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  • Low rate of reoperations after acute type A aortic dissection repair from The Nordic Consortium Registry.

    Pan, Emily; Gudbjartsson, Tomas; Ahlsson, Anders; Fuglsang, Simon; Geirsson, Arnar; Hansson, Emma C; Hjortdal, Vibeke; Jeppsson, Anders; Järvelä, Kati; Mennander, Ari; Nozohoor, Shahab; Olsson, Christian; Wickbom, Anders; Zindovic, Igor; Gunn, Jarmo; 1 Heart Center, Turku University Hospital, Turku, Finland; Department of Surgery, University of Turku, Turku, Finland. 2 Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland. 3 Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Orebro, Sweden; School of Health and Medicine, Orebro University, Orebro, Sweden. 4 Department of Thoracic and Cardiovascular Surgery, Aarhus University Hospital, Skejby, Denmark. 5 Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 6 Heart Center, Tampere University Hospital, Tampere, Finland; University of Tampere, Tampere, Finland. 7 Department of Cardiothoracic Surgery, Skane University Hospital, Lund, Sweden; Clinical Sciences, Lund University, Lund, Sweden. 8 Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden. 9 Heart Center, Turku University Hospital, Turku, Finland; Department of Surgery, University of Turku, Turku, Finland. Electronic address: jarmo.gunn@tyks. (MOSBY-ELSEVIER, 2018-09-01)
    To describe the relationship between the extent of primary aortic repair and the incidence of reoperations after surgery for type A aortic dissection. A retrospective cohort of 1159 patients treated for type A aortic dissection at eight Nordic low- to medium-sized cardiothoracic centers from 2005 to 2014. Data were gathered from patient records and national registries. Patients were separately divided into 3 groups according to the distal anastomoses technique (ascending aorta [n = 791], hemiarch [n = 247], and total arch [n = 66]), and into 2 groups for proximal repair (aortic root replacement [n = 285] and supracoronary repair [n = 832]). Freedom from reoperation was estimated with cumulative incidence survival and Fine-Gray competing risk regression model was used to identify independent risk factors for reoperation. The median follow-up was 2.7 years (range, 0-10 years). Altogether 51 out of 911 patients underwent reoperation. Freedom from distal reoperation at 5 years was 96.9%, with no significant difference between the groups (P = .22). Freedom from proximal reoperation at 5 years was 97.8%, with no difference between the groups (P = .84). Neither DeBakey classification nor the extent of proximal or distal repair predicted freedom from a later reoperation. The only independent risk factor associated with a later proximal reoperation was a history of connective tissue disease. Type A aortic dissection repair in low- to medium-volume centers was associated with a low reoperation rate and satisfactory midterm survival. The extent of the primary repair had no significant influence on reoperation rate or midterm survival.
  • Sex differences in the spatial distribution of bone in relation to incident hip fracture: Findings from the AGES-Reykjavik study.

    Marques, Elisa A; Carballido-Gamio, Julio; Gudnason, Vilmundur; Sigurdsson, Gunnar; Sigurdsson, Sigurdur; Aspelund, Thor; Siggeirsdottir, Kristin; Launer, Lenore; Eiriksdottir, Gudny; Lang, Thomas; Harris, Tamara B; 1 National Institute on Aging, Intramural Research Program, Laboratory of Epidemiology and Population Sciences, Bethesda, MD, USA. Electronic address: 2 Department of Radiology, School of Medicine, University of Colorado Denver, Denver, CO, USA. 3 Icelandic Heart Association Research Institute, Kópavogur, Iceland; University of Iceland, Reykjavik, Iceland. 4 Icelandic Heart Association Research Institute, Kópavogur, Iceland; University of Iceland, Reykjavik, Iceland; Landspitalinn University Hospital, Reykjavik, Iceland. 5 Icelandic Heart Association Research Institute, Kópavogur, Iceland. 6 Icelandic Heart Association Research Institute, Kópavogur, Iceland; Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland. 7 National Institute on Aging, Intramural Research Program, Laboratory of Epidemiology and Population Sciences, Bethesda, MD, USA. 8 Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA. (Elsevier Science, 2018-09-01)
    In this case-cohort study, we used data-driven computational anatomy approaches to assess within and between sex spatial differences in proximal femoral bone characteristics in relation to incident hip fracture. One hundred male and 234 female incident hip fracture cases, and 1047 randomly selected noncase subcohort participants (562 female) were chosen from the population-based AGES-Reykjavik study (mean age of 77 years). The baseline -i.e. before hip fracture- hip quantitative computed tomography scans of these subjects were analyzed using voxel-based morphometry, tensor-based morphometry, and surface-based statistical parametric mapping to assess the spatial distribution of volumetric bone mineral density (vBMD), internal structure, and cortical bone properties (thickness, vBMD and trabecular vBMD adjacent to the endosteal surface) of the proximal femur, respectively, in relation to incident hip fracture. Results showed that in both men and women: 1) the superior aspect of the femoral neck and the trochanteric region (except for cortical bone thickness) were consistently identified as being associated with incident hip fracture, and 2) differences in bone properties between noncases and incident hip fracture cases followed similar trends, were located at compatible regions, and manifested heterogeneity in the spatial distribution of their magnitude with focal regions showing larger differences. With respect to sex differences, most of the regions with a significant interaction between fracture group and sex showed: 1) differences of greater magnitude in men between noncases and incident hip fracture cases with different spatial distributions for all bone properties with the exception of cortical bone thickness, and 2) that while most of these regions showed better bone quality in male cases than in female cases, female cases showed higher vBMD in the principal compressive group and higher endotrabecular vBMD at several regions including the anterior, posterior, and lateral aspects of the proximal femur. These findings indicate the value of these image analysis techniques by providing unique information about the specific patterns of bone deterioration associated with incident hip fracture and their sex differences, highlighting the importance of looking to men and women separately in the assessment of hip fracture risk.
  • Interactions between drugs and geriatric syndromes in nursing home and home care: results from Shelter and IBenC projects.

    Onder, Graziano; Giovannini, Silvia; Sganga, Federica; Manes-Gravina, Ester; Topinkova, Eva; Finne-Soveri, Harriet; Garms-Homolová, Vjenka; Declercq, Anja; van der Roest, Henriëtte G; Jónsson, Pálmi V; van Hout, Hein; Bernabei, Roberto; [ 1 ] Univ Cattolica Sacro Cuore, Dept Gerontol Neurosci & Orthoped, Ctr Med Invecchiamento, Largo F Vito 1, I-00168 Rome, Italy Show more [ 2 ] Charles Univ Prague, Dept Geriatr & Gerontol, Fac Med 1, Prague, Czech Republic Show more [ 3 ] Univ South Bohemia, Fac Hlth & Social Sci, Ceske Budejovice, Czech Republic Show more [ 4 ] Natl Inst Hlth & Welf, Helsinki, Finland [ 5 ] HTW Berlin Univ Appl Sci, Dept Econ & Law, Berlin, Germany Show more [ 6 ] Katholieke Univ Leuven, LUCAS, Leuven, Belgium Show more [ 7 ] Katholieke Univ Leuven, Ctr Sociol Res, Leuven, Belgium Show more [ 8 ] Vrije Univ Amsterdam Med Ctr, Amsterdam Publ Hlth Inst, Dept Gen Practice & Elderly Care Med, Amsterdam, Netherlands Show more [ 9 ] Univ Iceland, Dept Geriatr, Fac Med, Landspitali Univ Hosp, Reykjavik, Iceland (Springer, 2018-09-01)
    Drugs may interact with geriatric syndromes by playing a role in the continuation, recurrence or worsening of these conditions. Aim of this study is to assess the prevalence of interactions between drugs and three common geriatric syndromes (delirium, falls and urinary incontinence) among older adults in nursing home and home care in Europe. We performed a cross-sectional multicenter study among 4023 nursing home residents participating in the Services and Health for Elderly in Long-TERm care (Shelter) project and 1469 home care patients participating in the Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care (IBenC) project. Exposure to interactions between drugs and geriatric syndromes was assessed by 2015 Beers criteria. 790/4023 (19.6%) residents in the Shelter Project and 179/1469 (12.2%) home care patients in the IBenC Project presented with one or more drug interactions with geriatric syndromes. In the Shelter project, 288/373 (77.2%) residents experiencing a fall, 429/659 (65.1%) presenting with delirium and 180/2765 (6.5%) with urinary incontinence were on one or more interacting drugs. In the IBenC project, 78/172 (45.3%) participants experiencing a fall, 80/182 (44.0%) presenting with delirium and 36/504 (7.1%) with urinary incontinence were on one or more interacting drugs. Drug-geriatric syndromes interactions are common in long-term care patients. Future studies and interventions aimed at improving pharmacological prescription in the long-term care setting should assess not only drug-drug and drug-disease interactions, but also interactions involving geriatric syndromes.
  • MAP1B mutations cause intellectual disability and extensive white matter deficit.

    Walters, G Bragi; Gustafsson, Omar; Sveinbjornsson, Gardar; Eiriksdottir, Valgerdur K; Agustsdottir, Arna B; Jonsdottir, Gudrun A; Steinberg, Stacy; Gunnarsson, Arni F; Magnusson, Magnus I; Unnsteinsdottir, Unnur; Lee, Amy L; Jonasdottir, Adalbjorg; Sigurdsson, Asgeir; Jonasdottir, Aslaug; Skuladottir, Astros; Jonsson, Lina; Nawaz, Muhammad S; Sulem, Patrick; Frigge, Mike; Ingason, Andres; Love, Askell; Norddhal, Gudmundur L; Zervas, Mark; Gudbjartsson, Daniel F; Ulfarsson, Magnus O; Saemundsen, Evald; Stefansson, Hreinn; Stefansson, Kari; 1 deCODE genetics/Amgen, Reykjavik, 101, Iceland. 2 Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland. 3 Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 405 30, Sweden. 4 Department of Radiology, Landspitali University Hospital, Fossvogur, Reykjavik, 108, Iceland. 5 School of Engineering and Natural Sciences, University of Iceland, Reykjavik, 101, Iceland. 6 Faculty of Electrical and Computer Engineering, University of Iceland, Reykjavik, 101, Iceland. 7 The State Diagnostic and Counselling Centre, Kopavogur, 200, Iceland. 8 deCODE genetics/Amgen, Reykjavik, 101, Iceland. 9 deCODE genetics/Amgen, Reykjavik, 101, Iceland. 10 Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland. (Nature Publishing Group, 2018-08-27)
    Discovery of coding variants in genes that confer risk of neurodevelopmental disorders is an important step towards understanding the pathophysiology of these disorders. Whole-genome sequencing of 31,463 Icelanders uncovers a frameshift variant (E712KfsTer10) in microtubule-associated protein 1B (MAP1B) that associates with ID/low IQ in a large pedigree (genome-wide corrected P = 0.022). Additional stop-gain variants in MAP1B (E1032Ter and R1664Ter) validate the association with ID and IQ. Carriers have 24% less white matter (WM) volume (β = -2.1SD, P = 5.1 × 10
  • Genetic association analysis identifies variants associated with disease progression in primary sclerosing cholangitis.

    Alberts, Rudi; de Vries, Elisabeth M G; Goode, Elizabeth C; Jiang, Xiaojun; Sampaziotis, Fotis; Rombouts, Krista; Böttcher, Katrin; Folseraas, Trine; Weismüller, Tobias J; Mason, Andrew L; Wang, Weiwei; Alexander, Graeme; Alvaro, Domenico; Bergquist, Annika; Björkström, Niklas K; Beuers, Ulrich; Björnsson, Einar; Boberg, Kirsten Muri; Bowlus, Christopher L; Bragazzi, Maria C; Carbone, Marco; Chazouillères, Olivier; Cheung, Angela; Dalekos, Georgios; Eaton, John; Eksteen, Bertus; Ellinghaus, David; Färkkilä, Martti; Festen, Eleonora A M; Floreani, Annarosa; Franceschet, Irene; Gotthardt, Daniel Nils; Hirschfield, Gideon M; Hoek, Bart van; Holm, Kristian; Hohenester, Simon; Hov, Johannes Roksund; Imhann, Floris; Invernizzi, Pietro; Juran, Brian D; Lenzen, Henrike; Lieb, Wolfgang; Liu, Jimmy Z; Marschall, Hanns-Ulrich; Marzioni, Marco; Melum, Espen; Milkiewicz, Piotr; Müller, Tobias; Pares, Albert; Rupp, Christian; Rust, Christian; Sandford, Richard N; Schramm, Christoph; Schreiber, Stefan; Schrumpf, Erik; Silverberg, Mark S; Srivastava, Brijesh; Sterneck, Martina; Teufel, Andreas; Vallier, Ludovic; Verheij, Joanne; Vila, Arnau Vich; Vries, Boudewijn de; Zachou, Kalliopi; Chapman, Roger W; Manns, Michael P; Pinzani, Massimo; Rushbrook, Simon M; Lazaridis, Konstantinos N; Franke, Andre; Anderson, Carl A; Karlsen, Tom H; Ponsioen, Cyriel Y; Weersma, Rinse K; 1 Department of Gastroenterology and Hepatology, University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands. 2 Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands. 3 Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK. 4 Academic Department of Medical Genetics, University of Cambridge, Cambridge, UK. 5 Norwegian PSC Research Center, Division of Cancer Medicine, Surgery and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway. 6 Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway. 7 Department of Surgery, Wellcome Trust-Medical Research Council Stem Cell Institute, Anne McLaren Laboratory, University of Cambridge, Cambridge, UK. 8 Department of Surgery, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, UK. 9 Institute for Liver and Digestive Health, University College London, Royal Free Hospital, London, UK. 10 Department of Gastroenterology Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany. 11 Integrated Research and Treatment Center-Transplantation (IFB-tx) Hannover Medical School, Hannover, Germany. 12 Division of Gastroenterology and Hepatology, University of Alberta, Edmonton, Alberta, Canada. 13 Department of Medicine, Division of Hepatology, University of Cambridge, Cambridge, UK. 14 Department of Clinical Medicine, Division of Gastroenterology, Sapienza University of Rome, Rome, Italy. 15 Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden. 16 Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. 17 Department of Internal Medicine, Division of Gastroenterology and Hepatology, Landspitali University Hospital, Reykjavik, Iceland. 18 K G Jebsen Inflammation Research Centre and Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 19 Division of Gastroenterology and Hepatology, University of California Davis, Davis, California, USA. 20 Sapienza University of Rome, Medico-Surgical Sciences and Biotechnologies, Rome, Italy. 21 Department of Medicine and Surgery, Program for Autoimmune Liver Diseases, International Center for Digestive Health, University of Milan-Bicocca, Milan, Italy. 22 Department of Hepatology, AP-HP, Hôpital Saint Antoine, Paris, France. 23 General Internal Medicine, University Health Network, Toronto General Hospital, Toronto, Canada. 24 Department of Medicine and Research Laboratory of Internal Medicine, Medical School, University of Thessaly, Larissa, Greece. 25 Division of Gastroenterology and Hepatology, Mayo Clinic Minnesota, Rochester, Minnesota, USA. 26 Department of Medicine, Snyder Institute of Chronic Diseases, University of Calgary, Calgary, Canada. 27 Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany. 28 Department of Medicine, Division of Gastroenterology, Helsinki University Hospital, Helsinki, Finland. 29 Department of Surgical Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy. 30 Department of Surgery Oncology and Gastroenterology, University of Padova, Padova, Italy. 31 Department of Medicine, University Hospital of Heidelberg, Heidelberg, Germany. 32 Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham, UK. 33 Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands. 34 Department of Medicine II, Liver Center Munich, University of Munich, Munich, Germany. 35 Popgen Biobank, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany. 36 Institute for Epidemiology, Christian-Albrechts University, Kiel, Germany. 37 Wellcome Trust Genome Campus, Wellcome Trust Sanger Institute, Cambridge, UK. 38 Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden. 39 Department of Gastroenterology, Università Politecnica delle Marche, Ospedali Riuniti University Hospital, Ancona, Italy. 40 Liver and Internal Medicine Unit, Medical University of Warsaw, Warsaw, Poland. 41 Department of Internal Medicine Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany. 42 Liver Unit Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain. 43 Department of Internal Medicine IV, University Hospital of Heidelberg, Heidelberg, Germany. 44 Department of Medicine I, Krankenhaus Barmherzige Brüder, Munich, Germany. 45 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 46 Department for General Internal Medicine, Christian-Albrechts-University, Kiel, Germany. 47 Section of Gastroenterology, Department of Transplantation Medicine, Division of Cancer, Surgery and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway. 48 Inflammatory Bowel Disease (IBD) Group Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital Toronto, Ontario, Canada. 49 Department of Hepatobiliary Surgery and Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 50 1st Department of Medicine, University of Mainz, Mainz, Germany. 51 Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands. 52 Department of Internal Medicine, University of Thessaly, Larissa, Greece. 53 Department of Hepatology, John Radcliffe University Hospitals NHS Trust, Cambridge, UK. (BMJ Publishing Group, 2018-01-01)
    Primary sclerosing cholangitis (PSC) is a genetically complex, inflammatory bile duct disease of largely unknown aetiology often leading to liver transplantation or death. Little is known about the genetic contribution to the severity and progression of PSC. The aim of this study is to identify genetic variants associated with PSC disease progression and development of complications. We collected standardised PSC subphenotypes in a large cohort of 3402 patients with PSC. After quality control, we combined 130 422 single nucleotide polymorphisms of all patients-obtained using the Illumina immunochip-with their disease subphenotypes. Using logistic regression and Cox proportional hazards models, we identified genetic variants associated with binary and time-to-event PSC subphenotypes. We identified genetic variant rs853974 to be associated with liver transplant-free survival (p=6.07×10 We present a large international PSC cohort, and report genetic loci associated with PSC disease progression. For liver transplant-free survival, we identified a genome-wide significant signal and demonstrated expression of the candidate gene
  • Systems analysis of metabolism in platelet concentrates during storage in platelet additive solution.

    Jóhannsson, Freyr; Guðmundsson, Steinn; Paglia, Giuseppe; Guðmundsson, Sveinn; Palsson, Bernhard; Sigurjónsson, Ólafur E; Rolfsson, Óttar; [ 1 ] Univ Iceland, Ctr Syst Biol, Sturlugata 8, Reykjavik, Iceland Show more [ 2 ] Univ Iceland, Med Dept, Sturlugata 8, Reykjavik, Iceland Show more [ 3 ] European Acad Bolzano Bozen, Ctr Biomed, Via Galvani 31, Bolzano, Italy Show more [ 4 ] Landspitali Univ Hosp, Blood Bank, Snorrabraut 60, Reykjavik, Iceland Show more [ 5 ] Reykjavik Univ, Sch Sci & Engn, Menntavegur 1, Reykjavik, Iceland (Portland Press, 2018-07-17)
    Platelets (PLTs) deteriorate over time when stored within blood banks through a biological process known as PLT storage lesion (PSL). Here, we describe the refinement of the biochemical model of PLT metabolism, iAT-PLT-636, and its application to describe and investigate changes in metabolism during PLT storage. Changes in extracellular acetate and citrate were measured in buffy coat and apheresis PLT units over 10 days of storage in the PLT additive solution T-Sol. Metabolic network analysis of these data was performed alongside our prior metabolomics data to describe the metabolism of fresh (days 1-3), intermediate (days 4-6), and expired (days 7-10) PLTs. Changes in metabolism were studied by comparing metabolic model flux predictions of iAT-PLT-636 between stages and between collection methods. Extracellular acetate and glucose contribute most to central carbon metabolism in PLTs. The anticoagulant citrate is metabolized in apheresis-stored PLTs and is converted into aconitate and, to a lesser degree, malate. The consumption of nutrients changes during storage and reflects altered PLT activation profiles following their collection. Irrespective of the collection method, a slowdown in oxidative phosphorylation takes place, consistent with mitochondrial dysfunction during PSL. Finally, the main contributors to intracellular ammonium and NADPH are highlighted. Future optimization of flux through these pathways provides opportunities to address intracellular pH changes and reactive oxygen species, which are both of importance to PSL. The metabolic models provide descriptions of PLT metabolism at steady state and represent a platform for future PLT metabolic research.
  • Garnaflækja á bugaristli á Landspítala 2000-2013

    Hörður Már Kolbeinsson; Birta Dögg Ingudóttir Andrésdóttir; Pétur H. Hannesson; Elsa Björk Valsdóttir; Páll Helgi Möller; Hörður Már Kolbeinsson, Skurðlækningadeild Landspítala - Birta Dögg Ingudóttir Andrésdóttir, Skurðlækningadeild Landspítala - Pétur H. Hannesson, röntgendeild Landspítala‚ læknadeild Háskóla Íslands - Elsa Björk Valsdóttir, Skurðlækningadeild Landspítala‚ læknadeild Háskóla Íslands Páll Helgi Möller læknir‚ Skurðlækningadeild Landspítala‚ læknadeild Háskóla Íslands
    Inngangur Garnaflækja á bugaristli er sjaldgæf orsök garnastíflu í flestum vestrænum löndum. Kjörmeðferð er ristilspeglun og síðar skurðaðgerð. Tilgangur rannsóknarinnar var að kanna meðferð og horfur garnaflækju á bugaristli á Landspítala. Efniviður og aðferðir Framkvæmd var afturskyggn rannsókn á einstaklingum sem greindust með garnaflækju á bugaristli á Landspítala á árunum 2000-2013. Farið var yfir sjúkraskrár og skráð kyn, aldur, legutími, meðferð, fylgikvillar meðferðar, vefjagreining og tíðni endurkomu. Niðurstöður Heildarfjöldi sjúklinga var 49; 29 karlar og 20 konur (1,5:1). Meðalaldur var 74 ár (bil: 25-93). Einn sjúklingur fór beint í bráða aðgerð vegna gruns um lífhimnubólgu, aðrir (n=48) voru meðhöndlaðir með ristilspeglun (n=45), skuggaefnisinnhellingu um endaþarm og endaþarmsröri (n=2) eða einungis endaþarmsröri (n=1). Þrír enduðu í bráðaaðgerð sökum misheppnaðrar ristilspeglunar en 8 sjúklingar fóru í skipulagða aðgerð í legunni. Þrjátíu og sex útskrifuðust eftir íhaldssama meðferð með ristilspeglun (n=35), innhellingu (n=1) eða endaþarmsröri (n=1). Tveir sjúklingar lögðust inn síðar til valaðgerðar á ristli. Tuttugu og tveir (61%) fengu endurkomu sjúkdóms. Miðgildi tíma að endurkomu var 101 dagur (bil: 1-803). Líkur á að fá ekki endurkomu eftir þrjá mánuði, 6 mánuði og 24 mánuði voru 66%, 55% og 22%. Heildardánartíðni (innan 30 daga) var 10,2%. Dánartíðni eftir bráðaaðgerðir var 25% (1/4) en 16,6% eftir skipulagðar aðgerðir (3/18). Ályktanir Meirihluti sjúklinga sem ekki fer í aðgerð í fyrstu innlögn fær endurkomu sjúkdóms. Heildardánartíðni vegna garnaflækju á bugaristli á Landspítala er lág en dánartíðni eftir skurðaðgerðir er há.
  • Defining Clinical-Posturographic and Intra-Posturographic Discordances: What Do These Two Concepts Mean?

    Perrin, Philippe; Mallinson, Art; Van Nechel, Christian; Peultier-Celli, Laetitia; Petersen, Hannes; Magnusson, Mans; Kingma, Herman; Maire, Raphaël; 1 ] Univ Lorraine, Fac Med, Res Unit, EA 3450,DevAH Dev Adaptat & Handicap, Nancy, France [ 2 ] UFR STAP, Nancy, France Show more [ 3 ] Univ Hosp Nancy, Dept Pediat Otolaryngol, Nancy, France Show more [ 4 ] Univ British Columbia, Vancouver Gen Hosp, Div Otolaryngol, Unit Neurootol, Vancouver, BC, Canada Show more [ 5 ] Erasme Univ Hosp, Unit Neuroophthalmol, Brussels, Belgium Show more [ 6 ] Landspitali Univ Hosp, Dept Otorhinolaryngol, Reykjavik, Iceland Show more [ 7 ] Univ Hosp Lund, Clin Sci, Dept Otorhinolaryngol Head & Neck Surg, Lund, Sweden Show more [ 8 ] Maastricht Univ, Med Ctr, Dept Otorhinolaryngol Head & Neck Surg, Maastricht, Netherlands Show more [ 9 ] Tomsk Res State Univ, Fac Phys, Tomsk, Russia Show more [ 10 ] Lausanne Univ Hosp, Clin Otolaryngol Head & Neck Surg, Neurotol Unit, Lausanne, Switzerland (AVES, 2018-04-01)
    The European Society for Clinical Evaluation of Balance Disorders - ESCEBD - Executive Committee meets yearly to identify and address clinical equilibrium problems that are not yet well understood. This particular discussion addressed "discordances" (defined as "lack of agreement") in clinical assessment. Sometimes there is disagreement between a clinical assessment and measured abnormality (ies); sometimes the results within the assessment do not agree. This is sometimes thought of as "malingering" or an attempt to exaggerate what is wrong, but this is not always the case. The Committee discussed the clinical significance of unexpected findings in a patient's assessment. For example intraposturographic discordances sometimes exhibit findings (eg performance on more difficult trials may sometimes be better than on simpler trials). This can be suggestive of malingering, but in some situations can be a legitimate finding. The extreme malingerer and the genuine patient are at opposite ends of a spectrum but there are many variations along this spectrum and clinicians need to be cautious, as a posturography assessment may or may not be diagnostically helpful. Sometimes there is poor correlation between symptom severity and test results. Interpretation of posturography performance can at times be difficult and a patient's results must be correlated with clinical findings without stereotyping the patient. It is only in this situation that assessment in a diagnostic setting can be carried out in an accurate and unbiased manner.
  • Burðarmálsdauði á Íslandi 1988-2017

    Ragnhildur Hauksdóttir; Þórður Þórkelsson; Gestur Pálsson; Ragnheiður I Bjarnadóttir; Ragnhildur Hauksdóttir 1,4, Þórður Þórkelsson 1,2,3, Gestur Pálsson 1,2,3, Ragnheiður I. Bjarnadóttir 1,2,4 -1 Landspítali, 2 læknadeild Háskóla Íslands, 3 Barnaspítala Hringsins, 4 kvennadeild Landspítala. (Læknafélag Íslands, 2018-07)
    Inngangur Með burðarmálsdauða er átt við fæðingu andvana barns eða dauða þess á fyrstu 7 dögunum eftir fæðingu. Tíðni burðarmálsdauða á Íslandi hefur verið ein sú allra lægsta í heiminum undanfarin ár. Markmið rannsóknarinnar var að kanna hvernig tíðni og orsakir burðarmálsdauða hafa breyst á síðastliðnum 30 árum, einkum til að meta hvort hugsanlega sé hægt að lækka tíðnina enn frekar. Efniviður og aðferðir Gerð var afturskyggn rannsókn og var rannsóknartímabilið 1988-2017. Upplýsingar um þau börn sem dóu á burðarmálsskeiði voru fengnar úr Fæðingaskrá og þau flokkuð samkvæmt NBPDC-flokkunarkerfi, sem byggist á að skilgreina þá flokka burðarmálsdauða sem hugsanlega væri hægt að fyrirbyggja. Breyting á burðarmálsdauða var reiknuð út sem árleg prósentubreyting með Poisson-aðhvarfsgreiningu. Niðurstöður Tíðni burðarmálsdauða lækkaði að meðaltali um 3,3% (p<0,001) á ári á tímabilinu miðað við ≥28+0 vikna meðgöngu. Börnum sem létust vegna meðfæddra galla fækkaði um 4,8% (p=0,001) á ári. Andvana fæðingum vaxtarskertra einbura eftir ≥28+0 vikna meðgöngu fækkaði um 3,1% (p=0,029) á ári. Andvana fæðingum einbura eftir ≥28+0 vikna meðgöngu sem voru ekki vaxtarskertir fækkaði ekki marktækt. Ályktun Tíðni burðarmálsdauða hefur lækkað umtalsvert síðastliðin 30 ár. Dauðsföllum vegna meðfæddra galla fækkaði mikið vegna framfara í fósturgreiningu. Andvana fæðingum vaxtarskertra barna hefur fækkað og hefur árvökul mæðravernd skipt þar miklu máli. Erfiðast hefur reynst að fækka andvana fæddum einburum án áhættuþátta eins og vaxtarskerðingar. Mikilvægt að fræða konur um þýðingu minnkaðra hreyfinga fósturs á meðgöngu, hlusta á þær og rannsaka þegar ástæða þykir til.
  • Árangur kransæðahjáveituaðgerða hjá konum á Íslandi

    Helga Rún Garðarsdóttir; Linda Ósk Árnadóttir; Jónas A. Aðalsteinsson; Hera Jóhannesdóttir; Sólveig Helgadóttir; Þórdís Jóna Hrafnkelsdóttir; Arnar Geirsson; Tómas Guðbjartsson; Helga Rún Garðarsdóttir1 kandídat Linda Ósk Árnadóttir1 deildarlæknir Jónas A. Aðalsteinsson1 deildarlæknir Hera Jóhannesdóttir1 deildarlæknir Sólveig Helgadóttir4 læknir Þórdís Jóna Hrafnkelsdóttir2,3 læknir Arnar Geirsson5 læknir Tómas Guðbjartsson1,3 læknir 1Hjarta- og lungnaskurðdeild, 2hjartadeild Landspítala, 3 læknadeild Háskóla Íslands, 4svæfinga- og gjörgæsludeild Akademíska sjúkrahússins í Uppsölum, Svíþjóð, 5hjartaskurðdeild Yale New Haven spítala, Bandaríkjunum. (Læknafélag Íslands, 2018-07)
    Inngangur Markmið þessarar rannsóknar var að bera saman árangur kransæðahjáveituaðgerða hjá konum og körlum á Íslandi með áherslu á snemm- og síðkomna fylgikvilla, 30 daga dánartíðni og langtímalifun. Efniviður og aðferðir Afturskyggn rannsókn á öllum sjúklingum sem gengust undir kransæðahjáveituaðgerð á Íslandi á árunum 2001-2013. Upplýsingar fengust úr sjúkraskrám og Dánarmeinaskrá Embættis landlæknis. Fylgikvillum var skipt í snemm- og síðkomna fylgikvilla og heildarlifun reiknuð með aðferð Kaplan-Meier. Fjölþátta aðhvarfsgreining var notuð til að meta forspárþætti dauða innan 30 daga og Cox aðhvarfsgreining til að meta forspárþætti verri langtímalifunar. Meðaleftirfylgd var 6,8 ár. Niðurstöður Af 1755 sjúklingum voru 318 konur (18%). Meðalaldur þeirra var fjórum árum hærri en karla (69 ár á móti 65 árum, p<0,001), þær höfðu oftar sögu um háþrýsting (72% á móti 64%, p=0,009) og EuroSCOREst þeirra var hærra (6,1 á móti 4,3, p<0,001). Hlutfall annarra áhættuþátta eins og sykursýki var hins vegar sambærilegt, líkt og útbreiðsla kransæðasjúkdóms. Alls létust 12 konur (4%) og 30 karlar (2%) innan 30 daga frá aðgerð en munurinn var ekki marktækur (p=0,08). Tíðni snemmkominna fylgikvilla, bæði minniháttar (53% á móti 48% p=0,07) og alvarlegra (13% á móti 11%, p=0,2), var sambærileg. Fimm árum frá aðgerð var lifun kvenna 87% borin saman við 90% hjá körlum (p=0,09). Þá var tíðni síðkominna fylgikvilla sambærileg hjá konum og körlum 5 árum frá aðgerð (21% á móti 19%, p=0,3). Kvenkyn reyndist hvorki sjálfstæður forspárþáttur 30 daga dánartíðni (OR 0,99; 95%-ÖB: 0,97-1,01) né verri lifunar (HR 1,08; 95%-ÖB: 0,82-1,42). Ályktun Mun færri konur en karlar gangast undir kransæðahjáveituaðgerð á Íslandi og eru þær fjórum árum eldri þegar kemur að aðgerð. Árangur kransæðahjáveitu er góður hjá konum líkt og körlum, en 5 árum eftir aðgerð eru 87% kvenna á lífi.
  • Hypophosphatemia and duration of respiratory failure and mortality in critically ill patients.

    Federspiel, C K; Itenov, T S; Thormar, K; Liu, K D; Bestle, M H; 1 ] Univ Copenhagen, Nordsjaellands Hosp, Dept Anaesthesiol, Hillerod, Denmark Show more [ 2 ] Univ Calif San Francisco, Dept Med, San Francisco, CA 94143 USA Show more [ 3 ] Univ Calif San Francisco, Dept Anaesthesia, San Francisco, CA 94143 USA [ 4 ] Landspitali Haskolasjukrahus, Dept Anaesthesiol, Reykjavik, Iceland (Wiley, 2018-04-23)
    Hypophosphatemia has been associated with prolonged duration of respiratory failure and increased mortality in critically ill patients, but there is very limited evidence supporting the negative effects of low phosphate. We examined the association between hypophosphatemia at ICU admission and time to successful weaning and 28-day mortality. This was a cohort study that included all mechanically ventilated adult patients admitted to the ICU in 2013 at Nordsjaellands Hospital. Hypophosphatemia was defined as a serum level below 0.80 mmol/L. Multivariate Cox-regression was used to evaluate the effect of hypophosphatemia on mechanical ventilation and 28-day mortality. Multiple imputation was used to adjust for missing values. A total of patients were admitted during the study period, of whom 190 were eligible. 122 (64.2%) had serum phosphate levels measured during the first 24 hours of admission, of whom 25 (20.5%) were found to be hypophosphatemic. About 74% of patients were successfully weaned from the ventilator within 28 days. Hypophosphatemia was not associated with this outcome (HR: 0.56; 95% CI: 0.30-1.04; P = .067). All-cause 28-day mortality was 32.6%. Hypophosphatemia was also not associated with 28-day mortality (HR: 1.64; 95% CI: 0.65-4.17; P = .447). Similar results were present in supplementary analysis where missing data were included by means of multiple imputation. Hypophosphatemia at ICU admission was not associated with prolonged respiratory failure nor mortality. Further studies are warranted, where phosphate is measured systematically on all patients to elucidate the effect of low phosphate on relevant outcomes.
  • Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes.

    Escaned, Javier; Ryan, Nicola; Mejía-Rentería, Hernán; Cook, Christopher M; Dehbi, Hakim-Moulay; Alegria-Barrero, Eduardo; Alghamdi, Ali; Al-Lamee, Rasha; Altman, John; Ambrosia, Alphonse; Baptista, Sérgio B; Bertilsson, Maria; Bhindi, Ravinay; Birgander, Mats; Bojara, Waldemar; Brugaletta, Salvatore; Buller, Christopher; Calais, Fredrik; Silva, Pedro Canas; Carlsson, Jörg; Christiansen, Evald H; Danielewicz, Mikael; Di Mario, Carlo; Doh, Joon-Hyung; Erglis, Andrejs; Erlinge, David; Gerber, Robert T; Going, Olaf; Gudmundsdottir, Ingibjörg; Härle, Tobias; Hauer, Dario; Hellig, Farrel; Indolfi, Ciro; Jakobsen, Lars; Janssens, Luc; Jensen, Jens; Jeremias, Allen; Kåregren, Amra; Karlsson, Ann-Charlotte; Kharbanda, Rajesh K; Khashaba, Ahmed; Kikuta, Yuetsu; Krackhardt, Florian; Koo, Bon-Kwon; Koul, Sasha; Laine, Mika; Lehman, Sam J; Lindroos, Pontus; Malik, Iqbal S; Maeng, Michael; Matsuo, Hitoshi; Meuwissen, Martijn; Nam, Chang-Wook; Niccoli, Giampaolo; Nijjer, Sukhjinder S; Olsson, Hans; Olsson, Sven-Erik; Omerovic, Elmir; Panayi, Georgios; Petraco, Ricardo; Piek, Jan J; Ribichini, Flavo; Samady, Habib; Samuels, Bruce; Sandhall, Lennart; Sapontis, James; Sen, Sayan; Seto, Arnold H; Sezer, Murat; Sharp, Andrew S P; Shin, Eun-Seok; Singh, Jasvindar; Takashima, Hiroaki; Talwar, Suneel; Tanaka, Nobuhiro; Tang, Kare; Van Belle, Eric; van Royen, Niels; Varenhorst, Christoph; Vinhas, Hugo; Vrints, Christiaan J; Walters, Darren; Yokoi, Hiroyoshi; Fröbert, Ole; Patel, Manesh R; Serruys, Patrick; Davies, Justin E; Götberg, Matthias; 1 Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain. 2 Hammersmith Hospital, Imperial College London, London, United Kingdom. 3 CRUK & UCL Cancer Trials Centre, University College London, London, United Kingdom. 4 Hospital Universitario de Torrejón and Universidad Francisco de Vitoria, Madrid, Spain. 5 King Abdulaziz Medical City Cardiac Center, Riyadh, Saudi Arabia. 6 Colorado Heart and Vascular, Lakewood, Colorado. 7 Mesa, Arizona. 8 Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal. 9 Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden. 10 Royal North Shore Hospital, Sydney, Australia. 11 Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden. 12 Gemeinschaftsklinikum Mittelrhein, Kemperhof Koblenz, Koblenz, Germany. 13 Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain. 14 St. Michaels Hospital, Toronto, Ontario, Canada. 15 Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden. 16 Hospital Santa Maria, Lisbon, Portugal. 17 Kalmar County Hospital, and Linnaeus University, Faculty of Health and Life Sciences, Kalmar, Sweden. 18 Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. 19 Department of Cardiology, Karlstad Hospital, Karlstad, Sweden. 20 Royal Brompton Hospital, Imperial College London, United Kingdom, and University of Florence, Florence, Italy. 21 Inje University Ilsan Paik Hospital, Daehwa-Dong, South Korea. 22 Pauls Stradins Clinical University Hospital, Riga, Latvia. 23 Conquest Hospital, St. Leonards-on-Sea, United Kingdom. 24 Sana Klinikum Lichtenberg, Lichtenberg, Germany. 25 Department of Cardiology, Reykjavik University Hospital, Reykjavik, Iceland. 26 Klinikum Oldenburg, European Medical School, Carl von Ossietzky University, Oldenburg, Germany. 27 Departments of Cardiology and Medical and Health Sciences, Linköping University, Linköping, Sweden. 28 Sunninghill Hospital, Johannesburg, South Africa. 29 University Magna Graecia, Catanzaro, Italy. 30 Imelda Hospital, Bonheiden, Belgium. 31 Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and Unit of Cardiology, Capio S:t Görans Sjukhus, Stockholm, and Department of Medicine, Sundsvall Hospital, Sundsvall, Sweden. 32 Stony Brook University Medical Center, Stony Brook, New York. 33 Department of Internal Medicine, Västmanland Hospital Västerås, Västerås, Sweden. 34 Department of Cardiology, Halmstad Hospital, Halmstad, Sweden. 35 John Radcliffe Hospital, Oxford University Hospitals Foundation Trust, Oxford, United Kingdom. 36 Ain Shams University, Cairo, Egypt. 37 Fukuyama Cardiovascular Hospital, Fukuyama, Japan. 38 Charite Campus Virchow Klinikum, Universitaetsmedizin, Berlin, Germany. 39 Seoul National University Hospital, Seoul, South Korea. 40 Helsinki University Hospital, Helsinki, Finland. 41 Flinders University, Adelaide, Australia. 42 Department of Cardiology, St. Göran Hospital, Stockholm, Sweden. 43 Gifu Heart Center, Gifu, Japan. 44 Amphia Hospital, Breda, the Netherlands. 45 Keimyung University Dongsan Medical Center, Daegu, South Korea. 46 Catholic University of the Sacred Heart, Rome, Italy. 47 Departments of Cardiology and Radiology, Helsingborg Hospital, Helsingborg, Sweden. 48 Department of Cardiology, Sahlgrenska University Gothenburg, Sweden. 49 AMC Heart Center, Academic Medical Center, Amsterdam, the Netherlands. 50 University Hospital Verona, Verona, Italy. 51 Emory University, Atlanta, Georgia. 52 Cedars-Sinai Heart Institute, Los Angeles, California. 53 MonashHeart and Monash University, Melbourne, Australia. 54 Veterans Affairs Long Beach Healthcare System, Long Beach, California. 55 Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey. 56 Royal Devon and Exeter Hospital and University of Exeter, Exeter, United Kingdom. 57 Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea. 58 Washington University School of Medicine, St. Louis, Missouri. 59 Aichi Medical University Hospital, Aichi, Japan. 60 Royal Bournemouth General Hospital, Bournemouth, United Kingdom. 61 Tokyo Medical University, Tokyo, Japan. 62 Essex Cardiothoracic Centre, Basildon and Anglia Ruskin University, Chelmsford, United Kingdom. 63 Institut Coeur Poumon, Lille University Hospital, and INSERM Unité 1011, Lille, France. 64 VU University Medical Center, Amsterdam, the Netherlands. 65 Department of Medical Sciences, Uppsala University, Uppsala, Sweden. 66 Hospital Garcia de Horta, Lisbon, Portugal. 67 Antwerp University Hospital, Antwerp, Belgium. 68 Prince Charles Hospital, Brisbane, Australia. 69 Fukuoka Sannou Hospital, Fukuoka, Japan. 70 Duke University, Durham, North Carolina. 71 Department of Cardiology, Imperial College London, London, United Kingdom. 72 Hammersmith Hospital, Imperial College London, London, United Kingdom. Electronic address: (Elsevier Science, 2018-08-13)
    The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p < 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04).
  • Factors associating with differences in the incidence of renal replacement therapy among elderly: data from the ERA-EDTA Registry.

    Helve, Jaakko; Kramer, Anneke; Abad-Diez, Jose M; Couchoud, Cecile; de Arriba, Gabriel; de Meester, Johan; Evans, Marie; Glaudet, Florence; Grönhagen-Riska, Carola; Heaf, James G; Lezaic, Visnja; Nordio, Maurizio; Palsson, Runolfur; Pechter, Ülle; Resic, Halima; Santamaria, Rafael; Santiuste de Pablos, Carmen; Massy, Ziad A; Zurriaga, Óscar; Jager, Kitty J; Finne, Patrik; 1 Finnish Registry for Kidney Diseases, Helsinki, Finland. 2 Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. 3 ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands. 4 Renal Registry of Aragon, Aragon Health Service, Arogan, Spain. 5 Coordination nationale de REIN, Agence de la biomédecine, France. 6 Sección de Nefrologia, Hospital Universitario de Guadalajara, Guadalajara, Spain. 7 Department of Nephrology, Dialysis and Hypertension, Dutch-speaking Belgian Renal Registry (NBVN), Sint-Niklaas, Belgium. 8 Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden. 9 Service de Néphrologie, Centre hospitalier et universitaire de Limoges, Limoges, France. 10 Department of Medicine, Zealand University Hospital, Roskilde, Denmark. 11 Department of Nephrology, Clinical Centre of Serbia, Belgrade, Serbia. 12 Veneto Dialysis and Transplantation Registry, Regional Epidemiology System, Padua, Italy. 13 Nephrology Dialysis Unit, Padua, Italy. 14 Division of Nephrology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland. 15 Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland. 16 Department of Internal Medicine, University of Tartu, Estonia. 17 Clinic for Hemodialysis, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina. 18 Nephrology Service, Reina Sofia University Hospital, Cordoba, Spain. 19 Registro de Enfermos Renales de la Región de Murcia, Servicio de Epidemiologia, Consejeria de Sanidad, IMIB-Arrixaca, Murcia, Spain. 20 Division of Nephrology, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, Paris, France. 21 Institut National de la Santé et de la Recherche Medical Unit 1018 team5, Research Centre in Epidemiology and Population Health, University of Paris Ouest-Versailles-St Quentin-en-Yveline, Villejuif, France. 22 Dirección General de Salud Pública. Conselleria de Sanitat Universal i Salut Pública, Valencia, Spain. 23 Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain. (Oxford University Press, 2018-04-18)
    The incidence of renal replacement therapy (RRT) in the general population ≥75 years of age varies considerably between countries and regions in Europe. Our aim was to study characteristics and survival of elderly RRT patients and to find explanations for differences in RRT incidence. Patients ≥75 years of age at the onset of RRT in 2010-2013 from 29 national or regional registries providing data to the European Renal Association-European Dialysis and Transplant Association Registry were included. Chi-square and Mann-Whitney U tests were used to assess variation in patient characteristics and linear regression was used to study the association between RRT incidence and various factors. Kaplan-Meier curves and Cox regression were employed for survival analyses. The mean annual incidence of RRT in the age group ≥75 years of age ranged from 157 to 924 per million age-related population. The median age at the start of RRT was higher and comorbidities were less common in areas with higher RRT incidence, but overall the association between patient characteristics and RRT incidence was weak. The unadjusted survival was lower in high-incidence areas due to an older age at onset of RRT, but the adjusted survival was similar [relative risk 1.00 (95% confidence interval, 0.97-1.03)] in patients from low- and high-incidence areas. Variation in the incidence of RRT among the elderly across European countries and regions is remarkable and could not be explained by the available data. However, the survival of patients in low- and high-incidence areas was remarkably similar.
  • Comparison of glomerular filtration rate estimating equations derived from creatinine and cystatin C: validation in the Age, Gene/Environment Susceptibility-Reykjavik elderly cohort.

    Björk, Jonas; Grubb, Anders; Gudnason, Vilmundur; Indridason, Olafur S; Levey, Andrew S; Palsson, Runolfur; Nyman, Ulf; 1 Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden. 2 Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden. 3 Department of Clinical Chemistry, Skåne University Hospital, Lund University, Lund, Sweden. 4 Icelandic Heart Association, Kopavogur, Iceland. 5 University of Iceland, Reykjavik, Iceland. 6 Division of Nephrology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland. 7 Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, USA. 8 Department of Translational Medicine, Division of Medical Radiology, Lund University, Malmö, Sweden. (Oxford University Press, 2017-10-05)
    Validation studies comparing glomerular filtration rate (GFR) equations based on standardized creatinine and cystatin C assays in the elderly are needed. The Icelandic Age, Gene/Environment Susceptibility-Kidney cohort was used to compare two pairs of recently developed GFR equations, the revised Lund-Malmö creatinine equation (LMRCr) and the arithmetic mean of the LMRCr and Caucasian, Asian, Paediatric and Adult cystatin C equations (MEANLMR+CAPA), as well as the Full Age Spectrum creatinine equation (FASCr) and its combination with cystatin C (FASCr+Cys), with the corresponding pair of Chronic Kidney Disease Epidemiology Collaboration equations (CKD-EPICr and CKD-EPICr+Cys). A total of 805 individuals, 74-93 years of age, underwent measurement of GFR (mGFR) using plasma clearance of iohexol. Four metrics were used to compare the performance of the GFR equations: bias, precision, accuracy [including the percentage of participants with estimated GFR (eGFR) within 30% of mGFR (P30)] and the ability to detect mGFR <60 mL/min/1.73 m2. All equations had a P30 >90%. LMRCr and FASCr yielded significantly higher precision and P30 than CKD-EPICr, while bias was significantly worse. LMRCr, FASCr and CKD-EPICr showed similar ability to detect mGFR <60 mL/min/1.73 m2 based on the area under the receiver operating characteristic curves. MEANLMR+CAPA, FASCr+Cys and CKD-EPICr+Cys all exhibited consistent improvements compared with the corresponding creatinine-based equations. None of the creatinine-based equations was clearly superior overall in this community-dwelling elderly cohort. The addition of cystatin C improved all of the creatinine-based equations.
  • Atrial fibrillation is associated with decreased total cerebral blood flow and brain perfusion.

    Gardarsdottir, Marianna; Sigurdsson, Sigurdur; Aspelund, Thor; Rokita, Hrafnhildur; Launer, Lenore J; Gudnason, Vilmundur; Arnar, David O; 1 ] Landspitali Natl Univ Hosp Iceland, Dept Radiol, IS-101 Reykjavik, Iceland Show more [ 2 ] Iceland Heart Assoc, Holtasmari 1, IS-201 Kopavogur, Iceland Show more [ 3 ] Univ Iceland, Sch Hlth Sci, Fac Med, Vatnsmyrarvegur 16, IS-101 Reykjavik, Iceland Show more [ 4 ] Regensburg Univ Hosp, Dept Internal Med 2, Franz Josef Strauss Allee 11, D-93042 Regensburg, Germany Show more [ 5 ] NIA, Lab Epidemiol & Populat Sci, NIH, 7201 Gateway Bldg, Bethesda, MD 20892 USA [ 6 ] Landspitali Natl Univ Hosp Iceland, Dept Cardiol, IS-101 Reykjavik, Iceland (Oxford University Press, 2017-08-09)
    Atrial fibrillation (AF) has been associated with cognitive impairment. Additionally, brain volume may be reduced in individuals with AF. Potential causes may include cerebral micro-embolism or reduced stroke volume due to the beat-to-beat variation in AF. The aims of this study were to measure cerebral blood flow and estimate whole brain perfusion in elderly individuals with and without AF. Blood flow in the cervical arteries was measured with phase contrast MRI and brain perfusion estimated in a large cohort from the AGES-Reykjavik Study. Individuals were divided into three groups at the time of the MRI: persistent AF, paroxysmal AF, and no history of AF. Of 2291 participants (mean age 79.5 years), 117 had persistent AF and 78 had paroxysmal AF but were in sinus rhythm at the time of imaging AF. Those with persistent AF had lower cholesterol and used more anti-hypertensive medication and warfarin. The three groups were similar with regard to other cardiovascular risk factors. Those in the persistent AF group had significantly lower total cerebral blood flow on average, 472.1 mL/min, both when compared with the paroxysmal AF group, 512.3 mL/min (P < 0.05) and the no AF group, 541.0 mL/min (P < 0.001). Brain perfusion was lowest in the persistent AF group, 46.4 mL/100 g/min compared with the paroxysmal AF group, 50.9 mL/100 g/min in (P < 0.05) and those with no AF, 52.8 mL/100 g/min (P < 0.001). Persistent AF decreases blood flow to the brain as well as perfusion of brain tissue compared with sinus rhythm.
  • Reluctance of patients with chronic obstructive pulmonary disease in its early stages and their families to participate in a partnership-based self-management trial: A search for explanation.

    Jónsdóttir, Helga; Ingadóttir, Thorbjörg Sóley; [ 1 ] Univ Iceland, Sch Hlth Sci, Fac Nursing, Eiriksgata 34, IS-107 Reykjavik, Iceland Show more [ 2 ] Landspitali Univ Hosp, Dept Resp Med & Sleep, Reykjavik, Iceland (SAGE Publications, 2018-08-01)
    Recruitment, the process of accessing, screening, selecting and retaining participants for research remains a challenge. In a randomized controlled trial, partnership-based self-management intervention for patients who have chronic obstructive pulmonary disease (COPD) in its initial stages, and their families, a theoretical framework developed for patients with an advanced COPD and their families was modified and implemented in a primary care context. In contrast to recruitment to the original study where 4% decline participation, in this study 25% of the potential patients declined participation. Although participants were encouraged to bring a family member, only 25% of them did so. The main reason for not being accompanied by a family member was that patients did not want anybody accompany them. Those who had quit smoking were more often accompanied by a family member compared to those who smoked. Reviewing the literature, the most compelling explanations for non-participation are shame and self-blame due to smoking, and that potential participants may not have envisioned any benefits from participating since they might not have realized that they had COPD. An alternative recruitment process needs to embrace the situation that potential participants find themselves in and which takes account of the issues at stake.
  • Use of complementary therapies in nursing homes: Descriptive study.

    Gunnarsdottir, Thora Jenny; Vilhjalmsson, Runar; Hjaltadottir, Ingibjorg; 1 Faculty of Nursing, University of Iceland, Iceland. Electronic address: 2 Faculty of Nursing, University of Iceland, Iceland. Electronic address: 3 Faculty of Nursing, University of Iceland, Iceland; National University Hospital, Reykjavik, Iceland. Electronic address: (Elsevier, 2018-08-01)
    Complementary therapies may have positive effect on residents in nursing homes. The aim of this research was to investigate what kind of complementary therapies are provided in Icelandic nursing homes and who are the providers. Also whether the nursing homes need assistance to support the use of such therapies. A questionnaire was mailed to all the nursing homes in Iceland (N = 59). Total of forty-five nursing homes replied or 76% response rate. Registered nurses and licenced practical did most of the planning and provision of complementary therapies. The most common therapies were: heat packs, physical exercise and massage. Managers would like to have more knowledge and support in providing complementary therapies. The use of some complementary therapies is common in Icelandic nursing homes. More knowledge is needed to support the use of CT in Icelandic nursing homes.
  • Parent perspectives on home participation of high-functioning children with autism spectrum disorder compared with a matched group of children without autism spectrum disorder.

    Egilson, Snæfrídur T; Jakobsdóttir, Gunnhildur; Ólafsdóttir, Linda B; [ 1 ] Univ Iceland, Reykjavik, Iceland Show more [ 2 ] Natl Univ Hosp Iceland, Reykjavik, Iceland (SAGE PUBLICATIONS LTD, 2018-07-01)
    Few studies have focused on home participation of high-functioning children with autism spectrum disorder. We employed a mixed-methods design to explore and compare parent perspectives on (1) participation of children with and without autism spectrum disorder in activities at home, (2) the environmental features and resources that affect these children's home participation and (3) the strategies parents use to help their children participate at home. The Participation and Environment Measure for Children and Youth (PEM-CY) was used to gather online survey and qualitative data from parents of 99 high-functioning children with autism spectrum disorder and 241 children without autism spectrum disorder. Independent sample t-tests and χ
  • A Escala Multidimensional de Ansiedade para Crianças (MASC): Propriedades psicométricas e análise fatorial confirmatória numa amostra de adolescentes portugueses

    Salvador, Maria do Céu; Matos, Ana Paula; Oliveira, Sara; S. March, John; Arnarson, Eirikur Örn; Carey, Sean C.; Craighead, W. Edward; 1 ] Univ Coimbra, Fac Psicol & Ciencias Educ, Rua Colegio Novo, P-3000115 Coimbra, Portugal Show more [ 2 ] Duke Univ, Med Ctr, Durham, NC USA Show more [ 3 ] Univ Iceland, Landspitali Univ Hosp, Fac Med, Sch Hlth Sci, Reykjavik, Iceland Show more [ 4 ] Emory Univ, Sch Med, Dept Psychiat & Behav Sci, Invest, Atlanta, GA USA Show more [ 5 ] Emory Univ, Dept Psychol, Dept Psychiat & Behav Sci, Child Adolescent & Young Adult Programs, Atlanta, GA 30322 USA (AIDEP, 2017-10-15)
    A psychometric analysis of a Portuguese version of the Multidimensional Anxiety Scale for Children (MASC) was undertaken in a school-based sample of 2041 Portuguese adolescents aged 12-18 years. A confirmatory factor analysis did not support the original four-factor structure (March, Parker, Sullivan, Stallings, & Conners, 1997). Therefore a confirmatory factor analysis with a 3rd order model was conducted (with subfactors, factors, and total score) revealing better adjustment indexes. The difference between models was also significant. After a multigroup analysis, this structure revealed to be invariant across gender, but only configural and metric invariance was found across age groups. The convergent and divergent validity of the MASC was confirmed using measures of anxiety, depression, and general well-being. A moderate to high temporal stability, in a three-week interval, was obtained. This study confirmed that the Portuguese edition of the MASC is a reliable and useful self-report instrument to assess anxiety in adolescents.
  • Associations between neutrophil recovery time, infections and relapse in pediatric acute myeloid leukemia

    Løhmann, Ditte J. A.; Asdahl, Peter H.; Abrahamsson, Jonas; Ha, Shau-Yin; Jónsson, Ólafur G.; Kaspers, Gertjan J. L.; Koskenvuo, Minna; Lausen, Birgitte; De Moerloose, Barbara; Palle, Josefine; Zeller, Bernward; Hasle, Henrik; [ 1 ] Aarhus Univ Hosp, Dept Pediat & Adolescent Med, Palle Juul Jensens Blvd 99, DK-8200 Aarhus N, Denmark Show more [ 2 ] Aarhus Univ Hosp, Dept Hematol, Aarhus, Denmark [ 3 ] Queen Silvia Childrens Hosp, Inst Clin Sci, Dept Pediat, Gothenburg, Sweden Show more [ 4 ] Queen Mary Hosp, Dept Pediat, Hong Kong, Hong Kong, Peoples R China [ 5 ] HKPHOSG, Hong Kong, Hong Kong, Peoples R China Show more [ 6 ] Landspitali Univ Hosp, Dept Pediat, Reykjavik, Iceland [ 7 ] VU Univ Med Ctr Amsterdam, Dept Pediat, The Hague, Netherlands Show more [ 8 ] Dutch Childhood Oncol Grp, The Hague, Netherlands Show more [ 9 ] Univ Helsinki, Div Hematol Oncol & Stem Cell Transplantat, Childrens Hosp, Helsinki, Finland Show more [ 10 ] Univ Copenhagen, Dept Pediat & Adolescent Med, Rigshosp, Copenhagen, Denmark Show more [ 11 ] Ghent Univ Hosp, Dept Pediat, Ghent, Belgium Show more [ 12 ] Uppsala Univ, Dept Womans & Childrens Hlth, Uppsala, Sweden Show more [ 13 ] Oslo Univ Hosp, Div Pediat & Adolescent Med, Oslo, Norway; Department of Pediatrics and Adolescent Medicine; Aarhus University Hospital; Aarhus Denmark; Department of Hematology; Aarhus University Hospital; Aarhus Denmark; Institution for Clinical Sciences; Department of Pediatrics; Queen Silvia Children's Hospital; Gothenburg Sweden; Department of Pediatrics; Queen Mary Hospital and Hong Kong Pediatric Hematology and Oncology Study Group (HKPHOSG); Hong Kong China; Department of Pediatrics; Landspitali University Hospital; Reykjavik Iceland; Department of Pediatrics; VU University Medical Center Amsterdam, and Dutch Childhood Oncology Group; The Hague The Netherlands; Division of Hematology-Oncology and Stem Cell Transplantation; Children's Hospital; University of Helsinki; Helsinki Finland; Department of Pediatrics and Adolescent Medicine; Rigshospitalet; University of Copenhagen; Copenhagen Denmark; Department of Pediatrics; Ghent University Hospital; Ghent Belgium; Department of Woman´s and Children´s Health; Uppsala University; Uppsala Sweden; Division of Pediatric and Adolescent Medicine; Oslo University Hospital; Oslo Norway; Department of Pediatrics and Adolescent Medicine; Aarhus University Hospital; Aarhus Denmark (Wiley, 2018-09)
    BACKGROUND: Children with acute myeloid leukemia (AML) treated similarly show different toxicity and leukemic responses. We investigated associations between neutrophil recovery time after the first induction course, infection and relapse in children treated according to NOPHO-AML 2004 and DB AML-01. PROCEDURE: Newly diagnosed patients with AML with bone marrow blast <5% between day 15 after the start of the treatment and the start of second induction course, and in complete remission after the second induction course were included (n = 279). Neutrophil recovery time was defined as the time from the start of the course to the last day with absolute neutrophil count <0.5 × 109 /l. Linear and Cox regressions were used to investigate associations. RESULTS: Neutrophil recovery time after the first induction course was positively associated with neutrophil recovery time after the remaining courses, and longer neutrophil recovery time (≥25 days) was associated with increased risk of grade 3-4 infections (hazard ratio 1.4, 95% confidence interval [CI], 1.1-1.8). Longer neutrophil recovery time after the first induction (>30 days) was associated with the increased risk of relapse (5-year cumulative incidence: 48% vs. 42%, hazard ratio 1.7, 95% CI, 1.1-2.6) for cases not treated with hematopoietic stem cell transplantation in first complete remission. CONCLUSION: Longer neutrophil recovery time after the first induction course was associated with grade 3-4 infections and relapse. If confirmed, this knowledge could be incorporated into risk stratification strategies in pediatric AML.

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