Den rummelige forskningsdiagnose: Om fravær og forhandlingsrum i tilblivelsen af en diagnose

Antropologiske studier af diagnoser har fra mange forskellige vinkler diskuteret og belyst, hvilken social betydning det kan have at være diagnosticeret med en bestemt diagnose – og, tilsvarende, hvad det kan betyde at mangle en diagnose. Bodily Distress Syndrome (BDS) er en ny forskningsdiagnose, der endnu ikke figurerer i de internationale diagnosemanualer, og som i en vis forstand befinder sig i krydsfeltet mellem diagnose og ’ikke-diagnose’.På baggrund af et etnografisk feltarbejde i Danmark udforsker vi i artiklen, hvilke forhandlingsmuligheder der for mennesker med Bodily Distress Syndrome knytter sig til at blive diagnosticeret med en forskningsdiagnose. Med fokus på diagnosens tilblivelsesfase viser vi, at den særlige ikke-synlighed, der ligger indlejret i BDS-diagnosen, i visse sammenhænge er forbundet med bestemte muligheder for mennesker med BDS. Ud fra en teoretisk forståelse af fravær som ejendel, argumenterer vi for, at ikke-synligheden åbner op for et rum for forhandling om diagnosens indholdsmæssige beskaffenhed, og at mennesker med BDS – i dette forhandlingsrum – kan tage medejerskab over tilblivelsen og afgrænsningen af BDS som diagnose og fænomen.A room for negotiation – On absence and flexibility in the becoming of a diagnosisAnthropological studies of diagnoses have from several perspectives discussed and shed light on the social meaning and implication of having or not having a diagnosis. Bodily Distress Syndrome (BDS) is a new research diagnosis that does not yet appear in WHO’s International Classification of Diseases. In that sense BDS is situated in a position of structural ambiguity, simultaneously being and not being a real diagnosis.Based on ethnographic fieldwork in Denmark this article examines the possibilities of negotiation connected to being diagnosed with a research diagnosis. Focusing on the very becoming of BDS the article suggests that the absence in the diagnosis of clear pathological findings offers certain possibilities to people recently diagnosed with BDS. Leaning on a theoretical understanding of absence as a specific kind of possession, we argue that the absence opens up a room for negotiation of the content of the diagnosis, thereby offering people with BDS a shared ownership of the becoming and elaboration of the phenomenon BDS

Danish study of Non-Invasive Testing in Coronary Artery Disease 3 (Dan-NICAD 3):study design of a controlled study on optimal diagnostic strategy

Introduction Current guideline recommend functional imaging for myocardial ischaemia if coronary CT angiography (CTA) has shown coronary artery disease (CAD) of uncertain functional significance. However, diagnostic accuracy of selective myocardial perfusion imaging after coronary CTA is currently unclear. The Danish study of Non-Invasive testing in Coronary Artery Disease 3 trial is designed to evaluate head to head the diagnostic accuracy of myocardial perfusion imaging with positron emission tomography (PET) using the tracers 82Rubidium (82Rb-PET) compared with oxygen-15 labelled water PET (15O-water-PET) in patients with symptoms of obstructive CAD and a coronary CT scan with suspected obstructive CAD.Methods and analysis This prospective, multicentre, cross-sectional study will include approximately 1000 symptomatic patients without previous CAD. Patients are included after referral to coronary CTA. All patients undergo a structured interview and blood is sampled for genetic and proteomic analysis and a coronary CTA. Patients with possible obstructive CAD at coronary CTA are examined with both 82Rb-PET, 15O-water-PET and invasive coronary angiography with three-vessel fractional flow reserve and thermodilution measurements of coronary flow reserve. After enrolment, patients are followed with Seattle Angina Questionnaires and follow-up PET scans in patients with an initially abnormal PET scan and for cardiovascular events in 10 years.Ethics and dissemination Ethical approval was obtained from Danish regional committee on health research ethics. Written informed consent will be provided by all study participants. Results of this study will be disseminated via articles in international peer-reviewed journal.Trial registration number NCT04707859

Oral administration of sitagliptin activates CREB and is neuroprotective in murine model of brain trauma

Introduction: Traumatic brain injury is a major cause of mortality and morbidity. We have previously shown that the injectable glucagon-like peptide-1 (GLP-1) analogue, liraglutide, significantly improved the outcome in mice after severe traumatic brain injury (TBI). In this study we are interested in the effects of oral treatment of a different class of GLP-1 based therapy, dipeptidyl peptidase IV (DPP-IV) inhibition on mice after TBI. DPP-IV inhibitors reduce the degradation of endogenous GLP-1 and extend circulation of this protective peptide in the bloodstream. This class has yet to be investigated as a potential therapy for TBI. Methods: Mice were administrated once-daily 50 mg/kg of sitagliptin in a Nutella® ball or Nutella® alone throughout the study, beginning two days before severe trauma was induced with a stereotactic cryo-lesion. At two days post trauma, lesion size was determined. Brains were isolated for immunoblotting for assessment of selected biomarkers for pathology and protection.Results: Sitagliptin treatment reduced lesion size at day 2 post-injury by ~28% (p0.05). Conversely, apoptotic tone (alpha-spectrin fragmentation, Bcl-2 levels) and the neuroinflammatory markers IL-6, and Iba-1 were not affected by treatment.Conclusions: This study shows, for the first time, that DPP-IV inhibition ameliorates both anatomical and biochemical consequences of TBI and activates CREB in the brain. Moreover, this work supports previous studies suggesting that the effect of GLP-1 analogues in models of brain damage relates to GLP-1 receptor stimulation in a dose-dependent manner.Keywords: GLP-1, Traumatic Brain Injury, TBI, sitagliptin, liraglutide, CREB, Oxidative Stress, GIP, DPP-IV, DPP-

Danish study of Non-Invasive Testing in Coronary Artery Disease 3 (Dan-NICAD 3): study design of a controlled study on optimal diagnostic strategy

Introduction Current guideline recommend functional imaging for myocardial ischaemia if coronary CT angiography (CTA) has shown coronary artery disease (CAD) of uncertain functional significance. However, diagnostic accuracy of selective myocardial perfusion imaging after coronary CTA is currently unclear. The Danish study of Non-Invasive testing in Coronary Artery Disease 3 trial is designed to evaluate head to head the diagnostic accuracy of myocardial perfusion imaging with positron emission tomography (PET) using the tracers 82Rubidium (82Rb-PET) compared with oxygen-15 labelled water PET (15O-water-PET) in patients with symptoms of obstructive CAD and a coronary CT scan with suspected obstructive CAD.Methods and analysis This prospective, multicentre, cross-sectional study will include approximately 1000 symptomatic patients without previous CAD. Patients are included after referral to coronary CTA. All patients undergo a structured interview and blood is sampled for genetic and proteomic analysis and a coronary CTA. Patients with possible obstructive CAD at coronary CTA are examined with both 82Rb-PET, 15O-water-PET and invasive coronary angiography with three-vessel fractional flow reserve and thermodilution measurements of coronary flow reserve. After enrolment, patients are followed with Seattle Angina Questionnaires and follow-up PET scans in patients with an initially abnormal PET scan and for cardiovascular events in 10 years.Ethics and dissemination Ethical approval was obtained from Danish regional committee on health research ethics. Written informed consent will be provided by all study participants. Results of this study will be disseminated via articles in international peer-reviewed journal.Trial registration number NCT04707859