Publications by authors named "Finn Rasmussen"

262 Publications

Blood Volume as a new functional image-based biomarker of progression in metastatic renal cell carcinoma.

Sci Rep 2021 Oct 4;11(1):19659. Epub 2021 Oct 4.

Department of Oncology, Aarhus University Hospital, Aarhus N, Denmark.

RECIST v1.1 has limitations in evaluating progression. We assessed Dynamic Constrast Enhanced Computed Tomography (DCE-CT) identified Blood Volume (BV) for the evaluation of progressive disease (PD) in patients with metastatic renal cell carcinoma (mRCC). BV was quantified prospectively at baseline, after one month, then every three months until PD. Relative changes (ΔBV) were assessed at each timepoint compared with baseline values. The primary endpoint was Time to PD (TTP), the secondary endpoint was Time to the scan prior to PD (PDminus1). Cox proportional hazard models adjusted ΔBV for treatments and International mRCC Database Consortium factors. A total of 62 patients had analyzable scans at the PD timepoint. Median BV was 23.92 mL × 100 g (range 4.40-399.04) at PD and 26.39 mL × 100 g (range 8.70-77.44) at PDminus1. In the final multivariate analysis higher ΔBV was statistically significantly associated with shorter Time to PD, HR 1.11 (95% CI 1.07-1.15, P < 0.001). Also assessed at PDminus1, higher ΔBV was significantly associated with shorter time to PD, HR 1.14 (95% CI 1.01-1.28, P = 0.031). In conclusion, DCE-CT identified BV is a new image-based biomarker of therapy progression in patients with mRCC.
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http://dx.doi.org/10.1038/s41598-021-99122-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8490379PMC
October 2021

Blood Volume as a new functional image-based biomarker of progression in metastatic renal cell carcinoma.

Sci Rep 2021 Oct 4;11(1):19659. Epub 2021 Oct 4.

Department of Oncology, Aarhus University Hospital, Aarhus N, Denmark.

RECIST v1.1 has limitations in evaluating progression. We assessed Dynamic Constrast Enhanced Computed Tomography (DCE-CT) identified Blood Volume (BV) for the evaluation of progressive disease (PD) in patients with metastatic renal cell carcinoma (mRCC). BV was quantified prospectively at baseline, after one month, then every three months until PD. Relative changes (ΔBV) were assessed at each timepoint compared with baseline values. The primary endpoint was Time to PD (TTP), the secondary endpoint was Time to the scan prior to PD (PDminus1). Cox proportional hazard models adjusted ΔBV for treatments and International mRCC Database Consortium factors. A total of 62 patients had analyzable scans at the PD timepoint. Median BV was 23.92 mL × 100 g (range 4.40-399.04) at PD and 26.39 mL × 100 g (range 8.70-77.44) at PDminus1. In the final multivariate analysis higher ΔBV was statistically significantly associated with shorter Time to PD, HR 1.11 (95% CI 1.07-1.15, P < 0.001). Also assessed at PDminus1, higher ΔBV was significantly associated with shorter time to PD, HR 1.14 (95% CI 1.01-1.28, P = 0.031). In conclusion, DCE-CT identified BV is a new image-based biomarker of therapy progression in patients with mRCC.
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http://dx.doi.org/10.1038/s41598-021-99122-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8490379PMC
October 2021

Effects of the PRIMROSE prevention trial of childhood obesity on parental self-efficacy.

BMC Pediatr 2021 09 7;21(1):388. Epub 2021 Sep 7.

Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.

Background: Parental self-efficacy (PSE) has been suggested as a key factor for enabling parents to support children in the development of healthy dietary and physical activity behaviors and to prevent childhood obesity. However, studies of intervention effects on PSE are lacking. The present study involved a secondary analysis of data on PSE collected in a previous primary prevention trial of childhood obesity called the PRIMROSE trial. The trial involved a family-based intervention using motivational interviewing and principles of cognitive-behavioral therapy within a social-cognitive theory framework.

Methods: In the PRIMROSE trial, parents and their children were randomly allocated to the intervention or usual care. In the present study, 928 mothers who responded to the Parental Self-Efficacy for Promoting Healthy Physical Activity and Dietary Behaviors in Children Scale (PSEPAD) at follow-up assessment were included. Data were analyzed using linear regression based on generalized estimating equations, with adjustment made for PSE at baseline.

Results: At follow-up assessment, there was a statistically significant difference of 1.4 units, 95% CI [0.4, 2.4], p = 0.009, between the intervention and control conditions on the subscale of the PSEPAD concerning PSE for promoting healthy dietary behaviors in children. However, this difference was deemed as without clinical importance. On the total scale or other subscales of the PSEPAD there were no statistically significant differences in PSE between conditions.

Conclusions: There was a statistically significant, but not clinically meaningful, intervention effect on PSE. However, because previous research repeatedly has shown positive associations of PSE with dietary and physical activity behaviors in children and that self-efficacy mediates behaviors, the construct may be important for influencing dietary and physical behaviors in children. Therefore, more research is warranted evaluating the effects of interventions on PSE in the context of childhood obesity prevention.

Trial Registration: Retrospectively registered 9 October 2013 at ISRCTN (ISRCTN16991919 ).
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http://dx.doi.org/10.1186/s12887-021-02862-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8422655PMC
September 2021

Neurosarcoidosis resembling multiple meningiomas: A misleading presentation of the disease and diagnostic challenge.

Acta Radiol Open 2021 Jul 30;10(7):20584601211036550. Epub 2021 Jul 30.

Department of Oncology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.

Sarcoidosis is characterized by the presence of noncaseating granulomatous inflammation in the affected organs. Neurosarcoidosis denotes the involvement of the nervous system and can be either isolated or coexisting with extraneural systemic inflammation. The diagnosis of isolated neurosarcoidosis may be challenging due to unspecific symptoms and similar appearances with other disease processes. This report presents an uncommon case of intracranial sarcoidosis mimicking multiple meningiomas. Familiarity with the spectrum of magnetic resonance imaging findings in neurosarcoidosis is crucial to prevent interpretive errors which may in turn lead to an inappropriate diagnosis and treatment.
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http://dx.doi.org/10.1177/20584601211036550DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8330481PMC
July 2021

Prognostic value of DCE-CT-derived blood volume and flow compared to core biopsy microvessel density in patients with metastatic renal cell carcinoma.

Eur Radiol Exp 2021 Jul 30;5(1):32. Epub 2021 Jul 30.

Department of Oncology, Aarhus University Hospital (AUH), Palle Juul-Jensens Blvd. 99, 8200, Aarhus N, Denmark.

Background: Angiogenesis is prominent in metastatic renal cell carcinoma (mRCC). We compared two angiogenesis assessment methods: dynamic contrast-enhanced computed tomography (DCE-CT)-derived blood volume (BV) and blood flow (BF) and core biopsy microvessel density (MVD).

Methods: As planned in DaRenCa Study-1 study, DCE-CT and core biopsy were performed from the same tumour/metastasis at baseline. MVD was assessed by CD34 immunostaining in tumour (CD34-index) or tumour including necrosis (CD34-index). BV and BF were assessed using the DCE-CT software. Overall survival (OS) and progression-free survival (PFS) were assessed by Kaplan-Meier analysis. Spearman coefficient (rho) tested the correlation between MVD and BV, BF, or CT density (HU).

Results: At baseline, 25 patients had analysable scans and tissue. BV, BV, and BF > median were associated with favourable OS (43.2 versus 14.6 months, p = 0.002; 31.6 versus 20.2 months, p = 0.015; and 31.6 versus 24.5 months, p = 0.019). CD34-index and CD34-index did not correlate with age (p = 0.543), sex (p = 0.225), treatment (p = 0.848), International mRCC Database Consortium category (p = 0.152), synchronous versus metachronous metastatic disease (p = 0.378), or tumour volume (p = 0.848). CD34-index or CD34-index > median was not associated with PFS (p = 0.441 and p = 0.854, respectively) or OS (p = 0.987 and p =0.528, respectively). CD34-index or CD34-index was not correlated with BV, BF, or HU (rho 0.20-0.26).

Conclusions: Differently from MVD, DCE-CT-derived BV and BF had prognostic impact and may better reflect angiogenesis in mRCC.

Trial Registration: NCT01274273.
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http://dx.doi.org/10.1186/s41747-021-00232-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8322257PMC
July 2021

International multidisciplinary team discussions on the diagnosis of idiopathic non-specific interstitial pneumonia and the development of connective tissue disease.

Eur Clin Respir J 2021 Jun 10;8(1):1933878. Epub 2021 Jun 10.

Department of Pathology, Aarhus University Hospital, Aarhus, Denmark.

Background: Idiopathic Non-Specific Interstitial Pneumonia (iNSIP) is a rare interstitial lung disease, diagnosed, by definition, on the basis of a multidisciplinary team discussion (MDD). Association with an autoimmune background has been suggested in iNSIP.

Aims: To test the feasibility of conducting a multinational MDD to review the diagnosis in iNSIP cases and to estimate the emergence of connective tissue disease (CTD) during follow-up.

Methods: Investigators from three expert centers (Denmark, Estonia and Norway) met and discussed cases of biopsy-proven iNSIP at an international MDD. The cases were previously diagnosed at a national level between 2004 and 2014. Based on clinical, radiographic and pathological data, the diagnosis of iNSIP was re-evaluated and a consensus diagnosis was made. Cases incompatible with iNSIP were excluded. Relevant data were registered comprising any development of CTD.

Results: In total, 31 cases were discussed and 23 patients were included with a diagnosis of iNSIP. The mean follow-up time was 57 months. None of the patients developed CTD according to the rheumatologic criteria during the follow up period. Four patients (17.4%) met the criteria for interstitial pneumonia with autoimmune features.

Conclusion: We found that an international MDD was a feasible and valuable tool in the retrospective diagnostic evaluation of iNSIP. Diagnosis was changed in a statistically significant number of patients by our international MDD team. None of the patients developed CTD during follow-up.
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http://dx.doi.org/10.1080/20018525.2021.1933878DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8205078PMC
June 2021

Clusters of comorbidities in idiopathic pulmonary fibrosis.

Respir Med 2021 Aug-Sep;185:106490. Epub 2021 Jun 1.

Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark.

Introduction: Comorbidities are common in patients with idiopathic pulmonary fibrosis (IPF) and negatively impact health-related quality of life, health-care costs and mortality. Retrospective studies have focused on individual comorbidities, but clusters of multiple comorbidities have rarely been analysed. This study aimed to comprehensively and prospectively assess comorbidities in a multicentre, real-world cohort of patients with IPF, including prespecified conditions of special interest and to analyse clusters of comorbidities and examine characteristics, disease course and mortality of the clusters.

Methods: Several measurements, questionnaires, medications and medical history were combined to assess comorbidities. Using self-organizing maps, clusters of comorbidities were identified and phenotypes characterized. Disease course was assessed using mixed effects models and mortality using Cox regression.

Results: One-hundred and fifty IPF patients were included prospectively. All except one patient suffered from at least one comorbidity and multimorbidity was common. Arterial hypertension, gastro-oesophageal reflux disease, hypercholesterolemia, emphysema and obstructive sleep apnea were most prevalent. Four comorbidity clusters were identified. Each cluster had distinct comorbidity profiles, patient characteristics, symptom burden and disease severity. Patients with fewer comorbidities had better exercise capacity and less dyspnea at baseline, but a trend towards faster deterioration was observed. Mortality analyses showed no significant differences between clusters.

Conclusions: Multimorbidity is prevalent in patients with IPF. Four specific clusters of comorbidities may represent phenotypes in IPF. A trend towards faster decline in exercise capacity and dyspnea was observed in patients with fewer comorbidities. Increased knowledge of comorbidities facilitates prevention and treatment of comorbidities in patients with IPF.
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http://dx.doi.org/10.1016/j.rmed.2021.106490DOI Listing
June 2021

Fungal diversity driven by bark features affects phorophyte preference in epiphytic orchids from southern China.

Sci Rep 2021 05 28;11(1):11287. Epub 2021 May 28.

Natural History Museum of Denmark, University of Copenhagen, 1350, Copenhagen K, Denmark.

Epiphytic orchids exhibit varying degrees of phorophyte tree specificity. We performed a pilot study to investigate why epiphytic orchids prefer or avoid certain trees. We selected two orchid species, Panisea uniflora and Bulbophyllum odoratissimum co-occurring in a forest habitat in southern China, where they showed a specific association with Quercus yiwuensis and Pistacia weinmannifolia trees, respectively. We analysed a number of environmental factors potentially influencing the relationship between orchids and trees. Difference in bark features, such as water holding capacity and pH were recorded between Q. yiwuensis and P. weinmannifolia, which could influence both orchid seed germination and fungal diversity on the two phorophytes. Morphological and molecular culture-based methods, combined with metabarcoding analyses, were used to assess fungal communities associated with studied orchids and trees. A total of 162 fungal species in 74 genera were isolated from bark samples. Only two genera, Acremonium and Verticillium, were shared by the two phorophyte species. Metabarcoding analysis confirmed the presence of significantly different fungal communities on the investigated tree and orchid species, with considerable similarity between each orchid species and its host tree, suggesting that the orchid-host tree association is influenced by the fungal communities of the host tree bark.
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http://dx.doi.org/10.1038/s41598-021-90877-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8163780PMC
May 2021

Comparison of contrast-enhanced CT, dual-layer detector spectral CT, and whole-body MRI in suspected metastatic breast cancer: a prospective diagnostic accuracy study.

Eur Radiol 2021 May 18. Epub 2021 May 18.

Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.

Objectives: To compare diagnostic accuracy of contrast-enhanced CT, dual-layer detector spectral CT (DL-CT), and whole-body MRI (WB-MRI) for diagnosing metastatic breast cancer.

Methods: One hundred eighty-two biopsy-verified breast cancer patients suspected of metastatic disease prospectively underwent contrast-enhanced DL-CT and WB-MRI. Two radiologists read the CT examinations with and without spectral data in consensus with 3-month washout between readings. Two other radiologists read the WB-MRI examinations in consensus. Lymph nodes, visceral lesions, and bone lesions were assessed. Readers were blinded to other test results. Reference standard was histopathology, previous or follow-up imaging, and clinical follow-up.

Results: Per-lesion AUC was 0.80, 0.84, and 0.82 (CT, DL-CT, and WB-MRI, respectively). DL-CT showed significantly higher AUC than CT (p = 0.001) and WB-MRI (p = 0.02). Sensitivity and specificity of CT, DL-CT, and WB-MRI were 0.66 and 0.94, 0.75 and 0.95, and 0.65 and 0.98, respectively. DL-CT significantly improved sensitivity compared to CT (p < 0.0001) and WB-MRI (p = 0.002). Per-patient AUC was 0.85, 0.90, and 0.92 (CT, DL-CT, and WB-MRI, respectively). DL-CT and WB-MRI had significantly higher AUC than CT (p = 0.04 and p = 0.03). DL-CT significantly increased sensitivity compared to CT (0.89 vs. 0.79, p = 0.04). WB-MRI had significantly higher specificity than CT (0.84 vs. 0.96, p = 0.001) and DL-CT (0.87 vs. 0.96, p = 0.02).

Conclusions: DL-CT showed significantly higher per-lesion diagnostic performance and sensitivity than CT and WB-MRI. On a per-patient basis, DL-CT and WB-MRI had equal diagnostic performance superior to CT.

Key Points: • Spectral CT has higher diagnostic performance for diagnosing breast cancer metastases compared to conventional CT and whole-body MRI on a per-lesion basis. • Spectral CT and whole-body MRI are superior to conventional CT for diagnosing patients with metastatic breast cancer. • Whole-body MRI is superior to conventional CT and spectral CT for diagnosing bone metastases.
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http://dx.doi.org/10.1007/s00330-021-08041-2DOI Listing
May 2021

Breast cancer: comparison of quantitative dual-layer spectral CT and axillary ultrasonography for preoperative diagnosis of metastatic axillary lymph nodes.

Eur Radiol Exp 2021 Apr 9;5(1):16. Epub 2021 Apr 9.

Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.

Background: Our aim was to compare the diagnostic performance of quantitative dual-layer spectral computed tomography (DLSCT) and axillary ultrasound (US) for diagnosing lymph node metastases in breast cancer patients.

Methods: DLSCT and axillary US were prospectively performed in 70 needle biopsy-verified breast cancer patients. Histopathology and imaging data were available for evaluation in 36 axillae from 34 patients. In each patient, ipsilateral, contralateral, and inguinal lymph nodes (LNs) were semiautomatically segmented, and iodine density, spectral slope, Z effective, virtual non-contrast (VNC), conventional CT HU values, and Δ contrast enhancement (ΔCE, conventional CT HU minus VNC) were measured. Using histopathology as reference, the diagnostic performance of DLSCT and axillary US was compared.

Results: Of 36 axillae, 23 had metastatic lymph nodes. Compared with non-metastatic LNs, metastatic LNs had significantly different iodine density (p = 0.021), spectral slope (p < 0.001), Z effective (p < 0.001), conventional CT HU values (p < 0.01), and ΔCE (p < 0.01). All DLSCT parameters were significantly different between arterial phase and portal-venous phase (p < 0.001) except for VNC (p = 0.092). ΔCE had the highest diagnostic performance (sensitivity 0.79, specificity 0.92, positive predictive value 0.95, negative predictive value 0.69) with a significantly increased sensitivity compared with conventional CT HU (p = 0.027). There were no significant differences between ΔCE and axillary US for sensitivity (p = 1.000) or specificity (p = 0.320).

Conclusions: DLSCT is a promising quantitative technique for evaluating LN metastases and could potentially reduce the need for sentinel LN biopsy.
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http://dx.doi.org/10.1186/s41747-021-00212-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8032829PMC
April 2021

Metastases or benign adrenal lesions in patients with histopathological verification of lung cancer: Can CT texture analysis distinguish?

Eur J Radiol 2021 May 18;138:109664. Epub 2021 Mar 18.

Department of Radiology Aarhus University Hospital, Skejby, Denmark. Electronic address:

Introduction: Distant metastases are found in the many of patients with lung cancer at time of diagnosis. Several diagnostic tools are available to distinguish between metastatic spread and benign lesions in the adrenal gland. However, all require additional diagnostic steps after the initial CT. The purpose of this study was to evaluate if texture analysis of CT-abnormal adrenal glands on the initial CT correctly differentiates between malignant and benign lesions in patients with confirmed lung cancer.

Materials And Methods: In this retrospective study 160 patients with endoscopic ultrasound-guided biopsy from the left adrenal gland and a contrast-enhanced CT in portal venous phase were assessed with texture analysis. A region of interest encircling the entire adrenal gland was used and from this dataset the slice with the largest cross section of the lesion was analyzed individually.

Results: Several texture parameters showed statistically significantly difference between metastatic and benign lesions but with considerable between-groups overlaps in confidence intervals. Sensitivity and specificity were assessed using ROC-curves, and in univariate binary logistic regression the area under the curve ranged from 36 % (Kurtosis 0.5) to 69 % (Entropy 2.5) compared to 73 % in the best fitting model using multivariate binary logistic regression.

Conclusion: In lung cancer patients with abnormal adrenal gland at imaging, adrenal gland texture analyses appear not to have any role in discriminating benign from malignant lesions.
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http://dx.doi.org/10.1016/j.ejrad.2021.109664DOI Listing
May 2021

Tissue-Specific Ultra-Short Telomeres in Chronic Obstructive Pulmonary Disease.

Int J Chron Obstruct Pulmon Dis 2020 30;15:2751-2757. Epub 2020 Oct 30.

Department of Medical Genetics, Faculty of Medicine, Near East University, Nicosia, Cyprus.

Purpose: Telomere biology, especially tissue-specific ultra-short telomeres, might provide a strong contribution to our current knowledge in COPD development as well as a predictive marker for prognosis. To test this hypothesis, we investigated telomere lengths in lung tissue and leukocytes in patients diagnosed with COPD.

Patients And Methods: Thirty-two patients were included in the current study. All patients showed a post-bronchodilator ratio of less than 70% post-bronchodilator predicted value of forced expiratory volume in second (FEV1%), mean 56%; range [19% to 86%]. To be able to investigate ultra-short telomeres, universal single telomere length analysis (U-STELA) was used.

Results: Our results showed a higher level of the ultra-short telomere presence in bronchoalveolar lavage (BAL) cells when compared to leukocytes with statistical significance t(62)=5.771, p<0.00001. The FEV1% was lower in subjects with ultra-short telomeres in BAL (50.6% vs 81.6%: p<0.001) and in ultra-short telomeres in blood leukocytes (37.3% vs 58.5%: p=0.051) when compared to subjects without ultra-short telomeres in leukocytes. Furthermore, the patients who had ultra-short telomeres in BAL samples were significantly older (p=0.014) than patients who did not have ultra-short telomeres. Ultra-short telomeres in BAL (p=0.05) but not in leukocytes (p=0.33) were associated with FEV1% in a regressions model adjusting for age (p<0.0001), ever smoking (p<0.0001) and sex (p=0.71). The patients with ultra-short telomeres were graded higher in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification (p=0.006).

Conclusion: This study emphasizes the need to investigate the correct tissue to get a representative evaluation of the stage or advancedness of COPD. To our knowledge, this is the first study to show that there is a correlation between the presence of ultra-short telomeres in lung tissue and COPD severity. Our results suggest that ultra-short telomeres are involved in the molecular pathogenesis of COPD and might be used as a tissue-specific predictive biomarker.
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http://dx.doi.org/10.2147/COPD.S267799DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7608580PMC
June 2021

Updated North Cyprus response status for COVID-19 in comparison with similar country sizes. Highlights on the importance of population per square meter.

Multidiscip Respir Med 2020 Jan 22;15(1):699. Epub 2020 Sep 22.

Department of Allergy Sleep and Respiratory Medicine, Near East University Hospital, Near East University, Lefkosa, Nicosia, Cyprus.

The COVID-19 pandemic is straining health systems worldwide. The World Health Organization has provided guidelines on a set of targeted and immediate actions that countries can use on a national, regional, and local level. Recommendations go from public hand hygiene stations, making face masks use obligatory, testing, and index finding which together with national closure of borders have been used to limit the disease so the countries' health care system can cope with the challenges. This is especially important as there seems to be an increased mortality rate even in countries normally regarded as well-functioning and having strong health system. In more susceptible countries this maybe even more important. The effect of these measures should be easier seen in small communities or countries. Societies have acted differently on when to apply the lockdown but most European countries have initiated lockdown after the first SARS-CoV-2 was diagnosed in their countries. With the COVID-19 pandemic and its economic consequences, it became especially important to re-evaluate the effect of response in light of a possible second wave. Yet, little is known about the effect of lockdown with respect to disease development and its handling. Hereby, we compare responses from relatively small 17 European countries including islands in three groups based on their population and report the response from North Cyprus in comparison to other small European countries. Our results indicate the importance of population per meter square, degree of isolation from others as well as social distancing, hygiene rules, timing of lockdowns in response to COVID-19 pandemic in small countries/ societies that are more susceptible for overwhelming their health system.
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http://dx.doi.org/10.4081/mrm.2020.699DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520854PMC
January 2020

Mobile X-ray outside the hospital: a scoping review.

BMC Health Serv Res 2020 Aug 20;20(1):767. Epub 2020 Aug 20.

Department of Geriatrics, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark.

Background: For several years mobile X-ray equipment has been routinely used for imaging in patients too unwell within the hospital, when transportation to the radiology department was inadvisable. Now, mobile X-ray examinations are also used outside the hospital. The literature describes that fragile patients may benefit from mobile X-ray, but we need to provide insights into the breadth, depth and gaps in a body of literature.

Methods: The scoping review was performed by searching PubMed, Cinahl, Embase, EconLit and Health Technology Assessment. English-, Danish-, Norwegian-, German-, Italian-, French- and Swedish-language studies, published 1.1.2009-1.5.2020 about mobile X-ray outside the hospital were included. Participants were patients examined using mobile X-ray as the intervention. PRISMA was used when eligible to build up the review. To extract data from the selected articles, we used a structured summary table.

Results: We included 12 studies in this scoping review. The results were divided into four topics:1. Target population 2. Population health 3. Experience of care and 4. Cost effectiveness. The main findings are that target population could be larger for instance including hospice patients for palliative care, group dwelling for people with intellectual disabilities, or psychiatric patients, population health may be improved, image quality seems to be good and mobile X-ray may be cost effective. Limitations of language, databases and grey literature may have resulted in studies being missed.

Conclusions: Mobile X-ray may be used outside hospital. There seems to be potential benefits to both patients and health care staff. Based on the published studies it is not possible to draw a final conclusion if mobile X-ray examination is a relevant diagnostic offer and for whom. Further studies are needed to assess the feasibility of use in fragile patients, also regarding staff, relatives and societal consequences and therefore the topic mobile X-ray needs more research.
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http://dx.doi.org/10.1186/s12913-020-05564-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7439673PMC
August 2020

Genetic and environmental variation in educational attainment: an individual-based analysis of 28 twin cohorts.

Sci Rep 2020 07 29;10(1):12681. Epub 2020 Jul 29.

Washington State Twin Registry, Washington State University - Health Sciences Spokane, Spokane, WA, USA.

We investigated the heritability of educational attainment and how it differed between birth cohorts and cultural-geographic regions. A classical twin design was applied to pooled data from 28 cohorts representing 16 countries and including 193,518 twins with information on educational attainment at 25 years of age or older. Genetic factors explained the major part of individual differences in educational attainment (heritability: a = 0.43; 0.41-0.44), but also environmental variation shared by co-twins was substantial (c = 0.31; 0.30-0.33). The proportions of educational variation explained by genetic and shared environmental factors did not differ between Europe, North America and Australia, and East Asia. When restricted to twins 30 years or older to confirm finalized education, the heritability was higher in the older cohorts born in 1900-1949 (a = 0.44; 0.41-0.46) than in the later cohorts born in 1950-1989 (a = 0.38; 0.36-0.40), with a corresponding lower influence of common environmental factors (c = 0.31; 0.29-0.33 and c = 0.34; 0.32-0.36, respectively). In conclusion, both genetic and environmental factors shared by co-twins have an important influence on individual differences in educational attainment. The effect of genetic factors on educational attainment has decreased from the cohorts born before to those born after the 1950s.
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http://dx.doi.org/10.1038/s41598-020-69526-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7391756PMC
July 2020

Baseline blood volume identified by dynamic contrast-enhanced computed tomography as a new independent prognostic factor in metastatic renal cell carcinoma.

Transl Oncol 2020 Oct 9;13(10):100829. Epub 2020 Jul 9.

Department of Oncology, Aarhus University Hospital, Aarhus, Denmark. Electronic address:

Background: Preliminary data showed prognostic impact of contrast-enhanced computed tomography (DCE-CT) identified Blood Volume (BV) in patients with metastatic renal cell carcinoma (mRCC). BV as an independent prognostic factor remains to be assessed.

Materials And Methods: DCE-CT identified BV was prospectively quantified in patients with mRCC receiving first line therapies, adjusted for International mRCC Database Consortium (IMDC) individual features and treatments, and associated with overall survival (OS), progression-free survival (PFS) and objective response (ORR), using Cox and logistic regression, respectively.

Results: 105 patients with mRCC were included. Median baseline BV was 32.87 mL × 100 g (range 9.52 to 92.87 mL × 100 g). BV above median was associated with IMDC favorable risk category (P = 0.004), metastasis free interval ≥ 1 year (P = 0.007), male gender (P = 0.032), normal hemoglobin (P = 0.040) and normal neutrophils (P = 0.007), whereas low BV was associated with poor risk IMDC features (P < 0.05). Patients with high vs. low baseline BV had longer PFS (12.5 vs. 5.6 months, P = 0.015) and longer OS (42.2 vs. 22.4 months, P = 0.001), respectively. In multivariate analysis high baseline BV remained independent favorable for OS (HR 0.49, 95% CI 0.30-0.78, P = 0.003) and PFS (HR 0.64; 95% CI 0.42-0.97, P = 0.036). BV as a continuous variable was also associated with OS in the multivariate analysis (HR 0.98, 95% CI 0.96-1.00, P = 0.017). The estimated concordance index (c-index) was 0.688 using IMDC score and 0.701 when BV was added.

Conclusions: DCE-CT identified Blood Volume is a new, independent prognostic factor in mRCC, which may improve the prognostic accuracy of IMDC.
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http://dx.doi.org/10.1016/j.tranon.2020.100829DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7350156PMC
October 2020

Impact of spectral body imaging in patients suspected for occult cancer: a prospective study of 503 patients.

Eur Radiol 2020 Oct 4;30(10):5539-5550. Epub 2020 May 4.

Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, Aarhus, 8200, Denmark.

Objectives: To investigate the diagnostic impact and performance of spectral dual-layer detector CT in the detection and characterization of cancer compared to conventional CE-CT.

Methods: In a national workup program for occult cancer, 503 patients (286 females and 217 males) were prospectively enrolled for a contrast-enhanced spectral CT scan. The readings were performed with and without spectral data available. A minimum of 3 months between interpretations was implemented to minimize recall bias. The sequence of reads for the individual patient was randomized. Readers were blinded for patient identifiers and clinical outcome. Two radiologists with 9 and 33 years of experience performed the readings in consensus. If disagreement, a third radiologist with 11 years of experience determined the outcome of the reading RESULTS: Significantly more cancer findings were identified on the spectral reading. In 73 cases of proven cancer, we found a sensitivity of 89% vs 77% and a specificity of 77% vs 83% on spectral CT compared to conventional CT. A slight increase in reading time in spectral images of 82 s was found (382 vs 300, p < 0.001). For all cystic lesions, the perceived diagnostic certainty increased from 30% being completely certain to 96% most pronounced in the kidney, liver, thyroid, and ovaries. And adding the spectral information to the reading gave a decrease in follow-up examination for diagnostic certainty (0.25 vs 0.81 per reading, p < 0.001).

Conclusion: The use of contrast-enhanced spectral CT increases the confidence of the radiologists in correct characterization of various lesions and minimizes the need for supplementary examinations.

Key Points: • Spectral CT is associated with a higher sensitivity, but a slightly lower specificity compared to conventional CT. • Spectral CT increases the confidence of the radiologists. • The need for supplementary examinations is decreased, with only a slight increase in reading times.
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http://dx.doi.org/10.1007/s00330-020-06878-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7476920PMC
October 2020

Mobile X-ray Outside the Hospital vs. X-ray at the Hospital Challenges Exposed in an Explorative RCT Study.

Healthcare (Basel) 2020 Apr 30;8(2). Epub 2020 Apr 30.

Department of Geriatrics, Aarhus University Hospital, 8200 Aarhus, Denmark.

Background: For frail patients, it may sometimes be preferable to carry out X-ray examinations at the patients' own home. The general state of such patients may worsen due to transport and change of environment when transported for examination at the hospital.

Objective: The aim of the randomized controlled trial (RCT) was to investigate if mobile X-ray improves healthcare for fragile patients. The primary outcome was the number of hospitalizations.

Data Sources: We collected all data using questionnaires and data from the Electronic Patient Record (ER).

Participants: Patients referred to a mobile X-ray examination living in nursing homes and homes for the elderly in the Aarhus Municipality (Denmark).

Intervention: mobile X-ray examinations compared to those at the hospital. Study appraisal: Data were collected and stored using the computer programme Redcap. Stata was used for statistical calculations. One hundred and thirty-six patients were included in the RCT. We did not find significant differences between mobile X-ray (intervention) and X-ray at the hospital (control) concerning hospitalizations and number of hospital days. Challenges: We met several challenges when carrying out RCT in the planned study population. Doctors often withdraw the referral when they found out that their patient should go to the hospital instead of mobile X-ray. The nursing home staff often considered the patient too frail to allow the test person to ask questions post X-ray. We also met challenges in the randomization method resulting in bias in the first data collection, so we had to adjust the randomization method.

Conclusions: For the fragile patients in the present explorative study, mobile X-ray did not significantly reduce the number of hospitalizations compared to X-ray at the hospital. Yet, mobile X-ray may be a new important diagnostic tool for more precise treatment to the frailest patients for whom transportation to the hospital is too exhausting. We need studies with focus on this aspect. We also recommend future RCT studies in a population for which mobile X-ray has not yet been a possibility.
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http://dx.doi.org/10.3390/healthcare8020118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7349166PMC
April 2020

Comparison of anterior mandible anatomical characteristics between obstructive sleep apnea patients and healthy individuals: a combined cone beam computed tomography and polysomnographic study.

Eur Arch Otorhinolaryngol 2020 May 24;277(5):1427-1436. Epub 2020 Jan 24.

Department of Allergy, Sleep and Respiratory Diseases and Cyprus Sleep Center, Faculty of Medicine, Near East University, Nicosia, Cyprus.

Purpose: This study aims to evaluate the morphology of the genial tubercle (GT) and lingual foramen (LF) between obstructive sleep apnea (OSA) and non-OSA patients for considerations of mandibular advancement surgery.

Methods: Cone beam CT records of 198 patients were retrospectively collected and analyzed. Five variables were measured for genial tubercle; anterior mandible thickness (AMT), the distance from the lower incisors to the superior border of the genial tubercle, the distance from the inferior border of the genial tubercle to inferior border of the mandible, the height of GT, and genial tubercle width. Lingual foramen were classified according to the genial tubercle. The frequencies, distances of lingual foramen to alveolar crest, lower border of mandible (LVDL) and diameter of LF were also measured.

Results: Significant differences was found for genial tubercle width, anterior mandible thickness, and the distance of lower mandibular border to the midline lingual foramina between OSA and non-OSA patients (p < 0.05). AMT gets thicker and GT gets narrower in OSA patients (p < 0.05). A linear regression analysis on the apnea hypopnea index with measured anatomical variables showed the LVDL (R = - 0.355*), body mass index (R = 0.254), and age (R = 0.33) showed a statistically significant association (p < 0.05). None of the other variables reached formal significance.

Conclusion: LVDL is linearly associated with sleep apnea severity. The variable dimensions and anatomy of genial tubercle as well as lingual foramen for OSA patients suggest the need of 3D preoperative radiological evaluation before genioglossus advancement surgery. Cone beam CT can be a powerful low radiation dose tool both for evaluating the anatomy of the upper airway and mandibular structures at the same time for OSA patients.
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http://dx.doi.org/10.1007/s00405-020-05805-2DOI Listing
May 2020

Counseling of inhalation medicine perceived by patients and their healthcare providers: insights from North Cyprus.

Int J Clin Pharm 2019 Oct 16;41(5):1272-1281. Epub 2019 Jul 16.

Faculty of Pharmacy, Near East University, Near East Boulevard, P.O. Box: 922022, Nicosia, North Cyprus, Mersin 10, Turkey.

Background In order to achieve patient adherence, individuals require different levels of information. Basic and adequate information must be provided by different health care providers to patients. Objective To assess the information level of patients with asthma and chronic obstructive pulmonary disease (COPD) and to determine the source of their information regarding the medicine they use in addition to their satisfaction, inhalation usage techniques and perception of the information providing role of health care professionals. Setting Respiratory disease clinics in Nicosia and Famagusta state hospitals and community pharmacies in North Cyprus. Method A cross-sectional multicentered observational study was carried out in respiratory disease clinics and community pharmacies. Patients' knowledge and healthcare providers' perceptions of their roles were evaluated using "The satisfaction with information about medicines scale". Evaluation of patient's inhalation techniques was performed using a validated checklist. Main outcome measure (a) Patients' knowledge of their medication and satisfaction with the information provided by health care professionals, (b) the prevalence of critical inhalation mistakes, (c) health care professionals' perceptions of their patient counseling practice. Results A total of 110 patients were evaluated, and 6 physicians and 76 pharmacists were recruited for the interview. The health care professionals reported that they talk about the action and the use of medicines with the patients. The standardized average patients' satisfaction score for action and use was 0.35 (± 0.21), whereas for potential side effects, it was 0.26 (± 0.15). Even though 92% of patients believed that they use their inhaler properly, 75% of the patients made at least one critical mistake while using the inhalation demo, which would likely affect the delivery of the medicine to the lungs. Conclusion In spite of health care professionals feeling comfortable with their counseling practices, the majority of patients reported dissatisfaction with the information they provided about medicine, and three out of four patients were making critical mistakes in the use of inhalers. More effort is warranted by health care professionals on patient education to limit critical mistakes.
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http://dx.doi.org/10.1007/s11096-019-00882-8DOI Listing
October 2019

Is There an Increased Risk of Criminal Behavior Among Children Who Were In Utero When Their Mothers Were Exposed to Increased Alcohol Availability? A Register-Based Study Using a Natural Experiment Setting.

J Stud Alcohol Drugs 2019 05;80(3):371-379

Department of Public Health Sciences, Karolinska Institutet, Torsplan, Solnavägen, Stockholm, Sweden.

Objective: Increased alcohol availability influences drinking behavior; however, little is known about the effect of availability changes on subsequent generations. This study examined whether exposure to increased alcohol availability while pregnant is associated with criminal behavior in subsequent generations.

Method: A register-linked study was conducted using data from a natural experiment setting, including 363,207 children born between 1965 and 1971. During 1967/68, strong beer became temporarily available in grocery stores instead of state-owned monopoly stores only, for individuals less than 21 years of age, in two regions of Sweden. Children born in regions exposed to the policy change were compared with children born elsewhere in Sweden (excluding a border area), children born before 1967, and children conceived after 1968. Information on criminal outcomes was obtained from the National Register of Criminal Convictions. Follow-up was from age 15 to 42 years. Hazard ratios with 95% confidence intervals were estimated using Cox regression analysis.

Results: Compared with the unexposed cohorts, children conceived by young mothers before the policy change but exposed to the change in utero did not appear to be at an increased risk of being convicted of a violent crime, theft, or drunk driving later in life. Similar patterns of results were found among children conceived by older mothers.

Conclusions: Using data from a natural experiment setting, no consistent evidence was found that being exposed to increased alcohol availability while pregnant increased the risk of having a child who would be convicted of a crime later in life.
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May 2019

The association of mobility disability and obesity with risk of unemployment in two cohorts from Sweden.

BMC Public Health 2019 Mar 28;19(1):347. Epub 2019 Mar 28.

Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, 221 00, Lund, Sweden.

Background: People with mobility disability (MD) or obesity often have more health problems and are less able to participate in work than individuals without these conditions. This study investigated whether people burdened with MD and obesity have a greater risk of unemployment than people with either one (MD only or obesity only) or none of these conditions.

Methods: The study included two Swedish population-based cohorts, a national cohort (n = 39,947) and a regional cohort (n = 40,088). Six exposure groups were created using baseline self-reported data on MD and body mass index from participants aged 19 to 64 years. The MD definition differed between the cohorts. Various sources of socio-demographic factors were used to address confounding. Participants' risks of unemployment were assessed longitudinally in a nationwide register with objective data and with almost no loss of follow-up (< 1%). Cox regression was used to analyse associations of MD and/or obesity (BMI ≥ 30) with risk of any (≥1 day) and long-term unemployment (≥90 days during two consecutive years). Quantile regression was used to estimate participants' unemployment risks as average days of unemployment. Normal-weight people without MD were used as a reference group. The Wald test was applied for specific group comparisons other than to the reference group.

Results: In summary, the groups with MD and the obese group without MD had a higher risk of becoming unemployed than the reference group (regional survey adjusted hazard ratio range: 1.30-1.59; 95% CI range: 1.06-1.90, national survey adjusted hazard ratio range: 1.11-1.34; 95% CI range: 0.88-1.81). The obese group with MD did not differ from the groups with MD only or obesity only in terms of unemployment risk.

Conclusions: People with MD and/or obesity are vulnerable groups at risk of prolonged unemployment during their working life in a country with a highly developed welfare system.
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http://dx.doi.org/10.1186/s12889-019-6627-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6437925PMC
March 2019

Adolescent mental health and unemployment over the lifespan: Population evidence from Sweden.

Soc Sci Med 2019 02 8;222:305-314. Epub 2019 Jan 8.

Department of Public Health Sciences, Karolinska Institutet, SE-17176, Stockholm, Sweden.

Rationale: Symptoms of mental health problems have been shown to predict adverse labour market outcomes including unemployment, but no studies have used sibling models to examine the relationship between clinically diagnosed psychiatric conditions in adolescence and subsequent unemployment.

Objective: This study used extensive Swedish registry data to investigate the link between psychiatric conditions diagnosed during military conscription and unemployment over two decades. Further, we identified whether this relation was amplified during an economic downturn and tested whether it was affected by adjustment for unobserved family characteristics using sibling fixed-effects models.

Method: Psychiatric conditions were diagnosed by psychologists and psychiatrists at military conscription in sample of 929,191 Swedish men (mean age = 18.4 years) between 1969 and 1989. The average number of days unemployed per year was observed from 1992 to 2012, using the records of the Swedish Public Employment Services.

Results: After adjustment for physical health and childhood socioeconomic status those diagnosed with any psychiatric condition experienced approximately an additional 10 days per year unemployment compared to others. Alcohol (16 days unemployment) and other substance use disorders (17 days) were the strongest predictors of exposure to future unemployment, followed by personality disorders (10 days), neurotic and adjustment conditions (nine days), and depressive disorders (six days). Family background factors accounted for approximately half of the observed relationship between mental health conditions and unemployment. Psychiatric conditions interacted with macroeconomic conditions such that those with pre-existing alcohol-related, and neurotic and adjustment disorders were disproportionately more likely to become unemployed following the 1990s crisis in Sweden.

Conclusions: Adolescent mental health conditions forecast an elevated risk of unemployment, which endures over the life course and is amplified in times of economic uncertainty. Investment in youth mental health services and alcohol and substance use prevention programs may yield economic benefits by reducing unemployment.
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http://dx.doi.org/10.1016/j.socscimed.2018.12.030DOI Listing
February 2019

Tracheal collapsibility in adults is dynamic over time.

Respir Med 2019 01 12;146:124-128. Epub 2018 Dec 12.

Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark.

Background: Tracheal collapse is a weakness of the tracheal wall leading to expiratory central airway collapse of more than 50% compared to inspiration. It has previously been discussed whether the collapsibility of the greater airways is a stable or a dynamic condition. Indeed, other well-known lung diseases such as asthma are characterized by dynamic changes with respect to pulmonary function indices. There are several different morphologies of the trachea related to collapsibility such as the crescent type and the saber-sheath type both involving the tracheal cartilage and excess dynamic airway collapse only involving the posterior membranous part of the trachea. Is the morphology of the trachea important for the course of the disease? The effect or adverse effects of inhaled corticosteroids are thought to play a role in the increasing incidence of the excess tracheal collapse. In this pilot study, we hypothesized that the excess collapsibility of the tracheal wall is dynamic.

Methods: We prospectively examined 20 patients with excessive tracheal collapse on previous CT scans performed primarily due to bronchiectasis. A repeat CT scan was performed in order to evaluate the collapsibility. Before the repeat scan, patients were trained in maximal inspiration, expiration and breathholding. CT was performed in full inspiration and at end-expiration. Image assessment was performed on a dedicated CT workstation using standard lung window display settings. The percentage expiratory collapse based on cross sectional areas from carina to the thoracic inlet was calculated. Pulmonary function tests were performed and analysed in accordance with the American Thoracic Society and the European Respiratory Society guidelines.

Results: Repeat CT scan were performed after 24 month +/- 7.2. Six of the 20 participants (30%) were males. Mean age was 67 +/- 11.3 years. Mean FEV1 was 83% of predicted, FVC 96.6 % of predicted and FEV1/FVC-ratio 71%. In 45% of the patients tracheal expiratory collapse improved (by more than 10%) based on percentage change in cross sectional areas in expiration compared to inspiration. 35% of patients showed disease progression with increased collapse and in 20% the collapsibility remained unchanged.

Conclusion: We demonstrate that the collapsibility in a large fraction of the patients had actually improved at the follow up examination. We do not find any dependency of the change in collapsibility on the morphology of the trachea after end expiration, use of corticosteroid, or recurrent infections. In addition, no correlation between the changes in collapse and changes in the pulmonary function tests and the symptoms is observed.
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http://dx.doi.org/10.1016/j.rmed.2018.11.018DOI Listing
January 2019

Texture in the monitoring of regorafenib therapy in patients with colorectal liver metastases.

Acta Radiol 2019 Sep 6;60(9):1084-1093. Epub 2019 Jan 6.

1 Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.

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http://dx.doi.org/10.1177/0284185118817940DOI Listing
September 2019

Hypercortisolism in Newly Diagnosed Type 2 Diabetes: A Prospective Study of 384 Newly Diagnosed Patients.

Horm Metab Res 2019 Jan 6;51(1):62-68. Epub 2018 Dec 6.

Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.

Cross-sectional studies in small and selected populations report a high prevalence of hypercortisolism in patients with type 2 diabetes (T2D), which could have therapeutic implications, if confirmed. We therefore estimated the prevalence of hypercortisolism in a large and unselected cohort of recently diagnosed T2D patients. Consecutive patients with recently diagnosed T2D first underwent an overnight dexamethasone (1 mg) suppression test (OD). Patients not suppressing serum cortisol ≤50 nmol/l proceeded with a 48-h low dose dexamethasone suppression test (LDDST) and 24-h urinary free cortisol collection (UFC). Patients with elevated cortisol levels according to LDDST and/or UFC underwent imaging guided by plasma ACTH levels, and assessment of bone mineral density. A total of 384 T2D patients (232male/152 females) with a mean age of 60±10 years were included. Eighty-five (22%) patients suppressed incompletely to OD of whom 20 (5%) failed to suppress after LDDST and/or had elevated UFC (=hypercortisolism). Patients with hypercortisolism did not differ as regards age, BMI, HbA1c, T-score or blood pressure, but a higher proportion of them received antihypertensive treatment (100% vs. 64%, p=0.001). Imaging revealed adrenal adenoma(s) in 9 cases and a pituitary macroadenoma in 1 case. We found a 5% prevalence of hypercortisolism in unselected, recently diagnosed T2D, which was not associated with a persuasive cushingoid phenotype. The clinical implications are therefore uncertain.
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http://dx.doi.org/10.1055/a-0809-3647DOI Listing
January 2019

Association of current and former smoking with body mass index: A study of smoking discordant twin pairs from 21 twin cohorts.

PLoS One 2018 12;13(7):e0200140. Epub 2018 Jul 12.

Norwegian Institute of Public Health, Oslo, Norway.

Background: Smokers tend to weigh less than never smokers, while successful quitting leads to an increase in body weight. Because smokers and non-smokers may differ in genetic and environmental family background, we analysed data from twin pairs in which the co-twins differed by their smoking behaviour to evaluate if the association between smoking and body mass index (BMI) remains after controlling for family background.

Methods And Findings: The international CODATwins database includes information on smoking and BMI measured between 1960 and 2012 from 156,593 twin individuals 18-69 years of age. Individual-based data (230,378 measurements) and data of smoking discordant twin pairs (altogether 30,014 pairwise measurements, 36% from monozygotic [MZ] pairs) were analysed with linear fixed-effects regression models by 10-year periods. In MZ pairs, the smoking co-twin had, on average, 0.57 kg/m2 lower BMI in men (95% confidence interval (CI): 0.49, 0.70) and 0.65 kg/m2 lower BMI in women (95% CI: 0.52, 0.79) than the never smoking co-twin. Former smokers had 0.70 kg/m2 higher BMI among men (95% CI: 0.63, 0.78) and 0.62 kg/m2 higher BMI among women (95% CI: 0.51, 0.73) than their currently smoking MZ co-twins. Little difference in BMI was observed when comparing former smoking co-twins with their never smoking MZ co-twins (0.13 kg/m2, 95% CI 0.04, 0.23 among men; -0.04 kg/m2, 95% CI -0.16, 0.09 among women). The associations were similar within dizygotic pairs and when analysing twins as individuals. The observed series of cross-sectional associations were independent of sex, age, and measurement decade.

Conclusions: Smoking is associated with lower BMI and smoking cessation with higher BMI. However, the net effect of smoking and subsequent cessation on weight development appears to be minimal, i.e. never more than an average of 0.7 kg/m2.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0200140PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6042712PMC
January 2019
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