Background: Treatment with combined oral contraceptives (COC) is associated with an increased risk of venous thromboembolism. Several changes of coagulant and anticoagulant factors induced by ethinyloestradiol during treatment with COC, have been demonstrated. Thrombin generation is a global test measuring both coagulant and anticoagulant factors, but the effect of COC on individuals starting COC, has not been examined before on the new equipment, ST Genesia. The aim of this project was to examine the effect of COC on thrombin generation on ST Genesia, in individuals before and after starting COC. Methods: Twenty-four female participants between 15 and 34 years of age, who were about to start treatment with ethinylestradiol/levonorgestrel-containing COC, were included in the study. Two blood samples were drawn from each of the study subjects, a baseline sample immediately before first COC dose, and a follow-up blood sample approximately 3–4 months after COC start. Standard biochemical analyses as well as standard and special coagulation analyses including thrombin generation on ST Genesia, were performed in all samples. Results: Thrombin generation, i.e., endogenous thrombin generation (ETP) and peak increased considerably after COC start, whereas time-to-peak was shortened. Thrombin-antithrombin complexes (TAT), prothrombin fragments (F1 + 2) and sex hormone binding globulin (SHBG) increased, and the coagulation inhibitors tissue factor pathway inhibitor (TFPI), protein S activity and antithrombin decreased slightly after COC start. Conclusion: Although the coagulation factors only changed modestly, the global test thrombin generation performed on ST Genesia showed a considerable change after start of COC.

Bone scintigraphy is key in imaging skeletal metastases in newly diagnosed prostate cancer. Unfortunately, a notable proportion of scans are not readily classified as positive or negative but deemed indeterminate. The extent of reporting of indeterminate bone scans and how such scans are handled in clinical trials are not known. A systematic review was conducted using electronic databases up to October 2016. The main outcome of interest was the reporting of indeterminate bone scans, analyses of how such scans were managed, and exploratory analyses of the association of study characteristics and the reporting of indeterminate bone scan results. Seventy-four eligible clinical trials were identified. The trials were mostly retrospective (85%), observational (95%), large trials (median 195 patients) from five continents published over four decades. The majority of studies had university affiliation (72%), and an author with imaging background (685). Forty-five studies (61%) reported an indeterminate option for the bone scan and 23 studies reported the proportion of indeterminate scans (median 11.4%). Most trials (44/45, 98%) reported how to handle indeterminate scans. Most trials (n = 39) used add-on supplementary imaging, follow-up bone scans, or both. Exploratory analyses showed a significant association of reporting of indeterminate results and number of patients in the study (p = 0.024) but failed to reach statistical significance with other variables tested. Indeterminate bone scan for staging of prostate cancer was insufficiently reported in clinical trials. In the case of indeterminate scans, most studies provided adequate measures to obtain the final status of the patients.

The contact system (CAS) is part of the coagulation system, consisting of a group of plasma proteins stimulating inflammation, coagulation, and fibrinolysis when activated. CAS can be triggered by several activating surfaces, and CAS may play a potential role in thrombus formation. Combined oral contraceptives (COCs) are known to increase the risk of venous thromboembolism, and COCs induce various prothrombotic changes in the coagulation system, whereas the effect of COC on CAS has not been thoroughly investigated. To investigate CAS in COC users compared with nonusers. Blood samples from 62 study subjects, 30 COC users, and 32 nonusers, were analyzed. Coagulation factor XII (FXII), prekallikrein (PK), H-Kininogen (HK), cleaved HK (cHK), C1-esterase inhibitor (C1-inh), and the endogenous kallikrein potential (EKP) were measured. COC users had significantly higher FXII (median, 38.4 vs 28.9 mg/L) and lower C1-inh levels (0.20 vs 0.23 g/L) than nonusers. The levels of PK and HK were not significantly different. Measurement of EKP indicated an increased capacity of CAS in COC users (1860 vs 1500 nmol/L × min), and increased plasma levels of cHK (2.02 vs 1.07 μg/L) indicated an increased activity in vivo. This study demonstrates an increased CAS capacity in women using COC compared with nonusers and also an increased activity in vivo. The results indicate that increased contact activation may contribute to the increased thrombotic risk caused by COC.

Tumoral calcinosis is a benign condition characterized by periarticular calcified lesions that is frequently observed in patients with chronic renal failure. Tumoral calcinosis often presents with subcutaneous masses and joint swelling. We present a case of tumoral calcinosis with dramatically increased ¹⁸F-fluoro-2-deoxy-d-glucose (¹⁸F-FDG) uptake on positron emission tomography/computed tomography (PET/CT) that mimicked lymphoma or lymph node metastases.

Reliable biochemical measurements are essential to patient care and rely on the correct preanalytical handling of blood samples. In Denmark, whole blood samples are transported from general practitioners to local hospital laboratories daily, and whole blood stability for 10 h is required for analytes to be included in this transportation service in the North Jutland Region. Therefore, this study aimed to determine the stability of 17 analytes in whole blood during transportation and storage for 6 and 10 h at room temperature (21 °C). Ten randomly selected participants were included in the Department of Clinical Biochemistry at Aalborg University Hospital. Three serum vacutainer tubes were collected from each participant, and 17 analytes (lipoprotein a, immunoglobulin G1, β-2-Microglobulin, κ free light chain, λ free light chain, peptidyl peptidase A, protein, apolipoprotein B, insulin-like growth factor 1, somatotropin, thyroxin binding globulin, anticardiolipin antibodies IgM, prolactin, thyroid peroxidase antibodies, thyroglobulin, thyroglobulin antibodies,17-Hydroxyprogesterone) were measured at baseline, after 6 h, and after 10 h. All analytes showed 6- and 10-hour stability within the limits of the preestablished analytical variation, reflected by coefficients of variation, in the laboratory (accredited by ISO-15189). Thus, transportation and storage of whole blood at room temperature for 6 and 10 h did not result in significant changes in the levels of the 17 studied analytes. Therefore, all analytes were suitable for the transportation service in the North Jutland Region, Denmark.

Combined oral contraceptives (COC) are associated with an increased risk of venous thromboembolism (VTE). The contact system (CAS) can, when activated, stimulate coagulation, and may play a role in thrombus formation. Our recent case-control study showed increased CAS capacity and in vivo activity in COC users, indicating a systemic activation that could contribute to VTE risk during COC treatment. Aim This study investigates intraindividual changes in CAS in women before and after start of COC treatment. Twenty-four women aged between 15 and 34 years, who were starting treatment with COC, were included in the study. A baseline blood sample was drawn before start of COC, and a follow-up blood sample 3-4 months later. The capacity and activity of CAS, i.e. factor XII (FXII), prekallikrein (PK), H-kininogen (HK), C1-esterase inhibitor (C1inh), cleaved HK (cHK) and endogenous kallikrein potential (EKP), were analyzed. Our study showed significantly increased levels of FXII (median 29.4 vs 42.9 mg/L; p < 0.0001) and decreased levels of C1inh (0.21 vs 0.20 g/L; p = 0.005). Increased EKP (1859 vs 2203 nmol/L*min; p = 0.0004) demonstrated an increased capacity of CAS, and increased levels of cHK (0.70 vs 0.96 μg/L; p < 0.0001) indicated an increased activity of CAS in vivo. The levels of PK and HK showed no significant changes. This study demonstrates an increased intraindividual CAS capacity as well as an increased CAS activity during treatment with COC supporting the previous research. These effects on CAS may contribute to the increased thrombotic risk caused by COC.