Severe hypercalcemia caused by parathyroid hormone in a rectal cancer metastasis: a case report

Background - Hypercalcemia of malignancy is relatively common in several cancers. However, in colorectal cancer, paraneoplastic phenomena that cause hypercalcemia is uncommon. In the few cases that are reported, secretion of parathyroid hormone-related peptide mediates the effect. We describe the first case of severe hypercalcemia mediated by intact parathyroid hormone secretion from a bone metastasis of colorectal origin. This was a diagnostic and therapeutic challenge. Case presentation - A 68-year-old male treated for rectal adenocarcinoma 10 years earlier developed a bone metastasis. After initial treatment of the metastasis with surgery and irradiation, he developed a relapse with severe hypercalcemia and corresponding elevated parathyroid hormone levels. The workup showed no signs of parathyroid adenomas, but the metastasis produced intact parathyroid hormone. The hypercalcemia was successfully treated by irradiation and osteoclast inhibitor, and the patient received chemotherapy. Survival was 24 months from the onset of hypercalcemia. Conclusions - Proper diagnosis of the uncommon endocrine disturbance allowed targeted therapy and avoidance of neck exploration for wrongly suspecting primary hyperparathyroidism. Intact parathyroid hormone should be measured in cases of malignant hypercalcemia

”Ta hjemmetempen”. Rapport fra Forskningskampanjen 2012

Man vet en god del om hvor mye energi norske husholdninger bruker, men mindre om hvor varmt vi har det inne og hvordan temperaturen varierer over døgnet, både i Norge og internasjonalt. Vi vet også svært lite om hvor fornøyd vi er med innetemperaturen og hvordan innetemperatur og strømforbruk henger sammen med oppvarmingsutstyr og utetemperatur. Dette er noen av de spørsmålene Forskningskampanjen 2012 kan bidra til å gi svar på. Forskningskampanjen arrangeres hvert år av Norges forskningsråd og Nettverk for miljølære, og har som formål at skolebarn fra hele landet skal få delta i aktivt forskningsarbeid. Elevene som deltok i Forskningskampanjen 2012 målte temperaturen ute og inne i fire rom, morgen og kveld, og registrerte strømforbruket. I tillegg ble fokuset på strømforbruk og -sparing i familien kartlagt gjennom et intervju med familien om oppvarmingsutstyr, hvor fornøyd de er med innetemperaturen, holdninger til, og masing om, energisparing og ulike former for spareatferd. Denne informasjonen gjør datamaterialet fra Forskningskampanjen 2012 helt unikt, også i en internasjonal sammenheng. Vi finner at en stor andel av norske barnefamilier holder en lavere innetemperatur enn det de synes er behagelig på kalde vintermorgener, og mor fryser oftest. Det er også mange indikasjoner i dataene på at dette er bevisst atferd, og at mange velger å ha det litt kaldere enn det de synes er behagelig deler av døgnet for å spare energi eller penger. Vi finner også en klar sammenheng mellom innetemperaturen og hva slags oppvarmingsutstyr husholdningen har. Husholdninger med varmepumper og felles sentralfyr med andre husholdninger holder i gjennomsnitt en høyere innetemperatur, mens husholdninger som bruker vedfyring holder en lavere gjennomsnittlig innetemperatur i stua om morgenen enn andre husholdninger. Et annet spennende funn er at det er en sammenheng mellom innetemperatur og masing om energisparing1 , ved at det i de husholdningene hvor det mases mest om energisparing også er kaldest i stua om morgenen. Det kan imidlertid være vanskelig å si noe om hva som driver denne sammenhengen, siden det er grunn til å tro at det mases mest i de husholdningene hvor behovet for sparing er størst, og hvor man generelt er opptatt av strømsparing. Alt i alt viser resultatene fra denne undersøkelsen en utstrakt energisparing i norske husholdninger, og at mange husholdninger velger å holde en lavere temperatur inne i deler av døgnet enn det de synes er behagelig. Det er også klare indikasjoner på at så fort energi til oppvarming blir billigere, eller man ikke betaler etter forbruk, reduseres denne spareatferden, og husholdningene velger å øke temperaturen inne

Vessel Fleet Optimization for Maintenance Operations at Offshore Wind Farms under Uncertainty

In this paper we consider the problem of determining the optimal fleet size and mix of vessels to support maintenance activities at offshore wind farms. A two-stage stochastic programming model is proposed where uncertainty in demand and weather conditions are taken into account. The model aims to consider the whole life span of an offshore wind farm, and should at the same time remain solvable for realistically sized problem instances. The results from a computational study based on realistic data is provided.publishedVersio

Potential anti-inflammatory role of activin A in acute coronary syndromes

AbstractObjectivesWe sought to investigate whether activin A could be involved in the immunopathogenesis of acute coronary syndromes.BackgroundInflammatory mechanisms seem to play a pathogenic role in atherosclerosis and acute coronary syndromes, but the actual mediators have not been fully identified. Activin A, a pleiotropic member of the transforming growth factor-beta cytokine family, has recently been suggested to play a role in inflammation.MethodsWe examined the role of activin A and its endogenous inhibitor follistatin in patients with stable (n = 26) and unstable angina (n = 20) and healthy control subjects (n = 20) by different experimental approaches.Results1) Patients with stable angina had raised activin A concentrations, as assessed by protein levels in serum and messenger ribonucleic acid levels in peripheral blood mononuclear cells (PBMCs). 2) Although several activin A–related mediators were upregulated in PBMCs from patients with stable angina compared with controls (i.e., activin A and Smad3), no changes or even downregulation (i.e., Smad2) were seen in unstable disease. 3) The activin type II receptors, representing the primary ligand-binding proteins, were downregulated in unstable compared with stable angina. 4) Percutaneous coronary intervention induced a decrease in the activin A/follistatin ratio, suggesting downregulatory effects on activin A activity. 5) Although activin A dose-dependently suppressed the release of inflammatory cytokines from PBMCs in angina patients, an opposite effect was found in healthy controls.ConclusionsOur findings suggest an anti-inflammatory potential of activin A in angina patients, and such effects may be of particular relevance in unstable angina in which several of the activin parameters were downregulated

The Norwegian childhood cancer biobank

Background - The rapidly expanding era of “omics” research is highly dependent on the availability of quality-proven biological material, especially for rare conditions such as pediatric malignancies. Professional biobanks provide such material, focusing on standardized collection and handling procedures, distinctive quality measurements, traceability of storage conditions, and accessibility. For pediatric malignancies, traditional tumor biobanking is challenging due to the rareness and limited amount of tissue and blood samples. The higher molecular heterogeneity, lower mutation rates, and unique genomic landscapes, however, renders biobanking of this tissue even more crucial. Aim - The aim of this study was to test and establish methods for a prospective and centralized biobank for infants, children, and adolescents up to 18 years of age diagnosed with cancer in Norway. Methods - Obtain judicial and ethical approvals and administration through a consortium, steering committee, and advisory board. Develop pipelines including SOPs for all aspects in the biobank process, including collection, processing and storing of samples and data, as well of quality controlling, safeguarding, distributing, and transport. Results - The childhood cancer biobanking started at Oslo University Hospital in March 2017 and was from 2019 run as a national Norwegian Childhood Cancer Biobank. Informed consent and biological samples are collected regionally and stored centrally. Approximately 12 000 samples from 510 patients and have been included by January 1, 2021, representing a 96% consent and participation rate among our newly diagnosed patients. Conclusion - A well-functioning nationwide collection and centralized biobank with standardized procedures and national storage for pediatric malignancies has been established with a high acceptance among families

LIGHT/TNFSF14 is increased in patients with type 2 diabetes mellitus and promotes islet cell dysfunction and endothelial cell inflammation in vitro

Published version. Source at http://dx.doi.org/10.1007/s00125-016-4036-y Aims/hypothesis: Activation of inflammatory pathways is involved in the pathogenesis of type 2 diabetes mellitus. On the basis of its role in vascular inflammation and in metabolic disorders, we hypothesised that the TNF superfamily (TNFSF) member 14 (LIGHT/TNFSF14) could be involved in the pathogenesis of type 2 diabetes mellitus. Methods: Plasma levels of LIGHT were measured in two cohorts of type 2 diabetes mellitus patients (191 Italian and 40 Norwegian). Human pancreatic islet cells and arterial endothelial cells were used to explore regulation and relevant effects of LIGHT in vitro. Results: Our major findings were: (1) in both diabetic cohorts, plasma levels of LIGHT were significantly raised compared with sex- and age-matched healthy controls (n = 32); (2) enhanced release from activated platelets seems to be an important contributor to the raised LIGHT levels in type 2 diabetes mellitus; (3) in human pancreatic islet cells, inflammatory cytokines increased the release of LIGHT and upregulated mRNA and protein levels of the LIGHT receptors lymphotoxin β receptor (LTβR) and TNF receptor superfamily member 14 (HVEM/TNFRSF14); (4) in these cells, LIGHT attenuated the insulin release in response to high glucose at least partly via pro-apoptotic effects; and (5) in human arterial endothelial cells, glucose boosted inflammatory response to LIGHT, accompanied by an upregulation of mRNA levels of HVEM (also known as TNFRSF14) and LTβR (also known as LTBR). Conclusions/interpretation: Our findings show that patients with type 2 diabetes mellitus are characterised by increased plasma LIGHT levels. Our in vitro findings suggest that LIGHT may contribute to the progression of type 2 diabetes mellitus by attenuating insulin secretion in pancreatic islet cells and by contributing to vascular inflammation

The association between infant salivary cortisol and parental presence in the neonatal intensive care unit during and after COVID-19 visitation restrictions: A cross-sectional study

Objectives: Parent-infant interaction in the neonatal intensive care unit (NICU) promotes health and reduces infant stress. During the COVID-19 pandemic, however, NICUs restricted parent-infant interaction to reduce viral transmission. This study examined the potential relationship between pandemic visitation restrictions, parental presence and infant stress as measured by salivary cortisol. Methods: A two-NICU cross-sectional study of infants with gestational age (GA) 23–41 weeks, both during (n = 34) and after (n = 38) visitation restrictions. We analysed parental presence with and without visitation restrictions. The relationship between infant salivary cortisol and self-reported parental NICU presence in hours per day was analysed using Pearson's r. A linear regression analysis included potential confounders, including GA and proxies for infant morbidity. The unstandardised B coefficient described the expected change in logtransformed salivary cortisol per unit change in each predictor variable. Results: Included infants had a mean (standard deviation) GA of 31(5) weeks. Both maternal and paternal NICU presence was lower with versus without visitation restrictions (both p ≤0.05). Log-transformed infant salivary cortisol correlated negatively with hours of parental presence (r = − 0.40, p = .01). In the linear regression, GA (B = -0.03, p = .02) and central venous lines (B = 0.23, p = .04) contributed to the variance in salivary cortisol in addition to parental presence (B = -0.04 p = .04). Conclusion: COVID-19–related visitation restrictions reduced NICU parent-infant interaction and may have increased infant stress. Low GA and central venous lines were associated with higher salivary cortisol. The interaction between immaturity, morbidity and parental presence was not within the scope of this study and merits further investigation

Single-centre, triple-blinded, randomised, 1-year, parallel-group, superiority study to compare the effects of Roux-en-Y gastric bypass and sleeve gastrectomy on remission of type 2 diabetes and β-cell function in subjects with morbid obesity: a protocol for the Obesity surgery in Tønsberg (Oseberg) study

publishedVersio

Kommunikasjon kan være en utfordring

Tittelen på oppgaven min er ” Kommunikasjon kan være en utfordring” og problemstillingen lyder som følger: ”Hvordan kan sykepleier møte en pasient som lider av sosial fobi?” Jeg ønsket å lære mer om sosial angst og hvordan sykepleieren kan kommunisere med en som har denne lidelsen. I følge Butler (2008) var sosial angst en lite kjent lidelse og før den ble til en diagnose i 1980. Verdens helseorganisasjon har gjort undersøkelser som viser at sosial angst er den tredje mest vanlige psykiske lidelsen og at mellom 5-7 % av hele verdens befolkning har denne lidelsen. I følge Norsk Helseinformatikk (2010) er det mellom 2-7 % som lider av sosial angst i Norge. Som sykepleier kan vi møte pasienter med sosial fobi i ulike arenaer og ikke bare i psykiatrien. Det er derfor viktig å ha kunnskap om hvordan vi kan møte dem. For å kunne svare på problemstillingen har jeg benyttet meg av fagbøker og artikler som blant annet handler om hvordan kommunisere, danne relasjon og den kognitive behandlingsmåten. Jeg har funnet ut at det ikke finnes noen fasitsvar på hvordan vi kan møte pasienten med denne lidelsen men det finnes gode råd

Development Towards Autonomy: A Q methodological study of how college students who seek counselling experience their development towards autonomy

College serves as a venue for development, where one aim is to produce autonomous students. In this process of developing towards autonomy difficulty and challenges occurs, and thus some students choose to seek counselling. Based on this it has been desirable to gain a deeper understanding of how college students experience this process. Hence, the research question of this thesis is: How do college students who seek counselling experience their development towards autonomy? This thesis is conducted by using Q methodology. 14 college students who have been to counselling participated in this research. Based on the research question the participants sorted 36 statements in accordance with their recognition of themselves in them, from least like me to most like me. The statements were produced with the help of Fisher’s balanced block design. The research design includes theory about self-efficacy, self-awareness in a developmental perspective, and the counselling relation. Based on an analysis of the participants’ Q sorts, a four-factor solution appeared. The factors represent different viewpoints existing among the college students who seek counselling, related to the development towards autonomy. These were further interpreted and given names. Factor 1: Others make me feel strong, but I do not do what is required to succeed. Factor 2: All the expectations make me lack a feeling of control. Factor 3: I take responsibility for personal development, but not necessarily in school. Factor 4: Although I work hard I need others to believe in me. The factors were discussed in relation to theory. What emerged was an understanding that the factors represent different points along the journey towards autonomy. At the same time, all of the students also have a tendency to prevent themselves from full potential of development. An increased self-awareness is believed to be necessary to overcome this, which can be attained with the help of counselling