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Most patients with out-of-hospital cardiac arrest do not achieve sustained return of spontaneous circulation (ROSC). Resuscitative endovascular balloon occlusion of the aorta (REBOA) may increase blood pressure proximal to the ballon. If this technique is used during advanced life support (ALS), and occlusion is performed in the thoracic aorta, it may augment aortic pressure and coronary perfusion pressure. We investigated whether prehospital REBOA as an adjunct to ALS increased the rate of ROSC. REBOARREST was a pragmatic, parallel-group, multicentre, randomised controlled trial conducted at 12 sites in Norway, Denmark, and Italy. Adult patients (18–80 years) with non-traumatic out-of-hospital cardiac arrest were randomly assigned (1:1) to either a control group that received ALS or to an intervention group that received ALS combined with REBOA as an adjunct. Fulfilment of eligibility criteria was determined by the physician on scene and sealed envelopes were used to allocate patients. The statistician that performed the analyses was blinded for group allocation. The primary outcome was sustained ROSC, defined as lasting ≥ 20 min, assessed in the intention-to-treat population. From June 7, 2021, to June 28, 2025, 200 patients were randomly assigned to the study groups. Due to lack of consent 21 patients dropped out of the trial, hence data from 179 patients are presented, 88 in the intervention group and 91 in the control group. Most patients were male (76
Research on hip fracture prevention in men is limited. In men, physical activity and body mass index were independently and jointly associated with hip fracture risk, with the highest risk among inactive and thin men. Promoting exercise and healthy weight in midlife may reduce fracture burden and support healthy ageing. Hip fractures predominantly affect older people with frailty. The incidence increases with age, and the number is expected to increase substantially due to population aging. Physical inactivity and low body mass index (BMI) are key modifiable risk factors for hip fractures. This study aimed to explore the associations of physical activity and BMI with long-term hip fracture risk in men. This prospective cohort study included 12,900 men aged 40–49 years from the Oslo study 1972–1973. A questionnaire assessed physical activity, whereas height and weight were measured. Hip fractures were identified through linkage to a national database. Cox regression calculated adjusted hazard ratios (HR) with 95
Abstract No universal gold standard chemotherapy exists for the treatment of older (≥60 years) patients with classical Hodgkin lymphoma (cHL). To evaluate the current curative treatment strategies used in the Nordic countries, we collected data from patients diagnosed in Sweden, Denmark and Norway during the years 2000 to 2021. We included 1569 patients: 704 (45%) Swedish, 671 (43%) Danish, and 194 (12%) Norwegian. Of these, 671 (43%) received doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD), 123 (8%) received doxorubicin, vinblastine, and dacarbazine (AVD), 465 (31%) received cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), and 212 (13%) received other chemotherapy (single agent or combination). Eighty-two (5%) patients lacked information on first-line regimen. In multivariable analyses of overall survival (OS), treatment with AVD was associated with improved survival compared to ABVD, whereas there was a trend toward inferior survival among patients receiving CHOP or other regimens. For progression-free survival (PFS), multivariable analysis likewise demonstrated significantly improved outcome with AVD relative to ABVD, whereas outcomes for the CHOP group were comparable to ABVD. Outcome for patients receiving other regimens tended to be poorer. Collectively, outcome for AVD with respect to both OS and PFS was at least equal to ABVD and often superior to CHOP. By omitting bleomycin, treatment-related toxicity is known to be reduced in AVD compared to ABVD. Based on our findings, AVD is a preferable chemotherapy option in older patients with cHL and should rightly be considered as backbone in treatment with novel drugs.
Juvenile idiopathic arthritis (JIA) used to be a joint-destroying disease, but thanks to modern treatment strategies and medications, many patients with JIA today reach inactive disease. However, once disease remission is achieved, there is a lack of knowledge and recommendations regarding maintenance therapy. Drug-free remission is the ultimate goal in JIA, but withdrawal of medications increases the risk of disease flare. Clinical approaches vary widely, underscoring a need for knowledge about maintenance treatment strategies that allow for safe tapering and withdrawal of medications in JIA patients in sustained remission. The MOVE-JIA study is a randomized, controlled trial with the primary objective to compare the effect of two different treatment withdrawal strategies, to a stable dose of methotrexate (MTX) and tumor necrosis factor inhibitors (TNFi), based on the risk of flares in children and adolescents with JIA with sustained inactive disease. A key secondary objective is the proportion of children with disease flare compared between the two withdrawal groups. In this investigator-initiated multicenter, randomized, 3-grouped, parallel, open-label, noninferiority trial, treating physicians at seven Norwegian pediatric rheumatology hospital centers will include 150 patients with JIA. Key eligibility criteria are as follows: Fulfilment of the International League of Associations for Rheumatology (ILAR) classification criteria for non-systemic JIA, inactive disease for ≥ 12 months documented at a minimum of 2 consecutive visits, and no active uveitis for ≥ 24 months under treatment with stable doses of MTX and TNFi. They will be randomized in a 1:1:1 ratio to (A) stable treatment, (B) methotrexate withdrawal, or (C) TNFi withdrawal. Randomization will be stratified for JIA subtype and study center. For patients in group B and C who are still in remission after 12 months, a new randomization will be performed for complete medication withdrawal for the next 12 months. After 24 months, medication adjustments will be done with shared decision-making. The primary endpoint is the rate of disease flare compared between the drug withdrawal groups and the stable treatment group between baseline and 12 months follow-up. The key secondary endpoint is the proportion with disease flare compared between the two withdrawal groups. Incidence and severity of adverse events will be monitored. The results from the MOVE-JIA trial will present an evidence-based treatment strategy for JIA patients with inactive disease. The trial will also give us knowledge about regaining disease remission after flares and possibilities of drug-free remission. All outcomes from the trial will provide a scientific basis for optimized JIA care and result in new treatment recommendations. EU CT 2024–512017–12–00. Registered on October 24th, 2024; ClinicalTrials.gov NCT06653634. Registered on October 24th, 2024. URL: Study Details | NCT06653634 | Optimizing Treatment for Patients With Juvenile Idiopathic Arthritis in Sustained Remission: The MOVE–JIA Trial | ClinicalTrials.gov. Date of first recruitment: October 24th, 2024.
Deep learning is expected to aid pathologists in tasks such as tumour segmentation. We developed a general tumour segmentation model for histopathological images and examined its performance in different cancer types. The model was developed using over 20,000 whole-slide images from over 4000 patients with colorectal, endometrial, lung, or prostate carcinoma. Performance was validated in pre-planned analyses on external cohorts with over 3000 patients across six cancer types. Exploratory analyses included over 1500 additional patients from The Cancer Genome Atlas. Average Dice coefficient was over 80% in all validation cohorts with en bloc resection specimens and in The Cancer Genome Atlas cohorts. No performance loss was observed when comparing the general model with single-cancer models specialised in cancer types from the development set. In conclusion, extensive and rigorous evaluations demonstrate that generic tumour segmentation by a single model is possible across cancer types, patient populations, sample preparations and slide scanners.
