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Duchenne muscular dystrophy (DMD) is a severe genetic neuromuscular disease that causes progressive loss of muscle function. As life expectancy in DMD has gradually increased to a current median of 21-39 years, the disease serves as an example of childhood-onset, life-limiting conditions where attention to paediatric palliative care (PPC) in transition to adulthood is required. DMD-YOUNG is aimed at adolescents with DMD, to explore how PPC principles can be applied in the transition into adulthood and assist the participants in developing independence, empowerment, and the best possible quality of life. In project phase one, six young men with DMD, aged 14-28 years, were invited to participate in online discussions about their challenges, coping strategies, and needs for knowledge and social networking. In phase two, all boys aged 14-23 years with DMD in Norway were invited to a weekend gathering at Frambu Centre, with a programme of lectures and group sessions, covering medical information, social life, housing, higher education and employment, as well as social activities, in accordance with the results from phase one. The gathering also laid the foundation for project phase three, which is the establishment of a digital platform for discussions and social networking among adolescents with DMD. The 13 young men who attended the weekend gathering experienced group discussions and social activities as educational, inspirational, and motivational. They reported a sense of community and appreciated that the setting was tailored to them as adolescents rather than patients. The DMD-YOUNG project illustrates a successful approach to PPC for adolescents with a rare, life-limiting neuromuscular disorder. The project group acquired important insight into the participants' concerns and needs, coping strategies, experiences and hopes for the future. This will be invaluable in the establishment of a digital platform for, as well as improved management of, DMD in transition. [ABSTRACT FROM AUTHOR]

Muscle ultrasound (MUS) is a valuable imaging technique to examine muscle structure. Neuromuscular disorders (NMDs) often lead to pathological changes in the structure of muscles, where healthy muscle fibers are replaced by fat cells and fibrotic tissue. These changes can be quantified using grayscale analysis to evaluate the severity and progression of the disease. Patterns of muscle involvement in the various disorders can be mapped. However, to distinguish diseased from healthy muscles, reference and cutoff values need to be established. Due to technical limitations, reference values must be calculated for each ultrasound device. We aim to establish healthy muscle references and cutoff values for quantitative MUS as a foundation for future diagnostic and research use in our clinic. 80 healthy volunteers aged 16-80+, five males and females in each decade of the age range, will be examined using a Phillips Epiq 5 ultrasound machine with a linear eL4-18 probe. The examination protocol includes 23 selected muscles (left and right side) throughout the body. Four images are captured of each muscle, where three are used for calculating the mean grayscale value, while the fourth is used for measuring muscle thickness. Each muscle is measured at predefined locations on the muscle bulk to ensure comparability between all participants. The software "Quantitative Ultrasound Muscle Imaging Analysis" (Radboud Medical Centre) is used to define the mean grayscale value of each muscle. Height, weight, sex, and handedness are recorded as they are known to be confounding factors. SPSS will be used for statistical analyses. This is an ongoing project (2022-2025). At present 67 healthy volunteers have been examined using MUS. Recruiting volunteers for the youngest and oldest age categories has been challenging. Hence, the age range of the project has been altered to 20-79 years. The collection of healthy reference values and calculation of cutoffs will be useful in the neuromuscular clinic and for other research projects in the clinic. MUS is an attractive tool to use in the clinic as it is portable, non-invasive and provides accurate measures of disease severity and progression for NMD patients, and we expect to implement it in our clinic in the near future. [ABSTRACT FROM AUTHOR]

In Norway it is estimated that between 5-6,000 people live with a rare hereditary neuromuscular disorder (NMD). Symptomatic physiotherapy is considered a cornerstone in patient follow-up, as curative treatment is mostly not available. However, there does not exist an easily accessible, comprehensive and national overview over specialized physiotherapists (PTs) in Norway. At present, patients have to rely on the knowledge of individuals in either hospitals and/or the patient organization for help with finding a PT close to home. To develop a national and digital PT overview in order to facilitate better treatment, patient empowerment and independence. This is an ongoing 2-year project (2023-2025) in collaboration with ICT company Helse Nord IKT. We are developing a website with an interactive map of Norway with search and filter functions for where in the country you live and PT qualifications, accessible by mobile phone and computer. Data will be collected using Questback to generate a database of qualified PTs laying the foundation for the geopositioned pins in the interactive map. A national overview of specialized PTs will aid and empower patients in making their own health choices. The overview will benefit and be of great value to healthcare workers in the NMD field as a means of identifying qualified PTs to recommend to their patients, as well as providing contact details of coworkers in the field for potential networking. In addition, the project will identify regions of the country with lower coverage of PTs, hence lower regional expertise in treating NMDs. This in turn will allow the National Neuromuscular Center to target given regions for further training and knowledge enhancement. This is an ongoing project that will be completed spring 2025. The project is highly warranted and expected to make an immense difference in everyday life for patients and relatives. [ABSTRACT FROM AUTHOR]

Managing heavily manured soils for decreased P loss to waters requires improved understanding of the chemical and sorption-desorption characteristics of P in these soils. We used soils from agricultural fields receiving ≥8 yr of dairy, poultry, swine manure or spent mushroom compost for the determination of P functional groups in NaOH-EDTA extracts by solution 31P nuclear magnetic resonance (NMR) spectroscopy, degree of P saturation (DPS), and P sorption-desorption isotherms. The 31P NMR results show that inorganic orthophosphate was the primary form of P in manure treated (79-93% of total extract P) and untreated soils (33-71%). Pyrophosphate and phosphate monoesters were identified in all soils, whereas phosphate diesters were present in small proportions (<3%) in only a few soils. Polyphosphate, a more condensed form of inorganic P, was present in seven out of nine manured soils (9-47 mg P kg-1, <2%) but absent in untreated soils. Concentrations of inositol hexakisphosphate (IHP), mostly myo-IHP plus some scyllo-IHP, were similar in manured soils (52-116mg P kg-1, 2-8%) and untreated soils (43-137 mg p kg-1, 6-22%), suggesting a lack of IHP accumulation despite long-term manure applications, including poultry manures that are typically rich in IHP. Most of the treated soils had DPS 80 to 90% compared with 11 to 33% for the untreated samples. Results from P sorption isotherms showed that potential P release was 3 to 30 times greater from treated than untreated soils. The lack of IHP accumulation in soils receiving long-term manure applications implies that manure-derived IHP may not be biologically and environmentally benign. [ABSTRACT FROM AUTHOR]

Studies the measurement of oxidation kinetics of Mo(Al[sub 0.01]Si[sub 0.99])[sub 2] and Mo(Al[sub 0.1]Si[0.9])[sub 2]. Investigation of the qualitative oxidation; Details of the microstructural evolution of the oxide scales; Correlation of reduced oxidation kinetics with the in situ formation of an inner mullite scale.

The clinical outcome after successful conventional coronary balloon angioplasty is compared with that of stent implantation after 30 days and 12 months. The study took place at the Divisions of Cardiology and Thoracic Radiology, Norrland University Hospital, Umeå, a referral centre for northern Sweden. The first 100 consecutive patients with stable or unstable angina undergoing successful percutaneous transluminal coronary angioplasty (PTCA) in 1994 and the first 100 consecutive patients undergoing successful coronary stent implantation in 1995 were included. The cardiac endpoints studied were death, myocardial infarction, need for repeat PTCA or coronary artery bypass grafting (CABG). Significantly more adverse cardiac events were observed in the PTCA group compared with the stent group. Event-free 12 months' follow-up (no deaths, myocardial infarction or re-intervention) was 64% in the PTCA group and 86% in the stent group (p < 0.005). The main explanation for the observed difference was a reduction in the need for a repeat PTCA (7 vs 18, p < 0.05) or CABG (4 vs 12, p < 0.05) in the stent group. Patients with stable or unstable angina who can be treated with a stent have a better clinical outcome than those treated with coronary balloon angioplasty only. [ABSTRACT FROM AUTHOR]

Background: Spine radiosurgery has been performed at Oslo University hospital, The Norwegian Radium Hospital since July 2011. Our approach has been to develop a simple planning technique, where the organs at risk are spared while substantially reducing the planning time. Materials and methods: We have developed a library plan with nine static beams, where each beam is automatically formed to the PTV, but also manually ensuring that a spinal cord planning risk volume (PRV) is excluded in all directions. This is a fast forward planning (FFP) technique compared to regular IMRT or VMAT techniques for spine radiosurgery. In this work ten patient plans using FFP were compared to IMRT and VMAT plans for the identical patients. The dose distributions were compared for the different plans, emphasizing the dose to the target volumes and reduced dose to the surrounding tissue. The planning time consume and treatment time were also registered. Results: We found that the risk organs dose criteria normally were fulfilled within a sufficient margin for FFP, IMRT and VMAT techniques. The dose distribution following FFP yields a steeper gradient close to the spinal cord, but also gives a more heterogeneous dose distribution within the PTV. The GTV dose applying a FFP technique is normally higher than from IMRT and VMAT. For single fraction spine radiosurgery, the average GTV dose was 25.8 Gy for FFP, while the objective for an IMRT or VMAT optimization should exceed 18 Gy to D98%. Planning time for FFP is normally less than 30 minutes, while IMRT or VMAT optimization may last for several hours. Conclusions: The main alternative for this patient group at our hospital has traditionally been 30 Gy in 10 fractions, conventionally planned with one or two opposing fields. Our preliminary findings using this FFP technique suggest a sufficient and comparable dose distribution to those resulting from IMRT or VMAT, while the total time consume is comparable or less than the conventional method. Disclosure: No significant relationships. [ABSTRACT FROM AUTHOR]

Purpose: Stereotactic body radiation therapy for tumors near the central airways implies high-grade toxic effects, as concluded from the HILUS trial. However, the small sample size and relatively few events limited the statistical power of the study. We therefore pooled data from the prospective HILUS trial with retrospective data from patients in the Nordic countries treated outside the prospective study to evaluate toxicity and risk factors for high-grade toxic effects., Methods and Materials: All patients were treated with 56 Gy in 8 fractions. Tumors within 2 cm of the trachea, the mainstem bronchi, the intermediate bronchus, or the lobar bronchi were included. The primary endpoint was toxicity, and the secondary endpoints were local control and overall survival. Clinical and dosimetric risk factors were analyzed for treatment-related fatal toxicity in univariable and multivariable Cox regression analyses., Results: Of 230 patients evaluated, grade 5 toxicity developed in 30 patients (13%), of whom 20 patients had fatal bronchopulmonary bleeding. The multivariable analysis revealed tumor compression of the tracheobronchial tree and maximum dose to the mainstem or intermediate bronchus as significant risk factors for grade 5 bleeding and grade 5 toxicity. The 3-year local control and overall survival rates were 84% (95% CI, 80%-90%) and 40% (95% CI, 34%-47%), respectively., Conclusions: Tumor compression of the tracheobronchial tree and high maximum dose to the mainstem or intermediate bronchus increase the risk of fatal toxicity after stereotactic body radiation therapy in 8 fractions for central lung tumors. Similar dose constraints should be applied to the intermediate bronchus as to the mainstem bronchi., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Introduction: The use of proton therapy increases globally despite a lack of randomised controlled trials demonstrating its efficacy and safety. Proton therapy enables sparing of non-neoplastic tissue from radiation. This is principally beneficial and holds promise of reduced long-term side effects. However, the sparing of seemingly non-cancerous tissue is not necessarily positive for isocitrate dehydrogenase ( IDH )-mutated diffuse gliomas grade 2-3, which have a diffuse growth pattern. With their relatively good prognosis, yet incurable nature, therapy needs to be delicately balanced to achieve a maximal survival benefit combined with an optimised quality of life., Methods and Analysis: PRO-GLIO (PROton versus photon therapy in IDH -mutated diffuse grade 2 and 3 GLIOmas) is an open-label, multicentre, randomised phase III non-inferiority study. 224 patients aged 18-65 years with IDH -mutated diffuse gliomas grade 2-3 from Norway and Sweden will be randomised 1:1 to radiotherapy delivered with protons (experimental arm) or photons (standard arm). First intervention-free survival at 2 years is the primary endpoint. Key secondary endpoints are fatigue and cognitive impairment, both at 2 years. Additional secondary outcomes include several survival measures, health-related quality of life parameters and health economy endpoints., Ethics and Dissemination: To implement proton therapy as part of standard of care for patients with IDH -mutated diffuse gliomas grade 2-3, it should be deemed safe. With its randomised controlled design testing proton versus photon therapy, PRO-GLIO will provide important information for this patient population concerning safety, cognition, fatigue and other quality of life parameters. As proton therapy is considerably more costly than its photon counterpart, cost-effectiveness will also be evaluated. PRO-GLIO is approved by ethical committees in Norway (Regional Committee for Medical & Health Research Ethics) and Sweden (The Swedish Ethical Review Authority) and patient inclusion has commenced. Trial results will be published in international peer-reviewed journals, relevant conferences, national and international meetings and expert forums., Trial Registration Number: ClinicalTrials.gov Registry (NCT05190172)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The introduction of immune checkpoint inhibitors has transformed the treatment landscape of metastatic non-small cell lung cancer. However, challenges remain to increase the fraction of patients achieving durable clinical responses to these drugs and to help monitor the treatment effect. In this phase II trial, we investigated the toxicity, systemic responses and circulating tumour DNA responses in patients (n = 21) with advanced non-small-cell lung cancer treated with atezolizumab and stereotactic body radiotherapy in the second or later line. We found the combined treatment to be safe with grade 3 toxicity reported in three patients. As the best overall response, four patients had a partial response, eight had stable disease and five had progressive disease. Median overall survival time was still not reached after a median follow-up of 26.5 months and 10/15 patients with programmed death-ligand 1 negative tumours were alive >18 months after the start of the study treatment. ctDNA was detectable at baseline in 11 patients. A rapid decline in ctDNA to <30% of baseline levels was seen in three patients, two of which were radiographic responders and one was considered clinically benefiting from therapy for almost 1 year., (© 2022 The Authors. Molecular Oncology published by John Wiley & Sons Ltd on behalf of Federation of European Biochemical Societies.)

Background: Lower-leg injury and knee arthroscopy are both associated with venous thromboembolism (VTE). The mechanism of VTE in both situations is unknown, including the role of procoagulant microparticles. This may provide useful information for individualizing thromboprophylactic treatment in both patient groups., Objective: We aimed to study the effect of (1) lower-leg trauma and (2) knee arthroscopy on procoagulant phospholipid-dependent (PPL) activity plasma levels., Methods: POT-(K)CAST trial participants who did not develop VTE were randomly selected for the current study. Plasma was collected shortly after lower-leg trauma or before and after knee arthroscopy. For aim 1, samples of 67 patients with lower-leg injury were compared with control samples (preoperative samples of 74 patients undergoing arthroscopy). Linear regression was used to obtain mean ratios (natural logarithm retransformed data), adjusted for age, sex, body mass index, infections, and comorbidities. For aim 2, pre- and postoperative samples of 49 patients undergoing arthroscopy were compared using paired t tests. PPL activity was measured using modified activated factor X-dependent PPL clotting assay., Results: For aim 1, PPL activity levels were almost threefold higher in patients with lower-leg injury compared with controls, that is, mean ratio, 2.82 (95% confidence interval [CI], 1.98-4.03). For aim 2, postoperative PPL activity levels did not change significantly, that is, mean change, -0.72 mU/mL (95% CI, -2.03 to 0.59)., Conclusion: Lower-leg trauma was associated with increased plasma levels of PPL activity, in contrast to knee arthroscopy. Lower-leg trauma triggers the release of procoagulant microparticles., (© 2022 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis (ISTH).)