Stage-related increase in PIM2 expression in mycosis fungoides.

The oncogene PIM2 is upregulated in several malignancies but has never been investigated in mycosis fungoides (MF), the most common type of cutaneous T-cell lymphoma (CTCL). PIM2 is a well-known oncogene and is regulated by cell signaling pathways like the JAK/STAT- and NF-kB-pathway, key regulators in the pathogenesis of CTCL. The aim of this study was to examine the role of PIM2 in MF. PIM2 gene expression was measured in 81 formalin-fixed paraffin-embedded skin biopsies from patients with MF and 46 control biopsies from healthy skin (HS) and benign inflammatory skin disease (BID). Validation of PIM2 protein expression was performed on selected biopsies with immunohistochemical staining. We found a significant difference in gene expression levels between both early stage MF and HS (p < 0.0001), and BID (p < 0.0001). In addition, the PIM2 gene expression was higher in advanced-stage MF compared to early stage disease (p = 0.0001). No significant difference in gene expression levels was found between patients with and without disease progression. In conclusion, we found PIM2 expression is significantly increased in MF compared to controls, and in advanced-stage MF compared to early stage MF. These findings could potentially have diagnostic value in discriminating early stage MF from BID.

The cascade of care in tuberculosis infection screening and management in newly arrived refugees in Aarhus, Denmark.

BACKGROUND: Screening for tuberculosis (TB) disease and infection is often a part of health screening programs offered to refugees, but the yield of screening varies and losses along the steps from screening to treatment completion was reported. METHODS: A retrospective cohort study was performed investigating a newly arrived refugee population offered a systematic refugee health assessment in Aarhus, Denmark. Data was collected on screening, referral, diagnosis and treatment for TB disease and infection. RESULTS: Among both adults and children IGRA positivity was associated with origin in a high TB incidence country and increasing age. The number needed to screen (NNS) to find one case of TB infection was 7 among adult refugees and 19 among children, while NNS for TB disease was 266 and 164 respectively. The proportion of the eligible population with a valid result was 78.1% for adults and 71.3% for children, while 43.1% and 50% of adults and children with presumed TB infection completed preventive treatment. DISCUSSION: Screening for TB disease and infection among refugees in Aarhus had a high yield in terms of diagnosis, however significant losses were seen during screening, follow-up and preventive treatment completion.

Up-front F18-FDG PET/CT in suspected salivary gland carcinoma.

OBJECTIVE: To investigate whether a 18F-FDG PET/CT (PET/CT)-based diagnostic strategy adds decisive new information compared to conventional imaging in the evaluation of salivary gland tumours and the detection of cervical lymph node metastases, distant metastases, and synchronous cancer in patients with salivary gland carcinoma. METHODS: The study was a blinded prospective cohort study. Data were collected consecutively through almost 3 years. All patients underwent conventional imaging-magnetic resonance imaging (MRI) and chest X-ray (CXR)-in addition to PET/CT prior to surgery. Final diagnosis was obtained by histopathology. MRI/CXR and PET/CT were interpreted separately by experienced radiologists and nuclear medicine physicians. Interpretation included evaluation of tumour site, cervical lymph node metastases, distant metastases, and synchronous cancer. RESULTS: Ninety-one patients were included in the study. Thirty-three patients had primary salivary gland carcinoma and eight had cervical lymph node metastases. With PET/CT, the sensitivity was 92% and specificity 29% regarding tumour site. With MRI/CXR, the sensitivity and specificity were 90% and 26%, respectively. Regarding cervical lymph node metastases in patients with salivary gland carcinoma, the sensitivity with PET/CT was 100% and with MRI/CXR 50%. PET/CT diagnosed distant metastases in five patients, while MRI/CXR detected these in two patients. Finally, PET/CT diagnosed two synchronous cancers, whereas MRI/CXR did not detect any synchronous cancers. CONCLUSIONS: Compared with MRI/CXR PET/CT did not improve discrimination of benign from malignant salivary gland lesions. However, PET/CT may be advantageous in primary staging and in the detection of distant metastases and synchronous cancers.

PET/CT Versus Standard Imaging for Prediction of Survival in Patients with Recurrent Head and Neck Squamous Cell Carcinoma.

The purpose of this study was to examine whether staging with 18F-FDG PET/CT better predicts survival in patients with recurrent head and neck squamous cell carcinoma (HNSCC) than chest x-ray (CXR) plus head and neck MRI or chest CT (CCT) plus head and neck MRI. Methods: This was a prospective cohort study based on paired data. Consecutive patients with histologically verified HNSCC recurrence were enrolled from September 2013 to March 2016. All patients underwent CXR/MRI, CCT/MRI, and PET/CT on the same day and before biopsy. All imaging studies underwent masked interpretation by separate teams of experienced nuclear physicians or radiologists. Recurrent carcinomas were categorized as localized (equivalent to primary stages I-II), locally advanced (equivalent to primary stages III-IVB), or metastatic (equivalent to primary stage IVC). Discriminative abilities for each imaging strategy with respect to cancer-specific and stage-based survival were compared using Kaplan-Meier analysis, Cox proportional-hazards regression with the Harrell concordance index (C-index), and net reclassification improvement. Results: In total, 110 patients (90 men and 20 women; median age, 66 y; range, 40-87 y) were included. PET/CT significantly changed the assigned tumor stage when compared with imaging strategies based on CXR/MRI or CCT/MRI (P < 0.001 for both). Kaplan-Meier analysis of PET/CT-based staging showed progressively worsened prognosis with localized, locally advanced, or metastatic disease (log-rank test, P < 0.001), whereas CXR/MRI and CCT/MRI were unable to distinguish between these groups in terms of survival (log-rank test, P = 0.18 and P = 0.58, respectively). Overall discriminative ability in predicting cancer-specific mortality was significantly greater for PET/CT (C-index, 0.72) than for CXR/MRI (C-index, 0.55) (P = 0.001) and CCT/MRI (C-index, 0.55)(P < 0.001). The addition of PET/CT to either CXR/MRI or CCT/MRI was associated with a significantly positive net reclassification improvement (P < 0.001 for both). Conclusion: Contrary to standard imaging strategies, PET/CT-based staging in recurrent HNSCC was able to significantly discriminate among the survival courses of patients with local, locally advanced, or metastatic disease and predict their respective survival probability.

Associations between eating difficulties, nutritional status and activity of daily living in acute geriatric patients.

BACKGROUND & AIMS: Eating difficulties, having a poor nutritional status, and low activity of daily living are all prevalent issues in the geriatric population. The aim of this study was to explore associations between patients' eating difficulties, their nutritional status and their activity of daily living in patients aged 60 years or older who were admitted to an acute geriatric unit. METHODS: A cross-sectional study was conducted between March and September 2016 at the geriatric department of North Denmark Regional Hospital, Hjørring. The inclusion criteria were: ≥ 60years old and hospitalized for a minimum of 24 h. The patients' eating difficulties were assessed using the Minimal Eating Observational Form (MEOF-II), including observations related to ingestion, deglutition and energy/appetite. Eating difficulties were determined on the basis of one or more components of the MEOF-II. Poor nutritional status was defined as an age-specific low body mass index (BMI), <20 kg/m2 if < 70 years, or <22 kg/m2 if ≥ 70 years. Activity of daily living was assessed using the Barthel-100 Index and defined as low (<50) or high (≥50). RESULTS: A total of 297 geriatric patients were included; the mean age was 83.0 (7.7) years and 56.2% of the patients were female. The prevalence of eating difficulties was 55%. Geriatric patients with eating difficulties had a risk increase of 155% of having poor nutritional status (p = 0.003). Geriatric patients with eating difficulties had a risk increase of 60% of having low activity of daily living (p < 0.001). CONCLUSIONS: Eating difficulties were highly prevalent in geriatric patients and were associated with poor nutritional status and reduced activity of daily living. The identification of eating difficulties may be important for nutritional interventions and maintenance or improvement of activities of daily living in the geriatric population.

A PET/CT-Based Strategy Is a Stronger Predictor of Survival Than a Standard Imaging Strategy in Patients with Head and Neck Squamous Cell Carcinoma.

Our purpose was to examine whether staging of head and neck squamous cell carcinoma (HNSCC) by upfront 18F-FDG PET/CT (i.e., on the day of biopsy and before the biopsy) discriminates survival better than the traditional imaging strategies based on chest x-ray plus head and neck MRI (CXR/MRI) or chest CT plus head and neck MRI (CCT/MRI). Methods: We performed a masked prospective cohort study based on paired data. Consecutive patients with histologically verified primary HNSCC were recruited from Odense University Hospital from September 2013 to March 2016. All patients underwent CXR/MRI, CCT/MRI, and PET/CT on the same day. Tumors were categorized as localized (stages I and II), locally advanced (stages III and IVB), or metastatic (stage IVC). Discriminative ability for each imaging modality with respect to HNSCC staging were compared using Kaplan-Meier analysis, Cox proportional hazards regression with the Harrell C-index, and net reclassification improvement. Results: In total, 307 patients with histologically verified HNSCC were included. Use of PET/CT significantly altered the stratification of tumor stage when compared with either CXR/MRI or CCT/MRI (χ2, P < 0.001 for both). Cancer stages based on PET/CT, but not CXR/MRI or CCT/MRI, were associated with significant differences in mortality risk on Kaplan-Meier analyses (P ≤ 0.002 for all PET/CT-based comparisons). Furthermore, overall discriminative ability was significantly greater for PET/CT (C-index, 0.712) than for CXR/MRI (C-index, 0.675; P = 0.04) or CCT/MRI (C-index, 0.657; P = 0.02). Finally, PET/CT was significantly associated with a positive net reclassification improvement when compared with CXR/MRI (0.184, P = 0.03) but not CCT/MRI (0.094%, P = 0.31). Conclusion: Tumor stages determined by PET/CT were associated with more distinct prognostic properties in terms of survival than those determined by standard imaging strategies.

Head-to-Head Comparison of Chest X-Ray/Head and Neck MRI, Chest CT/Head and Neck MRI, and 18F-FDG PET/CT for Detection of Distant Metastases and Synchronous Cancer in Oral, Pharyngeal, and Laryngeal Cancer.

The purpose of this study was to determine the detection rate of distant metastasis and synchronous cancer, comparing clinically used imaging strategies based on chest x-ray + head and neck MRI (CXR/MRI) and chest CT + head and neck MRI (CHCT/MRI) with 18F-FDG PET/CT upfront in the diagnostic workup of patients with oral, pharyngeal, or laryngeal cancer. Methods: This was a prospective cohort study based on paired data. Consecutive patients with histologically verified primary head and squamous cell carcinoma at Odense University Hospital from September 2013 to March 2016 were considered for the study. Included patients underwent CXR/MRI and CHCT/MRI as well as PET/CT on the same day and before biopsy. Scans were read masked by separate teams of experienced nuclear physicians or radiologists. The true detection rate of distant metastasis and synchronous cancer was assessed for CXR/MRI, CHCT/MRI, and PET/CT. Results: A total of 307 patients were included. CXR/MRI correctly detected 3 (1%) patients with distant metastasis, CHCT/MRI detected 11 (4%) patients, and PET/CT detected 18 (6%) patients. The absolute differences of 5% and 2%, respectively, were statistically significant in favor of PET/CT. Also, PET/CT correctly detected 25 (8%) synchronous cancers, which was significantly more than CXR/MRI (3 patients, 1%) and CHCT/MRI (6 patients, 2%). The true detection rate of distant metastasis or synchronous cancer with PET/CT was 13% (40 patients), which was significantly higher than 2% (6 patients) for CXR/MRI and 6% (17 patients) for CHCT/MRI. Conclusion: A clinical imaging strategy based on PET/CT demonstrated a significantly higher detection rate of distant metastasis or synchronous cancer than strategies in current clinical imaging guidelines, of which European ones primarily recommend CXR/MRI, whereas U.S. guidelines preferably point to CHCT/MRI in patients with head and neck squamous cell carcinoma.

The effect of position on the precision of dual-energy X-ray absorptiometry and correlation with body condition score in dogs and cats.

Dual-energy X-ray absorptiometry (DEXA) has been used to assess body composition in dogs and cats in several studies, but studies are difficult to compare for several reasons. The aim of the present study was to evaluate whether positioning of dogs or cats in either dorsal or ventral recumbency during DEXA scanning influences results. Dogs and cats that were brought to the University Hospital for Companion Animals for euthanasia during the period 15 September-6 November 2015 were consecutively recruited if owners signed a written consent. Following euthanasia and before rigor mortis, the animals were body condition scored (BCS, nine-point scale) and DEXA scanned. DEXA measurements of total body mass (TBM), bone mineral content (BMC), bone mineral density (BMD), lean soft tissue mass (LSTM) and body fat (BF) were performed five times in ventral and two times in dorsal recumbency on each animal. Differences between positioning were analysed using Student's t test or Wilcoxon's test depending on normality of the data. A total of thirteen dogs and seven cats of different breeds, size, sexes and age were included. The CV for DEXA parameters in ventral or dorsal recumbency were, for dogs, TBM ≤ 0·1 %, BMC ≤ 1·63 %, BMD ≤ 1·29 %, LSTM ≤ 0·89 % and BF ≤ 1·52 %; and, for cats, TBM ≤ 0·08 %, BMC ≤ 0·61 %, BMD ≤ 0·49 %, LSTM ≤ 0·45 % and BF ≤ 0·88 %. In both positions, a good correlation was found for dogs (r 0·84-0·85; P < 0·0003) and cats (r 0·89-0·90; P < 0·0081) between the nine-point BCS system and BF percentage measured by DEXA. Ventral and dorsal recumbency provides comparable results, except that BMD measures were higher in dorsal recumbency (P < 0·0004).

Admission criteria to the Danish Brain Cancer Program are moderately associated with magnetic resonance imaging findings.

INTRODUCTION: The objective of this study was to evaluate the Danish Brain Cancer Program by examining the criteria for admission to the program and the results of magnetic resonance imaging (MRI) of the brain in 359 patients referred to the program at the Odense University Hospital during one year. The admission criteria given by the Danish Health and Medicines Authority are as follows: 1. Prior computed tomography or MRI indicating tumour. 2. Progressive focal neurological deficits. 3. Epileptic seizure in adults. 4. Change in behaviour or cognition showing progression. 5. Headache with progression over 3-4 weeks. MATERIAL AND METHODS: This was a retrospective analysis of the cerebral MRI of 359 patients. The patients were categorized by admission criteria and MRI outcome. The findings were grouped into four main outcomes: 1. Primary malignant intracerebral tumour. 2. Intracranial tumour -(including meningeoma and metastasis). 3. Acute pathology in total (including tumours and other acute pathologies). 4. Findings of no consequence. RESULTS: We found 46 acute/subacute pathologies including 21 tumours of which eight were primary intracerebral malignant tumours and 313 scans did not have findings of any consequence. In the group with monosymptomatic headache, we found significantly fewer tumours (p = 0.0066, Fisher's exact test) and acute pathologies (p = 0.0008) than in the remaining groups. In the group with change in behaviour or cognition, we found significantly more primary intracerebral malignant tumours (p = 0.0002), tumours in all (p = 0.0001) and acute pathologies (p = 0.0002) than in the other groups. CONCLUSION: Fewer tumours than expected were found. Significantly fewer pathologies were found in the group with monosymptomatic headache than in the remaining groups. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

[It is uncertain if caesarean section is a risk factor to the development of asthma]. / Det er uafklaret, om sectio har betydning for udvikling af astma hos barnet.

In Denmark the prevalence of both asthma and caesarean section has increased during the last 20 years. This review investigates the coherence between caesarean section and the development of asthma. Twelve epidemiological articles about children over three years were included. Eight of 12 studies discovered no association between caesarean section and asthma. There is no difference in the quality of the studies. We can conclude that it is uncertain if caesarean section is a risk factor to the development of asthma, but it cannot be eliminated that asthma is one of many consequences of caesarean section.

Wegener's granulomatosis presenting with pachymeningitis: clinical and imaging remission by rituximab.

A 27-year-old woman was admitted for intractable right-sided neck, ear, and jaw pain with gradual development of tinnitus and hearing loss. A cerebral MRI showed meningo-dural enhancement, and additional diagnostic workup revealed a right pulmonary infiltrate and positive PR-3 ANCA. Biopsies from nasal mucosa and lung showed chronic inflammation with granuloma formation. Based on these findings the patient was diagnosed with Wegener's granulomatosis with pachymeningitis. There was no clinical response to oral Prednisolone and Cyclophosphamide, but complete clinical and imaging remission was achieved by adding Rituximab.

PET/CT may change diagnosis and treatment in cancer patients.

INTRODUCTION: The national focus on cancer has propelled the use of PET/CT for cancer imaging in Denmark. We believe that first-year experiences from a large PET centre may be of interest to new users. MATERIAL AND METHODS: Data from all scans made in the period from February 28 2006 to March 1 2007 with a single PET/CT scanner and 18F-fluoro-deoxyglucose (FDG) were collected prospectively along with information on action diagnosis, study purpose, etc. Referring departments indicated if PET/CT had changed or confirmed diagnosis, staging and treatment plan. RESULTS: A total of 970 scans were made in 826 patients, 14% had 2-5 scans performed. Diagnostic CT was performed in 53%. In all, 792 referrals came from Odense University Hospital. Nearly 85% were from the specialities of oncology (31%), haematology (24%), surgery (14%), internal medicine (9%) and gynaecology (6%). PET/CT for primary diagnosis was mainly used in lung cancer and in cases with unknown primary tumour. In malignant lymphomas and colorectal cancer, the technique was mainly employed for response evaluation. Use of PET/CT for staging and recurrence was more evenly distributed across specialities. PET/CT changed the primary diagnosis in 16% and induced a change in staging and treatment plan in 28% to 32% of cases, respectively. CONCLUSION: FDG PET/CT was mainly used for diagnosis in lung cancer and in cases with an unknown primary tumour, and for response evaluation in lymphomas and colorectal cancer. PET/CT caused a change of staging and treatment plan in 25-33% of cases.

Fatal left cardiac failure caused by external compression of left internal mammary artery graft in an accident: a case report.

We report for the first time a case of a 54 years old man with a fatal motorcycle accident due to an external bleeding compression of left internal mammary artery graft to the left anterior descending artery. The possibility of cardiac failure in trauma caused by external compression or traumatic injury of the graft should be considered in people who previously underwent coronary artery bypass graft surgery.

[The scientific basis of current official dietary recommendations in relation to pregnancy]. / Det videnskabelige grundlag for officielle anbefalinger om kost i forbindelse med graviditet.

The Danish Nutrition Council has examined the latest scientific literature on nutrition during pregnancy to evaluate the basis for the existing official recommendations. The recommendation to overweight women to gain only eight kilo should be accompanied with a recommendation to lose weight pre-conceptionally. Individualised recommendations should be provided in the prevention of iron deficiency, and the recommendation for calcium should include information on quantity. The recommendation of periconceptional folic acid supplementation does not benefit unplanned pregnancies. Arguments exist for adding a recommendation for vitamin D.

Food intake is inhibited by oral oleoylethanolamide.

Oleoylethanolamide (OEA) may be an endogenous regulator of food intake, and intraperitoneal injection of this compound decreases food intake in 24 h-starved rats. It is generally believed that this kind of lipid amide is rapidly catabolized in the gastrointestinal tract, thereby preventing its use as an oral antiobesity compound. We now show that oral OEA inhibits food intake dose dependently at 90 min after food presentation to starved rats. Food intake was reduced by 15.5% (P < 0.01) by administration of 10 mg/kg OEA. [(3)H]OEA was used to assess the degree of catabolism in the gastrointestinal tract. The endogenous level of this acylethanolamide was increased 11 times in the intestinal tissue (to 3.91 +/- 0.98 nmol/g tissue, mean +/- SEM) at 90 min after food presentation, based on the finding of 0.48% of the dose as intact OEA. These findings reveal unexpected properties of orally administered OEA, which may have potential as a cheap and safe antiobesity drug.