Levanger Hospital

The management of complex bite wounds, particularly in patients with comorbidities, presents a significant clinical challenge due to the high risk of infection and prolonged healing times. This case report highlights the successful use of intact fish skin grafts as a novel treatment modality for a primary contaminated bite wound at the patient with comorbidities such as diabetes mellitus and rheumatoid artritis with cortisone use. A 54-year-old European female patient with a medical history of rheumatoid arthritis and type 2 diabetes mellitus presented with a large, full-thickness dog bite wound on her right lower leg. Surgical debridement and broad-spectrum antibiotic administration, an intact Kerecis fish skin graft was applied and secured. The application of an intact fish skin xenograft, combined with surgical debridement and appropriate antibiotic therapy, proved to be a highly effective treatment for a complex bite wound in an immunocompromised patient.

BACKGROUND:Venous thromboembolism (VTE) is a leading cardiovascular disease, yet its etiology is incompletely understood. This study used large-scale, high-throughput aptamer-based proteomics to identify new circulating protein biomarkers and biological pathways for incident VTE.METHODS:We included 4 longitudinal cohorts (the ARIC study [Atherosclerosis Risk in Communities], CHS [Cardiovascular Health Study], MESA [Multi-Ethnic Study of Atherosclerosis], and the HUNT study [Trøndelag Health]) that identified 1371 incident noncancer VTEs among 20 737 participants followed for a maximum of 10 to 29 years. We used the SomaScan to measure baseline plasma levels of ≈5000 to 7000 proteins and examined the prospective relationships between the protein biomarkers and noncancer VTE. We then conducted an external replication of top VTE proteins in 783 incident noncancer VTEs among 39 097 participants in the UKB study (UK Biobank) based on the Olink proteomics platform. We used Cox proportional hazards regression to estimate the association between each protein biomarker and VTE risk. Mendelian randomization (MR) analysis was used to assess the possible causal associations between identified proteins and VTE risk.RESULTS:There were 23 proteins that exceeded a false discovery rate–adjusted P<0.05 (unadjusted P<6.5×10-4) in the discovery meta-analysis of ARIC, CHS, and MESA and were replicated in HUNT at (unadjusted) P<0.05. Of these, 15 are new to VTE, and 3 of the 15 (transgelin, sushi, von Willebrand factor type A, EGF and pentraxin domain-containing protein 1, and TIMP4 [metalloproteinase inhibitor 4]) exceeded the Bonferroni corrected significance threshold in HUNT. Sixteen of the 23 top VTE proteins were available on the UKB Olink panel, of which 11 were replicated in the UKB study after Bonferroni correction. MR analysis of the 15 new proteins provided significant evidence for a possible causal role of TIMD4 (T-cell immunoglobulin and mucin domain-containing protein 4) (Bonferroni-corrected P<0.05) and suggestive evidence for TIMP4 and CST3 (cystatin-c) (unadjusted P<0.05) in VTE risk. The direction of association from the MR analyses was opposite of that from the VTE proteomics analysis for TIMP4 and TIMD4 but was consistent for CST3.CONCLUSIONS:We identified several novel plasma proteins for VTE that reflect biological processes outside established VTE pathophysiology, including extracellular matrix regulation, immunity, immune–vascular endothelium interactions, and vascular senescence. Results may provide new modifiable targets to improve VTE risk stratification, prevention, or treatment.

Thyroid diseases are common and highly heritable. We performed a meta-analysis of genome-wide association studies from 19 biobanks for five thyroid diseases: thyroid cancer (ThC), benign nodular goiter, Graves’ disease, lymphocytic thyroiditis and primary hypothyroidism. We analyzed genetic association data from ~2.9 million genomes and identified 313 known and 570 new independent loci linked to thyroid diseases. We discovered genetic correlations between ThC, benign nodular goiter and autoimmune thyroid diseases (rg = 0.16–0.97). Telomere maintenance genes contributed to benign and malignant thyroid nodular disease risk, whereas cell cycle, DNA repair and damage response genes were associated with ThC. We propose a paradigm that explains genetic predisposition to benign and malignant thyroid nodules. We found polygenic risk score associations with ThC risk of structural disease recurrence, tumor size, multifocality, lymph node metastases and extranodal extension. Polygenic risk scores identified individuals with aggressive ThC in a biobank, creating an opportunity for genetically informed population screening.

ABSTRACTBackgroundPhosphatidylethanol 16:0/18:1 (PEth) is a widely used alcohol marker, but how sex, body size and composition and kidney function affect the dose–response relationship between alcohol consumption and PEth is not fully understood.ObjectiveThe aim of the study was to investigate whether sex, age, body size and composition and kidney function influence the estimate of alcohol consumed at a given PEth concentration.MethodsThis is a longitudinal population‐based cohort study including 24 902 participants from the Trøndelag Health Study (HUNT4). Associations were assessed using a regression model.FindingsWhen analysed together, sex and soft lean mass were statistically significant independent predictors of alcohol consumption at a given PEth concentration. To achieve the same PEth concentration as a female, a male with identical body composition could on average consume 21% more alcohol, according to our model. Independent of sex, a person with 10% higher soft lean mass could consume 3.9% more alcohol to achieve the same PEth concentration. When soft lean mass was excluded, height and body weight became significant predictors.ConclusionsSex, body composition and body size may have an impact on the dose–response relationship between alcohol consumption and PEth concentration. Thus, these factors will contribute to the uncertainty when estimating ethanol intake from a given PEth concentration.

ABSTRACTBackgroundPercutaneous mitral commissurotomy (PMC) of mitral stenosis is routinely performed by the Inoue balloon technique (IBT) which may be challenging with respect to valvular crossing. Using a novel wire‐assisted method (WAM) may improve feasibility and time efficiency.AimsIn a randomized clinical trial, we compared the feasibility and time consumption by WAM and IBT.MethodsTwenty mitral stenosis patients with a Wilkins score ≤10 were randomized 1:1 to IBT (n = 11) or WAM (n = 9). All procedures were performed under general anesthesia and optimized by in‐field and transesophageal echocardiographic guiding. The IBT balloon catheter was inserted over the coiled wire, and the stylet was used to advance it to the mitral valve, while WAM was performed by advancing a commercially available balloon over a stiff coiled wire placed in the left ventricle. 1st endpoint was time from interatrial septal puncture to balloon inflation, and 2nd outcomes were failure to double mitral valve area or severe mitral regurgitation.ResultsMean ± SD age was 28 ± 7 years (80% women) with all in NYHA class II or III. Symptom duration was median (IQR) 7 (4.8) years, Wilkins score was 8.8 ± 0.9, and mitral inflow gradient was 15.6 ± 4.6 mmHg. Procedural time (1st endpoint) was 14.4 ± 3.4 min and 21.8 ± 8.3 min in WAM and IBT, respectively (p = 0.020). Three patients in each group did not double the valve area by PMC, and no procedure was complicated by severe mitral regurgitation.ConclusionsWAM significantly reduced the time from interatrial septal crossing to first balloon inflation during equally optimized PMC in severe mitral stenosis patients compared to IBT.

BackgroundStudies show that oral health problems are common among older adults. However, population estimates of oral health problems are largely restricted to individual subgroups. Thus, we aimed to estimate the prevalence of oral health problems in an older adult population comprised of both community dwellers and nursing home residents, and to assess differences between sexes, age groups, and these living situations.MethodsThis cross-sectional study used data from HUNT4 Trondheim 70 + , a part of the fourth Trøndelag Health Study (HUNT4), Norway. Oral health was assessed using the Revised Oral Assessment Guide – Jönköping (ROAG-J). Dental status and use of dentures were evaluated as part of the oral health assessment. A total of 1562 participants aged ≥ 70 years had complete data on ROAG-J and were included for analysis. Prevalence estimates were standardised using inverse probability weighting.ResultsThe standardised prevalence of oral health problems and severe oral health problems were 56.1% (95% CI 53.5–58.7) and 9.4% (95% CI 8.0–10.9). The three most common problems were related to teeth (31.9%), dentures (22.0%), and tongue (16.3%). A total of 9.2% were edentulous and 29.6% used full or partial dentures. Differences in prevalences between sexes were found for oral health problems, edentulism, and the use of dentures. The prevalence of having oral health problems, few or no teeth, and using dentures increased with age, and was higher among nursing home residents than community dwellers.ConclusionMore than half of the population ≥ 70 years of age had oral health problems that indicated the need for preventive measures or further clinical assessment. This was especially apparent among the oldest and nursing home residents.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12903-025-06683-y.

SummarySepsis is a leading cause of death and disability worldwide, so identifying preventable risk factors is important. Iron is essential for immune function and microbial growth, and iron status varies substantially between individuals, across demographics, and is therapeutically modifiable. Here, we review the current understanding of iron status and associated risks of bloodstream infection, sepsis and severe COVID-19 highlighting relevant population-based studies and Mendelian randomisation studies. Both low and high iron status are associated with increased risk of sepsis. Low iron status is associated with sepsis, bloodstream infections and pneumonia. High iron status and mutations affecting hepcidin regulation are linked to increased risk of bloodstream infections, sepsis and COVID-19. Both iron status pathologies and sepsis are global health issues, and the epidemiological studies described indicate they may be linked. More population-scale investigations on iron status, infection and immunity, especially in areas of high iron deficiency and infectious burden are warranted.

Venous thromboembolism (VTE) has long been recognized as a harbinger of cancer. The epidemiology of VTE and cancer has evolved over the past decades, and contemporary data addressing the association between VTE and subsequent risk of cancer are needed.We aimed to investigate the short- (≤1 year) and long-term (>1 year) risk of cancer after incident VTE in a population-based cohort study.A total of 111,119 participants from Tromsø4-7 (1994-2016) and HUNT2-3 (1995-2008) surveys were followed through 2020, and all first-lifetime cancer and VTE events were recorded. Cox regression was used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for cancer diagnosis in participants with VTE compared with those without VTE, with VTE being modeled as a time-varying exposure.Among the 2,506 individuals with incident VTE, 417 had a subsequent diagnosis of incident cancer during a median follow-up after VTE of 5.2 years. In models adjusted for age (as a time-scale), sex, body mass index, smoking, and comorbidities, the HRs for cancer were 4.57 (95% CI 3.89-5.37) at 0 to 1 year, 1.19 (95% CI 0.93-1.52) at 1 to 3 years, and 1.14 (95% CI 0.99-1.31) at >3 years after overall VTE when compared with individuals without VTE, and the risk estimates were particularly pronounced at 0 to 1 year after unprovoked VTE (HR 5.63, 95% CI 4.67-6.77).Our results indicate a transient and substantially increased risk of cancer diagnosis within 1 year after an incident VTE, and especially after unprovoked VTE.