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Forskningens Dag 19. april 2012

Abstracts og program

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Forskningens Dag 2012 er tilrettelagt af: Birgitte Schantz Laursen, Forskningsenhed for Klinisk Sygepleje Britt Mejer Christensen, Afd. for Universitetshospitalsanliggender Maria Lundtoft Svendsen, Afd. for Universitetshospitalsanliggender Peter Friis Jeppesen, Afdelingen for Universitetshospitalsanliggender Søren Risom Kristensen, Klinisk Biokemisk Afdeling Mette Søgaard, Klinisk Mikrobiologisk Afdeling Carl-Otto Gøtzsche, centerchef v. Hoved- Orto- Hjertecentret

www.forskningenshus.dk 2

ISBN: 978-87-90880-38-5


Velkommen til Forskningens Dag 2012 på Aalborg Sygehus, Århus Universitetshospital Kære deltager Det er med stor glæde, at vi kan præsentere dig for endnu en festdag for forskningen på Aalborg SygeHus. Forskningens Dag er efterhånden blevet en veletableret begivenhed, hvor ansatte i det nordjyske sundhedsvæsen, politikere og samarbejdspartnere hylder den stadigt stigende forskningsaktivitet, som finder sted på hospitalet. Interessen for Forskningens Dag 2012 har i år været større end nogensinde. Vi har modtaget 117 abstracts om spændende forskningsprojekter fra forskere fra alle faggrupper - sygeplejersker, læger, ingeniører, statistikere, molekylærbiologer, farmaceuter, terapeuter, fysikere og bioanalytikere, for at nævne nogle. Det har derfor ikke været nogen helt let opgave at udvælge de 20 abstracts, som præsenteres mundtligt i to parallelle foredragssessioner i henholdsvis Medicinerhusets auditorium og kantine. De resterende abstracts præsenteres som postere i Medicinerhusets foyer. Alle de indsendte abstracts er samlet i denne bog. Under formiddagens program vil repræsentanter fra fire af sygehusets stærke forskningsmiljøer give et indblik i hver deres forskningsområde og ikke mindst af, hvordan tværfagligt samarbejde og netværk har bragt deres forskning op på et meget højt internationalt niveau. Endvidere har vi inviteret politisk kommentator og direktør i tænketanken Kraka, Peter Mogensen og bedt ham give sit bud på en politisk analyse af forskningen ved Aalborg Sygehus - det kan kun blive interessant! Skulle dagen i dag have givet dig inspiration til mere forskning, så besøg Aalborg Sygehus’ forskningsportal på nettet www.forskningenshus.dk, hvor du altid kan finde nyheder, praktiske oplysninger og spændende artikler om forskningen på Aalborg Sygehus. Vi håber, du får en god og inspirerende dag. Velkommen! Planlægningsudvalget

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Dagens program 8.30-8.40

Velkomst v. Lars Hvilsted Rasmussen, forskningschef, Aalborg Sygehus - Århus Universitetshospital

8.40-9.00

Om forsknings betydning for samfundet v. Flemming Møller Mortensen, medlem af Folketingets Sundheds- og Forebyggelsesudvalg

9.00-9.10

Det kommende Aalborg Universitetshospital v. Egon Toft, dekan for Det Sundhedsvidenskabelige fakultet, Aalborg Universitet.

9.10-10.10

En politisk analyse af forskningen på Aalborg Sygehus v. Peter Mogensen, politisk kommentator og direktør i tænketanken Kraka

10.10-10.40

Kaffepause og posterpræsentationer

10.40-11.00

Mech-Sense og internationale samarbejder v. Asbjørn Mohr Drewes, professor, overlæge, ph.d., dr.med., Mech-Sense, Medicinsk Gastroenterologisk Afdeling

11.00-11.20

CHEPRE - Forskningsidé, organisering, strategi og status - På vej mod individualiseret kræftbehandling ved hjælp af gentest v. Hans Erik Johnsen, professor, dr.med., Hæmatologisk Afdeling

11.20-11.40

Kardiovaskulært Forskningscenter - et springbræt til forskning v. Kim Overvad, professor, Kardiologisk Afdeling og centerleder ved Kardiovaskulært Forskningscenter

11.40-12.00

Er grønlændere sundere end danskere? v. Stig Andersen, leder af Center for Grønlandsforskning og afdelingslæge, Medicinsk Endokrinologisk Afdeling

12.00-12.45

Frokost og posterpræsentationer

12.45-14.00

Parallelle foredragssessioner: 1A: Auditoriet

1B: Kantinen

12.45-13.00

Abstract A

Abstract F

13.00-13.15 13.15-13.30 13.30-13.45 13.45-14.00

Abstract B Abstract C Abstract D Abstract E

Abstract G Abstract H Abstract I Abstract J

14.00-14.20

Kaffepause og posterpræsentationer (afstemning lukker)

14.20-15.35

Parallelle foredragssessioner:

15.40-16.00

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Tidspunkt

Tidspunkt

2A: Auditoriet

2B: Kantinen

14.20-14.35

Abstract K

Abstract P

14.35-14.50 14.50-15.05 15.05-15.20 15.20-15.35

Abstract L Abstract M Abstract N Abstract O

Abstract Q Abstract R Abstract S Abstract T

Afslutning samt præmiering af de tre bedste postere (foyeren) v. Lars Hvilsted Rasmussen, forskningschef, Aalborg Sygehus - Århus Universitetshospital


Formiddagens oplæg Mech-Sense og internationale samarbejder v. Asbjørn Mohr Drewes, Medicinsk Gastroenterologisk Afdeling Gennem de sidste 10 år har forskere ved Mech-Sense udviklet forskelligt udstyr og metoder inden for biomekanik og neurogastroenterologi. Disse metoder har hjulpet forskerne til at forstå den fysiologiske regulering af mekaniske og sensoriske forhold i mavetarmkanalen, sphincterfunktion og motorik, samt til at forklare patofysiologien bag en række symptomer hos patienter med funktionelle og organiske sygdomme. De farmakologiske metoder, som er udviklet ved centeret, har bibragt en nærmere forståelse af forskellige lægemidlers virkning med det endelige formål at identificere de rette patienter til en given behandling. Mech-Sense har etableret et internationalt netværk for at udvikle metoderne og applicere dem på forskellige patientgrupper. Dette netværk er overvejende baseret i Europa, men der er også etableret samarbejde med grupper i Sydog Nordamerika, Asien og Australien. Det internationale samarbejde har betydet store bevillinger på tværs af forskergrupperne og fælles projekter, samt master – og ph.d.-studerende. Samarbejderne er tidskrævende og dyre, men den interaktion der fremkommer, er af afgørende betydning for forskningen i gruppen og er med til at muliggøre at Aalborg kan udvikle sin funktion som universitetshospital.

CHEPRE - Forskningsidé, organisering, strategi og status - På vej mod individualiseret kræftbehandling ved hjælp af gentest v. Hans Erik Johnsen, Hæmatologisk Afdeling Hvert år rammes ca. 2.500 danskere af blod-, knoglemarvseller lymfeknudekræft i det bloddannende system. For flertallet af patienterne er den traditionelle behandling med lægemidler tilstrækkelig til at få sygdommen under kontrol, mens andre patienter ikke opnår den ønskede effekt og dør af resistent sygdom. I 2008 modtog Hæmatologisk Afdeling på Aalborg Sygehus og samarbejdspartnere en bevilling fra Det Strategiske Forskningsråd med det mål at udvikle og afprøve en metode, som kan forudsige effekten af et specifikt lægemiddel - og dermed åbne for muligheden for at tilbyde individuali-

serede behandlingsforløb til kræftpatienter. Idéen var at identificere gener, hvis aktivitet kunne kobles til øget resistens (modstand) over for specielle lægemidler efter screening i humane kræftcellelinjer. Det er lykkedes at videreudvikle allerede publicerede metoder, og dokumentere ”Proof of Concept” for en gentest som på baggrund af genaktiviteten i patienternes kræftceller kan identificere, om kræftsvulsten er modstandsdygtig mod udvalgte kræftlægemidler. Imidlertid er den diagnostiske specificitet og sensitivitet ikke tilstrækkelig til implementering i klinisk praksis. Det er nødvendigt at forbedre den diagnostiske ydeevne og herefter at teste fremgangsmåden i egentlige kliniske prospektive forsøg. Dette sker nu i nationale og internationale samarbejder.

Kardiovaskulært Forskningscenter - et springbræt til forskning v. Kim Overvad, Kardiologisk Afdeling Forskningsleder Kim Overvad vil fortælle om Kardiovaskulært Forskningscenter, der er en sammenslutning af afdelinger med interesse i det kardiovaskulære område. Omdrejningspunktet er en fælles statistisk konsulenttjeneste, som nu danner model for hele sygehusets adgang til hjælp med dataanalyse og fortolkning. Møder og seminarer inspirerer til egen forskning samt små og store samarbejdsprojekter. Det tværfaglige samarbejde har de seneste år medført store forskningsbevillinger til projekter, som ingen afdelinger kunne have initieret alene.

Er grønlændere sundere end danskere? v. Stig Andersen, Medicinsk Endokrinologisk Afdeling Leder af Center for Grønlandsforskning, Stig Andersen vil fortælle kolde facts om sundhed i Grønland. Sundhedsforskning i Grønland er særligt interessant, fordi 2 genetisk forskellige grupper - Inuit og Kaukasiere - deler samme ekstreme miljø, og fordi samme genetiske gruppe eksponeres for enten det kolde arktiske Grønland eller det lune Danmark. Hvad betyder det så for grønlændere og - for fedme? - for stofskifte? - for D-vitamin og knogler? - for leversygdom? for hjerte- karsygdom? Svaret kommer med den kolde nordenvind. 5


Foredragssessioner Foredragssession 1A - Auditoriet, Medicinerhuset kl. 12.45-14.00

Foredragssession 2A - Auditoriet, Medicinerhuset kl. 14.20-15.35

Moderator: Søren Lundbye-Christensen

Moderator: Bodil Steen Rasmussen

Kl. 12.45-13.00 Abstract # A: 1H NMR –based metabonomics reveals new insights into the pathogenesis of acute lung injury after cardiac surgery Ph.d.-studerende Raluca Gerogiana Maltesen, Anæstesien, Aalborg Sygehus Kl. 13.00-13.15 Abstract # B: Social marginalization reduces use of ENT physicians in primary careesis Overlæge Kirsten Fonager, Socialmedicinsk Enhed, Aalborg Sygehus

Kl. 14.20-14.35 Abstract # K: Mortalitet blandt intensiv patienter med forudbestående atrieflimren - et kohorte studie Reservelæge, ph.d.-studerende Jacob Gamst, Aalborg AF Study Group, Aalborg Sygehus Kl. 14.35-14.50 Abstract # L: Oesophageal Distension Parameters as Potential Biomarkers of Impaired Gastrointestinal Function in Diabetes Patients Jens Brøndum Frøkjær, Radiologisk Afdeling, Aalborg Sygehus

Kl. 13.15-13.30 Abstract # C: Decrease in the positive predictive value for stroke in the Danish National Health Registry over time

Kl. 14.50-15.05 Abstract # M: Sexuality in men operated for prostate cancer

Klinisk assistent Pernille Lühdorf, Neurologisk Afdeling, Aalborg Sygehus

Seniorforsker Birgitte Schantz Laursen, Forskningsenhed for Klinisk Sygepleje, Aalborg Sygehus

Kl. 13.30-13.45 Abstract # D: Implementering af næste generations sekventering (NGS) i cancerdiagnostikken

Kl. 15.05-15.20 Abstract # N: Sundhedsøkonomisk evaluering af endoskopisk versus åben venehøst til bypasskirurgi

Molekylærbiolog Inge Søkilde Pedersen, Afsnit for Molekylær Diagnostik, FBE Klinisk Biokemi Syd, Aalborg Sygehus

Ph.d.-studerende Lars Oddershede, Hjerte-lungekirurgisk afdeling, Aalborg Sygehus

Kl. 13.45-14.00 Abstract # E: Mathematical arterialisation for monitoring during exacerbation

Kl. 15.20-15.35 Abstract # O: The analgesic effect of pregabalin is correlated to alterations in pharmaco-EEG in chronic pain patients

Afdelingslæge Ulla Møller Weinreich, Lungemedicinsk Afdeling, Aalborg Sygehus

Postdoc, ingeniør Carina Graversen, Mech-Sense, Gastroenterologi, Aalborg Sygehus

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Foredragssession 1B - Kantinen, Medicinerhuset kl. 12.45-14.00

Foredragssession 2B - Kantinen, Medicinerhuset kl. 14.20-15.35

Moderator: Jane Andreasen

Moderator: Henrik Schønheyder

Kl. 12.45-13.00 Abstract # F: Acute mastoiditis - a surgical or medical disease?

Kl. 14.20-14.35 Abstract # P: Neuroleptic Malignant Syndrome – an eleven year longitudinal case-control study

Læge Svanhild Hansen, (Øre-næse-halskirurgisk Afdeling, Aalborg Sygehus)

Reservelæge René Ernst Nielsen, Aalborg Psykiatriske Sygehus, Psykiatrien

Kl. 13.00-13.15 Abstract # G: Bag masker og lukkede døre

Kl. 14.35-14.50 Abstract # Q: Prevalence of traumatic and non-traumatic anterior knee pain among adolescents

Kst. forskningsleder Erik Elgaard Sørensen, Forskningsenhed for Klinisk Sygepleje, Aalborg Sygehus Kl. 13.15-13.30 Abstract # H: Impact of isoforms of the transcription factors Pax5 and Prdm1 in B cell differentiation and diffuse large B-cell lymphoma pathogenesis Ph.d.-studerende Maria Bro Kloster, Hæmatologisk Afdeling, Aalborg Sygehus Kl. 13.30-13.45 Abstract # I: Is the seasonal variation in hospitalisation rates of atrial fibrillation related strokes in Denmark and New Zealand dynamic?

Læge Sune Kelm Skuldbøl, Reumatologisk Afdeling, Aalborg Sygehus Kl. 14.50-15.05 Abstract # R: Asbestos Exposure and Survival in Malignant Malignant Mesothelioma: A Description of 122 Consecutive Cases at an Occupational Clinic Overlæge Øyvind Omland, Arbejdsmedicinsk Klinik, Aalborg Sygehus Kl. 15.05-15.20 Abstract # S: Dose-response relationship of phototherapy for hyperbilirubinemia

Ph.d.-studerende Anette Luther Christensen, Kardiologisk Afdeling, Aalborg Sygehus

Læge Pernille Kure Vandborg, Børneafdelingen, Aalborg Sygehus

Kl. 13.45-14.00 Abstract # J: Ny indsigt i kræftcellens unikke energistofskifte igennem studier af ”cancer-testis antigener”

Kl. 15.20-15.35 Abstract # T: Treatment of leg-ischemia with axillofemoral bypassgrafting in Denmark over a 10 year period

Seniorforsker Søren Naaby Hansen, Klinisk Immunologisk Afdeling, Aalborg Sygehus

Afdelingslæge Marie-Louise Grønholdt, Karkirurgisk Afdeling, Aalborg Sygehus

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Abstracts Mundtlig præsentation A) 1H NMR –based metabonomics reveals new insights into the pathogenesis of acute lung injury after cardiac surgery Forfattere: Raluca G. Maltesen, Munsoor A. Hanifa, Sergey Kucheryavskiy, Shona Pedersen, Søren R. Kristensen, Reinhard Wimmer, Bodil S. Rasmussen Abstract: Introduction: Pulmonary dysfunctions, with development of acute lung injury (ALI), are common complications in patients undergoing coronary artery bypass grafting (CABG). The pathological mechanisms are not completely understood, and there are no biomarkers that can predict early progression into ALI. In this study, 1H nuclear magnetic resonance (NMR) spectroscopy– based metabonomics has been applied, for the first time to our knowledge, to investigate the metabolic fingerprints in serum of patients undergoing CABG, aiming for a better understanding and earlier diagnosis of ALI. Methods: 50 patients undergoing CABG have been recruited and their blood samples were taken at multiple time points before, during and after surgery. Postoperatively, some patients suffered mild or severe ALI, whilst others did not. Samples collected 16 hours after surgery were investigated using NMR spectroscopy and multivariate statistical analyses. Results: It was possible to discriminate between patients that progressed into mild or severe ALI, and patients with no signs of pulmonary dysfunction. Metabolites involved in sample grouping were identified and were related to metabolic pathways. Elevated levels of metabolites involved in oxidative stress, disturbances in lipid metabolism, fatty acid breakdown and apoptosis were correlated with mild and especially severe ALI compared to patients that did not develop ALI. By using a random test-set for validation, it was possible to predict the progression into severe ALI 16 hours after surgery. Conclusion: The results show the potential of NMR for 8

identifying putative biomarkers that predict progression into ALI and show the potential of the approach in the early diagnosis of the disease. Indsendt af: Ph.d.-studerende Raluca Gerogiana Maltesen, (Anæstesien, Aalborg Sygehus) Uddannelse: Civilingeniør i medicinsk bioteknologi, AAU E-mail: rm@bio.aau.dk / Telefon: 2662 5865 Forskningsansvarlig på afdelingen: Bodil Steen Ramussen

B) Social marginalization reduces use of ENT physicians in primary care Forfattere: Lous J, Friis K, Vinding AL, Fonager K Abstract: OBJECTIVE: The aim of this study was to explore the association between social marginalization of the mothers and their children’s use of the healthcare system and ear-nose-throat (ENT) physicians in the year 2009 in a region of Denmark. METHODS: A regional register-based cross-sectional study of use of healthcare services among children (n=10232) of marginalized mothers and children (n=101582) of non-marginalized mothers in the North Denmark Region. Social marginalization was defined as having received public social benefits for more than 80% of the year. RESULTS: Children with a marginalized mother had more chronic medical diagnoses (OR=1.22, 95% confidence interval 1.17-1.28), they had more frequently been in contact with their general practitioner during the year, and they used the healthcare system more often than children of non-marginalized mothers, except in the case of ENT specialists (OR=0.90, 0.85-0.95), and they had more seldom tympanostomy tubes inserted (OR=0.75, 0.66-0.87). The distance between ENTclinic and place of residence of the patients had only a small effect on the use of ENT-physician, and only significant in the non-marginalized.


CONCLUSIONS: Children of marginalized mothers used the healthcare system more than other children, except in case of ENT-physicians. They had fewer ENT-consultations and had less frequently inserted tympanostomy tubes when they attended the surgery. Indsendt af: Overlæge Kirsten Fonager, (Socialmedicinsk Enhed, Aalborg Sygehus) Uddannelse: E-mail: k.fonager@rn.dk / Telefon: 4117 4514 Forskningsansvarlig på afdelingen: Kirsten Fonager

when only patients from inpatients clinics, specialized units or when only primary discharge codes were included. Indsendt af: Klinisk assistent Pernille Lühdorf, (Neurologisk Afdeling, Aalborg Sygehus) Uddannelse: Læge E-mail: pelu@rn.dk Forskningsansvarlig på afdelingen: Flemming Winther Bach  

C) Decrease in the positive predictive value for stroke in the Danish National Health Registry over time Forfattere: Pernille Lühdorf(a), Kim Overvad(b+c), Erik B Schmidt(b), Søren P Johnsen(c), Flemming W Bach(a). a Department of Neurology, Aalborg Hospital, Aarhus University Hospital, Denmark. b Department of Cardiology, Centre for Cardiovascular Research, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark. c Section of Epidemiology, Department of Public Health, Aarhus University, Denmark Abstract: Objective: Investigation of the positive predictive values for stroke and different subtypes of stroke: subarachnoidal haemorrhage, intracerebral haemorrhage and cerebral infarction in then Danish national health registry. Study Design and Settings: Participants in the Danish cohort study “Diet Cancer and Health” with a possible stroke diagnosis between 1994 and 2009 were identified and medical records were retrieved and reviewed. Results: 3326 records with possible strokes were reviewed. The overall positive predictive value for stroke was 69.3% (95% CI 67.7-70.9%). When only primary discharge diagnosis were included the positive predictive value increased to 71.4 (95%CI 69.7-73.0%). A regression model showed that the positive predictive value decreased with 0.8 percent points per year (p<0.001). The positive predictive value differed from 42.8 to 87.8% between departments with the highest value in departments of neurology and the lowest in out patient clinics and emergency rooms. Conclusion: The stroke diagnosis in the Danish National Health Registry is inaccurate. Over the last 15 years the accuracy of stroke diagnosis in the Danish National Health Registry has decreased. This was the case even

D) Implementering af næste generations sekventering (NGS) i cancerdiagnostikken Forfattere: Inge Søkilde Pedersen, Anja Ernst, Henrik Okkels, Poul Henning Madsen, Henrik Bygum Krarup Abstract: NGS muliggør sekventering af hele genomet, exomet eller en række udvalgte gener til en pris og med en hastighed, der åbner mulighed for anvendelse i diagnostikken. I dag anvendes Sanger-sekventering til mutationsscreening for varianter involveret i arvelig cancer. Metoden er begrænset til den kodende del af en afgrænset gruppe gener. Med NGS kan flere gener undersøges på en gang. Desuden vil regulatoriske områder og introns kunne sekventeres. Inden overførsel af vores rutineanalyser til NGS, er det nødvendigt at sikre evnen til at detektere samtlige varianter identificeret med Sanger-sekventering. Til det formål har vi konstrueret en pool af 20 prøver med sjældne genetiske varianter i et af de to BRCA (BReast CAncer) gener. De udvalgte prøver indeholder et repræsentativt udsnit af varianter (enkelt base udskiftninger, deletioner/insertioner af 1-5 baser). Udover de sjældne varianter har prøverne en række polymorfier, blandt andet er alle prøver heterozygote for 13 hyppige polymorfier. Konstruktionen af denne pool muliggør bestemmelse af flere parametre: 1.Evnen til at detektere medfødte genetiske varianter. 2.Fejl-rate på basecalling. 3.Evnen til at detektere genetiske varianter, der findes i >2,5% af de analyserede alleler. Analysen køres på vores to NGS udstyr IonTorrent PGM og SOLiD 5500xl, der har hver sine forcer. Udover at dokumentere anvendeligheden af NGS til mutationsscreening for medfødte mutationer, vil bestemmelsen af fejl-rate og detektionsgrænser give os væsentlig viden i forbindelse med anvendelsen af de to udstyr. F.eks. til detektion af somatiske mutationer i cancervæv, der kan 9


have betydning for behandlingsstrategien for den enkelte patient. Indsendt af: Molekylærbiolog Inge Søkilde Pedersen, (Afsnit for Molekylær Diagnostik, FBE Klinisk Biokemi Syd, Aalborg Sygehus) Uddannelse: Cand. Scient., Ph.D E-mail: isp@rn.dk / Telefon: 9932 8085 Forskningsansvarlig på afdelingen: Henrik Bygum Krarup

E) Mathematical arterialisation for monitoring during exacerbation Forfattere: Dr. Ulla Møller Weinreich, ulw@rn.dk, MD1, Dr. Beata Rychwicka-Kielek, bark@rn.dk, MD1, Dr. Bjarne Andersen, bjfa@rn.dk, MD1, Dr. Rana Bibi, rabi@rn.dk, MD1, Dr. Lene Birket-Smith, lbbs@rn.dk, MD1, Prof. Søren Risom Kristensen, srk@rn.dk, MD2 and Mr. Stephen Edward Rees, sr@hst.aau.dk3. 1Pulmonary Medicine, Aalborg Hospital, Aalborg, Denmark, 9000; 2Clinical Biochemistry, Aalborg Hospital, Aalborg, Denmark, 9000 and 3Health Science and Technology, Aalborg University, Aalborg, Denmark, 9220. Abstract: Repeated arterial puncture for acid-base and oxygenation status is painful, but quite common in COPD patients admitted for periods of exacerbation. Recently, a method has been presented (Rees, S.E. et. al. Comput. Methods Programs Biomed. 2006;81:18-25) for mathematically transforming values in peripheral venous blood to arterial, potentially eliminating the need for painful arterial puncture. This method has been evaluated at a single time point in COPD patients (Rees, S.E. et. al. Eur J Appl Physiol. 2010;108:483-94). The aim of this study was to evaluate the method in patients during the whole period of admission to the hospital for exacerbation. Twenty patients were studied over an admission of on average 5 days, with an average of 3 arterial blood samples taken during this period. For each arterial sample a paired peripheral venous sample was taken and used to calculate arterial values. Values of pH and arterial PCO2 calculated by the method compared well with those measured with a mean and standard deviation of the difference between measured and calculated of 0.000± 0.010 pH and -0.03±0.26 kPa PCO2 . Figure 1 illustrates the ability of the calculated values (squares, dashed) of arterial pH, PCO2 and PO2 to mirror measured clinical changes (circles, solid) in a single patient studied on six consecutive days. 10

Conclusions: The method may be a useful tool to evaluate COPD patients during admission without the need for repeated arterial punctures and thereby reduce the discomfort to the COPD patients radically. Indsendt af: Afdelingslæge Ulla Møller Weinreich, (Lungemedicinsk Afdeling, Aalborg Sygehus) Uddannelse: Cand Med, ph.d.-studerende E-mail: ulw@rn.dk / Telefon: 9932 6433 Forskningsansvarlig på afdelingen: Ulla Møller Weinreich

F) Acute mastoiditis - a surgical or medical disease? Forfattere: Svanhild Hansen, Mikkel Attermann Bruhn, Michael Gaihede og Kjell Tveterås Abstract: Objective: To review the outcome of acute mastoiditis (AM) treated according to the described algorithm and discuss the future treatment modality – conservative or surgical? Design: Retrospective study. Material and method: Retrospective study in Northern Jutland from 1993 to 2010. ENT, Aalborg Hospital is the only ENT department in the region, and we therefore have an unselected study population. Journals of all patients admitted in this time period was examined retrospectively, and data collected. Patients with cholesteatoma and age above 16 were excluded. Results: 48 patients with a median age of 16.5 months were included. There was an age range from 3 months to 15 years. The incidence of acute mastoiditis in children < 16 is 2,8/100.000 children per year. 18.8% of the patients had an earlier history of middle ear disease. The clinical picture was dominated of protrusion of ear (98%), redness of skin (81%) and retroauricular swelling (96%). 33% underwent surgery, 67% was conservatively treated. Specimens revealed growth of pathogens in 2/3 of the cases. The most common pathogen was S.Pneumonia. We found 4 cases of Fusobacterium Necrophorum, who all underwent surgery. 58.3% did not receive antibiotic treatment before hospitalization. 27% underwent mastoidectomy as first treatment. 6,3% was converted from conservative to surgical due to lack of clinical improvement within 24-48 hours. Conclusion: Acute mastoiditis is a benign disease with few complications. Most patients can be treated conservatively without surgical intervention. There are no long term complications in either treatment modalities.


Indsendt af: Læge Svanhild Hansen, (Øre-næse-halskirurgisk Afdeling, Aalborg Sygehus) Uddannelse: læge E-mail: svha@rn.dk / Telefon: 9932 2928 Forskningsansvarlig på afdelingen: Michael L. Gaihede

G) Bag masker og lukkede døre Forfattere: Erik Elgaard Sørensen Abstract: Baggrund: I varetagelse af operationsassisterende funktioner (OF) tillægges teknisk instrumentelle kompetencer højeste status. Omsorgs etiske dokumenteres som understøttende og efterlyses af patienter. Der eksisterer et paradoks mellem at forbinde sygepleje med teknologi på den ene side og afvise en forbundenhed herimellem på den anden. Undersøgelser omhandlende samspil mellem sygepleje og teknologi i OF efterlyses. Der eksisterer ingen danske undersøgelser. Formål: Udvikling af ny viden om samspil mellem sygepleje og teknologi i OF varetaget af sygeplejersker på operationsstuer på danske hospitaler. Metode: Metodologien er feltforskning og tilvirkning af empiri foretaget ved hjælp af deltagerobservation og interview. Informanterne er 24 operationssygeplejersker i alderen 33 til 63 år fordelt på ni operationsafdelinger på to universitetshospitaler i Danmark. 122 operationer over 273 timer på 44 dage har været genstand for observation. Analysen er tofaset og tematisk. Fund: Tre fund udgør undersøgelsens resultater: Den beskyttede praksis, Det flydende team og Den adaptive kapacitet. Den beskyttede praksis omhandler korte patientkontakter, at være på forkant, få arbejdet afsluttet og samarbejde. Det flydende team omhandler serielle, parallelle og indbyrdes afhængige aktiviteter. Den adaptive kapacitet har betydning for den professionelle fremdrift i teamsamarbejdet. Konklusion: Operationssygeplejersker kombinerer teknisk instrumentelle færdigheder i spændet mellem teknisk flair og en teknisk ufaglært/teknofobisk adfærd med kommunikative og omsorgs etiske handlemåder afhængig af den enkelte sygeplejerskes teknologiske og sygeplejefaglige profil, interesse og evne til refleksion. Antal år i og erfaringer fra en konkret operationspraksis fremmer nødvendigvis ikke interaktionen i samarbejdet med kirurgen.

Implikationer: Varetagelse af OF kan optimeres gennem formaliseret kompetenceudvikling og uddannelsesgrundlaget må diskuteres. Indsendt af: Kst. forskningsleder Erik Elgaard Sørensen, (Forskningsenhed for Klinisk Sygepleje, Aalborg Sygehus) Uddannelse: Cand.cur., ph.d. E-mail: ees@rn.dk / Telefon: 9932 6807 Forskningsansvarlig på afdelingen: Erik Elgaard Sørensen

H) Impact of isoforms of the transcription factors Pax5 and Prdm1 in B cell differentiation and diffuse large B-cell lymphoma pathogenesis Forfattere: Maria Bro Kloster1, Martin Bøgsted1, Alexander Schmitz1, Preben Johansen2, Michael Gaihede3, Hans E. Johnsen1, and Karen Dybkær1 1Department of Hematology, Aalborg Hospital, Aarhus University Hospital, Denmark 2Department of Pathology, Aalborg Hospital, Aarhus University Hospital, Denmark 3Department of Otolaryngology, Head & Neck Surgery, Aalborg Hospital, Aarhus University Hospital, Denmark Abstract: B-cell differentiation is a stepwise process, where specific cellular subsets with individual phenotypic and molecular characteristics are recognized in both normal and malignant tissue. Deregulated expression of the early and late B-cell differentiation acting transcription factors (TFs), Pax5 and Prdm1, is observed in diffuse large B-cell lymphoma (DLBCL). For both TFs, two isoforms are recognized originating from alternative promotors. Thus, Pax5 transcripts exist as Pax5a and Pax5b, and Prdm1 transcripts exist as Prdm1a and Prdm1b where the latter encodes a truncated protein isoform with unknown function. The hypothesis in this project is that Pax5 and Prdm1 isoforms contribute to deregulated expression during the development of DLBCL. Utilizing isoform-specific TaqMan assays, mRNA expression levels of the Pax5 and Prdm1 isoforms were determined in DLBCL cell lines as well as primary tissues from 48 patients, and in B-cell subpopulations, including naïve B-cells, centroblasts, centrocytes, memory B-cells, and plasmablasts, from tonsils of six healthy individuals using RT-qPCR. In this study, it is demonstrated that Pax5b was equally or lower expressed than Pax5a in B-cell subpopulations. However, Pax5b levels were more than 2-fold higher than those of Pax5a levels in subsets of DLBCL cell lines 11


and primary tissues. Prdm1b was not expressed in any of the normal B-cell subpopulations, but was expressed contemporary with Prdm1a in subsets of DLBCL cell lines and primary tissues. The conclusions are that Pax5b and Prdm1b are deregulated in a subset of DLBCL. The prognostic impact of deregulated Pax5 and Prdm1 isoforms in DLBCL are at present being determined. Indsendt af: Ph.d.-studerende Maria Bro Kloster, (Hæmatologisk Afdeling, Aalborg Sygehus) Uddannelse: Civilingeniør i medicinsk bioteknologi E-mail: mabrkl@rn.dk / Telefon: 9832 6839 Forskningsansvarlig på afdelingen: Karen Dybkær  

I) Is the seasonal variation in hospitalisation rates of atrial fibrillation related strokes in Denmark and New Zealand dynamic? Forfattere: Anette Luther Christensen, Simon Hales, Søren Lundbye-Christensen, Lars Hvilsted Rasmussen, Kim Overvad, Claus Dethlefsen Abstract: Atrial fibrilation (AF) is the most common cardiac arrythmia and the hospitalisations rates of AF have increased during the last two decades; in fact AF is considered an epidemic. The frequency of AF increases with age and considering the population demographic it is expected that the number of people with AF will be increasing remarkably. Having AF often leads to palpitations, respiratory distress, and fatigue. Furthermore, AF is considered an independent risk factor for stroke. The consequences of stroke on patients are crucial and may be a considerable burden on society regarding rehabilitation of stroke patients. It has been reported that hospitalisations with stroke exhibit seasonal variation during the calendar year, however seasonal variations in AF related strokes have not been investigated. Furthermore, it has not been investigated whether there have been changes in the seasonal variation of AF related stroke hospitalisations. Knowledge of the seasonal variation of AF related stroke, and possible changes over time, may contribute to knowledge of the etiology of AF and may improve prophylaxis treatment in AF patients, which may lead to improved prognoses for AF patients. Using a state space model to fit daily incidence rates of AF related strokes, accounting for a secular trend and modelling the seasonal variation as a sum of sinusoids with different frequencies, it is possible to investigate whether hospitalisations of AF related strokes exhibit 12

seasonal variation. Furthermore, performing model selection we may be able to investigate the dynamic nature of the seasonal variation over time. Indsendt af: Ph.d.-studerende Anette Luther Christensen, (Kardiologisk Afdeling, Aalborg Sygehus) Uddannelse: Master Scient E-mail: anluc@rn.dk / Telefon: 9932 6885 Forskningsansvarlig på afdelingen: Svend Eggert Jensen

J) Ny indsigt i kræftcellens unikke energistofskifte igennem studier af ”cancertestis antigener” Forfattere: Søren Naaby Hansen, Annette H. Krogh og Allan Stensballe Abstract: Da vi første gang opdagede og efterfølgende klonede de to proteiner CABYR og AKAP3 antog vi udfra genekspressionsanalyser at de udelukkende blev udtrykt under gamatogenesen. Senere studier afslørede imidlertid at de to interaktive ”scaffolds” også bliver udtrykt i forskellige former for kræft, inklusive i hjerne-, æggestok-, og lunge-tumorer. I sædcellens hale (flagel) fungerer de to proteiner som en slags samlebokse, der integrerer de forskellige ovenfra og udefra kommende molekylære signaler der kontrollerer flagellens bevæge-mønster, -frekvens og -styrke. Skønt CABYR’ ekspression i tumorer har været kendt i de sidste fem år, er hverken dette eller AKAP3’ funktionelle rolle i kræftceller blevet afklaret. Formålet med dette studie var at afdække de to proteiners funktion i kræftceller igennem undersøgelse af deres molekylære interaktioner. Til dette benyttedes en kombination af immunoprecipitation (IP), masse spektrometri (MS) og western blot (WB) procedurer. Adskillige glykolyse regulerende enzymer, hypoxiainducible factor prolyl hydroxylase 3 (PH3) og ADP/ATP translocase 1 isoleredes sammen med CABYR fra lunge adenocarcinoma celler efter IP med monoklonale antiCABYR antistoffer. 2-vejs IP og WB eksperimenter bekræftede interaktioner imellem LDH, fruktose-bisfosfat aldolase, triosefosfat isomerase (TPI-1), fosfofruktokinase, enolase, GAPDH, GSK3b og CABYR i både æggestok og lunge kræftceller. Ligesom i flagellen fandtes CABYR at binde til AKAP3 i kræftcellerne. IP og WB eksperimenter viste at GAPDH og TPI-1 også bindes til AKAP3 i kræftceller. Disse resultater tyder på at CABYR og AKAP3 deltager i højmolekylære multikomponent protein komplekser, der er involveret i regulering af kræftcellernes energistofskifte. Hypoxia-inducible factor (HIF-1) vides at aktivere gener


der koder for glykolytiske enzymer, hvorfor den observerede binding imellem CABYR og PH3 (der aktiverer HIF-1) inspirerede os til at studere hvorledes de molekylære interaktioner reagerede når kræftcellernes vækstbetingelser ændredes fra normoxia (20% O2) til hypoxia (5% eller 2% O2) forhold. Induktion af hypoxia førte til en kraftig reduktion i antallet af bindinger imellem glykolytiske enzymer, AKAP3, og CABYR. Efter 48 hrs vækst under hypoxiske betingelser observeredes lysine-acetylering af CABYR og ophør af dets binding til AKAP3. Endvidere fandtes interaktioner imellem GAPDH, TPI-1 og AKAP3 at blive kraftigt nedreguleret under hypoxia. Friske videnskabelige rapporter viser at flertallet af cellens glykolytiske enzymer reguleres via lysine-acetylering. Det er endvidere blevet vist at lysine-deacetylasen SIRT-1 er involveret i så tilsyneladende forskelligartede cellulære funktioner som regulering af stofskiftet og evnen til at overleve under eksternt stress. Baseret på disse rapporter og de ovenstående fund undersøgte vi derfor hvorledes ændringer i SIRT-1’ aktivitet påvirkede interaktionen imellem GAPDH og AKAP3. Aktivering af SIRT-1 med resveratrol forebyggede den hypoxia-inducerede separation af GAPDH og AKAP3, mens hæmning af SIRT-1, via tilsætning af sirtinol til vækst mediet, ikke forhindrede proteinernes interaktion i at ophøre når ilt tensionen sænkes. Resultaterne tyder således på at hypoxia inducerer lysine-acetylering af et eller flere af partner proteinerne og at denne SIRT-1 -sensitive modifikation forhindrer den binding imellem proteinernes interaktions-domæner, der forekommer under vækst i normal ilt tension. Dette er den første beskrivelse af en molekylær mekanisme der forbinder hypoxia med ændringer i de glykolytiske enzymers molekylære interaktioner. Vores studier af cancer-testis antigenerne CABYR og AKAP3 har således åbnet et nyt vindue der kan kaste lys over reguleringen af kræftcellers energistofskifte under overgangen fra ærob til anærob glykolyse, en fase der hidtil har befundet sig i tusmørket. Præsentationen vil illustrere hvorledes modellen påtænkes at benyttes til at undersøge stofskifteregulering i kræftceller, herunder screening for kræftcelle-specifikke regulerende mekanismer der måtte egne sig for terapeutisk intervention. Indsendt af: Seniorforsker Søren Naaby Hansen, (Klinisk Immunologisk Afdeling, Aalborg Sygehus) Uddannelse: Dr.Med.Sci. E-mail: sonh@rn.dk / Telefon: 4047 0355 Forskningsansvarlig på afdelingen: Kim Varming

K) Mortalitet blandt intensivpatienter med forudbestående atrieflimren - et kohorte studie Forfattere: Jacob Gamst (1, 2, 3, 4) Christian Fynbo Christiansen (1) Martin Berg Johansen (1) Lars Hvilsted Rasmussen (2, 4) Bodil Steen Rasmussen (3) Reimar Wernich Thomsen (1) 1) Klinisk Epidemiologisk Afdeling, Aarhus Universitetshospital 2) Kardiologisk Afdeling, Aalborg Sygehus, Aarhus Universitetshospital 3) Anæstesiafdelingen, Aalborg Sygehus, Aarhus Universitetshospital 4) Aalborg AF Study Group Abstract: Atrieflimren (AFLI) er den hyppigst forekommende hjerterytmeforstyrrelse. Det vides ikke, om forudbestående AFLI har betydning for prognosen blandt patienter med behov for intensiv terapi. Formål: At undersøge dødeligheden 30 dage efter indlæggelse på intensiv afdeling blandt patienter med og uden tidligere AFLI. Metoder: Via Sundheds- og Sygelighedsregistrene identificerede vi alle patienter, der var indlagt på en intensiv afdeling i Region Nord- eller Midtjylland i perioden 2005 – 2007. Patienter med en AFLI diagnose inden for 5 år før indlæggelsen på intensiv afdeling blev ligeledes identificeret. 30-dages mortalitet blev estimeret med Kaplan-Meier metoden. Med Cox regressionsanalyse beregnedes Hazard Ratio (HR) for død efter 30 dage, justeret for køn, alder og tre niveauer af komorbiditet bestemt ved hjælp af Charlson Comorbidity Index. Resultater: Af de 28.172 inkluderede intensiv patienter havde 8,1% tidligere fået en AFLI diagnose. Patienter med AFLI havde en øget 30-dages mortalitet på 25,1% mod 14,9% blandt patienter uden AFLI. Efter confounder-justering var HR for død efter 30 dage på 1,04 (95% CI: 0,95 – 1,14) blandt patienter med AFLI sammenlignet med patienter uden AFLI. I subgruppen af intensiv patienter med tidligere myokardieinfarkt havde patienter med AFLI en justeret HR for død på 1,33 (95% CI: 1,02 – 1,75) sammenlignet med patienter uden AFLI. Konklusioner: Intensiv patienter med tidligere AFLI har betydeligt højere mortalitetsrisiko end intensiv patienter uden tidligere AFLI. Den øgede dødelighed synes imidlertid at være relateret til alder og komorbiditet frem for AFLI i sig selv. Blandt intensiv patienter med tidligere myokardieinfarkt prædikterer AFLI forværret prognose.

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Indsendt af: Reservelæge, ph.d.-studerende Jacob Gamst, (Aalborg AF Study Group, Aalborg Sygehus) Uddannelse: cand.med. E-mail: jacob.gamst@rn.dk / Telefon: 2294 9815 Forskningsansvarlig på afdelingen: Erik Berg Schmidt

L) Oesophageal Distension Parameters as Potential Biomarkers of Impaired Gastrointestinal Function in Diabetes Patients Forfattere: Jens Brøndum Frøkjær, Christina Brock, Eirik Søfteland, Jan Brun, Peter Funch-Jensen, Asbjørn Mohr Drewes, Hans Gregersen Abstract: Background & aims: Gastrointestinal (GI) symptoms, such as nausea, vomiting, bloating, postprandial fullness and abdominal pain, are frequent in patients with diabetes mellitus (DM). The pathogenesis of diabetes is complex and multi-factorial. In order to evaluate the biomechanical GI wall changes as a potential biomarker of disordered GI function, we performed oesophageal distension with assessment of the sensory response and biomechanical wall properties and correlated these findings with the clinical data. Methods: Seventeen patients with longstanding DM and GI symptoms and 13 healthy controls were studied with ultrasound monitored oesophageal distension. The sensory response was recorded and their symptoms registered. Biomechanical parameters such as compliance and stiffness were computed from luminal diameters during distension based on the ultrasound images and from pressures. Results: Diabetes patients had reduced oesophageal sensitivity compared to controls (P=0.046). The oesophageal compliance was reduced (P=0.004) and the oesophageal stiffness was increased (P=0.004) in the diabetes patients. Among patients, both postprandial fullness and bloating correlated negatively to the oesophageal compliance parameters (all P<0.05). Conclusions: Patients with longstanding DM and GI symptoms had reduced oesophageal sensitivity together with reduced compliance and increased stiffness. These alterations seem to have functional significance as biomechanical changes were correlated to the patients’ GI symptoms. Biomechanical parameters obtained during distension may serve as a valid independent biomarker of the GI dysfunction and may in the future contribute 14

to our understanding of the pathophysiology underlying GI dysfunction and symptoms in patients with longstanding DM. Indsendt af: Jens Brøndum Frøkjær, (Radiologisk Afdeling, Aalborg Sygehus) Uddannelse: E-mail: jebf@rn.dk / Telefon: Forskningsansvarlig på afdelingen: Jens Brøndum Frøkjær

M) Sexuality in men operated for prostate cancer Forfattere: Birgitte Schantz Laursen, Seniorforsker, cand.cur.ph.d. Abstract: Background: A growing number of men is diagnosed with prostate cancer and a growing number of these men are treated with surgery; radical prostatectomy. A well-know complication following radical prostatectomy is erectile dysfunction. There is only limited focus on this complication in the phase of rehabilitation. In the few cases where erectile dysfunction is on the agenda the focus is on the physical ability to gain an erection and perform a sexual intercourse not on sexuality in a broader perspective. Purpose: The purpose of this study is to investigate how erectile dysfunction influence male sexuality in a broad perspective. Method: The study is a descriptive explorative qualitative study with a phenomenological/hermeneutic frame of understanding. Qualitative interviews are used as data collection. Results: Through the analysis of the interviews four themes appeared; lack of spontaneous intercourse, identity and masculinity, the opposite sex, redefinition of gender Conclusion: The patients experience great influence on their sexuality in respect to their physical sex life, their body, their personal experience and their relations. This demonstrates that sexuality has many different expressions and that sexuality is close connected to human identity. The many aspects of sexuality give the individual variations of possibilities to express his sexuality in other ways than through sexual intercourse. Indsendt af: Seniorforsker Birgitte Schantz Laursen, (Forskningsen-


hed for Klinisk Sygepleje, Aalborg Sygehus) Uddannelse: Cand.cur. ph.d. E-mail: bisl@rn.dk / Telefon: 9932 6828 Forskningsansvarlig på afdelingen: Erik Elgaard Sørensen

N) Sundhedsøkonomisk evaluering af endoskopisk versus åben venehøst til bypasskirurgi Forfattere: Lars Oddershede1,2, MSc. Jan Jesper Andreasen1, MD, PhD. Barbara Cristina Brocki1, PT. Lars Ehlers2 MSc(econ), PhD. 1Hjerte-lungekirurgisk afdeling, Kardiovaskulært Forskningscenter, Aalborg Sygehus 2Center for Improvement in Health Care, det Samfunds- og Sundhedsvidenskabelige Fakultet, Aalborg Universitet. Abstract: Baggrund: Ved venehøst til bypass operationer kan kirurgerne vælge imellem traditionel åben venehøst og den minimalt invasive metode, endoskopisk venehøst. Den eksisterende litteratur har vist at den endoskopiske venehøst, i det postoperative forløb, medfører færre sårkomplikationer, mindre smerte, bedre mobilitet, større patienttilfredshed samt højere omkostninger end den åbne venehøst. Formål: At undersøge om den endoskopiske venehøst er omkostningseffektiv i forhold til den åbne venehøst. Metode: Undersøgelsen blev baseret på et randomiseret kontrolleret studie udført på Hjerte-lungekirurgisk afdeling på Aalborg Sygehus (Andreasen et al, 2008). Omkostninger og effekter indenfor 35 dage postoperativt blev opgjort. Tre omkostningsniveauer blev defineret da den eksisterende litteratur viste usikkerheder i hvilke typer ressourceforbrug der med sikkerhed varierede mellem de to behandlingsmetoder. Effektmålene var undgåede infektioner på benet samt et estimat for livskvaliteten der blev anvendt til at estimere vundne kvalitetsjusterede leveår. Resultaterne blev præsenteret med den inkrementale omkostningseffektivitetsratio, dvs. f.eks. den ekstra omkostning forbundet med at skabe et ekstra kvalitetsjusteret leveår. Usikkerhederne blev håndteret ved hjælp af probabilistiske følsomhedsanalyser og præsenteret i omkostningseffektivitets acceptabilitetsgrafer og sammenlignet med en fiktiv betalingsvillighed på $50.000/vundne kvalitetsjusterede leveår. Resultater: Den inkrementale omkostningseffektivitetsratio var $79.391/vundne kvalitetsjusterede leveår og $1.970/undgået infektion. Ved en betalingsvillighed på $50.000/vundne kvalitetsjusterede leveår var det mindre end 1 % sandsynligt at endoskopisk venehøst var omkostningseffektivt.

Konklusion: Endoskopisk venehøst var ikke en omkostningseffektiv behandling indenfor 35 dage postoperativt. Allokering af ressourcer til behandlinger med en lavere inkremental omkostningseffektivitetsratio ville skabe ”mere sundhed” for de samme ressourcer. Indsendt af: Ph.d.-studerende Lars Oddershede, (Hjerte-lungekirurgisk afdeling, Kardiovaskulært Forskningscenter & Center for Improvement in Health Care, det Samfunds- og Sundhedsvidenskabelige Fakultet, Aalborg Universitet., Aalborg Sygehus) Uddannelse: Kandidat i Medicin med Industriel Specialisering E-mail: l.oddershede@rn.dk / Telefon: 9940 2711 Forskningsansvarlig på afdelingen: Jan Jesper Andreasen  

O) The analgesic effect of pregabalin is correlated to alterations in pharmacoEEG in chronic pain patients Forfattere: C. Graversen, SS Olesen, AE Olesen, AM Drewes Abstract: Background and aims: To identify electroencephalographic (EEG) alterations reflecting the analgesic effect of pregabalin in patients with chronic visceral pain. Methods: Thirty-one patients suffering from visceral pain due to chronic pancreatitis participated in this double-blind, placebo-controlled study. During three weeks of treatment, patients received increasing doses of pregabalin (75mg - 300mg twice a day) or matching placebo. A diary based on the visual analogue scale was used to assess pain perception. Brief pain inventoryshort form (BPI) and quality of life questionnaires were collected prior to and after the study period to evaluate further aspects of the analgesic effect. Multi-channel resting EEG was recorded before treatment onset and at the end of the study. Individual changes in EEG frequency distribution were calculated, and changes were classified by a support vector machine (SVM) to discriminate the pregabalin and placebo responses. Changes in frequency distribution were correlated to changes in individual pain scores. Results: Pregabalin caused a slowing of brain oscillations evident as increased theta band (3.5-7.5Hz) intensity (P=0.03). No significant changes were seen after placebo. The maximum difference between pregabalin and placebo treated patients were seen in the parietal region, with a classification accuracy of 85.7% (P=0.009). Individual changes in all EEG frequency 15


bands simultaneously were correlated to changes in pain diary (P=0.04) and BPI pain composite scores (P=0.02). Conclusions: Slowing of brain oscillations was identified as a biomarker for the central analgesic effect of pregabalin. The developed methodology may provide future perspectives to assess individual responses to treatment in personalized medicine. Indsendt af: Postdoc, ingeniør Carina Graversen, (Mech-Sense, Gastroenterologi, Aalborg Sygehus) Uddannelse: MScEE, PhD E-mail: carina@graversen.mobi / Telefon: 2628 2093 Forskningsansvarlig på afdelingen: Asbjørn Mohr Drewes  

P) Neuroleptic Malignant Syndrome – an eleven year longitudinal case-control study Forfattere: First author: René Ernst Nielsen1 2, MD (researcher1 , clinician2) Second author: Signe Olrik Wallenstein Jensen1, MSc (statistician) Third author: Jimmi Nielsen1, MD, PhD (researcher) Affiliations 1: Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aarhus University Hospital, Aalborg, Denmark 2: Regional Psychiatric Services West, Central Region Denmark Abstract: Objective: To describe neuroleptic malignant syndrome cases (NMS), to establish occurrence of NMS, to investigate risk factors of NMS and to investigate mortality associated with NMS. Method: Longitudinal register linkage case-control study of NMS. Result: In health care registers covering the period 1996 – 2007 we identified among 224 372 patients diagnosed with organic, psychotic, affective or neurotic diagnosis 83 cases of NMS, equivalent to an occurrence of 0.04%. Second generation antipsychotics treatment in the three months preceding admission increased the NMS risk (OR 4.66 95%-CI: 1.96-11.10) and also first generation (FGA) high potency (OR 23.41 95%-CI: 5.29-103.61), FGA mid potency (OR 4.81 95%-CI: 1.96-11.79), and depot antipsychotic drugs (OR 4.53 95%-CI: 1.6012.80). Benzodiazepines (OR 3.43 95%-CI: 1.68-12.80 also increased the risk of NMS. NMS was associated with an increased mortality HR 1.88 (1.19-2.98) in cases compared with sex, age and diagnosis matched controls, but no significant difference in mortality between 16

cases and controls was observed after the initial 30 days (p =0.266). Conclusions: The occurrence of NMS is low, and the prediction of NMS is difficult. Previous treatment with FGAs, SGAs and benzodiazepines was identified as risk factors for developing NMS. NMS increased mortality within 30 days after NMS. Indsendt af: Reservelæge René Ernst Nielsen, (Aalborg Psykiatriske Sygehus, Psykiatrien) Uddannelse: Reservelæge, ph.d.-studerende E-mail: ren@rn.dk / Telefon: 2872 2962 Forskningsansvarlig på afdelingen: Zoltan Kovacs/Jens Ivar Larsen

Q) Prevalence of traumatic and nontraumatic anterior knee pain among adolescents Forfattere: Skuldbøl, S.K3; Rathleff, M.S1,2; Rasch, M3; Roos, E.M4; Rasmussen, S2; Olesen, J.L3. 1: Graduate School of Health Sciences, Aarhus University, Denmark 2: Orthopaedic Surgery Research Unit, Aalborg Hospital - Aarhus University Hospital, Denmark 3: Department of Rheumatology, Aalborg Hospital – Aarhus University Hospital, Denmark 4: Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark Abstract: Introduction: Knee pain is common during adolescence. The proportions of adolescents reporting pain relating to sudden onset trauma vs insidious slowly developing pain have not yet been investigated. The purpose is to investigate the prevalence of self-reported knee pain among adolescents between 15 and 19 years and to describe the proportions reporting pain relating to of trauma versus insidious onset. Secondly, to describe the diagnoses in those complaining of insidious anterior knee pain. Methods: Online questionnaires were forwarded to 2.846 students aged 15-19 in four upper secondary schools. Localization of pain was quantified through a pain mannequin where students marked areas with experienced pain during the last month. Students reporting knee pain were asked about pain localization, onset of symptoms and if the onset of pain was related to a traumatic event or insidious. If the onset of knee pain was insidious, felt anteriorly or diffusely they were offered a clinical examination by a rheuma-


tologist. Results: A total of 2.200 students answered the questionnaire (77,2% response rate). The prevalence of self-reported knee pain was 32.9%. Of those 28.5% students reported knee pain with a traumatic onset while 71.5 % reported an insidious onset of pain. 204 students were invited to a clinical examination, 92.2% accepted. Patellofemoral pain syndrome (85.0 %) and patellar tendinopathy (3.4%) were the two most frequent diagnosis made. Conclusion: These results indicate a high prevalence of both traumatic and non-traumatic knee pain among adolescents. In adolescents with non-traumatic anterior knee pain patellofemoral pain Syndrome may account for 85% of all cases. Indsendt af: Læge Sune Kelm Skuldbøl, (Reumatologisk Afdeling, Aalborg Sygehus) Uddannelse: Introduktionsstilling E-mail: suks@rn.dk / Telefon: 9932 8434 Forskningsansvarlig på afdelingen: Jens Lykkegaard Olesen

R) Asbestos Exposure and Survival in Malignant Malignant Mesothelioma: A Description of 122 Consecutive Cases at an Occupational Clinic Forfattere: E Skammeritz1,LH Omland2,JP Johansen1, Ø Omland1. 1 Danish Ramazzini Center, Department ofOccupational Medicine, Aalborg Hospital, Aarhus University hospital,Aalborg,Denmark 2Department of Infectious Diseases,Rigshospitalet Copenhagen,Denmark Abstract: Background: The natural history and etiology of malignant mesothelioma (MM) is already thoroughly described in the literature, but there is still debate on prognostic factors, and details of asbestos exposure and possible context with clinical and demographic data, have not been investigated comprehensively. Objectives: Description of patients with MM, focusing on exposure, occupation, survival and prognostic factors. Methods: Review of medical records of patients with MM from 1984 to 2010 from a Danish Occupational clinic. Survival was estimated using Kaplan-Meier survival analysis and prognostic factors were identified by Cox regression analysis.

Results: 110 (90.2%) patients were male, and 12 (9.8%) were female. The median (interquartile rang [IQR]) age was 65 (13) years. Pleural MM was seen in 101 (82.8%) patients, and peritoneal in 11 (9.0%); two (1.6%) had MM to tunica vaginalis testis, and eight (6.6%) to multiple serosal surfaces. We found 68 (55.7%) epithelial tumors, 26 (21.3%) biphasic, and 6 (4.9%) sarcomatoid. 12 (9.8%) patients received tri-modal therapy, 66 (54.1%) received one-/two-modality treatment, and 36 (29.5%) received palliative care. Asbestos exposure was confirmed in 107 (91.0%) patients, probable in four (3.3%), and unidentifiable in 11 (9.0%). The median (IQR) latency was 42 (12.5) years. Exposure predominantly occurred in shipyards. The median overall survival was 1.05 (95% CI: 0.96–1.39) years; 5-year survival was 5.0% (95% CI: 2.0%–13.0%). Female sex, good WHO performance status (PS), epithelial histology and tri-modal treatment were associated with a favorable prognosis. Conclusion: MM continuously presents a difficult task diagnostically and therapeutically, and challenges occupational physicians with regard to identification and characterization of asbestos exposure. Indsendt af: Overlæge Øyvind Omland, (Arbejdsmedicinsk Klinik, Aalborg Sygehus) Uddannelse: Cand.med. E-mail: oo@rn.dk / Telefon: 9631 3400 Forskningsansvarlig på afdelingen: Øyvind Omland

S) Dose-response relationship of phototherapy for hyperbilirubinemia Forfattere: 1 Pernille Kure Vandborg, MD 2Bo Moelholm Hansen, MD 2 Gorm Greisen, Professor, MD 1Finn Ebbesen, Professor, MD. Addresses: 1) Department of Pediatrics, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark 2) Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Denmark Abstract: Background: Using light emitting diodes (LED’s) during conventional phototherapy it is possible to reduce the distance from light source to infant, thereby increasing light irradiance. Objective: To examine the relation between light irradiance and the rate of decrease in total serum bilirubin concentration (TsB) and to see if we could identify a ”saturation point”, i.e. an irradiation level above which there is no further decrease in TsB. Design: Prospective randomised study. Setting: NICU, Aalborg Hospital, Denmark. Material and method: 151 infants with gestational age ≥ 17


33 weeks and uncomplicated hyperbilirubinaemia were randomised to one of 4 different distances from phototherapy device to mattress (20, 29, 38 and 47 cm). TsB was measured before and after 24 hours of phototherapy and irradiance every 8th hour. Main outcome was 24 hours decrease of TsB expressed in percent (∆ TsB0-24 (%)). Results: A highly significant linear relation was seen between light irradiance and ∆ TsB0-24 (%) (p < 0.001): when the irradiance increased from 20 to 55 μW/cm2/nm ∆ TsB0-24 (%) increased from approximately 30 to 50%. Further, smooth regression showed no tendency for ∆ TsB0-24 (%) to level off as irradiance increased. ∆ TsB0-24 (%) was negatively correlated to birth weight and positively to formula volume. Average weight gain during phototherapy was 1%, independent of light irradiance. Conclusion: Using LED’s we found a linear relation between light irradiance in the range 20–55 μW/cm2/nm and decrease in TsB after 24 hours of therapy, and no evidence of a “saturation point”. Indsendt af: Læge Pernille Kure Vandborg, (Børneafdelingen, Aalborg Sygehus) Uddannelse: Læge E-mail: pkv@rn.dk / Telefon: 2613 1711 Forskningsansvarlig på afdelingen: Finn Ebbesen

T) Treatment of leg-ischemia with axillofemoral bypassgrafting in Denmark over a 10 year period. Forfattere: Neven Akrawi, Nikolaj Eldrup, Marie-Louise Grønholdt Dept. Vasc. Surgery, Aalborg hospital. Abstract: Objectives: The indication for axillofemoral bypass (AXFB), primary patency and mortality after 30-days, 1 and 5 years were retrospectively investigated in patients with severe comorbidities. Methods: Patients included received an AXFB in Aarhus or Aalborg between 1999 and 2009 for aortoiliaco-occlusive disease (AIOD, n=130) or aortic disease (AD, n=11). AIOD included abdominal aortic aneurysms, or infectious or trombosed aorto-femoral grafts. Primary patency and mortality were analysed with Kaplan-Meier survival analysis and the difference herein calculated with a log-rank test. 18

Results: Postoperative complications occurred in 37%. Primary patency after 1 year for all patients was 91%, for the AIOD-group 95% and for the AD-group 78%. Primary patency after 5 year for all patients was 75%, for the AIOD-group 79% and for the AD-group 62%. 30-days mortality rates for all patients were 6%, for the AIODgroup 5% and for the AD-group 18%. Survival rates after 1 year were 79% for all patients, 79% for the AIOD-group and 67% for the AD-group. The survival rate after 5 years was 49% for all patients, 47% for the AIOD-group and 33% for the AD-group. There were no statistical significances in either primary patency or mortality after 1 or 5 years between the AIOD- and AD-group. Conclusion: Our study showed a high primary patency for all patients and a not surprisingly low survival rate after 5 years. Therefore, AXFB may still be considered a good alternative. Indsendt af: Afdelingslæge Marie-Louise Grønholdt, (Karkirurgisk Afdeling, Aalborg Sygehus) Uddannelse: Karkirurgisk specialllæge, dr.med., phd E-mail: mlg@dadlnet.dk / Telefon: 5125 9039 Forskningsansvarlig på afdelingen: Marie-Louise Grønholdt  


Abstracts Posterpræsentation 1) Effects of sertindole on cognition in clozapine-treated schizophrenia patients – a double-blinded, randomized, placebo-controlled trial.

E-mail: ren@rn.dk / Telefon: 2872 2962 Forskningsansvarlig på afdelingen: Zoltan Kovacs/Jens Ivar Larsen

Forfattere: First author: René Ernst Nielsen1 2, MD Second author: Sten Levander3, MD Third author: Jimmi Nielsen1, MD, PhD. Affiliations: 1: Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aarhus University Hospital, Aalborg, Denmark, 2: Regional Psychiatric Services West, Central Region Denmark, 3: Faculty of Health & Society, Malmo University, Malmo, Sweden

2) Patientsikkerhedskultur i Psykiatrien – Et interventionsstudie

Abstract: Objective: To assess the cognitive effects of sertindole augmentation in clozapine treated patients diagnosed with schizophrenia. Method: A 12-week, double blinded, randomized, placebo-controlled, augmentation study of patients treated with clozapine. Participants were randomized 1:1 to receive 16 mg of sertindole or placebo as adjunctive treatment to clozapine. Results: Participants displayed substantial cognitive deficits, one to three standard deviations below norms at baseline, particularly on tests of response readiness and focused attention. There were no significant differences between sertindole augmentation and placebo groups at study end, or any significant correlations between changes in cognition and symptoms/global functioning as assessed by PANSS, CGI and GAF-F. Conclusion: The clozapine-treated patients displayed marked cognitive deficits at baseline. Adding sertindole did not improve or worsen cognitive functioning which is in line with previous negative studies of augmenting clozapine treatment with another antipsychotic drug with cognition as outcome. Indsendt af: Reservelæge René Ernst Nielsen, (Aalborg Psykiatriske Sygehus, Aalborg Sygehus) Uddannelse: Ph.d.-studerende

 

Forfattere: Solvejg Kristensen, Paul Bartels, Svend Sabroe, Jan Mainz Abstract: Baggrund og formål: Patientsikkerhedskultur (PSK) skabes af medarbejderne, og angår patienterne. PSK er karakteriseret ved artefakter, fastlagte værdier, og grundlæggende antagelser, som forudsættes at være kausale for patienternes sikkerhed. Interventioner med forbedrende effekt på PSK er aldrig dokumenterede for danske forhold, ligesom der for nuværende ikke findes et dansk valideret spørgeskema til måling af PSK. Formålet med nærværende studie er primært, at undersøge effekten af en intervention til forbedring af PSK samt kliniske mål for patientsikkerheden (vurdering af selvmordsrisiko og somatiske symptomer samt planlagt opfølgning efter udskrivelse). Samtidig valideres et spørgeskema til måling af PSK. Metode: Undersøgelsen foretages i Afdeling Syd i Psykiatrien i Region Nordjylland. Der gennemføres en tværsnitsmåling af PSK i henholdsvis 2012 og 2013 blandt personalet. Indimellem PSK-målingerne gennemføres en intervention. Denne rettes dels mod de svageste områder af kulturen fundet ved baselinemålingen, dels mod forbedring af patientsikkerhedsmålene. Der indsamles indikatordata vedr. patientsikkerhedsmålene for to perioder fra henholdsvis før og efter interventionen. Indikatoroplysningerne indsamles via Regionernes Kliniske Kvalitetsudviklingsprogram. Interventionen tilrettelægges med udgangspunkt i ”The Comprehensive Unit-Based Safety Programme” (CUSP). CUSP baseres på stærk ledelsesopbakning og aktiv involvering af kli19


nisk personale. CUSP omfatter fem tiltag vedrørende: uddannelse, overvågning af patientsikkerhedsdata, patientsikkerhedsrunder, læring af fejl samt implementering af ”tools” til forbedring af de kliniske patientsikkerhedsmål. Tiltag implementeres trinvist og ikke flere end tre årligt. Perspektiver: Dette første danske studie med fokus på patientsikkerhedskultur i psykiatrien i Danmark forventes at kunne dokumentere validiteten af et PSK-spørgeskema og lancere et testet interventionsprogram. Disse redskaber vil ruste det danske sygehusvæsen yderligere til at forbedre patientsikkerhedskulturen. Indsendt af: Chefkonsulent / Stud. ph.d. Solvejg Kristensen, (Aalborg Psykiatriske Sygehus & Dansk Center for Forbedring - AAU, Psykiatrien) Uddannelse: Sundhedsfaglig Kandidat (MHSc) E-mail: solkri@rm.dk / Telefon: 2938 8364 Forskningsansvarlig på afdelingen: Jan Mainz  

3) Hematological clozapine monitoring with a point-of-care device: A randomized cross-over trial Forfattere: Jimmi Nielsen (a), Dorrit Thode (a), Elsebeth Stenager (b), Kristian Øllegaard Andersen (b), Ulla Sondrup (c), Tine N. Hansen (c), Anne Marie Munk (d), Signe Lykkegaard (d), Annette Gosvig (e), Igor Petrov (f), Phuong le Quach (f) (a) Centre for Schizophrenia, Aalborg Psychiatric Hospital, Aarhus University Hospital, Denmark (b) Psychiatric Department Odense-University Function, Community Psychiatry Centre, Odense, Denmark (c) Aarhus University Hosptal, Risskov, Denmark (d) Psychiatric Centre Greve, Region Zealand, Denmark (e) Psychiatric Department Esbjerg-Ribe, Community Psychiatry Centre, Esbjerg, Denmark, Denmark (f) Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark Abstract: Clozapine remains the drug of choice for patients with treatment-resistant schizophrenia, who show a response rate of about 50% despite their unresponsiveness to other antipsychotics. Although treatment with clozapine can lead to considerable savings on bed days, the drug is underutilized for several reasons, perhaps most importantly because of the mandatory hematological monitoring. The Chempaq Express Blood Counter (Chempaq XBC) is a point-of-care device providing counts of white blood cells (WBC) and granulocytes based on a capillary blood sampling. 20

A randomized cross-over trial design was used comparing capillary blood sampling using a point-of-care device with traditional venous blood sampling. Patients were randomized to two sequences starting with either capillary or venous blood sampling followed by a repeated sequence. Primary outcome was measured on a 10-cm visual analog scale. Eighty-five patients were included in the test. Eight (9.4%) dropped out before completion. Patients indicated that they found capillary blood monitoring less painful than venous sampling (VAS ratings: 0.55 cm 25–75 percentiles: 0.1–1.4 cm vs. 1.75 cm 25–75 percentiles: 0.7–2.6, pb0.001). They also felt less inconvenienced by the point-of-care method than the traditional blood sampling, which involved traveling to the laboratory clinical (0.3 cm 25–75 percentiles: 0.05–0.7 vs. 2.3 cm 25–75 percentiles: 0.75–4.5, pb0.001). For hematological monitoring of clozapine patients a pointof-care device based on capillary blood sampling is better tolerated than traditional venous blood sampling. Indsendt af: Videnskabelig medarbejder Dorrit Thode, (Aalborg Psykiatriske Sygehus, Center for Skizofreni, Psykiatrien) Uddannelse: Cand. polit, sygeplejerske E-mail: dwt@rn.dk / Telefon: 2272 6931 Forskningsansvarlig på afdelingen: Læge Jimmi Nielsen  

4) Clinical Decision-Making in Outpatient Mental Health Care Forfattere: Krogsgaard Bording, Malene; Munk-Jørgensen, Povl Abstract: Introduction: A large part of psychiatric treatment is based on consultations between the clinician and the mentally ill patient. During the treatment session, necessary decisions are made concerning the course of treatment, which type of treatment should be given, how should treatment be performed, how intensive should treatment be, are changes in treatment needed, should the patient be hospitalized or treated on an outpatient basis, and when should the patient be discharged. Considering how many decisions are to be made during a treatment session, it is a paradox what so little research has explored the decision-making in patients with mental health problems. Objective: This study explores aspects of clinical decision-making in outpatient mental health care with a specific focus on patients diagnosed with schizophrenia.


Methods: This study is an open, explorative study that deploys both qualitative and quantitative methods. The study population consists of severely mentally ill outpatients diagnosed with schizophrenia. Data consist of questionnaires, field observation and patient interviews. Expected results and conclusion: We expect that the study will identify primary areas for further improvement in clinical decision-making. Recommendations will be issued and formulated on the basis of study data to support the implementation of elements from best practice in clinical decision-making in the routine outpatient care for people with schizophrenia in particular, and severe mental illness in general. This focus will contribute to strengthening of the patient-perspective. Indsendt af: Ph.d.-studerende Malene Krogsgaard Bording, (Aalborg Psykiatriske Sygehus, Enheden for psykiatrisk forskning, Psykiatrien) Uddannelse: Sociolog E-mail: mafk@rn.dk / Telefon: 7213 7238 Forskningsansvarlig på afdelingen: Zoltan Kovacs  

5) Changes in the treated incidence of early onset schizophrenia over four decades Forfattere: First author: Niels Okkels1 Second author: Ditte Lammers2 Third author: Signe Olrik Wallenstein Jensen1, MSc Fourth author: John Joseph McGrath3, 4 Fifth author: René Ernst Nielsen1, 5, MD Affiliations: 1: Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aarhus University Hospital, Aalborg, Denmark, 2: Department of Child and Adolescent Psychiatry, Aalborg Psychiatric Hospital, Aarhus University Hospital, Aalborg, Denmark, 3: Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Queensland, Australia, 4: Queensland Brain Institute, The University of Queensland, Queensland, Australia, 5: Regional Psychiatric Services West, Central Region, Denmark Abstract: Objective: Explore changes in the treated incidence of early onset schizophrenia over four decades using a large, population-based mental-health register. Method: Using the Danish Psychiatric Central Register, we examined incidence rates for schizophrenia in patients below 18 years of age from 1971 to 2010. Results: Age-standardized incidence ratio (IR) of EOS in the study period from 1971-2010 was 3.17 (SD=0.20) per 100,000 person years, with higher IR for males than females. Age-standardized IR of EOS in the period

1971-1993 was 1.80 (SD=0.17) per 100,000 person years, also with higher IR for males than females. Agestandardized IR of EOS in the period 1994-2010 as 5.15 (SD=0.41) per 100,000 person years, with higher IR for females than males. The proportion of males diagnosed in the period 1971-1993 compared to 1994-2010 decreases, and in 1994-2010 there is an even distribution between sexes. The proportion of EOS of all psychiatric diagnoses gradually decreased from 1971 to 2010. Conclusion: In recent years the treated incidence of EOS has increased and the usual male excess has become less apparent. The changes in IR could be a result changes in diagnostic system, an increased awareness of early psychosis, or a reflection of actual underlying incidence of psychosis. Indsendt af: Medicinstuderende Niels Okkels, (Aalborg Psykiatriske Sygehus, Enheden for Psykiatrisk Forskning, Psykiatrien) Uddannelse: Medicinstuderende, forskningsvikariat E-mail: ren@rn.dk / Telefon: 2872 2962 Forskningsansvarlig på afdelingen: Zoltan Kovacs/Jens Ivar Larsen  

6) Improving Insight in Patients Diagnosed With Schizophrenia and Understanding Insight From a Patient Perspective – A Mixed Methods Study Forfattere: Rikke Jørgensen, MSN, PhD-Student, Unit for Psychiatric Research, Aalborg Psychiatric Hospital, aarhus University Hospital Povl Munk Jørgensen, Professor, MD, Aarhus University Psychiatric Hospital, Aarhus. Vibeke Zoffmann, Senior Researcher, PhD, MPH, Steno Diabetes Center, Gentofte Lars Hansson, Professor, PhD, Department of Health Sciences, Lund University, Sweden. Abstract: The method Guided Self-Determination (GSD) is originally developed and proved effective in difficult diabetes care and has been adjusted to patients with schizophrenia. Currently a randomised controlled study investigates if the method GSD has effect on the outcomes insight, self-esteem, recovery, psychopathology and social functioning when applied in psychiatric care. As an extension from the RCT we are planning a qualitative study using Grounded Theory. The overall approach is a Mixed Method Approach with a Sequential Explanatory Strategy. The RCT hypothesize that the method GSD improves both clinical and cognitive insight in patients measured by Birchwood Insight Scale and Beck Cognitive Insight 21


Scale, which both are self-rating scales. Lack of insight into illness is often associated with patients diagnosed with schizophrenia. In the literature lack of insight is a complex and multi dimensional phenomenon with disagreement on etiology but always described and investigated from health professionals’ point of view. Both self-rating scales are also developed by and represent health professionals´ understanding of insight. It appears that the patients’ perception and understanding of insight is missing in the literature. The qualitative study will both aim on elaborate on the results on clinical and cognitive insight from the RCT and investigate patients’ perception/understanding of insight and establish social relations consequences on this perception/understanding. Ten to fifteen participants will be interviewed by a semi-structured qualitative interview by theoretical sampling. All participants have participated in the RCT and worked with the method GSD. And field notes will be generated from the RCT follow-up visits. Indsendt af: Ph.d. studerende Rikke Jørgensen, (Aalborg Psykiatriske Sygehus, Enheden for Psykiatrisk Forskning, Psykiatrien) Uddannelse: Cand.cur E-mail: rikke@hoejdahl.dk / Telefon: 2272 6977 Forskningsansvarlig på afdelingen: Zoltan Kovacs  

7) Does the Severity of Depressive and Psychotic Symptoms Correlate during Major Depressive Episodes? Forfattere: Søren Dinesen Østergaard1, Jim Bille2, Henrik SøltoftJensen2, Nils Lauge2, Per Bech2 1) Unit For Psychiatric Research, Aalborg Psychiatric Hospital, Aarhus University Hospital, Aalborg, Denmark. 2) Psychiatric Research Unit, Psychiatric Center Nordsjælland, Copenhagen University Hospital, Hillerød, Denmark. Abstract: Introduction: Psychotic depression (PD) is classified as a sybtype of severe depression in the current diagnostic manuals. Accordingly, it is a common conception that psychotic features in depression arise as a consequence of depressive severity. Objectives: To determine whether the severity of depression and psychosis correlate in accordance with the “severity-psychosis” hypothesis and to detect potential differences in clinical features of psychotic- and nonpsychotic depression (non-PD).

22

Methods: Quantitative analysis of Health of the Nation Outcome Scales (HoNOS) scores from all patients admitted to a Danish general psychiatric hospital between 2000 and 2010 due to a severe depressive episode. Results: A total of 357 patients with severe depression, of which 125 (35%) were of the psychotic subtype, formed the study sample. Mean HoNOS scores at admission differed significantly between patients with non-PD and PD on the items hallucinations and delusions (non-PD=0.33 vs. PD=1.37, p<0.001), aggression (non-PD=0.20 vs. PD=0.36, p=0.044) and on the total score (non-PD=10.55 vs. PD=11.87, p=0.024). The HoNOS scores on the depression item did not differ between the two groups (non-PD=2.59 vs. PD=2.50, p=0.610). Finally, the correlation between item scores on depression and hallucinations and delusions was very weak (Spearman coefficient=0.12, p=0.026). Conclusions: The results suggest that the severity of depression is unlikely to be the key determinant for the development of psychotic symptoms and support the hypothesis that the psychotic- and non-psychotic subtypes of depression are in fact distinct clinical syndromes. Indsendt af: Læge, Ph.d.-studerende Søren Dinesen Østergaard, (Aalborg Psykiatriske Sygehus, Enheden for Psykiatrisk Forskning, Psykiatrien) Uddannelse: Cand.Med. E-mail: sdo@rn.dk / Telefon: Forskningsansvarlig på afdelingen:  

8) The cohort of young Danish farmers - A longitudinal study of the health effects of farming exposure. Forfattere: Elholm G, Omland O, Schlünssen V, Hjort C, Basinas I, Sigsgaard T. Department of Occupational Medicine,Aalborg Hospital and Institute of Public Health, Aarhus University; Abstract: Working in agriculture poses a serious risk for development of respiratory diseases, especially when working in animal housing. Animal workers are exposed to a mixture of organic and inorganic dust together with fumes and gases, including allergens and microbial-associated molecular patterns with a potentially major impact on respiratory health and the immune system. Exposure to microbial agents in animal housing is associated with an increased prevalence of respiratory symptoms,


including bronchial hyperresponsiveness, accelerated lung function decline, and neutrophil-mediated inflammation. These clinical findings are often seen without IgE-mediated sensitization. In fact it has been found in recent studies that the prevalence of atopic sensitization and atopic asthma is low among farmers compared with other populations. The SUS study was designed to identify the type and occurrence of respiratory symptoms and disease, and to investigate risk factors for respiratory disorders and changes in lung function among young farming students. The cohort of young Danish farmers was established in 1992/1994 and followed up in 2007/2008 with a participation rate of 51.7%. The cohort consists of 1734 male farming students, 230 female farming students, and 407 army recruits as controls. The study has so far lead to the publication of 16 peerreviewed articles,6, one thesis,27 and several presentations at international conferences and has contributed to our understanding of the inflammatory mechanisms involved in the immune response to organic dust exposure. Further we have demonstrated a lower prevalence of allergic symptoms, asthma, BHR, and sensitisation measured in subjects raised on a farm, compared with upbringing elsewhere.

vidde). Alle børnene udviklede pneumothorax indenfor de første fire levedøgn. 43 (88%) havde enkeltsidig pneumothorax og 6 (12%) dobbeltsidig. I alt 26 (53%) fik anlagt dræn: Kun 35% af børnene født til termin sammenlignet med fra 50% til 88% i de øvrige GA grupper (figur 1). Blandt børn, der udviklede pneumothorax, var sectio den hyppigste fødselsmåde: 38 % af børn født til termin og 76% af børn født før termin (figur 2). Kun 2 børn fik hverken CPAP eller blev ventileret (tabel 1). 12% af de nyfødte med pneumothorax havde samtidig mekoniumaspiration og 41% havde RDS. Diskusssion: I dette studie genfandtes sectio, CPAP, og ventilation som risikofaktorer. Som forventet var hyppigheden af børn med pneumothorax, der fik anlagt dræn større hos børn født før termin end hos børn født til termin. Opgørelsen kan bruges til at sammenligne med andre neonatalafdelinger for at se om vi har færre eller flere med neonatal pneumothorax.

Indsendt af: Overlæge Øyvind Omland, (Arbejdsmedicinsk Klinik, Aalborg Sygehus) Uddannelse: Cand. med. E-mail: oo@rn.dk / Telefon: 9631 3400 Forskningsansvarlig på afdelingen: Øyvind Omland

 

 

9) Neonatal pneumothorax Forfattere: Louise D. Vibede, Lisbeth V. Kruse, Lia M. Pedersen og Finn Ebbesen. Abstract: Formål: At registrere hyppigheden af pneumothorax hos nyfødte børn på neonatalafdelingen Aalborg Sygehus samt beskrive risikofaktorer. Metode: Retrospektiv undersøgelse fra neonatalafdelingen på Aalborg Sygehus, Århus Universitetshospital. Patienterne blev fundet ved søgning på ICD 10 koden pneumothorax (P251) i perioden fra januar 2006 til maj 2011. I alt 50 patienter blev fundet, én blev ekskluderet pga. fejlregistrering. Resultater: 49 patienter blev inkluderet. Der var en lille overvægt af drenge 28 (57%) contra piger 21 (43%). Fødselsvægten var 2900g (745-4425g), og gestationsalderen (GA) var 37+0 (24+5-42+3) (median (spænd-

Indsendt af: Reservelæge Louise Dyrberg Vibede, (Børneafdelingen, Aalborg Sygehus) Uddannelse: kursist E-mail: lodv@rn.dk / Telefon: 9932 8322 Forskningsansvarlig på afdelingen: Finn Ebbesen

10) Impact of hydrochloric acid instillationon on salvage of central venous catheters in children with Acute Lymphoblastic Leukemia Forfattere: Mette Madsen, Børneafdelingen Aalborg Sygehus Steen Rosthøj, Børneafdelingen, Aalborg Sygehus Abstract: INTRODUCTION: Hydrochloric acid (HCl) instillations have been reported to salvage central venous catheters CVCs with antibiotic-refractory infection. We implemented this treatment in 2002. MATERIEL AND METHODS: This retrospective cohort study evaluate the impact on the survival of catheters in children with newly diagnosed ALL 1999-2005 having their first CVC inserted before (comparison cohort, n = 16) and after introducing the procedure (intervention cohort, n = 24) all bacteremic episodes were reviewed, recording bacteriological findings and treatment, and the time to premature or planned removal of the CVC was determined. A supplemental follow up is made for CVCs for the period 2006-2010 according to lifetime and reason of removal of the catheter (n =. 20). RESULTS: In the comparison cohort 31% of bacteremic episodes (9/29) led to removal of the CVC, compared to 5.5% (2/36) in the intervention cohort (P=0.01). 23


Thus, the rate of catheter loss due to infection fell from 56% (9 of 16) to 8.3% (2 of 24) after introducing HCl treatment (P=0.003). The premature catheter removal rate fell from 75% (12/16) to 46% (11/24) (P=0.10). In a subgroup analysis of 21 monobacterial infections with coagulase negative staphylococci, a significant decrease in systemic and lock antibiotic therapy was found. The improved chance of the CVC remaining in place till elective removal was evident in a cusum plot. Results from 2006-2010 will be presented. CONCLUSION: HCl instillations significantly reduced the need to remove and replace CVCs. The procedure is practical, appears safe, and may reduce consumption of antibiotics. Indsendt af: Afdelingslæge Mette Madsen, (Børneafdelingen, Aalborg Sygehus) Uddannelse: Pædiater E-mail: mette.madsen@rn.dk / Telefon: 9932 8312 Forskningsansvarlig på afdelingen: Finn Ebbesen  

11) Ernæringsproblemer i forløbet af kemoterapi hos børn med cancer

tet. Børn med HR-ALL havde på trods af corticosteroid behandling et betydeligt vægttab under induktionsfasen. De fleste børn med HR eller IR-ALL havde en dårlig vægtstigning under konsolidering og intensifikationsfasen. Blandt børnene med CNS-tumorer var næsten halvdelen i ernæringsmæssig risiko på diagnosetidspunktet, og på trods af at de fleste af dem fik ernæringsmæssig støtte var vægtstigningen i behandlingsåret suboptimal. Detaljerede data vil blive præsenteret. Et skema til monitorering og evaluering af vægtændringer over kort tid vil også blive præsenteret. Konklusion: Ernæringsmæssige problemer er almindelige under kemoterapi, og det er nødvendigt med bedre strategier til at monitorere ernæringsstatus og beslutte hvornår der skal interveneres. Indsendt af: Stud. med. Sara Doroudian, (Børneafdelingen, Aalborg Sygehus) Uddannelse: Medicinstuderende E-mail: saradoroudian@hotmail.com / Telefon: 2654 1094 Forskningsansvarlig på afdelingen: Steen Rosthøj  

Forfattere: Sara Doroudian stud.med., Steen Rosthøj, MD

12) Validering af NeoBasen, en dansk neonatal klinisk database

Abstract: Baggrund og formål Dårlig ernæringstilstand forstærker bivirkninger og øger risikoen for komplikationer i forbindelse med kemoterapi hos børn med cancer. Det er vigtigt, men ofte svært at vedligeholde en tilstrækkelig ernæringsmæssig tilstand. Vi har i dette studie gennemgået ernæringstilstanden og anvendelsen af ernæringsmæssig intervention i to grupper af børn med cancer, for at identificere undergrupper af patienter og faser af kemoterapi som er forbundet med større risiko for ernæringsmæssige problemer.

Forfattere: Sofia Andersson, Finn Ebbesen.

Metoder: Journaler, på børn diagnosticeret 2001-2008 med akut lymphoblastisk leukæmi og behandlet efter NOPHO-ALL 2000 protokollen samt på børn diagnosticeret i samme periode med CNS-tumorer behandlet med kemoterapi, er blevet gennemgået. Højde og vægt på diagnosetidspunktet og på forskellige tidspunkter under og efter kemoterapi er blevet uddraget. Ernæringsmæssig intervention blev også registreret. Vægtændringer og BMI blev beregnet. En BMI under 10 percentilen blev anvendt som markør for ernæringsmæssig risiko. Standard vækstskemaer for vægt og BMI blev anvendt som reference. Resultater: Størstedelen af børnene med ALL havde en tilfredsstillende ernæringstilstand på diagnosetidspunk24

Abstract: Baggrund: NeoBasen er en national neonatal klinisk database, opstartet i 1990, der indeholder demografiske og behandlingsmæssige data til kvalitetssikring og forskning. NeoBasen udfyldes rutinemæssigt af børneafdelingernes læger ved udskrivelsen af alle indlagte børn på neonatalafdelingerne i Danmark. Formål: Studiets formål var, at validere NeoBasens oplysninger om indgivelse af surfaktant, sidste dato for kontinuerlig iltbehandling samt varighed af Nasal Continuous Positive Airway Pressure (N-CPAP)- og respiratorbehandling hos børn med gestationsalder < 32 uger i Region Nord- og Midtjylland. Metode: Valideringen blev lavet ud fra en stikprøve for året 2005, og inkluderede alle nyfødte børn med gestationsalder < 32 uger indlagt på neonatalafdelingerne på Aalborg og Skejby Sygehuse (N=164). Som guldstandard anvendtes sygeplejerskernes antegnelser, de så kaldte ”sygeplejerske-kardex”. Resultater: Samlet for begge sygehus viste resultaterne af valideringen ingen signifikante forskelle i rapporteringen mellem NeoBasen og guldstandard (p>0.05). Dette


gjaldt for samtlige variabler. Overensstemmelsen mellem NeoBasen og guldstandard var høj (>90%) i rapporteringen om surfaktant og respiratorbehandling, og moderat (70-90%) i rapporteringen om N-CPAP- og kontinuerlig iltbehandling. Der forekom ingen signifikante forskelle i rapporteringen mellem de to sygehuse, med undtagelse af oplysningerne om respiratorbehandling (p=0.02), hvor Aalborg Sygehus havde en signifikant underrapportering i NeoBasen (middelværdi: -0.1 dage, 95% CI -0.25; -0.02). På baggrund af de minimale forskelle i rapporteringen mellem de to sygehuse, skønnes resultaterne at være repræsentative for øvrige NeoBaser i Danmark. Konklusion: NeoBasen er en værdifuld, valid datakilde for klinisk og epidemiologisk forskning. Indsendt af: Forskningsvikar Sofia Andersson, (Børneafdelingen, Aalborg Sygehus) Uddannelse: Medicinstuderende E-mail: sofia.andersson@studmed.au.dk / Telefon: 2828 2653 Forskningsansvarlig på afdelingen: Finn Ebbesen  

13) TENS til behandling af dagurininkontinens hos børn Forfattere: Søren Hagstrøm (1,3), Birgitte Mahler (2,3), Bodil Madsen (2) og Jens Christian Djurhuus (3) og Søren Rittig (2) 1) Børneafdelingen, AUH, Aalborg Sygehus, 2) Børneafdelingen, AUH, Skejby, 3) Klinisk Institut, Aarhus Universitet. Abstract: Formål: At undersøge effekten af transcutan elektrisk nervestimulation (TENS) hos børn med overaktiv blære og behandlingsrefraktær dagurininkontinens. Materiale og Metoder: Vi inkluderede 27 børn i alderen 5-14 år med urge inkontinens refraktær til såvel uroterapi som anticholinergika, normal urinanalyse, upåfaldende UL af nyrer/urinveje og objektiv undersøgelse. Eksklusionskriterierne var underaktiv blære, mistanke om obstruktion i nedre urinveje, aktuelle defækations symptomer, tidligere urinvejskirurgi og tidligere TENS behandling. Efter 2 ugers run-in periode (med standard uroterapi og konfirmeret detrusor overaktivitet ved natural fill urodynamik) blev børnene randomiseret til 4 uger med 2 timer daglig enten aktiv eller placebo S2-S3 TENS. I en uge forud for randomisering og i uge 4 af interventionen udfyldtes registreringer af sværhedgraden af inkontinens og urge samt 48-timers blære-dagbog (inklusiv væske-vandladningsregistrering).

Resultater: 2 børn måtte ekskluderes inden randomiseringen, da den urodynamiske undersøgelse rejste mistanke om LUT obstruktion. Efter 8 ugers intervention havde 8 (61%) af børnene i ”aktiv-gruppen” signifikant reduktion i sværhedsgraden af inkontinens. Hvorimod det tilsvarende kun galt 2 børn (17%) i ”placebo-gruppen” (p<0.05). Tilmed havde ”aktiv-gruppen” signifikant større reduktion i antal inkontinens episoder pr dag sammenlignet med ”placebo-gruppen” (p<0.01). TENS førte ikke til ændring i blærekapaciteten. Konklusion og perspektiver: Dette er det første placebokontrollerede studie af sakral TENS ved dagurininkontinens hos børn. Studiet indikerer at TENS er placebo overlegen i behandlingen af behandlingsrefraktær dagurininkontinens hos børn. Således åbnes mulighed for et nyt behandlingsregime til en gruppe af børn med en lidelse, som hidtil har været meget vanskelig at behandle effektivt. Indsendt af: Kursusreservelæge Søren Hagstrøm, (Børneafdelingen, Aalborg Sygehus) Uddannelse: Læge, Ph.d. E-mail: soha@rn.dk / Telefon: 9932 8302 Forskningsansvarlig på afdelingen: Professor Finn Ebbesen  

14) Skokiler påvirker aktiviteten i hasemusklerne hos patienter med slidgigt i knæets mediale ledkammer Forfattere: Carsten Mølgaard, Lise Jensen, Nadja Kostending Overgaard Jensen, Henrik Riel Aagaard, Mette Blaabjerg Frandsen, Anders Laursen, Sten Rasmussen. Abstract: Baggrund: Knæets mediale ledkammer rammes oftest af slidgigt. En valgiserende kile i skoene har til formål at aflaste det mediale ledkammer, men kilernes betydning for muskelaktiviteten er ikke tilstrækkeligt kortlagt. Formål: At undersøge, hvilken effekt en lateral skokile har på muskelaktiviteten i lår og hofte under øvelserne squat og lunge. Materiale og metode: I studiet deltog 9 forsøgspersoner, som alle stod på venteliste til en valgiserende open wedge tibial osteotomy. Gennemsnitsalderen var 53±9 år. Peak amplitude og on-set af muskelaktiviteten blev registreret under squat og lunge henholdsvis med og uden kile i skoen. VAS-score blev registreret før og efter hvert øvelsessæt. Resultater: Der var en signifikant lavere aktivitet i m. bi25


ceps femoris under squat (P = 0.028) med kile (1,4 %). Der var ikke signifikante forskelle på de andre målinger af amplituden(P >0.05), men der var dog en tendens til en lavere gennemsnitlig muskelaktivitet, når patienterne havde en kile i skoen. M. vastus medialis havde tidligere onset under squat og lunge med kile og m. vastus lateralis havde tidligere onset under squat med kile(P >0.05). Der var en ligeledes en tendens til, at patienterne havde færre smerter målt med VAS, efter udførelsen af øvelserne med kile. Perspektiv: En reduktion i muskelaktiviteten for Biceps femoris kan potentielt reducere belastningen af knæet og derved lette træning og dagligsdagsaktiviteter, som indebærer dybe knæbøjninger. Det bør dog undersøges nærmere i studier med flere deltagere. Indsendt af: Forskningsfysioterapeut Carsten M. Mølgaard, (Ergoterapi- og fysioterapi afdelingen, Aalborg Sygehus) Uddannelse: PhD stud/Cand Scient San/Fysioterapeut E-mail: cmm@rn.dk / Telefon: 7269 0971 Forskningsansvarlig på afdelingen: Jane Andreasen  

15) Recruiting and maintaining theatre nurses in Danish University Hospitals Forfattere: Marianne Tewes, Anette S. Jakobsen, Ida Østrup Olsen, Erik Elgaard Sørensen Abstract: Background: Nurses have traditionally assisted surgeons in operating theatres. There will be a dearth of nurses in the future, which is one of the arguments for establishing new professions such as Surgical Technologist. However, no records consider the recruitment and maintenance of nurses in Operating Departments (OD) in Denmark Purpose: To examine activities, surgery assistance, workload, seniority, recruitment opportunities and staff turnover at OD’s in Danish University Hospitals over the past five years. Methodology: An electronic questionnaire with six main areas: Hospital and specialty; utilization of operating rooms and assistance; prescribed and staff composition; seniority; flow, and recruitment opportunities.13 hospitals and 54 OD’s participated; all surgical specialties were represented. Results: 24 departments participated (response rate: 44%). The surgical specialty was considered attractive 26

for younger and older nurses. The nurses had long seniority; thus the OD’s were characterised by experiencebased knowledge including options for high competence levels in attending the daily functions and tasks. Few changed their jobs while working in the OD. Respondents indicated that the main reasons for leaving the OD would be due to retirement and leave of absence; followed by work pressure and the burden of shift work. Only few changed their job due to lack of professional challenges and influence. It was not difficult to recruit qualified nurses to the surgical specialty. Implications for practice: It is possible to increase the recruitment of nurses to OD’s by articulating what surgical nursing consists of, as well as including OD’s in the clinical training of student nurses. Indsendt af: Kst. forskningsleder Erik Elgaard Sørensen, (Forskningsenhed for Klinisk Sygepleje, Aalborg Sygehus) Uddannelse: Cand.cur., ph.d. E-mail: ees@rn.dk / Telefon: 9932 6807 Forskningsansvarlig på afdelingen: Erik Elgaard Sørensen  

16) Effects of Nintendo Wii training on mechanical leg muscle function and postural balance in older adults: a randomized placebo-controlled trial Forfattere: Martin Grønbech Jørgensen, Uffe Læssøe, Carsten Hendriksen, Ole B.F. Nielsen, Per Aagaard Abstract: BACKGROUND: Older adults have an increased risk of falling. Major risk factors related to falling comprise of impaired muscle strength and postural balance. It is unknown whether biofeedback Nintendo Wii training (WII) can improve maximal voluntary contraction (MVC) and/or postural balance in older adults. METHODS: The present study was conducted as a randomized, placebo-controlled trial with older adults comparing 10 wks. of WII with daily use of insoles (CON). RESULTS: Of 212 subjects screened for eligibility, 154 (73%) were ineligible; thus, 58 (74.8 ± 5.9 yrs.) underwent randomization. The absolute change in MVC from pre-to-post intervention was 249.6 Newton (N) (+17.0%) for those assigned to WII and -19.9 N (-1.3%)


for subjects assigned to CON (absolute between group difference, 269.5 N; 95% confidence interval, 126.2 to 412.8; P<0.001). For Center of Pressure Velocity Moment (CoP-VM) the absolute change from pre-to-post intervention was -1.6 mm2/s (-7.8%) for the WII group and -1.6 mm2/s (-8.3%) for the CON group (absolute between group difference, 0.002 mm2; 95% confidence interval, -4.8 to 4.8; ns.). In secondary endpoints a statistical difference favoring the WII group was evident in Rate of Force Development (RFD) and various functional measures (P<0.05). Subjects rated the WII highly motivating (Likert scale) at 5 and 10 weeks of intervention. CONCLUSIONS: Biofeedback WII led to significant improvements in MVC, RFD and functional performance in older adults. Postural balance remained unaffected. The high level of motivation suggests that WII may ensure a high degree of compliance to home-based exercise programs using this system. Indsendt af: Ph.d. Studerende Martin Grønbech Jørgensen, (Geriatrisk Afdeling, Aalborg Sygehus) Uddannelse: Idrætsfysiolog (cand. scient.) E-mail: martin.joergensen@rn.dk / Telefon: 2014 8498 Forskningsansvarlig på afdelingen: Ole B. F. Nielsen  

17) Outcome of municipal rehabilitation evaluated by Dynamic Gait Index, Short Falls Efficacy Scale-International, 30-s Chair-Stand Test and Timed Up and Go in fall patients Forfattere: Villumsen, Morten, Nielsen, Ole Bruno Faurholt, Jørgensen, Martin Grønbech Abstract: BACKGROUND: It is well documented that the risk of falling increases with advancing age, especially amongst women. In addition, a history of falls is a strong predictor of future falls. OBJECTIVE: To examine the effectiveness of standard municipal rehabilitation on fall patients. METHODS: This study was an observational analysis of 48 fall patients (10 men and 38 women) with a mean age of 76.88 ±7.4. All patients were allocated to standard municipal rehabilitation by the Fall Prevention Clinic, Aalborg Hospital. The primary outcomes of interest were improvements in DGI, Short FES-I, 30-s Chair-Stand Test and TUG at 3 months follow up. One-

tailed unpaired t-tests and Mann Whitney U tests where applied appropriately to the scale type and the distribution of data. RESULTS: During 3 months of municipal rehabilitation DGI increased from 13 (Q1 = 10, Q3 = 15) to 15 (Q1 = 11.5, Q3 = 20) (p< 0.001; n = 41), 30-s Chair-Stand Test from 7.44 ± 3.185 to 8.44 ± 3.235 (p = 0.044; n = 40), whereas Short FES-I decreased from 14 (Q1 = 10.50, Q3 = 20) to 11 (Q1 = 9, Q3 = 13) (p<0.001; n = 21). CONCLUSIONS: Statistical significant improvements were observed in DGI, Short FES-I and 30-s Chair-Stand Test following 3 months of municipal rehabilitation in fall patients, however TUG remained unaltered in this patient group. It appears that a standard municipal rehabilitation regime has a clinical impact on fall patients in the Aalborg area. Indsendt af: Fysioterapeut Morten Villumsen, (Geriatrisk afdeling og Ergoterapi- og Fysioterapiafdelingen, Aalborg Sygehus) Uddannelse: Fysioterapeut, MSc i Klinisk Videnskab og teknologi E-mail: m.villumsen@rn.dk / Telefon: 9932 1668 Forskningsansvarlig på afdelingen: Ole Bruno Faurholt Nielsen  

18) Comparison of surgical and medical treatment methods for women with recurrent miscarriages Forfattere: Britta Lindberg, Ole B. Christiansen Abstract: Background: It is generally recommended to perform medical treatment with prostaglandin derivates rather than surgical treatment (curettage) after missed abortion (MA). In this study we compared the experience of women with recurrent miscarriage (RM) regarding the two treatments. Methods: Questionnaires were mailed to 233 women referred to a RM clinic from 2003 to 2010 who had a history of two or three MAs in the first trimester. Information was collected about abortion method, bleeding, pain, infection and discomfort associated with the treatment. Results: A total of 131 women responded. At the first MA, 57.8% experienced 1-7 days of pain after surgi27


cal compared with 89.2% after medical treatment (p < 0.001). At the second MA, 51.2% of those being surgically and 85.3% of those being medically treated suffered pain (p < 0.001). The duration and extent of vaginal bleeding was significantly longer in the latter group. There were signs of pelvic inflammation in 3.1% and 8.0% of the cases being surgically and medically treated, respectively (p = 0.06). On a VAS-score with level 10 indicating the highest possible discomfort, the median score was 4.2 and 4.4 for surgical and 7.3 and 8.2 for the medical treatment for the first and second MA, respectively. Conclusions: Women with RM had heavier and longer bleeding periods, longer pain duration, higher risk of pelvic inflammation and more discomfort undergoing medical compared with surgical treatment of MA. Women with RM therefore perhaps should be offered surgical rather than medical treatment after MA Indsendt af: Reservelæge Britta Lindberg, (Gynækologisk-obstetrisk Afdeling, Aalborg Sygehus) Uddannelse: cand. med. E-mail: brit_l@hotmail.com / Telefon: Forskningsansvarlig på afdelingen: Ole Bjarne Christiansen  

19) Gentagelsesrisiko for 2. trimester graviditetstab Forfattere: Reservelæge Kirstine Sneider Abstract: Baggrund: Præterm fødsel tegner sig for 75% af perinatal mortalitet og mere end 50% morbiditet. Risikoen for at udvikle komplikationer øges med faldende gestationsalder. Senabort og tidlig fødsel i forudgående graviditeter er i flere studier fundet at være associeret med øget risiko for gentagelse. Resultaterne er imidlertid modstridende, måske på grund af forskelle i selektionskriterier og stratificering. Formål: 1. At beskrive forløbet af efterfølgende graviditeter hos kvinder med tidligere 2. trimester senaborter/præterme fødsler. 2. At undersøge evt. association mellem udvalgte variable i forbindelse med kvindens første senabort/ præterme fødsel og risikoen for gentagelse, herunder gestationsalder, debutsymptomet, cervixlængde, flerfoldgraviditet samt behandling. 28

3. At identificere patientrelaterede risikofaktorer som alder, etnicitet, rygevaner, BMI, socioøkonomisk status og komorbiditet i forhold til gentagelsesrisikoen for 2. trimester graviditetstab. 4. At beskrive historiske- og regional forskelle i forebyggelses- og behandlingsstrategier. 5. At undersøge mulige sammenhænge mellem forældrenes fødselsvægt og gentagelsesrisikoen. Materiale og metode: Populationsbaseret kohortestudie på data fra Det Danske Fødselsregister 1997-2010. 3500 kvinder med > 1 senabort/fødsel mellem 15.og 28. uge identificeres. For disse kvinder udtrækkes gestationsalder, rækkefølge og øvrige tilgængelige oplysninger for samtlige kvindens graviditeter. Registeroplysningerne suppleres med personlige og socioøkonomiske data ved hjælp af spørgeskema udsendt pr post. Registeroplysninger og spørgeskema valideres ved journalgennemgang. Perspektiv: Dette studie vil øge forståelsen af epidemiologien bag tidlige graviditetstab og dermed danne grundlag for udarbejdelse af nationale retningslinjer. Det vil forsyne fødsels- og fertilitetslæger med pålidelige danske data omkring gentagelsesrisiko og risikofaktorer og dermed forbedre mulighederne for evidensbaseret vejledning af kvinder med tidligere senabort/præterm fødsel. Indsendt af: Reservelæge (ph.d. studerende pr 1/4-2012) Kirstine Sneider, (Gynækologisk-Obstetrisk Afdeling, Aalborg Sygehus) Uddannelse: Læge E-mail: k.sneider@rn.dk / Telefon: 2464 9856 Forskningsansvarlig på afdelingen: Ole Bjarne Christiansen  

20) 14 basepar insertion i exon 8 på det maternelle HLA-G gen er associeret til lav soluble HLA-G koncentration under graviditet Forfattere: Klitkou L., Piosek Z., Djurisic S., Hviid T.V.F., Christiansen O.B. Abstract: Introduktion: HLA-G er det dominante HLA molekyle på humane trofoblastceller. Membranbundet og soluble HLA-G modificerer sandsynligvis det maternelle immunrespons mod trofoblastcellerne. Lav plasmakoncentration af soluble HLA-G før graviditeten tyder på at


disponere til gentagne aborter.En 14 basepar (14 bp) insertion på exon 8 på HLA-G genet reducerer stabiliteten af HLA-G m-RNA og tidligere studier har vist at homozygoti for denne insertion er associeret til meget lave koncentrationer af soluble HLA-G i plasma hos ikke-gravide personer. Der er imidlertid ingen viden om hvorvidt HLA-G 14 bp polymorphismen er associeret til koncentrationen af soluble HLA-G hos gravide. Materiale og metode: 27 kvinder med ukomplicerede singleton graviditeter blev inkluderet i studiet i 20. gestationsuge, hvor de fik taget blodprøve. Den maternelle HLA-G 14 bp genotype blev bestemt vha PCR og plasmakoncentrationen af soluble HLA-G blev målt vha ELISA test. Resultater: 10 kvinder (37,0%) var homozygote for HLA-G 14 bp deletionen, 11 (40,7%) var HLA-G 14 bp insertion/deletion heterozygote og 6 (22,2%) var homozygote for HLA-G 14 bp insertionen. Mean soluble HLA-G koncentration (SD) var 266,0 U/ ml (81,4), 197,6 U/ml (81,2) og 176,0 U/ml (71,3) hos kvinder, der havde henholdsvis 0,1 eller 2 HLA-G 14 bp alleler. Koncentrationen af soluble HLA-G faldt signifikant i takt med antallet HLA-G 14 bp insertions alleler (p < 0,02). Konklusion: Disse resultater bekræfter at sammenhængen mellem lav soluble HLA-G og HLA-G 14 bp insertionen, der tidligere er fundet hos ikke gravide individer også er til stede hos gravide kvinder i 2. trimester. Fremtidige perspektiver er at komme nærmere en forklaring på problematikken omkring abortus habitualis og evt. behandle disse. Indsendt af: Forskningsassistent Louise Klitkou, (Gynækologisk/Obstetrisk Afdeling, Aalborg Sygehus) Uddannelse: gennemført intro uddannelse i gynækologi og obstetrik E-mail: louise.klitkou@.dk / Telefon: 31 71 99 69 Forskningsansvarlig på afdelingen: Ole Bjarne Christiansen  

21) Peroperativ kontaminering af kirurgiske handsker Forfattere: Lars B. Møller, Tove Ejlertsen, Bodil S. Rasmussen, Dorthe Aaen, Martin A. Nørgaard. Abstract: Dyb sternuminfektion og protese-endokarditis er en sjælden men frygtet komplikation til åben hjertekirurgi. Formålet med dette studie var at undersøge den per-

operative tilstedeværelse af bakterier på kirurgens og operationssygeplejerskens handsker i forbindelse med åben hjertekirurgi og relatere dette til bakteriefloraen i patientens dybe luftveje. Metode: 20 patienter, indlagt til elektiv åben hjertekirurgi, blev inkluderet i studiet. Umiddelbart før administration af antibiotika, blev der udtaget præoperative prøver fra patientens dybe luftveje. Peroperativt blev der taget prøver fra kirurgens og operationssygeplejerskens handsker efter sternotomi, hvorefter begge skiftede handsker. På samme vis blev der igen taget handskeprøver ved operationens afslutning efter lukning af huden. Resultater: På trods af at man fulgte anbefalede perioperative forholdsregler til forebyggelse af infektion, så blev der fundet såvel Propionebacterium acnes (P. acnes) som koagulasenegative stafylokokker (KNS’er) på kirurgens og operationssygeplejerskens handsker. P. acnes blev dyrket fra kirurgens handsker i 14 tilfælde efter sternotomi og i 12 tilfælde efter lukning af huden. KNS’er blev isoleret i henholdsvis 6 og 7 tilfælde. Tilsvarende isolater blev fundet i dyrkninger fra operationssygeplejerskens handsker. De bakterier, som blev dyrket fra patienternes dybe luftveje, havde ingen relation til de bakterier, som blev isoleret fra handskerne. Konklusion: Tilstedeværelsen af potentielt patogene bakterier på kirurgens og operationssygeplejerskens handsker kan spille en rolle i udviklingen af postoperativ dyb sternuminfektion og infektion i relation til protesemateriale. Disse fund kan understøtte, at man peroperativt skifter handsker før håndtering og indsættelse af protesemateriale og non-resorberbart materiale som f.eks. hjerteklapproteser og knoglevoks. For at belyse effektiviteten af dette tiltag kræves yderligere studier. Indsendt af: 1. reservelæge Lars Borgbjerg Møller, (Hjerte- lungekirurgisk afdeling, Aalborg Sygehus) Uddannelse: Læge E-mail: larmoe@rn.dk / Telefon: 9932 4887 Forskningsansvarlig på afdelingen: Ovl. Jan Jesper Andreasen  

22) Patientoplevelser med Hjerterehabilitering efter Hjertekirurgi Forfattere: Margrethe K, Bisgaard, Barbara C. Brocki Abstract: Hjerterehabilitering tilbydes patienter efter hjertekirurgiske indgreb. Formålet er at forbedre patientens funktionsniveau, fjerne eller mindske aktivitetsrelaterede 29


symptomer, minimere graden af invaliditet og gøre det muligt for patienten at vende tilbage til en personligt tilfredsstillende rolle i samfundet. I Hjerte-Lungekirurgisk Afdeling har vi tilbudt hjerterehabilitering siden 1996, og har til stadighed justeret samt forbedret tilbuddet. For at gøre dette på baggrund af den patientoplevede kvalitet, inviterede vi 16 tidligere patienter, til to semistrukturerede fokusgruppeinterview. De 16 patienter havde deltaget i afdelingens hjerterehabilitering indenfor de sidste 6 måneder. De emner, der blev evalueret var den fysiske træning og om patientinformation og undervisning fik patienterne til at ændre adfærd i forhold til at ændre livsstil, blandt andet rygeoophør og kostomlægning. Teamet bag rehabilitering er multidisciplinært og består af fysioterapeut, sygeplejersker og læge fra afdelingen samt en diætist. Programmet forløber over 6 uger, med start 4-6 uger efter udskrivelsen, og består af to timers seancer, der starter med fysisk træning og efterfølges af information/ undervisning. Resultatet fra fokusgruppeinterviewet var overvejende positivt, og patienterne påpegede enkelte områder, der med fordel kunne justeres. Patienterne udtalte, at det var meget vigtigt for dem at træne på sygehuset, hvor de oplevede større tryghed end hjemme fordi de var i professionelle hænder. De mødte ligestillede, der havde lignende symptomer, hvilket gjorde det lettere for dem, at acceptere og at leve med det. Tilsyneladende var det svært for dem, at holde aktivitetsniveauet ved lige, efter endt rehabilitering, og gamle vaner blev genoptaget. Klinisk praksis er justeret blandt andet på baggrund af fokusgruppeinterviewene, og fornyet interview er planlagt. Indsendt af: Oversygeplejerske Margrethe K. Bisgaard, (Hjerte-Lungekirurgisk Afdeling, Aalborg Sygehus) Uddannelse: Sygeplejerske, SD, MPA E-mail: mkb@rn.dk / Telefon: 9932 4888 Forskningsansvarlig på afdelingen: Jan Jesper Andreasen  

23) Det hjælper at gøre en indsat for at reducere brugen af blodtransfusion Forfattere: Jan J. Andreasen, Jesper E. Sindby, Barbara C. Brocki, Bodil S. Rasmussen. (Hjerte-Lungekirurgisk afdeling og Thoraxintensiv afsnit, Kardiovaskulært forkningscenter). Abstract: Baggrund: Generelt er blodtransfusion hyppig i Nordjylland. Blodtransfusion er imidlertid forbundet med en øget risiko for komplikationer og død ved hjertekirurgi, 30

og derfor bør blodforbruget om muligt reduceres. Formål: At under undersøge langtidseffekten efter en tværfaglig, multimodal indsats med henblik på at reducere brugen af blodtransfusion ved planlagt koronar bypasskirurgi (CABG). Metode: I alt 450 patientjournaler fra patienter der gennemgik en planlagt CABG (150 fra hvert af årene 2004, 2008 og 2010) blev gennemgået retrospektivt med henblik på at sammenligne transfusionspraksis over tid. Patientmaterialet var sammenligneligt igennem perioden. Siden 2005 har der været øget fokus på transfusionspraksis og anvendelse af blodbesparende foranstaltninger. Indsatsen bestod bl.a. af følgende: Tilbagevendende undervisning og information vedrørende resultater fra transfusionsaudits, indførelse af en algoritme til håndtering af postoperativ blødning herunder indførelse af tromboelastometri. En algoritme vedrørende systematisk præoperativ pausering med trombocythæmmende medicin blev indført, ligesom en systematisk anvendelse af fibrinolyse profylakse blev rutine. Alt dette skete samtidig med at sygehuset indførte et transfusionsskema med angivelse af generelle retningslinjer for transfusion. Resultater: Andelen af patienter som fik blodtransfusion faldt fra 64% til 47% i undersøgelsesperioden, og andelen af patienter, som fik en unødvendig blodtransfusion med røde blodlegemer (defineret ved en hæmoglobinkoncentration på >7 mmol/l efter transfusion med røde blodlegemer) faldt fra 36% til 16%. Konklusion og perspektiv: En tværfaglig multimodal indsat for at optimere transfusionspraksis bærer frugt også på lang sigt, og modellen der her er blevet benyttet i forbindelse med hjertekirurgi vil formentlig også kunne benyttes i andre specialer. Indsendt af: Ledende overlæge Jan Jesper Andreasen, (Hjerte-Lungekirurgisk afdeling, Kardiovaskulært Forskningscenter, Aalborg Sygehus) Uddannelse: Speciallæge i Thoraxkirurgi, PhD E-mail: jja@rn.dk / Telefon: 9932 2964 Forskningsansvarlig på afdelingen: Jan Jesper Andreasen  

24) CK-MB værdi efter OPCAB Forfattere: Jesper Eske Sindby Simon Lykkeboe Martin A. Nørgaard Abstract: Abstract Ved bypass-kirugi uden brug af hjerte-lunge-maskine (OPCAB) er der kort varighed af manglende blodforsyning til det distale område af hjertet. Deraf må følge at


koronar-markør udslip må afhænge af antallet af distale anastomoser (bypass) der udføres. Metode: Resultater fra 300 OPCAB-opereret patienter blev samlet; data om infarkter, antallet af anastomoser, CK-MB-værdier, EKG, EKKO-fund og KAG fund postoperativt. Antallet af anastomoser og den højeste CK-MB værdi blev sammenlignet. Resultat: Af 300 patienter havde 14 et infarkt under eller lige efter operation. De patienter MED infarkt havde alle en CK-MB værdi over 51mmol/l. Og af patienter UDEN infarkt var den højeste værdi 38,5 mmol/l. Der var en linær sammenhæng mellem antallet af anastomoser og enzym-udslip. Hældningen på linjen er meget flad og har derfor ikke klinisk betydning. Konklusion: Vi foreslår en grænse på 40 mmol/l efter OPCAB-procedure for hvornår man skal mistænke infarkter og foretage KAG mhp re-operation eller anden intervention. Grænsen på 40 mmol/l er det halve af hvad man bruger ved konventionel BYPASS kirurgi. Når man således vurderer BYPASS-patienter postoperativt skal man ikke bekymre sig om hvor mange anastomoser/omkørsler de har fået foretaget, men mere hvilket teknink (+/- hjertelungemaskine) der er blevet brugt og om man så derfor skal have en lavere grænse for hvornår man skal mistænke komplikationer. Indsendt af: Reservelæge Jesper Eske Sindby, (Hjertelungekirurgisk afd.T, Aalborg Sygehus) Uddannelse: Læge i hoveduddannelse i Thorax-kirurgi. E-mail: jeess@rn.dk / Telefon: 2685 5955 Forskningsansvarlig på afdelingen: Jan Jesper Andreasen  

25) Kvalitetssikring af koronar-anastomoser - Back to Basics Forfattere: Niels-Henrik Staalsen Abstract: I dag findes der ikke nogen alment accepteret metode til, under operationen, at kvalitetssikre vores karsammensyninger (anastomoser) mellem bypass grafter og hjertet ved CABG-operationer. Når bedst anvendes flowmåling (hvor mange ml. løber der i graften pr. minut?) - Flowet gennem graften er en dårlig indikator for anastomosernes kvalitet, og omkring 9 % af disse er >50 % forsnævrede umiddelbart efter operationen. Høj-frekvent (>10 MHz) epicardiel ekkokardiografi er en

lovende metode til at visualisere geometrien/anatomien af vores anastomoser, idet den temporale og spatielle opløsning er blevet tilstrækkelig god. Formål: At muliggøre/standardisere intraoperativ højfrekvent eckkokardiografisk billeddannelse af CABGanastomoser på en ”easy-to-do måde”. Metode: 80 kg grise, opereret med OPCAB-teknik, LIMA-LAD; blev anvendt som dyremodel til udvikling af måleprincippet på både end-to-side og side-to side anastomoser. Anastomoseplacering/geometri, anæstesi/ væsketerapi var standardiseret. BT, CVP, graftflow, CO og EKG blev simultant optaget/gemt/analyseret off-line. En 13 MHz ultralyds-transducer anvendtes sammen med en Vivd4 ekko-maskine (General Electric) mhp. at lave ekkooptagelser af anastomoserne. Der udvikledes en transducer-stabiliserende-og-positionerings device (Echoclip). Denne ”device” løser 3 problemer: Den stabiliserer anastomoseområdet og ”holder gelen på plads” uden at deformere anastomoseområdet. Der udvikledes en ”måleprotokol for visualisering af både end-to-side og side-to-side anastomoser = alle mulige koronaranastomoser. Resultater Diskussion: Da undersøgelse/fortolkning af ekkobilleder anses for både intra- and interoperator afhængige, bør ”udviklingen” gøre alt for at standardisere ekkokardiografisk målemetoder på CABG anastomoser. Echoclip devicen hjælper med at standardisere ekkokardiografisk billededannelse af CABG anastomoser på en ”easy-todo måde”. Indsendt af: Afdelingslæge, phd, Post Doc Niels-Henrik Staalsen, (Hjertelungekirurgisk Afdeling, Aalborg Sygehus) Uddannelse: Cand.med., phd, speciallæge i thoraxkirurgi E-mail: nhstaalsen@gmail.com / Telefon: 4234 5591 Forskningsansvarlig på afdelingen: Jan Jesper Andreasen  

26) Assessment of reproducibility of microarray experiments by semi-parametric mixture models applied to the detection of differentially expressed genes in B-cell subpopulations Forfattere: Anders Bilgrau1,2, Kim Steve Bergkvist1, Malene Krag Kjeldsen1, Steffen Falgreen1, Maria Rodrigo-Domingo1,2, Alexander Schmitz1, Julie Støve Bødker1, Mette Nyegaard1, Hans Erik Johnsen1, Karen Dybkær1, Jakob 31


Gulddahl Rasmussen2 and Martin Bøgsted1. 1) Department of Haematology, Aalborg Hospital, Aarhus University Hospital, 2) Department of Mathematical Sciences, Aalborg University

27) Overall agreement between SNP6.0 and cytogenetic 2.7M whole-genome microarrays from Affymetrix

Abstract: Detection of differential expression of thousands to millions of transcripts using microarrays between groups of biological samples with varying phenotypes and a small number of repeated measurements is a highly popular task in cancer research. However, there is substantial variability in the lists of differentially expressed transcripts produced by multiple studies, as high signalto-noise ratios are intrinsic to such experiments. The pivotal scientific principle of reproducibility has been somewhat overlooked. When done, the current method of assessment of reproducibility is by statistical tests such as Spearman rank correlation, Venn-diagrams, or simply judgment on the researchers part; all of which are statistically problematic. At best, the results are validated which, as we argue, cannot entirely be equated with a measure of reproducibility. We expand and apply a more rigorous concept of reproducibility based on semi-parametric mixture models introduced by Li et al. (Ann. of Appl. Stat., 2011) to assess the reproducibility of identified differentially expressed genes between B-cell subpopulations across different microarray platforms and patient samples. These reproducibility concepts involve both easy-to-interpret exploratory tools and the more sophisticated mixture-model to classify transcripts into an irreproducible and a reproducible group. The developed statistically methodology is widely applicable and capable of combining the reproducibility between interplatform, interpopulation, and even meta analysis of cancer studies to gain more statistical powerful conclusions and adhere to the scientific method and ensure reliable cancer research. Furthermore, the tool can be used for selecting the statistical methodologies and laboratory techniques that yield the highest reproducibility.

Forfattere: Julie Støve Bødker(1), Preben Johansen(2), Claus Gyrup(3), Alexander Schmitz(1), Paw Jensen(1), Hans Erik Johnsen(1), Martin Bøgsted(1), Karen Dybkær(1), and Mette Nyegaard(1), 1) Department of Haematology, Aalborg Hospital, Aarhus University Hospital, Denmark. 2) Department of Pathology, Aalborg Hospital, Aarhus University Hospital, Denmark. 3) Department of Biotechnology, Chemistry and Environmental Engineering, Aalborg University, Denmark.

Indsendt af: Biostatistiker/Specialestuderende Anders Ellern Bilgrau, (Hæmatologisk, Aalborg Sygehus) Uddannelse: B.Sc. i anvendt matematik/statistik E-mail: a.bilgrau@rn.dk / Telefon: 2533 7253 Forskningsansvarlig på afdelingen: Hans E. Johnsen  

Abstract: The Affymetrix SNP6.0 genome wide array is commonly used in research for detection of genomic alterations in many different sample types. In 2009 Affymetrix launched the cytogenetic 2.7M whole-genome array (Cyto2.7M), which only required 100 ng of genomic DNA (five times less than the SNP6.0 array). This reduced processing time approximately four times to one day and increased coverage in cancer related genes. While the SNP6.0 array is widely used in cancer research, the use of the 2.7M arrays on cancer samples has not previously been reported. We compared the performance of the two types of array on eight cancer samples of diffuse large B-cell lymphoma, a hematological cancer type associated with a large number of deletions and amplifications. We compared the two array types with respect to the size and breakpoints of the detected alterations, the actual copy number assigned to the copy number variations and finally loss of heterozygosity. Overall we found very good consistency between the two types of arrays on all parameters tested, even in regions with very complex changes. Copy number detection using quantitative PCR in regions of inconsistent array results, matched the Cyto2.7M and the SNP-6 arrays in two and four regions, respectively. In conclusion, the high degree of consistency between the array types suggests that the 2.7M array is well suited to detect genomic aberrations for cancer samples, and because of the lower input requirements, this could enable genomic analysis of samples where only limited DNA is available. Indsendt af: Post doc Julie Støve Bødker, (Hæmatologisk Afdeling, Aalborg Sygehus) Uddannelse: Cand. scient, PhD i Molekylærbiologi E-mail: j.boedker@rn.dk / Telefon: 9932 6933 Forskningsansvarlig på afdelingen: Karen Dybkær  

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28) Generation of a Documented Technique for Genetic Studies of Small Discrete Populations of Normal and Malignant B Cells Forfattere: Kim Steve Bergkvist (PhD student)(1), Alexander Schmitz(1), Martin Perez (Guest professor)(1), Julie Støve Bødker(1), Michael Gaihede(2), Martin Agge Nørgaard(3), John Bæch(4), Marie-Louise Grønholdt(5), Frank Svendsen Jensen(6), Jannie Lassen Pedersen(1), Martin Boegsted(1), Karen Dybkaer(1), Mette Nyegaard(1) and Hans E Johnsen(1) (1) The Research Laboratory, Department of Haematology, (2)Otorhinolaryngy, Head and Neck Surgery, (3)Cardiothoracic Surgery, (4) Clinical Immunology, (5) Vascular Surgery, (6) Abdominal Surgery Abstract: The B cell differentiation initiates in the bone marrow from a lymphoid stem cell, which eventually leads to the end stage plasma cell, located in peripheral lymphoid tissue. Differentiation is a stepwise process in a range of small and discrete subpopulations, regulated by genetic events or signalling pathways in the normal, but also the neoplastic phenotype of the B cell disease spectrum from leukaemia and lymphoma to multiple myeloma. Therefore, the Working Hypothesis of this PhD Project is that global gene expression analysis of the different subpopulation in the process, can improve our pathogenetic understanding. However, this is hampered by the fact that several subsets are small and there is no documented procedure for gene expression analysis of minor subsets. Assisted by the technologies for multi-parametric flow cytometry and single cell sorting as well as microarray gene assays, The Aims are 1) to generate a laboratory procedure for handling small numbers of flow sorted B cells for microarray analysis 2) to establish gene expression profiles (GEP) from normal B subpopulations in tonsils, bone marrow, blood, lymph fluid, lymph nodes, thymus and spleen. Results: A method has been established for genomic studies of flow sorted small B cell subpopulations, showing successfully amplification from a minimum of 2500-5000 cells for array analysis. Discriminatory GEP could be generated for naïve, centrocytes, centroblasts, memory and plasmablasts in normal tonsils. Perspectives: Increased insight in the molecular mechanisms in normal and malignant B subsets may improve the cancer diagnosis and treatment. Indsendt af: Ph.d. studerende Kim Steve Bergkvist, (Hæmatologisk afdeling, Aalborg Sygehus) Uddannelse: Ingeniør, Bioteknologi E-mail: kisb@rn.dk / Telefon: 2659 6170 Forskningsansvarlig på afdelingen: Karen Dybkær

 29) The role of miRNA and AID in B-

cell malignancies

Forfattere: Maria Bach Laursen, Hans E. Johnsen and Karen Dybkaer Department of Haematology, Aalborg Hospital, Aarhus University Abstract: miRNA deregulation is often associated with cancer, and given the importance of miRNA in developing and maintaining cellular fate, it is expected to play a profound role in cancer formation and progression. Deregulation of mature miRNA may take place at the level of biogenesis as a result of mutations in the miRNAtranscripts. In B-cell malignancies, such mutations could be caused by AID (Activation Induced cytidine Deaminase), a mutagenic factor which initiates antibody diversification by deaminating C to U in the immunoglobulin variable region. Thus, in healthy B-cell development, AID is tightly regulated; its expression is only transiently and specifically induced in Germinal Center (GC) B-cells. Accordingly, aberrant and constitutive expression of AID has been shown to cause accumulation of point mutations in non-Ig targets, such as proto-oncogenes. However, the effect of AID on miRNA transcripts has never been investigated. The hypothesis of the study is that aberrantly expressed AID leads to miRNA-transcript mutation that may impair miRNA biogenesis and thus result in deregulated miRNA expression. This will be investigated by: 1) analysing miRNA arrays and GEP data from DLBCL patient samples to identify differentially expressed miRNA in samples with high AID level 2) performing mutation screening of miRNA genes using High Resolution Melt (HRM) analysis 3) quantifying the amount of pri-, pre- and mature miRNA of the differentially expressed miRNA by Northern blot analysis 4) siRNA knockdown of AID in DLBCL cell lines to validate differentially expressed miRNA. Improved molecular understanding of B-cell-malignancies may contribute to better diagnosis and treatment. Indsendt af: Ph.d.- studerende Maria Bach Laursen, (Hæmatologisk Afdeling, Aalborg Sygehus) Uddannelse: Molekylærbiolog E-mail: mabala@rn.dk / Telefon: 2246 9794 Forskningsansvarlig på afdelingen: Karen Dybkaer  

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30) A reproducible probe level data analysis workflow for Affymetrix Exon arrays using aroma-affymetrix

31) Intrakraniel trykmonitorering og behandling ved communit-acquired bakteriel meningitis - 10års opgørelse

Forfattere: Maria Rodrigo-Domingo (1,2), Maria Bro Kloster (1), Anders Bilgrau (1,2), Steffen Falgreen Larsen(1), Julie Støve Bødker (1), Alexander Schmitz (1), Mette Nyegaard (1), Hans Erik Johnsen (1), Karen Dybkær (1), Rasmus Waagepetersen (2) and Martin Bøgsted (1), (1) Department of Haematology, Aalborg Hospital, Aarhus University Hospital, (2) Department of Mathematical Sciences, Aalborg University

Forfattere: Ulla Hjort, Infektionsmedicinsk Afd. Preben Sørensen, Neurokirurgisk Afd. Pernille Haure, Neuroanæstesiologisk Afd.

Abstract: Alternative splicing is the post-transcriptional process by which a single gene can produce multiple transcripts and thereby protein isoforms. Both healthy and malignant cells present alternative splicing, and some aberrant splicing patterns have been associated with disease phenotypes. The presence of different transcripts of a gene across several groups can be analyzed by wholetranscript microarrays, such as the Affymetrix Exon 1.0 ST array. Methods and software to handle standard analysis of the vast amount of data are now well established. However, to explore the full potential of the exon array new analysis tools should be developed. Nevertheless, not much methodological research is carried out by statisticians in this area as data is difficult to understand and dissect. An alternative to the traditional gene/exon level approach to the study of differential gene expression and splicing is a probe-level analysis. A basic requirement for this analysis is direct access to raw data and documentation of the entire data analysis workflow. We give a detailed tutorial on how to perform probe-level analysis by the Bioconductor package aroma.affymetrix and provide two examples of applications. First, we demonstrate, on a publicly available data set, differential splice detection by probe-level algorithms based on linear mixed effect models. Then we use probe-level analysis for detecting potential new cancer specific transcripts in a dataset from our own laboratory. We believe the present work will provide other researchers with an easy access to raw data and therefore sufficient details to develop their own analysis tools for the exon array. Indsendt af: PhD studerende Maria Rodrigo-Domingo, (Hæmatologisk Afdeling, Aalborg Sygehus) Uddannelse: Matematik-statistik E-mail: mariarodrigo@rn.dk / Telefon: 4297 8781 Forskningsansvarlig på afdelingen: Hans E. Johnsen   34

Abstract: Baggrund: Community-acquired bakteriel meningitis (CABM) er trods relevant antibiotika,dexamethasone og neurointensiv behandling fortsat forbundet med høj mortalitet og morbiditet. Pneumokokker og Meningokokker udgør 80-85% af tilfældene med mortalitet på henholdsvis 26% og 10%. 1/3 af overlevende har svære neurologiske sequelae. Medvirkende til dette, kan være det forhøjede intrakranielle tryk(ICP),som kan medføre iskæmi og incarceration. Formålet med studiet var at monitorere ICP hos patienter med CABM med klinisk mistanke om forhøjet ICP. Persisterende forhøjet ICP>20mmHg blev behandlet med extern ventrikeldrænage(EVD)eller decompressiv craniektomi. Mortalitet og morbiditet er opgjort. Værdien af CTcerebrum til at prædiktere forhøjet ICP er vurderet. Metode og materiale: Retrospektiv opgørelse af patienter med CABM indlagt på Intensiv Afd.,Aalborg Sygehus i perioden 1.1.2002 til 31.12.2011. ICP blev monitoreret med Caminotrykmåler. EVD-anlæggelse foregik med silikonedræn via borhul. Resultater: 52 patienter(medianalder52.5) blev inkluderet. 30 patienter(medianalder54.5)fik foretaget ICP-monitorering. 14(medianalder 42)af de 30 patienter havde et persisterende ICP>20mmHg(range25-70mmHg) og fik derfor anlagt EVD i gennemsnitlig 6.7dage. Hos 2(medianalder 36.5)med persisterende ICP>30mmHg blev foretaget decompressiv craniectomi. Kun hos 6 af 14 (42.8%), som ved intrakraniel trykmonitorering havde ICP>20mmHg, var der CT-forandringer, der gav mistanke om forhøjet ICP. Hos 10 af 14 (71.4%) med persisterende ICP>20mmHg var bakterieætiologien Pneumokokker. Den samlede mortalitet var 11.5% (medianalder 68). Hos de 14 patienter,som behandledes med EVD og craniektomi var mortaliteten 7.1% (54år) En patient havde en mindre cikatriceblødning efter trykmålerseponering. En patient udviklede ventrikulit med koagulasenegative stafylokokker efter drænseponering. Konklusion: Studiet viser,at der er indikation for, at patienter med CABM og klinisk mistanke om forhø-


jet ICP bliver ICP-monitoreret. Kun hos 42.8% med ICP>20mmHg var der CT-forandringer,der kunne prædiktere et forhøjet ICP. Flere patienter havde betydeligt forhøjet ICP, hvor vi vurderer, at aflastning med EVD eller decompressiv craniektomi kan have betydning for mortaliteten og morbiditeten. Indsendt af: Overlæge Ulla Hjort, (Infektionsmedicinsk Afd, Aalborg Sygehus) Uddannelse: Speciallæge i infektionsmedicin E-mail: ulh@rn.dk / Telefon: 9932 6530 Forskningsansvarlig p�� afdelingen: Prof., overlæge Henrik Nielsen  

32) Atrial Fibrillation: Ablation or Surgical Treatment II: FAST II Forfattere: H. Vadmann1, J.J. Andreasen2, S. Hjortshøj1, E.B. Schmidt1, S. Riahi1, 1) Kardiologisk Afdeling, Aalborg Sygehus, Aarhus Universitetshospital, 2) Hjerte-Lungekirurgisk Afdeling, Aalborg Sygehus, Aarhus Universitetshospital. Abstract: Introduktion: Nyere forskning tyder på, at væv lokaliseret i lungevenernes indmunding i venstre atrium indeholder ”trigger”-områder, som kan starte atrieflimren. Nyere behandlingsprincipper har derfor rettet fokus mod at stoppe udbredelsen af impulser fra ”trigger”områderne og elektrisk isolation af lungevenerne med perkutan radiofrekvens kateter ablation (P-RFA), og kirurgisk mini-invasiv torakoskopisk radiofrekvens ablation (K-RFA) har specielt været i fokus. K-RFA er i sin nuværende form en forholdsvis ny behandling, men selvom behandlingen er veletableret, er de langsigtede resultater stadig ukendte. Resultater fra randomiserede studier med direkte sammenligning af P-RFA og K-RFA som førstegangsbehandling er endnu ikke publiceret. Formål: Formålet med dette forsøg er at undersøge P-RFA og K-RFA hos patienter med symptomatisk paroksystisk atrieflimren. Forsøget går ud på at finde den mest effektive behandling med færrest mulige komplikationer. Vi ønsker desuden at undersøge, i hvilket omfang de to behandlingsmetoder forbedrer livskvalitet, samt at foretage en sundhedsøkonomisk analyse for at vurdere hvilken behandlingsmetode, der giver mest sundhed for pengene. Hypotese: Hypotesen er, at K-RFA er mere effektiv end P-RFA hos patienter henvist til invasiv behandling for første gang.

Materialer og metode: 180 patienter skal inkluderes i forsøget, som løber fra foråret 2011 til foråret 2014. Det er et randomiseret forsøg i samarbejde mellem Kardiologisk og Hjerte-Lungekirurgisk Afdeling på Aalborg Sygehus og St. Antonius Hospital, Nieuwegein, Holland. Endepunkt: Det primære endepunkt er prævalensen af atrieflimren, vurderet ved 7 døgns Holter monitorering, EKG og patientsymptomer efter 6 og 12 måneders opfølgning. Sekundære endepunkter i form af livskvalitet og sundhedsøkonomi vurderes ved hjælp af spørgeskemaer. Indsendt af: Reservelæge, ph.d.-studerende Henrik Vadmann, (Kardiologisk afdeling, Aalborg Sygehus) Uddannelse: Læge E-mail: henrik.vadmann@rn.dk / Telefon: 2125 6972 Forskningsansvarlig på afdelingen: Erik Berg Schmidt  

33) ICD-elektrodevalg og defibrilleringstest - et retrospektivt nationalt kohorte studie Forfattere: Larsen JM, Nielsen JC, Johansen JB, Hjortshøj SP, Jørgensen OD, Lundbye-Christensen S, Videbæk R, Haarbo J, Thøgersen AM og Riahi S. Abstract: Introduktion: Profylaktisk behandling med implanterbar cardioverter defibrillator (ICD) er veldokumenteret og effektiv som forebyggelse af pludselig hjertedød hos selekterede højrisikopatienter. Kliniske faktorer der bestemmer valget mellem enkelt-coil og dobbelt-coil stødelektroder og anvendelsen af defibrilleringstest ved ICD-implantation er dårligt belyst. Den kliniske betydning af elektrodevalget og anvendelsen af defibrilleringstest er ligeledes uklar. Formål: Primært formål er at beskrive udviklingen i valget af stødelektroder og anvendelsen af defibrilleringstest ved ICD implantation fra 2007 til 2011 i Danmark, og identificere up-to-date kliniske prædiktorer for valg af stødelektrode og defibrilleringstest. Sekundært formål er at undersøge betydningen af elektrodevalget og defibrilleringstest for mortalitet. Metode: Studiet er et retrospektivt kohortestudie baseret på alle danske patienter med en førstegangs ICD-implantation fra 2007 til 2011. Studiet størrelse estimeres til ca. 5.000 patienter. Tekniske og kliniske data fra ICDimplantation og ambulant opfølgning fås via Dansk ICD 35


Register. Supplerende data om diagnoser på tidspunktet for ICD-implantation til vurdering af komorbiditet fås via Landspatientregistret. Data fra 2010-2011 anvendes til at identificere up-to-date kliniske prædiktorer med multivariabel logistiske regression. Forskelle i mortalitet undersøges med multivariabel Cox regression. Resultater: Studiet er under udarbejdelse. Resultater foreligger endnu ikke. Perspektiv: Studiet vil bidrage med viden til optimering af valget af stødelektrode og anvendelse af defibrilleringstest ved ICD-implantation i klinisk praksis. Indsendt af: Ph.d.-studerende Jacob Moesgaard Larsen, (Kardiologisk Afdeling, Aalborg Sygehus) Uddannelse: Læge E-mail: jaml@rn.dk / Telefon: 2239 1625 Forskningsansvarlig på afdelingen: Erik Berg Schmidt  

34) Metoder til detektion af myokardiel viabilitet Forfattere: Thamilini Yogathas, stud.med. og overlæge PhD Svend Eggert Jensen, Kardiologisk afdeling, Aalborg Sygehus, Aarhus Universitetshospital. Abstract: Baggrund: Ved kronisk total okklusion (CTO) af en af hjertets kranspulsårer, er der hos den symptomatiske patient ofte behov for at detektere levedygtigt væv (viabilitet) forud for eventuel revaskulariserende behandling. Guldstandarden er FDG-PET, som imidlertid er både dyr og ressourcekrævende og derfor ikke er tilgængelig alle steder. Alternativt anvendes MR-skanning (CMR) eller dobutamin-ekkokardiografi (DSE) mange steder. Formål: At give et overblik over den eksisterende sammenlignende litteratur. Metode: Systematisk søgning i PubMed-databasen i perioden år 2000 til december 2011. Artiklernes relevans blev vurderet ved gennemlæsning af abstracts. Resultater: Der blev fundet ialt 44 engelskssprogede referencer. Af disse er 34 reviews, mens de resterende er originale arbejder. De originale arbejder omhandler en eller flere af skanningsmetoderne, men ingen originalarbejder omhandler en direkte sammenligning af de 3 modaliteter FDG-PET, CMR og DSE. Der findes at være overensstemmelse mellem FDG-PET og CMR hvad angår udbredelsen af arvæv i myokardiet, og der ses at være god overensstemmelse i detektionen af myokardiel 36

viabilitet. Ved FDG-PET og DSE findes også høj grad af overensstemmelse med hensyn til viabilitet, dog viser PET sig at have en højere sensitivitet end DSE, mens DSE har en højere specificitet end FDG-PET. Konklusion: Alle 3 skanningsmetoder anvendes ved undersøgelse for myokardiel viabilitet. Tilsyneladende er CMR bedst i stand til at finde de helt små infarkter, mens FDG-PET og DSE formentlig giver bedst information om det viable væv. Perspektiv: Der er brug for en klinisk undersøgelse, der prospektivt sammenligner forekomsten af viabilitet ved modaliteterne FDG-PET, DSE og CMR i en kohorte med CTO. Indsendt af: Stud.med. Thamilini Yogathas, (Kardiologisk Afdeling, Aalborg Sygehus, Aalborg Sygehus) Uddannelse: Stud.med. E-mail: t.yogathas@rn.dk / Telefon: 5361 4114 Forskningsansvarlig på afdelingen: Svend Eggert Jensen  

35) Validity of the diagnoses atrial fibrillation and atrial flutter in the Danish National Patient Registry Forfattere: Thomas Andersen Rix, Sam Riahi, Kim Overvad, Søren Lundbye-Christensen, Erik Berg Schmidt, Albert Marni Joensen Abstract: Objectives: To assess the validity of the diagnoses atrial fibrillation (AF) and atrial flutter (AFL) for men and women recorded in the Danish National Patient Registry, and to assess the relative distribution of AF and AFL in the cohort. Design: Review of medical records for incident cases of AF and/or AFL in the Diet, Cancer and Health cohort study. Results: The positive predictive value of the combined diagnosis AF and/or AFL was 92.6% (95% CI 88.8%; 95.2%) with no significant difference between sexes (men 93.7%, women 90.9%). The proportion of AFL either alone or in combination with AF was significantly higher in men compared to in women (13.5% vs. 5.4%, p=0.03). Conclusions: This study confirms earlier reports that the validity of the diagnosis AF and/or AFL is high and may be used for registry-based studies. A specified di-


agnosis of AFL was rarely used and was not reliable to distinguish between cases of AF and AFL. Indsendt af: ph.d.-studerende, læge Thomas Andersen Rix, (Kardiologisk Afdeling, Aalborg Sygehus, Aalborg Sygehus) Uddannelse: ph.d.-studerende, læge E-mail: tar@rn.dk / Telefon: 2534 6009 Forskningsansvarlig på afdelingen: Erik Berg Schmidt  

36) An Action Card - treatment of Suspected Unexpected Serious Adverse Reaction in clinical trials Forfattere: C. Hellum, B. Mortensen. Aalborg Hospital of the Aarhus University Hospital. Abstract: Background: Death caused by study medication in a clinical trial. GCP rules on how to handle and report the death of a subject in a clinical trial already existed, whereas there were no guidelines related to the human aspects in relation to patients, relatives, staff or the press. Aim: To develop guidelines to ensure professional and human handling of both patients and their bereaved relatives as well as the staff involved, the press and the public. Methods: Systematic literature search in PubMed and CINAHL. This literature search aimed to identify existing guidelines for the handling of deaths caused by study medication. This and the staff´s practical and empirical experience should form the basis for better handling of similar situations. Result: Based on hospital policies and guidelines, GCP rules, the Helsinki Declaration, literature research, and practical and empirical experience a written guideline was made. The guideline contains a detailed description of how an appropriate approach may be applied. This has been translated into an action card. This process has resulted in a general policy on media response in the Region of Northern Jutland in Denmark. Conclusion: The outlined action card has professionalized the overall handling of all relevant parties in connection with deaths caused by study medication in clinical trials or similar situations. Indsendt af: Projektsygeplejersker Camilla Fragtrup Hellum og Bet-

tina Mortensen, (Kardiologisk Afdeling, Den Kardiologiske Forskningsenhed, Aalborg Sygehus) Uddannelse: Sygeplejersker E-mail: c.hellum@rn.dk og bettina.mortensen@rn.dk / Telefon: 9932 6880 og Forskningsansvarlig på afdelingen: Erik Berg Schmidt  

37) Genetic polymorphisms in the lipoxygenase pathway and the risk of myocardial infarction – study design Forfattere: Michael Skjelbo Nielsen, Kim Overvad, Tina Obel, Jakob Stegger, Erik Berg Schmidt Abstract: Background: Atherosclerosis is widely accepted as an inflammatory disease. Previous studies have suggested that inflammatory mediators from the lipoxygenase pathway may be causal factors in cardiovascular disease. Aim: To investigate the association between single nucleotide polymorphisms (SNPs) in candidate lipoxygenase pathway genes and the risk of myocardial infarction (MI). Methods: The Prospective Diet, Cancer and Health (DCH) study was initiated in 1993-1995 when 57,053 Danish born residents, aged 50 to 64 years, participated in a clinical examination, sampling of biological tissue and a detailed lifestyle survey. The primary outcome was incident MI and by linkage of the National Patient Register and the National Cause of Death Register combined with a review of medical records we identified 2,104 cases with incident MI. We used a case-cohort study design and for the creation of a case cohort sample, 1869 participants (“controls”) were randomly selected from the entire DCH cohort. For genotyping, 28 SNPs previously described as either associated with CVD events or surrogate markers of CVD, were selected. DNA from blood samples collected at baseline will be used for the genotyping. Statistics: Hazard ratios and 95 % confidence intervals for the association between each of the SNPs and time to MI will be estimated using Cox proportional hazards regression with age as the underlying time-axis. Perspectives: This study will contribute to answer the question, whether the lipoxygenase pathway plays a causal role in CVD. Such knowledge is important in the development of new drugs for the treatment and prevention of CVD.

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Indsendt af: Læge, ph.d. studerende Michael René Skjelbo Nielsen, (Kardiologisk Afdeling, Lipidklinikken, Aalborg Sygehus) Uddannelse: Læge E-mail: mrsn@rn.dk / Telefon: 9932 6889 Forskningsansvarlig på afdelingen: Erik Berg Schmidt  

38) The effect of marine n-3 fatty acids on plasma levels of soluble CD36 in overweight subjects Forfattere: Stine Krogh Venø, Michael René Skjelbo Nielsen, Søren Lundbye-Christensen, Erik Berg Schmidt, Aase Handberg Abstract: Aim: CD36 is a scavenger receptor involved in lipid uptake and inflammation. Recently, non-cell-bound CD36 (sCD36) was identified in human plasma and suggested to be a marker of lipid accumulation in the vessel wall. Marine n-3 polyunsaturated fatty acids (PUFA) may have cardioprotective effects. This study evaluated the effect of marine n-3 PUFA on sCD36 levels in overweight subjects. Methods: Fifty overweight subjects were randomised to 2 externally identical capsules of oil containing either 1.1 g of n-3 PUFA or 2g of olive oil daily for 6 weeks. Neutrophils were collected at baseline and after 6 weeks of treatment, and their fatty acid content of n-3 PUFA was analysed by gas chromatography. Plasma levels of sCD36 were determined using an in-house ELISA. Results: At baseline, the neutrophil fatty acid composition was not significantly different between the two groups. After 6 weeks of supplementation the content of marine n-3 PUFA increased significantly in neutrophils whereas no changes were observed in controls. Plasma sCD36 was unaffected by the two diet supplements, and likewise sCD36 did not differ between supplements. There was no significant correlation between neutrophil levels of marine n-3 PUFA neither at baseline nor after 6 weeks of supplement. Conclusions: Supplementation with 1.1 g of n-3 PUFA for 6 weeks had no effect on plasma levels of CD36. Furthermore, there was no correlation between n-3 PUFA content in neutrophils and sCD36. This study therefore does not provide evidence for a cardioprotective effect of n-3 PUFA acting through a CD36 dependent mechanism.

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Indsendt af: Medicinstuderende Stine Krogh Venø, (Kardiologisk Afdeling, Lipidklinikken, Aalborg Sygehus) Uddannelse: Medicinstuderende E-mail: stine.venoe@studmed.au.dk / Telefon: 3023 0309 Forskningsansvarlig på afdelingen: Erik Berg Schmidt  

39) ”Vi kan gøre det anderledes” - Monitorering af VKA behandling i borgerens eget hjem Forfattere: Pernille Højbak, Helle Ravnslund Sørensen, Kirsten Damgaard, Bettina Nymark Abstract: Et udviklings og samarbejdsprojekt som bygger bro mellem primær og sekundær sektor. Borgere der bor i eget hjem eller i plejebolig som bliver behandlet med vitamin K antagonister, skal have foretaget reglmæssige blodprøve kontroller(INR). Dette kan medføre tidkrævende logistiske udfordringer for både borgere, hjemmesygepleje og praktiserende læge. Fokusområder i projektet: Er det muligt for hjemmesygeplejersker at måle INR hjemme hos borgerne og dermed udvikle en mere simpel, sikker og mindre tidskrævende behandlingskontrol? Der er i projektet spurgt til både borgerens og hjemmesygeplejerskernes tilfredshed med monitoreringsmetoden, både før og under projektfasen. Under hele projektfasen er behandlingskvaliteten fulgt tæt. Vi har fokuseret på brobygning på tværs af sektorer. Erfaringen har vist os, at vi via dialog, samarbejde og borgeren i centrum, har haft succes med at gøre op med silotænkning. Vi er overbevist om at projektet kan være med til, at gøre op med den traditionelle måde, at behandle kronisk syge borgere på. Samtidig viser projektet, at ”Vi Kan gøre det Anderledes” til gavn for både borgere og de sundhedsprofessionelle. Indsendt af: Afdelingssygeplejerske Pernille Højbak, (Kardiologisk Afdeling, Trombosecenteret, Aalborg Sygehus) Uddannelse: Forskningsansvarlig overlæge E-mail: p.hoejbak@rn.dk / Telefon: 9932 8100 Forskningsansvarlig på afdelingen: Erik Berg Schmidt


40) Developing cardiovascular risk scores from a statisticians perspective Forfattere: Flemming Skjøth, Søren Lundbye-Christensen Abstract: Cardiovascular research worldwide has established numerous systems for estimating the risk of a severe disease for cardiovascular patients. Most systems were the result of the study of cohorts, where patients were followed over time, others are more observational in nature. Some systems were based more on a meta-analysis style, summing up available knowledge from the research community. Establishing a risk score involves several crucial clinical and statistical considerations and decisions. The call for simplicity often leads to risk scores that are very simple count of number of risk factors. The cost for such simplification may be loss in predictive ability. We will on the basis of well established risk score systems for AF patients evaluate the effects of simplification in terms of model assumptions, such as linear effects, and in terms of weightening of riskfactors, such as rounding up to integer valued weights. Risk score models based on statistical modelling may be based on non-standard methods and may not lead to systems that can be evaluated without computerized aid. But we postulate that the prize paid complexity is gained in predictive ability. Indsendt af: Biostatistiker Flemming Skjøth, (Kardiovaskulært Forskningscenter, Aalborg Sygehus) Uddannelse: Statistiker E-mail: fls@rn.dk / Telefon: Forskningsansvarlig på afdelingen: Erik Berg Smidt  

41) Klogere gennem komprimering af kostdata Forfattere: Anders Gorst-Rasmussen, Christina C. Dahm, Claus Dethlefsen, Thomas Scheike og Kim Overvad Abstract: I ernæringsepidemiologi studerer man sammenhængen mellem kost og sygdom. Kost er en besværlig eksponering at studere observationelt, fordi kostemner typisk indtages i kombination, og det derfor sjældent er meningsfuldt at udrede en særskilt effekt af hvert kostemne på risiko for sygdom. En bekvem og gængs måde at

håndtere problematikken på er vha. statistiske dimensionsreduktionsmetoder, hvor en stor samling kostindtagsvariable komprimeres til en lille samling ”kostmønstre”, som erstatter de oprindelige eksponeringsvariable i videre analyser. Rationalet er, at kostmønstrene bedre respekterer den multidimensionelle struktur i indtagsdata. På baggrund af et studie vedrørende kost og risiko for myokardieinfarkt i ’Kost, Kræft og Helbred’-kohorten diskuterer vi de tekniske begrænsninger ved eksisterende dimensionsreduktionsmetoder og introducerer en alternativ metode med mere attraktive egenskaber. Den alternative metode er hentet fra statistisk maskinlæring og udmærker sig specielt ved at give anledning til en simplere fortolkning. Vi påpeger også en række grundlæggende begrænsninger, der gælder generelt for dimensionsreduktionsmetoder i en epidemiologisk kontekst. [Baseret på arbejde publiceret i American Journal of Epidemiology, maj 2011] Indsendt af: Biostatistiker Anders Gorst-Rasmussen, (Kardiovaskulært Forskningscenter, Aalborg Sygehus) Uddannelse: MSc, PhD E-mail: a.gorst@rn.dk / Telefon: 9932 8521 Forskningsansvarlig på afdelingen: Kim Overvad  

42) Få statistikbistand til dit forskningsprojekt! Forfattere: Claus Dethlefsen(1), Lars Hvilsted Rasmussen (2). (1) Kardiovaskulært Forskningscenter, Aalborg Sygehus, (2) Afdelingen for Universitetshospitalsanliggender, Aalborg Sygehus Abstract: I 2005 blev den første statistiker ansat ved Aalborg Sygehus. Det skete som et led i dannelsen af Kardiovaskulært Forskningscenter, idet en af flaskehalsene for forskning på medlemsafdelingerne var mangel på adgang til en statistiker. Primo 2012 har Kardiovaskulært Forskningscenter ansat 7 statistikere, 1 ph.d. studerende og 3 studentermedhjælpere og er placeret i Forskningens Hus. Siden 2005 har statistik-gruppen været involveret i omkring 400 forskningsprojekter. I et samarbejde med Afdelingen for Universitetshospitalsanliggender har alle forskere på Aalborg Sygehus nu adgang til statistisk bistand via Kardiovaskulært Forskningscenters statistikgruppe. Hver forskningsansvarlig kan disponere over 20 timers statistik-bistand årligt, finansieret via Afdeling for Universitetshospitalsanliggender. Det er muligt at tilkøbe ekstra timer, såfremt kapaciteten tillader det. Henvendelser om statistik-bistand sker til mailadressen stat@rn.dk. 39


Statistikerne kan være med flere steder og på flere niveauer i et forskningsprojekt. Vi vil give nogle eksempler på, hvor vi tidligere har bidraget til forskningsprojekter. Indsendt af: Biostatistiker Claus Dethlefsen, (Kardiovaskulært Forskningscenter, Aalborg Sygehus) Uddannelse: Cand.Scient., Ph.D. E-mail: cld@rn.dk / Telefon: 99326863 Forskningsansvarlig på afdelingen: Erik Berg Schmidt  

43) Allokeringsmetoder Forfatter: Gunnar Hellmund Abstract: De mest udbredte allokeringsmetoder i kliniske forsøg er præ-allokationsmetoderne simpel randomisering og blokrandomisering. De klassiske metoder har gode asymptotiske egenskaber, dvs. ligheder mellem forsøgsgrupper øges med størrelsen af studiepopulationen. I studier med små populationer kan man dog risikere betydelige afvigelser med hensyn til centrale kovariate. Stikprøvepopulationen og patienters villighed til at deltage og forblive i forsøget kan yderligere variere afhængigt af en række væsentlige baggrundsfaktorers fluktuation; dette har potentiel indvirkning på konklusionerne af forsøget. Adaptive metoder forsøger at håndtere disse problemer, som specielt er relevante for mindre forsøg. Blandt adaptive metoder skelnes mellem dynamisk allokering på baggrund af enten kovariate eller outcome (se CONSORT erklæringen). Anvendes adaptive metoder bør man dog være bevidst om en række faldgruber i de efterfølgende analyser. Alternativt kan klassiske præ-allokationsmetoder kombineres med stratificering. Den oftest omtalte dynamiske randomiseringmetode er minimering, alligevel anvendes denne i mindre end 2% af kliniske forsøg. Posteren giver et kort overblik over de mest udbredte allokeringsmetoder. Formålet er at påpege, at valg af allokeringsmetode er led i optimering af forsøgsdesign. Et netop opstartet projekt præsenteres, hvor forhåndsviden om den generelle patientpopulation inddrages. Metode illustreres med et simuleret forsøg. Indsendt af: Biostatistiker Gunnar Hellmund, (Kardiovaskulært Forskningscenter, Aalborg Sygehus) Uddannelse: cand.scient. og ph.d. i matematisk statistik E-mail: g.hellmund@rn.dk / Telefon: 9932 6962 Forskningsansvarlig på afdelingen: Ledende biostatistiker Claus Dethlefsen   40

44) Detection of Disease Outbreaks Forfattere: Tina Graungaard (Institut for Matematiske Fag, AAU og Kardiovaskulært Forskningscenter, Aalborg Sygehus) Abstract: Detection of disease outbreaks is of great interest in public health services, and the primary purpose is to detect outbreaks early enough for interventions. Seasonal variations affect the incidence of many diseases, and the number of affected individuals may peak at different times of the year, or show long-term trends. In the design of a detection system seasonal cycles, trends and past outbreaks should be taken into account, and it must be sufficiently robust to handle a wide range of different diseases. Statistical methods can be used to automatically analyse a large volume of data, when the amount of data exceeds the limits of manual surveillance. The objective of this project is to compare different statistical methods for automatic detection of possible outbreaks. Weekly counts of the incidence of mycoplasma pneumonia from July 1994 to July 2005 were analysed. The different methods flags weeks, where there is an abnormal high incidence count. The analysis showed different advantages and disadvantages of the different methods. Indsendt af: Speciale studerende, Studentermedhjælper Tina Graungaard, (Kardiovaskulært Forskningscenter, Aalborg Sygehus) Uddannelse: Bsc E-mail: t.graungaard@rn.dk / Telefon: Forskningsansvarlig på afdelingen: Erik Berg Schmidt  

45) State Space modellering af forekomsten af kardiovaskulære sygdomme Forfattere: Specialestuderende Janne Lund Tidselbak Larsen og Charlotte Bisgaard, Institut for Matematiske Fag, Aalborg Universitet og Kardiovaskulært Forskningscenter, Aalborg Sygehus Abstract: Tidligere studier har vist, at incidensraten for kardiovaskulære sygdomme er højest om vinteren i Danmark. Denne tendens kan muligvis skyldes vejret, og derfor er formålet med dette studie, at undersøge om en række meteorologiske variable har indflydelse på forekomsten af kardiovaskulære sygdomme i Danmark.


Fra landspatientregistret har vi incidente tilfælde af akut koronart syndrom, apopleksi, venøs tromboembolisme og atrieflimmer i Danmark i perioden 1.1.199531.12.2006. Derudover har vi målinger af meteorologiske variable på dagsbasis fra DMI for samme periode. I studiet anvendes state space modeller til at bestemme effekten af vejrets indflydelse på kardiovaskulære sygdomme. State space modeller er et statistisk værktøj, der er velegnet til analyse af multivariate tidsrækker og longitudinelt data. Studiet kan have del i ætiologien af kardiovaskulære sygdomme og vil måske kunne forbedre behandling og forebyggelse heraf. Indsendt af: Specialestuderende i statistik Charlotte Bisgaard, (Kardiovaskulært Forskningscenter (Aalborg Universitet), Aalborg Sygehus) Uddannelse: Bsc E-mail: c.bisgaard@rn.dk / Telefon: Forskningsansvarlig på afdelingen: Erik Berg Schmidt  

46) A Dynamic Prediction Model for Anticoagulant Therapy Forfattere: Peter Brønnum Nielsen, Søren Lundbye-Christensen, Torben Bjerregaard Larsen, Søren Risom Kristensen, and Ole K. Hejlesen

47) Radid Incorporation of Omega-3 Fatty Acids Into Patients Colonic Tissue After Oral Supplementation Forfattere: L. S. Sorensen*(1), H. H. Rasmussen(2), I. V. Aardestrup(3), O. T. Ussing(1), K. Varming(4), H. C. B. Norgaard(1), K. Lindorff-Larsen(1) E. B. Schmidt(3) (1) Department of Surgical Gastroenterology, (2) Centre for Nutrition and Bowel Disease, (3) Department of Cardiology, (4) Department of Clinical Immunology, Aalborg Hospital, Aarhus University, Aalborg, Denmark Abstract: Rationale: Supplementation with omega-3 (n-3) fatty acids (FA) may alter postsurgical inflammatory response. Aim of study: To investigate whether oral nutritional suppl. (ONS) rich in n-3 FA, given for 7 days before surgery would be sufficient to incorporate n-3 FA into cell membranes of the colonic mucosa and colonic wall. Methods: Randomized, double-blind, placebo-controlled single centre intervention trial. 148 patients referred for colorectal cancer surgery received either an n-3 FA enriched ONS twice daily, providing 2 g of eicasopentaenoic acid (EPA) and 1 g of docosahexaenoic acid (DHA) per day or a standard ONS for 7 days before surgery. Blood and tissue samples from a subgroup of 40 patients were taken. FA composition of tissues were analysed by gas chromatography.

Abstract: Patients with an increased risk of thrombosis require treatment with vitamin K-antagonists such as warfarin. Treatment with warfarin has been reported difficult mainly due to high inter- and intraindividual response to the drug. This paper reports the outcome of the development of a dynamic prediction model. It takes warfarin intake and International Normalized Ratio (INR) values as input, and uses an individual sensitivity parameter to model response to warfarin intake. The model is set on state-space form and uses Kalman filtering technique to optimize individual parameters. Retrospective test of the model proved robustness to choices of initial parameters, and feasible prediction results of both INR values and suggested warfarin dosage. Further studies to facilitate the impact of clinical outcome are currently under preparation.

Results: 40 patients included, median age of 67.The two groups were comparable. We found a significant incorporation of EPA but not DHA into colonic mucosa (p=0.001) and colonic wall (p=0.004) in patients randomized to the n-3 FA supplement when compared to controls. Mean (SD) EPA mucosa: 0.84(0.70) and EPA wall: 0.39(0.29) in patients who received the n-3 FA suppl. EPA mucosa:0.30(0.31) and EPA wall:0.16(0.10) in the control group. FA are given as % of total amount of FA.

Indsendt af: Biostatistiker Søren Lundbye-Christensen, (Kardiovaskulært Forskningscenter, Kardiologisk Afdeling, Aalborg Sygehus) Uddannelse: MSc, PhD E-mail: solc@rn.dk / Telefon: 9932 6864 Forskningsansvarlig på afdelingen: Erik Berg Schmidt

Indsendt af: Overlæge Lone Schmidt Sørensen, (Kirurgisk Gastroenterologisk Afdeling, Aalborg Sygehus) Uddannelse: Cand. med. E-mail: lss@rn.dk / Telefon: 9932 4457 Forskningsansvarlig på afdelingen: Ole ThorlaciusUssing

Conclusion: EPA was incorporated into colonic mucosa and colonic wall in patients receiving 7 days of n-3 FA suppl. This rapid uptake may be important for dietary recommendations in patients undergoing elective surgery to ensure any immune modulating effects and might affect cancer cells sensitivity for radiation and chemotherapy.

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48) A New Distensibility Technique to Measure Sphincter of Oddi Function Forfattere: Kunwald P1, Kjær DW2, Liao D1, Funch-Jensen P2, Kruse A2, McMahon B1, Gregersen H1 & Drewes AM1, 1) MechSense, Aalborg Hospital, 2) Department of Surgical Gastroenterology L, Aarhus University Hospital Abstract: Background: The sphincter of Oddi (SO) is a small muscle located at the end of the bile duct. It regulates the bile and pancreatic juice flow into the duodenum, and prevents reflux. Until now SO manometry has been considered as the gold standard for evaluating patients for sphincter dysfunction. Often a sphincterotomy is carried out based on elevated basal SO pressure from manometry studies. However some placebo controlled study shown that 60% of all sphincterotomy operations based on this elevated pressure do not benefit the patient. Objective: To invent a SO-probe for visualizing the geometry and simultaneously controlling and recording pressure in the SO. Methods: The probe was built using a three lumen ERCP catheter. Lumen1 is used for 12 electrode wires for measuring 8 cross sectional areas; lumen 2 is for bag pressure recording and lumen 3 for pressure controlling. Results: Reproducibility testing for the probe showed that the accuracy is acceptable with cross-sectional areas between 20 to 78mm2. Pilot experiments, where the SO was profiled in a patient suffers from gallstones, have been performed. Conclusions: It is possible to get reliable images and simultaneous pressure recordings from the SO in humans. On the basis of this technology, the biomechanical parameters such as tension, deformation and elasticity of the sphincter can be calculated. Furthermore, this technique can be used by the endoscopist to validate the sphincterotomy. A new diagnostic tool for the SO is on the way. Indsendt af: Ingeniør Peter Kunwald, (Kirurgisk Gastroenterologisk Afdeling, Aalborg Sygehus) Uddannelse: Ingeniør E-mail: pku1111@gmail.com / Telefon: 2290 4006 / 2 Forskningsansvarlig på afdelingen: Asbjørn M. Drewes  

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49) Prevalence of Pulmonary Embolism in Colorectal Cancer at Time of Diagnosis Forfattere: M. Poulsen1, AC. Larsen1, R. Leusink2, JB. Frøkjær2, T. Mandøe2, M. Stender1, O. Thorlacius-Ussing1 Affiliation 1: Department of Gastroenterological Surgery, Aalborg Hospital, Aarhus University Hospital, 2: Department of Radiology, Aalborg Hospital, Aarhus University Hospital Abstract: Background: Treatment of colorectal cancer is occasionally complicated by deep venous thrombosis (DVT) and is shown to be a predictor of reduced survival. Pulmonary thromboembolism (PE) is the fatal complication of DVT, but often is not diagnosed in the preoperative staging of colorectal cancer. Materials and methods: From February 2005 to May 2006 our Department used thoracic computer angiography (CTPA) in the preoperative staging of colorectal cancer. After May 2006, national recommendations on colorectal cancer staging interfered with this routine and it was abandoned. CTPA was henceforth only done on suspicion of PTE. We consecutively included 119 patients. They all underwent routine CTPA in combination with their staging computer tomography. One patient showed to have anal cell squamous cell carcinoma and was excluded. The rest were equally distributed between 59 colon cancer patients and 59 rectum cancer patients. Results: In 118 CTPA done on routine basis in the staging of colorectal cancer, two had preoperative PE at the time of colorectal cancer diagnosis (1.7%, 95%CI: 0.21% -6.0%). Both patients had colon cancer. In one case of rectal cancer, the CTPA was inconclusive. The two diagnosed PE where asymptomatic Conclusion: Despite the lack of symptoms, 2% of patients with colorectal cancer have a pulmonary thromboembolism at the time of diagnosis of their colorectal cancer. Indsendt af: KBU-læge Mette Poulsen , (Kirurgisk Gastroenterologisk afdeling A, Aalborg Sygehus, Aalborg Sygehus) Uddannelse: Læge E-mail: metpo@rn.dk / Telefon: 9932 4514 Forskningsansvarlig på afdelingen: Professor Ole Thorlacius-Ussing  


50) Manglende sammenhæng imellem to kommercielle metoder og med en inhouse ELISA metode til at kvantificere sCD36 i plasma Forfattere: Simon Lykkeboe*, Anne Lone Larsen ** & Aase Handberg * *Klinisk Biokemisk Afdeling, Aalborg Sygehus, Aarhus Universitetshospital and ** Klinisk Biokemisk Afdeling, Aarhus Sygehus, Aarhus Universitetshospital Abstract: Baggrund: CD36 er en receptor, der er udtrykt på overfladen af mange forskellige celletyper. CD36 binder blandt andet lipoproteiner, og menes at spille en patofysiologisk vigtig rolle for mange af de komplikationer, der er forbundet med det metaboliske syndrom. Vi har tidligere fundet en cirkulerende form af CD36 i cellefrit plasma (sCD36), og etableret en ELISA-metode til kvantitering af sCD36. Plasma sCD36 fandt vi forhøjet hos insulin resistente fede personer, hos patienter med type 2 diabetes og hos patienter med ustabile atherosclerotiske plaques. Formålet med dette studie var at sammenligne to kommercielle kits til bestemmelse af plasma sCD36 med vores egen ELISA-metode. Metoder: CD36-koncentrationen blev bestemt i 30 plasma prøver fra 10 personer med vores ELISA-metode og de to kommercielle metoder (Cusabio Biotech og Adipobioscience). Resultater: Vores resultater viser absolut uforlignelighed mellem de tre sæt resultater. Denne uforlignelighed skyldes ikke forskelle i de præ-analytiske procedurer mellem de 3 metoder. Konklusioner: Den manglende korrelation mellem resultaterne fra de tre metoder viser, at det er teknisk vanskeligt at måle sCD36 i plasma, og at de to kommercielle metoder ikke er egnede til dette formål. Dårligt karakteriserede metoder kan underminere et ellers relevant og lovende forskningsområde. Indsendt af: Kemiker Simon Lykkeboe, (Klinisk Biokemisk Afdeling, Aalborg Sygehus) Uddannelse: Cand.scient. E-mail: s.lykkeboe@rn.dk / Telefon: 9932 8034 Forskningsansvarlig på afdelingen: Henrik Krarup  

51) Implementering af næste generations sekventering (NGS) i diagnostikken Forfattere: Anja Ernst, Poul H. Madsen, Inge Søkilde Pedersen, Henrik Okkels & Henrik Krarup.

Abstract: Hepatitis C virus (HCV) er et RNA virus hvis genom består af ca 10.000 baser. HCV findes i form af flere forskellige genotyper og subtyper. Kendskab til genotypen har stor betydning for den enkelte patient i forbindelse med medicinsk behandling og prognose. Desuden vil behandling give anledning til fremkomst af undertyper, quasispecies. Til detektion af genotyper har vi hidtil anvendt specifikke primere og prober, men varianter indenfor hver genotype er hyppigt forekommende, hvorfor det vil være fordelagtigt at sekventere RNA. Inden overførsel af vores rutine analyser til NGS, er det nødvendigt at sikre at samtlige genotyper og subtyper kan detekteres. Med NGS teknologien kan flere virusisolater sekventeres på én gang ved anvendelse af barcoder. Vi har designet barcodede primere til sekventering af 16 forskellige prøver i samme analysegang. Sekventeringen er udført på en Ion Torrent PGM (Personal Genome Machine) og vi har sammenlignet udfaldet med resultaterne fra vores hidtidige rutinemetode. Indsendt af: Molekylærbiolog Anja Ernst, (Klinisk Biokemisk Afdeling, Afsnit for Molekylær Diagnostik, Aalborg Sygehus) Uddannelse: Cand. Scient. Phd E-mail: ae@rn.dk / Telefon: 9932 8084 Forskningsansvarlig på afdelingen: Henrik Krarup  

52) Clinical presentation and outcome among patients with pneumococcal isolates from the lower respiratory tract and/or blood: A population-based cohort study Forfattere: Marlene Skovgaard Sørensen (stud.med.), Henrik Carl Schønheyder (professor, overlæge (KMA)), Reimar W. Thomsen (afdelingslæge, lektor, ph.d. (KEA)). Abstract: Background: More than 25.000 Danes are hospitalized with pneumonia each year. Clinical presentation and outcome of patients with unspecified communityacquired pneumonia or pneumococcal bacteraemia have been studied thoroughly as these conditions are readily identifiable. In contrast, there are few prognostic data on patients with pneumococcal pneumonia and virtually no data pertaining to the group of hospitalized patients with lower respiratory tract isolates of pneumococci. Thus, we lack information whether the site of pneumococcal isolation predicts clinical severity and outcome in patients with lower respiratory tract infection. 43


Materials and Methods: A population-based cohort study was initiated in 2011 including all adult patients hospitalized in North Denmark and the Capital Region with a pneumococcal isolate from the lower respiratory tract and/or the bloodstream. Pneumococcal isolates have been referred to Statens Serum Institut for serotyping. A detailed chart review is ongoing with collection of demographic and clinical information including symptoms, radiographic findings, disease severity, laboratory values and antibiotic therapy. 30-day mortality is assessed by linkage with the civil registry system. Results: A total of 1280 isolates have been included in the cohort. We hypothesize that both clinical severity and mortality increase with site of pneumococcal isolation: 1) the respiratory tract without radiographically confirmed pneumonia 2) the respiratory tract with radiographically confirmed pneumonia 3) the blood only 4) the blood and the lower respiratory tract Conclusion (perspective): Data on the association between pneumococcal isolation site and clinical severity and outcome may provide insight into the clinical course for these patients and may improve treatment strategies. Indsendt af: Forskningsårstuderende Marlene Skovgaard Sørensen, (Klinisk Epidemiologisk Afdeling/Klinisk Mikrobiologisk Afdeling, Aalborg Sygehus) Uddannelse: Stud.med. (færdiggjort 9. semester) E-mail: marlene.skovgaard@studmed.au.dk / Telefon: 3022 1055 Forskningsansvarlig på afdelingen: Henrik Toft Sørensen (KEA)/Henrik Carl Schønheyder (KMA)  

53) Targeting antigen to DCs - screening of potential targets Forfattere: Lotte Pugholm, Kim Varming, Ralf Agger Abstract: Background: Targeting antigens to dendritic cells (DCs) may have great potential in vaccination procedures, including vaccination against cancer. During the last ten years several potential targets on DCs have been identified e.g. DEC205 & DC-SIGN. While targeting antigens to these receptors have been shown to enhance antigen-specific immune responses, it is, however, very likely that other structures will turn out to be even bet44

ter vaccine targets. Consequently, there is a great need for methods that allow screening of a large number of potential target structures, preferably permitting direct comparison between different targets regarding the strength and character of the T cell responses induced by the targeted DCs. Methods: We have developed a simple assay for screening for optimal vaccine targets on murine DCs. C57BL/6 mice are immunized with a monoclonal rat antibody of either isotype IgG2a or IgG2b. Splenocytes are harvested from immunized mice and cultured in vitro with monoclonal antibodies specific for each of the selected receptors. These monoclonal rat antibodies represent both the targeting principle and the antigen. Splenocytes targeted by different antibodies are subsequently tested for IFN-γ or IL-4 production using the ELISPOT technique. Results: So far, we have tested 10 different targets and seen that targeting DCs with monoclonal antibodies leads to antigen uptake and peptide presentation. The efficiency of the targeting process and the polarization of activated T-cells towards a Th1 or Th2 response vary between the different targets. Results from the ongoing screening will be presented. Indsendt af: MSc ph.d.-studerende Lotte Hatting Pugholm, (Klinisk Immunologisk afd, Aalborg Sygehus) Uddannelse: Cand Scient, Biomedicin E-mail: lohap@rn.dk / Telefon: 4094 9499 Forskningsansvarlig på afdelingen: Kim Varming  

54) Functional aspects of MHC class II molecules on T cells Forfattere: Anne Louise Revenfeld, Kim Varming, Malene Jørgensen, Allan Stensballe Abstract: Background: For a number of decades it has been observed both in vitro and in vivo that proteins regarded as cell-specific were found on the surface of other cell types. In this context, it has been demonstrated that T cells can acquire MHC class II molecules (MHCII) from antigen-presenting cells (APCs) as well as co-stimulatory proteins. It has also been demonstrated that the acquired proteins are fully functional, indicating potentially unknown regulatory roles of T cells. The significance of this acquisition is proposed to relate to immune response amplification or suppression and also induction of tolerance. Currently, the molecular and cellular


mechanisms as well as the functional consequences of this intercellular protein transfer are unknown. Purpose: This project is aimed at elucidating the functional aspects of the in vitro intercellular transfer of MHCII from APCs to T cells. The cellular and molecular mechanisms pertaining to the acquisition will also be investigated. Methods: The experimental procedures are based on a human cellular system. The study will combine methodologies of immunology and mass spectrometry driven proteomics. This allows for a global investigation of the mechanisms and possible functions of the molecules transferred between APC and T cell. Outcome: This project should expand the fundamental knowledge about the immune system, particularly in understanding the regulation of the adaptive immune response. This will have an impact on the understanding of the functions of our immune system in the healthy body and on the applied research caretaking the delineation of pathological processes involving the immune system. Indsendt af: Ph.d.-studerende Anne Louise Schacht Revenfeld, (Klinisk Immunologisk Afd., Aalborg Sygehus) Uddannelse: Civilingeniør i medicinsk bioteknologi E-mail: alsr@bio.aau.dk / Telefon: 9932 1674 Forskningsansvarlig på afdelingen: Kim Varming  

55) Billigere kvantificering af cytokiner og andre inflammatoriske markører ved hjælp af protein mikroarray Forfattere: Malene Jørgensen, Rikke Bæk, Evo Søndergaard og Kim Varming Forskningsenheden FBE Klinisk Immunologisk Afdeling, Aalborg Sygehus Abstract: Immunsystemet er opbygget af diverse celletyper, der hver især har en bestemt rolle i forbindelse med forskellige immunreaktioner. Kommunikationen imellem disse celler og kroppens øvrige celler foregår vha. en lang række signalmolekyler, heriblandt cytokiner. De seneste år er fokus på netop disse signalmolekyler blevet væsentligt forøget, da det viser sig, at f.eks. et øget eller faldende niveau af en eller flere af disse har stor betydning for et givent sygdomsforløb. Nyere forskning viser, at det er mere korrekt, at sammenligne niveauforskellene på en bred vifte af signalmolekyler, frem for kun at undersøge ændringen af et enkelt cytokin henover et sygdomsforløb. Dette har ledt

til udviklingen af multiplex-analyser, her iblandt proteinmikroarray teknologien, der endog på nogle områder er mere sensitiv sammenlignet med ELISA. Klinisk Immunologisk afdeling har investeret i en ny teknologisk platform, hvor det er muligt at fremstille og analysere protein-mikroarrays. Den grundlæggende idé er, at man på en glasplade kan afsætte meget små mængder (1 nL) antistof. Hvis en patient har dannet antigener (f.eks. cytokiner), vil disse binde sig til antistoffet på mikroarray-pladen. Denne binding kan detekteres med fluorescerende molekyler, hvorefter de kan måles vha. en laserscanner. Idéen om multiplex-analyse af cytokiner er ikke ny, men tidligere teknikker som Luminex100 har været meget omkostningsrige, hvilket har medført, at mange mindre forskningsgrupper ikke har råd til at få analysen lavet. Ved brug af vores protein-mikroarray kan serumprøver analyseres for op til 20 cytokiner simultant (indtil videre) ud fra kun 100 µl prøve og til en pris på 10 kr./ cytokin. Indsendt af: Cand. Polyt. Ph.D Malene Jørgensen, (Klinisk Immunologisk Afdeling, Aalborg Sygehus) Uddannelse: Cand. Polyt Ph.D E-mail: maljoe@rn.dk / Telefon: 9932 1157 Forskningsansvarlig på afdelingen: Kim Varming  

56) Socioeconomic Position and oneyear Mortality after Bacteremia. A Danish Population-based Cohort Study Forfattere: Kristoffer Koch, Mette Nørgaard, Henrik C. Schønheyder, Reimar W. Thomsen, Mette Søgaard Abstract: Background: Little is known about the impact of socioeconomic position on mortality after bacteremia. Objective: To examine the association between socioeconomic position and one-year mortality after bacteremia. Methods: We conducted a population-based cohort study in two Danish regions (North Denmark and Capital Region). From region-based bacteremia registries we identified 8,638 hospitalized patients with bacteremia in the age group 30-65 years from 2000 through 2008. Information on patient’s socioeconomic position and pre-existing comorbid diseases was obtained from Statistics Denmark’s registries and the National Patient Registry. By Cox regression, we examined the associations between personal income and mortality one year 45


after bacteremia, adjusting for potential mediators. Results: Overall one-year mortality rate was 30.4%. We found an income-mortality gradient, with an absolute difference in one-year mortality between the lowest and the highest income-group at 6.3% (95% CI, 3.5 to 9.0%). The age- and sex-adjusted hazard ratio for death within one-year was 1.38 (95% CI, 1.23 to 1.54) for lowincome versus high-income. Adjustment for a psychosocial factor, pre-existing comorbid diseases, bacteremia type and specialty attenuated the effect of income. Pre-existing comorbid diseases accounted for most of the explanatory effect (hazard ratio for death within one-year adjusted for age, sex and comorbidity for lowincome vs. high-income, 1.17 [95% CI, 1.04 to 1.30]). Conclusions: Our study demonstrated an income-mortality gradient one year after bacteremia. Pre-existing comorbid diseases were the most important mediator of this gradient. The finding suggests that better management of comorbid diseases may reduce socioeconomic disparities in mortality after bacteremia. Indsendt af: Ph.d.-studerende Kristoffer Koch, (Klinisk Mikrobiologisk Afdeling/Klinisk Epidemiologisk Afdeling, Aalborg Sygehus) Uddannelse: Læge E-mail: k.koch@rn.dk / Telefon: 9932 6919 Forskningsansvarlig på afdelingen: Professor, overlæge, dr. med. Henrik Carl Schønheyder  

57) Time required for PaO2 equilibration in patients with severe COPD Forfattere: Dr. Ulla Møller Weinreich, ulw@rn.dk, MD1,3, Dr.Søren Kjærgaard, sck@rn.dk, MD2, Anita Hansen, anh@rn.dk1, Mr Lars Pilegaard, lp@hst.aau.dk3 and Mr. Stephen Edward Rees, sr@hst.aau.dk3. 1) Pulmonary Medicine, Aalborg Hospital, Aalborg, Denmark, 9000; 2) Anaestesiology, Aalborg Hospital, Aalborg, Denmark, 9000 and 3 Health Science and Technology, Aalborg University, Aalborg, Denmark, 9220. Abstract: Adjusting the inspired oxygen level in spontaneous breathing patients with COPD can be time consuming. Typically 30 minutes are waited before drawing an arterial sample to verify the oxygenation level. Consensus does not exist as to whether 30 minutes is a necessary period. To the authors knowledge no study has systematically investigated PaO2 equilibrium time following clinically relevant decreases and increases in 46

inspired oxygen in spontaneously breathing patients with COPD. This study investigated PaO2 equilibration time in twelve patients with stable, severe COPD (mean FEV1% 25, mean MRC-score 4), by analysis of consecutively drawn arterial blood gas samples. The initial PaO2 level was measured by two ABG’s at the patient’s LTOT level (1-2 l/min). Hereafter, LTOT treatment was discontinued or reduced. Blood samples were drawn after 1, 2, 4, 8, 12, 17, 22, 32, and 33 minutes to analyse the reduction in PaO2. After 33 minutes LTOT treatment was set to the initial level and the increase in PaO2 was analysed at the same time periods. The 90 percent equilibrium times for PaO2 (+/- SD) were 5.3 (+/- 2.8) min for the decrease and 5.4 (+/- 0.4) min for the increase in O2. These results show a faster response to changes in FiO2 than seen previously, with similar response times for decrease and increase in O2. Results indicate that it may be possible to reduce the time waited before evaluating ABG following changes in inspired oxygen, beneficial for both patients and staff. Indsendt af: Afdelingslæge Ulla Møller Weinreich, (Lungemedicinsk Afdeling, Aalborg Sygehus) Uddannelse: Cand med, PhD-studerende E-mail: ulw@rn.dk / Telefon: 9932 6433 Forskningsansvarlig på afdelingen: Ulla Møller Weinreich  

58) Multivariate pattern analysis of evoked brain potentials by temporal matching pursuit and support vector machine Forfattere: Carina Graversen, Christina Brock, Jens Brøndum Frøkjær, Isabelle Larsen, Birgit Koch-Henriksen, Asbjørn Mohr Drewes Abstract: Diabetes mellitus is a multi-factorial and complex disease causing autonomic neuropathy and various gastrointestinal symptoms in some patients. The neural mechanisms behind these pain and symptom phenomenons are not completely understood, but it is believed that both peripheral and central mechanisms are involved. To gain further knowledge of the central mechanisms, the aim of this study was to identify biomarkers for the altered brain activity in diabetes mellitus type-1 patients compared to healthy volunteers. The study included 16 patients and 15 age and gender matched volunteers,


with brain activity recorded from 62 electroencephalography (EEG) channels. The EEG signals were recorded as evoked potentials (EPs) following painful electrical stimulations in the oesophagus. The EPs from all channels and subjects were decomposed simultaneously by a temporal matching pursuit (TMP) algorithm with Gabor atoms, and the amplitude and phase features were classified by a support vector machine (SVM) to discriminate patients from healthy volunteers. A classification performance of 93.1% (P<0.001) was obtained when applying a majority voting scheme to the 3 best performing channels (FC4, C1, and C6) and including features from 2 atoms. The most discriminative features were determined by the slope coefficients from the SVM decision rule, to identify the biomarkers as delayed latency of the first atom (N2-P2 complex) and decreased amplitude of the second atom (NI-P1 complex). The combination of TMP and SVM is a novel approach to classify two study populations, which may provide a new objective tool to identify biomarkers from various chronic pain study populations.

troduction of medical imaging modalities such as MRI, ultrasonography and FLIP system. These techniques have revolutionised the way in which many conditions are diagnosed and treated. The ability to examine in detail structures inside the body, without resorting to surgery, has allowed clinicians to diagnose disease at an early stage. In order to continue this exploration, it will be necessary to complement the traditional approach with an integrative approach. The aim of this review is to describe the diseases caused biomechanical remodelling in the GI tract, the imaging techniques based human GI tract simulation models, and new analytic methods and medical devices based in vivo tissue remodelling assessment. This will combine observations, theories and predictions across the temporal and dimensional scales, across the scientific disciplines, and across the anatomical subsystems.

Indsendt af: Forskningssygeplejerske Birgit Koch-Henriksen, (Mech Sense, med.gastroenterologisk ambulatoriegang, Aalborg Sygehus) Uddannelse: Sygeplejerske E-mail: bkh@rn.dk / Telefon: lokal 9932 6244 Forskningsansvarlig på afdelingen: Professor Asbjørn Mohr Drewes

 

 

Abstract: The ischemia of the intestine is a common problem in clinic. The aim of present study was to investigate the changes of intestinal wall biomechanical properties as function of acute mesentery ischemia time. Total fifty Wistar male rats, three month old, were used in the study. The number of the animals in each group was 10. Ten rats were used for normal control and another 40 rats were used for made intestinal acute ischemia. The acute ischemia of middle jejunum was induced by ligating five mesenteric arterial branches to that segment. The ischemia lasted 15 30, 60, and 120 minutes. Thereafter the ischemial intestinal segment and the corresponding segment from normal control rat were taken out for the experiments. The mechanical test on the intestinal segment was done as a ramp distension experiment. Circumferential stress and strain were computed. The morphometric data, such as opening angle, wall thickness, inner and outer circumferential length were obtained. The residual strains of the wall were also computed. Tthe intestinal wall thickness and cross-sectional wall area were significantly decreased in ischemia 60 and 120 min. groups (P<0.05 and 0.01). The open-

59) Mechanical Modelling Analysis in Gastrointestinal Tract: from in vitro to in vivo Forfattere: Donghua Liao Abstract: The major motor function of the gastrointestinal (GI) tract is driving the luminal contents facilitated by changes in the geometry of the GI wall and lumen. Therefore, the biomechanical properties of the GI tract are important determinants of flow, the stress distribution in the wall, and the remodelling process of the wall under physical environment change. The majority of the research done on measuring the mechanical properties of the GI tract has been performed in vitro. However, assessing the disease or treatment caused tissue remodelling in vivo is considerable important to have diagnosis and treatment in an early stage. Exploration of the human body has dramatically improved by the in-

Indsendt af: Forsker Donghua Liao, (Mech-Sense, Aalborg Sygehus) Uddannelse: Ph.D E-mail: dl@rn.dk / Telefon: 99 32 69 07 Forskningsansvarlig på afdelingen: Asbjørn Drewes

60) Effect of acute ischemia on the biomechanical properties of rat small intestine Forfattere: Jingbo Zhao

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ing angle and residual strain decreased as function of ischemia times (P<0.01). Furthermore the intestinal wall became stiffer after acute mesentery ischemia for 60 and 120 minutes. The morphometric and biomechanical properties of intestinal wall remodelled after acute mesentery ischemia. The biomechanical remodelling of ischemia intestinal wall may affect its function, such as motility and mechano-sensory activities. Indsendt af: Associate professor Jingbo Zhao, (Mech-Sense, Aalborg Sygehus) Uddannelse: Pathology, Biomechanics, Gastroenterology E-mail: jz@rn.dk / Telefon: 9932 6907 Forskningsansvarlig på afdelingen: Asbjørn M Drewes  

61) Evoked brain potentials identifies neural mechanisms correlated to visceral central sensitization in healthy volunteers Forfattere: C. Graversen, C. Brock, D. Farina, A.M. Drewes Abstract: Background and aims: To identify neural mechanisms in visceral central sensitization by classification of electroencephalography (EEG). Methods: In a double-blind placebo-controlled crossover study, EEG was recorded in twelve healthy volunteers before and after sensitization of the oesophagus with acid and capsaicin (or placebo). The EEG was recorded as evoked brain potentials (EPs) following painful electrical stimulations in the rectosigmoid colon at pain detection threshold. The current leading to moderate pain on a visual analogue scale was obtained to validate induction of hyperalgesia. The frequency distribution in standard frequency bands were extracted for each EP. Individual changes were calculated and classified by a support vector machine (SVM) to discriminate the sensitization and placebo responses. Changes in all frequency bands simultaneously were correlated to changes in subjective pain scores reflecting the degree of induced hyperalgesia. Results: The SVM was able to discriminate the sensitization and placebo responses with an accuracy of 91.7%, which was above chance level (P< 0.01). A correlation between individual changes in frequency distribution in all spectral bands simultaneously and changes in subjective pain scores were evident after sensitization (P=0.03), but not after placebo. The neural mecha48

nisms after visceral central sensitization were identified as increased power in the delta, theta, and alpha bands compared to after placebo treatment. Conclusions: This study showed that classification of EEG can be used to detect neural mechanisms reflecting visceral central sensitization, which may be used to extract more advanced and descriptive results in studies of pain physiology and pharmacological intervention in the future. Indsendt af: Postdoc, ingeniør Carina Graversen, (Mech-Sense, Gastroenterologisk, Aalborg Sygehus) Uddannelse: MScEE, PhD E-mail: carina@graversen.mobi / Telefon: 2628 2093 Forskningsansvarlig på afdelingen: Asbjørn Mohr Drewes  

62) Offset Analgesia: A Reproducibility Study Forfattere: Matias Nilsson, Thomas Dahl Nissen, Carina Graversen, Parisa Gazerani, Asbjørn Mohr Drewes, Christina Brock Abstract: Background and aims Offset analgesia (OA) is a newly discovered pain-inhibiting mechanism, defined as a disproportionately large decrease in pain perception in response to a decrease in noxious stimulus intensity. Heat is applied as painful stimulus (44-47 °C) and a slight decrease (1 °C) in stimulus intensity causes complete pain relief for 5-10 seconds, despite the presence of a constant noxious stimulus. The aim of the present study was to investigate the reproducibility of OA in order to evaluate whether the phenomenon can be used as a prognostic/ diagnostic tool or as a potential therapeutic target in pain treatment. Methods: Eighteen healthy volunteers were presented to painful thermal stimuli on the volar forearm in compliance with previous studies. Volunteers participated on two separate days and continuous pain ratings and electroencephalographic recordings were obtained throughout the procedure. Results: Reproducibility was examined for numerous parameters (e.g. peak pain intensity, magnitude of painrelief, etc.) pertaining to the continuous pain ratings. Paired T-tests, ICC, and CV displayed significant reproducibility both within the same day as well as between different days (All P-values > 0.05 and ICC values > 0.6).


Conclusion: The present model displayed high reproducibility, making it suitable for further studies using OA. This may provide a unique approach to study basic pain and pharmacological intervention in healthy volunteers as well as in patients with dysfunctional pain inhibition. Continuous EEG recordings enable evaluation of dynamic changes in brainwave activity during OA and can possibly be used as an objective means of measuring pain. Indsendt af: Research Assistant, Stud. Scient. Med. Matias Nilsson, (Mech-Sense, Gastroenterologisk Afdeling, Aalborg Sygehus Syd, Aalborg Sygehus) Uddannelse: Medicin med Industriel Specialisering E-mail: m.nilsson@rn.dk / Telefon: 6022 9686 Forskningsansvarlig på afdelingen: Asbjørn Mohr Drewes  

63) Genetic variation in opioid receptor genes and sensitivity to experimental pain in male and female healthy volunteers Forfattere: Olesen AE, Droney J, Sato H, Ross JR, Staahl C, Andresen T, Branford R, Riley J, Drewes AM. Abstract: Introduction: Pain is a common problem which significantly impacts on quality of life. Clinical pain is complicated to study due to numerous confounding variables. Normal volunteer models use standardised painful stimuli with resulting reduced phenotype variability. Current studies suggest an association between genetic variability and pain sensitivity.

(p=0.009) and muscle cuff pain (p=0.003). Visceral pressure pain was not associated with either gender or genotype. Conclusion: Genetic variations in the kappa opioid receptor appear to mediate different pain modalities. Gender remains an independent predictor of pain sensitivity. Indsendt af: Post. doc Anne Estrup Olesen, (Mech-Sense, Medicinsk Gastroenterologisk, Aalborg Sygehus) Uddannelse: Farmaceut E-mail: aeo@mech-sense.com / Telefon: 9932 6247 Forskningsansvarlig på afdelingen: Asbjørn Mohr Drewes  

64) Population pharmacokinetics of pregabalin in patients with chronic pancreatitis Forfattere: Anne Brokjær, Erik Olofsen, Søren Schou Olesen, Camilla Staahl, Trine Andresen, Albert Dahan, Asbjørn Mohr Drewes & Anne Estrup Olesen Abstract: Chronic pancreatitis (CP) is a continuing inflammatory disease of the pancreas. Pain is the dominating symptom and often complicated to treat. Pregabalin is an anticonvulsant drug which has shown clinical efficacy in treating CP associated pain. However, it is well known that CP patients suffer from fat malabsorption which may affect the absorption of pregabalin. Therefore, the aim of this study was to develop a population pharmacokinetic model of pregabalin in patients suffering with CP.

Methods: Data from 50 healthy volunteers in three studies of multi-modal, multi-tissue experimental pain stimulation were included. Skin heat, muscle cuff pressure and visceral pressure were analysed. Genetic variants in the genes coding for the mu, delta and kappa opioid receptors (OPRM, OPRD and OPRK) were studied using multivariate regression modelling to investigate association with pain sensitivity.

CP patients with a diagnosis based on The Mayo Clinic diagnostic criteria were recruited for this study. Each patient was given a 75 mg of pregabalin (oral capsule). Venous blood was collected at 0, 15, 30, 60, 90, 120, 180, 240 and 360 minutes after dosing and pregabalin concentrations were assayed using a validated liquid chromatographic method. Data analysis was performed using nonlinear mixed effects modeling methodology as implemented by NONMEM.

Results: Reproducibility of baseline data for skin heat, muscle cuff pressure and visceral pressure between studies was confirmed (Cronbach α >0.8). Gender differences in pain sensitivity were seen. Females were more sensitive to skin heat and muscle pressure (p=0.006 and 0.02 respectively). Genetic associations were also found. OPRK was associated with both skin heat pain

15 patients enrolled in this study (8 Females). Mean age was 54 yrs (range 25-73 yrs). Pregabalin was well tolerated by all patients. A one compartment model with firstorder absorption and elimination adequately described pregabalin pharmacokinetics.

49


Pregabalin was well absorbed in patients suffering from CP. Nevertheless, the maximum observed plasma concentration (Cmax) was reduced (1.95 vs. 2.18 μg/ml), the time to which it occurred (tmax) was delayed (1.5 vs.1.3h); and the area under the plasma concentrationtime profile (AUC) smaller (11.84 vs. 15.6 μg*h/ml) compared to values previously found in clinical studies of pharmacokinetics of pregabalin in healthy volunteers. CP does not affect the pharmacokinetic profile of pregabalin extensively and dosage reduction should not potentially be required in these patients. Indsendt af: Ph.d.-studerende Anne Brokjær, (Mech-Sense, Medicinsk Gastroenterologisk Afdeling, Aalborg Sygehus) Uddannelse: Bioanalytiker, Cand. Scient. E-mail: abr@mech-sense.com / Telefon: 9932 6247 Forskningsansvarlig på afdelingen: Asbjørn Mohr Drewes  

65) A pilot study of oesophago-gastric junction distensibility in patients with Barrett’s oesophagus and hiatal hernia compared with healthy controls assessed with Functional Luminal Imaging Probe (FLIP) Forfattere: Christian Lottrup MD (1), Jixi Liu MD (2), Per Ejstrud MD (3) , Marcin Ostapiuk MD (3), Barry P McMahon MSc, PhD (4), Asbjørn Mohr Drewes MD, DmSc, PhD (1) 1. Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg Hospital, Denmark 2. Department of Gastroenterology, China-Japan Friendship Hospital, Beijing, China 3. Advanced Endoscopy Unit, Department of Surgical Gastroenterology A, Aalborg Hospital, Denmark 4. Department of Medical Physics and Clinical Engineering, Adelaide and Meath Hospital Dublin, Tallaght, Ireland Abstract: Background: Patients with gastro-oesophageal reflux disease have previously been shown to have increased distensibilty of the oesophago-gastric junction (OGJ). The Functional Luminal Imaging Probe (FLIP) is a novel method to assess the distensibility as it relates to competency of sphincters in the gastrointestinal tract. The aim of this study was to use FLIP to assess the distensibility of two hernia separated sphincter components; namely the true lower oesophageal sphincter (LES) as well as the diaphragmatic crural component. Material and methods: A pilot study compared three 50

Barrett’s oesophagus patients with hiatal hernia to two healthy controls. A FLIP probe capable of measuring cross-sectional area during inflation with saline was placed straddling the oesophago-gastric junction. In patients with hiatal hernia the diaphragmatic hiatus and the LES were located and measured separately. Results: The true LES in the hiatal hernia patients was more distensible than in healthy controls. In hiatal hernia patients, the diaphragmatic sphincter component was more distensible than the true LES. At low distension volumes, the three-dimensional anatomy of a hiatal hernia could be assessed visually with both sphincter regions visible at the two ends of the hernia. Conclusion: FLIP is a practicable method to assess the distensibility of the OGJ also in the presence of a hiatal hernia. This assessment may be used to better understand the function and competency of the OGJ and the roles that the different parts of the junction play. Indsendt af: Klinisk assistent Christian Lottrup, (Mech-Sense, Medicinsk Gastroenterologisk Afdeling, Aalborg Sygehus) Uddannelse: Læge E-mail: chlo@rn.dk / Telefon: 2611 1781 Forskningsansvarlig på afdelingen: Asbjørn Mohr Drewes  

66) Can the analgesic effect of buprenorphine be predicted by quantitative sensory testing in healthy volunteers? Forfattere: Iben W. D. Fischer Anne E. Olesen Albert Dahan Eric Olufsen Trine Andresen Asbjørn Mohr Drewes Abstract: Objective: Large inter-individual variability in response to analgesic effects underlines the clinical importance of being able to predict responders and non-responders to opioid treatment. Up till now the primary diagnosis of the pain syndrome, rather than the patient’s individual characteristics, determine the choice of treatment. The aim of this study was to investigate if the interindividual response to buprenorphine induced analgesia could be predicted by quantitative sensory testing (QST). Method: A double-blinded crossover study, where twenty-two healthy volunteers received buprenorphine and placebo patches was performed. QST involved pressure at the tibial bone and cutaneous thermal stimulation.


QST was carried out at baseline and 72 hours after patch application. Pearson correlation was used to determine correlation between baseline and change in pain tolerance threshold at 72 hours. In pain test with significant correlation a linear regression model was utilised for prediction. Result: Correlations were found between heat pain tolerance threshold at baseline and the change in heat pain tolerance threshold at 72 hours (r =-0.627, P=0.002) and for baseline bone pressure pain threshold and the change in at 72 hours (r=-0.527, P=0.012). Lower baseline values for skin heat and bone pressure pain tolerance thresholds were associated with more pronounced analgesic effect of buprenorphine. Conclusion: It was possible to predict the analgesic effect of buprenorphine in healthy volunteers by skin heat stimulation and bone pressure. Indsendt af: Speciale studerende fra Farma, KU Iben W. D. Fischer, (Mech-sense, Medicinsk gastroenterologisk afdeling, Aalborg Sygehus) Uddannelse: Bachelor i Medicin med Industriel specialisering, AAU. Kandidat studerende ved Farma, KU - lægemiddelvidenskab E-mail: ibenfischer@hotmail.com / Telefon: 5357 5420 Forskningsansvarlig på afdelingen: Asbjørn Morh Drewes  

67) Effect of pregabalin on visceral sensation and central pain processing in patients with chronic pancreatitis Forfattere: Lasse Paludan Malver, Søren Schou Olesen, Carina Graversen, Anne Estrup Olesen, Jens Brøndum Frøkjær, Oliver Wilder-Smith, Harry van Goor, Massimiliano Valeriani & Asbjørn Mohr Drewes Abstract: Background and aims: Pregabalin has a broad spectrum of anti-hyperalgesic activity in both basic and clinical studies. However, its mechanisms and sites of action (spinal vs. supraspinal) have yet to be determined in man. The aim of this study was to assess the analgesic effect of pregabalin to experimental gut pain in patients with visceral hyperalgesia due to chronic pancreatitis (CP) and to reveal putative changes in corresponding central pain processing assessed by evoked brain potentials (EPs). Methods: Twenty-six patients were randomly assigned

to receive increasing doses of pregabalin or placebo for three consecutive weeks. Perceptual thresholds to electrical stimulation of the sigmoid with recording of corresponding EPs were obtained at baseline and after three weeks of study treatment. The brain source localisations reflecting direct neuronal activity were fitted by a five-dipole model projected to magnetic resonance imaging of the individuals brains. Results: As compared to placebo, pregabalin significantly increased the pain threshold to electrical gut stimulation from baseline (P = 0.02). No differences in EPs characteristics was seen after neither pregabalin nor placebo treatment (all P>0.05). In agreement with this, brain source locations remained stable during study treatment (all P>0.05). Conclusion: Pregabalin was superior to placebo for attenuation of experimental visceral pain in CP patients. We suggest its analgesic mechanism of action to be mediated primarily through a spinal mechanism. Indsendt af: Læge, ph.d. studerende Lasse Paludan Malver, (Med. gastroenterologisk forskningsafsnit, Aalborg Sygehus) Uddannelse: Læge, ph.d. studerende E-mail: lapm@rn.dk / Telefon: 9932 6243 Forskningsansvarlig på afdelingen: Asbjørn Mohr Drewes  

68) Rygning induceret hæmning af NIS er ledsaget af tegn på jodmangel hos gravide og nyfødte, men synes ikke at hæmme jodid passage over placenta Forfattere: Stine L. Andersen(1), Klaus M. Pedersen(2), Susanne B. Nøhr(1), Peter Laurberg(1) 1) Endokrinologisk Afdeling, Aalborg Sygehus, 2) Medicinsk Afdeling, Vejle Sygehus Abstract: Baggrund: Thyroideahormoner er essentielle for barnets CNS udvikling og vækst. Jod er substrat for thyroideahormon syntese, og fosteret er afhængig af jodid fra mater. NIS (natrium iodid symporter) er påvist i placenta, medierer jodid transport i glandula thyroidea og mamma og hæmmes af thiocyanat, som akkumuleres i blodet hos rygere, men det er fortsat uvist, om NIS er af betydning for jodid transport over placenta. Hypotese: Såfremt NIS er af betydning for jodid transport over placenta forventes forskel i biokemiske tegn på jodmangel hos gravide rygere og deres børn. 51


Metode: Tværsnitsundersøgelse før jodberigelsen i Danmark. 140 gravide kvinder klassificeret som ryger (n=50) eller ikke-ryger (n=90) og deres børn. 1/3 af kvinderne (n=47) tog regelmæssigt jodtilskud, og Thyroglobulin (Tg) blev anvendt som markør for jodmangel. Resultater: Ingen signifikant forskel i Tg (median) ryger vs. ikke-ryger blandt gravide som tog jodtilskud og deres børn; maternel Tg 14,5 vs. 13,8 μg/l, p = 0,34, navlesnorsblod Tg 31,7 vs. 38,3 μg/l, p = 0,94. Signifikant forskel i Tg (median) ryger vs. ikke-ryger blandt gravide uden jodtilskud og deres børn; maternel Tg 34,8 vs. 22,8 μg/l, p = 0,001, navlesnorsblod Tg 74,2 vs. 53,0 μg/l, p = 0,017, men den relative Tg medianstigning fandtes ikke signifikant forskellig gravide og nyfødte imellem; maternel 52,6% vs. navlesnorsblod 40,0%, differens 12,6% (95% CI -12; 37%), p > 0,3. Konklusion: Maternel rygning øger risikoen for jodmangel hos mor og barn. Vore biokemiske data giver ikke holdepunkter for, at NIS er af væsentlig betydning for jodid transport over placenta. Indsendt af: Læge, ph.d. studerende Stine Linding Andersen, (Medicinsk Endokrinologisk Afdeling, Aalborg Sygehus) Uddannelse: Læge E-mail: stine_andersen@sol.dk / Telefon: 2757 4916 Forskningsansvarlig på afdelingen: Professor Peter Laurberg  

69) Improved environment and individualized serving increased nutrition intake in hospitalized patients Forfattere: Beermann T, Mortensen MN, Skadhauge LB, Rasmussen HH, Holst M Abstract: Rationale: Poor eating environment and lack of focus on serving of meals, contribute to the challenges regarding nutrition intake in hospitalized patients. The aim of this qualitative study was to improve nutrition intake by increasing the environmental aesthetics and individualized meal service. Methods: A multi-modal three month intervention including three departments of infectious diseases, haematology and heart-lung surgery. Interventions were: Testing of “Type-categorising” of patients’ wishes for meals, improved menus and toppings to improve the delicacy impression on the plate and decoration of dining room. Furthermore, patients were welcomed to the department with a special serving and written materials about food and nutrition, and an interview, with the 52

aim of categorising patients into types associated with a specific menu and serving. Food intake was registered for patients hospitalized >three days, who were able to register for three consecutive days, before and after the intervention period, respectively. Patients were interviewed regarding satisfaction. Results: Food intake was registered for 22 patients (66 registration days) before and 36 (108 registration days) after the intervention period. Patients were similar regarding age and gender at both occasions. All patients were considered at nutritional risk. Along with improved energy intake (Table1), patient satisfaction with the improved environment and individual serving were very positive, and furthermore relative inexpensive. However, the “Type-categorising” of patients did not seem meaningful to either patients or staff. Conclusion: Improvement of surrounding environment, focus on meals and individualized serving, improved nutrition intake. Indsendt af: Ledende Klinisk Diætist Tina Beermann, (Medicinsk Gastroenterologisk Afdeling, Center for Ernæring og Tarmsygdomme, Aalborg Sygehus) Uddannelse: Cand Scient i Klinisk Ernæring E-mail: tina.beermann@rn.dk / Telefon: 9932 6270 Forskningsansvarlig på afdelingen: Asbjørn M Drewes  

70) Basic Metabolic Rate In Patients With Short Bowel Syndrome: Measured Versus Estimated Forfattere: M. Køhler, T. Beermann, L. Vinter-Jensen, B. A. Jacobsen, H. H. Rasmussen Abstract: Rationale: Patients with short bowel syndrome (SBS) are often in high risk of malnutrion and targeted nutritional therapy is mandatory including home parenteral nutrition (HPN). The Harris-Benedict equation is widely used to predict basal metabolic rate (BMR), but it may over- or underestimate the energy needs. The aim was to compare BMR measured by indirect calorimetric (BMRm) with BMR estimated by the Harris-Benedict equation (BMR-hb). Methods: A cross-sectional investigation of patients with SBS stratified according to -/+ HPN. Demographics, use of HPN, anthropometrics (hand grip strengths, weight, and height), bioimpedance, and indirect calorimetric for BMR were recorded. Statistics: Paired samples t-test and a Bland-Altman plot.


Results: Overall 44 patients (19 M/25 F, 62,6±12,8 yrs (mean±SD) were included. Of these 21 (48%) received HPN. BMR-m was 1220±241 kcal and BMR-hb was 1256±216 kcal. The mean difference between BMR-hb and BMR-m was -54 (SD 174) in patients on HPN and 118 (SD 112) in patients not on HPN. The mean difference between the 2 groups (-/+HPN) was statistical significant p < 0,001.In patients without HPN BMR-hb overestimated BMR-m especially in patients with low BMR-m. In patients on HPN BMT-hb underestimated the BMR-m especially in patients with high BMR-m. BMR-hb corrected for fat free mass, was higher in the non-HPN group (P<0,001). Conclusion: BMR by Harris-Benedict equation overestimated BMR in patients with SBS on oral nutrition especially in patients with low BMR, and underestimated BMR in patients on HPN especially in patients with high BMR. This may be due to nutritional adaptation. Indsendt af: Bioanalytiker Marianne Køhler, (Medicinsk Gastroenterologisk Afdeling, CET-Laboratoriet, Center for Ernæring og Tarmsygdomme, Aalborg Sygehus) Uddannelse: Bioanalytiker E-mail: mk@rn.dk / Telefon: 9932 6281 Forskningsansvarlig på afdelingen: Proff. Asbjørn M. Drewes  

71) Vippetest som første valg ved undersøgelse af patienter med vindueskiggersyndrom Forfattere: Annette Kirkeby Engilbertsdóttir Nielsen Abstract: Formål: Belastning af muskulaturen i benene bruges til at finde ud af, om patienter har vindueskiggersyndrom, når de har normalt distalt blodtryk i hvile. Gangbåndstesten bliver i dag brugt til belastning på vores afdeling. Et af problemerne med gangbåndstesten er, at patienterne skal gå i et hurtigt tempo. Ikke alle patienter kan gå hurtigt nok, og derfor kan gangbåndstesten ikke udføres. Et andet problem er, at gangbåndstesten involverer hele kredsløbet, så patienter med iskæmisk hjertesygdom og kronisk obstruktiv lungelidelse kan ikke lave gangbåndstesten. Til vippetesten bruger patienterne kun lægmusklerne, dette gør at flere patienter kan deltage. I dette studie vil jeg finde ud af, om vi med fordel kan bruge vippetesten som førstevalg, når patienter med symptomer på Vindueskiggersyndrom har normale tryk i hvile. Materialer og metoder: Der var 27 patienter (54 ben)

inkluderet i dette studie. Alle patienter havde normalt distalt blodtryk i hvile og symptomer på vindueskiggersyndrom. Alle patienter fik målt distalt blodtryk forud for de to test. Den ene halvdel af patienterne startede med gangbåndstesten, hvilede derefter i 30 minutter, og lavede herefter vippetesten. Den anden halvdel lavede først vippetesten, hvilede derefter i 30 minutter, hvorefter de lavede gangbåndstesten. Ankelindekset blev beregnet (DBT/systolisk armboldtryk) for både hvile og stress undersøgelserne. Et fald i ankelindeks på 0,15 eller mere betragtes som signifikant og testen er positiv. Resultater: Studiet giver en specificitet på 100 % og en sensitivitet på 56 % Konklusion: Studiet viser, at vippetesten finder alle de positive patienter. Vippetesten skal bruges om første valg, for patienter med vindueskiggersyndrom, der har normalt distalt blodtryk i hvile. Indsendt af: Bioanalytiker Annette Kirkeby Engilbertsdóttir Nielsen, (Nuklearmedicinsk Afdeling, Aalborg Sygehus) Uddannelse: Bioanalytiker E-mail: aken@rn.dk / Telefon: 9932 4603 Forskningsansvarlig på afdelingen: Henrik Christian Bertelsen  

72) Forbedring af detektibilitet af parathyreoidea adenom med SPECT og diagnostisk CT med iv-kontrast Forfattere: Victor Iyer, Søren Dammand Henriksen, Pia Afzelius, Rune Vincent Fisker og Jørgen Erik Assentoft Abstract: Primær hyperparathyreoidisme skyldes autonom overproduktion af parathyroideahormon (PTH). Sekundær hyperparathyreoidisme skyldes overproduktion af PTH på baggrund af og som kompensation for langvarig hypocalcæmi og evt. hyperplasi af parathyreoideakirtlerne. 85-90% af alle tilfælde af primær hyperparathyreoidisme er forårsaget af et enkelt parathyreoideaadenom; 5-10% af tilfældene skyldes parathyreoidea-hyperplasi. Parathyreoideacarcinom tegner sig for ca. 3-4% af tilfældene af primær sygdom. Technetium-99m-sestamibi (MIBI) er den nuværende foretrukne scintigrafiske procedure til lokalisering af parathyroideaadenom præoperativt. MIBI absorberes hurtigere af et hyperfungerende parathyroideaadenom end af en normal parathyroideakirtel. Udførelsen fore53


går ved en ”enkel-isotop, dobbelt-fase teknik”, som er baseret på det faktum, at MIBI udvaskes hurtigere fra skjoldbruskkirtlen end fra unormalt parathyroideavæv. For at finde forskellen kan der benyttes en subtraktionsbilledbehandling. Problemet er imidlertid, at ikke alle parathyroideaadenomer fastholder MIBI, og ikke alle thyreoideavæv udvasker hurtigt. SPECT/CT (Single-Photon Emission Computed Tomography) scanning kan lokalisere parathyreoideaadenomer og differentiere skjoldbruskkirtlen fra parathyreoideaadenomer, men hidtil publicerede studier er lavet med en SPECT/CT scanning uden diagnostisk CT undersøgelse. I denne undersøgelse har vi udvidet med en diagnostisk CT scanning af halsen med iv. kontrast (Siemens Symbia 16-slice SPECT/CT scanner). Det vil forbedre følsomheden mere end 90% og give en bedre lokalisering af det lokale parathyreoideaadenom og det ektopiske parathyroideavæv samt øge den diagnostiske sikkerhed. Det hjælper hals-kirurgerne til at foretage mere målrettede indgreb og at operere mere atraumatisk med reduktion af de postoperative komplikationer til følge. Vi præsenterer resultater af et retrospectivt SPECT/CT (diagnostisk CT) studium af 58 patienter med kirurgiskpatologisk korrelation undersøgt på Aalborg Sygehus mellem december 2010 og februar 2012. Indsendt af: Biomedical Engineer Jørgen Erik Assentoft, (Nuklearmedicinsk Afdeling, Aalborg Sygehus) Uddannelse: Biomedical Engineer E-mail: j.assentoft@rn.dk / Telefon: 6146 7298 Forskningsansvarlig på afdelingen: Pia Afzelius  

73) PET-scanning og uskarphed fra positroners rækkevidde Forfattere: Lars Jødal, Cindy Le Loirec, Chritophe Champion Abstract: Baggrund: PET-scanning benyttes til at diagnosticere en række forskellige sygdomme, herunder kræft. Ved scanningen indsprøjtes et kortlivet radioaktivt sporstof i patienten, og der måles på stråling fra udsendelse af positroner. Imidlertid når positronerne at bevæge sig et lille stykke vej, før strålingen udsendes, hvilket kan give uskarphed i billederne. Formål: At bestemme fordelingen af denne uskarphed for forskellige sporstoffer til PET-scanning. Hvis uskarp54

heden kendes præcist, kan der korrigeres for den matematisk. Metode og resultater: På basis af en computer-simulation (Monte Carlo simulation) af et stort antal positroner, blev uskarphedens fordeling bestemt for 7 forskellige sporstoffer (isotoper). Uskarpheden er lille for de mest anvendte stoffer, men har klinisk betydning for andre stoffer. Der blev fundet en metode til at forudsige uskarphedens fordeling for andre sporstoffer. Perspektiv: Med brug af projektets resultater vil det være muligt at korrigere for uskarpheden, når billederne fra PET-scanningen beregnes. Indsendt af: Hospitalsfysiker Lars Jødal, (Nuklearmedicinsk afdeling, Aalborg Sygehus) Uddannelse: cand.scient. E-mail: lajo@rn.dk / Telefon: 9932 3139 Forskningsansvarlig på afdelingen: Pia Afzelius  

74) Adjustment for blood pressure when measuring pulse wave velocity in newly diagnosed, untreated hypertensive patients Forfattere: Strandhave C, Department of Nephrology, Aalborg Hospital, Aarhus University Hospital Svensson M, Department of Nephrology, Skejby Hospital, Aarhus University Hospital Holdensen K, Department of Nephrology, Aalborg Hospital, Aarhus University Hospital Skov CM, Department of Nephrology, Aalborg Hospital, Aarhus University Hospital Krarup H, Department of Clinical Biochemistry, Aalborg Hospital, Aarhus University Hospital Christensen JH, Department of Nephrology, Aalborg Hospital, Aarhus University Hospital Abstract: Pulse wave velocity (PWV) is a valid and well-documented predictor of cardiovascular risk in hypertensive patients. It is essential to adjust for potential confounders, and especially age and blood pressure (BP) modulate the level of PWV. Both systolic BP and mean arterial pressure (MAP) have been used when adjusting in statistical models. However, in recent years MAP has been favoured for BP adjustment. The aim was to investigate if MAP was superiorly correlated to PWV compared to systolic BP in newly diagnosed, untreated hypertension. We included 126 newly diagnosed, untreated hyperten-


sive patients. Twenty-four hour ambulatory BP measurement was performed and PWV was measured using the SphygmoCor device. The cohort consisted of 61 men and 73 women with an average age of 50 ± 12 years. The mean systolic BP was 146 ± 12 mmHg and the mean MAP was 108 ± 9 mmHg with no significant difference between genders. The median PWV was 8.4 m/s (range 5.3 to 16.8) with no gender difference. In a linear regression model age was highly positively correlated with PWV (ß =.004, p<.001). In an ageadjusted model, MAP was positively correlated with PWV (ß=.004, p=.02) but systolic BP showed a higher positive correlation with PWV (ß=.003, p=.008). Yet, Steiger´s test for equal correlation showed that the correlation coefficients were not statistically different (p=.2). PWV measurements must be corrected for BP levels as well as age. Adjusting for systolic BP is not superiorly to adjusting for MAP in hypertensive patients. Thus, the two BP measurements can be equally used for adjustment. Indsendt af: Læge, Klinisk Assistent, Ph.d.-studerende Charlotte Strandhave, (Nyremedicinsk Afdeling, Aalborg Sygehus) Uddannelse: Cand. med. E-mail: charlotte.strandhave@rn.dk / Telefon: 9932 6724 Forskningsansvarlig på afdelingen: Professor Jeppe Hagstrup Christensen  

75) Relation between haptoglobin phenotype and arterial stiffness in newly diagnosed, untreated hypertensive patients Forfattere: Charlotte Strandhave, Department of Nephrology, Aalborg Hospital, Aarhus University Hospital My Svensson, Department of Nephrology, Skejby Hospital, Aarhus University Hospital Henrik Krarup, Department of Clinical Biochemistry, Aalborg Hospital, Aarhus University Hospital Jeppe Hagstrup Christensen, Department of Nephrology, Aalborg Hospital, Aarhus University Hospital Abstract: Arterial stiffness is a valuable predictor of cardiovascular risk in essential hypertension. Arterial stiffness is affected by genetic polymorphisms. Moreover, increased

arterial stiffness has been associated with oxidative stress. Haptoglobin (Hp) is an innate antioxidant which due to molecular heterogeneity forms three phenotypes: 1-1, 2-1, and 2-2. The antioxidant ability is phenotype dependent. In diabetes mellitus Hp 2-2 is a predictor of vascular complications but whether Hp 2-2 predicts vascular complications in essentiel hypertension has not previously been examined. The aim of the study was to investigate if Hp 2-2 was positively associated with aortic pulse wave velocity (aPWV) and central systolic blood pressure (sysBP). We examined 94 newly diagnosed, untreated hypertensive patients. aPWV and central sysBP were measured using the SphygmoCor devic and Hp phenotype using high-performance liquid chromatography. The cohort consisted of 42 men and 52 women with an average age of 48 ± 11 years. The median aPWV was 7.6 (6.0; 9.7) m/s in Hp 1-1, 8.0 (5.3; 11.0) m/s in Hp 2-1, and 8.3 (5.5; 10.6) m/s in Hp 2-2. The difference was non-significant (p=0.5, ANOVA). The median central sysBP was 147 (123; 163) mmHg in Hp 1-1, 151 (123; 187) mmHg in Hp 2-1, and 155 (124; 195) mmHg in Hp 2-2. Also, these differences were non-significant (p=0.4, ANOVA). This study showed a potential yet non-significant difference in aPWV and in central sysBP between Hp phenotypes with the highest levels in Hp 2-2 hypertensive patients. Thus, Hp 2-2 may be a useful, easy measured predictor for cardiovascular risk in hypertension. Indsendt af: Læge, klinisk assisten, Ph.d.-studerende Charlotte Strandhave, (Nyremedicinsk Afdeling, Aalborg Sygehus) Uddannelse: Cand. med E-mail: charlotte.strandhave@rn.dk / Telefon: 9932 6724 Forskningsansvarlig på afdelingen: Professor Jeppe Hagstrup Christensen  

76) The effect of n-3 polyunsaturated fatty acids on adiponectin levels in patients with end stage renal disease Forfattere: Frederik Harving1, My Svendsen3, Erik Bjerg Schmidt2, Kaj Anker Jørgensen3, Allan Flyvbjerg4 and Jeppe Hagstrup Christensen1 1) Department of Nephrology and 2) Department of Cardiology, Center for Cardiovascular Research, Aalborg Hospital, Aalborg, Denmark and 3) Department of Renal Medicine C, Skejby Hospital, 55


Aarhus University Hospital, Aarhus, Denmark, and 4) Department of Endocrinology and Internal Medicin & the Medical Research Laboratories, Clinical Institute, Aarhus University Hospital, Aarhus C, Denmark Abstract: Background and aim: In subjects without kidney disease, adiponectin appears to have anti-inflammatory, anti-diabetic, and anti-atherogenic effects. Also, in patients with end stage renal disease (ESRD) high levels of plasma adiponectin are associated with a reduced risk of cardiovascular disease. n-3 polyunsaturated fatty acids (PUFA) have several beneficial effects in ESRD patients and the aim of the present was to assess the effect of n-3 PUFA supplementation on adiponectin levels in ESRD patients. Methods: In a double blinded intervention trial 162 ESRD patients (mean age 67 years + 13, 56 women and 106 men) undergoing chronic haemodialysis were randomized to 1.7 g n-3 PUFA daily or placebo for 3 months. Adiponectin and lipids and lipoproteins were measured at baseline and after the intervention period. Results: At baseline a Correlation was found between adiponectin and HDL-cholesterol (r = 0.551, p < 0.001), and an inverse correlation between adiponectin and body mass index (r= - 0.43, p< 0.001). In the n-3 PUFA group baseline adiponectin was 18.5 µg/ml + 11 and after 3 months of supplementation no significant change was observed (18.8 µg/ml + 12, p = 0.56). Also compared to placebo n-3 PUFA supplementation did not change adiponectin levels. Conclusion: Treatment with n-3 PUFA has no effect on adiponectin levels in ESRD patients. However, as observed in other populations adiponectin is closely associated with body mass index and HDL-cholesterol in ESRD patients. Indsendt af: Reservelæge Frederik Harving, (Nyremedicinsk Afdeling, Aalborg Sygehus) Uddannelse: Igang med introduktionsstilling E-mail: frederik.harving@rn.dk / Telefon: 5192 3953 Forskningsansvarlig på afdelingen: Jeppe Hagstrup Christensen  

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77) Calcification of the Thoracic Aorta on chest X-ray – Associations With Abdominal Aortic Calcification And Pulse Wave Velocity In Patients On Renal Replacemend Therapy Forfattere: Schjelderup P., Jensen J.D., Otte K.E., Ladefoged S., Jensen P.B., Christensen J.H. Abstract: Background: Abdominal aortic calcification (AAC) on lateral abdominal x-ray and carotid-femoral pulse wave velocity (PWV) are independent predictors of mortality and non-fatal CV events in patients on renal replacement therapy (RRT). Guidelines suggest that the presence of AAC can be used to identify patients at high risk. In this study aortic arch calcification (AoAC) on chest x-ray was correlated with the above mentioned established markers of vascular calcification. Methods: AAC, AoAC and PWV were measured in 88 patients on RRT who were Danish participants in a European multicenter cross-sectional study. Inclusion criteria were: >18 years of age and >3 months of maintenance haemo- or peritoneal dialysis treatment. AoAC was measured using a semi-quantitative method. The cross section of the aortic arch was divided into 16 sectors on a plain frontal chest x-ray. Sectors showing signs of calcified plaques in the form of typically shaped densities were identified. The carotid-femoral PWV was measured using applanation tonometry. Results: 72% had a AoAC score > 0 compared to 81 % with a AAC score > 0. AoAC was significantly positively correlated with AAC (r=0.69, p<0.001) and PWV (r=0.35, p<0.001). The positive- and negative predictive values of AoAC with respect to AAC were 98% and 32%, respectively. Conclusion: The presence of calcification on chest x-ray was positively correlated with AAC and PWV. Chest xray is inexpensive and frequently obtained in this patient population. We believe it may provide valuable data on calcification and may be used in risk stratification of dialysis patients. Indsendt af: 1. Reservelæge Patrick Schjelderup, (Nyremedicinsk Afdeling, Aalborg Sygehus) Uddannelse: Hoveduddannelsesstilling i nyremedicin E-mail: pschjelderup@gmail.com / Telefon: 2877 8978 Forskningsansvarlig på afdelingen: Jeppe Hagstrup Christensen


78) Subclinical Bacteraemia and Mor-

tality Among Haemodialysis Patients HD-BACT

Forfattere: R.I. Glerup1, H.C. Schønheyder3, M. Svensson2, J.K. Madsen2, J.H. Christensen1 1) Department of Nephrology, Aarhus University Hospital Aalborg, 2) Department of Nephrology C, Aarhus University Hospital Skejby, 3) Department of Clinical Microbiology, Aarhus University Hospital Aalborg Abstract: Introduction: Mortality in the population of hemodialysis patients remains high. The annual mortality exceeds 20%. Cardiovascular disease (CVD) is the major course of mortality, accounting for half of all deaths in this population. There is a close relationship between inflammation and development of CVD. 30-60% of hemodialysis patients have chronically elevated markers of inflammation. Hypothesis: Chronic inflammation in hemodialysis patients may be caused by subclinical infection expressed by circulating bacterial DNA in the blood stream causing higher mortality and morbidity. Aim of the study: To investigate the influence of circulating bacterial DNA on mortality morbidity and levels of inflammatory markers among a group of hemodialysis patients. Material and Methods: Hemodialysis patients treated at five facilities are included (Aalborg, Skejby, Horsens, Randers and Hjørring Hospital; in total approximately 420 patients). Programme: Physical examination. Blood sample drawn from peripheral vein and from hemodialysis access. Nasal wipe. Dialysate samples. A group of approximately 100 hemodialysis patients will be examined again one week later with blood sampling to evaluate the expected continuous nature of circulating bacterial DNA. Blood samples: Bacterial DNA is detected by using broad range 16S rDNA PCR. Blood cultures: 3 culture bottles are drawn for 7 days of automated incubation. Inflammation markers: various cytokines, hsCRP, procalcitonin etc. Baseline parameters: Study participants will be followed for 2 years. The primary end point is all cause mortality and secondary end points: bacteraemia, cardiovascular death, cardiovascular events, and hospital admissions.

Indsendt af: Reservelæge Rie Io Glerup, (Nyremedicinsk Afdeling, Aalborg Sygehus) Uddannelse: Cand. med. og ph.d.-studerende E-mail: rig@rn.dk / Telefon: 9932 6648 Forskningsansvarlig på afdelingen: Professor Jeppe Hagstrup Christensen  

79) Fra pårørende til pårørende - Erfaringsudveksling i en gruppe af pårørende til patienter med hjernetumor Forfattere: Dorte Mosskov Poulsen, Merete Kinly Olsen, Laila Mikkelsen, Gitte Iversen. Abstract: Baggrund: Patienter med glioblastom kan pga. af sygdommens karakter blive ramt af halvsidig lammelse eller nedsat kraft i højre eller venstre side. De kan have afasi og taleforstyrrelser, ændre deres personlighed og blive plejekrævende med behov for hjælp døgnet rundt. Dette betyder, at de pårørende bliver udfordret på flere måder og får brug for hjælp til at håndtere denne situation. Formål: For at støtte de pårørende i at håndtere livet som pårørende, og skabe mulighed for erfaringsudveksling med andre pårørende og professionelle, etablerede vi en gruppe for pårørende, der kunne mødes hver 14. dag. Ud over pårørende deltog 2 sygeplejersker i gruppen. Resultat: Siden august 2010 har vi haft en gruppe med 3-5 deltager, som alle har været godt til at støtte hinanden. Nærvær og tillid i gruppen har desuden også medført, at vi har været i stand til at målrette sygeplejen ud fra den enkelte pårørendes aktuelle behov og eksempelvis involvere psykolog, socialrådgiver, kræftens bekæmpelse m.m. Alle pårørende har udtrykt stort tilfredshed med gruppen. De pårørende har følt sig forstået og anerkendt. Desuden har de oplevet, at de tanker, følelser og problemer de udtrykte, kunne genkendes af de andre i gruppen, og på den måde komme til at føle sig mere ”normale”. Perspektivering: På baggrund af vores erfaring, er vi nu parate til at etablere pårørendegrupper til alle patienter med hjernetumor, som får standardbehandling samt til patienter med progression af deres hjernetumor. Denne fremtidige udfordring vil blive planlagt og tilrettelagt i samarbejde med personalet i vores ambulatorium og stråleterapi.

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Indsendt af: Udviklingssygeplejerske Birgith Pedersen, (Onkologisk Afdeling, Aalborg Sygehus) Uddannelse: Cand. cur. E-mail: Birgith.Pedersen@rn.dk / Telefon: 9932 2925 Forskningsansvarlig på afdelingen: Ursula Falkmer

Indsendt af: Sygeplejerske Dorte Pallesen Koktved, (Onkologisk afdeling D2, Aalborg Sygehus) Uddannelse: E-mail: dorte.koktved@rn.dk / Telefon: 9932 2848 Forskningsansvarlig på afdelingen:

 

 

80) Cancer relateret Fatigue - En udfordring i sygeplejen

81) Kompas – hvilken vej er rigtig for dig?

Forfattere: Dorte Pallesen Koktved Birgith Pedersen, udviklingsygeplejerske i Onkologisk afd.

Forfattere: Lene Michelsen

Abstract: Baggrund: Selvom 80- 90 % af alle patienter med kræft, der er i behandling med kemoterapi og strålebehandling, lider af cancer relateret fatigue (CRF), er det ofte et overset problem. Flere undersøgelse tyder på, at CRF kan få konsekvenser for mange patienters hverdagsliv og påvirke deres livskvalitet.

Abstract: Baggrund: I praksis opleves, at kvinder med brystkræft efterlyser en formel afslutning på deres strålebehandlingsforløb. De udtrykker også behov for en samtale, der kan støtte dem i overgangen fra strålebehandling til hverdagsliv. Derudover stilles der politiske krav, om afholdelse af en afsluttende samtale, og at rehabilitering bør prioriteres højt.

Formål: Med henblik på at forbedre klinisk praksis er formålet med dette studie at sætte fokus på, hvordan patienterne oplever og håndterer CRF.

Formål: At undersøge hvilke behov kvinder med brystkræft (i Region Nord) har i forbindelse med en afsluttende samtale efter endt strålebehandling.

Metode: Til belysning af patienternes oplevelse af CRF er der valgt en fænomenologisk hermeneutisk ramme. Data er indsamlet via semistruktureredes interview med 9 patienter ca. 2 måneder efter afsluttet behandling. Interviewene er analyseret på baggrund af fortolkningsteori i en hermeneutisk proces. Fund: Analysen viser to centrale temaer 1) Når trætheden sætter grænser, 2) At håndtere trætheden. Når CRF sætter grænser for hverdagslivets udfoldelser, forsøger patienterne at håndtere det ved at ”give efter for trætheden”, ” kæmpe for at gøre som man plejer” eller ”komme overens med trætheden” Konklusion: Patienterne oplever en træthed, der varierer mellem træthed, fatigue og udmattelse. Trætheden begrænser deres hverdagsliv og de forsøger at håndtere den ved hjælp af deres tidligere erfaringer. Disse erfaringer kan være uhensigtsmæssige og utilstrækkelige og medføre, at trætheden forværres unødigt og får for store konsekvenser for hverdagslivets opretholdelse. Perspektivering: Både plejepersonale og patienter må kende til hvorledes CRF kan præsentere sig hos de enkelte patienter. Screening af CRF, med inddragelse af hver enkelt patients eget perspektiv og medfølgende vejledning, kan styrke patientens handlekompetence og derved minimere træthedens indflydelse. 58

Metode: Kvalitativ interviewundersøgelse med to fokusgrupper A og B, med hhv. 7 og 4 deltagere. Gruppe A blev interviewet i sidste uge af deres strålebehandlingsforløb, med et opfølgende telefoninterview 2 måneder efter. Gruppe B blev interviewet 6 måneder efter endt strålebehandling. Interviewene er analyseret og fortolket inspireret af Steinar Kvale og Bente Halkiers metoder vedrørende analyse af interviews. Resultater: Interviewene viser, at kvinderne har svært ved at forestille sig, hvilke behov der kan opstå efter endt strålebehandling. I analysen fremkommer 6 temaer, som belyser de områder, hvor kvinderne har behov for støtte. Temaerne er: træthed, individuelle behov/normalisering, arbejdsliv/pensionistliv, bivirkninger, psykiske reaktioner og overgang fra behandling til kontrol. Konklusion: Kvinderne har behov for en individuel tilrettelagt afsluttende samtale, da de oplever meget varierende og forskellige behov. Ligeledes bør en opfølgende telefonkonsultation prioriteres. Perspektivering: Projektet medvirker til, at der sættes fokus på kvindes individuelle perspektiv i den afsluttende samtale. Der arbejdes videre med udvikling af redskaber til anvendelse i samtalen, samt sikre deres anvendelighed i praksis.


Indsendt af: Sygeplejerske Lene Hedegaard Michelsen, (Onkologisk Afdeling, Stråleterapien, Aalborg Sygehus) Uddannelse: Stråleterapuet og Specialuddannelsen i Kræftsygepleje E-mail: lene.hedegaard.michelsen@rn.dk / Telefon: 9932 2855 Forskningsansvarlig på afdelingen: Ursula Falkmer  

82) Minimal Invasive Spine Surgery is safe and reduces surgical stress, muscular damage, blood loss, pain and length of stay without increased costs Forfattere: Sten Rasmussen Abstract: Introduction: The reasoning for performing minimal invasive spine surgery (MISS) is that a gentle surgery is more beneficial for the patient, than a traditional open surgery (TOS). Material and Methods: A randomized controlled trial of 16 patients investigating operative time, blood loss, pain and length of stay. A cohort of 40 patients investigating the safety of MISS and outcome. Surgical stress and muscular damage measured using microdialysis in a controlled trial of 19 patients. A retrospective study of costs based on 55 patients’ data obtained from DRG system and public health insurance data. Results: No blood loss (P = 0.0003), reduced operative time (P = 0.003), pain (P = 0.01) and length of stay (P = 0.01). No neural injuries after percutaneous placement of 188 pedicular screws. There was solid bony fusion in 36 of 40 patients. Accumulated Glycerol Concentration Difference (GCD) was reduced (P = 0.002). Peak GCD level were significant lower (P = 0001). Mean total costs were 143 versus 133 thousand DKr. Mean hospital costs was 126 versus 121 thousand DKr. Conclusions: Minimal Invasive Spine Surgery is safe and reduces surgical stress, muscular damage, blood loss, pain and length of stay without increased costs. Indsendt af: Lektor, forskningsansvarlig overlæge Sten Rasmussen, (Ortopædkirurgien, Aalborg Sygehus) Uddannelse: Læge E-mail: sten.rasmussen@rn.dk / Telefon: 99 32 23 67 Forskningsansvarlig på afdelingen: Sten Rasmussen

83) An advanced diagnostic algorithm in the evaluation of patients with problems related to a hip/knee-prosthesis. Forfattere: Khalid V, Nielsen PT, Schønheyder HC, Rasmussen S. Abstract: Background: Revision surgery after total hip/knee arthroplasty is seen more frequently due to an increasing number of primary surgeries. The most common symptom for patients seeking help after surgery is pain. The cause is divided between loosening, infection or chronic pain. Some are operated with the suspicion of chronic infection. However postoperative microbiological testing does not always correlate with the suspicion and the operation may have been superfluous. The financial cost could have been spared. Hence there is a need for a new scientific approach. Hypothesis: Our aim for the study is to employ an advanced diagnostic algorithm which may improve the diagnostic foundation made preoperatively. Through this approach revision surgery of patients with chronic pain conditions can be prevented. We expect a swift and accurate diagnosis. Materials and Methods: 200 patients referred with pain or other problems related to their hip/knee prosthesis are included. Patients are evaluated according to an advanced diagnostic algorithm which includes state of the art techniques in imaging, serological and molecular sampling. Results: We expect a reduction of up to 50 percent of revision surgery based on the suspicion of an infection. In addition we expect a nuanced and rational treatment to patients with an infection. Conclusion: The patient group needing revision after hip/knee arthroplasty is growing. Roughly 300 are done with the suspicion of infection. The expected financial gain of avoiding revision of chronic pain patients is 42 million kr. annually. The employment of the algorithm strengthens the basis of treatment. Indsendt af: Lægevikar Vesal Khalid, (Ortopædkirurgien, Aalborg Sygehus) Uddannelse: Stud.med E-mail: veuk@rn.dk / Telefon: 60 83 99 88 Forskningsansvarlig på afdelingen: Sten Rasmussen  

 

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84) Immunohistochemical laboratory proficiency - the role of external quality assessment Forfattere: Mogens Vyberg and Søren Nielsen, NordiQC, Institute of Pathology, Aalborg Hospital, Aarhus University Hospital, Denmark Abstract: Immunohistochemical (IHC) assays are highly complex analyses used in diagnostic pathology to aid in identification and characterization of tumour types. Standardization of IHC staining reactions is vital for reliable and comparable results. Yet, staining quality varies greatly between laboratories. Nordic Immunohistochemical Quality Control (NordiQC) was established at Aalborg Hospital in 2003 as an independent scheme for external quality assurance (EQA), with current participation of about 320 laboratories from 40 countries. Annually about 16 challenges are performed in a general module and 6 tests in a breast cancer module. The general results of each run are presented on the website www. nordiqc.org. During 8 years, NordiQC has tested staining for about 80 of the clinically most relevant epitopes up to 10 times based on more than 25,000 multi-tissue sections. The over-all scores have been almost evenly distributed between optimal (36%), good (33%) and insufficient (i.e., borderline or poor, 31%). The causes of insufficient stains could be identified in the large majority of cases, mostly ascribed to less successful primary Abs, improper calibration of the Ab concentration, and insufficient epitope retrieval. Less successful primary Abs were identified as the major cause of suboptimal stains in 18% of the cases, while improper calibration of primary Ab concentration was the major cause in 39%. Following tailored NordiQC recom¬mendations, complying laboratories improved in more than 70%, while non-responding laboratories improved in about 15%. Indsendt af: Overlæge Mogens Vyberg, (Patologisk Institut, Aalborg Sygehus) Uddannelse: Speciallæge i patologisk anatomi E-mail: mv@rn.dk / Telefon: 9932 1604 Forskningsansvarlig på afdelingen: Mogens Vyberg  

85) Altered Brain Microstructure assessed by Diffusion Tensor Imaging in Patients with Diabetes Mellitus and Gastrointestinal Symptoms Forfattere: Jens Brøndum Frøkjær, Lars Wiuff Andersen, Christina Brock, Magnus Simrén, Maria Ljungberg, Eirik Søfteland, Georg Dimcevski, Hans Gregersen & Asbjørn Mohr Drewes. Abstract: Objective: In patients with longstanding diabetes mellitus (DM) there is increasing evidence of abnormal sensory processing in the central nervous system, also including gastrointestinal (GI) sensation. Using magnetic resonance diffusion tensor imaging, we characterized brain microstructure in areas involved in visceral sensory processing and correlated these findings to clinical parameters. Methods: Twenty-six patients with DM and GI symptoms and 23 controls were studied in a 3T MR scanner. Apparent diffusion coefficient (ADC) (i.e. diffusivity of water) and fractional anisotropy (FA) (i.e. organisation of fibres) values were assessed in the cingulate cortex, insula, prefrontal and secondary sensory cortex, amygdala, corona radiata and corpus callosum. Results: Patients had decreased FA values, i.e. reduced organisation, compared to controls in 1) anterior, mid and posterior cingulate cortex, 2) prefrontal cortex grey matter, 3) corona radiata, 4) secondary sensory cortex, 5) anterior insula white and grey matter, and 6) posterior insula grey matter (all P<0.05). The microstructural changes were for some areas correlated to the clinical parameters such as bloating (in anterior insula), mental wellbeing (in prefrontal cortex, corona radiata, amygdala, cingulate cortex and anterior insula), physical wellbeing (in posterior insula), and the presence of gastroparesis (in anterior insula). Conclusion: Our findings suggest that microstructural changes of brain areas involved in visceral sensory processing might be involved in the pathogenesis of gastrointestinal symptoms in diabetes patients. Indsendt af: Jens Brøndum Frøkjær, (Radiologisk Afdeling, Aalborg Sygehus) Uddannelse: E-mail: jebf@rn.dk / Telefon: Forskningsansvarlig på afdelingen: Jens Brøndum Frøkjær  

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86) Changes of Brain Microstructure in Patients with Painful Chronic Pancreatitis assessed by Diffusion Tensor Imaging Forfattere: Jens Brøndum Frøkjær, Søren Schou Olesen, Mikkel Gram, Yousef Yavarian & Asbjørn Mohr Drewes. Abstract: Background and aims: In patients with painful chronic pancreatitis (CP) there is increasing evidence of abnormal pain processing in the central nervous system. Using magnetic resonance diffusion tensor imaging, we characterized brain microstructure in areas involved in processing of visceral pain and correlated these findings to clinical pain scores. Methods: Twenty-three patients with CP pain and 14 controls were studied in a 3T MR scanner. Apparent diffusion coefficient (ADC) (i.e. diffusivity of water) and fractional anisotropy (FA) (i.e. organization of fibers) values were assessed in the amygdala, cingulate cortex, insula, prefrontal cortex and secondary sensory cortex. Daily pain scores and brief pain inventory short form were collected one week before the investigation. Results: In grey matter, patients had increased ADC in amygdala, cingulate cortex, insula, and prefrontal cortex, as well as decreased FA values in cingulate cortex and secondary sensory cortex. In white matter, patients had increased ADC in insula and prefrontal cortex, and decreased FA values in insula and prefrontal cortex (all P-values<.05). An effect modification from pain pattern (attack-wise vs. continues pain) was seen in the insula and SII (P-values<.05), but no effect modifications from diabetes, alcoholic etiology and opioid treatment were seen (all P-values>.05). Microstructural changes in cingulate and prefrontal cortices were correlated to patients’ clinical pain scores. Conclusions: Our findings suggest that microstructural changes of the brain accompany pain in CP. The changes are likely a consequence of ongoing pain and structural reorganization of the neuromatrix as also seen in other diseases characterized by chronic pain. Indsendt af: Jens Brøndum Frøkjær, (Radiologisk Afdeling, Aalborg Sygehus) Uddannelse: E-mail: jebf@rn.dk / Telefon: Forskningsansvarlig på afdelingen: Jens Brøndum Frøkjær  

87) Determination of Brain toxicity after radiotherapy using advanced 3T MRI Forfattere: S. Ravn1, M. Holmberg3, P. Sørensen4, J. Frøkjær1, T. Christensen1, J. Carl2 1) Department of Radiology, Aalborg Hospital / Aarhus University Hospital, 2) Department of Medical Physics, Oncology, Aalborg Hospital / Aarhus University Hospital, 3) Department of Oncology, Aalborg Hospital / Aarhus University Hospital, 4) Department of Neurosurgery / Aarhus University Hospital Abstract: Background: Approximately 1000 new cases of primary brain tumours are diagnosed in Denmark each year. The main treatment objective is to remove/destroy as much tumour tissue as possible, using surgery and/or radiation and chemo therapy, without damaging healthy tissue. Today there is very little knowledge regarding dose-limits in radiation therapy (RT) towards the different functional areas of the brain, mainly because conventional MRI doesn’t allow us to visualize these areas. As a consequence we treat all normal appearing tissue as being equally important for the patients´ wellbeing. Objective: To investigate if a correlation can be identified between Brain toxicity after RT to healthy tissue and changes in tissue characteristics measured with advanced MRI. Material and Methods: 53 patients who have received RT directed towards the brain more than 1 year ago at Aalborg Hospital are invited to participate. Patients with any contraindication to MRI examination with contrast will be excluded. Each MRI-exam consists of: 1 anatomical 3D sequence, 3 functional Magnetic Resonance Imaging (fMRI) sequences (1 sequence for each paradigm - language, right and left hand), 1 Diffusion Tensor Imaging (DTI) sequence (for visualization of the arcuate fasciculus and the pyramidal tracts), 1 Diffusion Weighted Imaging (DWI) sequence and 1 Perfussion Weighted Imaging (PWI) sequence. The functional areas delineated with fMRI and DTI will be investigated with DWI and PWI and the RT dose received by each area will be compared with the DWI, DTI and PWI measurements. Results: No results is yet available. Indsendt af: Klinisk Assistent Søren Ravn, (Radiologisk Afdeling, Aalborg Sygehus) Uddannelse: Læge E-mail: sorl@rn.dk / Telefon: 2992 9795 Forskningsansvarlig på afdelingen: Jens Frøkjær

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88) Inflammatory bowel disease and

disability pension

Forfattere: Fonager K, Leth JB, Larsen TM, Jacobsen BA Abstract: Objective: To study if patients with inflammatory bowel disease had a higher probability of receiving disability pension than the background population. Method: The study included all patients in North Jutland diagnosed with ulcerative colitis (UC) or Crohn’s disease (CD) from 1993 to 2002. Data were linked to the DREAM database (Danish Rational Economic Agents Model), which holds information on public social benefits. Risks of receiving permanent health-related benefit after five years were estimated using logistic regression models. Sub-analysis was performed using a Poisson regression model to calculate the incidence rate ratios (IRRs) for disability pension among UC and CD patients compared with the background population. Results: A total of 558 patients with UC and 317 patients with CD were included. A total of 4.3% with UC and 8.2% with CD were receiving permanent health-related benefit within five years after diagnosis. CD women had a higher risk than UC women (OR 2.5 (1.0-6.0)), whereas no difference was found for men (OR 1.0 (0.4-2.8)). Both CD and UC patients had a higher risk than the background population of receiving disability pension (CD: IRR 2.82 (1.08-3.08); UC: IRR 1.82 (1.57-5.14)). Conclusions: The study showed that patients with inflammatory bowel disease, especially women with CD, had an increased risk of receiving disability pension five year after diagnosis. Indsendt af: Overlæge Kirsten Fonager, (Socialmedicinsk Enhed, Aalborg Sygehus) Uddannelse: E-mail: k.fonager@rn.dk / Telefon: 4117 4514 Forskningsansvarlig på afdelingen: Kirsten Fonager  

89) Når sexlivets krydderi må undværes - en kvalitativ undersøgelse af pars oplevelse af sexlivets forandring ved erektil dysfunktion som følge af operation Forfattere: Anette Højer Mikkelsen

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Abstract: Baggrund: Prostatacancer er én af de hyppigste kræftlidelser hos mænd. Behandlingsmuligheder er prostatektomi, kryoterapi og endokrin terapi ofte kombineret med strålebehandling. Erektil dyfunktion er ofte i varierende grad en følge af disse behandlinger og medfører ofte problemer og bekymringer hos patienten og partneren. Formål: Undersøgelsen formål er at frembringe viden om, hvordan erektil dysfunktion, som følge af operation, påvirker sexlivet, identiteten og parforholdet. Metode: Der anvendes en kvalitativ forskningsmetode indenfor en fænomenologisk-hermeneutisk forståelsesramme. Datamaterialet indsamles gennem kvalitative interviews, som efterfølgende analyseres og fortolkes gennem den naive læsning, strukturanalyse og kritisk fortolkning og diskussion inspireret af Paul Ricoeuer. Fund: Mænd oplever tab ved erektil dysfunktion, da det ikke længere er muligt at gennemføre spontan sex, hvilket påvirker deres identitet og maskulinitet. Lysten til og interessen for seksuel aktivitet daler som følge af manglende eller nedsat erektion. Identitetsfølelsen påvirkes, idet selvbilledet og kropsfornemmelsen er under forandring og følelsen af at tilhøre gruppen af mænd svækkes. Lyst og interesse for sex hos kvinder forandrer sig ikke på trods af mandens erektile dysfunktion. Savnet af orgasmefølelsen er størst hos kvinder, der kun kan få vaginale orgasmer, mens kvinder, der opnår orgasme ved stimulering af klitoris, ikke savner samlejet i væsentligt grad. Det kan opleves berigende og udfordrende, når der skal skabes andre måder at være sammen på seksuelt, som betyder, at intimiteten og nærheden i forholdet vokser. Opmærksomheden rettes mod flere kærtegn og berøringer, som både kvinder og mænd nyder, men mændene savner stadig samlejets kvaliteter. En viden sundhedsprofessionelle må drage nytte af ved samtale med patient og partner Indsendt af: udviklingssygeplejerske, specialist i sexologisk rådgivning Anette Højer Mikkelsen, (Urologisk Afdeling, Aalborg Sygehus) Uddannelse: sygeplejerkse, cand. cur., specialist i sexologisk rådgivning E-mail: anette.hoejer.mikkelsen@rn.dk / Telefon: 9932 2089 Forskningsansvarlig på afdelingen: Niels Christian Langkilde  


90) Efficasy of mydriatic cocktailsoaked sponge pupil dilation in patients using tamsulosin due to benign prostatic hypertrophy Forfattere: János Hargitai, Laszló Vezendi, Jørgen Vigstrup, Finn Eisgart, Bálint Hargitai, Henrik Vorum Abstract: Purpose: To investigate the effect of a mydriatic-cocktail soaked cellulose sponge on perioperative pupil diameter in tamsulosin-treated patients undergoing elective cataract surgery. Methods: 30 eyes of 30 patients using tamsulosin were dilated using mydriatic-cocktail soaked sponge (group 1) along with 28 eyes of 28 tamsulosin-treated patients using conventional eyedrop regiment (group 2). 31 eyes of 31 aged mathced control patients not using any α1 adrenergic receptor inhibtors were also dilated using mydriatic sponge (group 3). In all groups oxybuprocain, cocain, tropicamide, phenylephrine, diclophenac and chloramphenicol drops were used preoperatively. In the two sponge groups a 4mmx5mm piece of soaked wick was inserted in the lower fornix for 30 minutes. In the conventional group we applied the above drops 3 times with 10 minutes intervals. Pupil diameter was measured preoperatively, after nucleus delivery, and before IOL implantation using caliper. Adverse effects associated with the use of sponge were recorded. Results: Preoperative mean pupil diameter in group 1 was 7,52±1,21 compared 7,30±1,55 in group 2 and 7,99±0,96 in group 3. There was no statistically significant difference preoperatively between the three groups. After nucleus delivery pupil mean pupil diameters were: group 1: 6±1,20; group 2: 6,29±1,12 and group 3: 6,52±0,81. Before IOL implantation mean pupil diameters were as follows: group 1: 5,46±1,06; group 2: 5,83±1,088 and group 3: 6,17±0,89. No adverse effect related to sponge use was detected. Conclusion: The use of mydraitic cocktail-soaked sponge is an effective and timesaving way to achieve perioperative mydriasis even in high risk patients using tamsulosin. Indsendt af: Overlæge Janos Hargitai, (Øjenafdeling/Thy-Mors Sygehus, Aalborg Sygehus) Uddannelse: læge E-mail: janos.hargitai@rn.dk / Telefon: 2335 3854 Forskningsansvarlig på afdelingen: Henrik Vorum  

91) Oxygen is a key regulator of limbal epithelial stem cell growth and differentiation Forfattere: Chris Bath (1, 2), Sufang Yang (2), Danson Muttuvelu (1), Jeppe Emmersen (2), Henrik Vorum (1), Jesper Hjortdal (3) & Vladimir Zachar (2) Department of Ophthalmology, Aalborg University Hospital (1), Laboratory for Stem Cell Research, Aalborg University (2), Department of Ophthalmology, Aarhus University Hospital (3) Abstract: Purpose: Transplantation of ex vivo expanded limbal epithelial stem cells (LESCs) is emerging as a new treatment of choice for diseases with associated limbal epithelial stem cell deficiency. It is expected, that O2 (oxygen) concentrations vary from below 5% in the stem cell niche to 17% below the tear film. We hypothesized that exposure to a gradient of O2 concentrations during expansion of limbal epithelial cells (LECs) could selectively promote different epithelial cell phenotypes. Methods: Human LECs were expanded in parallel on either γ-irradiated 3T3 cells using serum-rich medium, or on plastic using serum-free EpiLife medium. Growth and phenotype of cells were examined in O2 concentrations of 2%, 5%, 10%, 15%, and 21%. Results: A bimodal growth pattern was observed with slow growth in 2-5% O2 and in 15% O2. cLECs expanded in 2-5% O2 exhibited a significant decrease of cells in replicative phase with increasing time in culture. ABCG2 (stem cell marker) and CK3 (differentiation marker) were inversely related across O2 concentrations with high ABCG2 and low CK3 expression in hypoxia. Highest level of clonogenicity was observed in hypoxic oxygen concentrations. Conclusions: Human LESCs and their progeny are selectively expanded in different physiologically relevant oxygen concentrations irrespective of the culture system employed. cLESCs are supported in 2-5% O2, transient accelerating cells in 10% O2, and terminal differentiated cells in 15% O2. The specific O2 concentrations used are very similar to layer-specific concentrations measured in vivo. Preparing grafts in a controlled hypoxic environment could enhance future outcome of transplantation. Indsendt af: Klinisk assistent Chris Bath Søndergaard, (Øjenafdelingen, Aalborg Sygehus) Uddannelse: Læge E-mail: c.bath@me.com / Telefon: 5154 3110 Forskningsansvarlig på afdelingen: Professor Henrik Vorum 63


92) Mastoiditis and Gradenigo’s Syn-

drome

Forfattere: Chris Ladefoged Jacobsen chlaj@rn.dk, Mikkel Attermann Bruhn mibr@rn.dk, Youssef Yavarian yy@rn.dk, Michael Gaihede mlg@rn.dk Abstract: Gradenigo’s syndrome is a rare disease, characterized by the triad of the following conditions: suppurative otitis media, pain in the distribution of the first and the second division of trigeminal nerve, and abducens nerve palsy. The full triad may often not be present, but can develop if the condition is not treated correctly. The syndrome is related to apical petrositis, which was a more common complication of otitis media and mastoiditis in the pre-antibiotic era. We report a case of a 3-yearold girl, who presented with fever and left-sided acute otitis media. She developed acute mastoiditis, which was initially treated by intravenous antibiotics, ventilation tube insertion and cortical mastoidectomy. Subsequently, general improvement resulted. However, after 6 days the clinical picture was complicated by development of leftsided abducens palsy. In order to exclude the possibility of septic sinus thrombosis an MRI-scanning was performed, which showed osteomyelitis within the petro-mastoid complex, and a hyperintense signal of the adjacent meninges, whereas no signs of sinus thrombosis were found. Microbiological investigations showed Staphyloccocus aureus and Fusobacterium necrophorum. She was treated successfully with intravenous broad-spectrum antibiotic therapy with anaerobic coverage for total of 20 days, after which she was discharged. After 8 weeks of follow-up there was no sign of recurrent infection or abducens palsy. Gradenigo’s syndrome is a rare, but life-threatening complication to middle ear infection that should be taken into consideration when atypical symptoms develop after acute otitis media. It is most commonly caused by aerobic microorganisms, but anerobic microorganisms may also be found. Indsendt af: Reservelæge Chris L Jacobsen, (Øre-Næse-Halskirurgisk Afdeling, Aalborg Sygehus) Uddannelse: Læge E-mail: chlaj@rn.dk / Telefon: 9932 8808 Forskningsansvarlig på afdelingen: Michael Gaihede  

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93) Total parathyroidektomi (PTX) for sekundær/tertiær-hyperparathyreoidisme (SHPT/THPT). En 10 års retrospektiv undersøgelse af patienter på Aalborg Sygehus Forfattere: René Thunberg Svendsen, Casper Søndergaard, Troels Ring, Henrik Baymler Pedersen Abstract: Baggrund: Ved terminal nyresygdom findes hos nogle patienter markante forhøjelser i serum parathyroidea hormon (SHPT), kaldet tertiær hyperparathyroidisme, når der samtidig er hy-percalcæmi (THTP). Det skyldes hyperfunktionelt parathyroidea væv, der ikke reagerer hensigtsmæssigt på fysiologisk regulering eller medicinsk behandling. Kirurgi udføres, når patienter udvikler behandlingsrefraktær hyperparathyroidisme mhp. at undgå øget risiko for kardiovaskulær comorbiditet/mortalitet eller mhp. at undgå afstødning af nyretransplantatet. Denne opgørelse er lavet mhp. at sammenligne intraoperativ vs. postoperativ biokemisk suc-ces ved PTX og at vurdere komplikationsraterne. Materialer og metoder: Retrospektiv opgørelse af 53 patienter med SHPT/THPT fra Region Nordjylland henvist fra Nyremedicinsk Afdeling til intenderet PTX fra 2001 til 2010. Postope-rativt fald i PTH blev opdelt i 3 grupper: 1) Kirurgisk succes = PTH <7.6 pm/L 2) Fysiologisk acceptabelt = 7.6 pm/L < PTH <30.4 pm/L 3) Manglende effekt = PTH >30,4 pm/L Intraoperativt PTH (iPTH) fald blev brugt som mål for om alle glandler var fjernet. Kriteriet var et iPTH fald > 80%. Resultater: Vi fandt kirurgisk succes hos 70%; fysiologisk acceptabelt hos 17% og manglende effekt hos 13%. Ved 4 fjernede glandler var god biokemisk succes hos 76%; for 3 fjernede var succesraten 20%. iPTH på 80% viste sensitivitet på 80% og specificitet på 25%. Komplikatio-ner var få med et tilfælde af forbigående recurrens parese og et postoperativt hæmatom. Konklusion: Der blev opnået god eller moderat biokemisk succes hos 87 % af patienterne. Værdien af iPTHmåling til SHPT/THPT er diskutabel på grund af lav specificitet, mens der var lav en komplikationsfrekvens. Indsendt af: Reservelæge Rene T Svendsen, (Øre-Næse-Halskirurgisk Afdeling, Aalborg Sygehus) Uddannelse: Læge E-mail: r.svendsen@rn.dk / Telefon: 9932 8802 Forskningsansvarlig på afdelingen: Michael Gaihede


94) Eustachian tube pressure equilibra-

tion. Quantitative analysis of the correlation be-tween pressure gradient and pressure change rate

Forfattere: Simona Padurariu, Michael Gaihede, Jef Aernouts, Joris JJ Dirckx Abstract: Background: Normal hearing requires middle ear (ME) pressure equal to ambient pressure, which is mainly provided by intermittent openings of the Eustachian tube (ET). Thus, the function of the ET is essential for understanding pathological events in diseased ears and ET dysfunction. Aim: To describe the ET function by investigating the pressure change rate by ET openings and the pressure gradient between in the ME cavity and ambient pressure. Hypothesis: Higher pressure change rate correlates to higher pressure gradient. Methods: The method consisted of directly ME pressure recordings by a catheter inserted into the mastoid of 4 healthy subjects. In each subject experimental pressure changes were induced by injec-tion/extraction of ±50, ±100, ±200 µl air, and the pressure counter-regulation was monitored over 10-minutes time frames. The separate openings of the ET were quantitatively analysed in terms of their durations and pressure gradients. Pressure change rates were calculated. Correlation plots of pressure change rate against pressure gradient were formed. Results: The results revealed a linear positive correlation between pressure change rate and pres-sure gradient in all fours subjects. The correlation was highly significant (p<0.001; r2 = 0,74; N = 75). Conclusions: We demonstrated a significant relationship between rate of pressure change and pres-sure gradient. This indicated that the pressure change during ET openings is driven only by the ac-tual pressure gradient, i.e. it is a passive mechanism. Contrary, the complex ET opening is an active process, which is coordinated by a neural feedback control. Indsendt af: projekt studerende Simona Padurariu, (Øre-Næse-Halskirurgisk Afdeling, Aalborg Sygehus) Uddannelse: Stud MEDIS E-mail: s.padurariu@rn.dk / Telefon: 9932 2912 Forskningsansvarlig på afdelingen: Michael Gaihede

 95) CWU bony mastoid obliteration in

cholesteatoma surgery. Recidivism and hearing results in follow-up of 164 cases Forfattere: Suzan Al Kole, Kjell Tveterås, Michael Gaihede Abstract: Baggrund: Kolesteatom forårsages grundlæggende af et negativt mellemøretryk, som betinger dannelsen af en retraktionslomme i trommehinden, hvor døde epithelceller akkumuleres og skaber kronisk infektion. Tilstanden breder i mellemøret og mastoidet, og forårsager erosion af knoglevæv med konduktivt høretab. Behandling af kolesteatom er kirurgisk resektion vævet og rekonstruktion af trommehinde og mellemøre. Et problem er, at lidelsen har tilbøjelighed til recidivisme (recidiv og residual) op til 40% hos børn. En række operations-teknikker er udviklet. Traditionelt har man haft lavere recidivisme med canalwall-downteknik(CWD), hvor øregangens bagvæg fjernes med behov for hyppige oprensninger og problemer med infektioner. Alternativt kan man anvende en canalwall-up(CWU), med bevarelse af øregangens bagvæg, som medfører ikke disse gener, dermed recidivisme risiko er højere. CWU er senest kombineret med en teknik, hvor mastoidet oblitereres. Formål: Formålet med denne undersøgelse er at undersøge langtids-resultaterne for recidivisme og hørelse efter CWU mastoidektomi med obliterations teknik. Metoder: Vi inkluderede 164 patienter i studiet i perioden mellem (1997- 2009), opereret med CWU obliterations teknik. Recidivisme rate analyseret via Kaplan-Meiers metode. Hørelse bestemt ved air-bone-gab(ABG) præog postoperativt. Resultater: Den gennemsnitlige observationstid var på 42mdr.(SD=6,43). Gennemsnit alderen var 34,0år(SD=9,6), hvoraf 76,8% var voksne. Det totale recidivisme var 9%(n=14/164). Recidivisme rate analyseret via Kaplan-Meier var 4,1% og 14,3% for hhv. 30 og 60mdr. Den gennemsnitlige ABG closure var 9,15(SD=2,86) dB HL. Der var statistik signifikant forskel mellem præ-og postoperative ABG(p<0,01). Konklusion: Langstids follow-up indikerede at CWU obliteration er en sikker metode for fjernelse af kolesteatom med lav recidivisme på 9% og et godt hørermæssigt resultat med forbedring på 9dB HL. Indsendt af: PhD-studerende Suzan Al Kole, (Øre-Næse-Halskirurgisk Afdeling, Aalborg, Aalborg Sygehus) 65


Uddannelse: Læge E-mail: suak@rn.dk / Telefon: 31252695 Forskningsansvarlig på afdelingen: Michael Gaihede

 96) Is canal wall up (CWU) with bony

obliteration technique in cholesteatoma surgery effective?

Forfattere: Suzan Al Kole, Kjell Tveterås and Michael Gaihede. Abstract: Objective: To evaluate the long term results and recurrence rate in patients, who have undergone CWU (canal wall-up) mastoidectomy and bony obliteration in cholesteatoma surgery. Cholesteatoma is progressive growing process that destroys the neighbouring bony structure. The primary aims of surgery were total eradication of cholesteatoma with no recurrence and residual disease and create a dry and self-cleaning ear. Methods: 180 cases were included in periode between 1997 and 2009. The follow-up rate was 91.1%. Mean follow-up time was 42 ± 36.43 months. All the cases underwent mastoid and epitympanic obliteration technique with bone chips and bone pate. Data included pre-and post-operative audiometry. The rate of recidivism was calculated by using the Kaplan-Meier method of survival analysis. Results: The overall rate of recurrence of cholesteatoma cases was 7.3% (n=12/164) and residual rate was 1.2% (n=2/164). The average preoperative air bone gap, postoperative air bone gap and air-bone gap closure were 29.62 ±2.16, 22.47 ± 1.88 and 7.15 ± 2.86, respectively. There were significant difference between pre- and postoperative air-bone gap values (p<0.01). Using KaplanMeier analysis at 30- and 60-months residual-recurrenc rates were 4.1% and 14.3% respectively. The percentage of ears that were free of recidivistic cholesteatoma at 30 and 60 months follow-up was 96% (95%CI: 92%-100%) and 88% (95%CI: 84%-95%) respectively. Conclusion:Our study clearly indicates that CWU with bony obliteration is a safe and useful method for treating primary or recurrent cholesteatoma and eliminating cavity problems. Our recurrence and residual rates are compared to the best results of the international studies. Indsendt af: PhD-studerende Suzan Al Kole, (Øre-Næse-Halskirurgisk Afdeling, Aalborg, Aalborg Sygehus) Uddannelse: Læge E-mail: suak@rn.dk / Telefon: 31252695 Forskningsansvarlig på afdelingen: Michael Gaihede 66

 97) Hvad er GCP? Forfattere: Kirsten Østergaard Nielsen Abstract: Hvad betyder GCP? Bliv klogere på Forsøg med lægemidler, der afprøves på mennesker. Kan et lovkrav fra EU understøtte forskningens kvalitet? Hvilke myndigheder skal godkende et sådant forsøg før det starter? Hvem ser nærmere på projektet, vedr.: • Etiske overvejelser? • Sikkerhed og rettighed for deltagerne? • Videnskabelige tankegang og planlægning? • Relevans og forsvarlig udførelse? • Analyser af data = resultater? • Forsvarlig håndtering af data? Hvad er et ”Informeret Samtykke”? Hvad omfatter en ”Fuldmagt” i denne sammenhæng? Hvilke krav er der til en protokol og bilag? Kan man fortryde sin deltagelse i et forsøg? Må man forske på børn, umyndige og bevidstløse? Hvordan håndteres GOD KLINISK PRAKSIS indenfor FORSKNING? Hvordan understøtter de tre offentlige GCP-Enheder forskningen i Danmark? TILBUD OM OPLÆG, INTRODUKTION, KURSER, STØTTE OG VEJLEDNING… Spørg GCP-koordinator Kirsten Østergaard Nielsen, Forskningens Hus, Tlf. 9932 6814 / Mobil 2925 5380 / kion@rn.dk Indsendt af: GCP-koordinator Kirsten Østergaard Nielsen, (GCPEnheden, Forskningens Hus, Aalborg Sygehus) Uddannelse: Sygeplejerske, cand.cur. E-mail: kion@rn.dk / Telefon: 29255380  


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Udgivet af: Afdelingen for Universitetshospitalsanliggender Aalborg Sygehus, Ă&#x2026;rhus Universitetshospital Forskningens Hus Sdr. Skovvej 15 9000 Aalborg Tlf. 99 32 68 00 E-mail: info@forskningenshus.dk Layout: Kommunikationsenheden, Forskningens Hus April 2012

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ISBN: 978-87-90880-38-5


Forskningens Dag 2012 - Abstractbog