| 1. |
- Jonsson, Stefan, et al.
(författare)
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Identification of sequence variants influencing immunoglobulin levels
- 2017
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Ingår i: Nature Genetics. - : Springer Science and Business Media LLC. - 1546-1718 .- 1061-4036. ; 49:8, s. 1182-1191
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Tidskriftsartikel (refereegranskat)abstract
- Immunoglobulins are the effector molecules of the adaptive humoral immune system. In a genome-wide association study of 19,219 individuals, we found 38 new variants and replicated 5 known variants associating with IgA, IgG or IgM levels or with composite immunoglobulin traits, accounted for by 32 loci. Variants at these loci also affect the risk of autoimmune diseases and blood malignancies and influence blood cell development. Notable associations include a rare variant at RUNX3 decreasing IgA levels by shifting isoform proportions (rs188468174[C>T]: P = 8.3 × 10(-55), β = -0.90 s.d.), a rare in-frame deletion in FCGR2B abolishing IgG binding to the encoded receptor (p.Asn106del: P = 4.2 × 10(-8), β = 1.03 s.d.), four IGH locus variants influencing class switching, and ten new associations with the HLA region. Our results provide new insight into the regulation of humoral immunity.
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| 2. |
- Sigurbergsdottir, Adalbjorg Yr, et al.
(författare)
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Disease associations with monoclonal gammopathy of undetermined significance can only be evaluated using screened cohorts: results from the population-based iStopMM study
- 2023
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Ingår i: REVISTA CHILENA DE LITERATURA. - 0718-2295. ; :108, s. 3392-3398
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Tidskriftsartikel (refereegranskat)abstract
- Monoclonal gammopathy of undetermined significance (MGUS) is an asymptomatic precursor condition that precedes multiple myeloma and related disorders but has also been associated with other medical conditions. Since systematic screening is not recommended, MGUS is typically diagnosed due to underlying diseases and most cases are not diagnosed. Most previous studies on MGUS disease associations have been based on clinical cohorts, possibly resulting in selection bias. Here we estimate this selection bias by comparing clinically diagnosed and screened individuals with MGUS with re-gards to demographics, laboratory features, and comorbidities. A total of 75,422 participants in the Iceland Screens, Treats, or Prevents Multiple Myeloma (iStopMM) study were screened for MGUS by serum protein electrophoresis, immunofixation and free light chain assay (clinicaltrials gov. Identifier: NCT03327597). We identified 3,352 individuals with MGUS, whereof 240 had previously been clinically diagnosed (clinical MGUS), and crosslinked our data with large, nationwide registries for information on comorbidities. Those with clinical MGUS were more likely to have at least one comorbidity (odds ratio=2.24; 95% confidence interval: 1.30-4.19), and on average had more comorbidities than the screened MGUS group (3.23 vs. 2.36, mean difference 0.68; 95% confidence interval: 0.46-0.90). They were also more likely to have rheumato-logical disease, neurological disease, chronic kidney disease, liver disease, heart failure, or endocrine disorders. These findings indicate that individuals with clinical MGUS have more comorbidities than the general MGUS population and that previous studies have been affected by significant selection bias. Our findings highlight the importance of screening data when studying biological and epidemiological implications of MGUS.
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| 3. |
- Sundbom, Magnus, et al.
(författare)
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Low overall mortality during 10 years of bariatric surgery : nationwide study on 63,469 procedures from the Scandinavian Obesity Registry
- 2020
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier. - 1550-7289 .- 1878-7533. ; 16:1, s. 65-70
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Tidskriftsartikel (refereegranskat)abstract
- Background: Bariatric surgery results in an improvement in quality of life, co-morbid diseases, and an increased life expectancy. However, to obtain these benefits perioperative mortality rates need to be low.Objectives: Evaluate 90-day and 1-year mortality after bariatric surgery in Sweden from 2008 to 2017.Setting: National quality register.Methods: Data on applicable patients from the Scandinavian Obesity Surgery Registry, including 63,469 patients (85.1% gastric bypass, 12.5% sleeve gastrectomy, .8% duodenal switch, .5% minor revisions, and 1.1% other procedures), were retrieved and matched to the Cause of Death registry.Results: During the 10-year period, 36 patients died within 90 days, resulting in a .06% overall mortality. The 1-year mortality rate was .19% (n = 111). Both mortality rates decreased over the study period. In a multivariate analysis, depression (odds ratio [OR] 2.38, [95% confidence interval 1.48-3.84]), leakage (OR 9.32 [4.85-17.94]), and thromboembolic events (OR 7.60 [1.63-35.37]) increased mortality risks at both 90 days and 1 year, whereas age (OR 1.03 [1.01-1.06] per increased year of age) and abdominal circumference (OR 1.03 [1.01-1.05] per cm) were also associated with increased mortality at 1 year. The predictive value of the Obesity Surgery Mortality Risk Score was confirmed.Conclusions: The low 90-day and 1-year mortality, .06% and .19%, respectively, demonstrates that bariatric surgery in Sweden is safe. The use of antidepressants and 2 serious postoperative complications were the most significant risk factors for early deaths, while increased age and preoperative abdominal circumference also contributed at 1 year.
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| 4. |
- Vidarsson, Bjarni, 1979-
(författare)
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Complications in bariatric surgery with focus on gastric bypass
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Obesity is rising in pandemic proportions. At present, one third of the world’s population has become overweight or obese, and estimates predict 60% in 2030. Thus, the problem is gigantic. Obesity is associated with numerous diseases such as diabetes, high blood pressure, sleep apnea and cancer. Untreated obesity decreases life expectancy by about 10 years. Gastric bypass has been one of the cornerstones of surgical treatment. Since 1994 this is done by laparoscopic technique (LRYGB)In this thesis, we have primarily used data from our national quality register, the Scandinavian Obesity Surgical Registry (SOReg), on patients that have been operated with LRYGB. In the first paper, we evaluated the use of a novel suture for closing the gastrojejunostomy (upper anastomosis). Paper II and III focused on incidence, risk factors, treatment and outcome of anastomotic leaks. Paper IV compares the weight results, quality of life, use of medications and healthcare consumption in patients suffering from a serious complication within 30 days after LRYGB.In Paper I, the use of the barbed suture resulted in shorter operative time compared to a standard polyfilament, without increased risk for complications. Paper II showed that the incidence of anastomotic leaks at the gastrojejunostomy was 0.6%. Risk factors were male sex, higher age (≥49 years), diabetes, conversion to open surgery and prolonged operative time (≥ 90 minutes). Almost all patients were reoperated and 1% died. Paper III showed that the incidence of small bowel leaks was 0.3% and these leaks were associated with prolonged operative time, and surgery at a low-volume centre for leaks at the enteroaenteral anastomosis. Surgical re-intervention was common. Paper IV showed that severe complications within 30 days postoperatively after LRYGB occurred in 2.9% of cases. Two years later, the patients still reported inferior quality of life and had a higher use of antidepressants, proton pump inhibitors and opioids compared to uncomplicated cases. The need for additional in-hospital care was higher, even after the first 30 days.In conclusion, the novel barbed suture reduced operative time without increasing risks. Anastomotic leaks are rare, but serious complications in LRYGB do affect the patient in numerous ways and increase healthcare costs.
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| 5. |
- Vidarsson, Bjarni, et al.
(författare)
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Impact of a severe complication two years after laparoscopic Roux-en-Y gastric bypass : A cohort study from the Scandinavian Obesity Surgery Registry
- 2021
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier. - 1550-7289 .- 1878-7533. ; 17:11, s. 1874-1882
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Although severe complications (SC) after laparoscopic Roux-en-Y gastric bypass (LRYGB) are rare, they can be devastating for the affected patient. We aimed to access the impact of SC (Clavien Dindo ≥3b) two years after LRYGB by using a nationwide Swedish cohort.Methods: Of 48 201 primary LRYGB operated between 2007 and June 2016, 1411 (2.9%) patients suffered an SC and 16 (0.03%) died. In total, 1403 SC patients (42 years, 75% females, 15.7% diabetics and BMI 41.9 kg/m2) could be matched 1:1 on age, gender, diabetic status, body mass index and year of operation to 1403 patients without an SC. Weight loss, patient-scored quality of life (QoL), antidepressant use, proton pump inhibitors (PPI) and opioids, and in-hospital care was gathered from three national registers.Results: Both groups had a total body weight loss of 32% at 2 years. An SC negatively affected the improvement of the physical, but not mental, QoL at two years. Antidepressant use, PPI and opioids was higher among SC patients, even two years after surgery. At this time point, a doubling of oral morphine equivalents (7.3 to 17.0 mg/day) was found in SC patients compared to prior to surgery. The SC group required more in-hospital care, also after the initial 30 days (3.8 vs. 0.9 days in the remaining part of the first year).Conclusion: An SC resulted in an inferior improvement in QoL, higher antidepressant use, PPI and opioids as well as higher need of in-hospital care during the first two postoperative years. Affected patients should therefore receive special attention during follow up.
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| 6. |
- Vidarsson, Bjarni, et al.
(författare)
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Incidence and treatment of leak at the gastrojejunostomy in Roux-en-Y gastric bypass : a cohort study of 40,844 patients
- 2019
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Ingår i: Surgery for Obesity and Related Diseases. - : ELSEVIER SCIENCE INC. - 1550-7289 .- 1878-7533. ; 15:7, s. 1075-1079
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Tidskriftsartikel (refereegranskat)abstract
- Background: Leak at the gastrojejunostomy (GJ) after Roux-en-Y gastric bypass is a rare but life-threatening complication. Objectives: To assess incidence, risk factors, treatment, and outcome of leaks at the GJ after Roux-en-Y gastric bypass in a nationwide cohort. Setting: Sweden. Methods: Leaks at GJ within 30 days postoperatively in 40,844 patients (age 41 yr, females 76%, and body mass index of 42.4 kg/m(2)) between 2007 and 2014 in the Scandinavian Obesity Surgery Registry were assessed. Register data and outcomes were verified by reviewing patient charts. Logistic regression was done to estimate odds ratios (ORs) for significant risk factors. Results: Leak at the GJ was registered in 262 (.6%) patients, with 44% diagnosed within the first 3 postoperative days. Risk factors were male sex (OR 1.5 [1.1-1.9]), age >= 49 years (OR 1.9 [1.3-2.7]), diabetes (OR 1.4 [1.1-1.9]), conversion to open surgery (OR 3.9 [2.2-6.9]), and operative time >= 90 minutes (OR 2.6 [1.8-3.8]). In most patients, the leak resulted in a severe complication. Reoperative surgery was done in 85%, with the placement of a feeding gastrostomy in 24%. Stents were used at some time point in 31% of leaks. Of all patients with leaks, 25% required intensive care, 4% developed multiorgan failure, and 1% died. Median duration of stay for patients with leaks was 22 days, versus 2 days for others (P < .001). Conclusion: GJ leaks occurred in .6% of patients. Risk factors were male sex, age >= 49 years, diabetes, operative time >= 90 minutes, and conversion to open surgery. Surgical reintervention was common. Mortality was 1%. (C) 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
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| 7. |
- Vidarsson, Bjarni, et al.
(författare)
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Incidence and treatment of small bowel leak after Roux-en-Y gastric bypass : a cohort study from the Scandinavian Obesity Surgery Registry.
- 2020
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier BV. - 1550-7289 .- 1878-7533. ; 16:8, s. 1005-1010
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Anastomotic leak at the gastrojejunostomy in Roux-en-Y gastric bypass is a rare, but serious, complication. Little has been published on leaks at other sites.OBJECTIVES: To assess incidence, risk factors, treatment, and outcome of small bowel leaks at the enteroenteral anastomosis (EA) and undiagnosed iatrogenic small bowel perforations in primary Roux-en-Y gastric bypass.SETTING: Nationwide cohort, Sweden.METHODS: All leaks within 30 days in 41,342 patients (age 40.8 [standard deviation 11.1] yr, females 68%, and body mass index 42.4 [standard deviation 5.4] kg/m2) between 2007 and 2014 in the Scandinavian Obesity Surgery Registry were assessed. Register data and outcomes were verified by reviewing patient charts. Logistic regression estimated odds ratios (OR) and 95% confidence intervals for significant risk factors.RESULTS: The incidence of small bowel leaks was .3%. Iatrogenic perforations were diagnosed earlier than EA leaks, 3.6 versus 6.5 days after surgery (P = .02). EA leaks were seen in 75 patients (.2%), with surgery at a low-volume center (<125 cases/yr, OR 2.1 [1.0-4.1]) and prolonged operative time (≥90 min, OR 3.5 [1.1-11.0]) as risk factors. The risk of iatrogenic small bowel perforations, .1%, was tripled by prolonged operative time (OR 3.4 [1.2-9.4]). Surgical reintervention was required in 97% of leaks, repairing the defect and draining the abdominal cavity in most cases. A third of the patients required intensive care, of which 5% developed multiorgan failure and 1% died.CONCLUSION: Small bowel leaks, seen in .3%, were associated to prolonged operative time, and surgery at a low-volume center for EA leaks. Surgical reintervention was common, while mortality was low.
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| 8. |
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| 9. |
- Vidarsson, Bjarni, et al.
(författare)
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Shorter overall operative time when barbed suture is used in primary laparoscopic gastric bypass : A cohort study of 25,006 cases
- 2017
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier BV. - 1550-7289 .- 1878-7533. ; 13:9, s. 1484-1488
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Closing the remaining opening in a linear stapled anastomosis, for example in laparoscopic Roux-en-Y gastric bypass (LRYGB), can be challenging.OBJECTIVES: To evaluate if the novel unidirectional barbed suture (BS) is of value in LRYGB compared with polyfilament (PS) suture. We have compared operative time, early complications, and length of stay, as well as anastomotic strictures and small bowel obstruction during the first year.SETTING: Retrospective study from the Scandinavian Obesity Surgery Registry (SOReg).METHODS: A nationwide cohort of 25,006 primary LRYGB (2211 BS and 22,795 PS) from SOReg were studied. No preoperative differences in age or gender were noted; however, BS patients had lower Body Mass Index (BMI) (41.3 versus 42.3 kg/m(2), P<.001) and less diabetes (13.7% versus 15.4%, P = .03).RESULTS: Total operative time was 11 minutes (16%) shorter using BS compared with PS (58 versus 69 minutes, P<.001), although the mesenteric openings were more frequently closed among BS patients (94% versus 71%, P<.001). No differences were seen in early complications; anastomotic leaks or intra-abdominal abscesses were noted in 1.8% and 1.4%, respectively, P = .17. The incidence of anastomotic strictures was similar (.13% versus .17%, P = .73) as was the incidence of surgery for small bowel obstruction (1.8% versus 1.6%, P = .69).CONCLUSIONS: The use of barbed suture for closing the remaining opening in the gastrojejunostomy shortened the operative time without increasing the risk of complications. BS is still uncommon in LRYGB, but its implementation could have significant impact on operative time.
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