Lillebaelt Hospital

Despite receiving curative radiotherapy (RT) for localized lung cancer, relapse may occur within the first year, and 5-year survival is low. In this study, we evaluated the prognostic ability of the combination of Natural Killer-cell activity (NKA), soluble programmed death-ligand 1 (sPD-L1), and circulating tumor DNA (ctDNA) to predict a relapse within 12-month follow-up. Sixty-eight patients had blood samples analyzed from baseline, the first follow-up visit, and 6 and 9months after treatment. NKA was measured with the NKVue® assay, sPD-L1 was measured with the Quantikine ELISA kit, and ctDNA was measured using in-house developed tumor-agnostic droplet digital polymerase chain reaction (ddPCR) assays for testing methylated loci near the genes HOXA9, TFAP2B, MCIDAS, and SP9. Chi2 statistics or Fisher's exact test was used for individual markers, and ROC analyses were used for the combined markers. Baseline reduced NKA was significantly associated with experiencing a relapse within 12-month follow-up (p = 0.01). Having a positive baseline ctDNA was also significantly associated with experiencing a relapse within 12-month follow-up (p = 0.03). The combination of all four ctDNA markers, sPD-L1, and NKA had an area under the curve of 0.86 (95% CI 0.74-0.98) for predicting a relapse within 12months of follow-up. Findings from this study suggest that a combination of all six biomarkers measured at baseline may help predict the risk of relapse following curative RT for lung cancer. Larger studies with longer follow-up are needed to further verify the results.

BackgroundMagnetic resonance enterography (MRE) can visualize Crohn's disease (CD) and its complications.PurposeTo determine the inter-observer agreement for the detection of ileocolonic CD.Material and MethodsThis post-hoc analysis included MRE scans from 48 patients selected from a prospective, blinded multicenter study of patients with suspected CD. Based on ileocolonoscopy in the main study, CD was diagnosed in 39 (81%) patients, with colonic involvement in 36 (69%). Two senior radiologists and two junior doctors undergoing specialist training, blinded to clinical data assessed the image quality, CD presence, and disease severity.ResultsThe inter-observer agreement for CD detection varied by location: terminal ileum (κ = 0.77, 95% confidence interval [CI] = 0.63-0.89), colon (κ = 0.59, 95% CI = 0.42-0.74), and ileocolon (κ = 0.65, 95% CI = 0.49-0.80). Agreement was higher among senior radiologists than juniors: terminal ileum (κ = 0.83 vs. 0.73; P = 0.60) and colon (κ = 0.73 vs. 0.41; P = 0.11), though differences were not statistically significant. The inter-observer agreement for disease severity was poor to moderate with intraclass correlation coefficients (ICCs) of 0.51 (95% CI = 0.35-0.67) for the MaRIA and 0.46 (95% CI = 0.29-0.62) for the simplified MaRIA. Senior radiologists showed higher consistency, with moderate to good agreement: ICC of 0.69 for the MaRIA, 0.70 for the simplified MaRIA, and 0.80 for bowel wall thickness.ConclusionIn early CD, MRE demonstrated moderate to substantial inter-observer agreement for ileocolonic evaluation. Limitations in colonic assessment likely reflect early disease detection rather than observer variability, highlighting the need for a complementary assessment.

ObjectiveTo describe the primary complaints of infants presenting to Danish chiropractic clinics and explore the secondary complaints, and type of referrals from other healthcare professionals.MethodsA cross-sectional study based on routinely collected medical records from a national sample of chiropractic clinics in Denmark. Data were collected retrospectively in December 2019 and January 2020, covering infants (0–1 year) seen between November 2018 and October 2019. All 238 chiropractic clinics in the Danish Chiropractors’ Association were invited to participate via an electronic survey. The questionnaire captured demographic characteristics, primary and secondary complaints, symptom duration, and referral sources.ResultsA total of 1,049 completed questionnaires were received. The most common primary complaint was abnormal range of motion (ROM) (48%), followed by crying/infantile colic (17%), feeding problems (5%), and disturbed sleep (5%). The majority of complaints had lasted between 1 week and 3 months, prior to consultation. Secondary complaints were reported in 58% of cases, most commonly abnormal ROM (41%), disturbed sleep (22%), and feeding problems (21%). Referrals were reported for 51% of infants, with healthcare visitors being the primary source (44%).ConclusionThis study provides insights into the clinical presentations and referral patterns of infants attending chiropractic clinics in Denmark. The findings highlight abnormal ROM as the predominant complaint, the central role of healthcare visitors in referrals, and the multifaceted nature of parental concerns. These results emphasize the need for evidence-based guidelines and stronger interdisciplinary collaboration to optimize infant care.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12998-026-00629-z.

Adolescent Idiopathic Scoliosis (AIS) affects over 1% of adolescents and is often diagnosed during a sensitive developmental period, with repeated radiographs, potentially increasing cancer risk. Previous studies have suggested an association between scoliosis and breast cancer, but have been limited by small cohorts, lack of matched controls, and incomplete registry data. The aim of this study, therefore, was to assess the hazard ratio (HR) of cancer among women with scoliosis compared to age-matched controls using nationwide registry data. This observational cohort study included all Danish women born 1967-1977 with a scoliosis diagnosis (ICD-8 735.0/735.2 or ICD-10 DM411), and four age-matched controls per case, identified through national health registers. Cancer outcomes were obtained from the Danish National Cancer Register, and Cox regression was used to estimate HRs, with time at risk beginning at age 12. Among 6,217 women (1,238 (20% with scoliosis), the mean follow-up time was approximately 38years. The HR (95% CI) for any cancer was 1.06 [0.85-1.31]. For breast cancer, HR was 1.25 [0.86-1.80], while HR for carcinoma in situ (CIS) of the breast was 13.62 [3.75-49.50]. Among 12 cases of ovarian cancer, the HR was 2.91 [0.92-9.18]. This study could not, however, discriminate between idiopathic and non-idiopathic scoliosis. Women with scoliosis showed a significantly increased HR for CIS of the breast, and a non-significant trend toward increased risk of invasive breast and gynecologic cancers. Findings support further investigation into genetic or developmental links between scoliosis and cancer risk. Women with scoliosis are at a higher risk of getting cancer, namely of the breast. Pregnancy did not appear to have a protective effect.

Life expectancy increases, leading to growth in an older population where frailty and comorbidities are more prevalent. Subsequent increased intensive care unit (ICU) treatment results in prolonged rehabilitation and post-discharge loss of physiological and intellectual functions, negatively influencing quality of life (QoL). This scoping review aims to identify existing research on assessment methods for frailty, QoL, and health-related outcomes for these ICU survivors. The review followed Joanna Briggs Institute guidelines for scoping reviews and reported using the PRISMA-P checklist. Systematic searches were conducted in Embase, Medline, PsycINFO, and CINAHL (2013 to 2023). Included studies were primary, peer-reviewed, or empirical studies written in English or Scandinavian, patients aged 70+, admitted to ICU more than 48 h, and inclusion of both frailty and QoL. A librarian qualified the search. Two reviewers independently screened articles and extracted data; a third reviewer resolved discrepancies. A total of 5,198 articles were identified. Nine met the eligibility criteria. Different tools assessed frailty and QoL. For frailty, Clinical Frailty Scale, Karnofsky Performance Status, Modified Katz Index of Activities of Daily Living, Groningen Frailty Indicator, CGA questionnaire, or Barthel Index were used. A combination of scales (SF-12, SF-36, EQ-5D, EQ-5D-5 L, or EQ-5D-3 L), questionnaires, or interviews (regarding residential and functional status and self-reported health-related QoL) was used for QoL. Frail older ICU survivors experience persistent physical, cognitive, and symptom-related challenges poorly captured by conventional QoL assessments, particularly regarding psychological and subjective experiences. The few studies addressing both frailty and QoL make it difficult to establish evidence, highlighting the need for standardised, multidimensional, patient-centred frameworks. Not applicable.

Studies evaluating [18F]fluorocholine PET/CT for parathyroid adenoma localisation fail to report the injection method used. At our department, manual injection method (MIM) was initially used, before converting to an automated injection system (AIS). Afterwards, physicians observed increased retention of the radiotracer within the veins leading from the injection site, which had not been as present previously. The aim of this study was to evaluate whether the injection method had a clinical impact. The study compared two groups consisting of 60 patients, where the injection method was the only difference. Two physicians, blinded to injection method, evaluated if retention was present and interpretation was jeopardised. Quantitative measures were determined based on the original diagnostic confidence scores (DCS) for each suspected lesion, as these were compared between patient groups. Additionally, the maximum standardised uptake values (SUVmax) were measured for the suspected lesions along with the thyroid and salivary glands as a physiological reference point. Comparisons of the quantitative parameters were also performed between patients with or without retention. There was significant more occurrence of retention in AIS-group (83.3%) than MIM group (36.7%), (p < 0.00001). Retention did not influence the interpretation of any patient. A significant difference of DCS was observed, as 18% of lesions in the AIS-group had a low score, compared to only 1% in the MIM-group (p < 0.001). SUVmax was significantly lower in the AIS-group than the MIM-group for the reported adenomas (10.1 vs. 11.8, p = 0.008). In addition, SUVmax in the AIS-group was significantly lower in both the thyroid (4.6 vs. 5.2, p = 0.023) and salivary glands (10.8 vs. 12.4, p < 0.001). Comparison between patients with and without retention revealed similar differences in DCS and SUVmax for adenomas. The AIS is associated with a significant higher presence of retention, low diagnostic confidence and overall lower SUVmax, which indicates an aspect of clinical impact. It could potentially lead to a parathyroid adenoma being missed or classified as normal parathyroid tissue. Thus, manual injection method might be the method of choice, to ensure the most optimal clinical outcome.

PRELUCA is a randomised, intervention, non-inferiority study designed to use real-time, longitudinal circulating tumour DNA (ctDNA) measurements to evaluate the efficacy of immunotherapy in patients with advanced non-small cell lung cancer (NSCLC). The primary outcome is overall survival between the two groups: the standard of care group (computer tomography scan evaluation) and intervention group (ctDNA evaluation). The inclusion and exclusion criteria align with European Society for Medical Oncology treatment guidelines and permit broad inclusion of NSCLC patients, ensuring 'real-world' representativeness. The study uses a tumour-informed method, using baseline next generation sequencing analyses to design patient-specific droplet digital PCR assays, which are run with collected blood samples 1 week prior to the intended treatment, enabling real-time evaluation via ctDNA Response Evaluation Criteria in Solid Tumours. Inclusion began in July 2023 and patients are now being actively included in five locations across Denmark. Approval by The Committee on Health Research Ethics of Region Zealand was gained on 4 May 2023. NCT05889247.

Chronic pain frequently co-occurs with multiple somatic comorbidities. However, little is known about how these conditions naturally cluster in patients with high-impact chronic pain. This study aimed to describe somatic comorbidities and identify clusters of co-occurring diseases in patients with high-impact chronic pain referred to specialised interdisciplinary treatment and to examine associations between these clusters and patient-reported physical health, mental health and pain distribution. A cross-sectional study was conducted with 10,256 chronic pain patients referred to specialised interdisciplinary pain treatment using data from the Danish PainData registry. Somatic comorbidities were self-reported from a list of 16 diseases and conditions. Exploratory factor analysis with tetrachoric correlations identified clusters of comorbidities. Physical and mental health were evaluated using the PROMIS-10 Global Health questionnaire and pain distribution was assessed by a 71-area pain drawing. Statistical analyses, including ANOVA and Kruskal-Wallis tests, evaluated differences in patient-reported outcomes between disease clusters. Patients reported a median of three somatic comorbidities, with migraine (56%), herniated disc/spinal disorders (53%) and osteoarthritis (42%) being most prevalent. Factor analysis revealed six disease clusters, including systemic illness, cardiovascular disease, musculoskeletal disorders, metabolic-vascular conditions, allergy-respiratory issues and neurosensory disturbances. Distinct clusters of co-occurring diseases and conditions were associated with poorer physical health and more widespread pain. Somatic comorbidities were highly prevalent in this large chronic pain cohort, with six disease clusters associated with varying levels of physical health and pain distribution. These findings highlight the need for stratified approaches in pain care, informed by somatic disease clustering. This study identifies distinct clusters of somatic comorbidities among patients with high-impact chronic pain and links them to health outcomes. Understanding these clusters may help clinicians tailor more precise, stratified pain interventions and offers basic scientists insight into potential underlying mechanisms connecting chronic pain with systemic disease patterns.

BackgroundSmoking cessation at or around the time of lung cancer diagnosis is associated with improved treatment outcomes, enhanced quality of life and increased survival. However, many patients continue smoking post-diagnosis.AimThis study evaluated the effectiveness of a national initiative in Denmark that integrated smoking cessation support into the diagnostic workup for lung cancer within a pragmatic, multicenter, cluster-randomised controlled trial.MethodsNine Danish hospitals were cluster-randomised to either the intervention group (integrated cessation support) or the control group (usual care). The intervention was implemented in five hospitals. Eighty-six patients (intervention = 39; control = 47) who were active smokers at referral completed questionnaires assessing smoking cessation initiation, motivation, quality of life and psychosocial consequences of diagnostic workup at baseline and 6-weeks follow-up. Logistic and multiple regression analyses were conducted. Additionally, 140 healthcare professionals completed a survey on cessation support practices pre-intervention, and 54 completed it post-intervention. Descriptive analyses were used to assess changes in clinical practice.ResultsThere were no statistically significant differences in smoking cessation initiation between the intervention and control groups (OR = 0.81 [0.41, 1.58], p = 0.53; adjusted OR = 0.79 [0.35, 1.79], p = 0.57). Among healthcare professionals in the intervention group, a larger proportion reported they “almost always” provided cessation after the implementation (35.1%) than before (18.3%). But the proportion who responded that they “almost never” provide support was also considerably larger after the implementation (13.5%) than before (3.2%). In the control group, proportions tended to shift more generally towards providing more support over time, and a considerably larger proportion reported to refer patients to external smoking cessation support at the follow-up measurement.ConclusionThe study was inconclusive, showing no significant effect of smoking cessation support during lung cancer diagnostic workup on patients' cessation initiation, possibly influenced by selection bias and varying intervention fidelity at study sites.