä mutta eripainoisia kaksosia voidaan selvittää lihavuuden vaikutusta aineenvaihduntaan DNA-sekvenssin samankaltaisuudesta riippumatta. Hankinnainen lihavuus vaikuttaa epäedullisesti veren rasvoihin, hyytymistekijöiden pitoisuuksiin ja tulehdusvälittäjäaineisiin sekä huonontaa endoteelitoimintaa ja altistaa ateroskleroosille. Tutkimusten perusteella rasvakudos on keskeisessä asemassa siinä, miten lihavuuden havaitut haitalliset aineenvaihdunnan muutokset syntyvät. Hankinnainen lihavuus liittyy rasvakudoksessa mitokondriotoiminnan heikentymiseen ja lievään tulehdukseen sekä insuliiniresistenssiin. Nämä muutokset heikentävät rasvakudoksen laajenemiskapasiteettia, jolloin ylimääräinen rasva alkaa varastoitua muihin kudoksiin, kuten maksaan, haimaan ja lihakseen, ja aiheuttaa aineenvaihdunnan laaja-alaisen häiriötilan. Erityisesti maksaan kertyvä rasva näyttää määrittävän lihavuuden haitallista metaboliaa.
  • Mina, Theresia H.; Lahti, Marius; Drake, Amanda J.; Forbes, Shareen; Denison, Fiona C.; Räikkönen, Katri; Norman, Jane E.; Reynolds, Rebecca M. (2017)
    Prenatal programming of hypothalamic-pituitary-adrenal (HPA) axis activity has long term implications for offspring health. Biological mechanisms underlying programming of the offspring HPA axis are poorly understood. We hypothesised that altered maternal metabolism including higher maternal obesity, glucose and lipids are novel programming factors for altered offspring HPA axis activity. Salivary cortisol levels were measured in 54 children aged 3-5 years under experimental conditions (before and after a delay of self-gratification test). Associations of child cortisol responses with maternal obesity in early pregnancy and with fasting glucose, triglycerides, HDL and total cholesterol measured in each pregnancy trimester were tested. Higher levels of maternal triglycerides and total cholesterol throughout pregnancy were associated with increased offspring cortisol reactivity. The associations were independent of maternal obesity and other confounders, suggesting that exposure to maternal lipids could be a biological mechanism of in utero programming of the offspring's HPA axis.
  • Linnaranta, O; Trontti, KT; Honkanen, J; Hovatta, I; Keinanen, J; Suvisaari, J (2021)
    he excess availability of glucose and lipids can also have an impact on the dynamics of activation and regulation of peripheral immune cellsWe aimed at understanding the correlations between peripheral metabolic state and immune system during the first year in first-episode psychosis (FEP). Patients with FEP (n = 67) and matched controls (n = 38), aged 18?40 years, were met at baseline, 2 and 12 months. Fasting peripheral blood samples were collected. We applied the NanoString nCounter in-solution hybridization technology to determine gene expression levels of 178 candidate genes reflecting activation of the immune system. Serum triglycerides, highdensity lipoprotein (HDL), low-density lipoprotein (LDL) cholesterol and insulin and plasma glucose (fP-Gluc) were measured. We applied Ingenuity Pathway Analysis (IPA) to visualize enrichment of genes to functional classes. Strength of positive or negative regulation of the disease and functional pathways was deduced from IPA activation Z-score at the three evaluation points. We correlated gene expression with plasma glucose, triglycerids and HDL and LDL, and used hierarchical clustering of the pairwise correlations to identify groups of genes with similar correlation patterns with metabolic markers. In patients, initially, genes associated with the innate immune system response pathways were upregulated, which decreased by 12 months. Furthermore, genes associated with apoptosis and T cell death were downregulated, and genes associated with lipid metabolism were increasingly downregulated by 12 months. The immune activation was thus an acute phase during illness onset. At baseline, after controlling for multiple testing, 31/178 genes correlated positively with fasting glucose levels, and 54/178 genes negatively with triglycerides in patients only. The gene clusters showed patterns of correlations with metabolic markers over time. The results suggest a functional link between peripheral immune system and metabolic state in FEP. Metabolic factors may have had an influence on the initial activation of the innate immune system. Future work is necessary to understand the role of metabolic state in the regulation of immune response in the early phases of psychosis.
  • Niskanen, Leo (2021)
    • Sekä hyperinsulinemialla että insuliiniresistenssillä on haitallisia vaikutuksia elimistöön. • Insuliiniresistenssi havaitaan energia-aineenvaihdunnan keskeisissä kudoksissa, eli rasvassa, lihaksissa ja maksassa. Tilaan liittyvän hyperinsulinemian aiheuttama anabolinen vaikutus ei kuitenkaan ole heikentynyt. • Hyperinsulinemia vaikuttaa sydän- ja verisuonisairauksien, lihavuuden sekä syöpäsairauksien syntyyn ja kehitykseen. Se on osallisena myös muistitoimintoja heikentävien sairauksien synnyssä ja kehityksessä. Lisäksi se vaikuttaa vanhenemiseen liittyviin perusmekanismeihin.
  • Kettunen, Jarno Lauri Tapani (Helsingin yliopisto, 2021)
    Dissertationes Scholae Doctoralis Ad Sanitatem Investigandam Universitatis Helsinkiensis
    The most common form of monogenic diabetes is called Maturity-onset Diabetes of the Young (MODY), which accounts for 1–3% of all cases of diabetes. Initially, MODY was a diagnosis for a familial form of diabetes that occurred in the lean and the young, demonstrated no dependence on exogenous insulin, and followed a dominant pattern of inheritance. Today, the clinical manifestation is more heterogeneous, and MODY has increasingly become a genetic diagnosis. More than 90% of the pathogenic gene variants responsible for MODY reside in GCK, HNF1A, HNF4A, or HNF1B. Although classical Mendelian diseases involve fully penetrant and distinctive phenotypes, heterogeneity in patients with MODY is pronounced. Even those with the same gene variant manifest with diverse clinical presentations. The characterization of gene–disease associations and heterogeneity in patients with MODY have inspired the three studies included in this thesis. In Study I, our aim was to systematically assess hepatobiliary and pancreatic manifestations in 14 Finnish patients affected by pathogenic gene variants of HNF1B. The patients underwent magnetic resonance imaging and magnetic resonance cholangiopancreatography. In conclusion, half of the patients (7 of 14) had an anomalous finding of the biliary system, and 6 of them had bile duct cysts (BDCs). Although untreated BDCs have generally been associated with a substantial risk of malignant transformation, it is not known whether the BDCs of genetic origin are similarly premalignant. In Study II, the aim of the international effort was to establish whether heterozygous protein-truncating variants (PTVs) in RFX6 are a novel genetic aetiology for MODY. Comparing between independent patient and control cohorts, we found that the RFX6 PTVs were enriched among the patients, whose clinical presentation was strongly suggestive of MODY, and among those routinely referred to genetic testing for MODY. In addition, the individuals heterozygous for the RFX6 PTVs demonstrated dysglycaemia and lower levels of serum glucose–dependent insulinotropic polypeptide (a.k.a. gastric inhibitory polypeptide, GIP). Study III was a multigenerational, longitudinal and cross-sectional family-based characterization study with a specific focus on the clinical and metabolic presentation of HNF1A p.(Gly292fs), the most common pathogenic variant responsible for HNF1A-MODY. The 12 families studied included 145 heterozygous carriers of the variant and their 139 first-degree relatives without the variant. Three of the 12 families were large multigenerational families who have continued their extensive follow-up ever since they were first identified and reported by our group in the 1990s. In conclusion, the carriers were leaner than the non-carriers, and they demonstrated enhanced lipolytic activity. Plasma glucose levels were higher in carriers than in non-carriers throughout the OGTT, and suggestive of insulin deficiency, serum insulin levels were lower in carriers than in noncarriers during the OGTT response. Although most carriers developed diabetes at a young age, one-third remained free of diabetes at 33 years. The polygenic risk score for type 2 diabetes also modified the age at onset of diabetes in patients with HNF1A-MODY. Studies I–III and numerous previous studies have indicated that patients with MODY are vastly heterogeneous. National efforts, including the studies conducted in Finland, might play a major role due to possible population differences. Personalized tailoring of medical therapy (e.g. a switch from insulin treatment to oral agents) is often possible regardless of the clinical presentation and origin of a patient, but further research is essential to explore individual predictors of the treatment response. Although the response has only rarely been assessed in engineered human cell line models, in vitro studies could provide novel mechanistic insights concerning MODY and other monogenic forms of diabetes. To summarize, systematic studies on individuals with a pathogenic gene variant can uncover profound heterogeneity associated with monogenic diabetes. These studies provide a valuable source for genetic laboratories to produce high-quality gene reports. Precision medicine in monogenic diabetes is progressively becoming a reality.
  • Puolakkainen, Tero; Rummukainen, Petri; Pihala-Nieminen, Vappu; Ritvos, Olli; Savontaus, Eriika; Kiviranta, Riku (2022)
    Introduction In postmenopausal osteoporosis, hormonal changes lead to increased bone turnover and metabolic alterations including increased fat mass and insulin resistance. Activin type IIB receptors bind several growth factors of the TGF-beta superfamily and have been demonstrated to increase muscle and bone mass. We hypothesized that ActRIIB-Fc treatment could improve bone and muscle mass, inhibit fat accumulation, and restore metabolic alterations in an ovariectomy (OVX) model of postmenopausal osteoporosis. Materials and Methods Female C57Bl/6 N mice were subjected to SHAM or OVX procedures and received intraperitoneal injections of either PBS or ActRIIB-Fc (5 mg/kg) once weekly for 7 weeks. Glucose and insulin tolerance tests (GTT and ITT, respectively) were performed at 7 and 8 weeks, respectively. Bone samples were analyzed with micro-computed tomography imaging, histomorphometry, and quantitative RT-PCR. Results Bone mass decreased in OVX PBS mice compared to the SHAM PBS group but ActRIIB-Fc was able to prevent these changes as shown by mu CT and histological analyses. This was due to decreased osteoclast numbers and function demonstrated by histomorphometric and qRT-PCR analyses. OVX induced adipocyte hypertrophy that was rescued by ActRIIB-Fc, which also decreased systemic adipose tissue accumulation. OVX itself did not affect glucose levels in GTT but ActRIIB-Fc treatment resulted in impaired glucose clearance in both SHAM and OVX groups. OVX induced mild insulin resistance in ITT but ActRIIB-Fc treatment did not affect this. Conclusion Our results reinforce the potency of ActRIIB-Fc as a bone-enhancing agent but also bring new insight into the metabolic effects of ActRIIB-Fc in normal and OVX mice.
  • Saraheimo, Markku; Tuomaala, Anna-Kaisa (2021)
    • Insuliinihoidon kehitys on nopeutunut viime vuosina. • Hoito on potilaalle haastavaa, sillä yksilöllinen insuliinintarve vaihtelee paljon eri vuorokausina ja ¬vuorokaudenaikoina. • Hyvä omahoito perustuu yhä hoidon yksilölliseen ohjaukseen ja aterioiden hiilihydraattien arviointiin. • Glukoosisensorit ja älykkäät insuliinipumput näyttävät parantavan hoitotasapainoa sekä lapsilla ¬että aikuisilla. Ne myös helpottavat hoitoa.
  • Vihonen, Hanna; Tierala, Ilkka; Kuisma, Markku; Puolakka, Jyrki; Westerbacka, Jukka; Nurmi, Jouni (2014)
  • CTR-TBI Investigators Participants; Huijben, Jilske A.; Volovici, Victor; Cnossen, Maryse C.; Haitsma, Iain K.; Stocchetti, Nino; Maas, Andrew I. R.; Menon, David K.; Ercole, Ari; Citerio, Giuseppe; Nelson, David; Polinder, Suzanne; Steyerberg, Ewout W.; Lingsma, Hester F.; van der Jagt, Mathieu; Raj, Rahul (2018)
    Background: General supportive and preventive measures in the intensive care management of traumatic brain injury (TBI) aim to prevent or limit secondary brain injury and optimize recovery. The aim of this survey was to assess and quantify variation in perceptions on intensive care unit (ICU) management of patients with TBI in European neurotrauma centers. Methods: We performed a survey as part of the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. We analyzed 23 questions focused on: 1) circulatory and respiratory management; 2) fever control; 3) use of corticosteroids; 4) nutrition and glucose management; and 5) seizure prophylaxis and treatment. Results: The survey was completed predominantly by intensivists (n = 33, 50%) and neurosurgeons (n = 23, 35%) from 66 centers (97% response rate). The most common cerebral perfusion pressure (CPP) target was > 60 mmHg (n = 39, 60%) and/or an individualized target (n = 25, 38%). To support CPP, crystalloid fluid loading (n = 60, 91%) was generally preferred over albumin (n = 15, 23%), and vasopressors (n = 63, 96%) over inotropes (n = 29, 44%). The most commonly reported target of partial pressure of carbon dioxide in arterial blood (PaCO2) was 36-40 mmHg (4.8-5.3 kPa) in case of controlled intracranial pressure (ICP) <20 mmHg (n = 45, 69%) and PaCO2 target of 30-35 mmHg (4-4.7 kPa) in case of raised ICP (n = 40, 62%). Almost all respondents indicated to generally treat fever (n = 65, 98%) with paracetamol (n = 61, 92%) and/or external cooling (n = 49, 74%). Conventional glucose management (n = 43, 66%) was preferred over tight glycemic control (n = 18, 28%). More than half of the respondents indicated to aim for full caloric replacement within 7 days (n = 43, 66%) using enteral nutrition (n = 60, 92%). Indications for and duration of seizure prophylaxis varied, and levetiracetam was mostly reported as the agent of choice for both seizure prophylaxis (n = 32, 49%) and treatment (n = 40, 61%). Conclusions: Practice preferences vary substantially regarding general supportive and preventive measures in TBI patients at ICUs of European neurotrauma centers. These results provide an opportunity for future comparative effectiveness research, since a more evidence-based uniformity in good practices in general ICU management could have a major impact on TBI outcome.