Publications by authors named "Jørgen Jensen"

581 Publications

Adverse events of hyperthermic intravesical chemotherapy for non-muscle invasive bladder cancer patients.

Scand J Urol 2021 Jun 14:1-6. Epub 2021 Jun 14.

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

Introduction: Non-muscle invasive bladder cancer (NMIBC) is one of the most frequent neoplasms in Denmark. Treatment of high-risk NMIBC usually consists of transurethral resection of bladder (TUR-B) followed by intravesical Bacillus Calmette-Guérin (BCG) instillations. Unfortunately, some patients are BCG-unresponsive and will relapse over time. Radical cystectomy is the recommended salvage treatment following BCG-failure or BCG-intolerance. However, not all patients are candidates for surgery and thus, in need of other treatment. This study investigates the adverse events of Hyperthermic Intravesical Chemotherapy (HIVEC) treatment.

Methods: Twenty-three high-risk NMIBC patients, who were BCG-unresponsive or had contraindications for BCG, received HIVEC with Mitomycin C. Prior to each instillation, patients were interviewed by a nurse, using a systematic questionnaire regarding the adverse events. Patients were followed with cytology and cystoscopy every fourth month. The primary outcome was adverse event related to the HIVEC treatment.

Results: In general, the adverse events were mild to moderate and often self-limiting. The most common adverse events were urinary frequency (23.6%), incontinence (19.4%) and urinary tract pain (12.2%).

Conclusion: In the current study, we found that HIVEC was a well-tolerated treatment. HIVEC might be a feasible option for patients, who experienced BCG-failure or BCG-intolerance and could potentially postpone or avoid radical cystectomy.
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http://dx.doi.org/10.1080/21681805.2021.1938664DOI Listing
June 2021

In vivo Motion Correction in Super Resolution Imaging of Rat Kidneys.

IEEE Trans Ultrason Ferroelectr Freq Control 2021 Jun 7;PP. Epub 2021 Jun 7.

Super Resolution (SR) imaging has the potential of visualizing the micro-vasculature down to the 10 μm level, but motion induced by breathing, heartbeats, and muscle contractions are often significantly above this level. The paper therefore introduces a method for estimating tissue motion and compensating for this. The processing pipeline is described and validated using Field II simulations of an artificial kidney. In vivo measurements were conducted using a modified bk5000 research scanner (BK Medical, Herlev, Denmark) with a BK 9009 linear array probe employing a pulse amplitude modulation scheme. The left kidney of ten Sprague-Dawley rats were scanned during open laparotomy. A 1:10 diluted SonoVue contrast agent (Bracco, Milan, Italy) was injected through a jugular vein catheter at 100 μl/min. Motion was estimated using speckle tracking and decomposed into contributions from the heartbeats, breathing and residual motion. The estimated peak motions and their precisions were: Heart: Axial: 7.0 ± 0.55 μm, Lateral: 38 ± 2.5 μm, Breathing Axial: 5 ± 0.29 μm, Lateral: 26 ± 1.3 μm, and Residual: Axial: 30 μm, Lateral: 90 μm. The motion corrected micro-bubble tracks yielded SR images of both bubble density and blood vector velocity. The estimation was, thus, sufficiently precise to correct shifts down to the 10 μm capillary level. Similar results were found in the other kidney measurements with a restoration of resolution for the small vessels demonstrating that motion correction in 2-D can enhance SR imaging quality.
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http://dx.doi.org/10.1109/TUFFC.2021.3086983DOI Listing
June 2021

Caffeine Increases Exercise Performance, Maximal Oxygen Uptake, and Oxygen Deficit in Elite Male Endurance Athletes.

Med Sci Sports Exerc 2021 May 24. Epub 2021 May 24.

Department of Physical Performance, Norwegian School of Sport Sciences, Ullevål Stadion, Norway MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Sciences, Cambridge Biomedical Campus, England, United Kingdom.

Caffeine increases endurance performance but the physiological mechanisms improving high intensity endurance capacity are not well characterised.

Purpose: The aim of the present study was to test the hypothesis that caffeine increases maximal oxygen uptake (VO2max), and to characterise the physiological mechanisms underpinning improved high intensity endurance capacity.

Method: 23 elite endurance trained male athletes were tested twice with and twice without caffeine (four tests) in a randomized, double-blinded and placebo-controlled study with cross-over-design. Caffeine (4.5 mg·kg-1) or placebo was consumed 45 min before standardized warm-up. Time-to-exhaustion during an incremental test (running 10.5° incline, start speed 10.0 km·h-1, and 0.5 km·h-1 increase in speed every 30 s) determined performance. Oxygen uptake was measured continuously to determine VO2max and O2-deficit was calculated.

Results: Caffeine increased time-to-exhaustion from 355 ± 41 to 375 ± 41 s (Δ19.4 ± 16.5 s; p < 0.001). Importantly, caffeine increased VO2max from 75.8 ± 5.6 to 76.7 ± 6.0 ml·kg-1·min-1 (Δ 0.9 ± 1.7 ml·kg-1·min-1; p < 0.003). Caffeine increased maximal heart rate (HRpeak) and ventilation (VEpeak). Caffeine increased O2-deficit from 63.1 ± 18.2 to 69.5 ± 17.5 ml·kg-1 (p < 0.02) and blood lactate compared to placebo. The increase in time-to-exhaustion after caffeine ingestion was reduced to 11.7 s after adjustment for the increase in VO2max. Caffeine did not significantly increase VO2max after adjustment for VEpeak and HRpeak. Adjustment for O2-deficit and lactate explained 6.2 s of the caffeine-induced increase in time-to-exhaustion. The increase in VO2max, ventilation, heart rate, O2-deficit and lactate explained 63% of the increased performance after caffeine intake.

Conclusion: Caffeine increased VO2max in elite athletes, which contributed to improvement in high intensity endurance performance. Increases in O2-deficit and lactate, also contributed to the caffeine-induced improvement in endurance performance.
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http://dx.doi.org/10.1249/MSS.0000000000002704DOI Listing
May 2021

[Catheter-related bladder discomfort].

Ugeskr Laeger 2021 05;183(19)

Catheter-related bladder discomfort is frequent in the post-perative setting, due to an indwelling urinary catheter. It clearly causes discomfort for the patient with the potential consequences of prolonging the post-operative course. Effective treatment to prevent the condition is missing, and lots of different strategies have been investigated. In this review, we aim to address the current options for treatment with the purpose to encourage focus on the topic and suggest strategies to prevent the condition in order to facilitate a better patient course.
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May 2021

Pig Farmers' Perceptions of Economic Incentives to Control Prevalence at Herd Level.

Front Vet Sci 2021 16;8:647697. Epub 2021 Apr 16.

Department of Food and Resource Economics, University of Copenhagen, Copenhagen, Denmark.

This paper investigates how perceived costs and benefits of control among Danish pig farmers affect the farmers' choice of action toward reducing the prevalence of in their herds. Based on data from an online questionnaire involving 163 Danish pig farmers, we find a considerable uncertainty among pig farmers about the perceived effects of the reducing actions. The results indicate large variations in the perceived costs of implementing different types of reducing actions (management-, hygiene- and feed-related). For some cases, farmers associate net benefits and positive productivity effects with implementation of the actions while studies by the industry indicate net costs to the farmers. Differences among farmers support the idea of an outcome-based penalty scheme but the large uncertainties about costs and effects of actions toward control might hamper the effectiveness of such a penalty scheme as a regulatory instrument to affect farmer behavior.
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http://dx.doi.org/10.3389/fvets.2021.647697DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8086553PMC
April 2021

Post-exercise recovery for the endurance athlete with type 1 diabetes: a consensus statement.

Lancet Diabetes Endocrinol 2021 05;9(5):304-317

Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address:

There has been substantial progress in the knowledge of exercise and type 1 diabetes, with the development of guidelines for optimal glucose management. In addition, an increasing number of people living with type 1 diabetes are pushing their physical limits to compete at the highest level of sport. However, the post-exercise recovery routine, particularly with a focus on sporting performance, has received little attention within the scientific literature, with most of the focus being placed on insulin or nutritional adaptations to manage glycaemia before and during the exercise bout. The post-exercise recovery period presents an opportunity for maximising training adaption and recovery, and the clinical management of glycaemia through the rest of the day and overnight. The absence of clear guidance for the post-exercise period means that people with type 1 diabetes should either develop their own recovery strategies on the basis of individual trial and error, or adhere to guidelines that have been developed for people without diabetes. This Review provides an up-to-date consensus on post-exercise recovery and glucose management for individuals living with type 1 diabetes. We aim to: (1) outline the principles and time course of post-exercise recovery, highlighting the implications and challenges for endurance athletes living with type 1 diabetes; (2) provide an overview of potential strategies for post-exercise recovery that could be used by athletes with type 1 diabetes to optimise recovery and adaptation, alongside improved glycaemic monitoring and management; and (3) highlight the potential for technology to ease the burden of managing glycaemia in the post-exercise recovery period.
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http://dx.doi.org/10.1016/S2213-8587(21)00054-1DOI Listing
May 2021

An integrated multi-omics analysis identifies prognostic molecular subtypes of non-muscle-invasive bladder cancer.

Nat Commun 2021 04 16;12(1):2301. Epub 2021 Apr 16.

Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.

The molecular landscape in non-muscle-invasive bladder cancer (NMIBC) is characterized by large biological heterogeneity with variable clinical outcomes. Here, we perform an integrative multi-omics analysis of patients diagnosed with NMIBC (n = 834). Transcriptomic analysis identifies four classes (1, 2a, 2b and 3) reflecting tumor biology and disease aggressiveness. Both transcriptome-based subtyping and the level of chromosomal instability provide independent prognostic value beyond established prognostic clinicopathological parameters. High chromosomal instability, p53-pathway disruption and APOBEC-related mutations are significantly associated with transcriptomic class 2a and poor outcome. RNA-derived immune cell infiltration is associated with chromosomally unstable tumors and enriched in class 2b. Spatial proteomics analysis confirms the higher infiltration of class 2b tumors and demonstrates an association between higher immune cell infiltration and lower recurrence rates. Finally, the independent prognostic value of the transcriptomic classes is documented in 1228 validation samples using a single sample classification tool. The classifier provides a framework for biomarker discovery and for optimizing treatment and surveillance in next-generation clinical trials.
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http://dx.doi.org/10.1038/s41467-021-22465-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8052448PMC
April 2021

Real-time Volumetric Synthetic Aperture Software Beamforming of Row-Column Probe Data.

IEEE Trans Ultrason Ferroelectr Freq Control 2021 Apr 8;PP. Epub 2021 Apr 8.

Two delay-and-sum beamformers for 3-D synthetic aperture imaging with row-column addressed arrays are presented. Both beamformers are software implementations for graphics processing unit (GPU) execution with dynamic apodizations and 3rd order polynomial subsample interpolation. The first beamformer was written in the MATLAB programming language and the second was written in C/C++ with the compute unified device architecture (CUDA) extensions by NVIDIA. Performance was measured as volume rate and sample throughput on three different GPUs: a 1050 Ti, a 1080 Ti, and a TITAN V. The beamformers were evaluated across 112 combinations of output geometry, depth range, transducer array size, number of virtual sources, floating point precision, and Nyquist rate or inphase/ quadrature beamforming using analytic signals. Real-time imaging defined as more than 30 volumes per second was attained by the CUDA beamformer on the three GPUs for 13, 27, and 43 setups, respectively. The MATLAB beamformer did not attain real-time imaging for any setup. The median, single precision sample throughput of the CUDA beamformer was 4.9, 20.8, and 33.5 gigasamples per second on the three GPUs, respectively. The CUDA beamformer's throughput was an order of magnitude higher than that of the MATLAB beamformer.
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http://dx.doi.org/10.1109/TUFFC.2021.3071810DOI Listing
April 2021

The Association between Vaginal Dysbiosis and Reproductive Outcomes in Sub-Fertile Women Undergoing IVF-Treatment: A Systematic PRISMA Review and Meta-Analysis.

Pathogens 2021 Mar 4;10(3). Epub 2021 Mar 4.

Department of Clinical Medicine, Aarhus University, Denmark and the Fertility Clinic Skive, Skive Regional Hospital, 7800 Skive, Denmark.

Recent advances in molecular microbiology have enabled refined studies of the genital tract microbiota. This constitutes the basis of the present updated systematic review and meta-analysis which investigate vaginal dysbiosis (VD) as defined by either microscopy (e.g., Nugent score for bacterial vaginosis) or molecular methods (qPCR and Next Generation Sequencing) to evaluate the impact of VD on the reproductive outcomes in women undergoing IVF-treatment. A total of 17 studies were included, comprising 3543 patients and with a VD prevalence of 18% (95%CI 17-19). Across all methods, VD is a significant risk factor for early pregnancy loss in IVF (Relative risk (RR) = 1.71 95%CI 1.29-2.27). Moreover, a predefined sub-analysis of studies using molecular methods for VD diagnosis showed a significant reduction in the clinical pregnancy rate when compared to normal vaginal microbiota patients (RR = 0.55 95%CI 0.32-0.93). However, regardless of diagnostic methodology, VD did not significantly influence live birth rate (LBR). In conclusion, molecular tools have provided a more detailed insight into the vaginal microbiota, which may be the reason for the increased adverse effect estimates in IVF patients with molecularly defined VD. However, the quality of evidence was very low across all outcomes according to GRADE and thus, more studies are warranted to understand the impact of VD in IVF.
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http://dx.doi.org/10.3390/pathogens10030295DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8001118PMC
March 2021

3D printed calibration micro-phantoms for super-resolution ultrasound imaging validation.

Ultrasonics 2021 Jul 4;114:106353. Epub 2021 Mar 4.

Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark.

This study evaluates the use of 3D printed phantoms for 3D super-resolution ultrasound imaging (SRI) algorithm calibration. The main benefit of the presented method is the ability to do absolute 3D micro-positioning of sub-wavelength sized ultrasound scatterers in a material having a speed of sound comparable to that of tissue. Stereolithography is used for 3D printing soft material calibration micro-phantoms containing eight randomly placed scatterers of nominal size 205 μm × 205 μm × 200 μm. The backscattered pressure spatial distribution is evaluated to show similar distributions from micro-bubbles as the 3D printed scatterers. The printed structures are found through optical validation to expand linearly in all three dimensions by 2.6% after printing. SRI algorithm calibration is demonstrated by imaging a phantom using a λ/2 pitch 3 MHz 62+62 row-column addressed (RCA) ultrasound probe. The printed scatterers will act as point targets, as their dimensions are below the diffraction limit of the ultrasound system used. Two sets of 640 volumes containing the phantom features are imaged, with an intervolume uni-axial movement of the phantom of 12.5 μm, to emulate a flow velocity of 2 mm/s at a frame rate of 160 Hz. The ultrasound signal is passed to a super-resolution pipeline to localise the positions of the scatterers and track them across the 640 volumes. After compensating for the phantom expansion, a scaling of 0.989 is found between the distance between the eight scatterers calculated from the ultrasound data and the designed distances. The standard deviation of the variation in the scatterer positions along each track is used as an estimate of the precision of the super-resolution algorithm, and is expected to be between the two limiting estimates of (σ̃,σ̃,σ̃) = (22.7 μm, 27.6 μm, 9.7 μm) and (σ̃,σ̃,σ̃) = (18.7 μm, 19.3 μm, 8.9 μm). In conclusion, this study demonstrates the use of 3D printed phantoms for determining the accuracy and precision of volumetric super-resolution algorithms.
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http://dx.doi.org/10.1016/j.ultras.2021.106353DOI Listing
July 2021

STAG2 as a prognostic biomarker in low-grade non-muscle invasive bladder cancer.

Urol Oncol 2021 Mar 9. Epub 2021 Mar 9.

Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University School of Medicine, Washington, DC. Electronic address:

Objective: Improvements to bladder cancer risk stratification guidelines are needed to better tailor post-operative surveillance and adjuvant therapy to individual patients. We previously identified STAG2 as a commonly mutated tumor suppressor gene in bladder cancer and an independent predictor of progression in NMIBC. Here we test the value of combining STAG2 immunostaining with other risk stratification biomarkers in NMIBC, and as an individual biomarker in MIBC.

Materials And Methods: STAG2 immunohistochemistry was performed on a progressor-enriched cohort of tumors from 297 patients with NMIBC, and on tumors from 406 patients with MIBC from Aarhus University Hospital in Denmark. Survival analysis was performed using Kaplan-Meier survival analysis, the log rank test, and Cox proportional hazards models.

Results: STAG2-negative low-grade NMIBC tumors were 2.5 times less likely to progress to muscle invasion than STAG2-positive low-grade NMIBC tumors (Log-rank test, P = 0.008). In a composite group of patients with AUA intermediate and high-risk NMIBC tumors, STAG2-negative tumors were less likely to progress (Log-rank test, P = 0.02). In contrast to NMIBC, we show that STAG2 is not useful as a prognostic biomarker in MIBC.

Conclusions: STAG2 immunostaining can be used to subdivide low-grade NMIBC tumors into two groups with substantially different risks of disease progression. Furthermore, STAG2 immunostaining may be useful to enhance NMIBC risk stratification guidelines, though larger cohorts are needed to solidify this conclusion in individual risk groups. STAG2 is not useful as a biomarker in MIBC. Further study of the use of STAG2 immunostaining as a biomarker for predicting the clinical behavior in NMIBC is warranted.
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http://dx.doi.org/10.1016/j.urolonc.2021.02.007DOI Listing
March 2021

Staphylococcal Communities on Skin Are Associated with Atopic Dermatitis and Disease Severity.

Microorganisms 2021 Feb 19;9(2). Epub 2021 Feb 19.

Bacteria, Parasites, and Fungi, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark.

The skin microbiota of atopic dermatitis (AD) patients is characterized by increased colonization, which exacerbates disease symptoms and has been linked to reduced bacterial diversity. Skin bacterial communities in AD patients have mostly been described at family and genus levels, while species-level characterization has been limited. In this study, we investigated the role of the bacteria belonging to the genus using targeted sequencing of the gene with genus-specific primers. We compared staphylococcal communities on lesional and non-lesional skin of AD patients, as well as AD patients with healthy controls, and determined the absolute abundance of bacteria present at each site. We observed that the staphylococcal community, bacterial alpha diversity, and bacterial densities were similar on lesional and non-lesional skin, whereas AD severity was associated with significant changes in staphylococcal composition. Increased , , and abundances were correlated with increased severity. Conversely, abundance was negatively correlated with severity. Furthermore, relative abundance was reduced on AD skin compared to healthy skin. In conclusion, various staphylococcal species appear to be important for skin health.
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http://dx.doi.org/10.3390/microorganisms9020432DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7921937PMC
February 2021

Consumer preferences for reduced antibiotic use in Danish pig production.

Prev Vet Med 2021 Apr 23;189:105310. Epub 2021 Feb 23.

Department of Food and Resource Economics, University of Copenhagen, Rolighedsvej 25, Frederiksberg C, DK-1958, Denmark.

Denmark has a large and intensive pig production sector which accounts for around half of the total use of antimicrobials in Demark. The economic feasibility of alternative strategies involving reduced use of antibiotics depends not only on their effects on productivity but also on consumers' demand, and willingness-to-pay (WTP), for pork from pigs with no or lower antibiotic treatment. This study investigates the various concerns that consumers might have about the use of antibiotics in pig production, and how they affect demand and WTP. We used data from an online questionnaire survey of approximately 1000 Danish consumers. WTP estimates were obtained using payment card data analysed in an ordered probit regression. We found that 41 % of the respondents wanted antibiotic use to be reduced substantially, and that they linked reduced use of antibiotics in pig production primarily with reduced risk of antibiotic residues in pork and a lowered risk of resistant bacteria developing. A considerable share of the consumers we sampled also linked reduced antibiotic use with improved animal welfare, and with price increases for pork. Two thirds of the consumers stated a positive WTP for reduced use of antibiotics, but only one in five were willing to pay more than 10 % for pork produced using antibiotics 20 % less than average. The WTP estimates differed with socio-demographic variables (education, geography, gender and age). In addition, the respondents' perceptions of the effects of reducing antibiotic use and of externalities associated with the pig industry, and the frequency of their pork consumption, were found to affect their WTP for pork produced with lower antibiotic use. As the vast majority of the Danish pork is exported, future studies should examine consumer perceptions of antibiotic use in pig production in importing countries.
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http://dx.doi.org/10.1016/j.prevetmed.2021.105310DOI Listing
April 2021

The case for developing a cohesive systems approach to research across unhealthy commodity industries.

BMJ Glob Health 2021 02;6(2)

Center for International Health Protection, Robert Koch Institute, Berlin, Germany.

Objectives: Most non-communicable diseases are preventable and largely driven by the consumption of harmful products, such as tobacco, alcohol, gambling and ultra-processed food and drink products, collectively termed unhealthy commodities. This paper explores the links between unhealthy commodity industries (UCIs), analyses the extent of alignment across their corporate political strategies, and proposes a cohesive systems approach to research across UCIs.

Methods: We held an expert consultation on analysing the involvement of UCIs in public health policy, conducted an analysis of business links across UCIs, and employed taxonomies of corporate political activity to collate, compare and illustrate strategies employed by the alcohol, ultra-processed food and drink products, tobacco and gambling industries.

Results: There are clear commonalities across UCIs' strategies in shaping evidence, employing narratives and framing techniques, constituency building and policy substitution. There is also consistent evidence of business links between UCIs, as well as complex relationships with government agencies, often allowing UCIs to engage in policy-making forums. This knowledge indicates that the role of all UCIs in public health policy would benefit from a common approach to analysis. This enables the development of a theoretical framework for understanding how UCIs influence the policy process. It highlights the need for a deeper and broader understanding of conflicts of interests and how to avoid them; and a broader conception of what constitutes strong evidence generated by a wider range of research types.

Conclusion: UCIs employ shared strategies to shape public health policy, protecting business interests, and thereby contributing to the perpetuation of non-communicable diseases. A cohesive systems approach to research across UCIs is required to deepen shared understanding of this complex and interconnected area and also to inform a more effective and coherent response.
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http://dx.doi.org/10.1136/bmjgh-2020-003543DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7888371PMC
February 2021

Reply to Claudia Signorini and Massimo Maffezzini's Letter to the Editor re: Maria S. Lindgren, Peter Bue, Nessn Azawi, et al. The DaBlaCa-13 Study: Short-term, Intensive Chemoresection Versus Standard Adjuvant Intravesical Instillations in Non-muscle-invasive Bladder Cancer-A Randomized Controlled Trial. Eur Urol 2020;78:856-62.

Eur Urol 2021 May 13;79(5):e137. Epub 2021 Feb 13.

Department of Urology, Aarhus University Hospital, Aarhus, Denmark; Department of Urology, Gødstrup Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus Denmark.

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http://dx.doi.org/10.1016/j.eururo.2021.02.001DOI Listing
May 2021

Complications after scrotal surgery - still a major issue?

Scand J Urol 2021 Feb 11:1-4. Epub 2021 Feb 11.

Department of Urology, Regional Hospital West Jutland, Holstebro, Denmark.

Objective: Gold standard treatment of symptomatic hydrocele or spermatocele is surgery. Despite a minor procedure, complications such as bleeding and infections leading to reoperations may be devastating for the patients. In autumn 2018, an accumulation of complications was seen in our department. The aim of this study was to investigate the rate and grade of complications and to identify potential means to reduce these.

Materials And Methods: Patient records of all patients undergoing surgical repair of hydrocele or spermatocele from December 2017 to November 2018 were examined. Results were audited to identify potential causes of complications. The focus was on the perioperative hemostasis and postoperative activity restrictions. The outcome was compared to a consecutive patient series operated the following year.

Results: Sixty-five men were operated on during the first period. Twenty-two patients contacted the department postoperatively due to swelling or pain, 19 patients were examined at the hospital and six patients were re-operated 1-9 times. The following year, 69 patients were operated on. Of these, 16 patients contacted the department postoperatively ( = 0.17), 13 patients were examined at the hospital, and five patients were re-operated ( = 0.68). There was the same complication rate in patients operated by specialist urologists or supervised younger doctors. However, patients preoperatively examined and informed by a specialized urologist had significantly fewer complications compared to those informed by urological residents and interns ( = 0.012).

Conclusion: Despite the change in patient information and increased awareness of possible complications, a high proportion of patients still were in need of unplanned contact to the department and reoperation.
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http://dx.doi.org/10.1080/21681805.2021.1884131DOI Listing
February 2021

DaPeCa-8: drawing the map of lymphatic drainage in patients with invasive penile cancer - evidence from SPECT/CT and sentinel node surgery.

Scand J Urol 2021 Feb 11:1-9. Epub 2021 Feb 11.

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

Background: Anatomy of the lymphatic drainage guides the extent of inguinal lymph node dissection in penile cancer.

Objective: To prospectively assess the lymphatic drainage of penile cancer with single-photon emission computed tomography CT (SPECT-CT) and implications for the extent of inguinal lymph node dissection.

Methods: We assessed the lymphatic drainage of 62 patients with at least unilateral clinical lymph node-negative (cN0) status with SPECT-CT at our tertiary referral centre. We evaluated 122 cN0 inguinal basins and compared them to the histopathological outcome. The inguinal regions were divided into ten different Daseler zones on SPECT-CT. The surgical team filled in a corresponding scheme at sentinel node biopsy and sent lymph nodes from each Daseler zone individually for histopathological examination.

Results: SPECT-CT successfully visualized lymphatic drainage in 116 of the 122 cN0 inguinal basins (95.1%). The vast majority of sentinel nodes and all metastatic nodes were located in central and superior inguinal zones, including six metastatic nodes in lateral superior zones. Minimal lymphatic drainage was seen to the inferior Daseler zones and no metastatic deposits were located here. No direct pelvic drainage was observed.

Conclusions: Penile cancer lymphatic drainage is primarily to sentinel in the superior and central zones of Daseler. Colleagues practicing a modified inguinal lymph node dissection as a standard in cN0 patients are encouraged to include all these zones, while the inferior zones can be omitted. This study confirms the absence of lymphatic drainage directly to the pelvic region and supports the practice of omitting pelvic nodes from sentinel node biopsy.
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http://dx.doi.org/10.1080/21681805.2021.1882560DOI Listing
February 2021

Which data are available in central registries on bladder cancer patients in the five Nordic countries.

Scand J Urol 2021 Apr 28;55(2):135-141. Epub 2021 Jan 28.

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

Objective: The aim of this study was to give a collective overview on all available data sources on bladder cancer patients in the Nordic countries including the amount of detail and coverage.

Methods: National representatives from five Nordic countries were asked to fill out a questionnaire on available information regarding bladder cancer patients from databases in their respective countries. Additional information was retrieved from descriptions of the relevant registries.

Results: : from all countries, information on stage and grade at transurethral resection of the bladder (TURB) could be retrieved. Details on procedures (TURB, instillation therapy, photodynamic diagnosis, and perioperative instillation) were varying within different databases. : in all Nordic countries, detailed information on cystectomy patients could be retrieved but with variable registration of complications. Completeness of available information on oncological treatment (radiation, chemotherapy, and immunotherapy) were varying. : Information on overall survival was available in all countries whereas recurrence-free survival and cancer-specific survival were available for some but not all patients depending on treatment modality.

Conclusions: Despite limitations, we found that it was possible to retrieve detailed information on diagnostics, treatment, and outcome for most aspects of bladder cancer in the Nordic countries on a population based, non-selected patient cohort.
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http://dx.doi.org/10.1080/21681805.2021.1877344DOI Listing
April 2021

Food Taxation and the Double Burden of Malnutrition.

World Rev Nutr Diet 2020 6;121:159-165. Epub 2020 Oct 6.

Department of Food and Resource Economics, University of Copenhagen, Frederiksberg, Denmark,

Dietary transition towards more animal-based and more highly processed energy-dense foods and beverages has led to sufficient or excessive intake of calories, but also a risk of insufficient intake of various essential macro- and micronutrients (the so-called double burden of malnutrition), in high-income countries, as well as in low- and middle-income countries. Taxation of energy-dense and non-essential food and beverage products has been proposed as a policy tool to reduce the intake of these foods, and such taxes have been implemented in several countries, often targeted at sugared beverages, candies, or snacks. Several studies tend to confirm an effect of such taxes on the consumption of the targeted products, but there is less knowledge as to how these taxes influence the "double burden" challenges associated with insufficient intake of important nutrients for some consumers. This paper reviews and discusses the mechanisms and experiences with taxation of unhealthy food products, as well as some implications of food taxation in light of the double burden perspective. Existing evidence suggests that taxation of unhealthy food products has the potential to reduce consumers' intake of these products and a potential to stimulate the consumption of other food products through substitution effects. However, except for the taxation of "sweets," it is not generally evident whether such substitution effects will be beneficial or harmful from a nutritional point of view. Concerns in this respect include whether individuals' sufficiency in different macro- and micronutrients will be improved or deteriorated by such effects, and whether these effects differ between population segments with currently high and low nutritional risk.
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http://dx.doi.org/10.1159/000507490DOI Listing
October 2020

Vaginal, Cervical and Uterine pH in Women with Normal and Abnormal Vaginal Microbiota.

Pathogens 2021 Jan 20;10(2). Epub 2021 Jan 20.

Department of Obstetrics and Gynecology, Aarhus University Hospital, DK-8200 Aarhus, Denmark.

Introduction: Healthy women of reproductive age have a vaginal pH around 4.5, whereas little is known about pH in the upper genital tract. A shift in the vaginal microbiota may result in an elevated pH in the upper genital tract. This might contribute to decreased fertility and increased risk of preterm birth. Therefore, we aimed to measure pH in different compartments of the female genital tract in both nonpregnant and pregnant women, stratifying into a normal and abnormal vaginal microbiota.

Material And Methods: In this descriptive study, we included 6 nonpregnant, 12 early-pregnant, and 8 term-pregnant women. A pH gradient was recorded with a flexible pH probe. An abnormal vaginal microbiota was diagnosed by a quantitative polymerase chain reaction technique for ; ; ; bacterial vaginosis-associated bacterium 1, 2, 3, and TM7; and spp. among others.

Results: In all participants we found the pH gradient in the lower reproductive canal to be most acidic in the lower vagina and most alkaline in the upper uterine cavity. Women with an abnormal vaginal microbiota had an increased pH in the lower vagina compared to the other groups.

Conclusions: There is a pronounced pH gradient within the female genital tract. This gradient is not disrupted in women with an abnormal vaginal microbiota.
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http://dx.doi.org/10.3390/pathogens10020090DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7909242PMC
January 2021

Patients with NMIBC with the highest risk of progression are correctly selected for cystectomy in Sweden.

Scand J Urol 2021 Feb 7;55(1):54-55. Epub 2021 Jan 7.

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

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http://dx.doi.org/10.1080/21681805.2020.1866662DOI Listing
February 2021

Low-Carbohydrate High-Fat Diet and Exercise: Effect of a 10-Week Intervention on Body Composition and CVD Risk Factors in Overweight and Obese Women-A Randomized Controlled Trial.

Nutrients 2020 Dec 30;13(1). Epub 2020 Dec 30.

Institute of Physical Performance, Norwegian School of Sport Sciences, 0863 Oslo, Norway.

We assessed the effect of weight-loss induced with a low-carbohydrate-high-fat diet with and without exercise, on body-composition, cardiorespiratory fitness and cardiovascular risk factors. A total of 57 overweight and obese women (age 40 ± 3.5 years, body mass index 31.1 ± 2.6 kg∙m) completed a 10-week intervention using a low-carbohydrate-high-fat diet, with or without interval exercise. An equal deficit of 700 kcal∙day was prescribed, restricting diet only, or moderately restricting diet and adding exercise, producing four groups; normal diet (NORM); low-carbohydrate-high-fat diet (LCHF); normal diet and exercise (NORM-EX); and low-carbohydrate-high-fat diet and exercise (LCHF-EX). Linear Mixed Models were used to assess between-group differences. The intervention resulted in an average 6.7 ± 2.5% weight-loss ( < 0.001). Post-intervention % fat was lower in NORM-EX than NORM (40.0 ± 4.2 vs. 43.5 ± 3.5%, = 0.024). NORM-EX reached lower values in total cholesterol than NORM (3.9 ± 0.6 vs. 4.7 ± 0.7 mmol/L, = 0.003), and LCHF-EX (3.9 ± 0.6 vs. 4.9 ± 1.1 mmol/L, = 0.004). Post intervention triglycerides levels were lower in NORM-EX than NORM (0.87 ± 0.21 vs. 1.11 ± 0.34 mmol/L, = 0.030). The low-carbohydrate-high-fat diet had no superior effect on body composition, V˙O or cardiovascular risk factors compared to a normal diet, with or without exercise. In conclusion, the intervention decreased fat mass, but exercise improved body composition and caused the most favorable changes in total cholesterol and triglycerides in the NORM-EX. Exercise increased cardiorespiratory fitness, regardless of diet.
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http://dx.doi.org/10.3390/nu13010110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7824646PMC
December 2020

Exhaustive Exercise and Post-exercise Protein Plus Carbohydrate Supplementation Affect Plasma and Urine Concentrations of Sulfur Amino Acids, the Ratio of Methionine to Homocysteine and Glutathione in Elite Male Cyclists.

Front Physiol 2020 15;11:609335. Epub 2020 Dec 15.

Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway.

Plasma and tissue sulfur amino acid (SAA) availability are crucial for intracellular methylation reactions and cellular antioxidant defense, which are important processes during exercise and in recovery. In this randomized, controlled crossover trial among eight elite male cyclists, we explored the effect of exhaustive exercise and post-exercise supplementation with carbohydrates and protein (CHO+PROT) vs. carbohydrates (CHO) on plasma and urine SAAs, a potential new marker of methylation capacity (methionine/total homocysteine ratio [Met/tHcy]) and related metabolites. The purpose of the study was to further explore the role of SAAs in exercise and recovery. Athletes cycled to exhaustion and consumed supplements immediately after and in 30 min intervals for 120 min post-exercise. After ~18 h recovery, performance was tested in a time trial in which the CHO+PROT group cycled 8.5% faster compared to the CHO group (41:53 ± 1:51 vs. 45:26 ± 1:32 min, < 0.05). Plasma methionine decreased by ~23% during exhaustive exercise. Two h post-exercise, further decline in methionine had occured by ~55% in the CHO group vs. ~33% in the CHO+PROT group (p × < 0.001). The Met/tHcy ratio decreased by ~33% during exhaustive exercise, and by ~54% in the CHO group vs. ~27% in the CHO+PROT group (p × < 0.001) post-exercise. Plasma cystathionine increased by ~72% in the CHO group and ~282% in the CHO+PROT group post-exercise (p × < 0.001). Plasma total cysteine, taurine and total glutathione increased by 12% ( = 0.03), 85% ( < 0.001) and 17% ( = 0.02), respectively during exhaustive exercise. Using publicly available transcriptomic data, we report upregulated transcript levels of skeletal muscle (log fold-change: 0.45, FDR:1.8) and log fold-change: 0.38, FDR: 3.4) after acute exercise. Our results show that exercise acutely lowers plasma methionine and the Met/tHcy ratio. This response was attenuated in the CHO+PROT compared to the CHO group in the early recovery phase potentially affecting methylation capacity and contributing to improved recovery.
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http://dx.doi.org/10.3389/fphys.2020.609335DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769812PMC
December 2020

Fatal 3-Nitropropionic Acid Poisoning after Consuming Coconut Water.

Emerg Infect Dis 2021 01;27(1):278-280

We describe the fatal course of a patient with initial symptoms of vomiting and nausea who developed symptoms of dystonia, encephalopathy, and coma. The cause of death was poisoning with 3-nitropropionic acid from coconut water spoiled with the fungus Arthrinium saccharicola. We present the clinical findings and forensic analysis.
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http://dx.doi.org/10.3201/eid2701.202222DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7774558PMC
January 2021

Tensor Velocity Imaging With Motion Correction.

IEEE Trans Ultrason Ferroelectr Freq Control 2021 May 26;68(5):1676-1686. Epub 2021 Apr 26.

This article presents a motion compensation procedure that significantly improves the accuracy of synthetic aperture tensor velocity estimates for row-column arrays. The proposed motion compensation scheme reduces motion effects by moving the image coordinates with the velocity field during summation of low-resolution volumes. The velocity field is estimated using a transverse oscillation cross-correlation estimator, and each image coordinate's local tensor velocity is determined by upsampling the field using spline interpolation. The motion compensation procedure is validated using Field II simulations and flow measurements acquired using a 3-MHz row-column addressed probe and the research scanner SARUS. For a peak velocity of 25 cm/s, a pulse repetition frequency of 2 kHz, and a beam-to-flow angle of 60°, the proposed motion compensation procedure was able to reduce the relative bias from -27.0% to -9.4% and the standard deviation from 8.6% to 8.1%. In simulations performed with a pulse repetition frequency of 10 kHz, the proposed method reduces the bias in all cases with beam-to-flow angles of 60° and 75° and peak velocities between 10 and 150 cm/s.
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http://dx.doi.org/10.1109/TUFFC.2020.3046101DOI Listing
May 2021

Male erectile function after treatment for colorectal cancer: a population-based cross-sectional study.

Colorectal Dis 2021 Feb 2;23(2):367-375. Epub 2021 Feb 2.

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

Aim: The aim of this work was to determine the knowledge gap in the field of erectile function (EF) after colorectal cancer surgery and investigate and compare long-term male EF in colon and rectal cancer survivors in a national population.

Method: Danish male patients alive without evidence of recurrence who were treated for colon or rectal cancer between May 2001 and December 2014 were invited to participate. Using the International Index of Erectile Function (IIEF) score the derived dichotomized erectile dysfunction (ED) was defined as moderate/severe or no/mild. Patients were grouped based on type of surgery [colon resection, rectal resection (RR) or local resection] and stratified for stoma, preoperative radiotherapy (RT), age and American Society of Anesthesiologists (ASA) score.

Results: Of 10 037 eligible patients, 4334 responded (43.18%). The EF score was significantly lower for RR (mean 12.14) compared with both colon resection (mean 15.82) and local resection (mean 14.81) (p < 0.0001). No significant difference between colon resection and local resection was found (p = 0.29). Both a stoma and the use of RT were independent risk factors for ED. After excluding patients with stoma and RT and adjusting for age and ASA score, RR still had a higher risk of ED (OR 1.42, CI 1.20-1.67) compared with colon resection.

Conclusion: RR has a negative affect on EF. No difference between patients who underwent colon resection and local resection was found. RT and stoma were independent risk factors for ED.
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http://dx.doi.org/10.1111/codi.15482DOI Listing
February 2021

Urine collection in cervical cancer screening - analytical comparison of two HPV DNA assays.

BMC Infect Dis 2020 Dec 4;20(1):926. Epub 2020 Dec 4.

Department of Public Health Programmes, Randers Regional Hospital, Østervangsvej 48, 8930, Randers, NØ, Denmark.

Background: To reach non-participants, reluctant to undergo clinician-based cervical cancer screening and vaginal self-sampling, urine collection for high-risk human papillomavirus detection (hrHPV) may be valuable. Using two hrHPV DNA assays, we evaluated the concordance of hrHPV positivity in urine samples in comparison with vaginal self-samples and cervical cytology samples taken by the general practitioner (GP). We also studied women's acceptance of urine collection and preferences towards the different sampling procedures.

Methods: One hundred fifty paired self-collected urine and vaginal samples and GP-collected cervical cytology samples were obtained from 30 to 59-year-old women diagnosed with ASC-US within the Danish cervical cancer screening program. After undergoing cervical cytology at the GP, the women collected first-void urine and vaginal samples at home and completed a questionnaire. Each sample was hrHPV DNA tested by the GENOMICA CLART® and COBAS® 4800 assays. Concordance in hrHPV detection between sample types was determined using Kappa (k) statistics. Sensitivity and specificity of hrHPV detection in urine was calculated using cervical sampling as reference.

Results: With the COBAS assay, urine showed good concordance to the vaginal (k = 0.66) self-samples and cervical samples (k = 0.66) for hrHPV detection. The corresponding concordance was moderate (k = 0.59 and k = 0.47) using CLART. Compared to cervical sampling, urinary hrHPV detection had a sensitivity of 63.9% and a specificity of 96.5% using COBAS; compared with 51.6 and 92.4% for CLART. Invalid hrHPV test rates were 1.8% for COBAS and 26.9% for CLART. Urine collection was well-accepted and 42.3% of the women ranked it as the most preferred future screening procedure.

Conclusions: Urine collection provides a well-accepted screening option. With COBAS, higher concordance between urine and vaginal self-sampling and cervical sampling for hrHPV detection was found compared to CLART. Urinary hrHPV detection with COBAS is feasible, but its accuracy may need to be improved before urine collection at home can be offered to non-participants reluctant to both cervical sampling and vaginal self-sampling.
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http://dx.doi.org/10.1186/s12879-020-05663-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7716507PMC
December 2020

The Epidome - a species-specific approach to assess the population structure and heterogeneity of Staphylococcus epidermidis colonization and infection.

BMC Microbiol 2020 11 26;20(1):362. Epub 2020 Nov 26.

Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark.

Background: Although generally known as a human commensal, Staphylococcus epidermidis is also an opportunistic pathogen that can cause nosocomial infections related to foreign body materials and immunocompromized patients. Infections are often caused by multidrug-resistant (MDR) lineages that are difficult and costly to treat, and can have a major adverse impact on patients' quality of life. Heterogeneity is a common phenomenon in both carriage and infection, but present methodology for detection of this is laborious or expensive. In this study, we present a culture-independent method, labelled Epidome, based on an amplicon sequencing-approach to deliver information beyond species level on primary samples and to elucidate clonality, population structure and temporal stability or niche selection of S. epidermidis communities.

Results: Based on an assessment of > 800 genes from the S. epidermidis core genome, we identified genes with variable regions, which in combination facilitated the differentiation of phylogenetic clusters observed in silico, and allowed classification down to lineage level. A duplex PCR, combined with an amplicon sequencing protocol, and a downstream analysis pipeline were designed to provide subspecies information from primary samples. Additionally, a probe-based qPCR was designed to provide valuable absolute abundance quantification of S. epidermidis. The approach was validated on isolates representing skin commensals and on genomic mock communities with a sensitivity of < 10 copies/μL. The method was furthermore applied to a sample set of primary skin and nasal samples, revealing a high degree of heterogeneity in the S. epidermidis populations. Additionally, the qPCR showed a high degree of variation in absolute abundance of S. epidermidis.

Conclusions: The Epidome method is designed for use on primary samples to obtain important information on S. epidermidis abundance and diversity beyond species-level to answer questions regarding the emergence and dissemination of nosocomial lineages, investigating clonality of S. epidermidis communities, population dynamics, and niche selection. Our targeted-sequencing method allows rapid differentiation and identification of clinically important nosocomial lineages in low-biomass samples such as skin samples.
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http://dx.doi.org/10.1186/s12866-020-02041-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7691061PMC
November 2020

The discovery of bacterial biofilm in patients with muscle invasive bladder cancer.

APMIS 2021 May 26;129(5):265-270. Epub 2021 Feb 26.

Department of Urology, Zealand University Hospital, Roskilde, Denmark.

The carcinogenic effects of microorganisms have been discovered in multiple cancer types. In urology, the development of squamous cell carcinoma of the bladder due to the parasitic infection with Schistosoma Mansoni is widely accepted. The oncogenic potential of biofilms has been studied in colorectal cancer and experimental studies have shown that bacteria such as Escherichia coli drive the development of colorectal cancer. Notably, Escherichia coli is responsible for 80% of all urinary tract infections. Recent findings suggest an altered urinary microbiome in patients with bladder cancer compared to healthy subjects. In this case series, we demonstrate our findings of biofilm formation in human bladder cancer tissue. Tissue samples from ten patients that underwent routine Transurethral Resection of Bladder Tumor (TURBT) were obtained from the Danish National Biobank. Pathological tissue was examined for presence of bacterial aggregates by Fluorescence in situ Hybridization. In two of ten patients, analysis showed abundant bacterial aggregation on the surface epithelium. Both positive cases had pT2 urothelial bladder cancer. Our findings suggest that biofilm occurs in urothelial cancer tissue indicating an association between biofilm formation and bladder cancer.
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http://dx.doi.org/10.1111/apm.13097DOI Listing
May 2021