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2.
  • Edberg, Niklas J. T., et al. (author)
  • Spatial distribution of low-energy plasma around comet 67P/CG from Rosetta measurements
  • 2015
  • In: Geophysical Research Letters. - 0094-8276 .- 1944-8007. ; 42:11, s. 4263-4269
  • Journal article (peer-reviewed)abstract
    • We use measurements from the Rosetta plasma consortium Langmuir probe and mutual impedance probe to study the spatial distribution of low-energy plasma in the near-nucleus coma of comet 67P/Churyumov-Gerasimenko. The spatial distribution is highly structured with the highest density in the summer hemisphere and above the region connecting the two main lobes of the comet, i.e., the neck region. There is a clear correlation with the neutral density and the plasma to neutral density ratio is found to be approximate to 1-210(-6), at a cometocentric distance of 10km and at 3.1AU from the Sun. A clear 6.2h modulation of the plasma is seen as the neck is exposed twice per rotation. The electron density of the collisionless plasma within 260km from the nucleus falls off with radial distance as approximate to 1/r. The spatial structure indicates that local ionization of neutral gas is the dominant source of low-energy plasma around the comet.
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  • Anna Karin, Hedström, et al. (author)
  • The impact of bariatric surgery on disease activity and progression of multiple sclerosis : A nationwide matched cohort study
  • 2022
  • In: Multiple Sclerosis Journal. - : Sage Publications. - 1352-4585 .- 1477-0970. ; 28:13, s. 2099-2105
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Surgical outcomes in patients with multiple sclerosis (MS) following metabolic surgery appear to be similar compared to those of the general bariatric population.OBJECTIVE: To study the impact of metabolic surgery on the clinical course of MS.METHODS: Using data from the Scandinavian Obesity Surgery Registry and the Swedish Multiple Sclerosis register, we compared disease outcomes in 122 cases of MS who had undergone metabolic surgery with those of 122 cases of MS without surgery, matched by a two-staged Propensity score match, including age at disease onset, sex, MS phenotype, body mass index, and preoperative severity of MS as measured by the Expanded Disability Status Scale.RESULTS: The time to 6-month confirmed disability progression during the first five years postbaseline was shorter among the surgical patients (hazard ratio (HR) = 2.31, 95% confidence interval (CI) = 1.09-4.90; p = 0.03). No differences were observed regarding postoperative annual relapse rate (p = 0.24) or time to first postoperative relapse (p = 0.52).CONCLUSION: Although metabolic surgery appears to be a safe and efficient treatment of obesity in patients with MS, the clinical course of the disease might be negatively affected. Long-term nutritional follow-up after surgery and supplementation maintenance are crucial, particularly among those with preoperative deficits.
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  • Cao, Yang, Associate Professor, 1972-, et al. (author)
  • A Comparative Study of Machine Learning Algorithms in Predicting Severe Complications after Bariatric Surgery
  • 2019
  • In: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 8:5
  • Journal article (peer-reviewed)abstract
    • Background: Severe obesity is a global public health threat of growing proportions. Accurate models to predict severe postoperative complications could be of value in the preoperative assessment of potential candidates for bariatric surgery. So far, traditional statistical methods have failed to produce high accuracy. We aimed to find a useful machine learning (ML) algorithm to predict the risk for severe complication after bariatric surgery.Methods: We trained and compared 29 supervised ML algorithms using information from 37,811 patients that operated with a bariatric surgical procedure between 2010 and 2014 in Sweden. The algorithms were then tested on 6250 patients operated in 2015. We performed the synthetic minority oversampling technique tackling the issue that only 3% of patients experienced severe complications.Results: Most of the ML algorithms showed high accuracy (>90%) and specificity (>90%) in both the training and test data. However, none of the algorithms achieved an acceptable sensitivity in the test data. We also tried to tune the hyperparameters of the algorithms to maximize sensitivity, but did not yet identify one with a high enough sensitivity that can be used in clinical praxis in bariatric surgery. However, a minor, but perceptible, improvement in deep neural network (NN) ML was found.Conclusion: In predicting the severe postoperative complication among the bariatric surgery patients, ensemble algorithms outperform base algorithms. When compared to other ML algorithms, deep NN has the potential to improve the accuracy and it deserves further investigation. The oversampling technique should be considered in the context of imbalanced data where the number of the interested outcome is relatively small.
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  • Cao, Yang, Associate Professor, 1972-, et al. (author)
  • Deep Learning Neural Networks to Predict Serious Complications After Bariatric Surgery : Analysis of Scandinavian Obesity Surgery Registry Data
  • 2020
  • In: JMIR Medical Informatics. - : JMIR Publications. - 2291-9694. ; 8:5
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Obesity is one of today's most visible public health problems worldwide. Although modern bariatric surgery is ostensibly considered safe, serious complications and mortality still occur in some patients.OBJECTIVE: This study aimed to explore whether serious postoperative complications of bariatric surgery recorded in a national quality registry can be predicted preoperatively using deep learning methods.METHODS: Patients who were registered in the Scandinavian Obesity Surgery Registry (SOReg) between 2010 and 2015 were included in this study. The patients who underwent a bariatric procedure between 2010 and 2014 were used as training data, and those who underwent a bariatric procedure in 2015 were used as test data. Postoperative complications were graded according to the Clavien-Dindo classification, and complications requiring intervention under general anesthesia or resulting in organ failure or death were considered serious. Three supervised deep learning neural networks were applied and compared in our study: multilayer perceptron (MLP), convolutional neural network (CNN), and recurrent neural network (RNN). The synthetic minority oversampling technique (SMOTE) was used to artificially augment the patients with serious complications. The performances of the neural networks were evaluated using accuracy, sensitivity, specificity, Matthews correlation coefficient, and area under the receiver operating characteristic curve.RESULTS: In total, 37,811 and 6250 patients were used as the training data and test data, with incidence rates of serious complication of 3.2% (1220/37,811) and 3.0% (188/6250), respectively. When trained using the SMOTE data, the MLP appeared to have a desirable performance, with an area under curve (AUC) of 0.84 (95% CI 0.83-0.85). However, its performance was low for the test data, with an AUC of 0.54 (95% CI 0.53-0.55). The performance of CNN was similar to that of MLP. It generated AUCs of 0.79 (95% CI 0.78-0.80) and 0.57 (95% CI 0.59-0.61) for the SMOTE data and test data, respectively. Compared with the MLP and CNN, the RNN showed worse performance, with AUCs of 0.65 (95% CI 0.64-0.66) and 0.55 (95% CI 0.53-0.57) for the SMOTE data and test data, respectively.CONCLUSIONS: MLP and CNN showed improved, but limited, ability for predicting the postoperative serious complications after bariatric surgery in the Scandinavian Obesity Surgery Registry data. However, the overfitting issue is still apparent and needs to be overcome by incorporating intra- and perioperative information.
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  • Cao, Yang, Associate Professor, 1972-, et al. (author)
  • Using a Convolutional Neural Network to Predict Remission of Diabetes After Gastric Bypass Surgery : Machine Learning Study From the Scandinavian Obesity Surgery Register
  • 2021
  • In: JMIR Medical Informatics. - : JMIR Publications. - 2291-9694. ; 9:8
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Prediction of diabetes remission is an important topic in the evaluation of patients with type 2 diabetes (T2D) before bariatric surgery. Several high-quality predictive indices are available, but artificial intelligence algorithms offer the potential for higher predictive capability.OBJECTIVE: This study aimed to construct and validate an artificial intelligence prediction model for diabetes remission after Roux-en-Y gastric bypass surgery.METHODS: Patients who underwent surgery from 2007 to 2017 were included in the study, with collection of individual data from the Scandinavian Obesity Surgery Registry (SOReg), the Swedish National Patients Register, the Swedish Prescribed Drugs Register, and Statistics Sweden. A 7-layer convolution neural network (CNN) model was developed using 80% (6446/8057) of patients randomly selected from SOReg and 20% (1611/8057) of patients for external testing. The predictive capability of the CNN model and currently used scores (DiaRem, Ad-DiaRem, DiaBetter, and individualized metabolic surgery) were compared.RESULTS: In total, 8057 patients with T2D were included in the study. At 2 years after surgery, 77.09% achieved pharmacological remission (n=6211), while 63.07% (4004/6348) achieved complete remission. The CNN model showed high accuracy for cessation of antidiabetic drugs and complete remission of T2D after gastric bypass surgery. The area under the receiver operating characteristic curve (AUC) for the CNN model for pharmacological remission was 0.85 (95% CI 0.83-0.86) during validation and 0.83 for the final test, which was 9%-12% better than the traditional predictive indices. The AUC for complete remission was 0.83 (95% CI 0.81-0.85) during validation and 0.82 for the final test, which was 9%-11% better than the traditional predictive indices.CONCLUSIONS: The CNN method had better predictive capability compared to traditional indices for diabetes remission. However, further validation is needed in other countries to evaluate its external generalizability.
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  • Dahlberg, Karuna, 1979-, et al. (author)
  • Incident self-harm after bariatric surgery : A nationwide registry-based matched cohort study
  • 2023
  • In: Clinical Obesity. - : John Wiley & Sons. - 1758-8103 .- 1758-8111. ; 13:3
  • Journal article (peer-reviewed)abstract
    • The aims of this study were to evaluate the longitudinal risk of self-harm and the risk factors for self-harm after bariatric surgery in patients and control subjects without prior self-harm. This observational cohort study was based on prospectively registered data. Patients 18–70 years at time of surgery, body mass index (BMI) > 30 kg/m2, who underwent a primary Roux-en-Y gastric bypass (RYGB) procedure or a primary sleeve gastrectomy between 2007 and 2019 were considered for inclusion. All patients who met the inclusion criteria were matched 1:10 to the general population in Sweden (69 492 patients vs. 694 920 controls). After excluding patients and controls with previous self-harm, a self-harm event occurred in 1408 patients in the surgical group (incidence rate (IR) 3.54/1000 person-years, 95% confidence interval (CI) 3.36–3.73) versus in 3162 patients in the control group (IR 0.81/1000 person-years, 95% CI 0.78–0.84), with a hazard ratio (HR) of 4.38 (95% CI 4.11–4.66, p < .001). Median follow-up time was 6.1 years. Risk factors were younger age, lower BMI, cardiovascular, and chronic obstructive pulmonary disease, all aspects of psychiatric comorbidities (except neuropsychiatric disorder), lower socioeconomic status, RYGB, lower health-related quality of life, lower postoperative weight loss, and not attending postoperative follow-up visits. Self-harm is clearly higher after bariatric surgery than in the general population. A qualitative follow-up may be particularly important for patients at increased risk.
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  • Gryth, Karin, et al. (author)
  • The Influence of Socioeconomic Factors on Quality-of-Life After Laparoscopic Gastric Bypass Surgery
  • 2019
  • In: Obesity Surgery. - : Springer. - 0960-8923 .- 1708-0428. ; 29:11, s. 3569-3576
  • Journal article (peer-reviewed)abstract
    • Introduction: Patients with low socioeconomic status have been reported to experience poorer outcome after several types of surgery. The influence of socioeconomic factors on health-related quality-of-life (HRQoL) after bariatric surgery is unclear.Materials and Methods: Patients operated with a primary laparoscopic gastric bypass procedure in Sweden between 2007 and 2015 were identified in the Scandinavian Obesity Surgery Register. Patients with a completed assessment of health-related quality-of-life based on the Obesity-related Problem Scale (OP Scale) were included in the study. Socioeconomic status was based on data from Statistics Sweden.Results: A total of 13,723 patients (32% of the 43,096 operated during the same period), with complete OP scores at baseline and two years after surgery, were included in the study. Age, lower preoperative BMI, male gender, higher education, professional status and disposable income as well as not receiving social benefits (not including retirement pension), and not a first- or second-generation immigrant, were associated with a higher postoperative HRQoL. Patients aged 30-60 years, with lower BMI, higher socioeconomic status, women and those born in Sweden by Swedish parents experienced a higher degree of improvement in HRQoL. Postoperative weight-loss was associated with higher HRQoL (unadjusted B 16.3, 95%CI 14.72-17.93, p < 0.0001).Conclusion: At 2 years, a strong association between weight loss and improvement in HRQoL was seen, though several factors influenced the degree of improvement. Age, sex, preoperative BMI and socioeconomic status all influence the postoperative HRQoL as well as the improvement in HRQoL after laparoscopic gastric bypass surgery.
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  • Hedberg, Suzanne, et al. (author)
  • Comparison of Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass : A Randomized Clinical Trial
  • 2024
  • In: JAMA Network Open. - : American Medical Association (AMA). - 2574-3805. ; 7:1
  • Journal article (peer-reviewed)abstract
    • IMPORTANCE: Laparoscopic sleeve gastrectomy (SG) and laparoscopic Roux-en-Y gastric bypass (RYGB) are widely used bariatric procedures for which comparative efficacy and safety remain unclear.OBJECTIVE: To compare perioperative outcomes in SG and RYGB.DESIGN, SETTING, AND PARTICIPANTS: In this registry-based, multicenter randomized clinical trial (Bypass Equipoise Sleeve Trial), baseline and perioperative data for patients undergoing bariatric surgery from October 6, 2015, to March 31, 2022, were analyzed. Patients were from university, regional, county, and private hospitals in Sweden (n = 20) and Norway (n = 3). Adults (aged ≥18 years) eligible for bariatric surgery with body mass indexes (BMIs; calculated as weight in kilograms divided by height in meters squared) of 35 to 50 were studied.INTERVENTIONS: Laparoscopic SG or RYGB.MAIN OUTCOMES AND MEASURES: Perioperative complications were analyzed as all adverse events and serious adverse events (Clavien-Dindo grade >IIIb). Ninety-day mortality was also assessed.RESULTS: A total of 1735 of 14 182 eligible patients (12%; 1282 [73.9%] female; mean (SD) age, 42.9 [11.1] years; mean [SD] BMI, 40.8 [3.7]) were included in the study. Patients were randomized and underwent SG (n = 878) or RYGB (n = 857). The mean (SD) operating time was shorter in those undergoing SG vs RYGB (47 [18] vs 68 [25] minutes; P < .001). The median (IQR) postoperative hospital stay was 1 (1-1) day in both groups. The 30-day readmission rate was 3.1% after SG and 4.0% after RYGB (P = .33). There was no 90-day mortality. The 30-day incidence of any adverse event was 40 (4.6%) and 54 (6.3%) in the SG and RYGB groups, respectively (odds ratio, 0.71; 95% CI, 0.47-1.08; P = .11). Corresponding figures for serious adverse events were 15 (1.7%) for the SG group and 23 (2.7%) for the RYGB group (odds ratio, 0.63; 95% CI, 0.33-1.22; P = .19).CONCLUSIONS AND RELEVANCE: This randomized clinical trial of 1735 patients undergoing primary bariatric surgery found that both SG and RYGB were performed with a low perioperative risk without clinically significant differences between groups.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02767505.
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  • Jans, Anders, et al. (author)
  • Duration of type 2 diabetes and remission rates after bariatric surgery in Sweden 2007-2015 : A registry-based cohort study
  • 2019
  • In: PLoS Medicine. - : Public Library of Science. - 1549-1277 .- 1549-1676. ; 16:11
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Although bariatric surgery is an effective treatment for type 2 diabetes (T2D) in patients with morbid obesity, further studies are needed to evaluate factors influencing the chance of achieving diabetes remission. The objective of the present study was to investigate the association between T2D duration and the chance of achieving remission of T2D after bariatric surgery.METHODS AND FINDINGS: We conducted a nationwide register-based cohort study including all adult patients with T2D and BMI ≥ 35 kg/m2 who received primary bariatric surgery in Sweden between 2007 and 2015 identified through the Scandinavian Obesity Surgery Registry. The main outcome was remission of T2D, defined as being free from diabetes medication or as complete remission (HbA1c < 42 mmol/mol without medication). In all, 8,546 patients with T2D were included. Mean age was 47.8 ± 10.1 years, mean BMI was 42.2 ± 5.8 kg/m2, 5,277 (61.7%) were women, and mean HbA1c was 58.9 ± 17.4 mmol/mol. The proportion of patients free from diabetes medication 2 years after surgery was 76.6% (n = 6,499), and 69.9% at 5 years (n = 3,765). The chance of being free from T2D medication was less in patients with longer preoperative duration of diabetes both at 2 years (odds ratio [OR] 0.80/year, 95% CI 0.79-0.81, p < 0.001) and 5 years after surgery (OR 0.76/year, 95% CI 0.75-0.78, p < 0.001). Complete remission of T2D was achieved in 58.2% (n = 2,090) at 2 years, and 46.6% at 5 years (n = 681). The chance of achieving complete remission correlated negatively with the duration of diabetes (adjusted OR 0.87/year, 95% CI 0.85-0.89, p < 0.001), insulin treatment (adjusted OR 0.25, 95% CI 0.20-0.31, p < 0.001), age (adjusted OR 0.94/year, 95% CI 0.93-0.95, p < 0.001), and HbA1c at baseline (adjusted OR 0.98/mmol/mol, 95% CI 0.97-0.98, p < 0.001), but was greater among males (adjusted OR 1.57, 95% CI 1.29-1.90, p < 0.001) and patients with higher BMI at baseline (adjusted OR 1.07/kg/m2, 95% CI 1.05-1.09, p < 0.001). The main limitations of the study lie in its retrospective nature and the low availability of HbA1c values at long-term follow-up.CONCLUSIONS: In this study, we found that remission of T2D after bariatric surgery was inversely associated with duration of diabetes and was highest among patients with recent onset and those without insulin treatment.
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  • Jans, Anders, 1981-, et al. (author)
  • Factors affecting relapse of type 2 diabetes after bariatric surgery in Sweden 2007-2015 : a registry-based cohort study
  • 2022
  • In: Surgery for Obesity and Related Diseases. - : Elsevier. - 1550-7289 .- 1878-7533. ; 18:3, s. 305-312
  • Research review (peer-reviewed)abstract
    • BACKGROUND: Although a large proportion of patients with type 2 diabetes (T2DM) who have undergone metabolic surgery experience initial remission some patients later suffer from relapse. While several factors associated with T2D remission are known, less is known about factors that may influence relapse.OBJECTIVES: To identify possible risk factors for T2D relapse in patients who initially experienced remission.SETTING: Nationwide, registry-based study.METHODS: We conducted a nationwide registry-based retrospective cohort study including all adult patients with T2D and body mass index ≥35 kg/m2 who received primary metabolic surgery with Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) in Sweden between 2007 and 2015. Patients who achieved complete diabetes remission 2 years after surgery was identified and analyzed. Main outcome measure was postoperative relapse of T2D, defined as reintroduction of diabetes medication.RESULTS: In total, 2090 patients in complete remission at 2 years after surgery were followed for a median of 5.9 years (interquartile range [IQR] 4.3-7.2 years) after surgery. The cumulative T2D relapse rate was 20.1%. Duration of diabetes (hazard ratio [HR], 1.09; 95% confidence interval [CI], 1.05-1.14; P < .001), preoperative glycosylated hemoglobin A1C (HbA1C) level (HR, 1.01; 95% CI, 1.00-1.02; P = .013), and preoperative insulin treatment (HR, 2.67; 95% CI, 1.84-3.90; P < .001) were associated with higher rates for relapse, while postoperative weight loss (HR, .93; 95% CI, .91-.96; P < .001), and male sex (HR, .65; 95% CI, .46-.91; P = .012) were associated with lower rates.CONCLUSION: Longer duration of T2D, higher preoperative HbA1C level, less postoperative weight loss, female sex, and insulin treatment prior to surgery are risk factors for T2D relapse after initial remission.
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  • Josefsson, Emma, et al. (author)
  • The effect of routine division of the greater omentum on small bowel obstruction after Roux-en-Y gastric bypass
  • 2023
  • In: Surgery for Obesity and Related Diseases. - : Elsevier. - 1550-7289 .- 1878-7533. ; 19:3, s. 178-183
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: It remains unknown whether routine division of the greater omentum during laparoscopic Roux-en-Y gastric bypass (LRYGB) influences the risk for small bowel obstruction (SBO) after RYGB.OBJECTIVE: To evaluate the effect of omental division on SBO after LRYGB stratified by handling of the mesenteric defects.SETTING: Nationwide, registry-based.METHODS: In this registry-based cohort study, 40,517 patients who underwent LRYGB in Sweden within the period from January 1, 2007, to December 31, 2019, with data from the Scandinavian Obesity Surgery Registry (SOReg) were included. The study was based on combined data from the SOReg, the National Patient Register, the Swedish Prescribed Drugs Register, and the Total Population Registry. The main outcome was reoperation for SBO.RESULTS: During a follow-up period of 5.9 ± 2.6 years, the cumulative incidence of SBO was 11.2% in the nondivision group compared with 9.7% among patients with divided omentum (hazard ratio [HR] = .83, 95% confidence interval [CI]: .77-.89, P < .001). The association was seen in patients without mesenteric defects closure (HR = .69, 95% CI: .61-.78, P < .001) as well as patients with closed mesenteric defects (HR = .80, 95% CI: .74-.87, P < .001).CONCLUSION: Division of the greater omentum is associated with reduced risk for SBO after antecolic, antegastric LRYGB and should be considered as a complement to mesenteric defects closure to further reduce the risk for SBO after LRYGB.
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  • le Roux, Carel W., et al. (author)
  • Bariatric Surgery : There Is a Room for Improvement to Reduce Mortality in Patients with Type 2 Diabetes
  • 2021
  • In: Obesity Surgery. - : Springer. - 0960-8923 .- 1708-0428.
  • Journal article (peer-reviewed)abstract
    • The new Scandinavian Obesity Surgery Registry (SOReg) report may influence current guidelines. Patients without type 2 diabetes (T2DM) prior to bariatric surgery had lower mortality over 6.3 years compared to those with T2DM. Moreover, patients with T2DM who achieved remission within 1 year after surgery had lower mortality than those who did not remit. Finally, there was no threshold at 10 years, but rather a linear relationship between duration of T2DM and glycemic remission. The SOReg report challenges existing recommendations and clinical practice. A case may also be made for patients with T2DM who did not achieve glycemic remission after 1 year to have a combination approach of surgery with medicines rather than surgery alone. Ultimately, the impact of T2DM duration on glycemic remission again suggest that patients with T2DM should have bariatric surgery earlier.
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  • Näslund, Erik, et al. (author)
  • Association of Metabolic Surgery With Major Adverse Cardiovascular Outcomes in Patients With Previous Myocardial Infarction and Severe Obesity A Nationwide Cohort Study
  • 2021
  • In: Circulation. - : Lippincott Williams & Wilkins. - 0009-7322 .- 1524-4539. ; 143:15, s. 1458-1467
  • Journal article (peer-reviewed)abstract
    • Background: The number of patients with myocardial infarction and severe obesity is increasing and there is a lack of evidence how these patients should be treated. The aim of this study was to investigate the association between metabolic surgery (Roux-en-Y gastric bypass and sleeve gastrectomy) and major adverse cardiovascular events in patients with previous myocardial infarction (MI) and severe obesity.Methods: Of 566 patients with previous MI registered in the SWEDEHEART registry (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) undergoing metabolic surgery and registered in the nationwide Scandinavian Obesity Surgery Registry, 509 patients (Roux-en-Y gastric bypass n=465; sleeve gastrectomy n=44) could be matched 1:1 to a control with MI from SWEDEHEART, but no subsequent metabolic surgery regarding sex, age (+/- 3 years), year of MI (+/- 3 years), and body mass index (+/- 3). The 2 groups were well matched, except for a lower proportion of reduced ejection fraction after MI (7% versus 12%), previous heart failure (10% versus 19%), atrial fibrillation (6% versus 10%), and chronic obstructive pulmonary disease (4% versus 7%) in patients undergoing metabolic surgery.Results: The median (interquartile range) follow-up time was 4.6 (2.7-7.1) years. The 8-year cumulative probability of major adverse cardiovascular events was lower in patients undergoing metabolic surgery (18.7% [95% CI, 15.9-21.5%] versus 36.2% [33.2-39.3%], adjusted hazard ratio, 0.44 [95% CI, 0.32-0.61]). Patients undergoing metabolic surgery had also a lower risk of death (adjusted HR, 0.45 [95% CI, 0.29-0.70]; MI, 0.24 [0.14-0.41]) and new onset heart failure, but there were no significant differences regarding stroke (0.91 [0.38-2.20]) and new onset atrial fibrillation (0.56 [0.31-1.01]).Conclusions: In severely obese patients with previous MI, metabolic surgery is associated with a low risk for serious complications, lower risk of major adverse cardiovascular events, death, new MI, and new onset heart failure. These findings need to be confirmed in a randomized, controlled trial.
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16.
  • Rydén, Mikael, et al. (author)
  • Lipolysis defect in people with obesity who undergo metabolic surgery
  • 2022
  • In: Journal of Internal Medicine. - : Wiley-Blackwell Publishing Inc.. - 0954-6820 .- 1365-2796. ; 292:4, s. 667-678
  • Journal article (peer-reviewed)abstract
    • OBJECTIVE: Cross-sectional studies demonstrate that catecholamine stimulation of fat cell lipolysis is blunted in obesity. We investigated whether this defect persists after substantial weight loss has been induced by metabolic surgery, and whether it is related to the outcome.DESIGN/METHODS: Patients with obesity not able to successfully reduce body weight by conventional means (n = 126) were investigated before and 5 years after Roux-en-Y gastric bypass surgery (RYGB). They were compared with propensity-score matched subjects selected from a control group (n = 1017), and with the entire group after adjustment for age, sex, body mass index (BMI), fat cell volume and other clinical parameters. Catecholamine-stimulated lipolysis (glycerol release) was investigated in isolated fat cells using noradrenaline (natural hormone) or isoprenaline (synthetic beta-adrenoceptor agonist).RESULTS: Following RYGB, BMI was reduced from 39.9 (37.5-43.5) (median and interquartile range) to 29.5 (26.7-31.9) kg/m2 (p < 0.0001). The post-RYGB patients had about 50% lower lipolysis rates compared with the matched and total series of controls (p < 0.0005). Nordrenaline activation of lipolysis at baseline was associated with the RYGB effect; those with high lipolysis activation (upper tertile) lost 30%-45% more in body weight, BMI or fat mass than those with low (bottom tertile) initial lipolysis activation (p < 0.0007).CONCLUSION: Patients with obesity requiring metabolic surgery have impaired ability of catecholamines to stimulate lipolysis, which remains despite long-term normalization of body weight by RYGB. Furthermore, preoperative variations in the ability of catecholamines to activate lipolysis may predict the long-term reduction in body weight and fat mass.
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17.
  • Sonesson, Ulf, et al. (author)
  • Paths to a sustainable food sector: integrated design and LCA of future food supply chains : the case of pork production in Sweden
  • 2016
  • In: The International Journal of Life Cycle Assessment. - : Springer Ferlag. - 0948-3349 .- 1614-7502. ; 21:5, s. 664-676
  • Journal article (peer-reviewed)abstract
    • Purpose: To describe a more sustainable food sector, a supply chain approach is needed. Changing a supply chain inevitably means that various attributes of the product and its system will change. This project assumed this challenge and delivered detailed descriptions, life cycle assessment (LCA) evaluations, and consequence assessments of the supply chains of six commodities, i.e., milk, cheese, beef, pork, chicken, and bread, from a Swedish region. This paper presents results for the pork supply chain. Methods: In the project setup, experts on production along supply chains designed three scenarios for environmentally improved systems. These scenarios, i.e., the ecosystem, plant nutrients, and climate scenarios, were intended to address different clusters of environmental goals. The next step was to challenge these scenarios by considering their possible consequences for products and systems from the food safety, sensory quality, animal welfare, consumer appreciation, and (for primary production only) cost perspectives. This led to changes in production system design to prevent negative consequences. The final supply chains were quantified using LCA and were again assessed from the three perspectives. Results and discussion: The scenario design approach worked well, thoroughly and credibly describing the production systems. Assessment of consequences bolstered the credibility and quality of the systems and results. The LCA of pig production and smoked ham identified large potentials for improvement by implementing available knowledge: global warming potential (GWP) could be reduced 21–54 % and marine eutrophication by 14–45 %. The main reason for these improvements was improved productivity (approaching the best producers’ current performance), though dedicated measures were also important, resulting in increased nitrogen efficiency, more varied crop rotations for crop production and better production management, and improved animal health and manure management for animal production. Reduced post-farm wastage contributed as did reduced emissions from fertilizer production. Conclusions: The working approach applied was successful in integrating LCA research with food system production expertise to deliver results relevant to supply chain decision-makers. The consequence assessments brought considerable value to the project, giving its results greater credibility. By introducing constraints in the form of “no negative consequences and no increased costs,” the work was “guided” so that the scenario design avoided being hampered by too many opportunities.
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18.
  • Stenberg, Erik, 1979-, et al. (author)
  • Association between attention deficit hyperactivity disorder and outcomes after metabolic and bariatric surgery : a nationwide propensity-matched cohort study
  • 2023
  • In: Surgery for Obesity and Related Diseases. - : Elsevier. - 1550-7289 .- 1878-7533. ; 19:2, s. 92-100
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: The risks and benefits of metabolic and bariatric surgery for patients with attention deficit hyperactivity disorder (ADHD) remain to be investigated.OBJECTIVE: The aim of this study was to assess short- and long-term outcomes after metabolic and bariatric surgery in patients with previous ADHD compared with matched control individuals.SETTING: Registry based.METHODS: This 2-staged matched-cohort study included all adults with a body mass index of ≥30 kg/m2 who underwent primary Roux-en-Y gastric bypass or sleeve gastrectomy from 2007 until 2017 registered in the Scandinavian Obesity Surgery Registry. Patients with prescribed medication for ADHD were matched with control individuals without ADHD with a follow-up of up to 11 years after surgery.RESULTS: Among 1431 patients with ADHD and 2862 control individuals (mean body mass index, 42 kg/m2; mean age, 35 years), no difference in weight loss or follow-up attendance over 2 years was seen. ADHD was associated with a higher risk for early postoperative complications (odds ratio [OR] = 1.31; 95% confidence interval [CI], 1.05-1.63), self-harm (hazards ratio [HR] = 1.39; 95% CI, 1.11-1.75), and substance abuse (HR = 1.34; 95% CI, 1.16-1.55), while associations with overall mortality (HR = 1.42; 95% CI, .99-2.03), major adverse cardiovascular and cerebrovascular events (HR = 1.93; 95% CI, .98-3.83), and effects on obesity-related diseases were uncertain. ADHD was associated with a lower health-related quality of life in all aspects before surgery. These differences increased for mental and obesity-related aspects but remained unchanged over time for physical aspects.CONCLUSIONS: Compared with patients without ADHD, patients treated pharmacologically for ADHD experience similar weight loss and remission of obesity-related diseases without an increased risk for serious complications but report a lower health-related quality of life and have an increased risk of substance abuse and self-harm. This further emphasizes the need for close follow-up care for this group of individuals.
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19.
  • Stenberg, Erik, 1979-, et al. (author)
  • Association between metabolic surgery and cardiovascular outcome in patients with hypertension : A nationwide matched cohort study
  • 2020
  • In: PLoS Medicine. - : Public Library of Science (PLoS). - 1549-1277 .- 1549-1676. ; 17:9
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Hypertension, together with obesity, is a leading cause of mortality and disability. Whilst metabolic surgery offers remission of several metabolic comorbidities, the effect for patients with hypertension remains controversial. The objective of the present study was to evaluate the effect of metabolic surgery on cardiovascular events and mortality on patients with morbid obesity (body mass index [BMI] ≥ 35 kg/m2) and hypertension.METHODS AND FINDINGS: We conducted a matched cohort study of 11,863 patients with morbid obesity and pharmacologically treated hypertension operated on with metabolic surgery and a matched non-operated-on control group of 26,199 subjects with hypertension (matched by age, sex, and area of residence) of varied matching ratios from 1:1 to 1:9, using data from the Scandinavian Obesity Surgery Register (SOReg), the Swedish National Patient Registers (NPR) for in-hospital and outpatient care, the Swedish Prescribed Drug Register, and Statistics Sweden. The main outcome was major adverse cardiovascular event (MACE), defined as first occurrence of acute coronary syndrome (ACS) event, cerebrovascular event, fatal cardiovascular event, or unattended sudden cardiac death. The mean age in the study group was 52.1 ± 7.46 years, with 65.8% being women (n = 7,810), and mean BMI was 41.9 ± 5.43 kg/m2. MACEs occurred in 379 operated-on patients (3.2%) and 1,125 subjects in the control group (4.5%). After adjustment for duration of hypertension, comorbidities, and education, a reduction in risk was seen in the metabolic surgery group (adjusted hazard ratio [HR] 0.73, 95% confidence intervals [CIs] 0.64-0.84, P < 0.001). The surgery group had lower risk for ACS events (adjusted HR 0.52, 95% CI 0.41-0.66, P < 0.001) and a tendency towards lower risk for cerebrovascular events (adjusted HR 0.81, 95% CI 0.63-1.01, P = 0.060) compared with controls. The main limitations with the study were the lack of information on BMI and history of smoking in the control group and the nonrandomised study design.CONCLUSION: Metabolic surgery on patients with morbid obesity and pharmacologically treated hypertension was associated with lower risk for MACEs and all-cause mortality compared with age- and sex-matched controls with hypertension from the general population.
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20.
  • Stenberg, Erik, 1979-, et al. (author)
  • Bariatric and metabolic surgery in patients with morbid obesity and multiple sclerosis : a nationwide, matched cohort study
  • 2021
  • In: Surgery for Obesity and Related Diseases. - : Elsevier. - 1550-7289 .- 1878-7533. ; 17:6, s. 1108-1114
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Despite an association between obesity and multiple sclerosis (MS), very little is known regarding the safety and efficacy outcomes for patients with MS and severe obesity undergoing metabolic surgery.OBJECTIVES: The aim of the present study was to evaluate early complications and efficacy outcomes of metabolic surgery in patients with severe obesity and MS.SETTING: Nationwide, Sweden.METHODS: In this, matched cohort study, 196 patients with an MS diagnosis in the Swedish MS register who were undergoing metabolic surgery (gastric bypass or sleeve gastrectomy) with a registration in the Scandinavian Obesity Surgery Registry (SOReg) were matched 1:10 with a control group without MS diagnosis from the SOReg. A 2-stage matching procedure was used (exact match by surgical method, followed by propensity Score matching, including age, sex, preoperative BMI, surgical center, surgical access, year of surgery, hypertension, diabetes, sleep apnea, and dyslipidemia).RESULTS: Weight loss at 2 years after surgery was similar for patients with MS and controls (total weight loss 31.6 ± 9.1 versus 31.8 ± 9.2, P = .735). No significant differences were seen in either the overall postoperative complication rate (7.9% versus 7.2%, P = .778), or serious postoperative complications (3.7% versus 2.8%, P = .430). All aspects of health-related quality of life (HRQoL) improved in both groups but less so for the physical aspects of HRQoL in patients with MS.CONCLUSION: Metabolic surgery is a safe and efficient treatment for severe obesity in patients with MS, and it leads to subsequent improvements in HRQoL. Further studies addressing the effects of metabolic surgery on MS-related symptoms are needed.
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21.
  • Stenberg, Erik, 1979-, et al. (author)
  • Early complications after laparoscopic gastric bypass surgery : results from the Scandinavian Obesity Surgery Registry
  • 2014
  • In: Annals of Surgery. - : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 260:6, s. 1040-1047
  • Journal article (peer-reviewed)abstract
    • OBJECTIVE: To identify risk factors for serious and specific early complications of laparoscopic gastric bypass surgery using a large national cohort of patients.BACKGROUND: Bariatric procedures are among the most common surgical procedures today. There is, however, still a need to identify preoperative and intraoperative risk factors for serious complications.METHODS: From the Scandinavian Obesity Surgery Registry database, we identified 26,173 patients undergoing primary laparoscopic gastric bypass operation for morbid obesity between May 1, 2007, and September 30, 2012. Follow-up on day 30 was 95.7%. Preoperative data and data from the operation were analyzed against serious postoperative complications and specific complications.RESULTS: The overall risk of serious postoperative complications was 3.4%. Age (adjusted P = 0.028), other additional operation [odds ratio (OR) = 1.50; confidence interval (CI): 1.04-2.18], intraoperative adverse event (OR = 2.63; 1.89-3.66), and conversion to open surgery (OR = 4.12; CI: 2.47-6.89) were all risk factors for serious postoperative complications. Annual hospital volume affected the rate of serious postoperative complications. If the hospital was in a learning curve at the time of the operation, the risk for serious postoperative complications was higher (OR = 1.45; CI: 1.22-1.71). The 90-day mortality rate was 0.04%.CONCLUSIONS: Intraoperative adverse events and conversion to open surgery are the strongest risk factors for serious complications after laparoscopic gastric bypass surgery. Annual operative volume and total institutional experience are important for the outcome. Patient related factors, in particular age, also increased the risk but to a lesser extent.
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22.
  • Stenberg, Erik, 1979-, et al. (author)
  • Factors determining chance of type 2 diabetes remission after Roux-en-Y gastric bypass surgery : a nationwide cohort study in 8057 Swedish patients
  • 2021
  • In: BMJ Open Diabetes Research & Care. - : BMJ Publishing Group Ltd. - 2052-4897. ; 9:1
  • Journal article (peer-reviewed)abstract
    • INTRODUCTION: Bariatric and metabolic surgery is an effective treatment option for type 2 diabetes (T2D). Increased knowledge regarding factors associated with diabetes remission is essential in individual decision making and could guide postoperative care. Therefore, we aimed to explore factors known to affect the chance of achieving diabetes remission after bariatric and metabolic surgery and to further investigate the impact of socioeconomic factors.RESEARCH DESIGN AND METHODS: In this nationwide study, we assessed all patients with T2D who underwent Roux-en-Y gastric bypass (RYGB) surgery between 2007 and 2015 in the Scandinavian Obesity Surgery Registry. Remission was defined as absence of antidiabetic medication for T2D 2 years after surgery. Multivariable logistic regression was used to evaluate factors associated with diabetes remission, with missing data handled by multiple imputations.RESULTS: , mean hemoglobin A1c 59.0±17.33, and 61.7% (n=4970) were women. Two years after surgery, 6211 (77.1%) patients achieved T2D remission. Preoperative insulin treatment (OR 0.26, 95% CI 0.22 to 0.30), first-generation immigrant (OR 0.66, 95% CI 0.57 to 0.77), duration of T2D (OR 0.89, 95% CI 0.88 to 0.90), dyslipidemia (OR 0.71, 95% CI 0.62 to 0.81), age (OR 0.97, 95% CI 0.96 to 0.97), and high glycosylated hemoglobin A1c (HbA1c) (OR 0.99, 95% CI 0.98 to 0.99) were all associated with lower T2D remission rate. In contrast, residence in a medium-sized (OR 1.39, 95% CI 1.20 to 1.61) or small (OR 1.46, 95% CI 1.25 to 1.71) town and percentage of total weight loss (OR 1.04, 95% CI 1.03 to 1.04) were associated with higher remission rates.CONCLUSION: Among patients with T2D undergoing RYGB surgery, increasing age, HbA1c, and diabetes duration decreased the chance of reaching diabetes remission without cut-offs, while postoperative weight loss demonstrated a positive linear association. In addition, being a first-generation immigrant and living in a large city were socioeconomic factors having a negative association.
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23.
  • Stenberg, Erik, 1979-, et al. (author)
  • Limited Effect of Beta-blockade on Postoperative Outcome After Laparoscopic Gastric Bypass Surgery
  • 2020
  • In: Obesity Surgery. - : Springer Science+Business Media B.V.. - 0960-8923 .- 1708-0428. ; 30:1, s. 139-145
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: The benefit of beta-blockade on postoperative outcome remains controversial, though recent studies have suggested a role during major non-cardiac surgery. The benefit of beta-blockade during minimally invasive gastric bypass surgery remains unclear. The aim of the present study was to evaluate the possible association between preoperative beta-blocker therapy and postoperative outcome after laparoscopic gastric bypass surgery.METHODS: Patients operated with primary laparoscopic gastric bypass surgery in Sweden between 2007 and 2017 were identified through the Scandinavian Obesity Surgery Registry. The dataset was linked to the Swedish National Patient Registry, the Swedish Prescribed Drug Registry, and Statistics Sweden. The main outcome was serious postoperative complication within 30 days of surgery; with postoperative complication, 90-day and 1-year mortality, and weight loss at 2 years after surgery as secondary endpoints. The Poisson regression model was used to evaluate primary and secondary categorical outcomes. A general mixed model was performed to evaluate 2-year weight loss.RESULTS: In all, 50281 patients were included in the study. No difference was seen between patients on beta-blockade and the control group regarding postoperative complications (adjusted incidence rate ratio 1.04 (95%CI 0.93-1.15), p = 0.506), serious postoperative complication (adjusted IRR 1.06 95%CI 0.89-1.27), p = 0.515), 90-day mortality (adjusted IRR 0.71 (95%CI 0.24-2.10), p = 0.537), and 1-year mortality (adjusted IRR 1.26 (95%CI 0.67-2.36), p = 0.467). Weight loss 2 years after surgery was slightly greater in patients on beta-blockade (adjusted coefficient 0.53 (95%CI 0.19-0.87), p = 0.002).CONCLUSIONS: Beta-blockade has limited impact on postoperative outcome after laparoscopic gastric bypass surgery.
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24.
  • Stenberg, Erik, 1979-, et al. (author)
  • Long-term Safety and Efficacy of Closure of Mesenteric Defects in Laparoscopic Gastric Bypass Surgery : A Randomized Clinical Trial
  • 2023
  • In: JAMA Surgery. - : American Medical Association (AMA). - 2168-6254 .- 2168-6262. ; 158:7, s. 709-717
  • Journal article (peer-reviewed)abstract
    • IMPORTANCE: Short-term and midterm data suggest that mesenteric defects closure during laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery reduces the risk of internal herniation with small bowel obstruction (SBO) but may increase risk of kinking of the jejunojejunostomy in the early postoperative period. However, to our knowledge, there are no clinical trials reporting long-term results from this intervention in terms of risk for SBO or opioid use.OBJECTIVE: To evaluate long-term safety and efficacy outcomes of closure of mesenteric defects during LRYGB.DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial with a 2-arm, parallel, open-label design included patients with severe obesity scheduled for LRYGB bariatric surgery at 12 centers in Sweden from May 1, 2010, through November 14, 2011, with 10 years of follow-up after the intervention. INTERVENTIONS: During the operation, patients were randomly assigned 1:1 to closure of mesenteric defects beneath the jejunojejunostomy and at the Petersen space using nonabsorbable running sutures during LRYGB or to nonclosure.MAIN OUTCOME AND MEASURES: The primary outcome was reoperation for SBO. New incident, chronic opioid use was a secondary end point as a measure of harm.RESULTS: A total of 2507 patients (mean [SD] age, 41.7 [10.7] years; 1863 female [74.3%]) were randomly assigned to closure of mesenteric defects (n = 1259) or nonclosure (n = 1248). After censoring for death and emigration, 1193 patients in the closure group (94.8%) and 1198 in the nonclosure group (96.0%) were followed up until the study closed. Over a median follow-up of 10 years (IQR, 10.0-10.0 years), a reoperation for SBO from day 31 to 10 years after surgery was performed in 185 patients with nonclosure (10-year cumulative incidence, 14.9%; 95% CI, 13.0%-16.9%) and in 98 patients with closure (10-year cumulative incidence, 7.8%; 95% CI, 6.4%-9.4%) (subhazard ratio [SHR], 0.42; 95% CI, 0.32-0.55). New incident chronic opioid use was seen among 175 of 863 opioid-naive patients with nonclosure (10-year cumulative incidence, 20.4%; 95% CI, 17.7%-23.0%) and 166 of 895 opioid-naive patients with closure (10-year cumulative incidence, 18.7%; 95% CI, 16.2%-21.3%) (SHR, 0.90; 95% CI, 0.73-1.11).CONCLUSIONS AND RELEVANCE: This randomized clinical trial found long-term reduced risk of SBO after mesenteric defects closure in LRYGB. The findings suggest that routine use of this procedure during LRYGB should be considered.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01137201.
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25.
  • Stenberg, Erik, 1979-, et al. (author)
  • Major adverse cardiovascular events among patients with type-2 diabetes, a nationwide cohort study comparing primary metabolic and bariatric surgery to GLP-1 receptor agonist treatment
  • 2023
  • In: International Journal of Obesity. - : Nature Publishing Group. - 0307-0565 .- 1476-5497. ; 47:4, s. 251-256
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Glucagon-like Peptide-1 receptor agonists (GLP-1 RA) and metabolic and bariatric surgery (MBS) both improve cardiovascular outcomes in patients with severe obesity and type-2 diabetes (T2D). The aim of the present study was to assess the impact of MBS on major cardiovascular adverse events (MACE) in patients with severe obesity and T2D compared to patients with T2D treated with GLP-1 RA. SUBJECTS ANDMETHODS: In this propensity score matched cohort study on nationwide data, patients with T2D and severe obesity who underwent MBS in Sweden from 2007 until 2019 were identified from the Scandinavian Obesity Surgery Registry and matched to a non-surgical group with T2D treated with GLP-1 RA (81.7% liraglutide, 9.0% dulaglutide, 6.0% exenatide, 1.6% lixisenatide and 0.8% semaglutide) from the general population using generalized linear model. Major outcome was MACE (hospitalization for acute coronary syndrome or cerebrovascular event or all-cause death), evaluated with multivariable Cox regression.RESULTS: In total 2161 patients (obesity class I (10.2%), class II (40.3%), class III (49.5%)) were matched to 2161 non-surgical patients (mean age 51.1 ± 9.29 vs 51.5 ± 8.92 years, 64.8% vs. 64.4% women, with mean number of diabetes drugs of 2.5 ± 0.89 vs 2.6 ± 0.87, a mean duration of diabetes of 6.0 ± 4.15 vs 6.0 ± 4.51 years with 44.2% vs. 42.8% being treated with insulin at baseline). During the study period, 113 patients (8-year cumulative incidence 9.3%) compared to 130 non-surgical patients (8-year cumulative incidence 11.3%) suffered from MACE or all-cause mortality (HR 0.76, 95%CI 0.59-0.98), and 69 patients (8-year cumulative incidence 5.1%) compared to 92 non-surgical patients (8-year cumulative incidence 7.6%) suffered from a non-fatal MACE (HR 0.68, 95%CI 0.49-0.93).CONCLUSION: In this matched cohort study, MBS was associated with lower risk for MACE compared to treatment with early GLP-1 RA in patients with T2D.
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26.
  • Stenberg, Erik, 1979-, et al. (author)
  • Major cardiovascular events after metabolic surgery in patients with previous heart disease with or without type 2 diabetes : a nationwide cohort study
  • 2022
  • In: Surgery for Obesity and Related Diseases. - : Elsevier. - 1550-7289 .- 1878-7533. ; 18:7, s. 935-942
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: While metabolic surgery is known to improve type 2 diabetes (T2D) as well as established heart disease separately, it is not known whether the outcome is influenced by T2D status in patients with established heart disease.OBJECTIVES: To evaluate the risks for major cardiovascular events (MACE) or mortality in patients with established heart disease with or without T2D.SETTING: Nationwide and registry-based (Sweden).METHODS: Patients with established heart disease operated with sleeve gastrectomy or Roux-en-Y gastric bypass in Sweden from 2007-2019 were matched 1:1 to normal population controls using 2-staged matching (exact matching on T2D, followed by optimal matching on propensity score for age, sex, dyslipidemia, chronic obstructive pulmonary disease, type of heart disease, T2D duration, county of residence, and level of education). The risk for MACE was evaluated separately depending on T2D status.RESULTS: In total, 1513 patients who underwent surgery and 1513 matched controls were included. Reduced risk for MACE and mortality were seen after metabolic surgery for patients with heart disease and T2D compared with controls (adjusted hazard ratio [HR] = .59, 95% confidence interval [CI]: .48-.72, P < .001, and adjusted HR = .52, 95% CI: .40-.67, P < .001, respectively), and for patients with heart disease alone compared with controls (adjusted HR = .73, 95% CI: .57-.94, P = .016, and adjusted HR = .63, 95% CI: .45-.89, P = .008, respectively).CONCLUSION: Metabolic surgery was associated with a reduced risk for MACE and mortality in patients with preexisting heart disease and T2D as well as in patients with heart disease without T2D. Patients with heart disease and T2D seem to experience the highest risk reduction.
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27.
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28.
  • Stenberg, Erik, 1979-, et al. (author)
  • Remission of Obesity-Related Sleep Apnea and Its Effect on Mortality and Cardiovascular Events After Metabolic and Bariatric Surgery : A Propensity Matched Cohort Study
  • 2024
  • In: Journal of the American College of Surgeons. - : Elsevier. - 1072-7515 .- 1879-1190.
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: While obstructive sleep apnea (OSA) is common among patients with obesity and linked to cardiovascular disease, there is a lack of studies evaluating the effects of reaching remission from OSA after metabolic and bariatric surgery (MBS).STUDY DESIGN: A registry-based nationwide study including patients operated with sleeve gastrectomy or Roux-en-Y gastric bypass from 2007 until 2019 in Sweden. Patients who reached remission of OSA were compared to those who did not reach remission, and a propensity score matched control group of patients without OSA at the time of operation. Main outcome was overall mortality, secondary outcome was major cardiovascular events (MACE).RESULTS: In total, 5892 patients with OSA and 11,552 matched patients without OSA completed a 1-year follow-up and were followed for a median of 6.8 years. Remission of OSA was seen for 4334 patients (74%). Patients in remission had a lower risk for overall mortality (cumulative incidence 6.0% v. 9.1%;p<0.001) and MACE (cumulative incidence 3.4% vs 5.8%;p<0.001) at 10-years after operation compared to those who did not reach remission. The risk was similar to that of the control group without OSA at baseline (cumulative incidence for mortality 6.0%, p=0.493, for MACE 3.7%, p=0.251).CONCLUSION: The remission rate of OSA was high after MBS. This was in turn associated with reduced risk for death and MACE compared to patients who did not achieve remission reaching a similar risk seen among patients without OSA at baseline. A diligent follow-up of patients who do not reach remission remains important.
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29.
  • Stenberg, Erik, 1979-, et al. (author)
  • Remission, relapse, and risk of major cardiovascular events after metabolic surgery in persons with hypertension : A Swedish nationwide registry-based cohort study
  • 2021
  • In: PLoS Medicine. - : Public Library of Science. - 1549-1277 .- 1549-1676. ; 18:11
  • Journal article (peer-reviewed)abstract
    • Background: Several studies have shown that metabolic surgery is associated with remission of diabetes and hypertension. In terms of diabetes, factors such as duration, insulin use, weight loss, and age have been shown to contribute to the likelihood of remission. Such factors have not been determined for hypertension. The aim of this study was to evaluate factors associated with the remission and relapse of hypertension after metabolic surgery, as well as the risk for major adverse cardiovascular event (MACE) and mortality in patients with and without remission.Methods and findings: All adults who underwent metabolic surgery between January 2007 and June 2016 were identified in the nationwide Scandinavian Obesity Surgery Registry (SOReg). Through cross-linkage with the Swedish Prescribed Drug Register, Patient Register, and Statistics Sweden, individual data on prescriptions, inpatient and outpatient diagnoses, and mortality were retrieved. Of the 15,984 patients with pharmacologically treated hypertension, 6,286 (39.3%) were in remission at 2 years. High weight loss and male sex were associated with higher chance of remission, while duration, number of antihypertensive drugs, age, body mass index (BMI), cardiovascular disease, and dyslipidemia were associated with lower chance. After adjustment for age, sex, BMI, comorbidities, and education, the cumulative probabilities of MACEs (2.8% versus 5.7%, adjusted odds ratio (OR) 0.60, 95% confidence interval (CI) 0.47 to 0.77, p < 0.001) and all-cause mortality (4.0% versus 8.0%, adjusted OR 0.71, 95% CI 0.57 to 0.88, p = 0.002) were lower for patients being in remission at 2 years compared with patients not in remission, despite relapse of hypertension in 2,089 patients (cumulative probability 56.3%) during 10-year follow-up. The main limitations of the study were missing information on nonpharmacological treatment for hypertension and the observational study design.Conclusions: In this study, we observed an association between high postoperative weight loss and male sex with better chance of remission, while we observed a lower chance of remission depending on disease severity and presence of other metabolic comorbidities. Patients who achieved remission had a halved risk of MACE and death compared with those who did not. The results suggest that in patients with severe obesity and hypertension, metabolic surgery should not be delayed.Author summary:Why was this study done?Hypertension, particularly in combination with morbid obesity, is a leading cause of mortality and disability worldwide.There is a growing body of evidence supporting the reduction of major adverse cardiovascular events (MACEs) and mortality among patients with metabolic comorbidities after bariatric surgery. Less is known of the factors associated with remission and relapse of disease as well as the impact on MACEs and morality from reaching remission.The main purpose of this study was to assess which factors that contribute to the remission and relapse of hypertension after metabolic surgery, as well as the risk for MACE and mortality in patients who have achieved remission of hypertension.What did the researchers do and find?In this nationwide observational study, 15,984 patients with hypertension undergoing a primary metabolic procedure were included.Almost 40% of patients with hypertension experienced remission of hypertension 2 years after surgery. While 56% relapsed over 10-year follow-up, those who reached remission experienced lower probability for MACEs and all-cause mortality compared with those who did not reach remission.What do these findings mean?The results of this study suggest that metabolic surgery has the highest success rate for patients early in the course of disease and thus suggests that metabolic surgery should not be delayed for patients with severe obesity and hypertension.
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30.
  • Stenberg, Erik, 1979-, et al. (author)
  • Risk Prediction Model for Severe Postoperative Complication in Bariatric Surgery
  • 2018
  • In: Obesity Surgery. - : Springer. - 0960-8923 .- 1708-0428. ; 28:7, s. 1869-1875
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Factors associated with risk for adverse outcome are important considerations in the preoperative assessment of patients for bariatric surgery. As yet, prediction models based on preoperative risk factors have not been able to predict adverse outcome sufficiently.OBJECTIVE: This study aimed to identify preoperative risk factors and to construct a risk prediction model based on these.METHODS: Patients who underwent a bariatric surgical procedure in Sweden between 2010 and 2014 were identified from the Scandinavian Obesity Surgery Registry (SOReg). Associations between preoperative potential risk factors and severe postoperative complications were analysed using a logistic regression model. A multivariate model for risk prediction was created and validated in the SOReg for patients who underwent bariatric surgery in Sweden, 2015.RESULTS: Revision surgery (standardized OR 1.19, 95% confidence interval (CI) 1.14-0.24, p < 0.001), age (standardized OR 1.10, 95%CI 1.03-1.17, p = 0.007), low body mass index (standardized OR 0.89, 95%CI 0.82-0.98, p = 0.012), operation year (standardized OR 0.91, 95%CI 0.85-0.97, p = 0.003), waist circumference (standardized OR 1.09, 95%CI 1.00-1.19, p = 0.059), and dyspepsia/GERD (standardized OR 1.08, 95%CI 1.02-1.15, p = 0.007) were all associated with risk for severe postoperative complication and were included in the risk prediction model. Despite high specificity, the sensitivity of the model was low.CONCLUSION: Revision surgery, high age, low BMI, large waist circumference, and dyspepsia/GERD were associated with an increased risk for severe postoperative complication. The prediction model based on these factors, however, had a sensitivity that was too low to predict risk in the individual patient case.
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31.
  • Stenberg, Erik, 1979-, et al. (author)
  • Safety of bariatric surgery in patients with previous acute coronary events or heart failure : nationwide cohort study
  • 2022
  • In: BJS Open. - : Oxford University Press. - 2474-9842. ; 6:3
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Metabolic (bariatric) surgery for patients with severe obesity and pre-existing heart disease has been reported to reduce the risk for cardiovascular events and mortality; however, concerns of short- and mid-term complications may limit the utility of metabolic surgery for these patients.METHOD: This was an observational, nationwide, matched study, including all adult patients operated with a primary gastric bypass or sleeve gastrectomy procedure in Sweden from January 2011 until October 2020. Patients with or without previous acute coronary syndrome or heart failure were matched 1:5 using propensity scores. The primary outcome was serious postoperative complications, and secondary outcomes were the occurrence of any short-term complications, mid-term complications, weight loss, and health-related quality of life estimates after surgery.RESULTS: Of patients who underwent metabolic surgery, 1165 patients with previous acute coronary syndrome or heart failure and 5825 without diagnosed heart disease were included in matched analyses. No difference was seen between the groups at risk for serious postoperative complications within 30 days of surgery (OR 1.33, 95 per cent c.i. 0.95 to 1.86, P = 0.094), whereas heart disease was associated with an increased risk for cardiovascular complications (incidence 1.1 per cent versus 0.2 per cent, P < 0.001). No differences in overall mid-term complications, weight loss, or improvement of health-related quality of life were seen. Pre-existing heart disease was associated with an increased risk for bowel obstruction and strictures (OR 1.89, 95 per cent c.i. 1.20 to 2.99, P = 0.006).CONCLUSION: Patients with severe obesity and heart disease undergoing metabolic surgery have an increased risk of postoperative cardiovascular complications compared with patients with severe obesity without heart disease. A careful preoperative cardiovascular work-up is needed but patients with severe obesity and heart disease should not be excluded from undergoing metabolic surgery.
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32.
  • Stenberg, Erik, 1979-, et al. (author)
  • The association between socioeconomic factors and weight loss 5 years after gastric bypass surgery
  • 2020
  • In: International Journal of Obesity. - : Nature Publishing Group. - 0307-0565 .- 1476-5497. ; 44:11, s. 2279-2290
  • Journal article (peer-reviewed)abstract
    • Introduction: Patients with low socioeconomic status have been reported to have poorer outcome than those with a high socioeconomic status after several types of surgery. The influence of socioeconomic factors on weight loss after bariatric surgery remains unclear. The aim of the present study was to evaluate the association between socioeconomic factors and postoperative weight loss.Materials and methods: This was a retrospective, nationwide cohort study with 5-year follow-up data for 13,275 patients operated with primary gastric bypass in Sweden between January 2007 and December 2012 (n = 13,275), linking data from the Scandinavian Obesity Surgery Registry, Statistics Sweden, the Swedish National Patient Register, and the Swedish Prescribed Drugs Register. The assessed socioeconomic variables were education, profession, disposable income, place of residence, marital status, financial aid and heritage. The main outcome was weight loss 5 years after surgery, measured as total weight loss (TWL). Linear regression models, adjusted for age, preoperative body mass index (BMI), sex and comorbid diseases were constructed.Results: The mean TWL 5 years after surgery was 28.3 +/- 9.86%. In the adjusted model, first-generation immigrants (%TWL, B -2.4 [95% CI -2.9 to -1.9],p < 0.0001) lost significantly less weight than the mean, while residents in medium-sized (B 0.8 [95% CI 0.4-1.2],p = 0.0001) or small towns (B 0.8 [95% CI 0.4-1.2],p < 0.0001) lost significantly more weight.Conclusions: All socioeconomic groups experienced improvements in weight after bariatric surgery. However, as first-generation immigrants and patients residing in larger towns (>200,000 inhabitants) tend to have inferior weight loss compared to other groups, increased support in the pre- and postoperative setting for these two groups could be of value. The remaining socioeconomic factors appear to have a weaker association with postoperative weight loss.
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33.
  • Stenberg, Erik, 1979-, et al. (author)
  • The impact of socioeconomic factors on the early postoperative complication rate after laparoscopic gastric bypass surgery : A register-based cohort study
  • 2019
  • In: Surgery for Obesity and Related Diseases. - : Elsevier. - 1550-7289 .- 1878-7533. ; 15:4, s. 575-581
  • Journal article (peer-reviewed)abstract
    • Background: Socioeconomic factors may influence the outcome of certain surgical procedures, but it is not known whether such factors influence the risk for postoperative complication after bariatric surgery.Objectives: Determining whether different socioeconomic factors influence the risk for postoperative complication after laparoscopic gastric bypass surgery.Setting: Nationwide in Sweden.Methods: Retrospective register-based cohort study that includes all primary laparoscopic gastric bypass procedures in Sweden between 2010 and 2016, using data from the Scandinavian Obesity Surgery Registry, Statistics Sweden, and the Swedish Population Register. Main outcome measures were occurrence and severity of early postoperative complications.Results: Included in this study were 41,537 patients with 30-day follow-up percentage of 96.7%. Study groups with increased risk for postoperative complication (age, sex, body mass index, and co-morbidity adjusted odds ratio with 95% confidence intervals) were as follows: being divorced, a widow, or a widower (1.14 [1.03-1.23]); receiving disability pension (1.37 [1.23-1.53]) or social assistance (1.22 [1.07-1.401); and being first- (1.22 [1.04-1.44]) or second-generation (1.20 [1.09-1.32]) immigrant. In contrast, being single (.90 [.83.991), having higher disposable income (50th-80th percentile:.84 [.76.93]; >80th percentile:.84 [72.98]), and living in a medium (.90 [.83.98]) or small (.84 [.76.92]) town were associated with lower risk. Increased risk for severe postoperative complication was seen for divorced, widowm, or widower (1.30 [1.12-1.521) and those receiving disability pension (1.37 [1.16-1.611) or social assistance (1.32 [1.08-1.62]), while higher disposable income (50th-80th percentile:.79 [.68.92]; >80th percentile .57 [.46.72]) was associated with lower risk.Conclusion: Socioeconomic factors influence the risk for early postoperative complication after laparoscopic gastric bypass surgery. The impact is not enough to exclude patients from surgery, but they must be taken into account in preoperative risk assessment.
  •  
34.
  • Sundbom, Magnus, et al. (author)
  • Results from the Scandinavian Obesity Surgery Registry : A narrative review
  • 2024
  • In: Obesity Reviews. - : Wiley-Blackwell Publishing Inc.. - 1467-7881 .- 1467-789X. ; 25:2
  • Research review (peer-reviewed)abstract
    • In 2007, the Scandinavian Obesity Surgery Registry (SOReg) was started by the profession to monitor the results of bariatric surgery and to provide a high-quality database for research. In the end of August 2023, SOReg contains 88,379 patients (body mass index [BMI] 41.7 kg/m2 , 41.2 years, 77.1% females, gastric bypass 76.8%). In this narrative review, we demonstrate that preoperative weight loss is of value and that the laparoscopic double omega-loop technique is highly suitable for gastric bypass. Closing the mesenteric openings is, however, important. Swedish bariatric surgery has low mortality, and our results are comparative to those of other countries. Significant long-term improvements are found in common obesity-related diseases such as diabetes, hypertension, and sleep apnea. Furthermore, the risk for cardiac failure and major adverse cardiovascular events is significantly reduced. Pregnancy-related outcomes are also improved. Gastric bypass results in significant improvements in quality of life and seems to be cost saving. We have revealed that low socioeconomic status is associated with reduced chance of undergoing bariatric surgery and inferior outcomes. Of note, we have performed several randomized clinical trials within the registry database. In conclusion, high-quality national registry databases, such as SOReg, are important for maintaining high-quality care and present a platform for extensive research.
  •  
35.
  • Wallén, Stefan, 1978-, et al. (author)
  • Impact of socioeconomic status on new chronic opioid use after gastric bypass surgery
  • 2023
  • In: Surgery for Obesity and Related Diseases. - : Elsevier. - 1550-7289 .- 1878-7533. ; 19:12, s. 1375-1381
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Socioeconomic status may influence weight loss, postoperative complications, and health-related quality of life after bariatric surgery. Chronic use of opioid analgesics is a known risk after bariatric surgery, but whether socioeconomic factors are associated with new chronic use of opioid analgesics has not been investigated in depth.OBJECTIVES: The aim of this study was to identify socioeconomic factors associated with the development of new chronic use of opioid analgesics after gastric bypass surgery.SETTING: All hospitals performing bariatric surgery in Sweden.METHODS: This was a retrospective cohort study with prospectively collected data including all primary gastric bypass procedures in Sweden between 2007 and 2015. Data were collected from the Scandinavian Obesity Surgery Registry, the Swedish Prescribed Drug Register, and Statistics Sweden. The primary outcome was new chronic opioid use.RESULTS: Of the 44,671 participants, 1438 patients became new chronic opioid users. Longer education (secondary education; odds ratio [OR] = .71; 95% CI, .62-.81) or higher education (OR = .45; 95% CI, .38-.53), higher disposable income (20th-50th percentile: OR = .75; 95% CI, .66-.85; 50th-80th percentile: OR = .50; 95% CI, .43-.58; and the highest 80th percentile: OR = .40; 95% CI, .32-.51) were significantly associated with lower risk for new chronic opioid use. Being a second-generation immigrant (OR = 1.54; 95% CI, 1.24-1.90), being on a disability pension or early retirement (OR = 3.04; 95% CI, 2.67-3.45), receiving social benefits (OR = 1.88; 95% CI, 1.59-2.22), being unemployed for <100 days (OR = 1.25; 95% CI, 1.08-1.45), being unemployed for >100 days (OR = 1.41; 95% CI, 1.16-1.71), and being divorced or a widow or widower (OR = 1.35; 95% CI, 1.17-1.55) were significantly associated with a higher risk for chronic opioid use.CONCLUSION: Given that long-term opioid use has detrimental effects after bariatric surgery, it is important that information and follow-up are optimized for patients with shorter education, lower income, and disability pension or early retirement because they are at an increased risk of new chronic opioid analgesics use.
  •  
36.
  • Ahlgren, Per, 1960-, et al. (author)
  • A bibliometric analysis of battery research with the BATTERY 2030+ roadmap as point of departure
  • 2022
  • Reports (other academic/artistic)abstract
    • In this bibliometric study, we analyze the six battery research subfields identified in the BATTERY 2030+ roadmap: Battery Interface Genome, Materials Acceleration Platform, Recyclability, Smart functionalities: Self-healing, Smart functionalities: Sensing, and Manufacturability. In addition, we analyze the entire research field related to BATTERY 2030+ as a whole, using two operationalizations. We (a) evaluate the European standing in the subfields/the BATTERY 2030+ field in comparison to the rest of the world, and (b) identify strongholds of the subfields/the BATTERY 2030+ field across Europe. For each subfield and the field as a whole, we used seed articles, i.e. articles listed in the BATTERY 2030+ roadmap or cited by such articles, in order to generate additional, similar articles located in an algorithmically obtained classification system. The output of the analysis is publication volumes, field normalized citation impact values with comparisons between country/country aggregates and between organizations, co-publishing networks between countries and organizations, and keyword co-occurrence networks. For the results related to (a), the performance of EU & associated (countries) is similar to China and the aggregate Japan-South Korea-Singapore and well below North America regarding citation impact and with respect to the field as a whole. Exceptions are, however, the subfields Battery Interface Genome and Recyclability. For the results related to (b), there is a large variability in the EU & associated organizations regarding volume in the different subfields. For citation impact, examples of high-performing EU & associated organizations are ETH Zurich and Max Planck Society for the Advancement of Science.
  •  
37.
  • Ahlgren, Per, 1960-, et al. (author)
  • BATTERY 2030+ and its Research Roadmap : A Bibliometric Analysis.
  • 2023
  • In: ChemSusChem. - : Wiley. - 1864-5631 .- 1864-564X. ; 16:21
  • Journal article (peer-reviewed)abstract
    • In this bibliometric study, we analyze two of the six battery research subfields identified in the BATTERY 2030+ roadmap: Materials Acceleration Platform and Smart functionalities: Sensing. In addition, we analyze the entire research field related to BATTERY 2030+ as a whole. We (a) evaluate the European standing in the two subfields/the BATTERY 2030+ field in comparison to the rest of the world, and (b) identify strongholds of the two subfields/the BATTERY 2030+ field across Europe. For each subfield and the field as a whole, we used seed articles, i. e. articles listed in the BATTERY 2030+ roadmap or cited by such articles, in order to generate additional, similar articles located in an algorithmically obtained classification system. The output of the analysis is publication volumes, field normalized citation impact values with comparisons between country/country aggregates and between organizations, co-publishing networks between countries and organizations, and keyword co-occurrence networks.
  •  
38.
  • Al-Mashhadi, Ammar, et al. (author)
  • Changes of arterial pressure following relief of obstruction in adults with hydronephrosis
  • 2018
  • In: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 123:4, s. 216-224
  • Journal article (peer-reviewed)abstract
    • Background: As much as 20% of all cases of hypertension are associated with kidney malfunctions. We have previously demonstrated in animals and in pediatric patients that hydronephrosis causes hypertension, which was attenuated by surgical relief of the ureteropelvic junction (UPJ) obstruction. This retrospective cohort study aimed to investigate: (1) the proposed link between hydronephrosis, due to UPJ obstruction, and elevated arterial pressure in adults; and (2) if elevated blood pressure in patients with hydronephrosis might be another indication for surgery.Materials and methods: Medical records of 212 patients undergoing surgical management of hydronephrosis, due to UPJ obstruction, between 2000 and 2016 were assessed. After excluding patients with confounding conditions and treatments, paired arterial pressures (i.e. before/after surgery) were compared in 49 patients (35 years old; 95% CI 29–39). Split renal function was evaluated by using mercaptoacetyltriglycine (MAG3) renography before surgical management of the hydronephrotic kidney.Results: Systolic (−11 mmHg; 95% CI 6–15 mmHg), diastolic (−8 mmHg; 95% CI 4–11 mmHg), and mean arterial (-9 mmHg; 95% CI 6–12) pressures were significantly reduced after relief of the obstruction (p < 0.001). Split renal function of the hydronephrotic kidney was 39% (95% CI 37–41). No correlations were found between MAG3 and blood pressure level before surgery or between MAG3 and the reduction of blood pressure after surgical management of the UPJ obstruction.Conclusions: In adults with hydronephrosis, blood pressure was reduced following relief of the obstruction. Our findings suggest that elevated arterial pressure should be taken into account as an indication to surgically correct hydronephrosis.
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39.
  • Al-Mashhadi, Ammar Nadhom Farman, et al. (author)
  • Changes in arterial pressure and markers of nitric oxide homeostasis and oxidative stress following surgical correction of hydronephrosis in children
  • 2018
  • In: Pediatric nephrology (Berlin, West). - : Springer. - 0931-041X .- 1432-198X. ; 33:4, s. 639-649
  • Journal article (peer-reviewed)abstract
    • Objective Recent clinical studies have suggested an increased risk of elevated arterial pressure in patients with hydronephrosis. Animals with experimentally induced hydronephrosis develop hypertension, which is correlated to the degree of obstruction and increased oxidative stress. In this prospective study we investigated changes in arterial pressure, oxidative stress, and nitric oxide (NO) homeostasis following correction of hydronephrosis.Methods Ambulatory arterial pressure (24 h) was monitored in pediatric patients with hydronephrosis (n = 15) before and after surgical correction, and the measurements were compared with arterial pressure measurements in two control groups, i.e. healthy controls (n = 8) and operated controls (n = 8). Markers of oxidative stress and NO homeostasis were analyzed in matched urine and plasma samples.Results The preoperative mean arterial pressure was significantly higher in hydronephrotic patients [83 mmHg; 95% confidence interval (CI) 80–88 mmHg] than in healthy controls (74 mmHg; 95% CI 68–80 mmHg; p < 0.05), and surgical correction of ureteral obstruction reduced arterial pressure (76 mmHg; 95% CI 74–79 mmHg; p < 0.05). Markers of oxidative stress (i.e., 11- dehydroTXB2, PGF2α, 8-iso-PGF2α, 8,12-iso-iPF2α-VI) were significantly increased (p < 0.05) in patients with hydronephrosis compared with both control groups, and these were reduced following surgery (p < 0.05). Interestingly, there was a trend for increased NO synthase activity and signaling in hydronephrosis, which may indicate compensatory mechanism(s).Conclusion This study demonstrates increased arterial pressure and oxidative stress in children with hydronephrosis compared with healthy controls, which can be restored to normal levels by surgical correction of the obstruction. Once reference data on ambulatory blood pressure in this young age group become available, we hope cut-off values can be defined for deciding whether or not to correct hydronephrosis surgically.Keywords Blood pressure . Hydronephrosis . Hypertension . Nitric oxide . Oxidative stress . Ureteral obstruction 
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40.
  • Al-Mashhadi, Ammar Nadhom Farman, et al. (author)
  • Surgical treatment reduces blood pressure in children with unilateral congenital hydronephrosis
  • 2015
  • In: Journal of Pediatric Urology. - : Elsevier BV. - 1477-5131 .- 1873-4898. ; 11:2, s. 91.e1-91.e6
  • Journal article (peer-reviewed)abstract
    • Objective Renal disorders can cause hypertension, but less is known about the influence of hydronephrosis on blood pressure. Hydronephrosis due to pelvo-ureteric junction obstruction (PUJO) is a fairly common condition (incidence in newborns of 0.5-1%). Although hypertensive effects of hydronephrosis have been suggested, this has not been substantiated by prospective studies in humans [1-3]. Experimental studies with PUJO have shown that animals with induced hydronephrosis develop salt-sensitive hypertension, which strongly correlate to the degree of obstruction [4-7]. Moreover, relief of the obstruction normalized blood pressure [8]. In this first prospective study our aim was to study the blood pressure pattern in pediatric patients with hydronephrosis before and after surgical correction of the ureteral obstruction. Specifically, we investigated if preoperative blood pressure is reduced after surgery and if split renal function and renographic excretion curves provide any prognostic information. Patients and methods Twelve patients with unilateral congenital hydronephrosis were included in this prospective study. Ambulatory blood pressure (24 h) was measured preoperatively and six months after surgery. Preoperative evaluations of bilateral renal function by Tc99m-MAG3 scintigraphy, and renography curves, classified according to O'Reilly, were also performed. Results As shown in the summary figure, postoperative systolic (103 +/- 2 mmHg) and diastolic (62 +/- 2 mmHg) blood pressure were significantly lower than those obtained preoperatively (110 +/- 4 and 69 +/- 2 mmHg, respectively), whereas no changes in circadian variation or pulse pressure were observed. Renal functional share of the hydronephrotic kidney ranged from 11 to 55%. There was no correlation between the degree of renal function impairment and the preoperative excretory pattern, or between the preoperative excretory pattern and the blood pressure reduction postoperatively. However, preoperative MAG3 function of the affected kidney correlated with the magnitude of blood pressure change after surgery. Discussion Correction of the obstruction lowered blood pressure, and the reduction in blood pressure appeared to correlate with the degree of renal functional impairment, but not with the excretory pattern. Thus, in the setting of hypertension, it appears that the functional share of the hydronephrotic kidney should be considered an indicator of the need for surgery, whereas the renography curve is less reliable. The strength of the present study is the prospective nature and that ambulatory blood pressure monitoring was used. Future longitudinal prolonged follow-up studies are warranted to confirm the present findings, and to understand if a real nephrogenic hypertension with potential necessity of treatment will develop. Conclusion This novel prospective study in patients with congenital hydronephrosis demonstrates a reduction in blood pressure following relief of the obstruction. Based on the present results, we propose that the blood pressure level should also be taken into account when deciding whether to correct hydronephrosis surgically or not.
  •  
41.
  • Al-Tai, Saif, 1978-, et al. (author)
  • The impact of the bougie size and the extent of antral resection on weight-loss and postoperative complications following sleeve gastrectomy : results from the Scandinavian Obesity Surgery Registry
  • 2024
  • In: Surgery for Obesity and Related Diseases. - : Elsevier. - 1550-7289 .- 1878-7533. ; 20:2, s. 139-145
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: The optimal sleeve diameter and distance from the pylorus to the edge of the resection line in laparoscopic sleeve gastrectomy (LSG) remain controversial.OBJECTIVES: To evaluate the influence of bougie size and antral resection distance from the pylorus on postoperative complications and weight-loss results in LSG.SETTING: Nationwide registry-based study.METHODS: This study included all LSGs performed in Sweden between 2012 and 2019. Data were obtained from the Scandinavian Obesity Surgery Registry. Reference bougie size of 35-36 Fr and an antral resection distance of 5 cm from the pylorus were compared to narrower bougie size (30-32 Fr), shorter distances (1-4 cm), and extended distances (6-8 cm) from the pylorus in assessing postoperative complications and weight loss as the outcomes of LSG. RESULTS: The study included 9,360 patients with postoperative follow-up rates of 96%, 79%, and 50% at 30 days, 1 year, and 2 years, respectively. Narrow bougie and short antral resection distance from the pylorus were significantly associated with increased postoperative weight loss. Bougie size was not associated with increased early or late complications. However, short antral resection distance was associated with high risk of overall early complications [odds ratio: 1.46 (1.17-1.82, P = .001)], although no impact on late complications at 1 and 2 years was observed.CONCLUSIONS: Using a narrow bougie and initiating resection closer to the pylorus were associated with greater maximum weight loss. Although a closer resection to the pylorus was associated with an increased risk of early postoperative complications, no association was observed with the use of narrow bougie for LSG.
  •  
42.
  • Al-Tai, Saif, 1978-, et al. (author)
  • THE IMPACT OF THE BOUGIE SIZE AND THE EXTENT OF ANTRAL RESECTION ON WEIGHT-LOSS AND POSTOPERATIVE COMPLICATIONS FOLLOWING SLEEVE GASTRECTOMY : RESULTS FROM THE SCANDINAVIAN OBESITY SURGERY REGISTRY
  • 2023
  • In: Obesity Surgery. - : Springer. - 0960-8923 .- 1708-0428. ; 33:Suppl. 2, s. 332-332
  • Journal article (other academic/artistic)abstract
    • Background: Laparoscopic sleeve gastrectomy (LSG) as a primary bariatric procedure has gained increasing popularity world-wide. However, controversies still exist regarding several operative aspects, such as the optimal diameter of thesleeve and the optimal distance from the pylorus to the edge of the resection line, and whether these aspects haveeffects on weight-loss results and the risk to develop postoperative complications.Objective: The aim of this study was to compare weight-loss results and the incidence of postoperative complications betweensleeve with different diameters measured in bougie size and with different distances from the pylorus to the edge ofthe resection line measured in centimeter.Setting: Nationwide registry-based study.Method: This study is an analysis of sleeve gastrectomy performed in Sweden between 2012 and 2019. Data were collectedfrom Scandinavian Obesity Surgery Registry (SOReg). Patients with bougie size 30-32 and 35-36 and patients withdistance from pylorus 1-4 cm, 5 cm, 6-8 cm were identified and compared regarding weight-loss results and the riskto develop postoperative complications.Results: 9,360 patients were included. Follow-up rate was 96% at day 30, 78.8% at one year and 50% at two years. Bothbougie size 30-32 compared to 35-36 and distance from the pylorus 1-4 cm compared to 5 cm were associated withsignificant higher weight-loss at one and two years. No difference in the risk for early or late complications was seenbetween bougie size groups 30-32 and 35-36. Resection starting 1-4 cm from the pylorus compared to 5 cm was as-sociated with higher risk for overall early postoperative complications (OR 1.46 (1.17-1.82, P=.001)), but there wasno significant difference in the risk to develop late complication at 1 and 2 years. No difference in the leak rate andin the risk to develop stricture was seen between different Bougie sizes, nor distances from the Pylorus.Conclusion: Using a smaller Bougie size and starting the resection closer to the pylorus was associated with better maximumweight-loss. Closer resection to the Pylorus, but not Bougie size was associated with increased risk for early postop-erative complications after sleeve gastrectomy.
  •  
43.
  • Amanda, Demir, et al. (author)
  • The Influence of Mesenteric Defects Closure on the Use of Computed Tomography for Abdominal Pain 5 Years After Laparoscopic Gastric Bypass-a Post Hoc Analysis of a Randomized Clinical Trial
  • 2022
  • In: Obesity Surgery. - : Springer. - 0960-8923 .- 1708-0428. ; 32:2, s. 266-272
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Abdominal pain after laparoscopic Roux-en-Y gastric bypass (LRYGB) is a common and unwanted complication that typically leads to further exploration through radiology. Concerns have been raised regarding the consequences of this radiation exposure and its correlation with the lifetime risk of cancer. The aim of this study was to evaluate the differences in computed tomography (CT) use between LRYGB patients with open and closed mesenteric defects and to assess the radiological findings and radiation doses.METHODS: This subgroup analysis included 300 patients randomized to either closure (n = 150) or nonclosure (n = 150) of mesenteric defects during LRYGB. The total number of CT scans performed due to abdominal pain in the first 5 postoperative years was recorded together with the radiological findings and radiation doses.RESULTS: A total of 132 patients (44%) underwent 281 abdominal CT scans, including 133 scans for 67 patients with open mesenteric defects (45%) and 148 scans for 65 patients with closed mesenteric defects (43%). Radiological findings consistent with small bowel obstruction or internal hernia were found in 31 (23%) of the scans for patients with open defects and in 18 (12%) of the scans for patients with closed defects (p = 0.014). The other pathological and radiological findings were infrequent and not significantly different between groups. At the 5-year follow-up, the total radiation dose was 82,400 mGy cm in the nonclosure group and 85,800 mGy cm in the closure group.CONCLUSION: Closure of mesenteric defects did not influence the use of CT to assess abdominal pain.
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44.
  • Andersson, Dan-Erik, et al. (author)
  • Källmaterialet förstördes
  • 2009
  • In: Sydsvenskan. - 1652-814X.
  • Journal article (pop. science, debate, etc.)
  •  
45.
  • André, Mats, et al. (author)
  • Lower hybrid waves at comet 67P/Churyumov-Gerasimenko
  • 2017
  • In: Monthly notices of the Royal Astronomical Society. - : OXFORD UNIV PRESS. - 0035-8711 .- 1365-2966. ; 469, s. S29-S38
  • Journal article (peer-reviewed)abstract
    • We investigate the generation of waves in the lower hybrid frequency range by density gradients in the near plasma environment of comet 67P/Churyumov-Gerasimenko. When the plasma is dominated by water ions from the comet, a situation with magnetized electrons and unmagnetized ions is favourable for the generation of lower hybrid waves. These waves can transfer energy between ions and electrons and reshape the plasma environment of the comet. We consider cometocentric distances out to a few hundred km. We find that when the electron motion is not significantly interrupted by collisions with neutrals, large average gradients within tens of km of the comet, as well as often observed local large density gradients at larger distances, are often likely to be favourable for the generation of lower hybrid waves. Overall, we find that waves in the lower hybrid frequency range are likely to be common in the near plasma environment.
  •  
46.
  • Austrell, Per Erik, et al. (author)
  • Survey of Design Methods and Material Characteristics in Rubber Engineering
  • 1999
  • Reports (other academic/artistic)abstract
    • The unique properties of elastomeric materials are taken advantage of in many engineering applications. Elastomeric units are used as couplings or mountings between stiff structures. Examples of these are shock absorbers, vibration insulators, flexible joints, seals and suspensions.The development of computers and of analysis programs in this area has given engineers a new tool for the design of elastomeric components. Computer simulation by finite element analysis has become increasingly important, allowing the mechanical behavior of products with for complex geometries, as well as loading cases of different kinds to be evaluated. Computer simulations enable both static and dynamic aspects to be analyzed. These matters have been recognized by the manufacturers of rubber products and by their customers. The benefits are shorter time for product development and also quality improvements.However, the possibilities available for finding less complicated technical solutions at lower cost with the use of elastomers, has not been fully utilized. Rubber components could be employed more frequently in design if engineers were more familiar with materials of this sort.Part of the problem lies in education and in the dissemination of information. Engineers working in the design area tend to not be very familiar with elastomeric materials and their properties. The offerings of courses on the mechanics of polymers at schools and universities are very limited. Skillful engineers in this field have usually acquired their knowledge through many years of experience and not formal education.Moreover, the complicated nature of the material behavior involved makes it difficult to devise general design rules and design tools. Only recently have computers and analysis programs become powerful enough for the analysis of nonlinear elastic problems involving large strains.It is essential, if one is to become competitive in high-tech applications, to possess a thorough knowledge of computer methods, material models and test methods available.There has likewise been a lack of relevant data for the computer analysis of elastomeric materials. The design tools employed rely on the material models available and on the test data required for the calibration of these models. In many cases, the only information available for analysis is a value for the hardness of the rubber in question. The wide variety of rubber compounds is also a problem. The characterization of different materials is costly and time-consuming. There is thus a need for simple and reliable methods to characterize the different vulcanizates.
  •  
47.
  • Bergman, Sofia, 1991-, et al. (author)
  • Ion bulk speeds and temperatures in the diamagnetic cavity of comet 67P from RPC-ICA measurements
  • 2021
  • In: Monthly notices of the Royal Astronomical Society. - : Oxford University Press. - 0035-8711 .- 1365-2966. ; 503:2, s. 2733-2745
  • Journal article (peer-reviewed)abstract
    • Y Comets are constantly interacting with the solar wind. When the comet activity is high enough, this leads to the creation of a magnetic field free region around the nucleus known as the diamagnetic cavity. It has been suggested that the ion-neutral drag force is balancing the magnetic pressure at the cavity boundary, but after the visit of Rosetta to comet 67P/Churyumov-Gerasimenko the coupling between ions and neutrals inside the cavity has been debated, at least for moderately active comets. In this study, we use data from the ion composition analyser to determine the bulk speeds and temperatures of the low-energy ions in the diamagnetic cavity of comet 67P. The low-energy ions are affected by the negative spacecraft potential, and we use the Spacecraft Plasma Interaction Software to model the resulting influence on the detected energy spectra. We find bulk speeds of 5-10 km s(-1) with a most probable speed of 7 km s(-1), significantly above the velocity of the neutral particles. This indicates that the collisional coupling between ions and neutrals is not strong enough to keep the ions at the same speed as the neutrals inside the cavity. The temperatures are in the range 0.7-1.6 eV, with a peak probability at 1.0 eV. We attribute the major part of the temperature to the fact that ions are born at different locations in the coma, and hence are accelerated over different distances before reaching the spacecraft.
  •  
48.
  • Bergström, Hannah, et al. (author)
  • Audio-video recording during laparoscopic surgery reduces irrelevant conversation between surgeons : a cohort study
  • 2018
  • In: BMC Surgery. - : BioMed Central. - 1471-2482. ; 18:1
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: The prevalence of perioperative surgical complications is a worldwide issue: In many cases, these events are preventable. Audio-video recording during laparoscopic surgery provides useful information for the purposes of education and event analyses, and may have an impact on the focus of the surgeons operating. The aim of the present study was to investigate how audio-video recording in the operating room during laparoscopic surgery affects the focus of the surgeon and his/her assistant.METHODS: A group of laparoscopic procedures where video recording only was performed was compared to a group where both audio and video recordings were made. All laparoscopic procedures were performed at Lindesberg Hospital, Sweden, during the period August to September 2017. The primary outcome was conversation not relevant to the ongoing procedure. Secondary outcomes were intra- and postoperative adverse events or complications, operation time and number of times the assistant was corrected by the surgeon.RESULTS: The study included 41 procedures, 20 in the video only group and 21 in the audio-video group. The material comprised laparoscopic cholecystectomies, totally extraperitoneal inguinal hernia repairs and bariatric surgical procedures. Irrelevant conversation time fell from 4.2% of surgical time to 1.4% when both audio and video recordings were made (p = 0.002). No differences in perioperative adverse event or complication rates were seen.CONCLUSION: Audio-video recording during laparoscopic abdominal surgery reduces irrelevant conversation time and may improve intraoperative safety and surgical outcome.TRIAL REGISTRATION: Available at FOU Sweden (ID: 232771) and retrospectively at Clinical trials.gov (ID: NCT03425175 ; date of registration 7/2 2018).
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49.
  •  
50.
  • Booker, Ian Don, et al. (author)
  • Carrier lifetime in p- and n-type 4H-SiC
  • Other publication (other academic/artistic)abstract
    • Temperature-dependent time-resolved photoluminescence measurements made in the temperature range from 77 K to 1000 K on free-standing as grown n-type 4H-SiC and p-type 4H-SiC epilayers, which are either as-grown or annealed at 1000 °C, 1400 °C or 1700 °C, are analyzed. The development of the instantaneous carrier lifetime over temperature, calculated from the decay curves of all n- and p-type samples, is found to be identical in the entire temperature range. With increasing annealing temperature only the magnitude of the lifetime in p-type 4H-SiC decreases while the trend remains identical to that in the as-grown n-type sample. Annealing thus only increases the density of the main recombination center which appears to control lifetime in as-grown n- and p-type material. The results implies that the lifetime in all samples may be governed by the same intrinsic defect, which we suggest to be Z1/2.
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