| 196421. |
- Axer, Stephan, 1971-
(författare)
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Revisional bariatric surgery : more than a moral obligation
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Growing awareness of biological, genetic, environmental, and behavioural factors contributed to the recognition of obesity as a chronic disease. Nowadays, obesity and its medical/surgical treatment is widely acknowledgedin the medical curriculum. Bariatric surgery has long been shown to provide superior induction and maintenance of weight loss, together with improvement or resolution of obesity-related diseases. The role of revisional bariatric surgery for treatment of procedure-related complications is accepted. However, its role as second-line treatment of patients with primary or secondary non-response is still a matter of debate. This prompted Dr Henry Buchwald in 2015 to publish his article “Revisional Metabolic/Bariatric Surgery: A Moral Obligation”. Studies I and II in this doctoral thesis covered issues that fuel the ongoing controversy, namely effects and risks of revisional surgery. Conversion to gastric bypass is the most common revisional procedure in Sweden. In Studies I and II, we found revisional gastric bypass to give inferior weight loss with a higher risk for perioperative complications compared to primary gastric bypass. However, the beneficial effects on obesity-related disease were similar (Papers I and II). In Study III, the theoretical need for revisional bariatric surgery in patients with primary or secondary weight non-response was evaluated. When applying four different indication criteria, more than 13% of patients met the criteria for second-line treatment, with a significant higher probability after sleeve gastrectomy compared to gastric bypass (Paper III). To gain a clearer picture, a systematic review of the literature on revisional bariatric surgery after sleeve gastrectomy was inevitable. However, an evidence-based treatment strategy for patients with primary or secondary weight non-response could not be deduced from the current literature (Paper IV).
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| 196422. |
- Axer, Stephan, 1971-, et al.
(författare)
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Weight loss and alterations in co-morbidities after revisional gastric bypass : A case-matched study from the Scandinavian Obesity Surgery Registry
- 2017
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier. - 1550-7289 .- 1878-7533. ; 13:5, s. 796-800
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Tidskriftsartikel (refereegranskat)abstract
- Background: In Sweden, Roux-en-Y gastric bypass is the most common procedure when revising a previous bariatric procedure. This study is an analysis of all revisional gastric bypass operations (rGBP) compared with a matched group of primary gastric bypass (pGBP) operated between 2007 and 2012.Objective: The aim was to determine whether improvement of obesity-related co-morbidity and changes in weight after revisional gastric bypass surgery were comparable with those seen after primary surgery.Setting: 44 hospitals in SwedenMethods: Retrospective data were retrieved from the Scandinavian Obesity Surgery Registry. The study group (rGBP) comprised 1224 patients, and the control group (pGBP) comprised 3612 patients matched for age and gender.Results: The indication for revision was weight failure in 512 patients (42%), a late complication of the initial procedure in 330 patients (27%), and a combination of weight failure and complication in 303 patients (25%). A total of 66% of patients in the rGBP group and 67% in the pGBP group completed the 2-year follow-up in the Scandinavian Obesity Surgery Registry.The rGBP-group had significantly less excess BMI loss (%EBMIL, 59.4 +/- 147.0 versus 79.5 +/- 24.7, P < .001) and a lower dyslipidemia remission rate (42.9% versus 62.0%, P = .005) at the time of the 2-year follow-up. Remission rates of sleep apnea, hypertension, type 2 diabetes, and depression were similar. The effects on obesity-related co-morbidity were not related to the indication for revisional surgery or the initial bariatric procedure.Conclusion: Even if weight results might be inferior compared with primary bypass procedures, the improvement of co-morbidity is similar. (C) 2017 American Society for Metabolic and Bariatric Surgery. All right reserved
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| 196423. |
- Axer, Stephan, et al.
(författare)
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Weight-Related Outcomes After Revisional Bariatric Surgery in Patients with Non-response After Sleeve Gastrectomy : a Systematic Review
- 2023
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Ingår i: Obesity Surgery. - : Springer. - 0960-8923 .- 1708-0428. ; 33:7, s. 2210-2218
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Forskningsöversikt (refereegranskat)abstract
- Weight non-response after sleeve gastrectomy is an emerging issue. This systematic review compared revisional procedures for weight-related outcomes. We searched several databases for relevant articles and included adult patients with revisional bariatric procedures after primary sleeve gastrectomy. Twelve trials with 1046 patients were included, covering five revisional procedures. There were no randomised controlled trials, and 10 studies had a critical risk of bias. Significant variations in inclusion criteria, therapy benchmarks, follow-up schemes, and outcome measurements were observed, preventing meaningful comparison of results. Evidence-based treatment strategies for weight non-response after sleeve gastrectomy cannot be deduced from the current literature. Prospective studies with well-defined indications, standardised techniques, and strict adherence to outcome measurements are needed.
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| 196424. |
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| 196425. |
- Axfors, Cathrine, et al.
(författare)
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Adult attachment's unique contribution in the prediction of postpartum depressive symptoms, beyond personality traits
- 2017
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Ingår i: Journal of Affective Disorders. - : Elsevier BV. - 0165-0327 .- 1573-2517. ; 222, s. 177-184
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Tidskriftsartikel (refereegranskat)abstract
- Background:Personality traits such as neuroticism can help identify pregnant women at risk of postpartum depressive symptoms (PPDS). However, it is unclear whether attachment style could have an additional contribution to this risk elevation. This study aimed to examine the overlap of adult attachment insecurity and neuroticism/trait anxiety as PPDS predictors, taking into account baseline depressive symptoms.Methods:A Swedish population-based sample of pregnant women reported on adult attachment and either neuroticism (n = 1063) or trait anxiety (n = 555). Depressive symptoms were assessed at baseline, and at six weeks and six months postpartum. Correlations between attachment and neuroticism/trait anxiety were calculated. Generalized linear models of PPDS tested the effect of attachment anxiety and avoidance, adjusting for neuroticism/trait anxiety and baseline depression. Logistic regression models with combined high attachment anxiety and-neuroticism/trait anxiety visualized their value as risk factors beyond antenatal depression.Results:Attachment and neuroticism/trait anxiety were highly correlated (r = .55.77). Attachment anxiety exerted a partially independent effect on PPDS at six weeks (p < .05) and at six months (p < .05) adjusting for neuroticism. Among antenatally non-depressed, combined high attachment anxiety and high neuroticism or trait anxiety was predictive of PPDS at both assessment points. Limitations: Low acceptance rate, exclusive use of self-reports.Conclusions:Beyond personality, attachment anxiety had a small independent effect on the risk of PPDS. Combining items of adult attachment and neuroticism/trait anxiety could prove useful in antenatal screening for high risk of PPDS.
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| 196426. |
- Axfors, Cathrine, et al.
(författare)
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Psychometric properties of the attachment style questionnaire in Swedish pregnant women : short and full versions
- 2017
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Ingår i: Journal of Reproductive and Infant Psychology. - : Routledge. - 0264-6838 .- 1469-672X. ; 35:5, s. 450-461
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: (i) To evaluate the reliability and factor structure of the Attachment Style Questionnaire – Short Form (ASQ-SF) for use in pregnant women and (ii) to compare the reliability and factor structure of the short- and full version-ASQ among pregnant women. Background: Adult attachment insecurity is currently included as a major risk factor in studies of perinatal health. None of the self-report measures with a Swedish translation have been psychometrically evaluated in a pregnant cohort.Methods: A population-based cohort of 1631 pregnant women answered the ASQ in late pregnancy. Internal consistency (item- subscale correlations, Cronbach’s α, and α if item deleted) was evaluated for the seven available subscales. Con rmatory factor analysis (CFA) was run to examine the factor structure of the short form compared with the full-version. Test–retest correlations were assessed in a subgroup (n = 48).Results: All mean item-subscale correlations for the ASQ-SF were > 0.30. Cronbach’s α’s for ASQ-SF dimensions were as follows: Avoidance (0.87); Anxiety (0.89); Discomfort with Closeness (0.85); Relationships as Secondary (0.54); Con dence (0.83); Need for Approval (0.76); and Preoccupation with Relationships (0.77). No item removal substantively increased subscale α’s. The CFA demonstrated better model t for the ASQ-SF than for the full-version ASQ, while other reliability measures were similar. Test–retest correlations ranged from 0.65 to 0.84.Conclusion: The ASQ-SF showed similar psychometric properties in pregnant women as in the general population and had good reliability, but the optimal factor structure needs to be studied further. Results support the usage of the ASQ-SF in pregnant cohorts.
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| 196427. |
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| 196428. |
- Axler, Olof
(författare)
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APOLIPOPROTEIN M
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Apolipoprotein M (apoM) is composed of 188 amino acids and has an apparent molecular weight of 25 kDa. ApoM belongs to the lipocalin protein superfamily, and is found in all major lipoprotein classes, although the majority of apoM is found in high density lipoprotein, HDL. In apoM, the signal peptide is retained in the mature protein. ApoM with a cleavable signal peptide was constructed. In contrast to wild-type protein, the size of apoM with a cleaved signal peptide corresponded to free, unassociated apoM, strongly indicating that the signal peptide is necessary for the protein´s ability to associate with lipoproteins. To facilitate clinical studies, an ELISA for the measurement of apoM was developed and reference ranges established using samples from the NOBIDA biobank. Correlation studies of apoM with 26 common clinical chemical analytes was performed and a marked positive correlation was observed with plasma total cholesterol (r=0.52) and LDL and HDL cholesterol (r=0.43 and 0.36, respectively). To investigate whether apoM levels predict the risk for coronary disease, apoM was measured in samples from CHD and control subjects drawn from two prospective case-control studies, FINRISK ´92 and the Copenhagen City Heart Study (255 and 1865 individuals in total, respectively). In conditional logistic regression analyses, apoM was not a predictor of CHD events. Plasma apoM was investigated as a possible biomarker for MODY3 disease. Mean serum apoM was 5% lower in carriers of the P291fsinsC mutation of HNF-1a compared to family control subjects. The difference remained statistically significant after exclusion of diabetic individuals but is too small for apoM to be employed as a biomarker for HNF-1a mutation status. In a separate study, no significant difference in apoM concentration was observed between MODY3 and type 2 diabetic patients.
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| 196429. |
- Axler, Olof, et al.
(författare)
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Intermittent Maple Syrup Urine Disease: Two Case Reports
- 2014
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Ingår i: Pediatrics. - : American Academy of Pediatrics (AAP). - 1098-4275 .- 0031-4005. ; 133:2, s. 458-460
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Tidskriftsartikel (refereegranskat)abstract
- The presenting symptoms and clinical course of 2 cases of intermittent maple syrup urine disease (MSUD) are described. Intermittent MSUD is a potentially life-threatening metabolic disorder caused by a deficiency of branched-chain alpha-keto acid dehydrogenase, the enzyme complex that decarboxylates the 3 branched-chain amino acids. In contrast to classic MSUD, children with the intermittent form show normal development with normal intelligence and, when asymptomatic, normal levels of branched-chain amino acids. Symptoms usually appear between 5 months and 2 years of age, when a trivial infection such as otitis media or viral gastroenteritis triggers catabolism of muscle protein. Intermittent MSUD should be suspected in cases of common infections with a clinically atypical course, especially in children displaying ataxia or marked drowsiness.
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| 196430. |
- Axling, Ulrika, et al.
(författare)
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Rose hip exerts antidiabetic effects via a mechanism involving downregulation of the hepatic lipogenic program
- 2011
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Ingår i: American Journal of Physiology: Endocrinology and Metabolism. - : American Physiological Society. - 1522-1555 .- 0193-1849. ; 300:1, s. 111-121
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Tidskriftsartikel (refereegranskat)abstract
- Andersson U, Henriksson E, Strom K, Alenfall J, Goransson O, Holm C. Rose hip exerts antidiabetic effects via a mechanism involving downregulation of the hepatic lipogenic program. Am J Physiol Endocrinol Metab 300: E111-E121, 2011. First published October 19, 2010; doi:10.1152/ajpendo.00268.2010.-The aim of this study was to investigate the metabolic effects of a dietary supplement of powdered rose hip to C57BL/6J mice fed a high-fat diet (HFD). Two different study protocols were used; rose hip was fed together with HFD to lean mice for 20 wk (prevention study) and to obese mice for 10 wk (intervention study). Parameters related to obesity and glucose tolerance were monitored, and livers were examined for lipids and expression of genes and proteins related to lipid metabolism and gluconeogenesis. A supplement of rose hip was capable of both preventing and reversing the increase in body weight and body fat mass imposed by a HFD in the C57BL/6J mouse. Oral and intravenous glucose tolerance tests together with lower basal levels of insulin and glucose showed improved glucose tolerance in mice fed a supplement of rose hip compared with control mice. Hepatic lipid accumulation was reduced in mice fed rose hip compared with control, and the expression of lipogenic proteins was downregulated, whereas AMP-activated protein kinase and other proteins involved in fatty acid oxidation were unaltered. Rose hip intake lowered total plasma cholesterol as well as the low-density lipoprotein-to-high-density lipoprotein ratio via a mechanism not involving altered gene expression of sterol regulatory element-binding protein 2 or 3-hydroxymethylglutaryl-CoA reductase. Taken together, these data show that a dietary supplement of rose hip prevents the development of a diabetic state in the C57BL/6J mouse and that downregulation of the hepatic lipogenic program appears to be at least one mechanism underlying the antidiabetic effect of rose hip.
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