St. Olav’s University Hospital (Norwegian: St. Olavs Hospital Universitetssykehuset i Trondheim) is the hospital in Trondheim, Norway located at Øya. It is part of St. Olavs Hospital Trust that operates all the hospitals in Sør-Trøndelag and thus indirectly state owned. It cooperates closely with the Norwegian University of Science and Technology in research and in education of medical doctors. The university is named for Olaf II of Norway, also known as St. Olav. It performed 274,441 somatic and 88,692 psychiatric consultations in 2005 with 8,691 employees and a budget of Norwegian krone 5.1 billion. Trondheim Heliport, St. Olav's Hospital (ICAO: ENTR) is a helipad located adjacent to the emergency ward. It opened on 1 February 2010 and has a fuel tank.
Abstract Digital mobility outcomes (DMOs) offer unique insights into recovery of real-world mobility after proximal femoral fracture (PFF), but their clinical validity remains to be established. This study assessed construct validity (convergent, divergent, and known-groups) of 24 DMOs measuring walking activity (amount, pattern) and gait (pace, rhythm, bout-to-bout variability) in patients within one year after PFF. Patients were recruited from inpatient and outpatient lists at five European sites, resulting in 505 included participants (66% female), with mean age of 77.6 ± 9.4 years and supervised gait speed of 0.7 ± 0.4 m/s. Mobility was monitored over seven days using a single wearable device on the lower back. Convergent and divergent validity analyses were stratified by two groups: acute (≤ 14 days since surgery) and non-acute (≥ 15 days since surgery). Correlations between DMOs and related (clinical- and patient-reported mobility outcomes) and unrelated constructs (hearing impairment and systolic blood pressure) were compared to a priori expected correlations. Known-groups validity was assessed across four recovery phases. The results were evaluated individually by experts and in a subsequent consensus meeting, with 17 of 24 DMOs showing evidence of construct validity in non-acute PFF patients. These findings represent an initial step in a larger process towards regulatory endorsement.
There is limited data regarding the rare and aggressive colorectal neuroendocrine carcinoma (CR-NEC). In this large prospective study, molecular-clinical characteristics and treatment outcomes following palliative chemotherapy are reported for 163 metastatic CR-NEC patients, with a comparison to a population-based prospective cohort of 263 metastatic colorectal adenocarcinoma (CR-AC) patients. Eighty-three percent of CR-NEC received first-line platinum-etoposide, while 98% of CR-AC patients received first-line fluorouracil-based chemotherapy. Disease control rate across all first-line regimens in CR-NEC and CR-AC was 43% vs. 74%, immediate progressive disease 46% vs. 15%, progression-free survival 2.4 months (m) (95% CI 2.1-3.3) vs. 7.7 m (95% CI 6.9-8.5), and overall survival 6.7 m (95% CI 5.6-8.8) vs. 16.8 m (95% CI 13.7-20.3), all, p < .001. CR-NEC more often had synchronous metastases, worse performance status, and symptom burden at treatment initiation than CR-AC (all, p < .001). Two-year survival was 9% vs. 37% in CR-NEC and CR-AC (p < .001). BRAF mutations were frequent in CR-NEC and CR-AC (26% vs. 20%, p = .153) and associated with shorter OS in CR-NEC and CR-AC (p = .025 and p = .003). KRAS mutations were less frequent in CR-NEC than CR-AC (34% vs. 45%, p = .041), but only associated with shorter OS in rectal NEC (p = .04). The frequencies of APC and TP53 mutations were similar between the cohorts and did not impact survival. Metastatic CR-NEC and CR-AC are clinically distinct, with NEC demonstrating more aggressive features, limited treatment effect, and worse prognosis. Although they share important driver mutations, the underlying reason for their marked clinical differences remains unclear.
The cellular composition of the chronic myeloid leukemia (CML) bone marrow (BM) beyond granulocyte enrichment remains poorly understood. We analyzed 1548 routinely stained BM aspirate slides from 598 patients across seven sites using deep learning-based image analysis to identify cytomorphological markers predictive of major molecular response. Erythroid precursor enrichment, monocyte nuclear lobulation, and low peripheral leukocyte count were associated with improved tyrosine kinase inhibitor (TKI) response. These features were validated both visually and computationally in two independent cohorts. We developed a Morphoclinical model integrating these image-derived and clinical variables, outperforming (area under the receiver-operating curve [AUROC] 0.76) the clinically used EUTOS long-term survival score (AUROC 0.53) and BCR::ABL1 halving time (AUROC 0.61). Notably, poor-risk patients treated with second-generation TKIs achieved outcomes similar to favorable-risk patients on imatinib. These results underline the overlooked prognostic value of BM cytomorphology to refine risk stratification and support more personalized frontline therapy in CML.
AIMS:The 2022 European Society of Cardiology cardio-oncology guidelines recommend cardiovascular disease (CVD) risk stratification for cancer patients and suggest using SCORE2 and SCORE2-OP. However, these models have not been validated or specifically adapted for cancer populations. Our aim was to refine the SCORE2 and SCORE2-OP models to accurately predict 10-year fatal and non-fatal CVD risk in cancer patients. METHODS AND RESULTS:We included 1622 patients from the HUNT3 study (2006-08) who were diagnosed with cancer within 4 years after their enrolment and followed until 2023 linked to national registries. The primary outcome was a composite of myocardial infarction (MI), stroke, or CVD mortality. Model performance was assessed using Harrel's C-statistic and calibration curves. Both models were recalibrated by applying a multiplicative adjustment factor based on expected-observed (E/O) ratios. The most prevalent cancers were gastrointestinal (23%), prostate (17%), and breast (14%). Mean age was 65.2 years, 52% were female. During a median follow-up of 8.8 years [inter-quartile range 1.9-12.6], 252 CVD events (39% MI, 36% stroke, 25% CVD deaths) and 708 non-CVD deaths occurred. SCORE2 initially underestimated CVD risk (E/O ratio for men and women: 0.91 and 0.63, respectively) but showed adequate agreement after recalibration. C-statistics for SCORE2 was 0.693 [95% confidence interval (CI) 0.643-0.743], and 0.730 (95% CI 0.676-0.784) after excluding those not surviving the first 2 years. For SCORE2-OP, the C-statistics were 0.586 (95% CI 0.529-0.643) and 0.648 (95% CI 0.577-0.720). CONCLUSION:SCORE2 underestimated CVD risk in cancer patients. After recalibration, the model may serve as a valuable tool for risk stratification in cancer patients.
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.
