Published in 2020

Dual-Energy CT for Suspected Radiographically Negative Wrist Fractures: A Prospective Diagnostic Test Accuracy Study

Müller, F. C., Gosvig, K. K., Børgesen, H., Gade, J. S., Brejnebøl, M., Rodell, A., Nèmery, M. & Boesen, M., sep. 2020, I: Radiology. 296, 3, s. 596-602 7 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Background Patients with wrist trauma and negative findings on radiographs often undergo additional MRI examinations to assess for radiographically occult fractures. Dual-energy CT may be more readily available than MRI in some settings. Purpose To evaluate the diagnostic test accuracy of dual-energy CT in helping detect bone marrow edema and fracture in participants with wrist trauma and clinical suspicion of a wrist fracture but with negative findings on radiographs. Materials and Methods Adults were prospectively enrolled between January 2018 and November 2018. Wrists were examined with dual-energy CT and MRI, and images were read by four readers who were blinded to clinical information. The presence of bone marrow edema and fracture was rated per bone. The reference standard for bone marrow edema was the combined reading of MRI scans. The reference standard for fracture was a combined reading of MRI and dual-energy CT scans. A fifth radiologist arbitrated results in case of discrepancies. Diagnostic test accuracy was calculated per reader and for readers combined using exact binomial tests. Results Forty-six participants (mean age, 47 years ± 19 [standard deviation]; 24 men [52%]) were enrolled, and 750 bones (50 wrists) were assessed. Dual-energy CT had an average sensitivity of 94% (95% confidence interval [CI]: 80%, 99%; 31 of 33 wrists) and specificity of 65% (95% CI: 38%, 86%; 11 of 17 wrists) in the detection of wrists with bone marrow edema and a sensitivity of 69% (95% CI: 55%, 81%; 36 of 52 bones) and a specificity of 98% (95% CI: 97%, 99%; 682 of 696 bones) in the detection of edema in individual bones. MRI had a sensitivity of 80% (95% CI: 63%, 91%; 28 of 35 wrists) and a specificity of 93% (95% CI: 68%, 100%; 14 of 15 wrists) in helping detect wrists with fractures. Dual-energy CT had a sensitivity of 91% (95% CI: 77%, 98%; 32 of 35 wrists) and a specificity of 87% (95% CI: 60%, 98%; 53 of 60 wrists) in helping detect wrists with fractures. McNemar tests showed no significant differences between MRI and dual-energy CT (P = .07 to >.99) for all readers. Conclusion Dual-energy CT had a high sensitivity and a moderate specificity in the detection of bone marrow edema of the wrist. Dual-energy CT had high sensitivity and specificity in depicting fractures of the wrist in patients with suspected wrist fractures and negative findings on radiographs. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Fukuda in this issue.

Originalsprog Engelsk
Tidsskrift Radiology
Vol/bind 296
Udgave nummer 3
Sider (fra-til) 596-602
Antal sider 7
ISSN 0033-8419
DOI
Status Udgivet - sep. 2020

Early development of tendinopathy in humans: Sequence of pathological changes in structure and tissue turnover signaling

Tran, P. H. T., Malmgaard-Clausen, N. M., Puggaard, R. S., Svensson, R. B., Nybing, J. D., Hansen, P., Schjerling, P., Zinglersen, A. H., Couppé, C., Boesen, M., Magnusson, S. P. & Kjaer, M., jan. 2020, I: FASEB Journal. 34, 1, s. 776-788 13 s.

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Overloading of tendon tissue with resulting chronic pain (tendinopathy) is a common disorder in occupational-, leisure- and sports-activity, but its pathogenesis remains poorly understood. To investigate the very early phase of tendinopathy, Achilles and patellar tendons were investigated in 200 physically active patients and 50 healthy control persons. Patients were divided into three groups: symptoms for 0-1 months (T1), 1-2 months (T2) or 2-3 months (T3). Tendinopathic Achilles tendon cross-sectional area determined by ultrasonography (US) was ~25% larger than in healthy control persons. Both Achilles and patellar anterior-posterior diameter were elevated in tendinopathy, and only later in Achilles was the width increased. Increased tendon size was accompanied by an increase in hypervascularization (US Doppler flow) without any change in mRNA for angiogenic factors. From patellar biopsies taken bilaterally, mRNA for most growth factors and tendon components remained unchanged (except for TGF-beta1 and substance-P) in early tendinopathy. Tendon stiffness remained unaltered over the first three months of tendinopathy and was similar to the asymptomatic contra-lateral tendon. In conclusion, this suggests that tendinopathy pathogenesis represents a disturbed tissue homeostasis with fluid accumulation. The disturbance is likely induced by repeated mechanical overloading rather than a partial rupture of the tendon.

Originalsprog Engelsk
Tidsskrift FASEB Journal
Vol/bind 34
Udgave nummer 1
Sider (fra-til) 776-788
Antal sider 13
ISSN 0892-6638
DOI
Status Udgivet - jan. 2020

Bibliografisk note

© 2019 Federation of American Societies for Experimental Biology.

EAU-ESMO Consensus Statements on the Management of Advanced and Variant Bladder Cancer-An International Collaborative Multistakeholder Effort†: Under the Auspices of the EAU-ESMO Guidelines Committees

Witjes, J. A., Babjuk, M., Bellmunt, J., Bruins, H. M., De Reijke, T. M., De Santis, M., Gillessen, S., James, N., Maclennan, S., Palou, J., Powles, T., Ribal, M. J., Shariat, S. F., Der Kwast, T. V., Xylinas, E., Agarwal, N., Arends, T., Bamias, A., Birtle, A., Black, P. C., Bochner, B. H., Bolla, M., Boormans, J. L., Bossi, A., Briganti, A., Brummelhuis, I., Burger, M., Castellano, D., Cathomas, R., Chiti, A., Choudhury, A., Compérat, E., Crabb, S., Culine, S., De Bari, B., De Blok, W., J L De Visschere, P., Decaestecker, K., Dimitropoulos, K., Dominguez-Escrig, J. L., Fanti, S., Fonteyne, V., Frydenberg, M., Futterer, J. J., Gakis, G., Geavlete, B., Gontero, P., Grubmüller, B., Hafeez, S., Hansel, D. E., Hartmann, A., Hayne, D., Henry, A. M., Hernandez, V., Herr, H., Herrmann, K., Hoskin, P., Huguet, J., Jereczek-Fossa, B. A., Jones, R., Kamat, A. M., Khoo, V., Kiltie, A. E., Krege, S., Ladoire, S., Lara, P. C., Leliveld, A., Linares-Espinós, E., Løgager, V., Lorch, A., Loriot, Y., Meijer, R., Mir, M. C., Moschini, M., Mostafid, H., Müller, A-C., Müller, C. R., N'Dow, J., Necchi, A., Neuzillet, Y., Oddens, J. R., Oldenburg, J., Osanto, S., J G Oyen, W., Pacheco-Figueiredo, L., Pappot, H., Patel, M. I., Pieters, B. R., Plass, K., Remzi, M., Retz, M., Richenberg, J., Rink, M., Roghmann, F., Rosenberg, J. E., Rouprêt, M., Rouvière, O., Salembier, C., Salminen, A., Sargos, P., Sengupta, S., Sherif, A., Smeenk, R. J., Smits, A., Stenzl, A., Thalmann, G. N., Tombal, B., Turkbey, B., Lauridsen, S. V., Valdagni, R., Van Der Heijden, A. G., Van Poppel, H., Vartolomei, M. D., Veskimäe, E., Vilaseca, A., Rivera, F. A. V., Wiegel, T., Wiklund, P., Williams, A., Zigeuner, R. & Horwich, A., feb. 2020, I: European Urology. 77, 2, s. 223-250 28 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND: Although guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial.

OBJECTIVE: To bring together a large multidisciplinary group of experts to develop consensus statements on controversial topics in bladder cancer management.

DESIGN: A steering committee compiled proposed statements regarding advanced and variant bladder cancer management which were assessed by 113 experts in a Delphi survey. Statements not reaching consensus were reviewed; those prioritised were revised by a panel of 45 experts prior to voting during a consensus conference.

SETTING: Online Delphi survey and consensus conference.

PARTICIPANTS: The European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), experts in bladder cancer management.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Statements were ranked by experts according to their level of agreement: 1-3 (disagree), 4-6 (equivocal), and 7-9 (agree). A priori (level 1) consensus was defined as ≥70% agreement and ≤15% disagreement, or vice versa. In the Delphi survey, a second analysis was restricted to stakeholder group(s) considered to have adequate expertise relating to each statement (to achieve level 2 consensus).

RESULTS AND LIMITATIONS: Overall, 116 statements were included in the Delphi survey. Of these statements, 33 (28%) achieved level 1 consensus and 49 (42%) achieved level 1 or 2 consensus. At the consensus conference, 22 of 27 (81%) statements achieved consensus. These consensus statements provide further guidance across a broad range of topics, including the management of variant histologies, the role/limitations of prognostic biomarkers in clinical decision making, bladder preservation strategies, modern radiotherapy techniques, the management of oligometastatic disease, and the evolving role of checkpoint inhibitor therapy in metastatic disease.

CONCLUSIONS: These consensus statements provide further guidance on controversial topics in advanced and variant bladder cancer management until a time when further evidence is available to guide our approach.

PATIENT SUMMARY: This report summarises findings from an international, multistakeholder project organised by the EAU and ESMO. In this project, a steering committee identified areas of bladder cancer management where there is currently no good-quality evidence to guide treatment decisions. From this, they developed a series of proposed statements, 71 of which achieved consensus by a large group of experts in the field of bladder cancer. It is anticipated that these statements will provide further guidance to health care professionals and could help improve patient outcomes until a time when good-quality evidence is available.

Originalsprog Engelsk
Tidsskrift European Urology
Vol/bind 77
Udgave nummer 2
Sider (fra-til) 223-250
Antal sider 28
ISSN 0302-2838
DOI
Status Udgivet - feb. 2020

Bibliografisk note

Copyright © 2019 European Society of Medical Oncology and European Association of Urology. Published by Elsevier B.V. All rights reserved.

Effect of aerobic exercise training on asthma in adults - A systematic review and meta-analysis

Hansen, E. S. H., Pitzner-Fabricius, A., Toennesen, L. L., Rasmusen, H. K., Hostrup, M., Hellsten, Y., Backer, V. & Henriksen, M., 2020, I: European Respiratory Journal. Supplement. 56, 1, s. 2000146

Publikation: Bidrag til tidsskriftReviewForskningpeer review

Objective: To evaluate the effect of aerobic exercise training on asthma control, lung function and airway inflammation in adults with asthma. Design: Systematic review and meta-analysis. Methods: Randomised controlled trials investigating the effect of ≥8 weeks of aerobic exercise training on outcomes for asthma control, lung function and airway inflammation in adults with asthma were eligible for study. MEDLINE, Embase, CINAHL, PEDro and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched up to April 3, 2019. Risk of bias was assessed using the Cochrane Risk of Bias Tool. Results: We included 11 studies with a total of 543 adults with asthma. Participants' mean (range) age was 36.5 (22-54) years; 74.8% of participants were female and the mean (range) body mass index was 27.6 (23.2-38.1) kg·m-2. Interventions had a median (range) duration of 12 (8-12)weeks and included walking, jogging, spinning, treadmill running and other unspecified exercise training programmes. Exercise training improved asthma control with a standard mean difference (SMD) of -0.48 (-0.81 - -0.16). Lung function slightly increased with an SMD of -0.36 (-0.72-0.00) in favour of exercise training. Exercise training had no apparent effect on markers of airway inflammation (SMD -0.03 (-0.41-0.36)). Conclusions: In adults with asthma, aerobic exercise training has potential to improve asthma control and lung function, but not airway inflammation.

Originalsprog Engelsk
Bogserie European Respiratory Journal. Supplement
Vol/bind 56
Udgave nummer 1
Sider (fra-til) 2000146
ISSN 0904-1850
DOI
Status Udgivet - 2020

Bibliografisk note

Funding Information:
Support statement: The Centre for Physical Activity Research (CFAS) is supported by TrygFonden (grants ID 101390 and ID 20045).

Elimination af hepatitis C-virus i Danmark

Døssing, A., Røge, B. T., Madsen, L. G., Laursen, A. L., Hansen, J. B., Bukh, J. & Weis, N., 24 feb. 2020, I: Ugeskrift for Laeger. 182, 9

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

In Denmark, about 50% of patients with chronic hepatitis C virus (HCV) infection are undiagnosed. Since 2014, therapy containing direct-acting antivirals (DAA) has proven efficient and is available to all patients, who have a chronic HCV infection and a Danish personal identification number. The World Health Organization has a goal of elimination of viral hepatitis in 2030. Elimination of HCV in Denmark should focus on reducing HCV transmission, incidence and prevalence, combined with treatment with DAA of all infected patients. Micro-elimination strategies may play a major role, but a national strategy is lacking.
Bidragets oversatte titel Elimination of hepatitis C virus in Denmark
Originalsprog Dansk
Tidsskrift Ugeskrift for Laeger
Vol/bind 182
Udgave nummer 9
ISSN 0041-5782
Status Udgivet - 24 feb. 2020

Estimating physical activity and sedentary behaviour in a free-living environment: A comparative study between Fitbit Charge 2 and Actigraph GT3X

Mikkelsen, M-L. K., Berg-Beckhoff, G., Frederiksen, P., Horgan, G., O'Driscoll, R., Palmeira, A. L., Scott, S. E., Stubbs, J., Heitmann, B. L. & Larsen, S. C., jun. 2020, I: PLoS One. 15, 6 June, s. e0234426 e0234426.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND: Activity trackers such as the Fitbit Charge 2 enable users and researchers to monitor physical activity in daily life, which could be beneficial for changing behaviour. However, the accuracy of the Fitbit Charge 2 in a free-living environment is largely unknown.

OBJECTIVE: To investigate the agreement between Fitbit Charge 2 and ActiGraph GT3X for the estimation of steps, energy expenditure, time in sedentary behaviour, and light and moderate-to-vigorous physical activity under free-living conditions, and further examine to what extent placing the ActiGraph on the wrist as opposed to the hip would affect the findings.

METHODS: 41 adults (n = 10 males, n = 31 females) were asked to wear a Fitbit Charge 2 device and two ActiGraph GT3X devices (one on the hip and one on the wrist) for seven consecutive days and fill out a log of wear times. Agreement was assessed through Bland-Altman plots combined with multilevel analysis.

RESULTS: The Fitbit measured 1,492 steps/day more than the hip-worn ActiGraph (limits of agreement [LoA] = -2,250; 5,234), while for sedentary time, it measured 25 min/day less (LoA = -137; 87). Both Bland-Altman plots showed fixed bias. For time in light physical activity, the Fitbit measured 59 min/day more (LoA = -52;169). For time in moderate-to-vigorous physical activity, the Fitbit measured 31 min/day less (LoA = -132; 71) and for activity energy expenditure it measured 408 kcal/day more than the hip-worn ActiGraph (LoA = -385; 1,200). For the two latter outputs, the plots indicated proportional bias. Similar or more pronounced discrepancies, mostly in opposite direction, appeared when comparing to the wrist-worn ActiGraph.

CONCLUSION: Moderate to substantial differences between devices were found for most outputs, which could be due to differences in algorithms. Caution should be taken if replacing one device with another and when comparing results.

Originalsprog Engelsk
Artikelnummer e0234426
Tidsskrift PLoS One
Vol/bind 15
Udgave nummer 6 June
Sider (fra-til) e0234426
ISSN 1932-6203
DOI
Status Udgivet - jun. 2020

European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020

Husby, S., Koletzko, S., Korponay-Szabó, I., Kurppa, K., Mearin, M. L., Ribes-Koninckx, C., Shamir, R., Troncone, R., Auricchio, R., Castillejo, G., Christensen, R., Dolinsek, J., Gillett, P., Hróbjartsson, A., Koltai, T., Maki, M., Nielsen, S. M., Popp, A., Størdal, K., Werkstetter, K. & Wessels, M., jan. 2020, I: Journal of Pediatric Gastroenterology and Nutrition. 70, 1, s. 141-156 16 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

OBJECTIVES: The ESPGHAN 2012 coeliac disease (CD) diagnostic guidelines aimed to guide physicians in accurately diagnosing CD and permit omission of duodenal biopsies in selected cases. Here, an updated and expanded evidence-based guideline is presented.

METHODS: Literature databases and other sources of information were searched for studies that could inform on 10 formulated questions on symptoms, serology, HLA genetics, and histopathology. Eligible articles were assessed using QUADAS2. GRADE provided a basis for statements and recommendations.

RESULTS: Various symptoms are suggested for case finding, with limited contribution to diagnostic accuracy. If CD is suspected, measurement of total serum IgA and IgA-antibodies against transglutaminase 2 (TGA-IgA) is superior to other combinations. We recommend against deamidated gliadin peptide antibodies (DGP-IgG/IgA) for initial testing. Only if total IgA is low/undetectable, an IgG-based test is indicated. Patients with positive results should be referred to a paediatric gastroenterologist/specialist. If TGA-IgA is ≥10 times the upper limit of normal (10× ULN) and the family agrees, the no-biopsy diagnosis may be applied, provided endomysial antibodies (EMA-IgA) will test positive in a second blood sample. HLA DQ2-/DQ8 determination and symptoms are not obligatory criteria. In children with positive TGA-IgA <10× ULN at least 4 biopsies from the distal duodenum and at least 1 from the bulb should be taken. Discordant results between TGA-IgA and histopathology may require re-evaluation of biopsies. Patients with no/mild histological changes (Marsh 0/I) but confirmed autoimmunity (TGA-IgA/EMA-IgA+) should be followed closely.

CONCLUSIONS: CD diagnosis can be accurately established with or without duodenal biopsies if given recommendations are followed.

Originalsprog Engelsk
Tidsskrift Journal of Pediatric Gastroenterology and Nutrition
Vol/bind 70
Udgave nummer 1
Sider (fra-til) 141-156
Antal sider 16
ISSN 0277-2116
DOI
Status Udgivet - jan. 2020

Evaluation of serum ARGS neoepitope as an osteoarthritis biomarker using a standardized model for exercise-induced cartilage extra cellular matrix turnover

Bjerre-Bastos, J. J., Nielsen, H. B., Andersen, J. R., He, Y., Karsdal, M., Bay-Nielsen, A-C., Boesen, M., Mackey, A. L. & Bihlet, A. R., apr. 2020, I: Osteoarthritis and Cartilage Open.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Originalsprog Engelsk
Tidsskrift Osteoarthritis and Cartilage Open
Status Udgivet - apr. 2020

Everyday activities when living at home with advanced cancer: A cross-sectional study

Waehrens, E. E., Brandt, Å., Peoples, H. & la Cour, K., sep. 2020, I: European Journal of Cancer Care. 29, 5, s. e13258 e13258.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

OBJECTIVE: This study aimed at exploring everyday activities of people with advanced cancer living at home: which everyday activities they perform; perceived and observed quality of performance of self-care and household activities; which activities they would like to be able to perform; and determine any gender differences.

METHODS: Outpatients (n = 164) with advanced cancer were recruited from Danish oncology units. Data were based on medical hospital records, standardised questionnaires, a 1-day diary, standardised interviews and standardised observations. All data were subject to descriptive and statistical analyses.

RESULTS: More than 95% of the study sample was classified in ECOG performance status 1 and 2. Compared to population-based norms, the participants reported lower levels of global health and quality of life, as well as lower physical and role functioning. Across gender, participants spent the majority of the day involved in self-care and leisure activities. They reported to perform self-care independently without risk, although 60% reported problems with mobility. While heavy household activities were reported as most problematic, participants prioritised support to engage in more active leisure and social activities.

CONCLUSION: People with advanced cancer experience problems related to performance of and engagement in everyday activities indicating a need for palliative rehabilitation services.

Originalsprog Engelsk
Artikelnummer e13258
Tidsskrift European Journal of Cancer Care
Vol/bind 29
Udgave nummer 5
Sider (fra-til) e13258
ISSN 0961-5423
DOI
Status Udgivet - sep. 2020

Bibliografisk note

© 2020 John Wiley & Sons Ltd.

Familial associations in hair cortisol concentration: A cross-sectional analysis based on the Healthy Start study

Dauegaard, S., Olsen, N. J., Heitmann, B. L. & Larsen, S. C., nov. 2020, I: Psychoneuroendocrinology. 121, s. 104836 104836.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

A few studies have shown a direct association between maternal and child hair cortisol concentrations (HCC), but the potential correlations within paternal-child and maternal-paternal dyads are not clear from the current evidence. Thus, we aimed to thoroughly examine associations between family members HCC. We conducted a cross-sectional study based on 159 children and their parents (159 mothers and 159 fathers) participating in the Danish Healthy Start Study. Information was available on HCC from both children, mothers and fathers, as well as on several sociodemographic factors. First, Pearson's correlation coefficients were applied to assess crude correlations between family members' HCC. Secondly, analysis of covariance, adjusted for covariates, was applied to estimate child mean HCC in quartiles of maternal and paternal HCC, and mean paternal HCC in quartiles of maternal HCC. Our results showed direct associations between HCC of all family members. We found statistically robust correlations between maternal and child HCC (r = 0.33; P < 0.001), paternal and child HCC (r = 0.37; P < 0.001) and between maternal and paternal HCC (r = 0.31; P < 0.001). Similar results were found when adjusting for covariates in analyses of covariance. Our data provides evidence of associations between family members' HCC. However, we were unable to determine the extent to which these associations were due to shared genetics, assortative mating or environmental factors.

Originalsprog Engelsk
Artikelnummer 104836
Tidsskrift Psychoneuroendocrinology
Vol/bind 121
Sider (fra-til) 104836
ISSN 0306-4530
DOI
Status Udgivet - nov. 2020

Bibliografisk note

Copyright © 2020 Elsevier Ltd. All rights reserved.

Fetal exposure to paternal smoking and semen quality in the adult son

Haervig, K. K., Høyer, B. B., Giwercman, A., Hougaard, K. S., Ramlau-Hansen, C. H., Specht, I. O., Toft, G., Bonde, J. P. & Søgaard Tøttenborg, S., sep. 2020, I: Andrology. 8, 5, s. 1117-1125 9 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND: The negative impact of maternal smoking during pregnancy on offspring semen quality is well established. Less is known about the impact of paternal smoking.

METHODS: We estimated differences in semen parameters and testicle size according to paternal smoking in 772 adult sons of women enrolled in the Danish National Birth Cohort when pregnant. Parents' smoking was reported around gestational week 16, and analyses were adjusted for parents' ages at conception, maternal pre-pregnancy body mass index, maternal alcohol and caffeine intake, family occupational status, ejaculatory abstinence time, clinic of semen analysis, and season.

RESULTS: Sons of smoking fathers and non-smoking mothers had a 10% (95% confidence interval: -24%, 7%) lower semen concentration and 11% (95% confidence interval: -27%, 8%) lower sperm count than sons of non-smoking parents. Having two smoking parents was associated with 19% reduction in sperm count (95% confidence interval: -37%, 3%). Paternal smoking was not associated with volume, motility, or morphology. Adjusting for maternal smoking, paternal smoking was associated with a 26% increased risk of small testicular volume (95% confidence interval: 0.89, 1.78).

DISCUSSION: Exclusion of sons with a history of testicular cancer, chemotherapy, orchiectomy, and with only one or no testicles may have caused us to underestimate associations if these men's reproductive health including semen quality are in fact more sensitive to paternal smoking.

CONCLUSION: The study provides limited support for slightly lower sperm concentration and total sperm concentration in sons of smoking fathers, but findings are also compatible with no association.

Originalsprog Engelsk
Tidsskrift Andrology
Vol/bind 8
Udgave nummer 5
Sider (fra-til) 1117-1125
Antal sider 9
ISSN 2047-2919
DOI
Status Udgivet - sep. 2020

Bibliografisk note

© 2020 American Society of Andrology and European Academy of Andrology.

Fetal Programming of Semen Quality (FEPOS) Cohort - A DNBC Male-Offspring Cohort

Keglberg Hærvig, K., Bonde, J. P., Ramlau-Hansen, C. H., Toft, G., Hougaard, K. S., Specht, I. O., Giwercman, A., Nybo Andersen, A-M., Olsen, J., Lindh, C., Bjerre Høyer, B. & Tøttenborg, S. S., 2020, I: Clinical Epidemiology. 12, s. 757-770 14 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Background: Prenatal exposures may contribute to male infertility in adult life, but large-scale epidemiological evidence is still lacking. The Fetal Programming of Semen quality (FEPOS) cohort was founded to provide means to examine if fetal exposures can interfere with fetal reproductive development and ultimately lead to reduced semen quality and reproductive hormone imbalances in young adult men.

Methods: Young adult men at least 18 years and 9 months of age born to women in the Danish National Birth Cohort living in relative proximity to Copenhagen or Aarhus and for whom a maternal blood sample and two maternal interviews during pregnancy were available were invited to FEPOS. Recruitment began in March 2017 and ended in December 2019. The participants answered a comprehensive questionnaire and underwent a physical examination where they delivered a semen, urine, and hair sample, measured their own testicular volume, and had blood drawn.

Results: In total 21,623 sons fulfilled eligibility criteria of whom 5697 were invited and 1058 participated making the response rate 19%. Semen characteristics did not differ between sons from the Copenhagen and Aarhus clinics. When comparing the FEPOS semen parameters to similar cohorts, the median across all semen characteristics was slightly lower for FEPOS participants, although with smaller variation.

Conclusion: With its 1058 young adult men, the FEPOS cohort is the largest population-based male-offspring cohort worldwide specifically designed to investigate prenatal determinants of semen quality. Wide-ranging information on maternal health, lifestyle, socioeconomic status, occupation, and serum concentrations of potential reproductive toxicants during pregnancy combined with biological markers of fertility in their sons collected after puberty allow for in-depth investigations of the 'fetal origins of adult disease hypothesis'.

Originalsprog Engelsk
Tidsskrift Clinical Epidemiology
Vol/bind 12
Sider (fra-til) 757-770
Antal sider 14
ISSN 1179-1349
DOI
Status Udgivet - 2020

Bibliografisk note

© 2020 Keglberg Hærvig et al.

Fysioterapeutisk træning til patienter med knæartrose

Henriksen, M. & Skou, S. T., 12 okt. 2020, I: Ugeskrift for Laeger. 182, 42

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Therapeutic exercise for knee osteoarthritis is recommended globally, based on more than 100 randomised, controlled trials documenting beneficial effects on pain and function. There are adverse effects of exercise and symptom exacerbations may occur in the first 4-6 weeks of an exercise programme, but will most often decline with time. If pain and function do not improve after a structured exercise program, other treatments must be considered. The effects of exercise decline over time, if regular exercise is not implemented in the daily life of the patient.

Bidragets oversatte titel Exercise for knee osteoarthritis
Originalsprog Dansk
Tidsskrift Ugeskrift for Laeger
Vol/bind 182
Udgave nummer 42
ISSN 0041-5782
Status Udgivet - 12 okt. 2020

Glucocorticoid-trials in rheumatoid arthritis mostly study representative real-world patients: A systematic review and meta-analysis

Palmowski, A., Nielsen, S. M., Buttgereit, T., Palmowski, Y., Boers, M., Christensen, R. & Buttgereit, F., dec. 2020, I: Seminars in Arthritis and Rheumatism. 50, 6, s. 1400-1405 6 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

OBJECTIVE: Randomized controlled trials (RCTs) are considered the gold standard in clinical research due to credible causality. Their results, however, may not be generalizable to real-world populations. While glucocorticoids (GCs) remain a mainstay of rheumatoid arthritis (RA) treatment, it is unclear whether the results of GC-RCTs are generalizable to current real-world RA patients.

METHODS: MEDLINE was searched for RCTs and, as comparators, cohort studies (CSs) in RA evaluating systemic GCs. Random-effects meta-analyses were performed for descriptive baseline characteristics (including general demographics, comorbidities, and disease activity) that have been shown to be able to modify the benefit-risk-ratio of various RA therapeutics. These meta-analyses were stratified by study type (RCT and CS). Stratified estimates were subsequently compared. Further sensitivity analyses were performed stratifying by disease duration.

RESULTS: 56 RCTs (7053 participants) and 10 CSs (14,688 participants) were included. 12 characteristics were reported frequently enough to allow for comparative analysis. In 10/12 characteristics (83%), RCT estimates did not appear to differ from CS estimates. However, RCT participants were younger (-4.7 years [95% CI -7.2 to -2.1]; p < 0.001) and had higher erythrocyte sedimentation rates (11.8 mm/h [5.7 to 17.8]; p < 0.001) than CS participants. Comorbidities could not be assessed due to insufficient reporting.

CONCLUSION: Our findings suggest that evidence from GC trials in RA is of acceptable generalizability to current real-world patients - especially compared to findings from biologic agents in RA. However, RCT participants were younger than real-world patients, potentially limiting the generalizability of trial results to elderly patients.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO (CRD42019134675).

Originalsprog Engelsk
Tidsskrift Seminars in Arthritis and Rheumatism
Vol/bind 50
Udgave nummer 6
Sider (fra-til) 1400-1405
Antal sider 6
ISSN 0049-0172
DOI
Status Udgivet - dec. 2020

Bibliografisk note

Copyright © 2020 Elsevier Inc. All rights reserved.

BACKGROUND: Myocardial injury after non-cardiac surgery occurs in a high number of patients, resulting in increased mortality in the post-operative period. The use of high inspiratory oxygen concentrations may cause hyperoxia, which is associated with impairment of coronary blood flow. Furthermore, the surgical stress response increases reactive oxygen species, which is involved in several perioperative complications including myocardial injury and death. Avoidance of hyperoxia and substitution of reactive oxygen species scavengers may be beneficial. Our primary objective is to examine the effect of oxygen and added antioxidants for prevention of myocardial injury assessed by area under the curve for troponin measurements during the first three post-operative days.

METHODS: The VIXIE trial (VitamIn and oXygen Interventions and cardiovascular Events) is an investigator-initiated, blinded, 2 × 2 factorial multicentre clinical trial. We include 600 patients with cardiovascular risk factors undergoing major non-cardiac surgery. Participants are randomised to an inspiratory oxygen fraction of 0.80 or 0.30 during and for 2 hours after surgery and either an intravenous bolus of vitamin C and an infusion of N-acetylcysteine or matching placebo of both. The primary outcome is the area under the curve for high-sensitive cardiac troponin release during the first three post-operative days as a marker of the extent of myocardial injury. Secondary outcomes are mortality, non-fatal myocardial infarction and non-fatal serious adverse events within 30 days.

PERSPECTIVE: The current trial will provide further evidence for clinicians on optimal administration of perioperative oxygen in surgical patients with cardiovascular risks and the clinical effects of two common antioxidants.

Originalsprog Engelsk
Tidsskrift Acta Anaesthesiologica Scandinavica
Vol/bind 64
Udgave nummer 3
Sider (fra-til) 400-409
Antal sider 10
ISSN 0001-5172
DOI
Status Udgivet - 1 mar. 2020

Bibliografisk note

© 2019 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

OBJECTIVES: The main study aim was to examine the applicability of a novel method to assess the criterion of values and preferences within the Grading of Recommendation, Assessment, Development and Evaluation evidence to decision framework. The group concept mapping (GCM) approach was applied to identify, organise and prioritise values and preferences in the example of health professionals' choice of analgesia for patients with acute trauma pain.

SETTING: Prehospital and emergency care centres in the Nordic countries of Denmark, Norway, Sweden, Finland and Iceland.

PARTICIPANTS: Acute care health professionals with qualifications to administer analgesic agents to patients in emergency and prehospital settings, including advanced ambulance assistants, rescue officers, paramedics, emergency physicians and emergency nurses, participated in an online survey in which statements were generated (n=40) and structured (n=11) and finally analysed and interpreted in a validation meeting (n=4).

RESULTS: Using GCM, ideas were generated and structured through online participation. Results were interpreted at a validation meeting. In total, 111 unique ideas were identified and organised into seven clusters: drug profile, administration, context, health professionals' preferences and logistics, safety profile, patient's medical history and acute clinical situation.

CONCLUSIONS: Based on GCM, a conceptual model was developed, and values and preferences around choice of analgesia in emergency care were revealed. Health professionals within acute care can apply the conceptual model to support their decision-making when choosing the best available treatment for pain for their patients in emergency care.

Originalsprog Engelsk
Artikelnummer e031863
Tidsskrift BMJ Open
Vol/bind 10
Udgave nummer 3
Sider (fra-til) e031863
ISSN 2044-6055
DOI
Status Udgivet - 10 mar. 2020

Bibliografisk note

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Background: Psoriasis (PsO) and psoriatic arthritis (PsA) are chronic diseases that affect patients' quality of life. The purpose of the present study was to develop a pilot outcome-based, patient-centric management model for PsO and PsA.

Methods: The non-interventional IMPROVE (Incentives for healthcare management based on patient-related outcomes and value) study being conducted in Denmark consists of 5 phases: 1) collecting real-world evidence to estimate treatment patterns and disease burden to the healthcare sector and patients; 2) identifying disease aspects which matter most to patients by use of concept mapping; 3) conducting interviews with healthcare professionals and patient organization involved in a typical PsO or PsA patient journey in order to determine relevant measures to quantify patient-identified outcomes; 4) developing a value-based remuneration model based on outcomes from phases 1-3; and 5) testing the outcome-based model in pre-selected hospitals in Denmark.

Results: Both PsO and PsA are associated with multiple co-morbidities, increased healthcare costs, and loss of earnings. Seven important 'clusters' of disease aspects were identified for both PsO and PsA, including uncertainty about disease progression and treatments, as well as inter-personal relations with healthcare providers. Hospital-based treatment was associated with high treatment costs. Although the outcome-based model could result in strategic behavior by doctors, those involved in defining the best outcome goals consider it unlikely.

Conclusion: The new patient-centric outcome-based management model is expected to support optimal treatment and secure best possible outcomes for patients suffering from PsO or PsA. The practical implication of the present study are that the models developed are expected to increase focus on patient-centered healthcare, and help eliminate some of the inappropriate incentives that exist in activity-based remuneration systems.

Trial registration: Not applicable; data collected from patient registries in Denmark.

Originalsprog Engelsk
Artikelnummer 95
Tidsskrift Archives of public health = Archives belges de sante publique
Vol/bind 78
Udgave nummer 1
Sider (fra-til) 95
ISSN 0778-7367
DOI
Status Udgivet - 12 okt. 2020

Bibliografisk note

© The Author(s) 2020.

Interhospital Transport of Sick Newborns In Denmark

Heiring, C., Zachariassen, G., Christensen, P. S., Kjærgaard, S., Nielsen, H. V., Hansen, T. G., Mortensen, S., Hertel, S. A. & Breindahl, M., 30 mar. 2020, I: Ugeskrift for Laeger. 182, 14A

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Interhospital transport of sick newborn infants is dangerous, but the risk of adverse events can be reduced, when transport is being performed by trained neonatal retrieval teams. In this review, we describe the current organisation of neonatal retrieval service in Denmark. The services are based at the neonatal intensive care units of the four university hospitals. Improved cooperation and harmonisation of operations between the teams is needed, as this is a prerequisite for the development of a national clinical consensus guideline and national quality metrics enabling benchmarking both within Denmark and abroad.

Bidragets oversatte titel Interhospital transport of sick newborns in Denmark
Originalsprog Dansk
Tidsskrift Ugeskrift for Laeger
Vol/bind 182
Udgave nummer 14A
ISSN 0041-5782
Status Udgivet - 30 mar. 2020

Irritable bowel syndrome symptoms in axial spondyloarthritis more common than among healthy controls: is it an overlooked comorbidity?

Wallman, J. K., Mogard, E., Marsal, J., Andréasson, K., Jöud, A., Geijer, M., Kristensen, L. E., Lindqvist, E. & Olofsson, T., 1 jan. 2020, I: Annals of the Rheumatic Diseases. 79, 1, s. 159-161 3 s.

Publikation: Bidrag til tidsskriftLetterForskningpeer review

Originalsprog Engelsk
Tidsskrift Annals of the Rheumatic Diseases
Vol/bind 79
Udgave nummer 1
Sider (fra-til) 159-161
Antal sider 3
ISSN 0003-4967
DOI
Status Udgivet - 1 jan. 2020

Less Severe Preoperative Synovitis is Associated With Higher Self-reported Pain Intensity 12 Months After Total Knee Arthroplasty-An Exploratory Prospective Observational Study

Petersen, K. K., Arendt-Nielsen, L., Vela, J., Skou, S. T., Eld, M., Al-Mashkur, N. M., Boesen, M., Riis, R. G. C. & Simonsen, O., jan. 2020, I: The Clinical journal of pain. 36, 1, s. 34-40 7 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

OBJECTIVES: Synovitis is one of the possible pain generators in osteoarthritis (OA) and is associated with upregulation of proinflammatory cytokines, which can lead to worsening of the postoperative pain. This exploratory study aimed to investigate the association between perioperative synovitis and self-reported pain 12 months after total knee arthroplasty (TKA) in patients with OA.

MATERIALS AND METHODS: Twenty-six knee OA patients were included in this analysis. The perioperative volume of synovitis in predefined locations was assessed by contrast-enhanced magnetic resonance imaging (CE-MRI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Perioperative synovitis was assessed histologically from biopsies of the synovium. Highest pain intensity within the last 24 hours (Visual Analog Scale, VAS, 0 to 100) was assessed before and 12 months after TKA. Patients were divided into a low-pain intensity (VAS≤30) and a high-pain intensity (VAS>30) group on the basis of 12 months postoperative VAS.

RESULTS: The high-pain intensity group had significantly lower perioperative contrast-enhanced-synovitis (P=0.025), DCE-synovitis (P<0.04), and a trend toward lower histologically assessed synovitis (P=0.077) compared with the low-pain intensity group. Perioperative synovitis scores were inversely correlated with pain intensity 12 months after TKA (P<0.05), indicating that more severe perioperative synovitis is associated with less severe pain intensity at 12 months.

DISCUSSION: Higher degrees of perioperative synovitis scores are found to be associated with less postoperative pain 12 months after TKA. Further, correlation analysis revealed that less severe perioperative CE-MRI and DCE-MRI synovitis was associated with higher pain intensity 12 months after TKA, suggesting that CE-MRI and DCE-MRI synovitis grades could be used as imaging markers for prediction of chronic postoperative pain after TKA.

Originalsprog Engelsk
Tidsskrift The Clinical journal of pain
Vol/bind 36
Udgave nummer 1
Sider (fra-til) 34-40
Antal sider 7
ISSN 0749-8047
DOI
Status Udgivet - jan. 2020

Pages