Sebastian Søby,
Department of Clinical Medicine

Immunotherapy (PD-1 inhibitors) is still a relatively new treatment for head and neck cancer. For this reason, national data have been needed to compare immunotherapy with other treatments such as chemotherapy. In addition, patients respond very differently to this treatment. Therefore, it is important to identify, before treatment, which patients are most likely to benefit. 

To address these questions, national data were collected from all Danish patients who received immunotherapy for head and neck cancer. The results showed that immunotherapy works about as well as chemotherapy overall. However, a smaller group of patients benefits particularly well. These patients are generally in good physical condition and have HPV-related throat cancer with higher levels of the biomarkers CD68 and FOXP3.

Signe Hirschel Mikkelsen,
Department of Clinical Medicine

A window to the hippocampus furthers the study of aging in mice. A new PhD project from Aarhus University, Health, investigates the function of the brain’s smallest blood vessels during early aging. 

Efficient delivery of oxygen and nutrients through the brain’s vascular network is essential for normal brain function. Disruptions in blood flow regulation and oxygen supply are thought to play an important role in cognitive decline and neurodegenerative disease, where aging is a primary risk factor. Vascular alterations typically arise before the onset of clinical symptoms, and these changes are particularly relevant in the hippocampus, a structure with unique vascular organization and a central role in learning and memory. This dissertation presents the development and validation of a cranial window to investigate hippocampal microvascular function in healthy aging in a murine model. Using complementary in vivo optical imaging techniques in awake mice, the project measured flow dynamics and oxygenation in the hippocampus, coupling the physiological estimates to assessments of learning and memory and immune-related changes associated with aging.

Acute Metabolic and Functional Effects of β-hydroxybutyrate on Working Skeletal Muscle

The role of ketone bodies in muscle function and energy metabolism

Skeletal muscle is central to human health and the ability to move. However, muscle function and metabolism can be compromised by ageing and fatigue. Ketone bodies are naturally occurring energy substrates that can also be consumed as dietary supplements and have the potential to influence muscle function and metabolism. A new PhD project from Aarhus University, Health investigates how ketone bodies affect working skeletal muscle – ranging from mechanistic experiments in isolated rat muscle to controlled human studies. 

A PhD project from Aarhus University, Health investigates the use of advanced cardiovascular magnetic resonance (CMR) imaging for the assessment of coronary atherosclerosis and prosthetic heart valve function.

CMR enables enables detailed evaluation of cardiac anatomy, function, and tissue characteristics without exposing patients to ionizing radiation. Recent technological advances in image acquisition and reconstruction techniques have expanded its utility to include coronary artery imaging as well as quantitative assessment of blood flow and heart valve function.

In this project, patients with coronary artery disease were examined using a novel CMR technique that allows for characterization of coronary plaques without the use of ionizing radiation or contrast agents. When compared with cardiac computed tomography (CT), only partial overlap in measured plaque burden was observed, indicating that the two modalities capture different biological components of atherosclerotic disease.

Furthermore, CMR was used to assess prosthetic heart valve performance in patients undergoing transcatheter aortic valve implantation (TAVI). In a randomized clinical trial, two transcatheter valve systems were compared. Using phase-contrast CMR, valve opening area and regurgitation were quantified and compared between devices. The findings demonstrate good overall performance of contemporary aortic valve prostheses with low rates of paravalvular regurgitation for both prostheses. The results highlight the value of CMR for detailed, quantitative evaluation of prosthetic valve function as a complement to echocardiography.

Hypospadias refers to a congenital condition in which the urethral opening is located on the underside rather than at the tip of the penis. The foreskin is underdeveloped, and curvature of the penile shaft is often present. The global prevalence of hypospadias varies and is debated because the underlying causes are not yet fully understood.

Most boys with hypospadias undergo surgery early in life. Those who are not operated are typically not followed in hospital care, and boys without postoperative complications are usually discharged from follow-up around school age, resulting in limited knowledge about long-term effects.

The PhD project consists of four studies:

Study 1 showed an increase in the prevalence of hypospadias in Denmark until 2007. From 2008–18 it atabilised at 774 per 100,000 newborn boys.

Study 2 found lower reproductive hormone levels and lower birth and placental weights in infants with hypospadias compared with healthy controls. Only birth- and placental weights were related to the severity of hypospadias.

Study 3 described symptoms among untreated men with hypospadias, which varied by age. Treatment with temporary interventions or formal surgery was successfully tailored to the individual.

Study 4 identified age-specific relevant outcomes after surgery. There was consensus regarding outcomes for boys under 10 years, whereas agreement was lower beyond this age, possibly reflecting limited experience with long-term effects.

Osteoporosis and loss of muscle strength are major causes of reduced mobility, disability, and fracture risk, particularly during advanced age or periods of physical inactivity or disability. These conditions often occur together, and the combined impact can lead to rapid declines in health and independence. Effective treatments that target both tissues at the same time are still lacking.

This PhD project investigated anti-activin receptor antibody, a new antibody-based approach, designed to counteract deterioration of both bone and muscle simultaneously. The work focused on immobilization-induced muscle- and bone loss as well as bone health in obesity. Using controlled animal models and supporting cell studies, the project examined whether blocking activin receptors could protect bone structure and preserve muscle mass.

The research showed that the anti-activin receptor antibody alleviated muscle loss and improved the bone microstructure while promoting bone formation and reducing bone breakdown. The positive effects on bone were blunted in obese mice.

Inherited blood disorders can leave patients highly vulnerable to life-threatening infections and often require lifelong medical care. For many of these conditions, the most promising future treatment is to repair a patient’s own blood-forming stem cells so they can produce a healthy immune system. Gene-editing technologies such as CRISPR-Cas9 have opened new possibilities for directly repairing disease-cuasing variants, but current methods still carry risks: they can create unintended DNA damage and reduce the ability of a patient’s stem cells to successfully engraft after transplantation. To move these therapies closer to safe clinical use, more precise and less harmful editing strategies are urgently needed.

In this PhD project, Jonas Holst Wolff has developed improved gene-editing platforms designed to correct disease-causing mutations while preserving the health and function of human blood stem cells. His work focuses on two rare immune disorders: chronic granulomatous disease (CGD) and GATA2 deficiency.

For CGD, he refined CRISPR-based tools that minimize DNA damage while retaining the gene-edited stem cells’ ability to engraft in an immunocompromised mouse model.

For GATA2 deficiency, he established a gene-editing therapy based on prime editing, which repairs mutations without cutting both DNA strands, achieving high correction rates with minimal DNA damage and excellent stem-cell preservation.

Together, these advances outline a safer path toward future one-time, personalized gene therapies for blood and immune disorders.

Endometriosis affects up to 10% of women and can lead to significant health and economic consequences. However, there is limited knowledge about healthcare utilization and diagnoses in the years preceding diagnosis, as well as about the economic costs in the periods before and after diagnosis compared to women without endometriosis.

Using data from the Danish national registries, we applied regression models to compare the use of primary and secondary healthcare services in the ten years prior to diagnosis among women with and without endometriosis. In addition, we conducted a cost-of-illness analysis comparing costs related to primary and secondary healthcare, medication costs, and productivity loss in the five years before and five years after diagnosis.

Nanna Kristjánsdóttir, Department of Clinical Medicine

Why do some patients experience better disease outcomes than others? A new PhD project from Aarhus University, Health, sheds light on this question by exploring how the immune system's T cells behave in patients with bladder cancer.

The project mapped T cell receptors (TCRs), unique molecular "fingerprints" that allow T cells to recognise and attack cancer cells. Using advanced sequencing technologies, blood and tumour samples collected before, during and after treatment were analysed. The results showed that patients with less diverse T cell repertoires before treatment tended to have poorer survival, especially when combined with a low numbers of circulating T cells. This suggests a close link between the strength of the immune system and disease outcomes.

The project provides new insights into how the immune system shapes cancer progression and treatment responses and may help guide more personalised approaches to bladder cancer therapy in the future.

Mind the Heart

Children with congenital heart defects are at increased risk of mental health difficulties, such as neurodevelopmental and psychiatric disorders, compared with their heart-healthy peers. If unaddressed, these difficulties can have lasting effects on the child’s psychological well-being, educational progress, and future occupational functioning. Yet, studies indicate under-recognition and thus undertreatment of mental health difficulties in these children.  

A new PhD project from Aarhus University, Health, contributes to the knowledge base for developing strategies for the early identification of mental health difficulties in children and adolescents with congenital heart defects. In the PhD project, the prevalence of emotional and behavioural difficulties as well as unmet support needs among children with ventricular septal defects is examined quantitatively. In addition, experiences and perspectives are explored qualitatively among parents of children with congenital heart defecrs and co-occurring mental health difficulties, and cardiology healthcare professionals. Finally, online informational material has been developed, targeting affected families and relevant healthcare professionals, with the aim of raising awareness of and disseminating knowledge about mental health difficulties in children with congenital heart defects.

Patients who develop an infection in their hip or knee prosthesis face a markedly increased risk of death – and the reasons are far more complex than the infection itself.

A new PhD dissertation from Aarhus University shows that patients who experience infection in their hip or knee prosthesis (periprosthetic joint infection or PJI) have a 30–50 percent higher mortality than those undergoing revision surgery in the same artificial joint for other reasons.

The study is based on nationwide, microbiologically verified registry data and represents the most comprehensive analysis to date of mortality and causes of death following joint infection.

The infection alone does not explain the excess mortality. According to the dissertation, patients more often die from cardiovascular, respiratory, and gastrointestinal diseases – a pattern suggesting that the infection may trigger general deterioration in patients who are already vulnerable.

The findings highlight the need for a more holistic, multidisciplinary approach to the management of patients with joint infection – focusing not only on the infection itself but also on the patient’s overall health and resilience.

Medical imaging technologies such as CT and MRI are well-known from hospitals, where they are used to diagnose injuries and disease. However, these techniques are increasingly being used in research environments far beyond the clinic.

The research showcases how imaging data can be transformed from visual “pictures” into measurable information about anatomy, physiology, and body composition. One part of the work focuses on leveraging preserved shark specimens from natural history collections, where high-resolution CT and MRI scans were used to study skeletal structure and tissue composition without damaging the specimens. Another part of the project attempts to develop methods for estimating buoyancy properties in deceased individuals using post-mortem CT scans, with potential future relevance for search and recovery operations.

The work shows that medical imaging can act as a shared research platform across disciplines, supporting new forms of analysis while preserving valuable biological material.

Medication coordination in a siloed society is complex, and a lack of coordination can have serious consequences. In a new PhD project from Aarhus University and the Regional hospital Pharmacy, Central Denmark Region, clinical pharmacist Tina Birkeskov Axelsen has investigated why shared medication coordination (Shared MedCo) for individuals living with severe mental disorder has been challenging to implement at social psychiatric residences, despite more than ten years of success at one such residence. Based on the findings, and in collaboration with field representatives, Tina  has explored how the original model can be adapted to support the implementation of Shared MedCo at other social psychiatric residences.

The results show that an effective Shared MedCo model involves (1) 'shared residence consultations', which support shared decision-making among the involved doctors, pharmacists and residential staff; (2) 'supported resident involvement', which supports active participation and gives the resident a voice in decision-making; and (3) 'organised MedCo', which supports simultaneity and systematic approaches to cross-sectoral and interdisciplinary medication management.

The research contributes new knowledge on how a healthcare system, with limited resources and significant impact, can improve the quality and coherence of citizens' medication treatment. The project has the potential to support residents' health checks, increase job satisfaction among residential staff and promote health equality and quality of life for residents living with a severe mental disorder in social psychiatric residences.

Department of Forensic Medicine

Promising biomarker may improve detection of GHB in sexual assault cases     

Gamma-hydroxybutyrate (GHB) is a sedative drug that can be involved in cases of sexual assault. Proving GHB intake has long posed a challenge in forensic investigations, as the substance disappears rapidly from the body. New research now points to a potential biomarker that could make it easier to document the use of GHB. 

In a clinical study involving healthy volunteers, the project aimed to identify new biomarkers capable of extending the detection window for GHB. The results revealed a promising compound in urine, GHB-ribose, which remained elevated for up to 72 hours after intake – considerably longer than GHB itself.

The study also showed that using specialised blood collection tubes (fluoride-oxalate) and rapid freezing can minimise the formation of new GHB in samples and thereby improve analytical reliability.

The findings may have important implications for forensic investigations in cases where GHB use is suspected, potentially strengthening the legal protection of victims of drug-facilitated sexual assault.

Transradial Access Site Optimization in Invasive Cardiology: Techniques to Improve Patient Safety and Optimize Hemostasis in Transradial Procedures

Today, accessing the heart via the wrist is the preferred method for most coronary angiographies and balloon angioplasties, due to fewer complications and faster recovery compared to access through the groin.

Despite widespread use, there is still debate about the best way to prevent bleeding after the procedure through compression, while avoiding complications such as permanent artery closure.

In the ACCESS-III project, we investigated how post-procedural care following wrist-access heart examinations can be improved. The study included 3,600 patients from three Danish regions. Two methods for wristband removal were compared: a traditional approach and a new sensor-guided method that monitors blood oxygenation in the fingers to guide pressure release.

Results showed both methods are safe and effective, but the sensor-guided approach allows for slightly faster removal without increasing the risk of bleeding or arterial closure.

The project also examined the impact of instrument size and bloodthinning treatments on bleeding risk. Findings suggest future procedures should be more tailored to the individual, potentially making wrist-access recovery both faster and safer.

Autoimmunity is a growing problem affecting many people in Denmark and around the world. B cells are immune cells that produce antibodies—the same antibodies detected in antibody tests—and help protect us against coronavirus and other diseases. However, B cells can also cause serious suffering when they attack the body’s own cells in autoimmune diseases. This PhD defense will present current research on the mechanisms B cells use to initiate autoimmune diseases. In addition, it will provide insight into how they communicate with other immune cells once the disease has started, which can potentially worsen the condition.     

Advances in DNA sequencing technologies have made it possible to study how mutations arise and contribute to disease in unprecedented detail. Nevertheless, detecting rare somatic mutations from whole-genome sequencing data remains challenging, as true variants must be distinguished from sequencing errors that occur at a similar rate. Local sequence context, the DNA sequence surrounding a given genomic position, can be used to improve the accuracy of somatic mutation detection and mutation rate estimation.

A new PhD dissertation from Aarhus University introduces three complementary computational methods that utilize local sequence context information to enhance whole-genome sequencing data analysis. The first method is an alignment-free approach for detecting circulating tumor DNA from blood plasma. The second method uses sample-specific sequencing error rate models to improve the precision of rare somatic variant detection. The third method applied a gradient boosting model to predict mutation and sequencing error rates more accurately.

Together, these studies demonstrate how local sequence context can be leveraged for cancer detection, rare variant discovery, and mutation rate prediction. The results contribute to the development of more accurate and personalized genomic analysis methods, supporting the advancement of precision medicine. 

Congenital pulmonary malformations (CPMs) are a group of rare developmental abnormalities of the lungs. With advances in prenatal (before birth) imaging and the widespread use of routine ultrasound screening, the detection of CPMs during pregnancy has increased. However, several uncertainties remain – particularly regarding the need and timing of surgery, the safety of conservative (non-surgical) management and the potential role of genetic predisposition. A new PhD project from the Department of Clinical Medicine, Aarhus University, Health, and Centre for Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital aimed to explore the diagnosis and management of children with CPM in Denmark. The project included four studies that investigated the prenatal incidence of CPM in Denmark, explored potential associations between prenatal findings and neonatal(within first 28 days after birth) respiratory morbidity, evaluated surgical approaches and outcomes in both symptomatic and asymptomatic children with CPM, assessed the outcomes of conservatively managed asymptomatic children and provided insight into DICER1 genetic test findings in patients with lung lesions. 

Vivi Just-Nørregaard, 
Department of Clinical Medicine

Psychosocial stressors in adolescence and their impact on later health

Adolescents who experience psychosocial stressors such as loneliness, perceived weight stigma, and stress may be at increased risk of poorer physical health later in life. This PhD project investigates associations between such psychosocial factors during adolescence and later BMI and HbA1c levels among younger Danish adults. By combining questionnaire, clinical, and register data from 7,000 participants in the VestLiv cohort, the project examines how psychosocial influences during adolescence are related to physical health in young adulthood.

The results show that adolescents who experience loneliness or perceived weight stigma tend to have greater increases in BMI in the following years. Experiences of weight stigma in the adolescent years are associated with BMI changes in both females and males, with effects more pronounced among females. In contrast, no consistent associations are found between psychosocial stressors—such as perceived stress, low family functioning, low social contact, and adverse life events—and young adults’ glycaemic regulation.

These findings contribute to a better understanding of how psychosocial stressors earlier in life may affect later health and may help to inform future research in this area.

Simulation-based team training and workforce well-being in healthcare: A complex intervention in a complex system.

Effective teamwork is crucial to ensuring that patients receive safe and coordinated care. Many hospitals, therefore, conduct regular simulation-based team training to prepare staff for managing critical situations—such as an acutely ill child or an unexpected complication during treatment.
In this PhD project, Anders Lund Schram examined whether such training might not only strengthen patient safety and clinical skills but also influence staff well-being and working conditions.

The study included eight paediatric departments across Denmark, involving approximately 1,200 healthcare professionals. Four departments in the Central Denmark Region participated in an intensive simulation programme, while four in the Southern Denmark Region continued their usual routines. Data were collected through surveys, register-based data on sick leave, and interviews with staff and managers.

Findings suggest that simulation-based team training potentially can have a positive impact on staff well-being and working conditions.

Kidney disease is a growing global health problem, and a common condition called nephrotic syndrome causes the body to lose large amounts of protein in the urine — raising the risk of heart disease and death. However, how this protein loss leads to broader health issues, is not understood. This study sheds light on the problem by focusing on the metabolism of arginine, an important nutrient that supports kidney and heart function. Using a mouse model of hereditary nephrotic syndrome, it was discovered that when protein leaks into the urine, the body changes how it processes arginine. Instead of being used in the liver to make urea — the usual way the body removes waste nitrogen — arginine is redirected to the kidneys and other organs, where it helps make other molecules such as glutamate and proline. This metabolic shift may reflect the body’s attempt to manage waste through alternative routes when normal kidney function is impaired. The study also found changes in heart metabolism and suggested that the amino acid aspartate might play a role in the progression of the disease. These findings reveal a new way that organs adapt to kidney disease and could open up fresh approaches to treatment.

New research investigates how the gene editing technology CRISPR/Cas9 can be used to correct the rare hereditary immunodeficiency GATA2 deficiency. The dissertation explores the possibilities for a personalized and safer treatment using the patient’s own stem cells.

GATA2 deficiency is a rare hereditary immunodeficiency caused by mutations in the GATA2 gene. The only current treatment is based on allogeneic hematopoietic stem cell transplantation, in which the patient is transplanted with stem cells from a donor. This is a risky treatment with high mortality, primarily because the donor cells can recognize the patient’s healthy tissue as foreign and attack it. This dissertation investigates the possibility of a treatment based on transplantation of the patient’s own hematopoietic stem cells in which the disease-causing mutation has been repaired. The CRISPR/Cas9 technology has been used to study different ways of performing this genetic repair. The dissertation describes optimization of such genetic correction strategies and investigates the effect of genetic correction in hematopoietic stem cells from a patient with GATA2 deficiency. In addition, potential unwanted side effects of the gene correction are also investigated.

Occupational exposures contribute substantially to the development of chronic obstructive pulmonary disease (COPD) and lung function decline.

Chemical occupational exposures contribute considerably to the development of COPD and to lung function decline. In her PhD project, Theresa Møller Kynde applied an exposome approach to investigate how multiple occupational exposures and biomarkers are related to incident COPD and lung function decline.

Using data from two multicentre cohorts and covering 49 occupational exposures, factors such as forward-bent postures, heavy lifting, gases and fumes, diesel exhaust, mineral dust, and solvents were linked to the development of COPD.

Analyses of biomarkers showed generally lower levels of CC16 and YKL-40 in exposed individuals. Lower CC16 levels were associated with reduced lung function and greater decline over time, while higher YKL-40 levels were associated with lower lung function and greater FEV₁ decline.

The project confirms that chemical occupational exposures play a role in the development of COPD and highlights novel associations with ergonomic and physical exposures, as well as links between CC16, YKL-40, and lung function decline.

Age-related macular degeneration (AMD) is a leading cause of vision loss and social blindness among the elderly. The most aggressive form of the disease, known as wet AMD, is characterized by pathological blood vessel growth that damages the retina. Current treatments involve repeated eye injections with drugs that inhibit the growth factor VEGF, which drives this abnormal vessel formation. A new PhD project from Aarhus University, Health, has explored innovative ways to treat wet AMD. Building on the clinical challenges of current therapies, the project has developed novel gene therapies capable of targeting several disease mechanisms simultaneously. The therapy has been shown to reduce VEGF levels in cell models and to lower both VEGF expression and abnormal blood vessel formation in mouse and pig models of wet AMD. To advance the preclinical development of gene therapy for wet AMD and improve its translation into clinical application, systematic literature reviews have also been conducted to provide an overview of contemporary animal models of wet AMD and to identify potential translational challenges.

Barriers and decision-making regarding participation in a proton therapy clinical trial - An exploration of trial participation barriers leading to the development of a clinical trial patient decision aid

Proton therapy is a highly precise cancer treatment that delivers radiation to the tumour while minimising dose to surrounding healthy tissue. However, participation in clinical trials investigating new treatments such as proton therapy can be affected by a range of barriers related to patients, physicians, and healthcare systems. 

In her PhD project, Anne Wilhøft Kristensen explored why some patients decline participation in the national DAHANCA 35 proton therapy trial and how these barriers can be addressed through improved information and communication. Combining quantitative and qualitative research methods, she identified structural, clinical, and psychosocial factors influencing participation and developed a patient decision aid to support informed and value-based decisions about trial enrolment. The results provide new insights into barriers to clinical trial participation and demonstrate how targeted decision support can help patients make more informed and value-based choices.     

A new research project from Aarhus University, Health, investigated the complex relationships between painful temporomandibular disorders, headaches, and prenatal nutrition. Using data from the Danish National Birth Cohort and clinical records from a tertiary orofacial pain center, the research explored how these conditions overlap and how maternal diet during pregnancy may influence the risk of developing p-TMD and headaches later in life. The findings contribute to a better understanding of the multifaceted nature of jaw and headache pain and may help shape future prevention and treatment strategies.

About half of all danish cancer patients receive radiotherapy as part of their treatment. While effective, the radiation can also damage healthy tissue surrounding the tumor, leading to unwanted adverce effects. Finding ways to reduce these effects could significantly benefit these patients.

A promising new approach, known as FLASH, delivers radiation at an ultrahigh rate. Previous studies have suggested that this method can reduce healthy tissue damage without compromising tumor control. But how effective FLASH really?

That is what this PhD project set out to investigate. Using a preclinical model, the projekt examined how effective FLASH was at reducing healthy tissue damage. The study looked at both acute and long-term side effects and compared different types of radiation (electrons and protons) as well as different treatment regimes (a single large dose split into several smaller doses).

The results showed that FLASH reduced both acute damages like skin reactions and long-term damages such as scar tissue formation (fibrosis) - regardless of the radiation type or treatment regime.

A lysine-dependent mechanism modulates renal metabolism and systemic glucose homeostasis

Recent studies have shown that lysine plays beneficial roles in both hypertensive kidney disease and glucose regulation. By integrating proteomics, metabolomics, and functional studies, the project explores how lysine influences these processes. 

In the study, lysine-binding proteins were first examined, revealing links to glucose metabolism. In diabetic animal models, lysine administration significantly reduced blood glucose levels. Using isotope-labeled glucose, the study revealed that lysine may alter renal tricarboxylic acid (TCA) cycle activity by consuming α-ketoglutarate for its degradation. This metabolic shift may further affect the abundance of renal ion transporters, thereby modulating the kidney’s control of blood pressure. The project provides novel insights into how amino acid metabolism contributes to kidney function and systemic energy regulation. 

Louise Bjerregaard Henningsen, Department of Clinical Medicine

New insights into HIV treatment interruptions and long-term health risks     
A new PhD thesis has shed light on how people living with HIV (PLWH) respond when pausing their antiretroviral therapy (ART), and how living with HIV from childhood may affect long-term heart health. 

The research shows that people with a larger “HIV reservoir” – the pool of virus that remains in the body despite treatment – tend to lose control of the virus more quickly once treatment is stopped. Certain experimental drugs may accelerate viral rebound, while promising antibody-based therapies could help extend control; however, more research is needed.

Another key finding is that temporary treatment interruptions do not appear to cause lasting damage to the immune system. Even after periods of detectable virus, patients’ immune cells were able to recover once ART was restarted.

The thesis also explores how lifelong HIV and exposure to treatment from childhood may affect cardiovascular health in adulthood, an area of growing importance as more people with perinatally acquired HIV reach older age.

Together, these findings provide valuable knowledge to guide future HIV treatment strategies and long-term health care for PLWH.

New large-animal model reveals how cisplatin distribures during HIPEC treatment. Findings may help improve future treatment strategies with heated chemotherapy for peritoneal cancers. 

A new large-animal model has made it possible to collect serial tissue and blood samples during and after HIPEC treatment. The study shows that cisplatin accumulates particularly in the peritoneum and raises questions about whether hyperthermia enhances tissue uptake. 

Peritoneal carcinomatosis is a serious condition where cancer cells spread to the peritoneum and abdominal organs. It is often seen in advanced ovarian cancer. HIPEC, hyperthermic intraperitoneal chemotherapy, is a newer treatment in which the abdominal cavity is perfused with heated chemotherapy, typically cisplatin, immediately after surgical removal of visible tumor tissue. The treatment is assumed to increase drug uptake in the tissue, but there is still limited knowledge about how cisplatin distributes in the body and what role heat plays.

This has been investigated by PhD student Christina Harlev from Aarhus University, Health, in preclinical studies. She developed a porcine model where microdialysis combined with mass spectrometry makes it possible to measure cisplatin in blood and tissue during and after HIPEC. The results show that cisplatin accumulates especially in the peritoneum, while heat does not increase uptake. Compared with intravenous chemotherapy, HIPEC results in lower concentrations in the blood and thus potentially fewer side effects. This new knowledge may help optimize future HIPEC treatments for patients with advanced ovarian cancer.

A new PhD project from Aarhus University, Health, has investigated adverse health outcomes among individuals who are socially disconnected and have a mental disorder. 

Individuals who are socially disconnected (e.g., lonely, socially isolated, or with low social support) face a higher risk of mortality and a particularly high risk of mental disorders compared with the general population. By combining survey and register data, this PhD project aimed to provide an overview of excess mortality (Study 1), morbidity (Study 3), and economic outcomes (Study 4) among individuals who are socially disconnected both with and without a co-occurring mental disorder. Furthermore, the project investigated the extent to which social disconnection could contribute to the higher mortality risk among individuals with mental disorders (Study 2).

The findings support that individuals who are socially disconnected, compared to those who are not, generally have higher mortality rates, higher incidence rates of medical conditions, higher healthcare costs, higher transfer payments, and lower wage income. Additionally, the findings suggested particularly high mortality rates among men with mental disorders who are also socially disconnected. Finally, aspects such as loneliness and social isolation could potentially explain part of the higher mortality risk among individuals with mental disorders. These results could help inform and guide tailored prevention efforts.

Mia Aagaard Doherty, 
Department of Clinical Medicine

NF1 is a rare inherited condition that increases the risk of cancer and other serious health challenges. Despite its impact, there is limited knowledge about how NF1 affects life expectancy and causes of death, especially in comparison to the general population. This PhD project is based on three large, nationwide studies that explore the influence of NF1 on cancer risk, causes of death, and survival.

By analysing decades of Danish registry data, the project sheds light on how individuals with NF1 face a much higher risk of developing cancer and are also affected by other significant diseases. The studies further examine which causes of death are most common among people with NF1 and how survival after a cancer diagnosis differs from that of the general population.

The body’s own metabolites influence the heart and blood vessels

Compounds such as lactate, 3-hydroxybutyrate (a ketone body), and butyrate are not merely energy sources. They also play a role in regulating cardiac contractility and vascular function. This insight may have important implications for understanding and potentially treating cardiovascular disease. 

In his PhD project, Casper Homilius explored how naturally occurring metabolites affect the heart’s pumping function and contribute to the regulation of blood flow throughout the body. Using advanced animal models, he also examined whether lactate and ketone bodies can reduce heart damage following a myocardial infarction and explored the underlying molecular mechanisms involved.

Cancer of the biliary tract and liver

The ph.d.-project examined changes over time in incidence, mortality, and treatment of cancer of the biliary tract (cholangiocarcinoma) in Denmark, and the effect of, among patients with alcohol-related cirrhosis in Denmark and England, offering surveillance for primary liver cancer.

The studies found an increase in the total number of patients diagnosed with cholangiocarcinoma in 1995-2022 in Denmark. In the same period, 1-year mortality following diagnosis was found to decrease, though the mortality risk remained high.

Among patients diagnosed with cholangiocarcinoma in 2004-2022, an increasing proportion received surgical treatment and an increasing proportion received chemotherapy. In these patients, the mortality risk remained stable across the period, which was likely a result of many different factors affecting the mortality risk in different ways.

Patients with alcohol-related cirrhosis in Denmark and England experience diverging guidelines on surveillance: in Denmark surveillance is not recommended, in England surveillance is recommended. The studies found that Danish and English patients had the same risk of primary liver cancer and the same high mortality risk from the time of diagnosis. The studies did not find evidence for recommending surveillance in these patients.

The studies have helped improve our understanding of cholangiocarcinomas and primary liver cancer. 

Fardous Reaz, 
Department of Clinical Medicine

Spatially fractionated proton beams have the potential to improve cancer treatment by sparing healthy tissue while maintaining effective tumor control. Developing reliable ways to deliver proton beams for this modality and measure its biological efficacy has been the focus of a PhD project at Aarhus University, Health. The project was carried out by Fardous Reaz, who will defend his dissertation on October 3rd.

Proton minibeam radiotherapy (pMBRT) is an emerging technique that combines the advantages of proton therapy with spatially fractionated dose patterns, aiming to reduce side effects. As part of this PhD project, the first national proton minibeam beamline for preclinical studies was developed and commissioned at the Danish Centre for Particle Therapy (DCPT), Aarhus University Hospital.  The group  developed new methods to measure its biological efficacy and conducted preclinical studies which showed that pMBRT substantially reduces acute toxicity while maintaining tumor control comparable to conventional proton therapy. The results point toward a new way of delivering radiation therapy, particularly in situations where sparing healthy tissue is essential.

Mental health problems in adolescence and adulthood are increasing and have long-term consequences for individuals and society. This thesis explored how mental health develops from adolescence to early adulthood, focusing on social inequalities and other determinants that influence mental health.

Using large Danish survey and register data, the thesis examined three main questions:

(1) Have social inequalities in adolescent mental health changed over the past 20 years?

(2) How is social status related to the development of mental health from age 15 to 32?

(3) Which personal, health, lifestyle, and social factors are most important for mental health at different life stages?

The findings showed that mental health problems have become more common among young people since 2002, but differences between socioeconomic groups have narrowed slightly. However, individuals from less advantaged families still face poorer mental health outcomes well into adulthood. Low subjective social status, stress, low self-esteem, and limited social support were especially important risk factors.

Overall, the results show that both persistent social inequalities and dynamic individual factors shape mental health. Preventive strategies should be tailored to different stages of life and give special attention to young people from disadvantaged backgrounds.

Diagnosis and Treatment of Implant-Associated Staphylococcal Infections: Imaging and Antimicrobial Strategies

The use of PET imaging to improve diagnostic accuracy, as well as the application of conventional and novel antimicrobials for the treatment of staphylococcal implant-associated infections, has been investigated in a recent PhD project. 

This project investigates the diagnosis, monitoring of treatment response, and efficacy of antimicrobial therapies for implant-associated infections caused by staphylococci, with a particular focus on vascular graft infections and implant-associated osteomyelitis, using in vivo models. The research comprises three studies:

1. The use of PET imaging to diagnose and monitor the antimicrobial treatment response in vascular graft infections using a rat model.

2. The efficacy of rifampicin-combination therapy for vascular graft infections in a rat model, emphasising its impact on the formation of non-stable small colony variants.

3. Evaluation of alternative antimicrobial therapies for implant-associated osteomyelitis in a mouse model.

Metabolic implications of a high-protein diet in steatotic liver disease

High-protein diet for metabolic fatty liver disease

Metabolic fatty liver disease is a rapidly growing public health challenge, and diet plays a key role in both prevention and treatment. Up to one in four adults in Denmark are affected by fatty liver disease, a condition closely linked to overweight and lifestyle. The disease can lead to serious complications, which is why there is strong interest in finding effective dietary strategies to reduce liver fat.

Epilepsy is one of the most common neurological disorders, but it can be difficult to diagnose and treat, particularly when seizures and EEG present unusual patterns. Some patterns may also be linked to serious complications. The project comprises three studies based on video-EEG recordings. Study 1 showed that motor symptoms are common in typical absence seizures, and that certain EEG findings (polyspikes) may indicate a less favourable treatment outcome. Study 2 demonstrated that focal signs often occur in generalized tonic-clonic seizures but do not seem to affect long-term outcome. A diagnostic flowchart was also validated and showed high accuracy in distinguishing between generalized and focal epilepsy. Study 3 found that changes in rhythmic jerks toward the end of seizures can predict pronounced EEG flattening, a potential marker of serious complications such as SUDEP (sudden unexpected death in epilepsy). Together, the results provide valuable insights into how specific patterns may improve diagnosis, risk assessment and individualized treatment.

Cancellations of operations, caused by different hospital-related reasons, are an ongoing and often unavoidable challenge in healthcare. Surgery cancellation can have negative consequences for patients, relatives, healthcare staff, and the healthcare system as a whole. The aim of this project was to develop an intervention to handle same-day cancellations of orthopedic surgeries. The intervention was built on evidence, exploratory research, theory, and co-production, with the overall goal of reducing the potential emotional impact on patients.The British Medical Research Council’s framework for developing complex healthcare interventions was used as the overall design.

During the development, the prevalence of patient-reported emotional and physical strain followed a cancellation was estimated. Furthermore, patients experience of the cancellation conversation, as well as the initial days of the extended waiting period. Based on these insights, a targeted intervention was created. Respect, defined as actions that uphold a person's dignity, played a central role in shaping the intervention across organisational levels.

Epidemiology of nontuberculous mycobacterial disease in Denmark: insights and global perspectives

The incidence, clinical significance, species distribution, and temporal trends of nontuberculous mycobacterial (NTM) infections in Denmark during the period 1991–2022 are described in a new PhD project from Aarhus University, Health. 

Infections with NTM have been reported as an increasing global health problem and primarily affect elderly individuals with chronic lung disease. NTM, a diverse group of more than 200 bacterial species, can also cause disease in lymph nodes in children, skin and soft tissue infections, and disseminated disease in immunocompromised individuals. Despite the clinical significance and complexity of these infections, their epidemiology remains poorly understood.

Skeletal muscle function is affected by severe obesity and type 2 diabetes. This research aims to advance our understanding of the manifestations, underlying mechanisms, and functional consequences of muscle complications in indiviudals with type 2 diabetes. In doing so, it sheds light on an understudied and unrecognized complication known as diabetic myopathy. Improving our understanding of this complication may help guide early detection and targeted interventions, ultimately preventing or mitigating age-realted functional decline and promoting healthier ageing in this at-risk population.

Skin diseases are among the most common reasons for visiting a general practitioner. Yet for many general practitioners, dermatology remains a challenge – partly due to limited training and long waiting times for specialist care. A new PhD project from Aarhus University, Health, explores which and how skin diseases are managed in general practice in Western Denmark.

The project shows that general practitioners find itch and childhood eczema particularly challenging, and many general practitioners seek additional dermatology training on their own initiative. An analysis of referrals to a hospital-based eczema clinic revealed that referral reasons differed depending on whether the patient came from a general practitioner or a dermatologist. This suggests a need for clearer referral guidelines and improved collaboration across sectors.Finally, the project explored whether fungal infections of the feet and nails could serve as early indicators of type 2 diabetes (unpublished results).

Christina Shen-Zhuang Yde
Department of Biomedicine

Acute ischaemic stroke (AIS) is caused by sudden blockage of a cerebral artery and fast emergency intervention is vital in minimising both physical and cognitive impairments. Nearly half of patients who receive timely and successful removal of the blockage do not recover as expected, and the underlying causes for this remain unknown.

Abnormalities in how blood flows through the brain after AIS have been suggested to play a key role. This may be assessed using the pulsatility index (PI), a Doppler ultrasonography parameter that reflects the resistance of blood flowing through blood vessels in the brain. However, PI is influenced by multiple pathophysiological factors, which complicates its interpretation.

Previous studies have compared PI obtained from the stroke-affected brain hemisphere to the opposite, un-affected side. This approach may be flawed, as the two brain hemispheres are closely connected by anatomical and functional interconntections, whereby pathological changes in one may influence vascular and neuronal dynamics in the other.

This PhD study aims to characterise changes in PI and cerebral blood flow velocity during, and after AIS, and provide mechanistic insights into how blood flows through the brain in the acute phase following AIS.

Relevance of tumor microenvironmental parameters for clinicopathological presentation features, treatment toxicity, and outcome in newly diagnosed and relapsed Hodgkin lymphoma

How the surroundings of cancer cells in Hodgkin lymphoma influence disease development, side effects, and treatment outcomes.

Hodgkin lymphoma is a cancer of the lymphatic system that can today be cured in most patients. Still, some patients experience relapse or serious side effects from treatment. Examination on how the so-called tumor microenvironment, the many immune cells that surround the few cancer cells, may help explain differences in disease course and side effects. The project suggests that the biological microenvironment can contribute to predicting which patients are at particular risk of relapse or treatment complications, such as lung damage after chemotherapy. This knowledge may in the future form the basis for more targeted and gentler treatment strategies.

Emilie Munk Lynderup, 
Department of Clinical Medicine

Wilson disease is a rare genetic disorder in which copper accumulates in the body, primarily in the liver and brain. The prognosis depends on early diagnosis, which faces challenges from false positives, and consistent treatment, which side effects from the medication may limit. The thesis was based on three studies that explored how positron emission tomography scans with the radioactive copper isotope 64Cu can be used for the diagnosis of Wilson disease and to monitor treatment effects.

The first study investigated the effect of zinc treatment on the liver's copper uptake in healthy volunteers. The second study aimed to enhance the diagnostic potential of 64Cu PET scans in healthy participants, individuals carrying the gene for Wilson disease, and Wilson disease patients. The third study investigated the effect of D-penicillamine and the experimental drug methanobactin on copper metabolism in a Wilson disease rat model. Overall, the studies demonstrated that 64Cu PET enables the visualisation of copper metabolism in Wilson disease, and may aid in both diagnosis and treatment evaluation. The results from the PhD project form the basis for further studies, which may validate the clinical use of 64Cu PET for diagnosis and treatment monitoring in Wilson disease.

A strong fixation of cementless knee implants is critical for ensuring longevity. For cementless implants, the surrounding bone plays a major role in the osseointegration of the implant. This PhD project investigated how bone mineral density, fixation methods (bone cement/no bone cement) and antiresorptive treatments influence the fixation of tibial implants, and thereby expectedly the overall longevity of knee implants. 

The project showed that while cementless tibial implants initially migrated more than cemented implants, they stabilised after the first year. Antiresorptive treatments (denosumab and locally applied zoledronic acid) were effective in reducing tibial implant migration. Additionally, local zoledronic acid preserved the bone around the tibial implant by suppressing bone resorption. The findings support implementation of intraoperative zoledronate application locally on the tibial bone to improve implant fixation and preserve tibial bone, which is expected to increase the survival of cementless tibial implants. However, the results should be confirmed by multicentre studies with greater patient volume and various cementless implant types.

Anastomotic leakage is one of the most serious complications in colorectal surgery. A new PhD project from Aarhus University, Health, investigates a laser-based method for assessing intestinal blood flow during surgery.

Using Laser Speckle Contrast Imaging (LSCI), the project explored intestinal microcirculation in both experimental animal models and clinical settings. The findings indicate that this technique may help surgeons identify poorly perfused tissue and reduce the risk of postoperative complications.

Nephrotic syndrome is a kidney disorder that significantly increases the risk of developing blood clots (thrombosis).The research showed that patients with nephrotic syndrome have increased thrombin generation, a key factor in blood clot formation, along with impaired ability to dissolve clots. one part of the study examined treatment with the anticoagulant apixaban to prevent thrombosis: Despite lower blood concentratios in pateints with nephrotic syndrome, apixaban had the same anticoagulant effect as in healthy individuals. In an observational study, no patients receiving apixaban experienced a thrombosis while on treatment, suggesting efficient, prophylactic effect.

Ectodermal dysplasias in Denmark: Nationwide studies of prevalence, characteristics, and prognosis

The prevalence, characteristics, and prognosis of the rare group of genetic skin disorders known as ectodermal dysplasias (EDs) have been mapped in Denmark in a new PhD study from Aarhus University, Faculty of Health. 

EDs comprise a group of rare genetic disorders characterized by abnormal formation of ectoderm-derived tissues, including the skin, hair, sweat glands, and teeth. Population-based investigations of the occurrence and prognosis of EDs have been lacking, and more knowledge is needed to support the care and counseling for patients and their families. This PhD study, therefore, aimed to use Danish national registries and databases to identify and validate a nationwide patient cohort and investigate the prevalence and characteristics of EDs in Denmark, as well as the patients' prognosis related to the risk of death, infectious diseases, and atopic diseases.

Villads Lundsteen Jacobsen,
Department of Clinical Medicine

Individuals admitted with acute coronary syndrome (ACS) who also have diabetes represent a particularly high-risk group in cardiac rehabilitation – a structured programme focused on physical training, prevention, and support following ACS.

The project investigates whether individuals with both ACS and diabetes achieve the same outcomes from cardiac rehabilitation as those without diabetes – and whether they are equally likely to participate in the recommended rehabilitation programme after hospital discharge. The study is based in part on data from municipal cardiac rehabilitation services in the Central Denmark Region.

The results show that individuals with both ACS and diabetes improve their physical capacity to a lesser extent compared to those without diabetes. They are also less likely to initiate rehabilitation after discharge.

Cardiac rehabilitation must be better tailored to people with multimorbidity – including those living with both ACS and diabetes. This group faces increased risks and has more complex needs, calling for more targeted and flexible rehabilitation pathways to ensure equitable access and outcomes, and to accommodate varying levels of function and health status.

New research reveals early brain changes in individuals with a genetic risk for Alzheimer’s disease

Individuals with a genetic risk for Alzheimer’s disease show reduced oxygen metabolism and altered blood flow in the brain. This is demonstrated in a new PhD project from Aarhus University, providing insights into the early development of the disease.

Non-muscle invasive bladder cancer (NMIBC) is a common form of bladder cancer that often returns after treatment. This means many patients, most of whom are elderly, must undergo repeated surgical procedures under general anaesthesia, which carries significant risks. Sometimes, small tumors may be left behind after surgery, contributing to early recurrences. This highlights the need for better diagnostic tools and less invasive treatment options.

Improving the detection of tumors during bladder surgery and assessing whether a gentler, outpatient laser treatment can be a safe alternative to repeated operations is explored in this PhD project.

In the first study, detection rates were compared before and after switching from photodynamic diagnosis (PDD) to narrow-band imaging (NBI) during bladder surgery. The results showed that the two methods were similarly effective in identifying tumors.

The second study examined laser treatment, known as transurethral laser ablation (TULA) of bladder tumors, in an outpatient setting. Patients were treated without general anaesthesia, and outcomes such as cancer recurrence, progression, and pain were monitored. The results suggest that TULA is a well-tolerated procedure with acceptable oncological safety.

The third study evaluated TULA in patients with intermediate- and high-risk NMIBC. Recurrence and progression rates remained low, and the treatment was associated with minimal discomfort. However, further research is needed to confirm long-term safety and effectiveness.

Overall, the project indicates that NBI is just as effective as PDD for detecting certain bladder tumors, and that laser treatment could offer selected patients a less invasive alternative to surgery. These findings may help shape future treatment pathways for recurrent bladder cancer.

3-hydroxybutyrate, commonly referred to as “ketones,” is a natural energy source in the human body and previously primarily known for leading to the serious complication diabetic ketoacidosis in individuals with type 1 diabetes. However, recent research has shown a range of health benefits associated with ketone supplementation. A new PhD project from Aarhus University, Health, has investigated the effects of ketones in individuals with type 1 and type 2 diabetes. 

Results from the PhD project showed that intake of ketone supplements lowers blood sugar and blood fatty acid levels in individuals with type 2 diabetes. These effects may potentially reduce the risk of developing long-term complications such as cardiovascular disease, suggesting that ketone supplements could be a promising treatment option for type 2 diabetes.

Furthermore, the studies showed how ketones reduce the release of fatty acids in the body of individuals with type 1 diabetes. This, in turn, limits further ketone production in the body and may serve as a protective mechanism against ketone levels becoming critically high, which could otherwise lead to diabetic ketoacidosis.

A new PhD project shows how advanced calculations and predictive models can help reduce the risk of side effects in prostate cancer patients treated with proton therapy. The findings may lead to more personalized and gentler treatment plans.

Proton therapy is an advanced form of radiotherapy that better spares healthy tissue compared to conventional methods. However, the increased biological effectiveness of protons can lead to unwanted side effects after treatment. A new study analyzed treatment data from over 800 prostate cancer patients, focusing on a factor called linear energy transfer (LET). The results show that high LET is linked to greater risk of long-term complications. Researchers developed predictive models to identify high-risk patients, enabling more targeted and safer treatment planning. This research marks a step forward in improving outcomes and quality of life for prostate cancer patients.

The phosphatidylinositol 3-kinase complex I beyond the synthesis of
phosphatidylinositol-3-phosphate

A fresh perspective on cellular clean-up: uncovering the hidden role of PI3K complex in autophagy using yeast

How do cells clean up their own waste to stay healthy? A vital process called autophagy allows cells to degrade and recycle unwanted components, helping maintain cellular health. Impairments in autophagy have been linked to several human diseases such as Alzheimer's disease, Parkinson's disease, cancer, cardivascular disorders, and type 2 diabetes. This PhD thesis focuses on a key player in autophagy, a protein complex called the phosphatidylinositol 3-kinase (PI3K) complex I. This complex plays an essential role in autophagy by producing the phosphatidylinositol-3-phosphate (PtdIns3P), a lipid critical for progression of this pathway. Using backer's yeast as a model organism, the thesis uncovers a previously unknown function of the PI3K complex I, shedding new light on its role in autophagy regulation. These findings advance the current understanding of how autophagy is controlled and may pave the way for developing future therapies targeting autophagy-related diseases.

When the aortic valve tightens its grip - Changes in the heart muscle in aortic valve stenosis and prognostic implications

Heart failure (HF), a condition where the pumping heart is unable to meet the body’s oxygen demand, is characterized by debilitating symptoms like breathlessness, ankle swelling, and fatigue. It is associated with high morbidity and mortality. A common and serious complication in HF is skeletal muscle wasting, a gradual loss of muscle mass and function. This decline in muscle health exacerbates symptoms and worsens prognosis. Hence, identifying the mechanisms driving skeletal muscle wasting in HF holds remarkable clinical importance. This PhD thesis comprises four studies that explore different aspects of skeletal muscle wasting in HF.

The studies include optimal identification of patients with low muscle mass, daily physical activity, inflammation, and skeletal muscle mitochondrial function.

An increasing number of people survive an out-of-hospital cardiac arrest, but many experience lasting challenges in everyday life, including reduced ability to carry out daily activities, poor quality of life – and a significant proportion do not return to work. In clinical practice, patients’ cognitive function and ability to perform daily activities are typically assessed at hospital discharge, but can these assessments also be used to identify those who are likely to experience long-term difficulties in daily life? And what are the societal costs associated with cardiac arrest – including healthcare expenses and sickness absence?

The aim of this PhD project was to investigate how survivors of cardiac arrest manage everyday life after hospital discharge, and whether clinical assessments at discharge can be used to identify those at risk of future limitations, reduced quality of life, or failure to return to work. The project also examined the societal costs associated with cardiac arrest.

The results show that a large proportion of patients had reduced ability to perform daily activities at the time of hospital discharge, and that many continued to experience limitations six months later. Assessments of patients’ cognitive function and ability to manage everyday activities at discharge proved to be potentially useful indicators of later difficulties, reduced quality of life, and return-to-work status. Finally, the findings point to substantial societal costs associated with cardiac arrest – not only in terms of healthcare use, but also due to sickness absence and early retirement – with higher costs observed compared to patients who had a myocardial infarction without cardiac arrest.

Parkinson’s disease is caused by the degeneration of dopamine-producing brain cells, leading to motor dysfunction. In her PhD project, Muyesier Maimaitili developed innovative strategies to generate these specific neurons from human stem cells, aiming to restore brain function in affected patients.

Using advanced tools such as gene editing and controlled cell programming, her work improves the efficiency and purity of neuron production in the lab. One of the key breakthroughs includes a strategy to block unwanted cell fates, ensuring that more cells become the desired midbrain neurons used in therapy. By combining developmental biology with innovative stem cell technologies, this research lays the foundation for improved disease models, next-generation drug screening, and future personalized cell therapies for Parkinson’s disease.

Every one of our cells carries the full set of instructions—our DNA—but these instructions can be marked by damage that sometimes slips through repair. In the first part of this work, the genomes of thousands of tumours were scanned for mutational signatures—patterns of DNA damage—that pinpoint why certain sites are especially prone to change, revealing where natural processes or environmental exposures leave their mark.

The second part tracked cell free DNA in the blood of colorectal cancer patients before and after chemotherapy. By detecting single cell damage events, the study showed how treatment produces its own mutational signature and found evidence that chemotherapy may activate APOBEC enzymes, creating lasting changes in healthy stem cells.

Together, these findings offer a clearer picture of the forces shaping cancer genomes and lay the groundwork for future blood based markers to help interpret mutation data and monitor long term treatment effects.

A new PhD thesis investigates whether patients with the kidney disease Minimal Change Disease can be effectively treated with a lower dose of corticosteroids combined with activated vitamin D. The disease causes the kidneys to leak protein and can lead to severe fluid retention in the body.

The current standard treatment with high-dose corticosteroids is effective—but often associated with significant side effects, both in the short and long term. This places a considerable burden on patients and highlights the need for new, gentler treatment strategies.

The thesis also explores how treatment approaches for relapsing disease have evolved over time, with increasing focus on minimizing side effects and tailoring treatment to improve patients’ quality of life and meet individual needs.

The indication for internal mammary node irradiation has been debated for the last 50 years due to  the risk of ischaemic heart disease. Previous studies have demonstrated a survival gain from internal mammary node irradiation. However, breast cancer prognosis has improved substantially due to screening and newer systemic therapies. Therefore, the need for internal mammary node irradiation has been questioned again.

The DBCG IMN2 study included 4541 node-positive breast cancer patients treated between 2007 and 2014. The study found a clinically relevant survival gain of 4.2% at 15-year follow-up in patients treated with internal mammary node irradiation compared with those not receiving it. Furthermore, the PhD project comprehensively evaluated and documented the quality of internal mammary node irradiation in Denmark.

Lastly, the DBCG IMN2 cohort was used to investigate the indication for another radiotherapy treatment modality: a boost to the tumour bed after breast-conserving surgery. These data have changed the Danish guidelines to recommend a tumour-bed boost to all breast cancer patients with ER-/HER2- tumours, regardless of age.

A new PhD project from Aarhus University, Health, investigates how large genomic variants contribute to the heterogeneity of colorectal cancer and evaluates the potential of these variants as biomarkers for patient stratification and recurrence detection.

Colorectal cancer can develop very differently from patient to patient, even when tumors appear similar. Understanding what drives this variability is key to improving treatment and follow-up. Among the possible contributors to these differences are structural variants - large changes in the genome that can be inherited (germline) or arise in cancer cells (somatic). These variants have long been difficult to study due to technical and analytical challenges, but recent advances in genome sequencing are starting to unlock their potential.

In this project, whole genome sequencing was used to explore how structural variants influence gene activity, disease progression, and the ability to detect cancer recurrence through blood samples. The results suggest that both inherited and tumor-specific structural variants can help explain differences in patient outcomes—and may serve as powerful tools for early detection and personalized treatment strategies.

Dyspnea is one of the most common reasons for seeking care in emergency departments and is associated with significant morbidity and mortality. However, it remains unclear how the diagnostic process – including the use of point-of-care ultrasound (POCUS) – best supports patient care.

A new PhD project from Aarhus University, Health, investigates the use of POCUS in the diagnostic work-up of emergency department patients presenting with dyspnea.

The dissertation includes a systematic mapping of existing studies in the field as well as a randomized clinical trial involving patients in the emergency department. The project contributes new knowledge on the role of POCUS in acute diagnostics and offers a methodological foundation for future research and clinical practice.

The NORTH-REG Dwell Time study; Effect of reduced BCG dwell time on side effects and completion rates -
A multinational randomised controlled trial

Potentially preventable hospital admissions are used as a quality indicator in the healthcare system. To understand the mechanisms behind these admissions, it is necessary to consider perspectives at the micro (individual), meso (governance), and macro (system) levels. This has been done through two register-based studies examining the characteristics of older persons admitted with preventable conditions, as well as the impact of multimorbidity on readmissions and mortality. An ethnographic study has explored the practices of healthcare aides in supporting older persons with chronic obstructive pulmonary disease (COPD) who are at risk of preventable hospital admissions.

The register-based studies show that multimorbidity significantly increases the risk of readmission and death, highlighting the need for individually tailored interventions. Patients admitted with preventable conditions represent a heterogeneous group in terms of demographic and clinical characteristics. The ethnographic study underscores the central role of healthcare aides in delivering person-centred care to older persons in home care, where they skilfully balance routine workflows with the ability to notice and respond to changes.

Sex chromosome abnormalities and genotype-phenotype links – clinical and molecular studies of Turner and Klinefelter syndrome

Men and women typically have two sex chromosomes—XX or XY—but what happens when this balance is disrupted? In his PhD project, Lukas Ochsner Reynaud Ridder explored the health consequences of having too few or too many sex chromosomes, as seen in Turner syndrome (45,X) and Klinefelter syndrome (47,XXY). The project investigated why individuals with these conditions often face problems like liver dysfunction, inflammation, or reduced muscle mass. Using advanced molecular methods—including several ‘omics’ technologies—Lukas studied how genetic differences influence disease risk and body function. One study examined how testosterone affects muscle cells in Klinefelter syndrome. Another revealed signs of chronic low-grade inflammation in Turner syndrome and identified a gene, TBL1X, that may help explain this immune response—perhaps pointing to a vital pathway for future treatment.

PhD defence, Anders Guldhammer Skjerbæk Walking impairments are a common and disabling symptom in persons with multiple sclerosis (MS). However, a variety of walking capacity and ability tests are used in clinical practice and research, which may influence treatment decisions and the interpretation of research results.

Consequently, there is a need to investigate the quality and differences between commonly used walking capacity and ability tests, as well as an understanding of the degree of walking impairments and variations across these tests in persons with MS. This new PhD project from Aarhus University, Health, has therefore investigated the psychometric properties of commonly used walking capacity and ability measures and their differences, as well as the degree of walking impairments and differences across these tests in Danish patients with multiple sclerosis.

The title of the project is "Psychometric properties and differences across common measures of walking capacity and ability in patients with multiple sclerosis – implications for clinical practice and research

New research reveals important mechanisms involved in systemic sclerosis: LAG3, PD-1, and PD-L1 are pivotal to the development of the disease.

Maithri Aspari's PhD studies on the disease systemic sclerosis (SSc) have revealed that the immune system proteins LAG3, PD-1, and PD-L1 are central factors in the disease's development. This discovery opens new avenues for understanding the pathogenesis of the disease and may lead to the creation of new therapies for treating this serious autoimmune condition.

Systemic sclerosis is a rare yet serious autoimmune disease that causes a progressive buildup of connective tissue in the skin and internal organs, potentially leading to severe organ failure and reduced quality of life for those affected by it. Despite significant advancements in understanding the disease, the mechanisms behind its development have remained unclear for many years.

The PhD study was conducted in collaboration with the Department of Biomedicine, the Department of Molecular Biology and Genetics at Aarhus University, the Department of Rheumatology at Aarhus University Hospital, and the Royal Free Hospital in London. Maithri Aspari has demonstrated that the immune system-related proteins LAG3, PD-1, and PD-L1 play a crucial role in the development of systemic sclerosis. The researchers have observed that the interaction between these proteins and immune system cells is vital for the inflammatory response characteristic of the disease.

Another significant finding from the study is the role of autoantibodies in SSc.– This study shows that certain autoantibodies erroneously attack the body's own tissues and can induce systemic sclerosis through mechanisms typically associated with our defence against viruses.

A new PhD project from Aarhus University examines whether midlife changes in alcohol consumption and different alcohol consumption patterns throughout adulthood are associated with the risk of breast cancer among postmenopausal women.

Several studies have associated alcohol consumption with the risk of breast cancer among postmenopausal women. However, despite substantial evidence of the effect of alcohol consumption on the risk of breast cancer, it remains largely unknown whether changes in alcohol consumption habits during adulthood and different alcohol consumption patterns are associated with breast cancer risk.

Using data from two large cohorts, we estimated midlife changes in alcohol intake and identified several distinct alcohol consumption patterns throughout adulthood using latent class mixed models. We used regression models to estimate the risk of breast cancer associated with both midlife changes in alcohol intake and the identified alcohol consumption patterns.

This PhD dissertation investigates how brain activity during movement is affected in patients with amyotrophic lateral sclerosis (ALS) – a serious and fatal disease that primarily affects the motor nervous system. Using two types of brain wave scanning techniques, including a novel method with small, flexible sensors called optically pumped magnetometers (OPMs), Tobias Sevelsted Stærmose has shown that specific brain signal patterns are altered in ALS, and that these changes are linked to hand weakness.

The studies also suggest that the new OPM technology could become an important and patient-friendly tool in future ALS research. The findings contribute to a better understanding of how the disease affects the brain and pave the way for the development of new diagnostic tools.

The immune system is essential for detecting and eliminating malignancies, with the tumor immune microenvironment playing a critical role in shaping responses to anti-cancer therapies. In a new PhD project from Aarhus university, new biological and methodological insights into the tumor immune cell landscape are being investigated.

Harnessing the body’s natural defenses to combat cancer is an area of growing therapeutic interest, with the cGAS-STING pathway emerging as a key target due to its potential to activate a strong anti-tumor immune response. This study investigates the cGAS-STING pathway and its role in shaping anti-cancer immunity and treatment response. Focusing on head and neck cancer and radiotherapy, the study highlights how the tumor immune microenvironment influences therapeutic outcomes. It also examines how methodological choices in preclinical models impact immune cell composition in the tumor microenvironment and reveals key differences between tumor implantation sites. Additionally, this thesis introduces a comprehensive 37-color immunophenotyping panel for flow cytometry, as a new tool for studying tumor-immune interactions. These findings enhance our understanding of STING-driven immunity, its therapeutic potential in cancer treatment, and provide valuable methodological advancements for future research.  

Ketone metabolism plays a central role in energy homeostasis, providing an alternative substrate for tissues such as the brain and heart under conditions of limited carbohydrate availability. This PhD project explores key aspects of ketone metabolism, its assessment using advanced imaging techniques, and its modulation by dietary interventions, with a particular focus on myocardial function and metabolism. The PhD project comprises three studies that collectively provide new insights into ketone metabolism, establish PET imaging as a reliable tool for investigating myocardial ketone dynamics, and highlight the potential of dietary interventions like ADF to enhance cardiovascular function. The results contribute to a deeper understanding of the interplay between metabolism and cardiovascular health, offering pathways for therapeutic innovation in metabolic and cardiovascular diseases.

Surgery is a common treatment for prostate cancer. It often leads to complications such as urinary incontinence and erectile dysfunction. While interventions typically address these issues postoperatively, evidence supports prehabilitation and preoperative strategies to optimise physical and mental resources. Heterogeneity and a unimodal focus of current interventions limit their effectiveness.

This dissertation is based on four studies with the overall aim to develop and assess the feasibility of a home-based, multimodal preoperative intervention program delivered via tele-health for patients awaiting nerve-sparing elective radical prostatectomy.

Findings from the studies demonstrated the feasibility and acceptability of a tailored home-based prehabilitation program for patients undergoing radical prostatectomy. While telehealth provides a viable platform for delivering interventions, it cannot fully replace in-person contact with healthcare professionals.

Intensive care units play a crucial role in treating patients with acute life-threatening conditions. Each year, more than 4,000 patients unfortunately do not survive critical illness and die intensive care units. However, there is a lack of knowledge about how palliative care is provided and whether there is consensus among experts in the field.

To address this, three independent studies were conducted, based on Danish health registers, journal audit and surveys among experts in palliative care in intensive care settings. The results show that patients often pass away shortly after life-prolonging treatment is withdrawn. Furthermore, the study indicates that patients who are gradually weaned off intensive treatment could benefit from increased focus on their palliative care needs at the time of discharge from intensive care.

A new Ph.D. project from Health, Aarhus University, explores how a mother's immune system affects her child's immunity and neurological development in the context of autoimmunity.

This Ph.D. defense investigates the complex interplay between maternal autoimmunity and fetal immunity, as well as the potential consequences for neurological development. The study utilizes mouse models of systemic lupus erythematosus (SLE) and employs both embryo-transfer techniques and a pristane-induced lupus model to distinguish genetic factors from influences of the maternal immune system.

These findings highlight that the maternal immune system plays a dual role in both transferring passive immunity and potentially imprinting the child's immune system. The study contributes valuable knowledge on how maternofetal immune interactions may impact the development of autoimmune diseases and neurological disorders in children.

A new PhD project from Aarhus University, Health, combines advanced tissue staining with AI-driven digital image analysis to develop a new digital tool for melanoma diagnostics.

The diagnosis of melanoma is challenging. Immunohistochemical biomarkers, such as Ki67, PRAME, and PD-L1, are often used to guide clinical decisions. However, interpreting these markers can be challenging because they are found not only in tumour cells but also in surrounding tissue. Traditional manual assessments can be time-consuming and prone to variation between pathologists. This project aims to develop a digital tool to help pathologists assess key biomarkers in skin cancer more precisely, enhancing diagnostic accuracy and reproducibility.

In this project, a double nuclear staining method was developed and combined with AI-driven digital image analysis into a tool that measures Ki67 and PRAME specifically in melanoma cells. The performance of this tool was evaluated in a cohort of challenging melanocytic lesions. Furthermore, the project explored whether this method could help predict patient outcomes for those receiving immunotherapy.

The proposed digital tool has the potential for clinical implementation, supporting pathologists with accurate, standardized, and reproducible biomarker measures to support the diagnoses of melanocytic lesions.

New PhD study highlights the need for screening of eating disorders in Danish adolescents with Type 1 Diabetes

A new Ph.D. dissertation is based on the 2-3-fold increased risk of eating disorders and disordered eating among ado-lescents with type 1 diabetes (T1D), aiming to investigate whether a simple systematic screening of these issues in youth is relevant in a Danish context.
The dissertation finds the Danish version of the questionnaire Diabetes Eating Problem Survey-Revised (DEPS-R) to be valid but also identifies limitations in detecting certain severe weight-regulating behaviors. The results show that more than 30% of young women with T1D exhibit signs of disordered eating (20% in the entire group) and that more than 30 % of adolescents in the study have experimented with severe weight-regulating behaviors within the past month.
Young people who participated in the screening were predominantly positive about using DEPS-R, as they recognized the issue in themselves or others, found that it encouraged reflection, and felt that DEPS-R opened the door to new relevant topics for discussion between themselves and healthcare professionals. This underscores the importance of us-ing screening tools in diabetes care. Furthermore, qualitative analyses highlight how diabetes management during adolescence can negatively impact body satisfaction and eating behavior.
The dissertation confirms the need to implement systematic screening to improve early detection and intervention, which may contribute to better health and quality of life for young people with T1D.

Advancing Stent Procedures with Better Imaging Techniques

This PhD study explores how advanced imaging can improve stent procedures for patients with complex coronary artery disease. The study, based on the OCTOBER trial, examines the role of optical coherence tomography (OCT) — a newer high-resolution imaging technique — in guiding these procedures compared to traditional X-ray-based methods.

The aims are to understand why some stent procedures fail, assess how well OCT guidance is followed in clinical practice, and determine whether traditional imaging techniques can provide equally reliable results. By addressing these questions, the study seeks to refine treatment strategies, improve procedural accuracy, and ultimately enhance patient outcomes.

The findings may help optimize the use of OCT in daily clinical practice, ensuring that heart patients receive safer and more effective treatments.

Post-stroke dementia is an important and common consequence of a stroke. Post-stroke dementia is associated with low quality of life and increased morbidity and mortality and thus poses a significant burden on patients and their caregivers. However, the risk factors for post-stroke dementia are still not completely understood. Determining risk factors for dementia among patients with acute stroke can be a first step towards finding preventive measures and treatments for post-stroke dementia.

To address this, we have conducted three nationwide register-based cohort studies of patients with acute stroke in Denmark. The studies linked data from Danish nationwide healthcare and administrative databases using the Danish Stroke Registry as the primary data source. We have examined whether treatment with intravenous thrombolysis of acute ischemic stroke is associated with the risk of post-stroke dementia, whether the incidence of post-stroke dementia differs among socioeconomic groups, and whether patients with acute ischemic stroke and atrial fibrillation have an increased risk of post-stroke dementia.

Mechanisms of Growth Hormone-induced Fibrosis in Human Adipose Tissue

Functional evaluation of intermediate coronary stenosis to guide revascularisation decisions is as sociated with improved patient outcomes and reduced number of stent implantations. However, the recommended pressure-wire-based method, fractional flow reserve (FFR), remains underuti lised. Quantitative flow ratio (QFR) is an angiography-based method for computation of FFR that does not require the use of pressure wires or medically induced hyperaemia. Whether QFR pro vides comparable prognostic benefit as FFR remains unknown.

Therefore we cundected a randomised multicentre trial. A total of 2,000 patients with intermediate coronary artery stenoses were randomly assigned to either a QFR-guided diagnostic strategy or an FFR-guided diagnostic strategy, followed by revascularisation of functionally significant lesions based on the diagnostic result. Moreover, a substudy was undertaken, in which we focused specifically on patients deferred from revascularization based on the QFR or FFR result.

Cancer is the leading course of death globally. It is effectively treated by radiotherapy, but as radiation damages healthy as well as tumour tissue, the overall aim of radiotherapy is to optimise the balance between tumour control and side effects. The location of the tumour and organs at risk are visualised just before treatment by scanning the patient on the treatment couch. Most modalities use X-ray CT, but the recent invention of integrating an MRI scanner with a linear accelerator, so-called MRI-guided radiotherapy (MRgRT), provides MRI images with enhanced soft tissue contrast and allows monitoring of internal organ motion. With these features MRgRT systems have the potential to optimize patient outcomes. 

Experimental validation of radiotherapy treatment plans is a prerequisite to ensure the quality of treatments and patient safety. Today, this is mostly done with point or planar measurements, however, the increased complexity of treatment delivery techniques demands 3D dose verification with high spatial resolution. The overall aim of this PhD thesis was to characterise a 3D silicone-based radiochromic dosimeter and to investigate its potential to validate dose distributions delivered by MRgRT systems.

In the first part of the study, a protocol for dosimeter fabrication was established. Subsequently, the dosimeter was characterised in MRgRT systems and a treatment plan was validated in 3D. Overall, the dosimeter showed clinical potential and applicability for dosimetric verification of treatment delivery of MRgRT systems.

The field of dentistry is continuously evolving to embrace the future. The changing needs of the population and society for dental care and technological advancements pose new demands on future dental care. To adapt to these changes, educating future dentists with a strong profile is essential, enabling them to make well-considered clinical decisions throughout their professional careers. In this profile, the ability to reflect and engage in self-directed learning is central to lifelong learning.

The purpose of the PhD project was to investigate the development of the dental curriculum. In addition, contribute to the knowledge of how learning tools such as reflective writing and multiple-choice questions (MCQ) can affect dental students' reflection and self-directed learning. To investigate this, we conducted three studies. First, we reviewed the literature for trends in curriculum development. In the second study, we examined dental students' perceptions of self-directed learning using MCQ as a learning tool. In the third study, we investigated whether reflective writing as a learning tool affects dental students' self-directed learning and reflective thinking ability.

There is a critical need to develop better medical treatments for patients with advanced cancer. Researchers are therefore working to find new ways to target cancer cells. In a new PhD project from Aarhus University, Martin Qvist Rasmussen has investigated two new potential targets for cancer treatment: the enzyme EGLN1 and the endocytic receptor LRP2.

Studies on the enzyme EGLN1 have shown that it plays an important role in the growth of melanoma cells. Inhibiting EGLN1, either genetically or with a drug, causes the cancer cells to stop dividing. This results from EGLN1 inhibtion altering the metabolism of cancer cells, limiting their ability to produce energy and molecules necessary for cell division. Drugs that inhibit EGLN1 have recently been clinically approved for the treatment of anemia in patients with chronic kidney disease. The results of this study therefore suggest that EGLN1 inhibitors could be repurposed as a potential new treatment for melanoma.

Studies on the endocytic receptor LRP2 have shown that it is highly expressed on the surface of cancer cells in several cancer types, particularly in mesothelioma. This discovery provided the basis for investigating LRP2 as a new target for drug delivery to cancer cells. To test this approach, monoclonal antibodies and antibody-drug conjugates against LRP2 were developed. These antibody-drug conjugates could selectively and effectively kill cancer cells expressing LRP2.

 The results of this PhD project provide the basis for further preclinical studies on EGLN1 inhibitors and LRP2-targeting antibody-drug conjugates as novel cancer treatments.

More than half a million Danes live with type 2 diabetes or ischemic heart disease, the vast majority of whom are treated in general practice. One in five patients also experiences poor mental well-being, such as depression or anxiety. This not only represents a significant burden for the individual but is also associated with poorer disease management and, ultimately, higher mortality rates.

In this Ph.D. study, we explored the use of problem-solving therapy in general practice. Initially, we investigated the feasibility of implementing this treatment in a general practice setting, and subsequently, we designed and conducted a randomized controlled trial to assess its effectiveness.

Citizens with screen-detected cardiovascular disease: Experience and adherence to preventive medication.    

This PhD project aims to gain insights into how citizens experience and adhere to recommendations for preventive medication for screen-detected cardiovascular disease (CVD), and how they are supported in their medication decisions.

CVD is the second leading cause of death in Denmark, with approximately one in four Danes dying from CVD each year. Research indicates that preventive medication for asymptomatic CVD, detected through screening, can reduce the risk and mortality of CVD, such as blood clots. However, there is a lack of knowledge about how citizens experience and adhere to recommendations for preventive medication initiated through screening. Additionally, there is a need for more insight into how citizens are supported in making informed medication decisions.

How does culture shape the way we hear, feel, and connect through music? This PhD project explores how cultural upbringing shapes not only our experience of music but also how we use it to engage with the world around us. 

Music is often called a universal language, but the way we listen, enjoy, and interact with it is deeply influenced by the culture we grow up in. This researcg takes the perspective of two distinct cultures, Denmark and China, to explore how culture shapes our relationship with music - and with each other through music.

The project includes five studies. The first three investigate how Danish and Chinese listeners perceive the three most fundamental components of music: rhythm, harmony, and melody. These studies reveal distinct cultural differences in what listeners find enjoyable and meaningful in their own and each other's musical traditions. Using behavioral and brain data, combined with advanced computational models, the research highlights how cultural upbringing influences not just our musical experiences but also how we make sense of the world around us.

The final two studies explore music’s social role, examining how cultural values shape our ability to synchronize and form emotional connections. By studying music cooperation and connection across cultures, the project highlights both what makes us different and what unites us.

Restoring STING and IFNλ signaling for anti-tumoral immunity using CRISPR activation

The cGAS-STING pathway is an immunological signaling pathway essential in th prevention of cancer. Activation of the pathway leads to the production of signaling molecules including interferons (IFNs), which can enhance antitumor immunity. However, suppressed STING expression is a common immune evasion mechanism in tumors, leading to reduced immune cell infiltration and weakened antitumor response. We developed a novel approach of increasing antitumor immunity by upregulating levels of the STING protein itself using CRISPR activation (CRISPRa). Although type I IFNs are commonly associated with STING activation, emerging research highlights the role of type III IFNs (IFNλ) in cancer immunity. IFNλ only affect a subset of cells and are thought to have fewer systemic side effects than type I IFNs which affect basically all cells. In lung cancer cell lines, we found that cGAS-STING pathway activation preferentially induced IFNλ. However, IFNλ signaling was impaired due to reduced expression of the receptor subunit IFNLR1. Using CRISPRa to restore IFNLR1 expression, we enhanced IFNλ signaling, leading to decreased cell viability and increased chemotherapy-induced apoptosis

Measurement and visualisation of the jawbone is required to replace missing teeth with dental implants. In some cases dentists can be dependent on scans with heavier radiation doses. In recent years a growing interest and technological advances has been seen in the field of magnetic resonance imaging, a scanning type free from radiation. A new PhD project from Aarhus University, Health, investigates the precision by which jawbone measurements can be achieved using this technology as compared to conventional X-ray based scans.

In the first part of the project the existing literature was reviewed to establish the state of affairs. This lead to two articles pinpointing strengths, weaknesses, and raised new questions regarding the potential of magnetic resonance imaging in dentistry.

In the second part of the project laboratory scans of human jaws was performed using magnetic resonance imaging technology to compare scans acquired with this relatively new technology to those from an older, radiation-based technology. During this period the method was refined and further parameters were introduced. This lead to two research articles.

The results of the project helped creating a model to measure and discuss bone measurements performed using magnetic resonance imaging in a controlled setup. It was shown that jawbone measurements could be performed with similar precision utilizing the two different methods of imaging: with and without exposure to ionising radiation.

The innate immune system recognizes bacteria using specialized molecules. The immune system relies on pattern recognition molecules (PRMs) and receptors (PRRs) to identify specific carbohydrate patterns on bacterial surfaces. These interactions help trigger immune responses, including the complement system, which fights infections. The focus of this PhD project has been to investigate these carbohydrate binding PRMs and PRRs an how they recognize various bacterial carbohydrate patterns.

In one study it was investigated how PRMs of the complement system like mannan-binding lectin (MBL) and ficolins bind to components of Gram-negative bacteria, such as lipopolysaccharides (LPS). These molecules recognized the O-antigen part of LPS, with unique binding patterns for each PRM. Experiments showed that factors like bacterial structure and environment also influence binding.

Another part of the project examined the interactions between C-type lectins (MBL, Surfactant protein-D, and langerin) and the Gram-positive bacterium Staphylococcus aureus specifically evaluating two carbohydrate structures Capsular polysaccharide (CP) and wall teichoic acid (WTA). S. aureus can produce CPs that impaired recognition by all three C-type lectins. While MBL binds to WTA, Langerin appeared to recognize additional bacterial components on the surface of S. aureus

Developmental transdiagnostic mechanisms underlying Functional Somatic Symptoms

Functional Somatic Symptoms (FSS) correspond to those physical symptoms like headaches, abdominal pain and fatigue, that can commonly not be attributed to a well-defined somatic condition. FSS are common in young people, and global prevalence rate of any kind of FSS estimates 31% to be affected. The etiology underlying FSS is suggested to be complex and multifactorial, involving various interacting biopsychosocial risk factors and mechanisms to placed young people at risk for developing FSS already at a young age. This project from Aarhus University, Health, offers new insights into child- and familial- risk factors for FSS at various developing developmental stages. Further, the project shows developmental symptom paths and highlights co-occurring psychopathology during adolescence, and emphasizes potential new avenues for preventive measures.

Gestational diabetes is a temporary form of diabetes that can develop during pregnancy, posing significant health risks for both mother and child in the short and long term. While there has been considerable progress in understanding the physiological aspects of gestational diabetes, less attention has been given to the psychosocial aspects, particularly the stigma experienced by women with gestational diabetes.

This PhD project investigated the stigma associated with gestational diabetes through four studies: a literature review, a qualitative interview study, a psychometric scale validation study, and a quantitative association study. One of the key findings is that women with gestational diabetes, both in Denmark and globally, may feel stigmatised due to their diagnosis. This includes experiences of negative treatment from healthcare professionals and close family members, which can lead to feelings of guilt and shame about their condition. As a consequence, some women reported avoiding disclosing high blood sugar levels or declining gestational diabetes screening in future pregnancies. These findings highlight the need for further systematic research into the stigma associated with gestational diabetes, the consequences, and potential strategies to reduce the stigma experienced by women with gestational diabetes.

Laurits Taul-Madsen, 
Department of Public Health 

Long-term effects of exercise on physical function in people with multiple sclerosis – the effect of exercise booster sessions

Multiple Sclerosis (MS) is a neurodegenerative disease affecting approximately 19.000 people in Denmark. MS presents with a broad range of symptoms, with one of the most frequently reported being loss of physical function. However, one of the most promising strategies to improve this specific symptom, and many others, is exercise. Nevertheless, sustaining an adequate level of exercise over time can be challeging. Therfore, the present study aimed to investigate the term effects of exericse by applying so called exercise booster sessions.

The project explores how the brain processes and remembers music, focusing on long-term memory and aging. While memory has been widely studied in visual tasks, this work dives into the lesser-explored auditory domain, especially music. Using advanced brain imaging techniques and cognitive tests, it investigates how we encode, store, and retrieve musical memories, how different auditory memory systems interact, and how aging affects these processes. Key results revealed that musical memory relies on the hierarchical interplay between brain regions involved in audition, memory, and decision-making, that working memory abilities and musical complexity are associated with better recall of musical sequences, and that healthy older adults recruit compensatory brain mechanisms to support recognition of musical sequences. Overall, this PhD dissertation advances our understanding of auditory memory and provides novel insights into cognitive aging.

External cervical resorption: Prevalence in adolescents, radiographic diagnosis and long-term prognosis

External Cervical resorption (ECR) is a pathologic condition in teeth, which damages the hard tissue. Over time, ECR risk progression and can lead to tooth loss. ECR is often detected by incident in radiographs, since ECR mostly appear asymptomatic. A new PhD project from Aarhus University, Health investigates the effect of two-dimensional (2D) and three-dimensional (3D) radiographic methods in diagnosing and assessing long-term prognosis of ECR.

In the first part of the project, a group of adolescents was examined to estimate the prevalence of ECR in posterior teeth in 2D and 3D radiographs. A small fraction of patients showed sign of ECR in 2D radiographs and therefore 3D radiographs were performed. The conclusion was that only a low number of patients were diagnosed with ECR.

The second part of the project, focused on comparing the severity of ECR in teeth in a group of referred patients based on 2D and 3D radiographs. The 3D radiographs showed more severe extension of ECR in more than one third of the cases compared to 2D radiographs.

In the third part of the project, a group of referred patients were examined in order to assess long-term prognosis for teeth with ECR in the same two radiographic modalities. The results showed that in almost one third of the cases long-term prognosis changed based on additional information from 3D radiographs. 

This PhD study explores the research opportunities of using existing data to follow children with obesity in a real-life setting. The aim was to investigate the long-term effect of already implemented municipality-driven lifestyle interventions and to better understand mechanisms related to the weight development in children already classified as having obesity.

The PhD study was conducted by combining the national registers with measures of weight and height obtained at the schools, hereby allowing the researchers to follow the individual child throughout childhood.

Management of bowel dysfunction following treatment of pelvic organ and colon cancers

The increasing number of cancer survivors in Denmark and globally has highlighted a critical need for dedicated rehabilitation services to address late sequelae from treatment. While many cancer survivors live with lasting physical and psychological effects, access to specialized rehabilitation services remains limited. In Denmark, national efforts, including the integration of survivorship care plans, have aimed to address these gaps in cancer care.

This dissertation examines the challenges faced by pelvic organ and colon cancer survivors, particularly those who experience late bowel dysfunction—a common and complex issue that diminishes quality of life for many patients. This research is part of a broader initiative led by the Centre for Research on Survivorship and Late Adverse Effects after Cancer in the Pelvic Organs, which was established to improve support for survivors through the creation of specialized late sequelae clinics. These clinics, founded in 2017 and 2018, employ multidisciplinary, algorithm-based approaches to address the diverse needs of patients with bowel dysfunction.

Through studies conducted within these clinics, this thesis investigates the effectiveness of specialized, patient-centered care in managing complex gastrointestinal sequelae. Findings aim to inform future cancer rehabilitation efforts by identifying effective treatment modalities and improving our understanding of the physiological mechanisms underlying these sequelae.

Heart disease is a significant threat to individuals with chronic kidney disease (CKD), especially those with severe CKD or kidney failure. In particular, coronary artery disease (CAD) plays a critical role in raising the risk of heart attacks and mortality in this group. Therefore a new PhD project at Aarhus University, Health investigated CAD among patients with severe CKD using coronary computed tomography angiography (CCTA).

The PhD project analyzed data from three historical patient cohorts in Western Denmark (2008-2021), with the majority of studies focusing on potential kidney transplant candidates. The findings reveal that patients with reduced kidney function show increased signs of adverse CAD characteristics, including high-risk plaques, higher burdens of calcified and non-calcified plaque, and impaired coronary flow which elevate the likelihood of heart attacks and other cardiac events. The project also indicated a low usage of systemic medical therapy among patients with reduced kidney function, despite the increased risk of cardiac events among these patients.  This research suggests that by leveraging CCTA, healthcare providers may better evaluate and address heart disease risk in CKD patients, especially in those being evaluated for kidney transplantation. Furthermore, it underscores the heightened cardiac risk in patients with reduced kidney function, and the need for optimizing and developing systemic preventive therapy in such patients

Rethinking Ethylmalonic Encephalopathy
Ethylmalonic Encephalopathy (EE) is a rare disorder caused by an inability to break down sulfide, a natural chemical that in normal levels helps relax blood vessels. In EE, sulfide builds up to toxic levels, blocking the body’s energy production and causing serious symptoms early in life. The project explored the use of cobinamide, a natural compound related to vitamin B12, to clear excess sulfide from the body. In laboratory and animal models, cobinamide has shown potential in neutralizing sulfide safely. However, despite its success in these models, cobinamide had limited effect in tests with cells and mice affected by EE. This unexpected result led to a re-evaluation of what drives EE, suggesting that the disease may involve more than just sulfide buildup and highligting new mechanisms that might give rise to the symptoms. This research could open new directions for understanding and treating EE by focusing on other underlying mechanisms of the disease.

Protecting Brain Health in Alzheimer’s Disease
Alzheimer’s disease is often accompanied by accumulation of protein debris around brain blood vessels. This can worsen disease progression and complicate treatment. To understand the effects of this buildup, brain tissue from a mouse model that mimics this disease feature was examined. To counteract these damaging changes, a class of well tolerated drugs used for treating mountain sickness and glaucoma, was tested. Remarkably, in agreement with recent reports, both drugs from this class reduced many of the harmful protein changes, helping to preserve vital brain connections in the Alzheimer’s model. This suggests that these repurposed drugs could be effective in slowing down the disease’s progression by maintaining brain health longer, potentially offering a new avenue for Alzheimer’s treatment.

Long COVID is a global health issue, and up to 10% of individuals infected with SARS-CoV-2 develop prolonged symptoms. There is currently no treatment, and the reason why some develop long-term effects is unknown. This project includes the world’s first treatment with a medication targeting long COVID. Furthermore, the project examines the presence of specific antibodies against the patient's own immune system and explores a genetic basis for the development of long-term effects after COVID-19.

Axial spondyloarthritis pathogenesis remains poorly understood and is difficult to diagnose in the early stages of the disease. While effective therapy is available, early disease identification continues to pose a challenge. The PhD study explores the complement system concerning diagnosis, disease activity, treatment response, and radiographic progression in patients with axial spondyloarthritis. The research involves cross-sectional and longitudinal cohorts conducted in collaboration with partners at COPECARE, CeVig, and Charité.

Endothelial cells (ECs), which line blood vessels, are essential in regulating immune responses by facilitating the passage of immune cells from the bloodstream to infection sites. This process increases vessel permeability and requires the rearrangement of junctional proteins between ECs, the expression of adhesion markers on their surface, and the release of inflammatory molecules. Moreover, these changes often require metabolic shifts in the ECs to support their activated state.

Coronary Magnetic Resonance Angiography (CMRA) is a non-invasive modality that can investigate Coronary Artery Disease (CAD) without the use of ionising radiation or iodinated contrast agents. However, prior clinical use has been inhibited by the long acquisition times, substantial technical expertise requirements and comparatively poor spatial resolution compared to other methods. Development of deep learning (DL) based automated software for planning and acquisition may overcome some of these challenges.

Epstein-Barr virus (EBV) is associated with the development of a wide range of cancers, including post-transplant lymphoproliferative disorder (PTLD) among solid organ transplant recipients. Consequently, screening for EBV-DNA in blood compartments (EBV-DNAaemia) is now included in international guidelines for transplant recipients. However, the clinical significance of EBV-DNAaemia in plasma and whole blood is yet to be determined, and evidence-based therapeutic preventive strategies against PTLD remain scarce.

This PhD project aimed to investigate 1) the clinical spectrum of EBV-associated disease in patients from the Central Denmark Region and to assess the diagnostic accuracy of EBV-DNAaemia in this population, 2) to estimate the incidence and risk factors for PTLD in EBV-seronegative kidney transplant recipients in the contemporary era of immunosuppression, and 3) to investigate the incidence of EBV-DNA in both plasma and whole blood as a predictor for PTLD in kidney transplant recipients.

Malnutrition requiring hospitalization, among children under 5 years of age, remains a major problem globally. Mortality is high and up to 2 out of 10 children die during hospitalisation. If this high mortality is to be lowered, it is necessary to find new treatment strategies to improve hospital management. The acute malnourished children can develop severe wounds and peeling of the skin, among other things. This is a symptom of malnutrition for which the cause is not yet known and for which the World Health Organization's (WHO) treatment guidelines do not yet provide an evidence-based management.

This PhD study is an investigation of skin changes in severe acute malnutrition. Published knowledge is reviewed, nomenclature is established and a scoring tool for clinical documentation of the skin changes is developed through a prospective observatory study. The prognostic effect of the skin changes is investigated and an exploratory study of the immune status of the patient group is included. Finally, a qualitative study of the challenges among health personnel illustrates the use of methods from health anthropology to identify the local agenda within the subject.

Coronavirus infections typically give rise to common cold symptoms. However, rare viral variants emerge, causing severe respiratory disease. At the outbreak of the SARS-CoV-2 pandemic in 2020, the lack of specific prophylactic and therapeutic treatment options was limiting for patient care. This PhD thesis explores the development of novel SARS-CoV-2 specific monoclonal antibodies for SARS-CoV-2 prophylaxis, through three stages: 1) Discovery of neutralizing monoclonal antibodies from convalescent individuals. 2)  In depth characterization of antibody potency, sensitivity to viral variants, and therapeutic potential of preventing infections in mice. 3) Investigation of the possibility of delivering antibody genetic sequences through Adeno Associated Virus for long-term expression and passive immune-prophylaxis.

Chronic cluster headache ranks among the most severe pain conditions known to man. Patients experience excruciatingly painful headache attacks, often described as a knife stabbing the eye. Sometimes, patients suffer from these headache attacks multiple times a day. For some patients, the conventional medical treatment options fail to provide sufficient relief. For this group of patients, a treatment modality called neuromodulation may be an option. Neuromodulation is a therapy where a nerve structure stimulated by weak electrical currents. Several smaller studies have shown that electrical stimulation of the so-called occipital nerves at the back of the head - occipital nerve stimulation (ONS), where a stimulation electrode in implanted under the scalp - can prevent the painful cluster headache attacks in patients where other treatment options seem exhausted.

A new Ph.D. project from Aarhus University, Health, systematically investigates the effect of ONS as a preventive treatment for patients with severe chronic cluster headache. The dissertation presents a database study of the clinical effect on patients already undergoing ONS treatment. It also includes an examination of the efficacy of a simpler, non-invasive stimulation, where the occipital nerves are stimulated through the skin of the scalp, and whether the effect of this transcutaneous stimulation can predict the effect of the implanted ONS electrode. 

Hip fracture is a devastating and common injury among older adults. The incidence rate of hip fracture in Denmark is among the highest globally and has increased in recent years. Despite infection being a potentially preventable and treatable condition, it remains one of the most frequent complications and causes of death following hip fracture surgery. Risk of infection after hip fracture has also increased.

What determines if the immune system can attack cancer cells? And how can we support it? This has been investigated in a new PhD project from Aarhus University, Health. 

The immune system plays an important role in cancer and represents a potential source of future treatments. One the constituents of the immune system, cells known as macrophages, are able to attack and kill cancer cells under the right conditions. This PhD project has investigated which factors regulate the ability of macrophages to destroy cancer cells, and how these factors can be medically influenced. The results of the project suggest that new techniques can potentially be used to support macrophage killing of cancer cells, and are based on laboratory experiments performed at the Department of Clinical Biochemistry at Aarhus University Hospital.

Follicular lymphoma (FL) is a lymphoid malignancy derived from germinal center B cells. Despite advancements in treatment, the disease remains generally incurable with recurrent relapses. Furthermore, a subset of patients will experience treatment refractoriness, early disease progression, and histological transformation into a more aggressive lymphoma type, most often diffuse large B-cell lymphoma. This event is manifested by a rapid clinical course, often with unresponsiveness to treatment, and shortened survival. Thus, transformation marks a pivotal change in disease trajectory, yet reliable predictors for subsequent progression or transformation remain elusive.

This Ph.d. project describes the transformation of FL, with the aim to unravel pre-treatment biological differences underlying the diverse disease course for upfront personalized risk stratification and improved patient care.

The dissertation comprises eight original papers. These include several molecular biological investigations of proteins and gene expression thoroughly examined in relation to transformation of FL, revealing predictive potential of several proteins in the neoplastic cells as well as the tumor microenvironment.

Workplace intervention to reduce sick leave among pregnant hospital employees – a cluster randomized trial.

In a recently completed Ph.D. project from Occupational Medicine, Aarhus University Hospital and Aarhus University, Jane Lauridsen evaluated an intervention with occupational midwifery support on pregnant employees' sick leave and well-being.

Sick leave during pregnancy is common and 36% of all pregnant employees are absent for more than two weeks. Sick leave can be associated with individual and occupational factors. Occupational factors can be exposure to harmful agents or strenuous working conditions such as walking and standing, heavy lifting, or shift work. Work adjustment is associated with reduced sick leave.
This project evaluates an intervention aiming to reduce strenuous occupational exposures. The overall aim was to evaluate the effect of occupational midwifery support, where midwives facilitated risk assessment and work adjustment in meetings with pregnant employees and their managers.
The study was conducted at Aarhus Universityhospital as a cluster-randomised trial with hospital departments allocated to intervention or reference.
In addition to evaluating midwifery support, the projct also investigated managers´ perspectives and engagement in pregnancy policy.

The intricate interplay between inflammatory bowel disease (IBD), cancer, infections, and mortality is explored in a new PhD project at Aarhus University, Health.

IBD are chronic, immune-mediated inflammatory disorders encompassing Crohn’s disease and ulcerative colitis. Patients with IBD face an increased risk of developing colorectal cancer, as well as several other types of cancer.

When patients with IBD develop colorectal cancer, their prognosis is typically worse compared to those without IBD, which may be exacerbated by their inherent increased risk of infections. Serious infections are a leading cause of hospitalization and mortality among IBD patients. Moreover, infections account for more than half of all oncology-related hospital admissions, negatively affecting cancer-specific survival rates.

This PhD project provides novel insights into the association between IBD and post-cancer infection risk, as well as the link between IBD and post-colorectal cancer mortality, based on data from a Danish cancer cohort.

Broadly neutralizing antibodies (bNAbs) are being used in clinical studies which seeks to lower the viral reservoir in persons living with HIV-1. bNAbs have shown to be able to neutralize cell-free virusparticles and activate the immune system and thereby increase the pressure on HIV-1 infected cells. Due to a high mutation rate in HIV-1, the bNAbs do not have an effect in all persons living with HIV-1, which makes it important to screen virus from the participants prior to inclusion in a study using bNAbs. 

In this PhD project a published clinical study is presented, in which persons with HIV-1 were randomised to receive two bNAbs and a drug (Lefitolimod), which have shown to reactivate virus in HIV-1 infected cells. The participants stopped their normal antiviral treatment and the study showed that participants who received the bNAbs had longer time before virus was detectable in the blood, than participants who did not receive the bNAbs.  

Addtionally, a study in which methods to screen participant-specific HIV-1 for sensitivity toward the bNAbs were compared. The study showed that there can be differences in the methods which are being used for sensitivity assessment for the bNAbs.

Fluorescence Microscopy of the Living Kidney to Visualize and Understand Renal Physiology

The dissertation is centered around a cutting-edge microscopy technique that allows the real-time visualization and assessment of kidney function in living small rodents. The research introduces key advancements aimed at overcoming the challenges of data acquisition and processing in this complex field. In addition, the study highlights two practical applications of this technology, offering new insights into renal physiology and potential implications for future medical research.

Diabetic polyneuropathy is a common and debilitating complication to diabetes that affects up to 50% of all patients with diabetes. It affects the long nerves of the body, causing loss of sensation as well as unpleasant sensory disturbances in the feet and legs. Between 10-35 % of patients with diabetic polyneuropathy suffer from pain. It is currently unknown what causes pain to develop. This condition, especially with concurrent pain, impacts the quality of life of patients in various negative ways, and no satisfactory treatment exists. Despite this, diabetic polyneuropathy has often been considered an overlooked complication to diabetes, which may be the reason that there are few detailed studies on its development over time.

This PhD project followed patients with diabetic polyneuropathy and type 2 diabetes over five years using state-of-the-art diagnostic methods to determine how both diabetic polyneuropathy and pain develops over time, which patients develop pain, what impacts this development, and how these changes affect patient quality of life and mental health.

Autoimmune diseases are rising in society and a huge burden to patients. The main characteristic shared by all of them is the patient’s own immune system attacking the body and damaging organs, up to the point of failure. However, current treatment options are limited and come with severe side effects such as infections and even cancer.

The development and progression of autoimmune diseases is complex, long-lasting and not fully understood – including the emergence and shutdown of autoreactive germinal centers, which are presumably contributing to disease progression, especially the germinal centers in the spleen.

The emergence and shutdown of germinal centers are week-long dynamic processes and therefore difficult to capture and understand. Thus the development of novel techniques is necessary to study germinal center dynamics to help understand the development and progression of autoimmunity to one day hopefully being able to develop better treatment.

In my PhD defense, I will present a newly developed and validated approach to study autoreactive germinal center dynamics over two weeks in a living organism by using serial intravital microscopy of the spleen. I will furthermore present how we are exploiting this technique to shed more light on the development of autoimmunity.

A positive screening test for colorectal cancer, but no cancer - What now?

In a recently completed Ph.D. project from Aarhus University and Randers Regional Hospital, Pernille Thordal Larsen investigated how many people are diagnosed with colorectal cancer after initially being screened without any findings of cancer. 

The evidence supporting the Danish recommendations for follow-up after a screening-derived colonoscopy is limited, despite the fact that since 2014, these recommendations for colonoscopy follow-ups have led to a significant increase in the number of colonoscopies performed in Denmark. This Ph.D. project utilized Danish health registers and databases to investigate how many people are diagnosed with cancer after initially undergoing a screening process that did not result in a cancer diagnosis. The project found that, in general, there were few cases of cancer, but the number of polyps found during the colonoscopy was a poor indicator of the risk at the next screening or follow-up examination. Therefore, it is concluded that screening recommendations should be based on risk factors that consider more than just the results of the colonoscopy, and further efforts should be made to ensure high-quality colonoscopies for all screening participants in Denmark.

Towards more accurate and gentle surgery for women with endometrial cancer - The SENTIREC-endo study

In endometrial cancer, the presence of lymph node metastasis is the most significant negative prognostic factor. Surgical staging is performed to identify women with lymph node metastasis to allocate them to adjuvant therapy, with the overall purpose to improve survival. Sentinel lymph node (SLN) mapping represents an accurate and minimally invasive staging technique, with the potential to increase the identification of lymph node metastases. This PhD thesis is based on two national prospective studies, SENTIREC-endo I and II, that investigated aspects of SLN mapping implementation in women with endometrial cancer. SENTIREC-endo I presents the result of a national protocolled implementation of SLN mapping in women with low- and intermediate-risk endometrial cancer. We conclude that SLN mapping, in a centralized setting, carries a very low risk of peri- and postoperative complications and that women benefit from the procedure in terms of increased detection of lymph node metastases compared to previous standards. Despite more comprehensive surgery for a large proportion of women, SLN mapping was not associated with an increased risk of clinically significant lymphoedema. SENTIREC-endo II, investigated diagnostically safe SLN mapping algorithms to replace the standard of pelvic and paraaortic lymphadenectomy in women with high-risk endometrial cancer. We identified two safe surgical algorithms. The SENTIREC-endo studies have changed clinical guidelines towards more gentle and accurate surgery for women with endometrial cancer and lead to new international evidence.

Tuberculosis is an infectious disease that is especially prevalent in low-income countries, where poverty and crowded living conditions contribute to disease transmission. Although tuberculosis can be cured with antibiotics, it is estimated that over 10 million people develop tuberculosis, and over 1 million people die from tuberculosis every year worldwide.

Malnutrition, especially undernutrition, is a well-known risk factor for developing tuberculosis. An insufficient intake of energy, protein, and micronutrients, weakens the immune system and thereby increases the risk of developing tuberculosis. Malnutrition may be a result of food insecurity in low-income countries. Furthermore, tuberculosis disease causes malnutrition through various disease-specific effects on the body. It is often difficult to ascertain which comes first - malnutrition or tuberculosis - and which makes the other worse.

The West African country Guinea-Bissau is one of the poorest countries in the world. It has a high prevalence of both food insecurity and tuberculosis. The Ph.d. project explores the relationships between malnutrition and tuberculosis in Guinea-Bissau, and examines if a combined treatment of both malnutrition and tuberculosis is beneficial to patients.

Fernando Valentim Bitencourt, Department of Dentistry

The prevalence of periodontitis, an inflammatory condition that affects the tissues supporting teeth, is three times greater in individuals with Type 2 Diabetes Mellitus (T2DM) than in those without T2DM. Despite this prevalence, the relationship between periodontitis and diabetes-related complications has remained unclear until now. The PhD studies, conducted through population-based studies, analyzed data from participants across US and Denmark: the National Health and Nutrition Examination Survey (NHANES) and the Health in Central Denmark (HICD) study. The findings reveal that periodontitis co-occurs with other diabetes-related complications, influenced by factors such as age, sex, obesity, physical activity, diet, socioeconomic status, smoking, HbA1c levels, and dyslipidaemia. The study also demonstrated that higher HbA1c levels and obesity had a significant indirect effect on periodontitis through dyslipidaemia. In addition, diabetic retinopathy, neuropathy, and both complications increase the likelihood of developing periodontitis by 1.2 to 1.5 times. Furthermore, dyslipidaemia was shown to significantly modify the odds of 'moderate/severe' periodontitis, particularly when multiple diabetic microvascular complications are present.

Faecal microbiota transplantation (FMT) involves the transfer of intestinal microbiota from a healthy donor to a patient. The choice of donor is crucial to ensure a safe and possible also effective treatment. Despite this, faeces donation criteria are not based on evidence.

The aim of this project was to produce knowledge that will contribute to establishing evidence-based criteria for faeces donation. A wide range of donor criteria are addressed, including gastrointestinal symptoms and bowel habits, asymptomatic Helicobacter pylori carriage, and an assessment of whether donor factors affect the clinical effect of FMT in patients with Clostridioides difficile infection.

Screening for breast, colorectal, and cervical cancer can reduce morbidity and mortality from these three types of cancer, but participation in the three national screening programmes varies.

The aim of the PhD project was to investigate cross-programme synergies and correlations across the three cancer screening programmes in Denmark.

In a clinical intervention study, women attending breast cancer screening in the Central denmark Region were offered an administrative check-up on their screening status for cervical and colorectal cancer. Women who were not up-to-date with their screenings were subsequently offered the opportunity to perfom self-collected screening for cervical and colorectal cancer.

In two register-based studies, the relationship between screening participation and both sociodemographic data and level of health literacy was examioned to better understand the characteristics of those who do not participate in all three screening programmes.