Lovisenberg Diakonale Sykehus

Diagnostic delay is common in pediatric inflammatory bowel disease (PIBD), and fecal calprotectin (FCP) is often limited by challenges with sample collection. Therefore, we aimed to identify and validate a blood-based diagnostic protein signature of PIBD. Proteins were analyzed using proximity extension assay in plasma samples from treatment-naïve pediatric patients in a Swedish inception cohort referred for suspected inflammatory bowel disease (IBD) and validated in an independent Norwegian population-based pediatric inception cohort. Diagnostic performance was estimated by the area under the curve (AUC) with 95% confidence intervals (CIs). The discovery cohort included 58 patients with PIBD and 36 symptomatic controls without evidence of IBD, while the validation cohort consisted of 79 patients with PIBD and 37 symptomatic controls. In total, 154 proteins were examined. Univariable analyses identified 26 differentially regulated proteins for PIBD versus symptomatic controls in the discovery cohort (q < 0.05), whereas 29 proteins were differentially regulated in the validation cohort. Using regularized logistic regression, we identified a diagnostic model of 31 proteins that differentiated PIBD from symptomatic controls in the discovery cohort (AUC = 0.83; 95% CI: 0.74-0.90). The protein signature was further reduced to a clinically relevant biomarker consisting of high-sensitivity C-reactive protein (hsCRP) and seven other proteins with diagnostic capacity (AUC = 0.85, 95% CI: 0.78-0.92) outperforming hsCRP in the validation cohort (p = 0.006). We identified and validated a blood-based protein signature for PIBD with superior diagnostic performance compared to hsCRP. Given the challenges of fecal sample collection, further assay development may enable integration of these biomarkers into diagnostic pathways for PIBD. ClinicalTrials.gov identifier: NCT02727959.

Fatigue is common in Crohn's disease (CD) and ulcerative colitis (UC), but the pathogenesis remains poorly understood. This study aimed to assess changes in fatigue prevalence during the first year after diagnosis and examine the association between disease course and substantial fatigue (SF) at the 1-year follow-up. Adults with newly diagnosed CD or UC were recruited from the population-based IBSEN III cohort. Fatigue was assessed at diagnosis and the 1-year follow-up using the Fatigue Questionnaire. Associations between SF at the 1-year follow-up and disease-related factors were quantified using multivariate logistic regression adjusted for sex, age and comorbidities. In total, 596 patients were included (CD: 196, UC: 400). SF was present at both baseline and after one year of disease for 46.9% (n = 92/196) and 40.5% (n = 162/400) of patients with CD and UC, respectively. In CD, development of endoscopically non-passable stricture and/or surgically treated stricture within first year of disease (OR = 4.52, 95%CI [1.61;12.68]), self-reported flares since diagnosis (OR = 2.55, 95%CI [1.26;5.16]), female sex (OR = 3.12, 95%CI [1.53;6.37]) and comorbidities (OR = 4.05, 95%CI [1.89;8.69]) were independently associated with SF at the 1-year follow-up. In UC, SF was associated with current biological treatment (OR = 5.14, 95%CI [1.56;16.96]), increasing Mayo endoscopic score at the 1-year follow-up (OR = 1.54, 95%CI [1.01;2.35]), self-reported flares since diagnosis (OR = 2.66, 95%CI [1.24;5.72]) and female sex (OR = 2.20, 95%CI [1.06;4.57]). Fatigue frequently persists through the first year after IBD diagnosis. Clinical factors reflecting a more severe disease course were associated with SF one year after diagnosis in both CD and UC.

Genetic selection occurs at multiple stages before and during pregnancy. While parental genomes influence the probability of fertilization, the fetal genome, once established, plays a critical role in early fetal survival. However, when estimated separately, parental and fetal genetic effects may confound each other. To address this, we developed an extension of the case-parent triad design to jointly estimate the genetic contributions of the parents and the fetus. Our approach considers all offspring as carriers of the trait "fetal survival". As use of assisted reproductive technology (ART) usually reflects fertility issues, we performed separate analyses on non-ART and ART family units, hypothesizing that parental and fetal effects differ between these groups. In the Norwegian Mother, Father, and Child Cohort Study, we had access to genotypes for approximately 43,000 family triads and dyads, including 1,336 offspring conceived through ART. In the non-ART sample, we identified genome-wide significant fetal effects on fetal survival for SNPs within regions harboring genes relevant to infertility and fetal development, such as MDC1, MICB, HCP5, and NOTCH4. These effects remained significant after adjusting for parental interaction effects, confirming their origin as fetal effects. When we replicated the analysis in the ART sample, we observed partial overlap in fetal effects with those identified in the non-ART sample. Parental interaction effects were observed in both the non-ART and ART samples, but the specific genetic associations differed between the groups. Notably, several SNPs associated with parental interaction effects in the ART sample mapped to genes previously implicated in male infertility, including ACTB, FSCN1, and RNF216. Our findings have broad implications for understanding the genetic architecture of infertility and fetal development. To support the interpretation of our results, we provide detailed descriptions of the models, highlighting their strengths and limitations.

Bakgrunn: Levertransplanterte pasienter utgjør en unik pasientgruppe som gjennomgår et regulert behandlingsforløp i helsevesenet. Oppsummert forskning har hovedsakelig undersøkt pasientgruppens livskvalitet i etterkant av levertransplantasjonen, men i mindre grad utforsket deres erfaringer knyttet til hvordan de opplever selve levertransplantasjonen og deres behov for oppfølging og støtte under tilfriskningsprosessen. Hensikt: Å sammenstille kunnskap fra kvalitative primærstudier som har utforsket levertransplanterte pasienters erfaringer knyttet til å bli transplantert, hvordan de opplever tilfriskningsfasen etter gjennomført levertransplantasjon og hvilket behov de har for oppfølging og støtte i denne fasen. Metode: Det er gjennomført en kunnskapsoppsummering av kvalitative studier basert på anbefalinger fra Booth, Sutton, Clowes og Martyn-St James. Litteratursøk ble utført i databasene CINAHL, MEDLINE og Embase, sist oppdatert i september 2024. Analyseprosessen er gjennomført med refleksiv tematisk analyse. Enhancing Transparency in Reporting the Synthesis in Qualitative Research (ENTREQ) er benyttet for rapportering av studien. Resultat: Ni studier innfridde inklusjonskriteriene. Analysen genererte tre hovedtema: «Betydningen av et godt støtteapparat for levertransplanterte pasienter», «Levertransplanterte erfarer en fysisk, emosjonell og eksistensiell berg-og-dal-bane» og «Å få livet i gave på ny – men stadig leve med frykt for avstøtning». Konklusjon: Levertransplantasjon er en livsendrende behandling som medfører fysiske og emosjonelle utfordringer for pasientene. Helsepersonells faglige spesialkompetanse spiller en avgjørende rolle for å skape tillit og trygghet for pasientene gjennom tilfriskningsprosessen. Levertransplanterte pasienter må følge anbefalte helseråd for å ta vare på den nye leveren, og helseinformasjonsprogrammer som strekker seg over tid kan styrke denne pasientgruppens helsekompetanse. Støtte fra nære relasjoner, sosialt nettverk og likepersoner er av avgjørende betydning for levertransplanterte pasienters tilfriskning. Samtidig er frykten for avstøtning en vedvarende bekymring pasientene opplever å leve med. Pasienterfaringer bør utforskes videre i empiriske studier for å få et utvidet kunnskapsgrunnlag for hvilke oppfølgingsformer som kan styrke levertransplanterte pasienters egenomsorg i tilfriskningsprosessen. ENGLISH ABSTRACT Receiving Life as a Gift Anew – Experiences of Liver Transplant Patients During the Recovery Phase After Liver Transplantation and Their Needs for Follow-Up Care and Support: A Systematic Literature Review from Qualitative Studies Background: Liver transplant patients represent a unique patient group undergoing a structured pathway within the healthcare system. Literature reviews have primarily investigated the quality of life of this patient group following liver transplantation but has explored their experiences related to the transplantation itself, to a lesser extent alongside their needs for follow-up care and support during the recovery process. Purpose: To synthesize knowledge from qualitative primary studies that have explored the experiences of liver transplant patients regarding the transplantation process, their perceptions of the recovery phase following liver transplantation, and their need for follow-up care and support. Method: A systematic literature review was conducted based on recommendations from Booth, Sutton, Clowes &amp; Martyn-St James. Literature searches were carried out using CINAHL, MEDLINE and Embase databases, updated in September 2024. The analysis process was carried out using reflexive thematic analysis. Enhancing Transparency in Reporting the Synthesis in Qualitative Research (ENTREQ) was used for reporting the study. Results: Nine studies met the inclusion criteria. The analysis generated three main themes: ‘The Importance of a Strong Support System for Liver Transplant Patients’; ‘Liver Transplant Patients Experience a Physical, Emotional, and Existential Roller Coaster’; and ‘Receiving Life as a Gift Anew – Yet Continually Living with the Fear of Rejection’. Conclusion: Liver transplantation is a life-changing care process that entails physical and emotional challenges for patients. The professional expertise of healthcare personnel plays a crucial role in creating trust and security for patients throughout the recovery process. Liver transplant patients need to follow recommended health advice to take care of their new liver, and health information programs that extend over the longer timeframe can enhance patients health literacy. Support from close relationships, social networks, and peers is of critical importance for the recovery of liver transplant patients. Simultaneously, patients experience a persistent worry over the fear of rejection. Patient experiences should be further explored in empirical studies to expand the knowledge base on what form of follow-up can strengthen liver transplant patients’ self-care during the recovery process.

(Watch the RECORDING.) Researchers motivated to foster a culture valuing reproducibility and transparency in their working environments have, more than ever, a wealth of resources and examples to draw on. Nonetheless, each research context is unique, requiring tailored resources and approaches. Here, we reflect on this process as carried out by the PsychGen Working Group for Open and Reproducible Science, a team of researchers committed to advancing open and reproducible science at the PsychGen Centre for Genetic Epidemiology and Mental Health, based at the Norwegian Institute of Public Health, since its inception in 2023. The predominant focus of researchers in the PsychGen Centre on secondary data analysis has guided the activities of our working group, leading us to prioritise preregistration (and, in particular, adapting preregistration templates for secondary data analytic contexts), open sharing of analytic code, and open access publication. We provide a narrative overview of the process of adapting resources, building competence, and promoting a cultural shift towards adoption of these practices across an interdisciplinary research group and its wider collaborative network. Notable successes in this process include the widespread adoption, within the group, of a tailored preregistration format for confirmatory secondary data analyses, publication of a first-in-field Registered Report, and improved code sharing practices. However, challenges remain, particularly in areas of open data - given the current data sharing restrictions - and navigation of an ever-changing open access publishing landscape. We conclude by offering insights into our current working practices and plans for the future, hoping to stimulate discussion on the ways in which transparency and reproducibility can be practically promoted ‘on the ground’.

Atrial fibrillation (AF) and obstructive sleep apnea (OSA) frequently coexist, contributing to cardiovascular risk, possibly through shared inflammatory pathways. The specific role of inflammatory markers in patients with AF and OSA is not well established. This study aimed to determine whether markers of inflammation and immune activation are elevated in patients with paroxysmal AF and OSA, assess the effects of continuous positive airway pressure (CPAP) and pulmonary vein isolation (PVI) on these markers, and evaluate their association with clinical outcomes, such as AF recurrence and thromboembolic risk. We studied 143 patients with paroxysmal AF and moderate to severe OSA (apnea-hypopnea index ≥15). Of these, 99 were randomised to receive CPAP plus standard care (n = 51) or standard care alone (n = 48). A comparison group of 19 patients with paroxysmal AF and mild/no OSA (AHI <15) and 22 healthy controls were also included. Inflammatory markers related to leukocyte activation, vascular inflammation, and extracellular matrix remodelling were assessed at baseline, 6 months and 12 months follow-up. Patients with OSA and paroxysmal AF had higher levels of NGAL, PTX-3, GDF-15, MMP-9, VCAM1 and ANGP2 than healthy controls. These markers correlated poorly with AF and OSA severity. There was no modifying effect of CPAP on any marker. PTX3 was associated with AF recurrence and a high-risk score for thromboembolic stroke. Moderate to severe OSA and AF are associated with elevated inflammatory markers. However, CPAP therapy did not significantly affect these levels. PTX-3 may hold prognostic value for AF recurrence and thromboembolic risk.

Background/aims Gastroparesis is a late complication of diabetes mellitus characterized by delayed gastric emptying and upper gastrointestinal symptoms. The disorder substantially impacts the quality of life, glycemic stability, nutrition and absorption of orally administered drugs. Since symptom severity is a poor predictor of gastric emptying status, the clinician has little to aid them in whom to refer for gastric emptying testing. In this study, we aim to identify clinical characteristics associated with delayed gastric emptying in diabetes patients with gastroparesis-like symptoms. Materials and methods Diabetes patients consecutively referred to Haukeland University Hospital for assessment of gastroparesis-like symptoms underwent gastric emptying scintigraphy, blood samples and questionnaires for assessing gastrointestinal symptoms (Gastrointestinal Symptom Rating Scale), neuroticism (Eysenck Personality Questionnaire-Short Form), and symptoms of anxiety and depression (Hospital Anxiety & Depression Scale). Results: Seventy-one patients were included in the study, of which 28 displayed delayed gastric emptying. Delayed gastric emptying was characterized by having type 1 diabetes, younger age, lower BMI, presence of other late complications including distal symmetric polyneuropathy and retinopathy, higher Hb1Ac levels and lower albumin and hemoglobin levels. Symptoms were not related to gastric emptying status. Conclusion We identified several clinical variables associated with delayed gastric emptying in diabetes patients with gastroparesis-like symptoms. These variables are commonly assessed during a medical consultation and may be used to aid the clinician in choosing who to refer for gastric emptying testing.

Bakgrunn: Kommunikasjon mellom pasient og intensivsykepleier er avgjørende for økt pasientkomfort og intensivsykepleierens arbeidsutøvelse. Above cuff vocalisation (ACV) er en kommunikasjonsmetode for våkne, trakeostomerte respiratoravhengige intensivpasienter. Metoden er ny i Norge, og ble godkjent og innført på Oslo universitetssykehus i september 2019. Tidligere internasjonale studier viser at ACV er en trygg og effektiv kommunikasjonsmetode som kan øke livskvaliteten til intensivpasientene. Innføring av metoden ble derfor vurdert til å være trygg, men det ble anbefalt å følge opp med kvalitetsmålinger. Hensikt: Hensikten med studien var å evaluere metoden ACV etter innføringen på Oslo universitetssykehus ved å kartlegge stemmekvalitet og eventuelle komplikasjoner hos våkne, trakeostomerte respiratoravhengige intensivpasienter under pågående ACV- forsøk. Metode: Observasjonsstudien er basert på data fra interne kvalitetsmålinger registrert ved ACV-forsøk i tidsperioden september 2019 til juli 2020 etter innføring av metoden på et universitetssykehus i Norge. Stemmekvalitet ble registrert av helsepersonell til stede med følgende kategorier: ingen, hviskende, hes, anstrengt og tydelig stemme. Komplikasjoner ble registrert med følgende kategorier: ingen komplikasjoner, subkutant emfysem, luft i ventrikkel, luftlekkasje rundt trakeostomi og annet. Beskrivende statistikk presenteres med antall (%) og median med interkvartil range (IKR). Resultat: Totalt 16 intensivpasienter fra 5 ulike intensivenheter fikk gjennomført totalt 36 ACV-forsøk. Hørbar (hvisking, hes, anstrengt) eller tydelig stemme ble registrert hos 75 prosent (11/16) av pasientene og ved 67 prosent (24/36) av ACV-forsøkene. Ingen komplikasjoner ble rapportert ved 53 prosent (19/36) av ACV-forsøkene, og mindre alvorlige komplikasjoner ble registret ved 44 prosent (16/36). De mindre alvorlige komplikasjonene inkluderte luftlekkasje rundt trakeostomi, luft i ventrikkel, hoste, brekning, ubehag i svelg og mye sekret. Konklusjon: Funnene tyder på at ACV kan fungere som en alternativ kommunikasjonsmetode for våkne, trakeostomerte respiratoravhengige intensivpasienter etter innføring på et sykehus, men at det kan oppstå mindre alvorlige komplikasjoner og forbigående observerte pasientubehag under pågående forsøk. ENGLISH ABSTRACT Give the patient a voice with Above Cuff Vocalisation: an observational study Background: Communication between patient and intensive care nurse is crucial for increased patient comfort and the intensive care nurse's work performance. Above cuff vocalisation (ACV) is a communication method for awake, tracheostomized ventilator-dependent intensive care patients. The method is new in Norway, approved and introduced in Oslo university hospital (September 2019). Previous international studies show that ACV is a safe and effective communication method that can increase the quality of life of intensive care patients. The introduction of the method was therefore considered to be safe, but it was recommended to follow up with quality measurements. Aim: The study aimed to evaluate and map voice quality and possible complications in awake, tracheostomized ventilator-dependent intensive care patients during ongoing ACV trials. Method: The study was a descriptive observational study at Oslo university hospital in Norway. The study was based on register data from quality registration forms for ACV trials in the time period September 2019 to July 2020. Result: A total of 16 intensive care patients from 5 different intensive care units generated 36 ACV trials. The findings of the study showed that 67% (24/36) of the ACV attempts resulted in an audible or clear voice in 75% (11/16) of the patients. No complications occurred in 53% (16/36) of the ACV trials, and less severe complications were recorded in 44% (16/36). Conclusion: The findings suggest that ACV works as an alternative communication method for awake, tracheostomized ventilator-dependent intensive care patients, but that less serious complications and transient patient discomfort may occur during ongoing trials.