Levanger Hospital

BACKGROUND:Adrenal crisis is a life-threatening emergency. Despite preventive strategies, previous reports suggest increasing incidence and substantial mortality, but robust validated data are limited. OBJECTIVE:To assess temporal trends in adrenal crisis incidence and identify associated risk factors. METHODS:We studied 1040 patients with autoimmune or idiopathic primary adrenal insufficiency enrolled in the Norwegian Addison Registry. Medical records were reviewed for crisis-related hospitalizations between 2000 and 2023. Overt adrenal crisis was defined by acute clinical deterioration with hemodynamic or biochemical abnormalities, whereas incipient crisis was defined by typical symptoms without objective abnormalities. RESULTS:During a median follow-up of 15 years, 660 patients (63%) experienced crisis-related hospitalizations, and 265 (25%) had an overt adrenal crisis after diagnosis. The incidence of overt crises was 3.2 per 100 person-years and that of incipient crises was 6.9 per 100 person-years. Admission rates for incipient crises increased significantly over time (p < 0.001), whereas overt crisis rates remained stable. Among 1754 admissions, five deaths (0.3%) were attributed to adrenal crisis. Both younger and older age (p < 0.001) and type 1 diabetes (incidence rate ratio 2.09, 95% confidence interval 1.45-3.01; p < 0.001) were associated with increased overt crisis risk. Daily corticosteroid dose was not associated with crisis risk. Prehospital stress dosing was used in about 50% of admissions. CONCLUSIONS:Overt adrenal crisis was uncommon and crisis-related in-hospital mortality was exceptionally low. Crisis risk was independent of replacement dose but increased in patients with type 1 diabetes. Strengthening education and implementation of prehospital stress dosing may further reduce the burden of adrenal crises.

Aims:To investigate sex-specific associations between longitudinal resting heart rate (RHR) and new-onset heart failure (HF) using RHR change and RHR trajectories. Methods:Participants from the Trøndelag Health Study attending two or three surveys between 1995 and 2019 were included. We investigated the association between new-onset HF and RHR using RHR categories based on the standard deviation of baseline RHR (12 bpm), continuous RHR modeled using restricted cubic splines (n = 47,712; mean 12-year follow-up), and latent class trajectory models (n = 47,162; mean 7-year follow-up). Cox regression was used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (95% CI). Results:During follow-up, 2,880 of the 47,712 participants developed HF. The HF incidence rate was lower in women than men (4.27 vs. 5.68 per 1,000 person-years; ratio (95% CI) 0.67 (0.57-0.77). Baseline RHR was 74 bpm in women and 70 bpm in men, and 74% maintained their RHR (±12 bpm) from baseline to the second attendance (mean change -2 ± 12 bpm). Each 10 bpm higher RHR was associated with higher HF risk for both women and men with HRs (95% CI) 1.15 (1.03-1.28) and 1.09 (1.00-1.20), respectively. Participants with a high RHR trajectory had higher HF risk than the low RHR trajectory with HRs (95% CI) 1.43 (1.14-1.79) for women and 1.41 (1.16-1.72) for men. Conclusion:All-cause HF was similarly associated with increased RHR and a high RHR trajectory for women and men. Estimating HF risk using RHR trajectories provided stronger associations than a single RHR measurement.

Accurate localization of thoracic lymph nodes during endobronchial ultrasound (EBUS) is crucial for lung cancer staging, treatment planning, and prognostication. Artificial intelligence (AI) has the potential to support this process. Deep learning (DL) models often lack transparency but can benefit from explainable AI (XAI) tools like Gradient-weighted Class Activation Mapping (Grad-CAM). However, no prior study has quantitatively assessed whether model attention in EBUS imaging corresponds to relevant anatomy. This study developed a convolutional neural network (CNN) to classify thoracic lymph node stations and evaluated the anatomical relevance of Grad-CAM activations using a structured annotation framework. Applied on 35,527 labeled EBUS images, the CNN achieved 63.1% accuracy, with the highest F1-score in stations 4L, 4R, and 10R. Three expert bronchoscopists independently annotated Grad-CAM maps from 3131 test images. Activations predominantly aligned with lymph nodes and/or blood vessels, yielding an accuracy of 65.9% and an F1-score of 58.4%, with moderate interobserver agreement. These findings indicate that DL can aid lymph node station classification and that XAI offers meaningful insight into model behavior. The proposed framework may enhance anatomical orientation and operator training during EBUS, although further optimization and multicenter validation are required.

High-dose melphalan with autologous stem-cell transplantation (HD-ASCT) prolongs progression-free survival (PFS) in transplant-eligible newly diagnosed multiple myeloma (TE-NDMM). However, most transplant trials exclude patients >65 years or those with poor performance status, aggressive disease, or significant comorbidities, limiting data on minimal residual disease (MRD)-negativity in these populations. REMNANT is a multicenter phase 2/3 study of TE-NDMM patients aged 18–75 years with broad eligibility criteria. This primary analysis reports MRD-negative complete response (CR) from the non-randomized phase 2 cohort. Patients received four cycles of bortezomib, lenalidomide, and dexamethasone (VRd) induction, HD-ASCT, and four cycles of VRd consolidation. MRD was tested in patients achieving ≥very good partial response (VGPR) post-consolidation. Between August 2020 and September 2024, 382 patients were enrolled (median age 63; 40% ≥65 years). MRD-negative CR was observed in 127 (33%) of 382 patients’ post-consolidation and 327 (86%) achieved ≥VGPR. The 12- and 24-month PFS were 88% and 79% (median follow-up 34.7 months), with comparable outcomes in patients <65 and ≥65 years. The most common adverse events of grade 3-4 were infections (44%) and cytopenias (21%). VRd induction, HD-ASCT, and VRd consolidation were effective and safe in a TE-NDMM cohort representative of the real-word NDMM population in Norway.

INTRODUCTION:Chemoradiotherapy is standard treatment for limited-stage SCLC. However, most patients relapse and there is a need for better treatment. We investigated whether twice-daily thoracic radiotherapy (TRT) of 60 Gy/40 fractions improves survival compared with the established schedule of 45 Gy/30 fractions. Here, we report final survival data and long-term toxicity. METHODS:Randomized, open-label, phase II trial. Eligible patients had performance status of 0 to 2, were above or equal to 18 years of age, underwent 18F-fluorodeoxyglucose positron emission tomography computed tomography and brain magnetic resonance imaging for staging, and were randomized 1:1 to TRT of 60 or 45 Gy. Patients were to receive four courses of platinum and etoposide chemotherapy, and responders were offered prophylactic cranial irradiation. RESULTS:A total of 170 patients were randomized (60 Gy: n = 89, 45 Gy: n = 81). Median age was 65 years, 31% above or equal to 70 years, 57% women, 89% had performance status of 0 to 1, 83% stage III disease, median planning target volume was 305 cm3, and 67% were treated with three-dimensional conformal radiotherapy. Median overall survival in the 60 Gy group was significantly longer (43.5 versus 22.5 mo, hazard ratio 0.68, 95% confidence interval 0.48-0.98, p = 0.037). The 60 Gy group did not experience more acute grades 3 to 4 esophagitis (60 Gy: 21%, 45 Gy: 18%, p = 0.83) or pneumonitis (60 Gy: 3%, 45 Gy: 0%, p = 0.39). Two patients, both in the 60 Gy group, developed esophageal strictures, whereas 11 patients (60 Gy: n = 5, 45 Gy: n = 6) developed severe long-term eating and swallowing dysfunction. CONCLUSION:Twice-daily TRT of 60 Gy/40 fractions was well tolerated and prolonged survival compared with 45 Gy/30 fractions in patients with limited-stage SCLC. This trial is registered at ClinicalTrials.gov: NCT02041845.